During pregnancy you are requested to make appointment for antenatal care as indicated below with your GP or our midwife

If you cannot attend your appointment – please phone 0844 477 0925 to cancel and rebook

LMP The first day of the last menstrual period you had before becoming pregnant - used to calculated your expected date of delivery

EDD The date when baby is due

USS Ultrasound scan

CEPHALIC "Head down" indicates the position of baby in your womb

FM Foetal movements - "FM felt" means that we have felt baby move when we examined you

Thank you for telling us that you are pregnant. You may be surprised that we do not "check-up" by doing a further pregnancy test, but research has shown us that the tests done at home or at the Chemist’s shop are just as accurate as those done at the hospital. Only in special circumstances are we allowed to undertake pregnancy testing on the National Health. You will be aware that being pregnant has caused some changes in your body - your breasts may feel more tender, you may go to pass water more often, and you may feel slightly sick.... this is all good confirmation of your pregnancy!

Because we know that a good intake of Folic Acid is beneficial during the early stages of pregnancy, we include a leaflet about this in this information pack. Some people do not like the dark green vegetables which the leaflet recommends, hence we also enclose a prescription (for which you do not pay) for folic acid tablets. These should be taken one a day during the first twelve weeks of pregnancy in order to reduce the incidence of spinal problems in developing babies.

All women who are pregnant are advised to take 400 mcg of folic acid per day. Useful sources of folate or folic acid are:

Broccoli 30 mcg Grapefruit 20mcg White rice 5mcg

Brussel Sprouts 100 mcg Orange 50mcg Brown rice 15mcg

Cabbage 25 mcg Orangejuice 40mcg Spaghetti 9mcg

Carrots 10 mcg Whitebread 25mcg

Green beans 50 mcg Wholemeal 40mcg

Peas 30 mcg Soft grain 105mcg

Potatoes (new) 40 mcg Cornflakes 100mcg

Cucumber(raw) 2 mcg

Lettuce(raw) 15 mcg Although liver is a rich source of folic acid

Tomatoes 15 mcg pregnant women are not advised to eat liver or

Liver products as they may gain too much Vitamin A

We also enclose a prescription (for which you do not pay) for two bottles of testing sticks. These are to be used to test your urine (at least weekly) for sugar and protein. During pregnancy your body can sometimes become a little stressed and your kidney may leak a little of these two substances. By testing your urine each week, you will be able to alert us to changes and we can then take the appropriate action. One of our nurses or midwives will explain how to test your urine.

Patient should be referred if considered at high risk. The Brighton High Risk pregnancy could include: >35 years at delivery; <150cm height; <50Kg or > 95 Kg weight; previous inherited abnormality; PMH of : Epilepsy; Inflammatory bowel disease; Thrombocytopenia; Splenectomy; Hypertension; Renal disease or renal infection; Heart disease; DVT/Pulmonary embolism;Clotting disorder; Thyroid Disease; Adrenal disease; Addictions; Anaemia; Myomectomy etc; deformed/fractured pelvis; Concerns about Toxoplasmosis or Genital Herpes; Previous pre-term delivery (<36 weeks); Previous small baby <2.5Kg or > 4.5 Kg; Previous perinatal loss; Previous traumatic delivery; Previous caesarian section /hysterotomy.

There have been a number of health concerns linked to various foods eaten during pregnancy. The current advice includes warnings about unpasteurised soft cheeses (rarely available in the UK), pate and Shark, Swordfish and Marlin. Unpastereurised cheese and pate have been linked to transmission of bacterial disease - listeriosis - and the Shark, Swordfish and Marlin to possible mercury ingestion. You are advised to minimise the consumption of these foods during pregnancy. Liver, although some consumption is acceptable, should be avoided in excess as it contains high levels of vitamin A which may damage the developing baby.

Homœopathy is ideal for women in their child bearing years as it is a gentle yet highly effective system of medicine.

By being as healthy as possible during pregnancy you are giving your baby the ideal conditions in which to thrive. Many homœopaths will advise you on diet and lifestyle to encourage a healthy pregnancy and birth.

Good homœopathic treatment prior to conception can help you be as healthy as possible during your pregnancy. The many physical and emotional changes of pregnancy may cause minor health problems, such as mild urinary problems, diarrhoea, heartburn, anaemia, varicose veins, backache, cramps, thrush or emotional distress. All these problems and more potentially complicated symptoms such as raised blood pressure or œdema, can still be helped by professional homœopathic treatment.

Most whole-food shops and high street chemists now stock a limited range of frequently use homœopathic remedies (in the 6C or 30C potencies). A homœopathic pharmacy will post remedies direct (most offer a next day delivery service) and they can make up remedies in different forms, including soft tablets which are easier to give to babies.

The suggestions in this leaflet are for minor complaints; if your symptoms are severe or chronic (on-going), or if they persist,consult a Registered Homœopath, your midwife and/or your General Practitioner. If you are undergoing a course of homœopathic treatment then contact your practitioner before prescribing for yourself.

Morning Sickness

Symptoms of morning sickness include nausea, occasional vomiting and tiredness. Many women experience these symptoms during the first three months of pregnancy, usually in the morning when the stomach is empty, although it can occur at any time of the day and some women may feel sick the whole day. The traditional cure of eating a dry biscuit before getting out of bed is worth trying. Avoid rich, fatty foods and try eating little and often if your nausea is worse when you are hungry. Seek professional help if your vomiting is severe, for example if you are unable to keep food down and are losing weight, or if it persists past your third month.

The following remedies are the more commonly indicated:

Ipecac: constant, deathly nausea with empty belching and retching. Vomiting is difficult and provides no relief (from the nausea). The tongue looks clean.

Nux vomica: nausea with retching that is relieved by vomiting; sour belching, retching, indigestion and heartburn; there may be a sensation that there is a knot in the stomach. Feels very irritable.

Pulsatilla: nausea (with little vomiting) which is worse after eating and drinking; and better in the fresh air and for company; feels generally weepy, moody and is better for being comforted.

Sepia: intermittent nausea which is worse in the mornings and worse for the smell or thought of food; there is an empty, sinking feeling in the stomach which is temporarily relieved by eating; feels apathetic, exhausted and heavy but oddly is better for vigorous exercise. Indifferent or cross with children and partner.

Constipation in pregnancy

Constipation is common in pregnancy as the hormones which prepare the muscles of the pelvis for labour can slow the digestive processes down. Mild constipation can often be helped by adjusting the diet: increasing the intake of fluids (especially water), fruits and vegetables. Any lasting change in your usual pattern of bowel movements should be assessed professionally, but for

a simple case of constipation in pregnancy try one of the following remedies:

Bryonia: large, hard, dry stools which are difficult to expel; with a headache which is worse for the slightest movement and irritability.

Nux vomica: frequent urging to pass a stool but cannot, in spite of straining, or passes only small amounts each time; feels as if some is left behind; with piles that itch and bleed.

Sepia: strains to pass a large, hard stool. Stomach feels full and there is a sensation of a lump in the rectum that may remain even after passing a stool. Feels generally sluggish.

Sulphur: constipation with piles that itch and burn and are worse for heat. Generally restless, thirsty and sensitive to the heat.

How do I take a homœopathic remedy?

As a general guide, take one dose of your selected remedy three times daily for up to three days. Stop as and when you feel better. Sometimes, say, during or after labour, you may find that you are wanting to take a remedy more often or you way want to take more than one remedy in a single day. This is fine, you can change your remedies according to your needs, as long as you do not take more than one remedy at a time. When giving birth, you may require different remedies at each stage of the process.

Let tablets dissolve under the tongue. Hard tablets maybe chewed if they do not dissolve. If possible, avoid drinking, smoking or brushing your teeth 10 minutes before and after taking a remedy (if possible).

During pregnancy it is especially important to eat well from a wide range of foods - as this will provide you with the extra trace minerals and vitamins that you need. If you are on a restricted diet or wish to take vitamin and mineral supplements then it is important that you do so on the advice of a competent medical practitioner, nutritionist or homœopath. Do avoid smoking, alcohol and coffee, as these are all bad for your health and that of your unborn child. Be sure to get plenty of rest and sleep, and to exercise regularly; any exercise that you enjoy will be good for you! Yoga has been found to be particularly helpful during pregnancy. Increase your intake of iron-rich foods to keep up with an increased demand. Foods rich in iron include green, leafy vegetables, blackstrap molasses, dried peaches and apricots, beans and lentils, whole grains, seeds (sunflower and pumpkin) and nuts, eggs, wheat bran and brewer's yeast. Vitamin C helps the body to absorb iron so take a fresh citrus drink with a meal to increase your iron intake. Avoid tea, especially with a meal, as it actually prevents iron from being absorbed. Iron tablets often have side-effects such as constipation so ask your homœopath about safe homœopathic alternatives if you need extra iron and are not able to get it from your diet. Many of the above foods (especially black-eye beans, wheat germ, brewer's yeast, blackstrap molasses and peanuts) are also high in folic acid, an important trace mineral that helps with the absorption of iron and is essential for a healthy pregnancy.

To find a good homœopath consult the Register of The Society of Homœopaths. All homœopaths registered with the Society practice in accordance with a Code of Ethics and Practice, have professional insurance, and have passed stringent academic and clinical assessments before being admitted to the Register. It is important that you feel happy with the manner and approach of your homœopath. In that way you will be more able to give your homœopath the information needed to prescribe well for you.

The Society of Homœopaths 4a Artizan Road Northampton NN1

One choice, which needs to be made as early as possible, is whether you wish to have a blood test done (blood is taken at 16 weeks pregnancy) to check for risk of Downs Syndrome or spina bifida in your baby. The following indented text is about this test and a discussion of the implications of the test, but in order to ensure that the test is as accurate as possible we need to arrange an early Ultrasound Scan of your womb to check the size of your baby. This will be done when we think that baby is between 10 and 14 weeks old and is undertaken at the Royal Sussex County Hospital or at Brighton General Hospital and will be arranged by your Lead Professional (GP or Midwife).

You have the opportunity of having a blood screening test for Down’s Syndrome and Spina Bifida. This blood test is optional and you must decide for yourself whether you want it or not.

Down’s syndrome is the most common cause of severe learning disabilities and babies with Down’s Syndrome may also have other birth defects such as a hole in the heart. About 1:700 of all babies born in this country have Down’s Syndrome.

The risk of having a baby affected by Down’s Syndrome increases with mother’s age. However, most babies are born to women under 35, therefore 75% of all babies born with Down’s Syndrome are born to women under 35 years of age.

Spina Bifida occurs when the column running beneath the baby’s backbone fails to form completely. If this spinal column does not form correctly at the top, the brain fails to develop - a condition known as anencephaly - and such babies usually do not survive long after birth. If the spinal column fails to form correctly at the bottom, the nerves to the lower part of the body do not develop properly - this is known as Spina Bifida and can result in difficulties with walking, bowel and bladder control. There may also be problems with water on the brain - known as hydrocephalus - which may require surgical treatment.

About 2 in every 1000 babies born have some form of defect with the spinal column.

The blood test helps to identify if a pregnancy is at a higher risk so that further more accurate tests can be offered. A single blood sample is taken at 16 weeks pregnancy. The blood test compares the levels of substances contained in the blood - including HCG (Human Chorionic Gonadotrophin) and AFP (Alpha-feto protein) - with levels which have been derived from thousands of other pregnancies which have resulted in Downs Syndrome or Spina Bifida as well as from normal babies. From the levels obtained in your blood, a risk is estimated for you. This blood test relies heavily on exactly how pregnant you are (hence you will have an ultrasound scan to check how pregnant you are.)

The blood test only provides an estimate of the risk. It does not say for certain whether or not your baby is affected. The test identifies those women for whom further tests should be offered.

The test will only pick up 3 out of every 4 Down’s Syndrome babies (actual detection rate in Brighton is 77% over the last ten years)

The test will only pick up 4 out of every 5 cases of Spina Bifida. However the 20 week scan which all pregnant women are offered, is able(even without the triple test) to diagnose over 95% of cases of Spina Bifida.

If the result shows an increased risk of spina bifida your anomaly ultrasound scan at 20 weeks will look for any indication of spina bifida or other visible problem.

If the result shows an increased risk of Down’s Syndrome, you will be offered an amniocentesis.

Amniocentesis involves taking a sample of the fluid surrounding the baby. The procedure is carried out using a scan to identify the baby, the placenta and the fluid. The obstetrician inserts a needle into the abdomen and a small amount of fluid is withdrawn. This may cause you some discomfort and bruising but is soon over. The fluid withdrawn contains cells from the baby which are used to make a definite diagnosis of whether your baby has Downs Syndrome or not. It may take three weeks to obtain the result of the cell analysis.

With amniocentesis there is a risk of miscarriage of 1 in 100 cases (99 out of 100 do not miscarry).

We will offer you any support or counselling that you may need. However both these conditions are untreatable at present and the only actions that we can offer are to offer to help you and to support you in caring for a handicapped child or to offer you a termination of the pregnancy. It is for this reason that you must be sure that you want the test done in the first place.

NO ! It is your choice. Even though they would not want a termination of pregnancy some people would like to know in advance if their baby had a handicap, while others could not agree to a termination of the pregnancy under any circumstances. It may be better not to have the blood test if you feel that you could not make a decision about having further tests uf your result shows a greater risk

PLEASE also seen next page about NUCHAL FOLD SCANNING & The INTEGRATED TEST

During the scan the doctor or radiographer will measure the size of the foetus and the nuchal translucency(the fluid behind the neck of the foetus) and will look for any major abnormalities. The majority of women will receive good news that their foetus appears to be developing normally. However in a few cases the scan will show that the foetus has died or has a serious abnormality.

If you wish to have this test done, then you may ask our reception staff to make you an appointment by telephoning the unit at The Harris Birthright Research Trust at King’s College Hospital in London. Their telephone number for more information is 0207 346 3040.

The major aims of the Nuchal Fold Scan are:

To date the pregnancy accurately – this is particularly important for women who cannot recall the date of their last period or who have an irregular menstrual cycle, or who have conceived while breast feeding or soon after stopping the contraceptive pill. By measuring the crown-rump length (CRL) of the foetus, the gestational age and therefore the expected date of delivery can be accurately calculated.

To diagnose multiple pregnancy – approximately 25% of natural conceptions and 10% of assisted conceptions result in multiple pregnancy. Ultrasound scanning can identify if twin babies are sharing the same placenta which can lead to problems in the pregnancy – requiring close monitoring throughout the pregnancy.

To diagnose early pregnancy failure – unfortunately in about 3% of women who attend for an 11-14 week scan it is found that the foetus has died – often several weeks before and without any warning. Couples will receive full counselling as to the possible cause of this problem and the options for subsequent measures that may be necessary.

To diagnose major foetal abnormalities – in about 1% of pregnancies the foetus has a major abnormality that may be visible at the 11-14 week scan. These abnormalities can be incompatible with life or they could lead to serious handicap. In some cases they may be corrected by surgery before or after birth. If an abnormality is detected the significance of the findings will be discussed with the parents.

To assess the chance of Down’s syndrome and other chromosomal abnormalities – all women, whatever their age, have a chance of delivering a baby with a chromosomal abnormality such as Down’s syndrome. The chance of the foetus having a chromosomal abnormality depends on the age of the mother and also on the amount of fluid behind the neck of the foetus (nuchal translucency). In 95% of foetuses the nuchal translucency is low and the chance that the foetus has a chromosomal abnormality is decreased. In 5% of pregnancies the nuchal translucency is high… in these cases the chance that the foetus has a chromosomal or other abnormality is higher than average but it is important to realise that the majority of foetuses will be normal.

This is undertaken by the Antenatal Screening Service at the Wolfson Institute in London - telephone 020 7882 6293 . This test is a two stage test - the first stage is carried out at 12 weeks of pregnancy (can be between 10 and 13 weeks) when a blood sample and ultrasound scan is undertaken. The second stage is a second blood sample taken at 15 or 16 weeks (although it is possible up to 22 weeks). The quoted performance of this integrated test is 85% detection rate for Down's Syndrome, 85% for open Spina Bifida and nearly 100% for anencephaly(lack of brain).

This test is not available locally and a charge will be made by the Wolfson Institute for screening patients. - please contact them direct for details

This appointment will allow you to meet one of our midwives. During the appointment the midwife will take some blood from you for a range of blood tests and will also arrange a "dating" ultrasound scan for you if you wish to have the TRIPLE TEST undertaken.

"PARENTCRAFT".

The Midwives and Health Visitors run a number of courses for expectant parents. These take place periodically throughout the year and although you may think that your baby is not due for a long time, it is best to book a place on one of the courses. The Midwife will discuss these with you and make the booking. Classes are available throughout the City - please ask the Midwife for information on classes nearest to where you live.

Please be especially careful about some of the foods that you eat during pregnancy…. Listerosis can result from eating certain soft cheeses – particularly unpasteurised cheese should you go over to France for the day! Also you are advised to ensure that all eggs are fresh and stored in a refrigerator to avoid salmonella.

By now we will have received back all the above blood tests and the results of your early ultrasound scan (if undertaken by this time). You will also have had chance to read some of the information in this pack and will no doubt have lots of questions for us! We would therefore like to invite you to attend a appointment with one of us. For the majority of patients this appointment is undertaken by our Practice Midwife as she has considerable experience in the processes of pregnancy. However if you would prefer another professional to undertake your appointment, this can be arranged and should be discussed with your GP or with our midwife in advance. Other possible professionals would include the Hospital Clinic midwife, the Hospital Clinic doctor or your General Practitioner. Your partner is invited to attend any appointment with you.

During the appointment we will double-check on any past illnesses that you or your baby’s father had experienced. We will undertake a general examination and check that there are no underlying problems. We will also have the opportunity to chat with you about the developments that will take place in your body during pregnancy and about how to keep in the best of health. You will also be given a date for a further Ultrasound Scan at 20 weeks pregnant. This appointment usually last for 45 minutes or so.

You may be asked at this stage what you think your plans might be for the delivery and immediate aftercare, there is no committment - it would just help us in planning workload a little more.

Please ask about antenatal support (parentcraft - labour discussions- etc)

If you have decided to have the test for Down’s Syndrome and Spina Bifida (please see explanation of test later in this booklet), you will need to see one of our practice nurses or midwives when you are 16 weeks pregnant for a blood test. The ultrasound scan you had earlier in pregnancy will have confirmed when you will be sixteen weeks pregnant. If you are unclear about when you should attend for the blood test, please do contact your GP or Midwife earlier rather than later! The test is less accurate when undertaken later in pregnancy.

The result of your triple test will be sent to your midwife and to your General Practitioner - the time it takes is between two and four weeks. If there is any indication that further tests are required, then your midwife will contact you. The test result will be entered onto your medical records and we would be pleased to advise you if you wish to contact the Surgery (telephone 206911(Goodwood Court) in the early afternoons for test results please).

Note to Lead Practitioner....

Any need for Specialist referral? Yes / No Why ? _________________________

If yes, has referral been made?

At about of pregnancy you will be offered an ultrasound scan of your baby, known as an anomaly scan. This examination will take place in the same hospital as your dating scan, if you had one. The anomaly scan is a detailed check of the baby’s anatomy and the position of the placenta. The sonographer, who is the person who performs the scan, will let you see the screen and will point out recognisable parts of your baby. If you really want to know the baby’s sex, the sonographer will look for you, but often it is not possible to be definite due to the position of the baby; so don’t raise your hopes too high!

If you make a donation, a "photo" of the baby’s scan can be obtained to take home. These pictures are heat and light sensitive and will fade if not stored out of the light. It is possible to have prints at scans other than at 20 weeks if the baby is lying in a suitable position. Do not be alarmed if you are asked to have a further scan to check some part of the baby’s anatomy. This is because some babies are not always very obliging in the way that they lie and sometimes have to be given a chance to change their position. If the placenta is low at 20 weeks you may need to be re-scanned at 34 weeks to check that the placenta has moved away from the birth canal. It usually moves as the uterus grows.

Progressing through pregnancy - this is the time that we usually see you again for a check on baby’s development and your own health. It gives us a chance to discuss any questions you and your partner may have as well as reviewing the scan. Many people will have felt baby move in their womb at this stage.

Please make appointment for four weeks to see the midwife

At this time we like to check that your body is coping well with the developments going on inside it. To do this we ask you to drink a glucose solution (260ml of LucozadeÔ .. please measure this out from a 350ml bottle) an hour before you see our practice nurse for a blood test. This is explained on one of the leaflets in the pack. By drinking a concentrated sugar solution your kidneys have to work hard to keep your blood sugar level to normal. If your blood level is higher than expected, then we would keep a special watch on you during the rest of the pregnancy to make sure that your baby does not become too big. At the same time as this sugar blood test we will also check on your blood for anaemia and also on the development of blood antibodies which sometimes happen at this stage in pregnancy if you are rhesus negative. If any blood tests are returned to us and an abnormality or problem is found, then your GP will write to you explaining the result. There is no need to telephone for the result unless you are particularly concerned.

The National Institute for Clinical Excellence has reviewed the literature and information regarding the use of treatments to prevent the birth of "blue babies" - rhesus positive babies born to rhesus negative mothers who have created antibodies to rhesus following a previous feto-maternal haemorrhage (which can arise from a previous pregnancy, miscarriage, amniocentesis or other invasive procedure. Haemolytic disease of the Newborn ("blue baby") can range in severity from being detectable only in laboratory testing through to stillbirth.

The recommendation is that routine antenatal anti-D prophylaxis (RAADP) should be offered to all non-sensitised pregnant women who are Rhesus D Negative and that this should be offered between 28 and 34 weeks of pregnancy. This is not current policy at the Royal Sussex County Hospital and we will need to discuss this with the consultant if applicable to yourself

More information can be obtained from the NICE website on www.nice.org.uk or by telephoning 0870 1555 455 and quoting reference N0093

¾ of the way through already! At this time we would like to see you again for a general check on your health and your baby’s development. We will also issue you a certificate known as a MAT B1 which should be given to your Employer or sent to the DSS (please read the instructions on your form) together with your application for Child Allowance for when your baby is born. It is often worth keeping a photocopy of this form as you may need to show it again if there is any difficulty getting your allowances. At this stage it would be worth considering in detail your plans for the birth of your baby and also for the care that you wish to receive immediately afterwards. Please have another look at the information about delivery in this pack.

At this time our midwife will not only take some more blood from you, she would like to see you to be able to answer any questions you might have and also check that all is going well! We may- if appropriate - check your blood count for anaemia once again and also for antibodies which can develop in some circumstances.

This is an important time to check the position of your baby and also to try and make some decisions about delivery. Your baby should be settled into a definite position at this time and you may start experiencing some tightenings of the womb muscles. If you haven’t seen your GP or a Hospital doctor during the pregnancy for some weeks it would be a good idea to see your GP now in order that he/she can have a listen to your heart and lungs as well as ensuring that baby is healthy. If there are any likely complications expected it is at this stage that you might be asked to see one of the hospital specialists. This is a good time for you to raise any worries or concerns you have and to check that you know what to do when you think you are in labour.

You may be feeling tired at this stage. We see you at this time to ensure that you and baby are not excessively tired - don’t forget to tell us if you are feeling a lot of indigestion or constipation as we can do something to help!

Again, a checkup to ensure that both of you are well. Often babies do not come exactly on time, so there is no need to worry. You will probably feel fewer kicks - more writhing movements as there is not much room for your baby to move. Keep your suitcase packed if you are having your baby in hospital.

At this stage if there is still no imminent delivery all is still well but your doctor or midwife will probably make an appointment for you to be seen at hospital in order that you can decide about enhancing delivery if baby gets tired. Usually this precipitates labour. The Midwife will arrange a date for induction of labour for about 10 days after your due date.

If you have had your baby in hospital, you will be monitored by the hospital midwives and doctors. When you and the midwife are both happy the time is right for you to go home then the hospital will notify our midwife who will arrange to call on you the next day at home. Your GP would also like to know when you are home and we would be grateful if you or a relative could phone the Surgery to advise us that you have come home

If you have had your baby at home, then our midwife -who is the expert practitioner in normal pregnancy and childbirth - will visit you regularly and will also notify your GP that you are home. If you are concerned about anything, do feel free to phone your GP or your midwife for advice.

After you and the midwife are both happy that all has gone well, our Health Visitors will contact you to come and say hello to your new arrival. They can offer you specialist support on all matters concerned with baby care, parentcraft and feeding.

Your Doctor will send you some more specialist information after your baby is born about what services we can offer you to help keep your baby as healthy as possible.

The Midwives, Nurses, Health Visitors and Doctors at Goodwood Court would strongly encourage you to breastfeed your baby as long as possible. We know from much research that breast feeding is not only the most natural way to feed your baby and also to develop a close relationship but it also gives your baby much protection against some of the major diseases. Breastfeeding decreases the risk of your baby developing diabetes or asthma or infections. Breastfeeding also decreases the risk of the mother developing breast cancer or osteoporosis or ovarian cancer or post-natal depression. All the "formula" milks or "bottled" milks are derived from Cow’s milk. Some mothers do have difficulty with breast feeding and need to change their baby to some other form of feed, but if possible we will do everything we can to make breastfeeding a success for YOU.

www.motherbliss.co.uk

A broad ranging site offering planning features and an on-line baby album, calendar and record book.

http://www.names2be.com/tamalyn1.html

About 3000 baby names for you to choose from including Welsh,Indian and Afghanistan names

www.netdoctor.co.uk

A fact-packed health site with a pregnancy and birth community where expectant mothers can come together to compare bumps, stretch marks and cravings

www.babyup.com

An informal website allowing you to chat online with other parents.

www.babydirectory.com

An A-Z guide to services, schools, clubs, health and shops in your area. Also contains online shopping and medical advice

www.fpa.org.uk

A guide to contraception, pregnancy and sexually transmitted disease

www.bpas.org

Plain speaking advice and information on pregnancy, emergency contraception and abortion. Also includes contact numbers for the BPAS actionline, the National Childbirth Trust and the Maternity Alliance

http://www.dwp.gov.uk/lifeevent/benefits/maternity_allowance.htm

http://www.dwp.gov.uk/lifeevent/benefits/sure_start_maternity_grant.htm

Girls, your country needs you. Apparently too many of today’s young women aren’t playing their part in adding to the UK’s population.

While late 20- and early 30-somethings are busy building their careers, doing what they want and generally enjoying their lives, the powers that be have decided a push is needed to get women to sprog up and avert a potential childbirth rate meltdown.

Currently, one in seven people suffer from fertility problems (the majority of which lie undiscovered until they try to have a baby). But this is set to rise to one in three within 10 years, and career-focused women, increasing obesity and a rise in STDs are to blame, the experts say.

Having a baby is a big decision, in so many ways. So whether you are having, or would like to have a baby, here’s the situation, work-wise at least.

When you’re pregnant, you’re entitled to paid time off to keep appointments for ante-natal care made on the advice of a registered medical practitioner, midwife or health visitor. This may include relaxation and ‘parent craft’ classes.

Your employer may ask to see the certificate that you’ll be given by your doctor or midwife confirming you’re pregnant, together with an appointment card or some other document showing that an appointment has been made. That’s their right. But they cannot stop you from attending, or dock your pay when you do.

Your entitlement to time off work before and after having a baby varies, depending on whether you work for yourself or work for a company. And even then, how long you’ve worked for your employer plays a part in how much time and money you can expect to receive.

All employees (ie women who work for an employer and are not self-employed) are entitled to 26 weeks off work under what is called ordinary maternity leave (OML), regardless of whether they’ve worked for their employer for 10 years, 10 days, or were pregnant before they started.

To qualify, all you have to do is tell your employer you are pregnant by the end of the 15th week before you expect to have the baby, and give them the expected week of childbirth (usually by means of a medical certificate - such as form MATB1).

You also need to sort out with your employer when you intend to start your maternity leave. The earliest you can begin maternity leave is 11 weeks before you expect to have the baby.

Your employer must then write to you within 28 days, setting out your agreed return date. You can change this date later (for example if you want to return to work early) as long as you give your employer 28 days' notice.

During the 26 weeks of OML, you’re entitled to all your normal terms and conditions of employment, except for remuneration (see below). And at the end of your leave, you have the right to return to your original job.

If a redundancy situation arises, you must be offered a suitable alternative vacancy if one is available. If the employer cannot offer suitable alternative work, you may be entitled to redundancy pay (see below for more details).

In addition, if you’ve worked for your employer for 26 weeks already by the time you’re 15 weeks pregnant - so you started working for them at least 11 weeks before you got pregnant - you can take an additional 26 weeks off, giving you a total of a year off work. During this period your contract of employment continues, but with limited terms and conditions.

All this maternity leave sounds all well and good. But the ‘time off’ element doesn’t guarantee you any salary at all. What you can expect to have to live off is a whole other ball game - and comes under the heading of statutory maternity pay and maternity allowance (see below).

Having a baby isn’t the cash-cow some of the national newspapers would have you believe. In fact, having a baby (aside from the costs of feeding, clothing and caring for Junior) makes a serious dent in your earnings.

If you get pregnant before you’ve worked for your company for 11 weeks (or you’re self-employed) then you can whistle when it comes to Statutory Maternity Pay (SMP), because you won’t get a penny.

To qualify for SMP you must have been employed for a continuous period of at least 26 weeks ending the fifteenth week before the expected week of childbirth. And for this, as of April 2005 (SMP is reviewed every April) you get 90% of your average weekly earnings for the first six weeks, and then the princely sum of £106 a week for up to the next 20 weeks (or 90% of your average weekly earnings if they’re less than £106 a week).

This money is paid in the same way as your salary. So if you receive your wages weekly, you will receive your SMP weekly. If you’re usually paid monthly well, you get the picture…

One point to remember though is that you won’t be paid SMP for any week in which you do any work for the employer paying you SMP. Your SMP will also be stopped if, after your baby is born, you start working for a new employer who did not employ you in your qualifying week (ie the 15th week beginning with midnight between Saturday and Sunday before the expected week of childbirth).

If you are self-employed, or you hadn’t worked for your company for 11 weeks before you got pregnant, you may find you can claim maternity allowance (MA). This is paid by the Benefits Agency and gives you a maximum of £106 a week for up to 26 weeks, payable directly into your bank account.

To qualify, you must have been employed or self-employed for 26 weeks out of the 66 weeks before the expected week of childbirth and have average weekly earnings of at least £30. And as with SMP, if you start working within the 26 week period your MA payments will stop.

Because of how little this pay entitlement gives, before you decide ‘stuff that, I’ll drop Junior off with my mum and start back to work straight away’, a word on compulsory maternity leave.

You must take two weeks off (four if you work in a factory) from the date you have your baby, whether you feel fit to go back to work or not. This is for your own health and safety, and it is unlawful for an employer to allow a woman to work during this compulsory maternity leave period. What you do after that period is up, is down to you.

The newspapers are full of stories of high-flying professionals who lost their jobs after taking time out to have a baby. Unfortunately it does happen.

Nearly one in 10 human resource professionals who took part in a survey carried out for the Equal Opportunities Commission (EOC) by Personnel Today magazine, confirmed that their employers had given a pregnant employee a package to end her employment in the last three years.

And for career girls in the finance sector, the risk of being paid off is even higher - with a quarter of HR professionals having admitted to seeing pregnant workers being given the push.

Your employer should consult you about any possible redundancy (even if you are on maternity leave) and must automatically offer you any suitable available vacancy if you are made redundant while on maternity leave.

If you are dismissed, made redundant or unfairly treated during pregnancy, ordinary or additional maternity leave, or for any reason connected with your pregnancy, this will automatically be treated as unfair dismissal.

You will be entitled to receive a written statement of the reasons you have lost your job from your employer. You’re entitled to this from day one of employment, regardless of how many hours you work and whether you have a permanent or temporary contract.

If you have been dismissed or unfairly treated because you are pregnant or have had a baby, you could also have a sex discrimination claim. If you have been employed for at least a year, you may also have a claim for ordinary unfair dismissal.

If you suffer a miscarriage earlier than the 25th week of pregnancy you don’t qualify for maternity leave, SMP or MA. But any time you take off will fall under your contractual sick pay, or Statutory Sick Pay if there is no contractual sick pay scheme.

It’s also worth checking your contract to see if your employer offers compassionate or bereavement leave. And you shouldn’t be in fear of losing your job over any sick leave you need to take either, because employers must not take any pregnancy-related sickness absence into account when working out a period of sick leave in order to justify dismissal.

If you suffer a stillbirth from the 25th week of pregnancy onwards, you are eligible for maternity leave, SMP and MA just as if your baby had been born alive. If you are already on maternity leave, you do not have to do anything.

If your baby is stillborn before you have started maternity leave, tell your employer as soon as you can (in writing if they request it) that you have given birth. The hospital will provide a certificate of stillbirth.

Once maternity leave is up, there is no need to give your employer notice that you intend to return to work. If you have been off for 26 weeks (OML) you have the right to return to exactly the same job.

After a year’s absence (AML) your employer must give you the same job back, unless this is not reasonably practical (for example, if your job has changed due to organisational restructuring).

In this case, you are entitled to return to a job that is suitable and appropriate for you and not substantially less favourable. If there is no alternative job available and you are genuinely redundant, you may be entitled to redundancy pay.

If there are five or fewer employees where you work, losing your job may not be an automatically unfair dismissal. But you should get legal advice on your situation.

If you are sick at the end of your maternity leave, you must follow your company’s normal procedures so that you are not treated as absent without authorised leave.

A number of blood tests are done throughout your pregnancy. These are kept to a minimum but are important in order to ensure that both you and your baby are healthy. This sheet gives a little information about the tests and what they mean.

Full Blood Count (FBC)

This is a measure of the red and white cells in your blood. The red cells carry the oxygen and other nutrients around the body. The white cells are an indication of infection. The usual problem with pregnancy is that the blood becomes thinner and anaemia develops. This happens because the growing baby and placenta require an increased blood circulation to the womb resulting in more blood vessels being formed. The more blood vessels, the greater the amount of blood needed to keep up the circulation and blood pressure - hence fluid is retained and the blood volume rises but the number of blood cells formed cannot keep pace with this demand if there are insufficient "building blocks" around. As iron is one of the main building blocks for blood cells as well as for the developing baby, it commonly is over-used and shows up as an anaemia in the blood test. If this happens you may be recommended to have iron supplements for the remainder of your pregnancy.

Your blood group is important if for any reason you should ever need to be given a blood transfusion. In pregnancy this is extremely rare but the laboratory will keep a sample of your blood in storage until after you have had baby in order that blood can be "cross-matched" with your own blood should you ever need it in an emergency during the pregnancy. It also serves as a double check on the antibodies which may develop.

When your baby’s blood circulates through the placenta, sometimes a little leaks across into your own blood stream. Your blood cells create special proteins called antibodies to remove baby’s blood from your blood stream. By checking for the development of these antibodies we can tell if there is likely to be any problem for your present pregnancy or for future babies. The most common antibody is the "rhesus" antibody which forms in a mother who is rhesus negative and who carries a child who is rhesus positive. If blood from the rhesus positive baby seeps into the mother’s circulation, then the mother can create antibodies to remove the baby’s blood cells. These antibodies might pass from the mother into the baby across the placenta and fight the baby’s blood - causing a "blue baby" who would need a transfusion at birth. This sort of test is therefore very important.

Rubella (German Measles) is a virus infection which causes a very mild illness in children or adults but can cause major damage to a developing baby in the early stages of pregnancy. For this reason most women are protected against rubella by immunisations earlier in life. In order that appropriate advice can be given we check the presence of antibodies against Rubella at the start of pregnancy in order to be sure that you are not at risk. If your blood rubella antibodies are low, then you should do your utmost to avoid contact with anyone who might have german measles. Fortunately, as we vaccinate children at the age of 13 months against Rubella, the number of people with Rubella in the community is now very low meaning the risk of damage to babies is now minimal.

Some infections are sexually transmitted. This is a reassuring test which can pick-up those people at risk of causing infection to their baby when baby is delivered. Fortunately the number of cases of such disease is now low, but there are still enough cases around to make it worthwhile running this screening test. If you had a positive result your Doctor or Midwife would be able to advise you about treatment.

Varicella is the name for the chickenpox virus. Like many virus infections, chickenpox can be quite a problem if it is caught during the very early stages of pregnancy or at the very end of pregnancy. It can make the mother quite poorly with chest infections. It can cause the new born baby to have difficulty in breathing if caught at the end of pregnancy. If you have definitely had chicken pox before you became pregnant, then there is no need to check a blood test. If you have not had chicken-pox. then we will do a blood test to see if you have any immunity to chicken pox. If the blood test is positive - ie: showing immunity to chicken pox, then you need take no further action. If the blood test is negative, or very weakly positive, then you are advised to report any contact or possible infection with chickenpox to your GP or Midwife. You would then be referred to the local consultant obstetrician if chickenpox does develop. If you notice the rash of chickenpox, please contact your GP or Midwife immediately.

Your blood sugar test is undertaken after drinking a "glucose load". This stresses the body to make sure that it is coping well with the demands of pregnancy. If the blood sugar level comes out higher than expected it might mean that you will have problems coping with the sugars and foods that you eat during pregnancy which would mean that your baby may become too big. If the blood sugar test shows a high level, then we would recommend that you are seen by Dr.Vaughan, or Dr.Quinn who are specialists in controlling or identifying problems with sugar metabolism. Most women do not have a problem, but we find it is well worthwhile screening everyone as we do not know who is likely to need help by any other means.

Regrettably there is an increasing incidence of children being born with neonatal hepatitis owing to a rising infection rate in adults. As a routine, we are now advised to screen all pregnant women for hepatitis in order that appropriate care can be given during your baby’s birth. This is done alongside your other blood tests and does not mean any extra blood has to be taken.

Routine testing to check all pregnant women for HIV is being undertaken throughout the UK. This is to allow the specialist teams to give additional supportive care in order that babies are not born with HIV acquired at birth. Testing for HIV for pregnancy care will not affect your future life assurance risks or your medical care in any other way.