Valerie Gommon Midwife’s Blog

Archive for the ‘Pregnancy Blood Tests’ Category

I’ve just been listening to the latest episode of The Archers where Helen has just had an emergency caesarean section for pre-eclampsia and thought that it would be a useful subject to write about.

I think it is fantastic that the subject has been covered by the radio programme and on the whole they have got it right (wouldn’t expect anything less from The Archers!) but I would like to add a bit more.

Pre-eclampsia is a potentially serious condition of pregnancy that we are still learning about.  For serious pre-eclampsia the only treatment is to deliver the baby (sometimes prematurely), however for most pregnancies the pre-eclampsia can be monitored and the labour may well start normally and spontaneously, or the labour may be induced around your due date and you may well have a normal birth.

Pre-eclampsia is one of the things that your midwife is looking for antenatally and is usually characterised by a collection of symptoms: raised blood pressure, protein in your urine, swelling (oedema), headaches, visual disturbances and upper abdominal (epigastric) pain.

Many women will experience one or more of these symptoms without developing pre-eclampsia, but if you have two or more symptoms or feel concerned you should definitely speak to your midwife urgently.  For example many women will have a headache or some swelling and this is normal during pregnancy – it is usually only when you have several symptoms that pre-eclampsia is suspected and you will then be referred to hospital for further investigations including blood and urine test and monitoring of the baby’s wellbeing.

Women at increased risk of pre-eclampsia include:

  • Those in their first pregnancy
  • Having high blood pressure
  • Having certain blood clotting disorders, diabetes, kidney disease, or an autoimmune disease like lupus
  • Having a close relative (a mother, sister, grandmother, or aunt, for example) who had preeclampsia
  • Being obese (having a body mass index of 30 or more)
  • Carrying two or more babies
  • Being younger than 20 or older than 40

However if you fall into any of these categories you are still more likely NOT to get pre-eclampsia.

There is some evidence (though not mainstream) that pre-eclampsia may be prevented by eating a really healthy diet and by increasing your protein and salt intake.  It may also be beneficial to stop work slightly earlier in your pregnancy and not to overdo things at the end of the pregnancy.

More information on the dietary aspect can be found at https://midwifevalerie.wordpress.com/2009/08/04/dietary-suggestions-for-pregnancy-from-tom-brewer/

This item is reproduced (with consent) from Birth Sense a common-sense guide approach to normal birth www.themidwifenextdoor.com/?p=747.  In the UK we sometimes use a large Lucozade drink or a heavy sugar syrup drink, and we probably wouldn’t do four blood tests, probably only two, however, this test is increasingly being used for all pregnant women in the UK and I agree with the points raised in this article.  It is certainly worth discussing whether you want/need the test with your midwife.

“Of all the tests pregnant women are expected to endure, glucose testing is probably the most dreaded.  Women groan, and tell me they’ve heard horror stories from their friends about how sick the drink will make you feel, or how they couldn’t hold it down.  There are two types of glucose tests.  The first involves drinking a sugary, flat soda type of drink (called a glucola), then getting your blood sugar levels drawn one hour later.  This is a screening test only, and helps practitioners decide who needs the three-hour test.  The three-hour test involves drinking a sugary drink on an empty stomach (after fasting 12 hours), and getting four blood draws: one before you drink the glucose; and subsequent draws at one, two, and three hours after drinking the glucose.  Having elevated blood sugars on any two of these four draws confirms a diagnosis of gestation diabetes.

The mystery to me is why glucose testing continues to be performed on nearly ALL pregnant women, regardless of risk factors.   The American Diabetes Association recommends categorizing women into high-risk, average-risk, or low risk groups.

High risk women are those who begin pregnancy with a high body mass index (BMI), have a personal history of GDM, or have a strong family history of diabetes.   Other risk factors include older maternal age (over 35) and African-American, Native American, or Hispanic ethnicity.  These women should be screened in early pregnancy, and again at 24-28 weeks.

Low-risk women, who do not need to be screened, are under age 25, normal weight at onset of pregnancy, do not belong to a higher-risk ethnic group, and have no personal history of GDM, poor obstetric outcome, or family history of diabetes in a first-degree relative.

Women of average risk, who are not in the high risk category, but don’t meet all the criteria for low-risk women, should be screened at 24-28 weeks.¹

However, evidence to support these recommendations is lacking, according to the Cochrane Review and the United States Preventive Health Taskforce (USPHT).  The USPHT recommends, “Until there is better evidence, clinicians should discuss screening for GDM with their patients and make case-by-case decisions. Discussions should include information about the uncertainty of benefits and harms as well as the frequency of positive screening test results.”²

When is the last time a pregnant woman receiving typical modern obstetric care was treated on a case-by-case basis?  Most women are treated with cookie-cutter, one-size-fits-all obstetric care.

A recent study found that testing fasting blood sugar by a simple finger-stick (which a woman could do herself at home) may be just as predictive of women who need a three-hour glucose screening as the one-hour test.³  Additionally, there are other tests which are alternatives to the one-hour test, and may be  more appealing to some women.4  These tests include a pancake breakfast, or eating a specified number of jelly beans.  Concerns about these tests as substitutes are that they may not  be as accurate as the one-hour glucose in predicting which women need the three-hour test, but they are used in government health agencies, including the Indian Health Services, which serves a high-risk population.

Many of my clients say to me, “I don’t eat refined foods when I’m pregnant, so why should I drink a big glass of refined sugar?”  The politically correct answer is, “So we can have an ‘approved’ diagnosis of gestational diabetes.”  But many women would prefer not to take the glucola test, especially if they are already very health-conscious and physically fit.

I have also worked with clients by loaning a glucose meter that is calibrated to simulate identical blood sugar levels as when you get your blood drawn from your arm.  They can check a fasting blood sugar when they first wake up in the morning, and then blood sugars two hours after a typical meal, on two or three different days and times.  I believe this provides a more accurate picture of how the woman’s body is handling her normal diet, although I admit it does not give us the “official” diagnosis of gestational diabetes.

Common-sense tip for today:  Talk with your provider about the USPHT recommendations.  Are you at increased risk for GDM?  Then consider testing, whether it is glucola or an alternative.  Are you at low or average risk?  You may wish to consider skipping testing, unless it seems that the baby is growing faster than usual, you are having consistent problems with sugar in the urine, or you are experiencing symptoms such as jitteriness/dizziness/nausea.

1.  American Diabetes Association.  Gestational diabetes.  Retrieved 03/25/10 from:  http://www.diabetes.org/diabetes-basics/gestational/

2.  National Guideline Clearinghouse.  Screening for gestational diabetes mellitus.  Retrieved 03/25/10 from: http://www.guideline.gov/summary/summary.aspx?doc_id=12507&nbr=6437&ss=6&xl=999

3.  Agarwal MM, Dhatt GS, OthmanY, Gupta R.  Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk population. Diabetic Medicine, 2009.  Retrieved 3/13/10 from: http://www.ncbi.nlm.nih.gov/pubmed/19709144?dopt=Abstract

4.  Indian Health Services. Alternatives to oral glucola testing.  Retrieved 03/15/10 from: http://74.125.95.132/searchq=cache:EWcHFJkuecMJ:www.ihs.gov/MedicalPrograms/MCH/M/documents/AltGlu4505.doc+IHS+alternative+glucose+testing&cd=1&hl=en&ct=clnk&gl=us

I have just “appeared” on 3 Counties Radio to discuss a local news item.  A Sainsbury’s employee refused to sell local woman, Janet Lehain, unpasteuried cheddar because she was pregnant!

Whilst applauding the employee for pointing out the recommendation that pregnant women do not consume unpasteurised products I have to say that I believe they overstepped the mark by refusing to sell her the cheese!  The woman could have been buying the cheese for her husband and whatever happened to freedom of choice? 

I am a firm believer in Informed Choice, we are very cautious where pregnancy is concerned because although the risks are very low there could be serious implications for the baby SHOULD the mother contract food poisoning.

The Department of Health guidance in early pregnancy is to be extra careful with hygiene; food poisoning is bad news for your baby. They suggest that women don’t eat any unpasteurised foods – most food is pasteurised, but some speciality milks, cheeses/diary are not.

The recommendation is to avoid moulded or veined cheeses and pate/salami. Eggs should be well cooked not runny. Fruit and vegetables should be washed prior to eating. It is suggested that you don’t eat swordfish or marlin and limit the consumption of “oily” fish to twice weekly. Sea food should be cooked not raw. Liver is not recommended for pregnant women.

Whilst pregnant the current recommendation is not to drink alcohol at all, and it is better to limit the amount of caffeine you take (tea, coffee, cola and fizzy drinks), and obviously it would be wise to stop smoking and avoid any “recreational” drugs prior to getting pregnant.

We are still evaluating the evidence regarding eating peanuts in pregnancy – the best current advice is that if you have nut allergies in the family it may well be best to avoid eating nuts in pregnancy; it there are no nut allergies then use your own instinct and judgement as to whether you feel safe to eat nuts (bearing in mind they are a good source of protein, particularly if you are vegetarian or vegan).

Having made a huge list of foods to avoid, you are encouraged to eat plenty of fruit and vegetables (aim for at least five a day), plenty of protein (at every meal if you possibly can) and plenty of iron rich foods (red meat, pulses, green vegetables).

You can read articles I have written at:

www.birthindex.co.uk/Planningababy.pdf and www.birthindex.co.uk/SOYOUAREPREGNANT!.pdf or

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=59

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=64

During your pregnancy you will usually be offered the following blood tests: www.screening.nhs.uk/anpublications/screening_tests.pdf

Full Blood Count – Mainly to test for anaemia

Blood Group – In case you need a blood transfusion
Rhesus group and antibodies – To look for unusual antibodies in your blood/to screen for potential rhesus disease

Rubella antibodies – To check your immunity to rubella (German measles)

Syphilis – To check for syphilis which although very rare could be harmful to you and your baby if untreated

Hepatitis B – An infectious liver disease

H.I.V. – If you are HIV positive treatment can be offered to both you and your baby

Sickle Cell and Thalassaemia – These are genetic blood diseases, usually specific to certain populations (if you feel your ancestors may come from these areas it may be wise to be tested) – we are moving to “universal” testing for these conditions, i.e. that everyone is offered the blood test

* Parts of Africa (the region south of the Sahara Desert)
* Spanish-speaking areas like South America, Cuba, and Central America
* Saudi Arabia
* India
* Mediterranean countries, such as Turkey, Greece, and Italy

Serum screening – This testing performed at around 16 weeks of pregnancy will give a risk factor (high or low) for your baby having Down’s syndrome and neural tube defects (spina bifida). You need to think carefully what you would do with the result. Further investigations such as detailed ultrasound scan or amniocentesis may be offered if you have a high risk result. Amniocentesis gives a definite result but incurs a small risk of causing miscarriage.

You will probably be offered repeat Blood Group and Full Blood Count later in pregnancy.

Ultrasound scans can be performed to:
* date/confirm pregnancy
* Check physical structure of baby
* Nuchal fold – checking for any anomalies in structure of baby
* Assess fetal wellbeing, growth, liquor volume

Many areas are now offering a combined early pregnancy scan and nuchal fold scan – this may be combined with a biochemistry blood test to assess your risk of having a baby affected by Down’s or other Syndromes – in this case the serum screening at 16 weeks in not needed.

It is important to remember that all these tests are OPTIONAL – you can have any, all or none of the above tests after discussing the options with your midwife.

Please do feel free to email me if you have any specific questions: info@3shiresmidwife.co.uk

You will be offered regular appointments with your midwife or doctor (frequency of appointments is usually decided by clinical need); they will offer to:

  • monitor your blood pressure
  • analyse your urine
  • assess the baby by palpating (feeling) the size and position of the baby
  • listen to your baby’s heartbeat
  • question you for signs of any potential problems

You will also be offered the following blood tests:

Full Blood Count – Mainly to test for anaemia
Blood Group – In case you need a blood transfusion at the birth
Rhesus group and antibodies – To look for unusual antibodies in your blood/to screen for potential rhesus disease
Rubella antibodies – To check your immunity to rubella (German measles)
Syphilis – To check for syphilis which although very rare could be harmful to you and your baby if untreated
Hepatitis B – Testing for this infectious liver disease
H.I.V. – If you are HIV positive treatment can be offered to both you and your baby
Sickle Cell and Thalassaemia – These are genetic blood diseases, usually specific to certain populations (if you feel your ancestors may come from these areas it may be wise to be tested)

  • Parts of Africa (the region south of the Sahara Desert)
  • Spanish-speaking areas like South America, Cuba, and Central America
  • Saudi Arabia
  • India
  • Mediterranean countries, such as Turkey, Greece, and Italy

Tay-Sachs – most commonly prevalent in Eastern European Jewish populations

Serum screening – This testing performed at around 16 weeks of pregnancy will give a risk factor (high or low) for your baby having Down’s syndrome and neural tube defects (spina bifida). You need to think carefully what you would do with the result. Further investigations such as detailed ultrasound scan or amniocentesis may be offered if you have a high risk result. Amniocentesis gives a definite result but incurs a small risk of causing miscarriage.

Usually repeat Blood Group and Full Blood Count testing will be offered later in pregnancy.

Ultrasound scans can be performed to:

  • date/confirm pregnancy
  • check physical structure of baby nuchal fold – checking for any anomalies in structure of the baby
  • assess fetal wellbeing, growth, liquor volume

In the past pregnant women were routinely prescribed an iron supplement; it is now recognised that many women do not require an iron supplement and that the best way to get iron is through a healthy diet.  Your midwife will offer you a blood test to check your iron stores during your pregnancy and it is actually normal for your haemoglobin (or iron) level to fall because you will have an increased amount of blood circulating as you grow bigger through the pregnancy and this causes a dilution of the haemoglobin levels.  It is also true that the growing baby will take what it needs and deplete you!  This said, it is obviously important to eat well, and to include iron rich foods in your diet to enable you to be in the best possible health to grow the baby, to give birth and to feed the baby afterwards.  I would also recommend that you consider increasing the amount of protein in your diet, try to eat protein several times a day.

If you are taking iron supplements and find that they don’t agree with you (they often cause either constipation or diarrhoea) do speak to your midwife or doctor as it is often possible to change to a different medication.  It is definitely better to get iron from your diet if you possibly can and although iron supplements can be useful for some women.

Foods rich in iron include:

– herbal tonic spa tone/floradix (consult pharmacist)
– red meat, steak and corned beef
– Legumes – lentils and butterbeans, harricot beans (baked beans) peas/beans)
– fish – salmon, kippers, pilchards, sardines
– cream and cottage cheese
– wholegrains – wheatgerm and oats and millet, bread and pasta, chapattis, oak cakes
– dried apricots, dates and figs, raisins, prunes, currents
– dark green leafy vegetables, cabbage, broccoli, spinach, sprouts, cooked nettle tops, dandelion leaves
– watercress and beansprouts
– dried peaches and prunes
– beetroot
– yeast/vecon extract
– soya flour
– breakfast cereals
– cane molasses (can stain teeth)
– chives/spring onions
– parsley
– nuts – especially almonds
– egg yolks
– Kelp/seaweed – use dried and add to stir fry, salads, or cook with rice
– Spiralina (health food shop – take advice
– fresh fruit, redcurrants, blackberries, loganberries, raspberries, cranberries

Limit use of dried fruits if have tendency to thrush.

NB Vitamin C taken at the same time (e.g. glass of orange juice will aid absorption, whilst bran, coffee and tea decrease absorption)
Vitamin C is found in: Fruit and vegetables, especially kiwi, oranges, rosehips, potatoes, broccoli, sprouts and cauliflower
Cooking – always try to steam vegetables and use vegetable water for soups, sauces or hot savoury drinks. Use cast iron pots and pans if you have any.

So you are having a baby! Fantastic, or maybe it’s been a bit of a surprise?  Having a baby is the most wonderful thing, but also a huge responsibility.  You are going to need support, so if possible try to involve your partner, your family and friends.

It is important to see a midwife as soon as possible – many women think they have to see a doctor, and it is fine to see your doctor if you wish, but you can just go straight to the midwife. Your local midwife will usually be found in the local doctor’s surgery, but sometimes also at Children’s Centres, you will usually be seen less often at the beginning and then more frequently as the pregnancy progresses. Don’t feel that any question is daft – it isn’t a daft question if you don’t know the answer!  Mums and friends can be great and really supportive, but they may not always have the correct information, and you can ask anything in complete confidence. A midwife is expert in pregnancy and birth and will help you throughout the pregnancy, birth and early days of parenting. She will also help you make decisions and support you in your wishes.

During the pregnancy it may be suggested that you take supplements and you will also be offered various tests and you will be asked to see the midwife regularly so that she can make sure that both you and the baby are well; use the appointments to ask any questions you may have. You should also be offered some antenatal or parentcraft classes which can be variable in quality, so consider NCT (the National Childbirth Trust) or active birth classes as well, they can be an opportunity to make friends with other expectant mums – often the friends made in these groups stay friends for years to come with the babies growing up together – it can be very supportive to be able to ask a friend “is this normal?”, “did your baby do this?”

It is really worth reading all you can about birth and babies. Your midwife will give you lots of information, but you can also go to the local library and borrow books. There are also sometimes local discussion groups, for example at Surestart Children’s Centres, NCT and Meet a Mum (MAMA), La Leche League and Association of Breastfeeding Mothers (ABM) both breastfeeding support groups may also have meetings to which pregnant women are invited – you midwife may know what is available locally or ask in the library.  There is actually quite a bit that you can do to prepare for the birth – you probably are young, fit and healthy and that is great. Giving birth is a bit likerunning a marathon – it is one of the hardest day’s work you will ever do, so if you are relatively fit that helps (I don’t mean that you should be exercising hard, but gentle exercise like walking and swimming is good). There may also be pregnancy yoga or aquanatal sessions in your area and both will be helpful to you. If you already exercise there is probably no reason why you shouldn’tcontinue, but don’t overdo it and ask your midwife for advice. Other strategies include learning self-hypnosis or ‘hypnobirthing’ techniques and seeing complementary therapists such as acupuncturists, homoeopaths, reflexologists, chiropractors etc throughout the pregnancy. 

As you get heavier it is hard to want to do too much and tempting to sit on the sofa, but this actually is the worst thing you can do. Instead sit on a diningchair, but sit on it backwards, with your legs open and facing the chair back –this is great because it keeps you in a nice upright position, opens your pelvis and tips the baby forward. If you slouch backwards onto the sofa it tends to tip the baby towards your back and this can make labour longer and more difficult. If you have access to an exercise or birthing ball these too are great to sit on for the same reason – you can sit on a chair or ball and watch TV or even read a book!  Some women prepare for the birth by gently massaging their perineum (this isthe area of skin between the vagina and the anus). If this is something that you think you might be able to do ask your midwife for more information about how to do this.

You also need to start considering where you want to give birth. Depending upon where you live you may have several options: at home, in a birthing unit or in a hospital – again this is something to discuss with your midwife.

The Antenatal Classes or Parentcraft Classes are usually run over a period of time, and you should be able to take along your partner or your Mum or a friend if you wish. The classes should give you lots of information about what to expect when you go into labour, they will tell you when you should call your midwife or hospital – bearing in mind that labour is usually a LONG process and women expecting their first baby nearly always contact the midwife before they really need to! The class may well also organise a visit to your local maternity unit so that everything can be explained to you – it is far less scary if you know what the place looks like and what machines are used for!  Sometimes a Mum will come along with her baby and a feeding or bathing demonstration may be given. The midwife will also talk about how you can help yourself during the birth – I would really encourage you to go along!

When you are planning a pregnancy it is important that you are in optimum health, firstly to help your body to conceive, and secondly to maintain the pregnancy and grow a healthy baby. It is true that the baby will take what it needs from your body, but your body needs to be healthy and strong to nurture the growing baby, to give birth and to enable you to feed and care for the baby.

When planning a pregnancy it is advisable to first see your midwife or GP to discuss your plans, this would be particularly important if you have a preexisting medical condition. It is worth having a rubella (German measles) blood test even if you have had German measles or had the immunisation in the past; for certain population groups further blood testing may also be suggested to exclude sickle cell, thalassaemia or Tay-Sachs disease. Your midwife or GP will check your physical wellbeing, perhaps offer you a cervical smear, check your blood pressure and ensure that there are no hazards to pregnancy in the workplace of both you and your partner.

The current Department of Health (DoH) recommendation is that it is
advisable to take a folic acid supplement in the months prior to getting
pregnant and for the first 12 weeks of pregnancy – if you don’t want to take a supplement it would be worth ensuring that you get additional folic acid in your diet from green vegetables, brown rice and walnuts. Folic acid supplementation has been shown to reduce the risk of neural tube defects (spina bifida).

A recent DoH recommendation is that pregnant women take Vitamin D
supplements, this may be especially important if your religion requires you to cover a significant amount of your body (Vitamin D is absorbed into our skin by exposure to sunlight).
Be aware of toxoplasmosis – a bacterial infection that can be picked up in cat and dog faeces – not good news for a growing baby. Either get someone else to clear up after animals, or just be extra careful of hygiene – this also applies to gardening as the bacteria lives in soil. So if you garden, consider wearing gloves and again wash hands, nails very carefully.

Food advice in early pregnancy is to be extra careful with hygiene; food
poisoning is bad news for your baby. Don’t eat any unpasteurised foods – most food is pasteurised, but some speciality milks, cheeses/diary are not. Avoid moulded or veined cheeses and pate/salami. Eggs should be well cooked not runny. Fruit and vegetables should be washed prior to eating. It is suggested that you don’t eat swordfish or marlin and limit the consumption of “oily” fish to twice weekly. Sea food should be cooked not raw. Liver is not recommended for pregnant women.

Whilst pregnant the current recommendation is not to drink alcohol at all, and it is better to limit the amount of caffeine you take (tea, coffee, cola and fizzy drinks), and obviously it would be wise to stop smoking and avoid any “recreational” drugs prior to getting pregnant.
We are still evaluating the evidence regarding eating peanuts in pregnancy – the best current advice is that if you have nut allergies in the family it may well be best to avoid eating nuts in pregnancy; it there are no nut allergies then use your own instinct and judgement as to whether you feel safe to eat nuts (bearing in mind they are a good source of protein, particularly if you are vegetarian or vegan).
Having made a huge list of foods to avoid, you are encouraged to eat plenty of fruit and vegetables (aim for at least five a day), plenty of protein (at every meal if you possibly can) and plenty of iron rich foods (red meat, pulses, green vegetables).

It can sometimes take many months to conceive and this can be a stressful time. I would encourage you to consider seeing complementary therapists as they may well be able to help you. It is worth considering acupuncturists, reflexologists, nutritionalists, homoeopaths or hypnotherapists – talk to different therapists and go to the one that you feel most comfortable with. The following websites also have lots of useful information:

www.haveababy.com
www.womantomother.co.uk
www.foresight-preconception.org.uk
www.zitawest.com

www.eatwell.gov.uk/agesandstages/pregnancy/whenyrpregnant/

Today I am going to write about my latest project, www.BirthIndex.co.uk

 

BirthIndex.co.uk is an on-line Listings Directory for all things related to Pregnancy, Birth and Baby.  As a Registered Midwife I saw the need to produce this on-line Directory to give clients and families comprehensive information about what is available in their LOCAL area. 

At the moment we have sites up and running in the Bedford, Milton Keynes and Northampton areas but hope to expand this shortly.

The site contains listings relating to pre-conception or fertility advice; pregnancy and birth; postnatal issues; baby equipment; complimentary therapists; childcare and other services for example photographers, activities to do with your baby/toddler.  We are also building a reference library of useful articles and currently have articles on the following subjects:

A Day In The Life Of An Independent Midwife

Alternatives To Hospital Induction

Blood Tests And Scans

Blood Tests For Your Baby

Breech Birth

Foods Rich In Iron

Heartburn Relief

Homebirth List Of Useful Items

Independent Midwives – Endangered Species

Planning A Baby

So You Are Pregnant!

The Big Day!

Top Tips For Labour

Vitamin K

Local events will happily be promoted on the site, and a periodic newsletter will be produced to keep families up-to-date.

I am inviting all related businesses to take a FREE listing on this site.  Additionally there are also other advertising opportunities available at half price for limited period; for example “Enhanced Listings” or “Box” and “Banner” advertisements.

Please do go and have a look around my new site www.birthindex.co.uk  

 

Valerie Gommon

 

 


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