Your Pregnancy / Tō Hapūtanga - HE1420

Just 12 weeks after conception, the baby is fully formed. It has all its organs, muscles, limbs and bones. From now on, it will grow and mature. The baby is already moving about, but the movements cannot yet be felt. First-time mothers tend to feel the baby first move at about 20 weeks, while for second-time mothers, the first movements are felt at about 16 weeks.

24 weeks

At 24 weeks, the baby is about 30 cm long and weights 0.6 kg. The baby's skin is thicker and less see-through (transparent), but remains wrinkled because there is no fat underneath. The baby is moving strongly and the eyelids are now separated. Baby starts practising breathing and swallowing movements.

28 weeks

At 28 weeks, the baby is over 38 cm long and is about 0.9 kg in weight. The baby’s skin begins to develop a white greasy covering called vernix, which waterproofs the skin. The baby’s movements can easily be felt at this stage.

 

40 weeks

At 40 weeks, the baby is 50 cm long and weighs over 3 kg. Over the past four months, the baby has fully developed and the lungs have matured, ready for birth.

Other information about the development of your baby is available in resources such as The New Zealand Pregnancy Book by Sue Pullon and Cheryl Benn.

Twins

Identical twins develop from one fertilised egg splitting into two separate cells. They therefore have the same genes, are the same sex and look very alike.

Non-identical twins result from two eggs being fertilised at the same time and are more common than identical twins.

 

 

Keeping healthy in your pregnancy

Keeping healthy throughout your pregnancy includes eating healthy food, getting exercise, getting enough rest, preventing the spread of infection, not smoking or drinking alcohol, and not taking recreational drugs. It also includes maintaining your cultural, spiritual and emotional wellbeing.

See also Further information for pregnant women for details of pamphlets that contain information for women who are pregnant or who have just had a baby.

Taking care with medicines

Some medicines can harm the developing baby. Only take those medicines that have been recommended by your midwife or your doctor. Always check with them or your pharmacist before taking anything else. X-rays and some local and general anaesthetics (including dental X-rays and anaesthetics) are best avoided during pregnancy.

Smoking

Smoking during pregnancy affects the baby’s growth and will mean more likelihood of health problems such as:

• a lower birthweight that could be harmful
• an increased risk of cot death, pneumonia, asthma or glue ear
• a risk of miscarrying or having a stillborn baby.

There are programmes available to help pregnant women quit or reduce smoking. There is also information available on how to quit smoking. You can call the Quitline (Quit–Me Mutu) on 0800 778 778.

Alcohol

There is no known safe level of alcohol use during pregnancy. If you think you are pregnant or know you are pregnant, it is safer to avoid alcohol altogether.

When you are pregnant, alcohol that you drink is carried by your bloodstream through the placenta to your baby. Drinking alcohol during pregnancy can cause brain damage to your baby, and that damage is permanent. This damage is called Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects or (FAE).

Drinking alcohol may harm your unborn baby because:

• there is a greater likelihood of miscarriage, stillbirth and premature birth
• babies may be born with intellectual disabilities or physical defects
• slower development may become obvious later in childhood, and the child may have poor co-ordination and learning and behavioural problems, including hyperactivity.

After the birth of your baby, some of any alcohol you drink will pass into your breast milk.

Cannabis and/or other recreational drugs

Using alcohol and/or other recreational drugs such as cannabis can cause special problems to the mother and baby, possibly causing premature birth or a low birthweight. Other drugs such as narcotics like heroin may cause the baby to be born drug-dependent and suffer from withdrawal symptoms. Drug-dependent babies will need expert management if they are to survive.

Diet

Eating well and doing moderate physical activity during pregnancy are important for you and your baby. Nutritional needs are higher when you are pregnant. Meeting these needs helps protect the long-term health of both you and your baby. It is important to eat a variety of healthy foods every day from each of the four main food groups:

1. vegetables and fruit
2. breads and cereals (wholegrain is best)
3. milk and milk products (reduced- or low-fat milk is best)
4. lean meat, chicken, seafood, eggs, legumes, nuts and seeds.

Drink plenty of fluids every day.

The only dietary supplements recommended for all pregnant women are folic acid and iodine. Folic acid is a vitamin that is needed for the formation of blood cells and new tissue. During pregnancy, your need for folic acid is higher. Lack of folic acid has been linked with neural tube birth defects, such as spina bifida. The risk of having a child with these birth defects is low but can be reduced by taking a folic acid tablet. Iodie is essential for normal growth and development including brain development. It is particularly important for the baby. Subsidised (reduced cost) folic acid and iodine tablets are available for all women. Discuss them with your LMC.

Some foods should be avoided because of the risk of catching listeriosis. Listeria is a common bacterium that can cause food-related illness. In pregnant women, this illness can cause miscarriage and stillbirth or it can cause infection in your baby. You can reduce your risk from listeria by avoiding certain foods and by using safe food practices. For more information on safe food practices, read the pamphlet Avoiding Listeria (available at www.healthed.govt.nz) and Food Safety in Pregnancy (available at www.mpi.govt.nz/food-safety/food-safety-forconsumers/food-and-pregnancy/).

The list of avoidable foods changes regularly. For an up-to-date list, refer to the MPI website or phone 0800 693 721. Examples of foods to avoid eating are:

• uncooked, smoked or ready-to-eat fish or seafood, including oysters, smoked ready-to-eat fish, sashimi or sushi*
• paté, hummus-based dips and spreads
• ham and all other chilled pre-cooked meat products including chicken, and fermented or dried sausages such as salami*
• pre-prepared or stored salads (including fruit salads) and coleslaws
• raw (unpasteurised) milk and any food that contains unpasteurised milk*
• soft-serve ice creams
• soft, semi-soft, or surface-ripened soft cheese (such as brie, camembert, feta, ricotta, and roquefort)*.

* Note that these foods are safe to eat if heated thoroughly until piping hot, that is, above 70 degrees Celsius.

Infections

Some infections during pregnancy can cause harm to your baby. If you are in contact with someone who has an infectious illness or you are not sure about symptoms, information is available to help you make any decisions about what you should do. Some of these infections include:

• rubella (German measles)
• toxoplasmosis – an infection that pregnant women can get from cat faeces and that can pass through the placenta to the baby
• human immunodeficiency virus (HIV)
• hepatitis B
• hepatitis C
• tuberculosis
• herpes.

A range of other infections, such as urinary tract infections, thrush, streptococcus B (strep B), chicken pox (varicella), and sexually transmitted infections (such as chlamydia or gonorrhoea) may also cause harm to you or your baby. If you come into contact with any of these infections, talk to your LMC.

Labour and birth - Te whakawhānau

Antenatal classes/childbirth education

Antenatal classes/childbirth education (also called pregnancy and parenting education) gives pregnant women, their partners, support people and families/whānau the opportunity to:

• learn more about what will happen to them and the care they are likely to receive during labour and the birth
• develop strategies to get through labour
• understand what happens after their baby is born
• meet other parents-to-be.

Preparing for birth

Every birth is different, and babies vary in when they arrive and how long they take to do so. Your LMC can answer any questions you might have about your labour and the birth and how you should prepare.

Your LMC will provide information to help you develop a birth plan:

• where to have your baby
• who you want to be with you
• what sort of environment you want and what position you may want to be in for giving birth
• choices for monitoring your labour, interventions that may be needed and treatment for things that don’t go well
• how to get breastfeeding started
• how long to stay in the hospital (if you go there) and plans for going home
• handling of placenta/whenua according to your wishes and culture
• support options for you after the birth and risk factors for postnatal depression.

Think about who you would like to support you at your baby’s birth. You may wish to have only your partner with you, or you may like other members of your family/whānau. You may have special cultural or spiritual practices that you wish to have for labour and at the birth, such as prayers/karakia.

Māori may wish the placenta/whenua to be kept and returned to them according to Māori tikanga and kaupapa. Other women may choose this too. Make this and any other preferences known to your LMC.

The stages of labour

There are three main stages in labour. The time taken for each stage will vary from woman to woman. In the first stage the cervix opens, in the second stage the baby is pushed down through the vagina and is born, and in the third stage the placenta/whenua comes away from the wall of the uterus and is pushed out through the vagina.

The membrane that holds the amniotic fluid and your baby (often called ‘the waters’) can break at any time. Often this happens near the end of the first stage or at the beginning of the second stage of labour. Sometimes the waters are deliberately broken to help get labour started.

When you think you are in labour, tell your LMC. They will then advise you what to do next. Your LMC may visit and assess you in your home or meet you at the maternity hospital, or they make some other suggestion(s).

  

Variations in labour and birth

No two births are the same.

You need to think about what pain relief you want during labour and the birth. Some strategies, such as relaxation and breathing techniques, keeping upright and mobile, a warm bath or shower, a birthing pool or a TENS machine, can be helpful. Medicines/rongoā, massage/mirimiri and prayer/karakia can also be helpful, as can homeopathy or aromatherapy. As you prepare for labour and the birth, discuss with your LMC any questions you have about relieving pain in labour through these strategies.

However, you may need extra help at your baby’s birth.

Medical pain relief

Gas, injections of drugs, or epidural or spinal anaesthetics can be used if necessary, although other methods should be tried first. It is important to note that all drugs pass through the umbilical cord to the baby up until the time the cord is cut, so only necessary drugs should be used. Some forms of medical pain relief increase the likelihood of other medical interventions.

Induction/augmentation of labour

Induction is when labour is started artificially because of risk to the mother or baby if the pregnancy went on any longer. Induction can be done by using the following:

• placing a medicated gel close to the cervix
• breaking the membrane that holds the amniotic fluid and your baby (‘the waters’)
• using intravenous synthetic hormones to cause the uterus to contract.

Inductions are likely to lead to increased intervention, such as a ventouse or forceps birth or a caesarean section.

Augmentation (assisting a labour that has already commenced) can be done by using the following:

• breaking the membrane that holds the amniotic fluid and your baby
• a hormone drip to strengthen the contractions.

Ventouse or forceps birth

Ventouse or forceps may be used to help deliver your baby. A ventouse is a suction cap that is placed on the baby’s head and, through firm pulling and you pushing, helps the baby to be born. The same method is used for a forceps birth, with the forceps being placed around the baby’s head. An episiotomy may be done for a ventouse or forceps birth. An episiotomy is when the perineum (area round the vaginal opening) is cut to make the opening bigger. Stitches are needed afterwards.

Caesarean section

A caesarean section is the removal of the baby from the uterus by surgery. This should only be done when there are medical reasons for it. An epidural or spinal anaesthetic is generally given. A general anaesthetic may be used when an emergency caesarean section is needed. After the operation, stitches or clips are used to seal the wound. These either dissolve or are removed about five to eight days later.

After the birth - I muri iho i te whānautanga

The postnatal period is the time for recovering from the birth and getting to know your baby. It is also a time for eating well, drinking lots of water, resting with your baby and getting support from your family/ whānau. It takes about six weeks for your body to return to its pre-pregnant state.

Postnatal care

You and your baby are entitled to six weeks of postnatal care by your LMC. Your baby will be checked by your LMC at each visit and given at least three more comprehensive examinations as well:

• within 24 hours of birth
• within seven days
• before being transferred to your chosen Well Child provider (ie, the health professional who will provide health care for your baby).

At your baby’s first examination, within 24 hours of birth, your LMC will check that your baby is feeding properly. Babies generally wake three to four hourly for feeding, although more frequently in the first days after birth (referred to as cluster feeding).

Vitamin K can be given to babies soon after birth to prevent the development of bleeding due to low vitamin K levels. This condition can be serious. Vitamin K can be provided by injection or by mouth. If given by mouth, three doses are required – at birth, one week and six weeks. It is important to get information from your LMC before your baby is born so that you can make an informed decision about whether or not you want your baby to have vitamin K.

Your LMC will also look for any potential health problems, such as jaundice. Newborn babies can have some mild jaundice about the third day after the birth. Jaundice gives the baby a yellow appearance and is easily remedied by frequent feeding. More severly jaundiced babies may need exposure to special light treatment, called phototherapy (treatment using blue light). This may involve the baby lying on special bed (bilibed) or having lights placed over the bassinet.

Hospital stay

If you have your baby in hospital, your LMC will visit you daily while you are in hospital unless they make special arrangements with the hospital staff. The length of your stay will depend on your clinical needs. The decision about when to leave will be made through discussions between you, your LMC, and the hospital staff.

In situations where your care has been transferred to the hospital specialist service, you will be transferred back to the care of your LMC when you no longer need the specialist service. Your LMC will explain what their role is, alongside that of the hospital specialist service, for the time you are in hospital.

Home visits

Once you have gone home, you can expect between five and 10 visits from your LMC or a midwife. You are entitled to at least five home visits unless you ask not to have them. If you had your baby in hospital, you will receive your first home visit within 24 hours of going home from hospital. The postnatal care you will receive from your LMC includes assistance with and advice about feeding and caring for your baby, as well as advice about caring for yourself, your nutritional needs and contraception.

Your LMC will refer your baby to your chosen Well Child provider. They will also refer you and your baby to your GP for ongoing care and the start of baby immunisations at 6 weeks of age.

Screening for your baby

Screening is an important way of identifying babies who are more likely than other babies to have a health issue. It is your choice whether your baby has screening. The Ministry of Health strongly recommends screening for your baby.

Newborn metabolic screening

The Newborn Metabolic Screening Programme detects rare but life-threatening metabolic disorders. This screening is a blood test and happens when babies are 48 hours old, or as soon as possible after this. Each year around 45 babies are found to have a metabolic disorder. Early diagnosis means that treatment can start quickly, before the baby becomes sick. Metabolic disorders are hard to find without screening.

Although these disorders cannot be cured, early treatment with medication or a special diet can help your baby stay well and prevent severe disability or even death. Metabolic disorders can occur in any family, even when there is no family history of disorders.

Your LMC will provide you with information about newborn metabolic screening (the heel prick test) before you consent for this test. Ask when to expect the results and consider whether you would like the leftover blood spots to be stored or returned to you after screening. Ask what these might be used for if stored.

For more information, see the brochure Your newborn baby’s blood test (available from your LMC or GP, or at www.healthed.govt.nz) or the National Screening Unit's website.

Newborn hearing screening

Parents or guardians of all babies born in New Zealand are offered the opportunity to have their baby’s hearing screened. This screening is designed to pick up moderate to profound hearing loss. If your baby can’t hear, it is hard for them to learn to speak, socialise and learn. Finding hearing loss early is important for your baby’s language, learning and social development.

Screening is usually done before you and your baby go home from the hospital. If your baby is not born in a hospital or not screened before you go home, screening may be offered at your local health clinic or hospital outpatients’ clinic. Screening should happen before your baby is one month of age. This is so that diagnostic testing can be completed by three months of age and, if a hearing loss is found, intervention can begin by six months of age.

You will be told the screening results straight away. Some babies need another screen because the earlier screening did not show a strong enough response in one or both ears. If this happens you will be offered a repeat screen, either before leaving the hospital or as an outpatient appointment. If your baby does not pass the screening, they will be referred to an audiologist for further testing. Most children who go to the audiologist will not have a hearing loss but need that additional testing to be sure.

Your LMC can provide you with more information about newborn hearing screening.

For more information, see the brochure Newborn Hearing Screening (available from your LMC or GP, or at www.healthed.govt.nz) or the National Screening Unit's website.

Breastfeeding

Breastfeeding is the best nutrition for your baby and has advantages for you too. To help make your breastfeeding experience positive, ask for information and advice early in your pregnancy. You can also talk to other mothers who have enjoyed breastfeeding their babies. Breastfeeding is a skill that needs to be learned. Some women experience no problems, whereas others need more help and support to get started and continue feeding. Having the practical support of your partner, family/whānau and friends is important.

Benefits of breastfeeding

The Ministry of Health recommends that all babies are fed only breast milk for the first six months of their life. This means no water, infant formula or fruit juices. After six months, you can slowly start your baby on solid foods and other fluids while you keep breastfeeding for one year or longer.

Breastfeeding is best for your baby because:

• it helps to develop a close bond between you and your baby
• breast milk is the only food that is exactly the right nutrition and temperature for your baby
• breast milk will help protect your baby from ear infections, gastroenteritis, respiratory infections and eczema.

Babies who are breastfed are less likely to have respiratory problems, coughs, colds or infections before they are one year old for which they may need to be admitted to hospital. Breastfeeding may also reduce the risk of cot death.

Breastfeeding is good for you because:

• you will recover from the birth faster
• it helps strengthen the natural bond between you and your baby
• you may lose weight gained during pregnancy faster
• you may be less likely to get some types of breast cancers
• you may be less likely to suffer from ovarian cancer, osteoporosis and hip fractures later in life.

Some things can help you breastfeed successfully. For example, a drug-free birth provides an excellent start. It is also important that you and your baby have skin-to-skin contact for at least the first hour after the birth and that you breastfeed your baby during this time. This develops a close bond and helps your body to begin producing breast milk. Your LMC can tell you about any support groups in your area, such as La Leche League, Parents Centre or Home Birth Association. There are also books and pamphlets available on breastfeeding.

Some mothers have health conditions or take medications that mean that they cannot breastfeed. If you are one of these mothers, discuss safe artificial feeding with your LMC.

If your new baby is not waking and feeding regularly (at least 3-4 hourly), contact your LMC because dehydration may be a problem or your baby may be unwell.

Safe sleeping

There are some important things you can do to reduce the risk of suffocation and sudden unexpected death in infancy (SUDI). This used to be called SIDS or cot death.

• Baby's own bed: Put your baby in his or her own bassinet, cot or other baby bed. This keeps them free from other adults or children who might smother and accidentally suffocate them. The bed should be firm and flat, free from gaps that could trap or wedge your baby and free from objects that might cover their face or head (no pillows, toys, loose bedding, or bassinet/cot bumpers). Wedges and positioning devices are not recommended.
• Sleeping position: Put your baby down to sleep on their back. Make sure your baby's feet are near the bottom of the bed so there is no wriggling down under blankets.
• Room sharing: Put your baby to sleep in a cot or bassinet near your bed while you sleep for the first 6 months. Make sure at least one parent is alert to your baby's needs and free from alcohol or drugs.
• Avoid bed sharing or falling asleep with baby to prevent suffocation: If you choose to sleep in bed with your baby - give them their own sleep space (Pepi-pod, wahakura, moses basket).
• A smokefree baby, breastfeeding and immunisation also reduce your baby's risk of SUDI.

If you need financial help so that baby can have his or her own bed you may be eligible for a grant from Work and Income. Depending on your situation, you may or may not be required to pay back the grant.

Registering your baby’s birth

The hospital (or your LMC if you had your baby at home) has to notify the Registrar of Births within five working days of your baby’s birth. The hospital will also give you a copy of the birth registration form for you to complete.

It is compulsory for you to complete and return this form to Births, Deaths and Marriages Central Registry, PO Box 10526, Wellington 6143, as soon as possible after the birth.

Start of your Well Child visits

Your final mother and baby check usually occurs between four and six weeks after your baby’s birth. This marks the end of your maternity care. Up until six weeks, you are still able to contact your LMC about any maternity-related problem.

You and your child have the right to publicly funded Well Child Tamariki Ora care. This Well Child care is different from the medical care you receive when your child is ill.

Talk to your LMC about who provides Well Child services locally. Some examples of Well Child providers are Plunket, the general practice team (but they may charge a co-payment), some Māori and Pacific providers, or the public health service. If you want your baby to have Well Child care, your LMC will refer you to your Well Child provider, usually between four and six weeks after your baby’s birth.

At six weeks, you can also take your baby to your usual GP for a further check. This is the same time as a baby’s first immunisation is due. This check is not a maternity visit or a Well Child visit but is part of the subsidised primary health care for children from birth to six years. You may be charged a part-payment for this.

Immunisation

Immunisation protects babies from twelve serious disease and begins when your baby is six weeks old. Immunising your baby at the recommended ages is the best protection against these diseases. The Ministry of Health supports immunisation but it is your choice whether to immunise your baby. All childhood immunisations are free in New Zealand. For more information talk to your health professional, contact the Immunisation Advisory Centre on 0800 IMMUNE (080 466 863) or visit the Ministry of Health website.

Returning to work

If you are returning to work and your baby will be using childcare facilities, try to make arrangements that allow you to easily see your baby during work time so you can continue breastfeeding. If you can’t do this, you can give your baby expressed breast milk while you are at work and breastfeed at other times of the day. One breastfeed a day is enough to continue lactation. Your LMC can advise you how to sterilise containers and safely store expressed breast milk in the fridge or freezer.

Appendices

Further information for pregnant women

Ask your LMC or Well Child provider for Ministry of Health pamphlets. You can order free copies from your local public health service or through the website www.healthed.govt.nz, which has the latest list of resources. Women who are pregnant or have just had a baby will be especially interested in the information in the pamphlets on the folllowing topics (the pamphlet codes are in brackets):

• alcohol (HE2523)
• breastfeeding (HE2098)
• SUDI/SIDS (HE1228)
• folic acid and spina bifida/iodine and iodine deficiency (HE4147)
• healthy eating and being active during pregnancy (HE1805) and while breastfeeding (HE1806)
• hepatitis B and C (HE4182)
• immunisation (HE1323)
• infant formula (HE1306)
• listeria (HE9007)
• antenatal HIV screening (HE1832)
• screening and testing for Down syndrome and other conditions (HE2382)
• newborn baby’s blood tests (HE2310)
• newborn hearing screening (HE2429)
• quitting smoking (HE10106)
• rubella (HE4172)
• sexually transmitted infections (HE7002)
• smokefree homes (HE1802)
• soy-based infant formula (HE1306)
• tuberculosis (TB) (HE2205).

You could also ask your LMC about additional information that may be available from other organisations in your area. For example, from:

• Home Birth Association
• La Leche League New Zealand
• NZ College of Midwives
• Maternity Services Consumer Council
• Parents Centre New Zealand.

You can also find further information regarding maternity services on the Ministry of Health’s website, and about screening for you and your baby on the National Screening Unit's website.

Choosing an LMC

Possible questions to ask before registering with an LMC are:

• Will you provide all my care, or will others be involved?
• How can I contact you if I need help or advice in and out of normal working hours?
• Are you taking leave in the month or months before or after my baby is due?
• Who will provide backup care for me if you can’t be there?
• What options do you offer for place of birth (eg, hospital, maternity unit, birthing unit, home birth)?
• Where will my antenatal visits be? In my home? At a clinic?
• How many antenatal visits can I expect to have? Will you visit me at home in early labour?
• What happens if you are away or with someone else when I go into labour?
• Will I be able to meet your backup midwife or doctor?
• What happens if I need specialist care during my pregnancy or my labour? If this happens, will you continue to provide care for me?
• If I stay in hospital, what will your role be?
• How many postnatal visits can I expect, both in hospital and at home?
• How many weeks do you visit for after the birth?
• Between visits, are you available for me to phone you for advice? Do you give me a chance to provide feedback on the care you provide?

You may also like to ask questions about your LMC’s experience and practice of delivering babies, such as:

• How would you describe the maternity care that you provide in pregnancy, labour and birth?
• What is your philosophy about childbirth?
• About how many births a year do you attend?
• How many other women have you got booked who are due about the same time as me?
• Have you had a standards review or an audit by your professional body?

If your LMC is a GP or a private obstetrician, other questions to ask are:

• Who will provide my midwifery care during labour?
• Can I meet the midwife who will provide me with care during labour?
• Who will provide my home visits when I go home from hospital?

Important contacts

MUM 2 BE	Information on how to access maternity services and what you are entitled to receive	0800 686 223
Work and Income	Information on whether you qualify for financial help	0800 559 009
Inland Revenue Department (IRD)	Information on family assistance and parental tax credits	0800 227 773
Department of Labour	Information on parental leave	0800 800 863
Quitline (Quit - Me Mutu)	Advice on giving up smoking	0800 778 778
Healthline	Advice about your baby	0800 611 116
Health and Disability Commissioner	Help with complaints about the care you received	0800 112 233

Complaints

If you have a complaint about the maternity care you have received, consider talking or writing directly to the person or organisation that provided the service. If your LMC was a midwife then you can download a feedback form from www.midwife.org.nz or contact 03 377 2732 for local resolution committee information. If you don’t feel comfortable about doing this, you can get support from an independent health and disability advocate, who is trained to help. There is no charge for this service. Your local advocacy service and the Health and Disability Commissioner can be reached by phoning 0800 112 233.

ISBN 978-0-478-41109-6 (print)
ISBN 978-0-478-41110-2 (online)

[HE1420]