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general information

work and benefits: having a baby does not come cheap, and there maybe a change in your household income. you should discuss your options regarding maternity leave and pay with your personnel officer or employer early in pregnancy; ensure everything is in writing. for more information on maternity protection in hong kong visit : http://www.labour.gov.hk/eng/public/wcp/maternityprotection.pdf

healthy eating and drinking. make sure you eat a variety of different foods to get the right balance of nutrients for your growing baby and for your body to deal with the changes taking place. it is important to prepare and cook your food carefully to prevent food poisoning. foods such as ready meals, meat, poultry, shellfish and eggs need to be thoroughly cooked. avoid p锟絫锟?and mould-ripened soft cheeses; liver and liver products; peanuts and unpasteurized milk. have no more than two portions of oily fish a week and avoid marlin, swordfish and shark. it is advised that you take supplements of folic acid, which helps to prevent abnormalities in the baby, e.g. spinal bifida. the recommended dose is 0.4mg per day for at least 8 weeks before pregnancy, and up to 12 weeks into the pregnancy. if you have diabetes or are taking anti-epileptic drugs or have a family history of fetal anomalies, the recommended dose is 5mg per day. vitamin d is needed for healthy bone development. to protect your baby and yourself from the problems caused by low levels, a 10mcgs vitamin d supplement is recommended.vitamin a supplements should not be taken in pregnancy and any other supplements should only be taken after checking with your doctor. if you require more advice about your diet your doctor can refer you to a dietician. weight control: it is important to accept you are going to put weight on in your pregnancy. the normal changes in your body during pregnancy and the growing baby can add up to an average weight gain of around 11kg. the more weight you put on above the recommended amount in pregnancy, the more weight you will be left carrying after the birth of your baby.more information @ healthy eating for pregnancy.

- caffeine is a stimulant that is contained in tea, coffee and cola drinks. too much caffeine should be avoided as it is passed through the placenta and may affect your baby.

- alcohol increases the risk of miscarriage or may lead to fetal alcohol syndrome, resulting in severe abnormalities. pregnant women should avoid drinking alcohol. if you chose to drink during pregnancy, you should drink no more than 1-2 units, once or twice a week. a unit of alcohol = half a pint of beer / lager, or a single measure of spirits or a small glass of wine. getting drunk or binge drinking could harm your unborn baby.

- drugs: taking street drugs during pregnancy is not recommended as it may seriously harm you and your baby. over-the-counter medicines should also be avoided.

labour and birth

choosing where to have your baby. depending upon your individual needs and what services are available locally, you and your partner will be able to choose where to have your baby. you may choose to have your baby in private or public hospital supported by a maternity team. home delivery is not a safe option in hong kong and is not recommended.. the team may include midwives, obstetricians, paediatricians and anaesthetists. when making your choice it is important to consider all of your personal circumstances and any additional care you or your baby may need. you can discuss your wishes and what options are available to you with your doctor.

sign of labour. labour usually starts with regular contractions which have an affect on the cervix (i.e. widening or shortening the neck of the womb ). sometimes the waters break before labour starts properly. your own obstetrician, or the midwife on duty in the delivery suite, will advise you when you need to have an assessment, which usually includes a vaginal examination.

inducing labour. most labours start by themselves, during a 4 week period surrounding your expected date of delivery (edd ). many units have a policy of advising induction of labour when you are 'overdue', 10-14 days after the edd. you may be offered an internal examination to stretch and sweep the neck of the womb, which is sometimes enough to stimulate labour. otherwise, labour may be started off which a vaginal gel or pessary, which ripens the cervix and may also start the contractions. if necessary, the contractions can be started with your membranes being broken with a small hook, which may be followed with an intravenous drip of oxytocin (syntocinon ). the baby will then need to be monitored continuously. induction of labour may be offered earlier if there are complications during pregnancy, such as high blood pressure, pre-eclampsia or concern about the baby's growth. more information @ induction of labour.

assessment of progress. many factors play a part in the way your labour progresses - including the 'three ps': the powers (how strong and effective the contractions are ); the passage (the shape and size of your pelvis and birth canal ) and the passenger (the size of the baby, and which way it is lying ). progress is assessed as necessary, and includes external and internal examinations to check whether the baby is moving down in the birth canal and whether the cervix is opening.

monitoring the baby during labour. your baby's heart beat will be monitored during labour to detect any changes that could indicate that it is becoming distressed. this is done either intermittently, or continuously with a monitor attached to your abdomen.

posture during labour and birth. you will be encouraged to move around during labour unless your chosen pain relief makes this difficult. during the active pushing phase, many mothers wish to remain upright, and there is evidence that birth can be easier in a squatting or kneeling position. it is important that you find the position which is most comfortable for you.

eating and drinking. in labour, unless there are reasons to the contrary, you may have fluids and light meals.

pain relief. there are many options and most mothers do not know how they will feel or what they need until the day. many women find relief from a warm bath, or try 'tens' or approved complementary therapies, especially in early labour. medical methods include entonox (gas and air ), pethidine injections, and epidurals. it is important to keep an open mind and choose what you feel you need at the time.for further information visit 'pain relief in labor'.

caesarean section. this is an operation that involves delivering your baby through a cut in your abdomen, typically in the bikini line. usually, you can be awake for it, with an epidural or spinal anaesthetic. although a caesarean section is generally a safe and straightforward procedure, it is still a major operation and should only be carried out for good reasons. a caesarean may be elective i.e. planned in advance - for example, if your baby is breech and did not turn, or it may be done as an emergency during labour, if your baby is distressed or the labour is unduly prolonged.

more information @ cesarean birth.

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the placenta (afterbirth ). the placenta and membranes usually deliver soon after the baby is born. unless you prefer not to, you will be given an injection of oxytocin/ergometrine in the thigh after the baby is delivered. this helps the uterus to contact more quickly and has been shown to reduce the risk of heavy bleeding (post partum haemorrhage, pph ). putting the baby straight to the breast also helps, as it helps to release natural oxytocin hormone.

vitamin k. this is recommended for all babies after birth to reduce the risk of a bleeding disorder.

bcg. this is a vaccine offered to all babies who may be at risk from contact with tb (tuberculosis ).

hepatitis b. if you are hepatitis b positive, immunisation will be offered to your baby after delivery.

general information

compiled and edited patient information...

weight gain during pregnancy. if you are overweight before you become pregnant, you need to gain less than women of normal weight. your doctor will be able to tell you how much weight you should gain based on your body mass index ( bmi ) before getting pregnant or at your first prenatal visit.

if your bmi before pregnancy was: you should gain:

less than 19 more than 35 lb

19锟?4.9 25锟?5 lb

25锟?9.9 15锟?5 lb

30 or more 15 lb

never try to lose weight while pregnant. a healthy diet and a doctor-approved exercise program may help you stick to the recommended weight gain. it is important to balance food and physical activity: getting more physical activity lets you eat more without gaining weight. the food pyramid developed by the u.s. department of agriculture ' mypyramid ' can help you plan a balanced diet. it takes into account your age, sex, and your amount of daily physical activity and shows the number of servings you should have each day from each of these six food groups:

grains, vegetables, fruit, oils, milk, meat and beans.

travel. if you are planning to travel abroad, you should discuss flying, vaccinations and travel insurance with your doctor. long-haul flights can increase the risk of venous thrombosis.

car safety. to protect you and your unborn baby, always wear a seatbelt with the diagonal strap across your body between your breasts and the lap belt over your upper thighs. the straps then lie above and below your 'bump', not over it. also, make sure all baby/child seats are fitted correctly according to hong kong safety standards.

relationships. some women find pregnancy to be a time of increased stress and physical discomfort. it can greatly affect your emotional state, your body image and relationships with others. if you feel anxious or worried about anything, you can discuss your problems in confidence with your doctor.

domestic violence. 1 in 4 women experience domestic violence at some point in their lives, and many cases start during pregnancy. it can take many forms, including physical, sexual, financial control, mental or emotional abuse. where abuse already exists, it has been shown that it may worsen during pregnancy and after the birth. domestic violence can lead to serious complications which affect you and your baby. you can speak in confidence to your doctor who can offer help and support. or you may prefer to contact a support agency such as local domestic violence helpline.

exercise. regular exercise is important to keep you fit and supple. make sure your instructor knows you are pregnant. provided you are healthy and have discussed this with your doctor, exercise such as swimming or aquanatal classes are safe. however scuba diving and any vigorous exercise or contact sports should be avoided. it is recommended you do pelvic floor exercises daily during pregnancy. you should aim for eight contractions three times a day; your doctor or midwife in antenatal class will advise you on how to do these.

parent education. expectant mothers who attend classes and prepare for birth and parenthood find that it helps them to cope better. the preparation also gives you the confidence to make your own, personal choices. ask your doctor what is available in your area to suit you. there are often also special classes for teenagers, mothers with twins and non-english speaking parents.more information @ antenatal parentcraft education.

newborn screening. after birth, your baby will be offered some screening tests. the newborn hearing screen is a quick test to detect hearing loss and the blood spot test is a simple blood test to find those very few babies who may be affected by phenylketonuria, congenital hypothyroidism, mcadd (medium chain acyl-coa dehydrogenase deficiency ) and haemoglobinopathy disorders. two detailed examinations of your baby will be performed, one within 72 hours of the birth and one when your baby is 6-8 weeks old. these include examinations of the baby's eyes, heart and lungs sounds, nervous system, abdomen and hips, all findings will be discussed with you. your paediatrician will explain to you all of these tests.

feeding your baby. nature provides breast milk - the prefect milk to feed your baby, balanced to suit his/her needs. it protects against gastro-enteritis and diarrhoea, urinary tract infections, ear infections and chest infections; it may also protect against allergies and diabetes. for you, breast feeding reduces the incidence of pre-menopausal breast cancer, ovarian cancer and hip fractures in later life. almost all women can breastfeed, but it often needs practice and support to get it right. discuss your options with your partner, family and friends. it is possible to breastfeed even if you plan to return to work soon after the baby is born. your midwife / health visitor / support group will help you with this. if you did not manage to feed your previous baby, consider it again for this pregnancy. the majority of mothers succeed the second time. if you decide not to breastfeed, your midwife can advise you on bottlefeeding and sterilisation techniques to ensure safe feeding.

smoking. when you smoke tobacco, carbon monoxide, nicotine and other toxic chemicals cross the placenta directly into the baby's blood stream - so the baby smokes with you. this will reduce its oxygen and nourishment, and put it at risk of low birth weight , premature birth, and other problems. the sooner you stop smoking the better, to give your baby a healthy start in life. your doctor can arrange referral to your local smoking cessation coordinator or group. cannabis smoking should also be avoided during pregnancy.

body mass index ( bmi )