Anything Pregnancy – Dr Duncan’s Book

What Should I Put In My Birth Plan?

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A birth plan is your way of expressing your preferences and priorities for the sort of birth you would like. By writing down what you want to happen, and what you’d ideally hope to avoid, you can communicate your thoughts and wishes to me and the team who will care for you and help you deliver your baby.

Table of Contents

Why do I need a plan?

Like most pregnancy healthcare professionals, I ask expectant mums to produce a birth plan. Not because I don’t know what to do, or because I will ever do anything other than what is best for mum and baby, it’s simply because I want to actively involve the mother in the decision-making process. A plan isn’t compulsory, so you can go with the flow if you prefer - but if you have specific views about what you want, or don’t want, during labour, it really helps if the people looking after you know what these things are.

What is it all about?

When it comes to birth, there’s an awful lot to consider. This is something I work through with every mother I care for - together we will prepare and perfect your plan. I’ll go into more detail later, but here’s a handy checklist, to help you cover the most important questions.

 

Birth plan checklist:

  • Who do I want as my birth partner?
  • Where do I want to deliver my baby?
  • How do I want to deliver my baby?
  • What pain relief would I prefer?
  • Do I want my baby delivered straight onto my body or cleaned and wrapped first?
  • If my labour doesn’t progress, what intervention would I prefer?
  • Am I happy for drugs to be used to speed up my labour?
  • What would I prefer if my labour has to be induced?
  • What are my feelings about instrumental deliveries?
  • What are my feelings about Caesarean sections?
  • What do I think about episiotomies?
  • Do I want an injection to be given to speed up the delivery of the placenta in the third stage?
  • Do I want my baby to be given an injection of vitamin K after the birth to prevent bleeding problems?
  • How am I planning to feed my baby?

I’m now going to emphasise something I say to every mother I care for: it’s important to remember that a birth plan is a guide and not a guarantee. What everyone wants most is a healthy baby and a healthy mum. If something happens to threaten either you or your baby, plans will have to be changed. I think it is helpful to think of this as revising your birth plan, even if you have to do it quickly.

"I did have a loose birth plan, but it was the opposite of what happened. I was keen for a vaginal birth and not a Caesarean but was happy to have interventions if necessary for the safety of the baby."
— Andrea, London

You need to trust the person attending your delivery - and that trust is exactly what our appointments together are for. If circumstances change on the day, you need to know I'm doing the right thing for you and your baby. It’s also important to have a partner with you, whom you trust completely and who can understand what’s going on when you may be in pain and under stress. That person has to be prepared to help change the birth plan in your place, if necessary.

"We discussed our wishes for the birth with our midwife in advance. I wanted a calm natural birth with as few drugs as possible and prepared for birth using a hypnobirthing CD. In the end, I ended up being induced five days before the due date due to poor fetal growth."
— Laurie, London

Researching your birth plan

When you’re putting together your birth plan, it’s important to find out as much about your birth options as possible. By gathering information from a variety of different sources, you can start to compose a picture of the sort of birth you would like to experience.

 

Ask the experts

At your antenatal appointments with me, we'll have plenty of time to talk through your options. I know that antenatal appointments can sometimes be hectic and a little overwhelming, so if you have specific questions, it can help to write them down so your mind doesn’t go blank at the critical moment.

 

Get out and about

Wherever you're considering giving birth, visiting in person helps you get a feel for the environment and ethos. Mothers under my care deliver at The Portland Hospital, and I always suggest arranging a tour with your partner before the big day - it takes a lot of the unknown out of labour when you already know where you'll be walking in.

 

Online knowledge

There’s a huge amount of information available online, some is fantastic and some is frankly dangerous and it can be difficult to tell the safe from the suspect - you are more than welcome to bring anything you find to your appointments with me, I'm always happy to help.

 

Been there, done that

Personal experiences and recommendations can be incredibly useful, and can really help you picture and understand the whole incredible process of childbirth. Chat to friends and family members who have been through birth or have played an active role in supporting a partner as they can tell you about the pros and cons of the choices they made. Many of the women I care for have come to me after a recommendation from a friend whose baby I delivered.

 

Lessons and learning

Sign up for antenatal classes. They’re a great opportunity to meet new people, exchange tips and learn about the nitty-gritty of labour. Talk to me about any groups running in your area.

"My ‘plan’ was to have as natural a birth as possible. I like ‘plans’, I like to feel in control. After researching other people’s birthing stories and discussing the topic openly with family and friends I felt prepared. I had booked the birthing pool at the hospital and was determined that everything would go as envisaged. I was that expectant mother with her hospital bag prepared by my front door weeks before my due date.
I woke on the 14th April at my usual time of approximately 8am. I felt terrible pains and at 37 weeks I excitedly rang my sister who, along with my husband, was to be my birthing partner. Once at the hospital I was pleased that I had involved her as she proved to be a fantastic support.
I soon regretted that I had opted against the pain relief offered. By the time I realised I wanted to suppress the pain, which had become almost unbearable, it was too late. I was offered the water birth pool but I couldn’t imagine anything worse; I wanted my baby out!"
— Hayley, Blackpool

Team talk

You, your birth partner and I are a team, so chat to your partner about the type of labour and birth you would like, how they envisage their role and any worries they may have. As you’re researching, scribble down any ideas that catch your eye as well as anything that doesn’t appeal. Don’t worry about crafting the perfect plan straight away. At the beginning it’s more about collecting, sorting and collating the mountain of available information. You can edit and tidy things up later on.

Questions to consider

1. Where do I want to give birth?

You have a choice about where to have your baby. When considering this question, you should think about your health, your medical history, your pregnancy so far and the options available to you - midwife-led units, hospital, home or a private unit are all possibilities. For the mothers I care for, delivery is at The Portland Hospital, and we'll talk through whether that's the right fit for you and your pregnancy at your first appointment. Wherever you're leaning, I'd encourage you to visit the potential places so you can weigh up the good and bad bits and come to the right decision for you and your baby.

 

2. Who do I want as my birth partner?

Most women like to have someone to support them during labour and childbirth. Many choose the father of the child, but that’s not the only option. Anyone who gives you confidence can help. Friends, relatives or professionals like doulas (women whose job is to support another woman during the late stages of pregnancy, through childbirth and into the early days of motherhood) are all valid alternatives, or you may want to go it alone. It’s about choosing what makes you most relaxed and comfortable.

 

3. Is there any special equipment I would like to try?

Birthing balls, beanbags, floor mats, birthing pools, TENS machines, soft music and aromatherapy oils can be used to help make the birthing process more personal and more bearable. Think about what you would like to try, and check whether it’s available in the place you’re planning to give birth. If not, make sure you buy or hire the equipment early so it’s ready and waiting on the big day.

 

4. Do I have any particular preferences for the birth?

Some hospital or birthing units have special facilities available. These can include birthing pools, dedicated labour/ delivery/recovery/postnatal rooms where you can stay in the same room throughout your stay and postnatal amenity side rooms that you can book for an overnight stay. We can talk through options available at The Portland Hospital during our appointments together.

 

5. How would I prefer to be monitored?

Every baby is monitored throughout labour to make sure they are healthy and well. There are different ways of checking the baby’s heartbeat to make sure there are no signs of distress. If everything is progressing well, the heart-beat may be checked every quarter of an hour or so with a Doppler device, or continually by a belt strapped around your waist. You can express a preference between these two options. However, problems, an epidural, a drip to strengthen contractions or any sign that your baby may be struggling can mean that continuous monitoring of your baby’s heart using a clip attached to their scalp is necessary. In childbirth, safety should be the first consideration.

 

6. Would I like to move during labour?

Actively moving and participating in the process of labour can help labour progress, increase your feeling of control and boost confidence. However, it may make you a little tired, and sometimes moving around is not possible with standard epidurals.

 

7. Positions for labour and birth

The positions you adopt in labour can make a big difference to how it progresses. So experiment with positions like kneeling on all fours or leaning over a beanbag and think about what might work for you. Standing, sitting, squatting, lying, kneeling, doggy position or standing up, you can choose as many positions as you want and change whenever you feel the need.

 

8. What pain relief would I prefer?

In my experience, many women seem to adopt the ‘suck it and see model’ for pain relief and come into the delivery room with an open mind. You may prefer to try some of the less invasive methods of pain relief, like TENS, relaxation exercises and gas and air in the early stages, and then progress onto something stronger, such as an epidural, as and when you need it. Some women feel strongly about avoiding injectable medications, like pethidine, because they want to avoid that out of control and woozy feeling, while others love it. The choice is yours. List any you would consider and make a note of any strong preferences.

 

9. If my labour doesn’t progress, what intervention would I prefer?

Sometimes labour doesn’t progress as planned and needs a helping hand. This is called augmentation of labour. Your body has its own contraction hormone called oxytocin. If your contractions start to fade, or if they need a boost, you can be given an artificial version of oxytocin called Syntocinon, or your waters could be broken to speed things along. Consider whether you would be happy to have this, or whether you would ideally prefer to wait and see what happens.

 

10. What are my feelings about instrumental delivery?

Very few women plan to have an assisted delivery, but sometimes things go wrong and babies need a little extra help into the world. You can say whether you have particular feelings about ventouse over forceps delivery and whether you would like a planned episiotomy to prevent tearing. You can also express whether you would like your partner to remain in the room if you need an assisted delivery. If you express a preference, I will try to follow your wishes if possible. However, it is important to try to be adaptable to ensure the safe delivery of your baby. If you are worried, chat through your concerns with me.

 

11. How do I feel about Caesarean sections?

A Caesarean section is an operation where an I make a small cut in your abdomen and womb and deliver your baby through it. It can be performed as a planned operation or in an emergency. If it is carried out under epidural or spinal anaesthetic, you will be awake for the operation and your partner can stay with you.

 

12. How do I feel about an episiotomy?

An episiotomy is a small cut made in the perineum during birth. It is done to avoid more extensive tearing, especially involving the structures surrounding the back passage. It may also be performed to help make the delivery of your baby a little easier, especially if you have an assisted delivery or a breech birth.

 

13. Do I have any preferences about clamping and cutting the cord?

If you’d like your partner to cut the cord or you’d prefer to delay the clamping of the cord, detail it in your plan. If everything goes well, I'll make sure this happens wherever possible.

 

14. Do I want an injection to be given to speed up the delivery of the placenta in the third stage?

Most hospitals and birth centres recommend an actively managed third stage of labour using an injection of a synthetic version of oxytocin. Research shows that this decreases the risk of losing lots of blood after the birth. However, you can choose to have a natural third stage, if you would prefer less intervention.

 

15. Do I want my baby delivered straight onto my body, or cleaned and wrapped first?

In the past, babies were often washed, wiped and returned to the mum as a neat little bundle wrapped in a blanket. You may prefer this, as newborn babies can be a little mucky. However, you may prefer immediate skin-to-skin contact to help with bonding and establishing breastfeeding.

 

16. Do I want my baby to be given an injection of vitamin K after the birth to prevent bleeding problems?

Babies have low levels of vitamin K at birth. For a small number of babies this can put them in danger of life-threatening haemorrhage. Because of this risk, it is recommended that all babies receive vitamin K after birth to protect them. The most effective way of giving this is by a single injection into the muscle of your baby’s leg immediately after birth. An alternative is oral vitamin K, three doses are needed if your baby is breastfed. Two are given in the first week followed by a top-up when they are one-month old. Bottle-fed babies only need two doses of vitamin K during their first week of life. The problem with this is that often doses can be missed in the chaos of the early weeks, which could put your baby at risk. You don’t have to consent to the vitamin K injection - talk to me about your choice.

 

17. How am I planning to feed my baby?

Whether you’re going to breast or formula feed, it’s important to let me and the midwifery team know your plans so they can help you get things started after the birth.

 

18. Do I have any special requirements for the birth?

Everyone has different needs and demands during birth. Whether English is not your first language, you have special educational needs, you follow a specific diet or you have religious customs you’d like observed, this is the place to detail your individual needs. It will help me help you to achieve a happy and healthy birth experience.

"I had a great birth plan! Lots of careful thought and preparation in the months leading up to the birth. I had candles, oils, yoga balls and numerous different music playlists at the ready. I had my first contraction as I walked through the door of the hospital and was howling within seconds. The midwife asked, ‘Have you thought about pain relief?’ I growled, ‘Give me an epidural!’ And do you know what? It was the best thing. As soon as it was administered I completely relaxed and actually began to enjoy the whole experience. No doubt it was still intense but I was completely coherent and with it when my little man was born. I could still feel the contractions, move my legs and had the urge to push, nor did it slow the labour down! Listen to your body!"
— Sarah, Larne

A plan is easier with someone beside you

If there's one thing to take from this chapter, it's that you don't have to figure any of this out alone. Working through your birth plan is one of the first things we do together when you join my care so if you're expecting, or planning to be, get in touch with my secretary, Colette, to arrange an appointment. I'd love to help you prepare for the day you meet your baby.

Frequently Asked Questions

No. A birth plan isn't compulsory, and you can simply go with the flow if you prefer. But if you have specific views about what you want, or don't want, during labour, writing them down really helps the people looking after you know what those things are. I ask every expectant mum I care for to produce one, not because I don't know what to do, but because I want to actively involve you in the decision-making process.

A birth plan is a guide, not a guarantee. What everyone wants most is a healthy baby and a healthy mum, and if something happens to threaten either, plans will have to change. I find it helpful to think of this as revising your birth plan rather than abandoning it - even if it has to be done quickly. That's also why it's important to trust the team attending your delivery, and to have a birth partner who understands your wishes and can help revise the plan on your behalf if you're in pain or under stress.

The key questions cover where you want to give birth, who you want as your birth partner, your preferred pain relief, your feelings about interventions such as induction, instrumental delivery, Caesarean section and episiotomy, preferences around cord clamping, delivery of the placenta, the vitamin K injection, immediate skin-to-skin contact, how you plan to feed your baby, and any special requirements - whether dietary, religious, language-related or otherwise.

Most women like to have someone supporting them during labour, and many choose the father of the child - but that's not the only option. Anyone who gives you confidence can help: friends, relatives, or a professional such as a doula. You may also prefer to go it alone. It's about choosing whatever makes you most relaxed and comfortable.

Gather information from a variety of sources: ask at your antenatal appointments (writing questions down beforehand helps), visit the hospital where you're considering giving birth, talk to friends and family who've been through it, and sign up for antenatal classes. There's plenty of information online too - some fantastic, some frankly dangerous - so bring anything you find to your next appointment and we can separate the safe from the suspect together.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

What Can I Do To Prevent Stretch Marks?

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The changing body shape, rapidly expanding bump and the hormones raging around conspire to ensure that loads of women get stretch marks during pregnancy. They seem to appear overnight; you may feel a little itchy, your skin can look thin and the next minute you’re covered in red stripes.

When your skin is stretched harder and faster than it can deal with, your tissues can tear, leaving a little linear wound and the purple or red streak of a stretch mark. They classically appear across the lower abdomen but can also affect your breasts, thighs and back.

They look red, angry and frankly alarming at the beginning, but with time they will fade to fine silvery lines that are barely noticeable.

 

Why me?

Stretch marks or striae gravidarum to use their scientific name, are common. In fact, by the end of pregnancy most women are affected. You’re more likely to get them if they run in your family, so ask your mum if she was affected. They’re also more common in darker skins, in people who gain lots of weight during pregnancy or if you’re having a multiple birth.

The trouble is, once you’ve got them, there’s little that can be done to blitz them. Although they shrink and fade with time, they don’t disappear. Laser treatment or resurfacing treatments are used to help fade the colour and improve the appearance, but the elastin in the skin remains damaged and the wound is still there. Prevention is better than cure, but what can you do?

 

Nourish your skin

Avoid excess rapid weight gain by maintaining a healthy balanced diet and make sure you get plenty of zinc, vitamin C and vitamin E to keep your skin healthy.

Keep your skin supple:

"I got terrible stretch marks in puberty. They’re all over my boobs, my thighs, my bum and even my calves. I’ve kind of learned to live with them, but I was paranoid about getting them in pregnancy too—it seemed like my tummy and my face were the only places without the damned things!
I was OBSESSIVE. Seriously, I rubbed oils in religiously twice a day. Some were expensive but actually, with a body oil a little goes a long way so it didn’t break the bank. Anyway, I didn’t get any new ones at all. I don’t know if it was the oils, but I do know that my skin is prone to them and that something made a difference."
—Elizabeth, Wetherby

Some early studies suggested that ANY cream regularly massaged into the abdomen, thighs and breasts could help to prevent stretch marks appearing. The extra moisture and the process of massage may help the skin to stretch and adapt to your changing shape. More recent research shows that anointing your bump in cocoa butter or olive oil doesn’t seem to make a blind bit of difference when it comes to stretch marks. However, regular moisturising will help make your skin soft, supple and smooth - so it’s worth a try. There’s no need to invest in pricey products; choose something that you like the smell and texture of and that doesn’t irritate your skin. Try to make moisturising your bump and breasts part of your morning and evening routine.

Follow the evidence: I’ve been through the research on stretchmark treatments and I’m not going to lie, it’s a little disappointing. However, the British Journal of Dermatology reported that there was some suggestion that certain lotions and potions may help prevent them appearing, so look out for these ingredients:

Centella (gotu kola or Indian pennywort) and vitamin E: Creams containing this herbal remedy together with vitamin E, appeared to protect women who developed stretch marks in puberty from getting more during pregnancy. Gotu kola is an active herb and should not be taken orally during pregnancy. Its safety topically is less clear, so it’s sensible to chat to me about it at your next appointment before you start using it.

One mum, who was also a complementary therapist told me that she found vitamin E cream helped her stretch marks fade quicker, so it may offer some benefit.

Bitter almond oil: Massage with this oil may prevent stretch marks appearing or reduce their severity.

Hyaluronic acid: The evidence for this working is a little weak, but hey, that’s better than nothing.

 

After they’ve appeared

At the moment, there’s no proven way of totally getting rid of stretch marks, and lots of mums find they can really affect their body image and sense of self-worth after the birth. While you’re waiting for them to fade, if your skin is pale, a good fake tan can even out your skin colour, camouflage the stripes and boost your confidence. Pulsed dye laser therapy can be used in private clinics to fade discolouration and make the marks less conspicuous. I was also interested to read about a new treatment developed by a team from the University of Manchester harnessing the calming properties of green tea. You don’t drink it or bathe in it. Instead, it’s formulated into a lotion, which has recently been launched. It is designed to tackle the marks as they appear and research is still in the early days, so watch this space.

 

Your body is doing something remarkable

Stretch marks are one small part of a much bigger story - and if any of it is worrying you, from how your skin is changing to how you're feeling about your changing shape, you don't have to keep it to yourself. If you'd like to talk it through, get in touch with my secretary, Colette, to arrange an appointment, you don't have to be on a package with me for a one-off appointment, and no question is too small.

Frequently Asked Questions

There's no guaranteed way, I'm afraid - the research on prevention is honestly a little disappointing. Recent studies show that rubbing cocoa butter or olive oil into your bump doesn't make a measurable difference. That said, avoiding rapid excess weight gain through a healthy balanced diet helps, as does getting plenty of zinc, vitamin C and vitamin E to keep your skin healthy. And while regular moisturising isn't proven to prevent stretch marks, it will keep your skin soft and supple - so it's worth making it part of your morning and evening routine. There's no need for pricey products; choose something you like the smell and texture of that doesn't irritate your skin.

Mostly, it comes down to factors outside your control. Stretch marks - striae gravidarum, to use their scientific name - affect most women by the end of pregnancy. You're more likely to get them if they run in your family (ask your mum if she was affected), if you have darker skin, if you've gained a lot of weight during pregnancy, or if you're expecting twins or more. They happen when your skin is stretched harder and faster than it can cope with, so the tissue tears slightly, leaving that red or purple streak.

They won't disappear completely, but they will fade - those red, angry-looking stripes shrink over time into fine silvery lines that are barely noticeable. There's currently no proven way to remove them entirely, because the elastin in the skin remains damaged. If they're affecting your confidence in the meantime, a good fake tan can camouflage the marks on paler skin, and pulsed dye laser therapy at private clinics can fade the discolouration. There's also a newly launched green tea-based lotion, developed by researchers at the University of Manchester, designed to tackle marks as they appear - the research is early, but it's one to watch.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

Is My Diet Good Enough For My Baby?

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Lots of evidence suggests that often our diets alone may not provide everything needed to give a child the healthiest start in life.

From the first moment of fertilisation your body is nurturing and protecting your baby. A balanced diet is important to provide the vitamins and minerals needed to support this extraordinary process of growth and development. In an ideal world you’d be able to get the nutrients you need from the food you eat. But in early pregnancy, a woman’s life is far from ideal. Morning sickness, tiredness and the conflicting demands of work and family life can conspire to make it difficult for mums to eat as well as they should.

A number of women I see come into pregnancy having spent periods of time dieting, taking the pill or suffering heavy periods. This means that many expectant mums are already lacking vital vitamins and minerals, even before facing the challenges of pregnancy.

For tailored pregnancy nutrition guidance and comprehensive obstetric care with nutritional input, speak to Dr Duncan about a personalised care plan.

Table of Contents

What nutrition do I need to build a healthy baby?

It’s important to choose nutrient-dense food, but it’s also important to take regular supplements. Because, when it comes to nutrition, you really are eating for two. The body’s need for micronutrients in pregnancy increases threefold, but the calorie requirement only goes up by a paltry 200 extra a day.

What is Folic Acid?

Folic acid is a vitamin that plays an essential role in the healthy development of your baby’s brain and spinal cord. Taking a daily supplement around the time of conception will help protect your baby against spina bifida and other neural tube defects. It should be continued for the vital first twelve weeks of pregnancy when the baby’s spine is developing. However, it’s safe to keep going for the whole nine months.

Can I get Folic Acid from Food?

Even a good diet does not give a pregnant woman enough folic acid. It’s found in lots of foods, including green leafy vegetables, wheat germ, yeast and eggs, but it rapidly loses its strength during storage and cooking. So, although it is sensible to choose folic-acid rich foods, the Department of Health recommends a 400-mcg folic acid tablet daily from the time you stop contraception until you’re three months pregnant.

Could I be at an increased risk of neural tube defect?

Some women may be at an increased risk of having a baby with a neural tube defect. This could be you if:

  • You or your partner have a neural tube defect
  • You’ve had a previous pregnancy with a neural tube defect
  • You or your partner have a family history of neural tube defects
  • You have diabetes
  • You are taking regular anti-epileptic medication

Can folic acid help protect against neural defect?

A higher dose of folic acid can really make a difference and help protect your developing baby. See your doctor as soon as you start trying to conceive for advice and a prescription for 5mg of folic acid each day until you’re 12 weeks pregnant. They may also recommend extra screening tests to pick up any problems or put your mind at rest during your pregnancy.

What other nutrients are important?

It’s not just folic acid that is important for healthy growth and development. Here are other nutrients you should include in your diet or supplement:

Vitamin D

Vitamin D is essential for your baby to use calcium and build healthy bones. Many people are deficient in vitamin D, so it’s recommended that women in the UK take a daily dose of 10 micrograms when they are pregnant or breastfeeding.

Our bodies can make vitamin D in sunlight but dark skin, an indoor lifestyle, gloomy weather and careful sun protection can leave our levels dangerously low. Taking supplements can make you happier and healthier, can support your baby’s growth during their first year of life and reduce their risk of developing rickets.

Even with a supplement it’s a good idea to boost the vitamin D in your diet. For those who eat dairy produce, cheese, yoghurt and milk and eggs can boost vitamin D. For vegans, vitamin D is found in fortified foods such as breakfast cereals and fortified fat spreads.

Iron

A supplement can help, but it’s sensible to eat an iron-rich diet throughout pregnancy, which may prevent problems arising. Lots of women become anaemic in pregnancy because there’s more blood circulating and the work of supporting your growing baby puts extra demands on your body.

You can be more at risk if you’re a vegetarian or vegan because you miss out on iron-rich foods like beef, lamb and the dark meat in poultry.

Anaemia can cause tiredness, listlessness and sometimes fainting. It can also lead to shortness of breath and a pale complexion. Beat anaemia by choosing:

  • Green leafy vegetables and watercress
  • Dried fruits such as apricots
  • Vitamin C, from citrus fruits or juices to help your body absorb more iron from your diet

Vitamin B12

Cyanocobalamin or vitamin B12 is critical in the manufacture of red blood cells. It also helps with the processing of folic acid and works to keep the nervous system healthy and release energy from food. You can find it in dairy produce like milk, yoghurt and cheese as well as in eggs.

Good sources for vegetarians and vegans include:

  • Fortified breakfast cereals
    • Fortified unsweetened soya ‘milks’
    • Yeast extracts such as Marmite or Vegemite

Calcium

Calcium helps your baby’s teeth and bones grow strong. You’ll find it in dairy produce like cheese and milk as well as in fish like sardines. If you’re a vegan, you’ll miss out on calcium from dairy produce. Boost your calcium by choosing:

  • Dark green leafy vegetables
  • Pulses and beans
  • Fortified non-dairy ‘milks’, such as soya, rice, oat or almond milks
  • Fortified bread and bread products
  • Calcium-set tofu
  • Sesame seeds
  • Dried fruit like raisins, apricots and prunes

Other important micronutrients

  • Zinc - Important to maintain growth in your developing baby.
  • Copper - Helps form the heart and blood vessels as well as the skeleton and nervous system.
  • Magnesium - Works to build strong bones and teeth, regulates sugar levels and repairs body tissues.
  • Vitamin E - Works hard to maintain healthy skin and blood vessels.
  • Vitamin C - Helps your body absorb iron and also maintains a healthy immune system
  • Other B-group Vitamins - Essential for the formation of healthy red blood cells, to release energy from food, and to maintain a healthy nervous system.

What is the ‘Belt and braces’ approach to nutrition?

Every woman should take a daily supplement to provide folic acid and vitamin D. However, if you’re struggling to get the nutrition you need, a multivitamin designed for pregnant women can provide these as well as the other important vitamins and minerals that will keep you well and help you build a healthy baby.

Remember that micronutrients are active substances and you can definitely have too much of a good thing. In particular, higher doses of vitamin A can harm a developing baby. Choose products designed for pregnant women, never double dose, and speak to your doctor or midwife if you have any questions or concerns.

I felt terrible in early pregnancy, I ate absolute rubbish because that was all I could keep down. I literally survived on plain bagels, white toast and ready salted crisps. I’d read all this stuff about nutrition and I wanted to scream. I felt terrible, but the idea of oily fish, salads and vegetables turned my stomach. I took a multivitamin every day, it made me feel a little less guilty and you know what? My baby was gorgeous and healthy.
~ Philippa, Gloucester

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

What Should I Pack In My Hospital Bag?

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There’s a lot to think about when packing your hospital bag, but armed with Dr Duncan’s hospital bag checklist you should have all you need for the birth and for your new baby. It’s very exciting to pack your bag for The Big Day, because after all this time of being pregnant, the birth is now in sight!

When should I pack my hospital bag?

My advice is to be prepared before you reach 36 weeks, in case your little one decides to make an early appearance! Here’s your hospital bag checklist for you, your baby and your partner:

What do I need for labour?

  • Your maternity notes (including your birth plan)
  • Something to wear for labour (hospital gowns are provided at The Portland if you prefer)
  • Massage oils/lotions (if desired)
  • Lip balm or Vaseline for dry lips
  • TENS machine (if desired)
  • Hairband or bobbles to keep your hair out of your face
  • Swim wear if desired for possible water birth
  • Essential oil (if you would like to use the diffuser)
  • Your favourite music playlist to relax to on the labour ward (there are bluetooth speakers available in each room)
  • Dressing gown
  • Socks and slippers
  • Books, magazines or downloaded films to keep you occupied during quiet moments
  • Your favourite snacks, and any specialty soft drinks or water which The Portland may not have on their menu
  • Towel and flannel or sponge, to stay fresh (a facial water mist can be cooling and refreshing, too)

What do I need for my baby?

  • Six vests
  • Six sleepsuits
  • Nappies
  • Wipes
  • Nappy cream
  • Hats, socks, booties and scratch mittens
  • Cotton wool
  • Baby blanket for swaddling
  • Towels
  • Car seat
  • Seasonally appropriate going home outfit for their first outing

Formula milk is available upon request/medical need at The Portland

What will I need after the birth?

  • Wash bag with toiletries (hair dryers are available at The Portland)
  • Disposable underwear and maternity pads, not glamorous but oh so useful
  • Clothes for a potential 3-4 night stay
  • Two nursing bras and breast pads
  • Nipple cream
  • Feeding pillow
  • Button fronted nightwear for easy breastfeeding access
  • Mobile phone, charger and spare battery pack
  • Hairbrush and makeup
  • Change and cash for food or vending machines
  • Comfortable clothes and shoes for travelling home (don’t be too ambitious; you won’t be squeezing into your old jeans yet)

Additional towels, disposable underwear and sanitary towels are provided at The Portland.

What does my partner need?

  • A copy of your birth plan
  • Contact list for passing on the good news
  • Toiletries
  • Phone, charger and backup battery pack
  • Camera, if they don’t use their phone
  • Clothes/nightwear for intended length of stay
  • Books, magazine or downloaded films
  • Snacks/food and drinks (complimentary breakfast is provided at The Portland but all other meals are chargeable)

Mums’ tips

I forgot a towel when I had my first and it was difficult to get one, so definitely put one in the bag. Talc is also good because hospitals are so warm—it was good to stop you sweating.

~ Lindsay, Kilkeel

My big recommendation is packing paper knickers. The blood floods through everything and who wants to spend time washing grubby underwear? The disposable ones were big and comfy and less hassle all round.

~ Philippa, Gloucester

I think you should pack something warm. I got shivery after the birth and would have loved to have had a fleecy blanket or shawl or something. Instead, I had to use a hospital towel and scratchy blanket. Next time I’m going to definitely pack something soft and snuggly for me, not just the baby.

~ Fi, Leeds

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

Is It Safe To Fly During Pregnancy?

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Pregnancy can be a great time to enjoy a last romantic break as a couple before baby arrives. Whether it’s a holiday booked before receiving your happy news, or squeezing in a ‘babymoon’. However, lots of women are worried about flying during pregnancy.

What are the recommended guidelines for flying when pregnant?

As long as your pregnancy is progressing without complications, flying shouldn’t harm you or your baby. Evidence suggests that in a healthy pregnancy, any changes in air pressure or humidity shouldn’t cause any problems or trigger miscarriage, pre-term labour or the early rupture of your waters.

Is radiation an issue? It is true that each and every person who flies is exposed to a very slight increase in radiation. But this is not thought to be a risk if you only fly occasionally.

For reassurance before you fly, private obstetric care with Dr Duncan includes a thorough review of your medical history and personalised travel advice. See our package fees for more details.

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When should I fly?

Up to week 36 (week 32 for twins) is now believed to be the safest time to fly. Because after this stage, you could theoretically go into labour at any moment, which could be a little challenging thousands of feet in the air! And if you’re pregnant with twins, the increased risks of early labour mean that you can only fly before 32 weeks. But don’t just take my medical advice. Please check the individual rules of your airline and your travel insurer before booking flights.

Some women avoid travelling in the first trimester because they feel sick and tired. However, many people who are already committed to holidays when they find out they’re pregnant continue with no problems. It’s about choosing what’s best for you and not over-doing things.

Remember, the final months of pregnancy are exhausting and uncomfortable, even without adding travel into the mix. So, sometime in mid-pregnancy, between thirteen weeks and six months, may be the sweet spot for a trip away.

Will I experience any problems or panics when flying?

You may find travelling a little more uncomfortable than usual. The side-effects of pregnancy combined with the side-effects of flying mean that you may notice:

  • Swelling of your feet and ankles due to fluid retention
  • A stuffy nose and difficulty ‘popping’ your ears and equilibrating the pressure
  • Sickness (motion during the flight can make pregnancy nausea worse)
  • Pregnancy increases the risk of developing a DVT (deep vein thrombosis). That risk increases when you fly, especially if it’s long haul. A DVT is a blood clot that develops in the deep veins of your leg or pelvis. There is a danger of bits breaking off and travelling to your lungs (a condition known as a pulmonary embolism), which could put your life in danger.

How can I help myself fly safely and comfortably?

Thankfuly, there is a lot you can do to stay safe and comfortable as you take to the skies:

  • Wear loose clothing and comfortable shoes.
  • Wear your seatbelt below your bump, and ask for an extension strap if it feels too tight.
  • Sip plenty of water and pack healthy snacks to stave off hunger and nausea.
  • Get up and walk around as much as you can and do stretches and ankle rotations in your seat.
  • Reserve your seat in advance to guarantee extra legroom or an aisle seat.
  • Longer flights of more than four hours can increase your risk of developing clots in the deep veins of your legs and pelvis (DVT). Protect yourself by drinking plenty of water, moving regularly and wearing compression stockings to prevent swelling and keep your blood moving.

When should I not fly during pregnancy?

Certain medical conditions or complications could mean that flying could put you or baby at risk. You will be advised not to fly if you:

  • Are at risk of early labour
  • Have severe anaemia
  • Have had recent episodes of significant vaginal bleeding
  • Suffer from serious medical problems such as heart and lung disease, or have sickle cell anaemia and have recently had a crisis

How do I travel safely whilst pregnant?

Wherever you decide to go, find out what the medical care options are and ensure that you have good insurance. Read the small print to ensure that medical care during labour, premature birth and changing flights because of problems are properly covered.

If you’re travelling within Europe, it’s also a good idea to take a UK Global Health Insurance Card (GHIC). Giving you the right to discounted rates in twenty- eight countries.

Take your handheld maternity notes, too. So, if you need medical help the doctors have the relevant information. But keep them in your hand luggage. As you don’t want them getting lost if your hold luggage goes astray.

Should I choose my destination carefully when pregnant?

If you live in the UK, British or European breaks are preferable during pregnancy. The travel times are shorter, so no uncomfortable lengthy flights. Try to stay close to good healthcare. Isolated lodges in the middle of nowhere with no good transport links may be romantic, but how will you get medical attention if you need it?

It’s better to stay away from areas where you need vaccinations or disease prevention. Places where there is a risk of mosquito-borne diseases, like malaria, dengue fever or zika should be avoided, if possible. If there’s no option, see your doctor or a travel health expert before you leave. They can advise on protection, precautions and which vaccinations are safe during pregnancy.

Is it safe to have vaccinations when pregnant?

A number of vaccines are not safe in pregnancy. Particularly those that contain live bacteria or viruses. For specific advice, you should see your GP, midwife or a travel health expert.

How can I protect against Infection when pregnant?

Take extra care if you do travel to exotic or far-flung destinations. There are many mosquito-carried infections that can affect your health and your developing baby. Including the zika virus, malaria, dengue fever and chi-kungunya

Protect yourself against bites by covering up, avoiding watery areas at dusk and using mosquito nets and wire-screens. Mosquitoes are repelled by some strong natural scents like citronella, peppermint and eucalyptus, so burn a candle or warm a little in a bowl.

The government says that insect repellents containing up to 50% DEET are effective and safe for pregnant women.

Any foods to avoid? Sampling local food can be a holiday highlight, but try to avoid foods that could cause stomach upsets and travellers’ diarrhoea. Anyone pregnant should avoid seafood. You should also take care to drink bottled water, avoid ice and be cautious with salads and raw veggies which may have been washed in tap water.

What should I take with me when travelling pregnant?

It’s important to be prepared for any eventuality when travelling whilst pregnant. Don’t forget to pack:

  • Your hand-held pregnancy notes
  • Any medication you need
  • Insurance documents and an UK GHIC card for Europe
  • A letter from your doctor or midwife confirming that you are healthy and well, and the details of your due date if you’re over 28 weeks

But most of all, remember to have plenty of rest and relaxation, as well as plenty of fun!

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

How do I know my baby will be ok?

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Throughout pregnancy, you will be offered a number of routine tests and checks to keep a close eye on your health and the development and wellbeing of the little life growing inside you. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your doctor should talk through the reasons for any tests, so you can assess the pros and cons and make an informed and intelligent choice.

At each antenatal appointment, you'll have a blood pressure measurement to check for pre-eclampsia, and a urine test to look for blood, protein and glucose. These can be an indication of infection, pre-eclampsia and gestational diabetes. You'll also be offered a number of blood tests to monitor your wellbeing throughout your pregnancy.

Dr Duncan offers a full range of specialist anomaly and growth scans to monitor your baby’s development. Book regular antenatal consultations for comprehensive care throughout your pregnancy.

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Monitoring your baby's health

Checking your baby's growth

As your baby grows, your bump will expand too. Your doctor or midwife can keep a close eye on their healthy development by measuring the size of your bump. By 20 weeks the womb will have reached your tummy button. That's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems so your baby can have further investigations.

Doppler Scans

Whenever we spot growth problems, it's important to keep a close eye on the baby, especially towards the end of pregnancy. A scan may be arranged to repeat the measurements. If there are concerns, a Doppler scan may also be offered. That's a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart.

A scan can give us a much better idea of how well the placenta is functioning. The placenta is the baby's life-support machine. If blood flow is decreased, the baby won't be getting the nutrition they need. That can significantly affect their growth, so we have to consider whether they are still safe within the womb and balance that against the risks of a premature birth. Sometimes the baby may be better off if they are delivered early.

Abdominal examination

The experienced hands of your pregnancy doctor or midwife can provide an enormous amount of information about the baby growing in your womb. They can identify movements, check position and see whether their head has started to move down into the pelvis ready for birth. They will also listen to the magical thump of your baby's heartbeat using a stethoscope or hand-held Doppler device.

In addition to these routine checks and measures you will also be offered a number of other screening tests and scans, or if you are thought to be at risk due to your age, your family or your medical history, diagnostic tests to identify certain genetic or chromosomal conditions may be suggested.

Ultrasound Scans

Your pregnancy ultrasound scans

The monochrome ultrasound images of your baby's dating scan usually offer the first picture of your beautiful baby. I say beautiful, but try to remember that ultrasound uses sound waves to develop an image of your baby. The waves bounce back from solid objects like bone and pass through liquids, so the scan sees all the way through your baby's skin to show the internal organs and structures. Believe me, all babies look a little like extras from Lord of the Rings!

Scans provide fantastic information; I can check the chambers of the heart, look for cleft lip and palate and examine the fold of fluid behind the neck. But it's not useful if you'd like to see a picture of your baby looking like... well, a baby.

"Sometimes silence is scary during a scan, but it is mostly concentration on their part. One doctor thought my baby was measuring quite small and made me have more appointments than usual, but I asked plenty of questions to get reassurance that all was OK. That would be my piece of advice — if you feel unsettled, or have a question, ask it. Don't feel silly or whatever — your baby is the most important thing and it's important you understand what is happening to it and to you!"
—Lindsey, Kilkeel

In the UK, pregnant women are offered at least two ultrasound scans during their pregnancy:

1. The dating scan - This ultrasound is carried out between 8 and 14 weeks. Your doctor or sonographer will check your pregnancy is progressing well, take a look to see if more than one baby is nestling in your womb and carefully measure the baby so the estimated date of delivery can be calculated. At this stage, a fold of fluid at the back of the neck called the nuchal fold may also be measured as part of the combined screening test for Down's syndrome.

2. The anomaly scan - This is a more detailed scan offered to every pregnant woman between 18 and 21 weeks. The sonographer will check that your baby has continued to grow at a healthy rate and will also check for any structural abnormalities. They will examine the chambers of the heart, the organs, the spine and the limbs and they'll also look at the face to check for cleft lip and palate. The scan will also show the position your baby is lying in and the location of the placenta.

"At my second scan at twenty weeks they picked up potential placenta praevia. It was frightening because I didn't know what this was, and the sonographer didn't give me much information. I was booked in for an extra scan for this at thirty-two weeks and then thirty-six weeks, when the placenta finally moved enough to have a natural birth."
—Sam, Northfield

Boy or girl?

To know, or not to know, that is the question. Your doctor or scanner will check your baby's genitals but actually discovering the sex of your baby isn't part of the screening programme. However, different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan.

But, be warned, even if they're happy to look it's not always possible to tell. Your baby may be demurely crossing their legs; they may be in an awkward position or it may be tricky to tell. Take my advice and don't splash out too much on pink or blue baby-grows unless they're really confident.

Can I have someone with me?

Having a scan can be an exciting but also a frightening time. You may be able to see your little one waving at you or sucking their thumb. Sadly, some people discover that there are problems with the baby, so it's a good idea to have a friend, partner or family member with you when you attend to provide support. There's not usually any childcare available, so it's important to arrange for someone to babysit any other children.

When will I get the results?

The results are immediate and the sonographer is usually able to tell you everything on the day. However, if they are struggling to see some details clearly or are concerned there may be a problem, they may ask for a second opinion. Sometimes you will be offered further tests, scans or a referral to a specialist fetal medicine consultant, like myself, to find out more.

Say cheese!

At most hospitals, you can get a printed picture of your scan, although there is often a small charge. Check with your unit for their policy and you'll have the first picture for your new family album.

Can I say no?

Ultrasound scans are considered safe for both mum and baby and can provide useful information. However, you don't have to have a scan, and if you refuse your choice will be respected.

If you are uncertain about scans because you know you will proceed with the pregnancy, no matter what anomalies and problems are shown, it is worth chatting through your concerns with your midwife or doctor. Scans are about much more than looking for abnormalities. They can also provide accurate information about the position of the placenta, whether you're having twins and your baby's growth. Put simply, they will help increase the chance of you delivering your baby safely.

Testing for chromosomal abnormalities

Chromosomes are long, thread-like structures made up of DNA and proteins. They store the genetic information that controls everything from the colour of our eyes, to our sex and our tendency to develop disease. Sometimes there can be problems with the chromosomes, leading to babies being born with syndromes that can affect their appearance, health and intelligence.

Screening can provide you with early information about your specific risk of having a baby with damaged or extra chromosomes. Knowledge gleaned from scans and blood-tests can be used to determine your risk of carrying a baby with the more common of these conditions, these include:

  • Down's syndrome, where there is an extra copy of chromosome 21, known as trisomy 21
  • Edward's syndrome, where there is an extra copy of chromosome 18, or trisomy 21
  • Patau's syndrome, which is trisomy 13

Screening

In the UK, screening tests are offered at around 12 weeks. However, if you book a little later, there are alternative options.

The combined test

The combined test is done when you are between 11 and 14 weeks pregnant. You will have a blood test to check for specific proteins in your blood, and an ultrasound scan, in which a specific fold of fluid that's found behind your baby's neck is measured. The blood test results, together with the information from the nuchal translucency scan are combined with your risk factors and your age to calculate your statistical risk of having a baby with a chromosomal condition.

The quadruple test

The quadruple test can be performed later than the combined test, so it can be used if you have booked late. It is ideally done between 16 and 19 weeks, although it can sometimes be carried out as late as 22 weeks if necessary. The clue is in the name; it's a blood test that tests for four different proteins. The results are fed into a computer programme, together with your age and other risk-factors, to work out the likelihood of your baby being affected by a chromosomal abnormality.

Non-invasive prenatal testing

NIPT is a new, simple blood test that can detect fetal cells in the maternal circulation. These cells can be tested to find out the baby's sex and to check for chromosomal abnormalities like Down's syndrome. Although it is a screening test, it can accurately identify Down's in 99.9% of cases.

A matter of choice

Remember, you don't have to have these tests. And if you do get a positive result, it doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.

Frequently Asked Questions

No. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however, incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your choice will always be respected.

Your doctor or midwife will measure the size of your bump. By 20 weeks the womb will have reached your tummy button - that's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems.

A Doppler scan is a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart. It may be offered if there are concerns about your baby's growth, as it gives a much better idea of how well the placenta is functioning.

Discovering the sex of your baby isn't part of the screening programme, and different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan - but be warned, it's not always possible to tell if your baby is in an awkward position.

The combined test is done between 11 and 14 weeks and uses both a blood test and a nuchal translucency scan. The quadruple test can be performed later - ideally between 16 and 19 weeks - and is a blood test that checks for four different proteins. It is useful if you have booked your antenatal care a little later.

A positive result doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

What is my risk of miscarriage?

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Most of the women I care for worry about miscarriage, particularly in the early months of pregnancy. Sadly, miscarriage is common in the first twelve weeks. Whenever it happens, it can be a distressing experience. However, it's important to remember that you are still much more likely to have a healthy, uncomplicated pregnancy. With personalised obstetric care, you'll have expert support and reassurance at every stage.

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Miscarriage facts and figures

A miscarriage is the loss of a pregnancy in the first 23 weeks. It's tricky to know exactly how many miscarriages take place. The truth is that frequently a miscarriage can happen before the mum even realises she is pregnant. The estimated figure is that miscarriage happens in up to one in four recognised pregnancies, with the great majority happening in the first trimester before 12 weeks. A late miscarriage is fortunately much less common, so there is good reason to relax a little after 12 weeks. After 24 weeks, the delivery of a baby who has died in the womb is no longer described as a miscarriage but is referred to as a stillbirth.

Facts and figures can't express the pain and the individual stories behind the losses. However, many couples tell me they want to know the statistics to help them understand their loss and start to look forward to the future:

  • 20% of women go to hospital with bleeding in the first twenty weeks of pregnancy
  • Miscarriage occurs in around 10–25% of pregnancies, although some may occur in the first five weeks, often before a woman knows she is pregnant - known as a 'chemical pregnancy'
  • 85% of miscarriages happen in the first twelve weeks
  • In the UK, 50,000 women are admitted with early pregnancy problems every year
  • After a normal scan, 95% of those with bleeding will go on to have an uncomplicated pregnancy
  • Over half of women with bleeding before 20 weeks will continue their pregnancy

Miscarriage risk

Some women do have a slightly higher risk of having a miscarriage. This includes those with underlying health problems and older mothers. Women who make potentially harmful lifestyle choices (such as heavy drinking of alcohol or caffeine, smoking and taking recreational drugs) can also be more likely to suffer pregnancy loss.

Although you cannot have any impact on chromosomal conditions or your age, there are some things you can do to bring down your overall risk of having a miscarriage. By getting to a healthy BMI, eating a balanced diet, kicking any bad habits and cutting down to 200mg of caffeine a day, you may help increase your chances of continuing your pregnancy and giving birth to a strong and healthy baby.

Early miscarriage

More than 85% of miscarriages happen in the first 12 weeks of pregnancy. These are known as 'early miscarriages'.

 

Causes of early miscarriage

It is thought that many pregnancies may be lost early, in the first five weeks, often before a mum knows she's expecting. The cause of many early miscarriages is not fully understood. However, it is believed that most are caused by chromosomal problems in the developing baby. Later, problems with the placenta can also lead to pregnancy loss.

 

Chromosomal abnormalities

It can help to think of the chromosomes as the building blocks of our genes. They contain the blueprint for developing every single cell in the body, with fifty per cent coming from the egg and fifty per cent from the sperm. If there's a serious problem when they combine at the time of conception, or during early development, this can mean that the baby is unable to live and there can be an early loss of the fetus.

Around half of early miscarriages may be caused by these kinds of genetic problems. But before you start to worry, it's important to understand that this usually doesn't mean you or your partner are carrying a chromosomal problem. It's often a new abnormality in the baby and most couples go on to have a healthy baby in the future.

 

Problems with the placenta

The placenta is your baby's life-support machine. It links your blood to your baby and is the source of food, fluid and oxygen. If there is a problem with the development or function of the placenta, it can cause miscarriage.

"I have been pregnant twice. The first time I had a miscarriage around six weeks. I was considered high risk. I had a pulmonary embolism when I was twenty-five. The cause was the pill. Therefore, my specialist team decided to put me on blood thinners during my pregnancy, which I had to inject in my stomach. I was scared that the blood thinners would harm the baby. When I found out I was pregnant two months after the miscarriage I went to my specialist immediately and my pregnancy was fantastic. My daughter is nine now and healthy."
— Patty, London

Dr Keith Duncan says:

Pulmonary embolisms are blood clots that reach the lungs and block blood flow, resulting in a heart attack or other serious medical problem. Some birth control pills are known to cause these blood clots. In addition, women who have had miscarriages are often given blood tests to check for genetic problems that may lead to blood clots. These inherited clotting problems affect about one in ten people. The fear is that having one of these clotting problems may cause clots to form in the placenta, choking the delivery of oxygen and nutrients to a growing baby. Research in the past suggested having a clotting disorder can lead to sticky blood and the risk of miscarriage, so doctors may prescribe a blood thinner to help prevent pregnancy loss and growth problems in the baby.

What will happen?

If you have had an early miscarriage, you may notice some bleeding or suffer lower abdominal pain and cramping. Sadly, you may notice no symptoms, and discover your loss on a routine ultrasound scan. This is known as a missed miscarriage.

With time, a full miscarriage will usually happen naturally. However, this can take days or sometimes weeks. Some women prefer if this process is speeded up, so they can put this difficult and stressful experience behind them and start to recover physically and emotionally. This can be done by the use of medical treatment or by a small operation.

Will it happen again?

"I felt anxious throughout the pregnancy due to the previous miscarriage. I kept thinking this pregnancy would end in miscarriage also. Compared with the first pregnancy, when I assumed everything would go perfectly, from the minute I found out I was pregnant, I did not allow myself to think ahead or get excited in case things didn't go well."

— Pauline, London

The good news is that whilst miscarriage is common, recurrent miscarriage is not. Only two per cent of pregnant women experience two pregnancy losses in a row, and only about one per cent have three consecutive pregnancy losses.

The technical definition for recurrent miscarriages or 'recurrent pregnancy loss' (RPL) requires three or more consecutive losses of recognised pregnancies before Week 20, or the fifth month of pregnancy. Currently, it isn't clear whether early pregnancy losses diagnosed by sensitive pregnancy tests and not by ultrasound should be included in this definition. Most doctors believe it is reasonable to send tests and start treatment of RPL after two consecutive miscarriages.

The risk of recurrence depends on many factors, including the cause of the first miscarriage, the age of the mother, and any previous history of a live birth. However, it's important to remember that most women with RPL have a good chance of eventually having a successful pregnancy, whether or not a cause is discovered and treatment initiated.

Looking forward

Your body is designed to recover physically from the demands of a miscarriage. However, when a baby dies it can be difficult to cope with your emotions and adapt to the loss of the baby you planned and the future you'd imagined.

If the worst does happen and you lose your baby, it can be a lonely and frightening experience. You may have avoided telling people about your pregnancy, which can add to your sense of isolation. Please understand that you are not alone. Even if a problem shared isn't exactly halved, it can help to talk to others about your feelings and your fears. Talk to your healthcare team and share your emotions with your partner, your family or trusted friends.

For reassurance in subsequent pregnancies, we offer early viability and reassurance scans from 6 weeks.

Mid-trimester loss

Most miscarriages happen in the first trimester. However, as many as fifteen per cent of miscarriages occur later (between 15 and 24 weeks), so they are not as rare as people think. In my unit, every month we see a patient who is suffering a late loss - it's one of the most upsetting and challenging parts of my job.

The sad truth is that we often don't fully understand the reason for late miscarriage, but there are a number of causes and conditions that could potentially increase the risk. The good news is that with early diagnosis of these, we can make a difference and prevent problems occurring.

Causes of late miscarriage

  • Cervical insufficiency: Problems with the neck of the womb can make it more likely to open up earlier in pregnancy. This weakness can be caused by surgery to the cervix, including treatment for abnormal or precancerous cells. It can also be due to birth trauma, or there may be an in-built tendency. If your healthcare team are aware of the risk, they can start treatment to prevent the cervix dilating too soon. An ultrasound scan can be done to assess the length of the cervix. If changes are noticed soon enough, there is research evidence that hormone therapy with progesterone pessaries can significantly decrease the risk of miscarriage. Also, a special stitch can be placed around the cervix earlier in pregnancy (known as cervical cerclage) to prevent premature dilatation.
  • Infection: Infections can really take their toll on your body, and that's especially true in pregnancy. Any severe infection such as a UTI spreading to the kidneys, septicaemia or bad gastroenteritis (especially bacterial infections) can increase the risk of pregnancy loss. Pelvic and vaginal infections can be a particular problem. If they spread to the womb, they can make the membranes inflamed, a condition known as chorioamnionitis, which can kick off contractions and miscarriage. Although this is thankfully rare, it's essential to get medical help promptly if you are feverish and unwell or have an unpleasant or smelly discharge.
  • Illness: When you have a chronic health condition, you become used to carefully managing your own health. This is particularly vital when you're expecting because chronic health conditions like diabetes, thyroid problems, high blood-pressure and kidney disease can increase the risk of miscarriage. It can really help if you get expert medical assessment and support early in pregnancy, or ideally when you are trying to conceive. This can ensure you're in tip-top health so your body is in the best condition to build a healthy baby.
  • Medication and treatment: It's important to be vigilant and get expert advice before taking any medications when you're pregnant. A number of drugs, herbal remedies and essential oils may trigger pregnancy loss. Check with your doctor, midwife, pharmacist or therapist before taking anything - that includes 'natural' and common over-the-counter treatments.
  • Problems with the womb: Sometimes the shape of the womb can affect the attachment of the placenta or the healthy growth of the baby. This is uncommon, but can be caused by problems during development or by the growth of fibroids. If this has caused a miscarriage for you in the past, it may be worth consulting a gynaecologist to consider whether surgery could make a difference, before planning any further pregnancies.
  • Twin and multiple pregnancies: The extra size and weight of multiple pregnancies can put extra pressure on the cervix, and trigger early changes to the neck of the womb and the danger of labour starting too soon. This increases the risk of premature deliveries and mid-trimester loss.
  • Genetic problems and fetal abnormalities: Some late miscarriages are caused by a problem with the chromosomes in the baby or developmental abnormalities that are incompatible with life. Although it is not a consolation for the loss, it can be reassuring to know that most women go on to have successful pregnancies in the future. However, it is worth further investigation and genetic counselling if there is a strong family history of pregnancy loss.

Understanding and planning for the future

After a late miscarriage, you may be offered tests to help understand what has caused your loss. This can include a post-mortem examination or autopsy, which I understand is difficult to consider when you're still reeling from your loss. However, these investigations can help you discover why you lost your baby and whether preventative treatment will be able to help prevent any problems in future pregnancies.

If you have experienced recurrent pregnancy loss or a late miscarriage, Dr Duncan can support you with specialist consultations, targeted screening and a personalised care plan. Contact us today to book your appointment with Dr Duncan.

Frequently Asked Questions

The risk of miscarriage is highest in the first 12 weeks of pregnancy, with around 85% of all miscarriages occurring during this period. After 12 weeks, the risk decreases significantly, and there is good reason to feel more reassured once you pass this point. After 24 weeks, pregnancy loss is classified as a stillbirth rather than a miscarriage.

Yes, some lifestyle factors can increase the risk. Heavy alcohol consumption, smoking, recreational drug use and excessive caffeine intake (above 200mg per day) have all been associated with a higher risk of pregnancy loss. Reaching a healthy BMI and eating a balanced diet before and during pregnancy can help reduce overall risk. That said, the majority of miscarriages are caused by chromosomal problems in the developing baby and are not within your control.

A missed miscarriage is when the pregnancy has been lost but the body has not yet recognised this, meaning there may be no bleeding or cramping. It is often discovered during a routine ultrasound scan.

Recurrent pregnancy loss (RPL) is technically defined as three or more consecutive losses before Week 20. However, most doctors consider it reasonable to begin investigation and treatment after two consecutive miscarriages. Only around 2% of women experience two losses in a row, and only around 1% experience three or more. If you are concerned, speaking to a specialist sooner rather than later is always worthwhile.

For most women, yes. Physically, many healthcare professionals advise waiting until after your first period following a miscarriage, both for dating purposes and to allow time for emotional recovery. The majority of women who have experienced a miscarriage - even a recurrent one - go on to have successful pregnancies.

You should consider seeking specialist advice if you have experienced two or more miscarriages, if you have had a late miscarriage, if you have an underlying health condition such as diabetes or a clotting disorder, or if you simply want reassurance and a clearer picture of your individual risk. Early, expert assessment can make a real difference - both to your physical outcomes and to your peace of mind.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.