Your pregnancy

The first thing you will need to do once you know you are pregnant is to book your birth at either St Richard’s or Worthing hospital, and read our links to useful information. 

Please read the PCSP Personalised Care and Support Plan and use for advice throughout your pregnancy. This will provide relevant information for your own personal circumstances and stage of pregnancy and a hard copy will be given to you at your first midwife appointment.

• Click here to refer yourself to maternity services
• Screening tests for you and your baby (STFYAYB) – GOV.UK (www.gov.uk)
• Vaccinations in pregnancy – NHS (www.nhs.uk)
• Coronavirus (COVID-19), pregnancy and women’s health | RCOG
• Public information campaign focuses on handwashing – GOV.UK (www.gov.uk)
• Infections in pregnancy that may affect your baby – NHS (www.nhs.uk)
• Antenatal support: meet the team – NHS (www.nhs.uk)

Antenatal Care plan:

Please read ‘Health and wellbeing in pregnancy’ section in your PCSP Personalised Care and Support Plan

• Click here to see an overview of your pregnancy care pathway: Your pregnancy care – NHS (www.nhs.uk) 
• Click here to see pregnancy health and wellbeing advice (diet, medication, supplements and more): Keeping well in pregnancy – NHS (www.nhs.uk)
• Click here to see common symptoms in pregnancy: Common symptoms in pregnancy – NHS (www.nhs.uk)
• Click here to see what to expect at each stage of pregnancy including physical and emotional changes: Pregnancy week-by-week – NHS (www.nhs.uk)

Diabetes in Pregnancy:

It is vital you contact the Maternity Diabetes team as soon as you are aware you are pregnant if you had diabetes in any previous pregnancies or have pre existing diabetes. This is in addition to your general pregnancy referral. You can self refer to the diabetes team by email: uhsussex.diabetesmaternity@nhs.net

Gestational diabetes

Diabetes that develops during pregnancy is known as gestational diabetes. It occurs because your body does not produce enough insulin, a hormone important in controlling blood glucose levels, to meet its extra needs in pregnancy. This results in high blood glucose levels which can have health implications for you and your baby. However, management of blood glucose during pregnancy can reduce any risk and this is why we offer diabetes screening. Most women who have gestational diabetes have healthy pregnancies and healthy babies.

Gestational diabetes usually starts in the middle or towards the end of pregnancy.

Gestational diabetes is very common. It affects at least 4-5 in 100 women during pregnancy. You are more likely to develop gestational diabetes if you have any of the following:

• BMI above or equal to 30kg/m
• a previous baby with a birth weight of 4.5kgs (10lbs) or more
• family history e.g. a first degree relative with Diabetes
• an ethnic origin with high prevalence of diabetes
• you had gestational diabetes in a previous pregnancy. We will manage your care in this pregnancy assuming that you have gestational diabetes again, as a precaution.

If you have any of the above (except previous gestational diabetes) you will be offered an oral glucose tolerance test (OGTT) in the first trimester (three months), and then again at around 28 weeks gestation.

• Click here to see the Diabetes UK advice on pregnancy care: Managing your diabetes during pregnancy | Diabetes UK
• Click here to see the RCOG patient information leaflet: Gestational diabetes | RCOG
• Click here to see the Research and Psychiatry Dept of Women’s Mental Health at Kings Collge London
• Click here to see the NHS advice on gestational (pregnancy) diabetes: Gestational diabetes – NHS (www.nhs.uk)

Corticosteroids in pregnancy

Corticosteroids are a type of medication given to you by injection into the muscle, usually of your thigh or upper arm, and are given to help your baby if there is a possibility that you may have your baby early. A single course of injections can consist of two to four injections over a 24 to 48 hour period.

Corticosteroids are given to lessen the chance of your baby having serious complications after being born early such as breathing problems, bowel inflammation and other serious infections. 

The Royal College of Obstetrics and Gynaecology RCOG have produced a document giving lots of information on when and why you may be offered corticosteroids during Pregnancy:

RCOG PATIENT INFORMATION LEAFLET

Weight Management in Pregnancy:

UH Sussex Hospitals runs a successful Weight Management Programme for women and birthing people who are receiving maternity care from St Richards or Worthing Hospital. Attending the weight management groups will help support and reassure you in a non-judgemental, friendly and fun way and alongside others with similar goals If your BMI at the beginning of pregnancy is 30 or above you will receive an appointment to attend this. You will also need to take higher doses of Folic Acid and Vitamin D, click here for more details: Vitamins, minerals and supplements in pregnancy – NHS (www.nhs.uk)

• Click here to join the Worthing Facebook Group for Pregnancy Weight Management: Worthing WMIP Group | Facebook
• Click here to join the St Richards Facebook Group for Pregnancy Weight Management: St Richard’s Weight Management in Pregnancy Group | Facebook

Clinics are held at these locations:

Alcohol in Pregnancy

There is no known safe level of alcohol consumption during pregnancy.

Drinking alcohol during the pregnancy can lead to long-term harm to the baby

The safest approach is to avoid alcohol altogether to minimise risks to the baby. 

• Click here to see the Royal College of Obstetricians and Gynaecologists information: Alcohol and pregnancy | RCOG
• Click here to see the Tommy’s information: Alcohol in pregnancy | Tommy’s (tommys.org)
• Click here to see the NHS information: Drinking alcohol while pregnant – NHS (www.nhs.uk)

Smoking in Pregnancy

All women are screened for carbon monoxide at booking and throughout pregnancy, anyone who smokes, has a raised CO result or recently quit will be contacted by the team.

Current smokers will be offered support. 

We offer a friendly non-judgemental approach. We aim to provide: 

• Personalised smoke free pathway with a stop smoking practitioner. 
• Free Nicotine Replacement Therapies (NRT) to support your quit. 
• Face to face /telephone behavioural support. 
• Support for partner wishing to quit 

What is secondhand smoke? 

More than 80% of secondhand smoke is invisible and odourless. Protect your loved ones by quitting and reducing their risk of serious illness including respiratory disease, heart disease and cancer. 

Whenever you light up, secondhand smoke is produced. This is the smoke exhaled by you, plus the smoke created by the lit end of a cigarette. The smoke contains more than 4,000 chemicals, many of which are irritants and toxins known to cause cancer. This isn’t just unpleasant; it can be a killer. 

So how harmful is secondhand smoke? 

Secondhand smoke harms everyone in your home, especially pregnant women, babies, children and young people; all of whom are most sensitive to tobacco smoke so protect your family by keeping your home and car smoke free. 

Families and any visitors to the home should always smoke outside and smoking in cars is now illegal if someone under the age of 18 is present. This is because smoking in close proximity to children exposes them to secondhand smoke and increases the risk of them developing asthma, colds, and ear infections. 

Babies with mothers who smoke are also at a higher risk of being born with a low birth weight, contracting Meningitis and Sudden Infant Death Syndrome. 

Non pregnant smokers – how to refer to stop smoking:

If you smoke and are not pregnant (partners, family and household members), there are trained advisors in the West Sussex Wellbeing Teams who are still available and can offer tailored advice and support via the telephone. There are Stop Smoking Services all across the West Sussex area.  To find out more and for further information, support and advice around stopping smoking, please visit the West Sussex Wellbeing website 

Domestic Abuse

The UK Government definition of Domestic Abuse can be found here: About domestic abuse | Safelives

If you believe you are being abused, or worried you may commit domestic abuse, please speak to your Midwife, GP or Health Visitor or contact one of the following services who will be able to help you. 

Call 999 and ask for the police if you are in immediate danger. The police will continue to respond to all emergency calls. 

If you are in danger and unable to talk on the phone, dial 999 and listen to the questions from the operator and respond by coughing or tapping the handset if you can. 

If prompted, press 55 to Make Yourself Heard and this will transfer your call to the police. 

The local West Sussex Domestic Abuse charity Worth, who offer support, can be found here: Local support for people being abused – West Sussex County Council

Your baby’s movements in pregnancy:

Feeling your baby move ENGLISH.pdf (tommys.org)

Your baby’s movement is a sign of their wellbeing.  It is important to get to know your baby’s normal pattern of movement so that you can be aware of any changes in what you consider to be ‘normal’ for your baby. Every baby has a different pattern and therefore we advise that you get used to your own baby’s pattern and not a set number of ‘kicks per day’. 

You should try to get to know the times of day that your baby is most active as this will help you know if they are moving less or if they have stopped moving.  ‘Reduced fetal movement’ is classed as a reduction in your baby’s regular pattern of movement and could be the first sign that your baby may not be well or is not growing properly in the womb.  Stillbirth affects 1 in 200 babies after 24 weeks’ gestation and a reduction in the baby’s movements may indicate an increased risk of stillbirth.  There are other factors which could affect the movements of your baby; for example drugs, pain relief, sedatives, alcohol and smoking.  We advise women and their partners to get help to quit smoking if they smoke at the time of pregnancy. 

When will I begin to feel my baby move? 

You may begin to feel your baby move between 16 and 24 weeks of pregnancy.  A baby’s movements can be described as anything from a kick, stretch, flutter, swish or jab. If you have not felt your baby move by 24 weeks, tell your midwife. There are some reasons why you may not feel your baby move as early as you would expect, such as your body weight or the position that the baby is lying in. 

At 36 to 42 weeks it is important to recognise that movements may feel different to what you are used to but the frequency should not and this applies before you go into labour.  If you notice any change, do not hesitate to contact us. 

If you have noticed any change in your baby’s movements, call our Maternity Triage advice line

24 hours a day, 7 days a week: 01903 285 269



Do not wait to call us.  

Please note: We strongly advise not to use or purchase your own baby heartbeat listening device.  Some of the devices that can be found on the market can be unreliable, difficult to interpret and can therefore create a false sense of security or unnecessary panic.  Take a look at a flyer produced by Kicks Count on the risks of using baby heartbeat listening devices. 

Click here to see the Royal College of Obstetricians and Gynaecologists advice on fetal movements: RCOG information 

Click here to see the Kicks Count website: Your Baby’s Movements Matter. Kicks Count is the UK’s leading baby movement campaign, keeping mums and babies safe.

We also run an excellent parent education programme to prepare you for your birth and beyond.

• Contact your named midwife for details of classes near you.

Multiple pregnancy

Most multiple pregnancies are normal and healthy and you can follow much of the same advice as women with singleton pregnancies. However, there are some factors that may lead to an increased risk of complications for you and your babies; therefore you will be monitored more closely during your pregnancy. It is important that you attend all your appointments.

Antenatal care with twins

Pregnant with twins – NHS (www.nhs.uk)

Twins Trust

Giving birth to twins or more – NHS (www.nhs.uk)

Anti D

Everybody’s blood falls into a number of blood groups.  You are probably aware of the four main blood groups:  Group A, Group O, Group B, and Group AB which are carried on the red blood cells.  Red blood cells are the commonest cells in the blood system and their job is to carry the oxygen you breathe around your body.  Usually when a mother and her baby have different blood groups, there is no problem.

However, sometimes the blood of mother and baby differ in a more important way.  This difference is called the Rhesus D Factor (RhD Factor).  The RhD Factor is the name given to a special protein attached to the red blood cells in the blood.  People whose red blood cells carry the RhD Factor are called ‘RhD-Positive’ and those without are called ‘RhD-Negative’. 

‘cfDNA’ Testing

All pregnant people have their blood group tested at booking of the pregnancy.  If Rh D-Negative, they are offered a blood test called cfDNA (cell-free DNA) this test is carried out in the antenatal clinic from 16 weeks onwards. This test will tell you if your baby’s blood group is D-Positive or D-Negative.  With multiple pregnancies, a positive result would mean that at least one of the babies is D-Positive, and the mother should still receive routine antenatal anti-D injections.  A negative result means that all the babies are D-Negative.

Potential complications during pregnancy

In the event of potentially sensitising events such as those listed below, additional injections of anti-D immunoglobulin may be necessary:

· Impending or actual miscarriage.

· Ectopic pregnancy.

· Termination of pregnancy.

· Vaginal bleeding.

· Obstetric interventions such as chorionic villus sampling, amniocentesis, or external version.

· Abdominal injury e.g. after a fall or a traffic accident.

It is important that in any such events you contact Telephone Triage on 01903 285269 as soon as possible.

Blood groups and red cell antibodies in pregnancy

D-negative-mothers-blood-test-to-check-her-unborn-babys-blood-group.pdf (mft.nhs.uk)

NHS.UK

Deep Vein Thrombosis and Venous Thromoembolism

Deep Vein Thrombosis or ‘DVT’ is a clot which can develop in the veins of your leg.  It can cause pain, swelling and redness, or at times have no symptoms at all.  A clot can also move to your lungs and this is known as a pulmonary embolism, or ‘PE’.  Symptoms of this include chest pains and breathlessness.  This is a serious condition, which can be life-threatening.

There is an increased risk of DVT and PE in women who are, or have recently been, pregnant, and the risk is increased further following surgery.

If you have ever experienced a DVT or VTE in your past, please call Triage as soon as you are aware you are pregnant so your health history can be reviewed an appropriate care plans can be put in place.

If you are planning a journey where you will be sat down for more than 4 hours, please inform your Community Midwife beforehand so they may undertake an updated risk assessment. Regular limb movements and hydration will decrease your risk of VTE.

DVT (deep vein thrombosis) – NHS (www.nhs.uk)

Reducing the risk of venous thrombosis in pregnancy and after birth patient information leaflet | RCOG

Group B Streptococcus (GBS): 

Group B Streptococcus, often abbreviated as GBS, is a common bacteria that can be present in our bodies. It usually causes no harm. This situation is called carrying GBS or being colonised with GBS.

GBS is commonly found in the digestive system and the female reproductive system. GBS is not a sexually transmitted disease and most women/people carrying GBS will have no symptoms. Most pregnant women who carry GBS bacteria have healthy babies. However, there’s a small risk that GBS can pass to the baby during childbirth. Most babies are unaffected, but a small number can become infected.

Very rarely GBS infection in newborn babies can cause serious complications that can be life-threatening.

Are pregnant women tested for GBS?

Currently the evidence suggests that screening all pregnant women routinely would not be beneficial overall. You can be tested privately for GBS but professional opinion does not recommend this because a positive test may possibly result in unnecessary and potentially harmful interventions. The test involves both a vaginal and rectal swab.

As GBS can cause urine infections in pregnant women, GBS infection may be detected by taking a mid-stream urine sample, sometimes referred to as an MSU, which is then sent to a laboratory for analysis. Urine infection caused by GBS should be treated with antibiotics. An MSU is offered routinely in early pregnancy.

GBS may sometimes be detected during pregnancy in the course of taking a vaginal swab for signs of other infections. However not all vaginal swabs will detect GBS so it is important to be aware that a negative swab test does not guarantee that you are not a carrier of GBS.

If GBS is detected either in urine or swabs during your current pregnancy you will be offered intravenous antibiotics in labour.

Click here for the NHS guide to GBS in pregnancy: What are the risks of group B streptococcus (GBS) infection during pregnancy? – NHS (www.nhs.uk)

Click here for the Royal College of Obstetricians and Gynaecologists (RCOG) guide: Group B Streptococcus (GBS) in pregnancy and newborn babies | RCOG

Click here for the Group B Streptococcus Support page: Group B Strep and pregnancy – Group B Strep Support (gbss.org.uk)

Pre-eclampsia and High Blood Pressure

Pre-eclampsia is a common condition that only occurs during pregnancy, affecting the mother, baby or both.  It can develop from around 20 weeks of pregnancy to as late as several days after birth, the severity of which can vary.  In the mother, the condition causes high blood pressure and protein leaks from the kidneys into the urine.  Other symptoms may develop and are mentioned below.  For the baby, growth may be slower than normal.

What are the symptoms of pre-eclampsia?

The severity of pre-eclampsia is usually, but not always, linked to the blood pressure level.  You may not have any symptoms at first.  If pre-eclampsia worsens one or more of the following symptoms may develop:

• Headaches.
• Blurring of vision, or other visual problems.
• Abdominal pain, generally in the upper part of the abdomen, under the ribs.
• Vomiting.
• Just not feeling right.

If you have any of these symptoms you should contact your Midwife or Maternity Telephone Triage as soon as possible.

Swelling of your feet, face and hands, known as oedema, is also a symptom of pre-eclampsia although it is also common in normal pregnancy.  Oedema may become worse with pre-eclampsia, therefore, if you notice a sudden increase in the swelling in your feet, face and/or hands you should inform your Midwife.

Pre-eclampsia – NHS

RCOG Patient information leaflet

Feeding your baby

However you choose to feed your baby, preparation is key!

During pregnancy you will have a full discussion with your Midwife and Health Visitor about feeding your baby, including information on the value of breastfeeding and breastmilk for both you and your baby.  This will provide you with all the facts you need to make an informed choice.

Expressing Colostrum

Read more about getting off to the best start including information on how to store milk. Research shows that women who learn to hand express in pregnancy are more confident and better prepared to breastfeed their babies. UNICEF- Video- how to hand express. Colostrum breastmilk is perfectly tailored to support the development of your baby’s immune system.

The first milk you have in your breasts is called Colostrum. Women start to produce colostrum from about sixteen weeks of pregnancy onwards. Sometimes women find that they leak colostrum from their breasts as early as 28 weeks of pregnancy. Do not worry if you do not – it is not an indicator of whether you will have milk for your baby. The amount of colostrum will vary from women to women. It can range from nothing initially, to a few drops, to a teaspoon full or more. Learning to express colostrum can increase your confidence and ability to breastfeed, especially in situations where the first feed may be delayed, for example if your baby needs to go to Special Care or you have a certain medical condition, i.e. Diabetes

During pregnancy, at approximately 34 weeks, you can collect a ‘colostrum harvesting pack’ from your midwife which will contain everything you need to get started. Breast milk can stored un-refrigerated for up to 6 hours; in the fridge for 3 days at a temperature of 5-10°c; for 4 days at a temperature of 0 – 4°c or in the freezer for up to 6 months. Frozen breastmilk should be defrosted and used within 24 hours.

In hospital, it is recommended that milk is stored in the refrigerators for no more than 48 hours. Sterile plastic bottles are available to store milk in. Very small amounts can be collected in purple syringes which are sealed by an ‘end cap’. Also available are small colostrum pots with blue lids that can be used to collect and store small amounts of milk. All milk needs to be labelled with your name, date and the time that it was expressed.

Bring your stored colostrum with you for birth in a cool bag with ice packs. Give this to the midwife caring for you so that it can be stored in the fridge-freezer so that it is ready for your baby. Please ensure that it is labelled with your name, date and time you expressed and froze it.

Skin to skin

Having skin to skin with your baby straight after giving birth will keep your baby warm and help to regulate their breathing. It help parents to bond with their baby and supports better physical and developmental outcomes for baby. .Skin-to-skin is holding your baby naked or with only a nappy on against your skin, usually with a blanket or towel over you both and left for at least an hour or until after the first feed.

Unicef Skin to skin page: Skin-to-skin contact – Baby Friendly Initiative (unicef.org.uk)

Unicef Building a happy baby Building a happy baby: A Guide for Parents Leaflet – Baby Friendly Initiative (unicef.org.uk)

Unicef Off to the best start leaflet Off to the best start (unicef.org.uk)

At University Sussex Hospitals NHS Foundation Trust, we are working towards the stages of UNICEF’s Baby Friendly Initiative.  Read more about how this initiative supports you as new parents.

Our aim is to give you all the help and support you need during your infant feeding journey.  This can be provided by a variety of health professionals including Midwives, Health Visitors or Maternity Support Workers as well as Breastfeeding Peer Supporters too. For postnatal support please call the infant feeding team on:

• Worthing Hopsital: 07808099816
• St Richard’s Hospital: 07808099829

Please click here to read more about breastfeeding support groups in the community: Breastfeeding help, drop ins and courses (sussexcommunity.nhs.uk)

• Breastfeeding information – Start4Life.
• Breastfeeding Tips for Parents – The Institute of Health Visiting

And we’re always at the end of the phone if you need help, advice or reassurance. It is extremely important to us that you feel listened to and if you have not had a satisfactory interaction with our staff, we would encourage you to contact PALS. Patient Advice and Liaison Service (PALS) / Complaints – Western Sussex Hospitals

• You can call our midwives on 01903 285269