When you use a health or disability service in New Zealand, you have the protection of a Code of Rights. The Code of Health and Disability Services Consumers’ Rights provides the following 10 rights:

Right 1 

The right to be treated with respect.

Right 2

The right to freedom from discrimination, coercion, harassment, and exploitation.

Right 3

The right to dignity and independence.

Right 4

The right to services of an appropriate standard.

Right 5

The right to effective communication.

Right 6

The right to be fully informed.

Right 7

The right to make an informed choice and give informed consent.

Right 8

The right to support.

Right 9

Rights in respect of teaching or research.

Right 10

The right to complain.

When it comes to pregnant women, there seems to be a long list of unwritten ‘rules’ that govern what they wear, when they work, what they eat, who they consult with, where they birth, etc. But at the end of the day, these choices are yours! While you should still make good decisions for yourself and your baby based on factual information, you are allowed to stray from the perceived norms.

The NZ health system is based on the premise of informed consent, which means that your health practitioner needs to keep you informed about all the different birthing options, potential risks, benefits, care, and their professional opinion regarding these factors.

You have a right only to receive service once you have given your ‘informed consent’. In order to give informed consent, you will need to be given unbiased information about the procedure you are interested in as well as alternative options. You will also need to be given time to consider all of the information provided before giving your consent willingly.

Before you make any decisions regarding hospital birth, natural home birth, treatments, procedures, etc., you should ensure that you gather as much information as possible. The acronym B.R.A.I.N may help you ask the right questions.

Using B.R.A.I.N to make informed decisions.

• B is for Benefits- Ask how the proposed treatment/procedure will help you, your pregnancy, your labour, and your baby.
• R is for Risks- It’s very important to get a clear idea of all the risks involved in any treatment/ procedure.
• A is for Alternatives- Ask about the other options that you have available to you. There may be an ideal option for you that you do not even know about.
• I is for Intuition and Information- If you have received a lot of factual information about something, and your intuition still tells you it is not right for you, then this may be a feeling worth exploring, or you may be needing more information.
• N is for Not Now – You don’t have to make hasty decisions about things when you are not entirely sure. Take some time to think about it.  You may want to choose to try other options first.

Pregnancy is a truly miraculous process and studies have shown that preconception health and nourishing your body before, during, and after pregnancy can play an important role in the health of you and your baby. When trying to get pregnant there are some things you can do to prepare, especially around the health and wellbeing of both you and your partner/donor, that may optimize your chances of becoming pregnant. It is suggested you begin at least 3 – 4 months leading up to conception, as that time frame relates to the time it takes for both sperm and eggs to mature.

Becoming pregnant is a team effort. Here are some other factors you and your partner may want to consider and then make a plan of which things you are going to focus on, before trying to conceive.

Contraception
Plan when you will discontinue the use of any contraception you are using. If you have been using hormone-based contraception, it may take time for your body to adjust back to its natural cycle. Understand and gain awareness of your body cycles, especially signs of ovulation, so you can plan the best times to try and get pregnant.

Nutrition
If you are planning to get pregnant you should focus on getting to and maintaining a healthy body weight. Both you and your partner eat a well balanced diet from a wide range of food, including lots of fruit and vegetables, to gain the nutrients your body requires. It is possible to consume supplements that provide the body with nutrients and minerals when trying to get pregnant.  However, if you’re eating a wide variety of foods you shouldn’t need to take additional supplements.

Folic acid is a vitamin B supplement used to decrease the chance of spina bifida and other neural tube defects in the baby. It is recommended you start taking folic acid at the usual daily dose of 800 micrograms, at least one month before conception, and continue until week 12 of your pregnancy.  Tablets can be prescribed by your GP or can be purchased over the counter at a pharmacy. Note, some dietary supplements contain folic acid, check the ingredients list to see if it is enough.

Have a check-up with your GP
You may want to visit your GP to talk about the fact you want to get pregnant. You can discuss any medical conditions you may have and any medications you are taking, as some are not safe during pregnancy and may need changing.  They can provide you with a prescription for iodine and folic acid and offer advice on what you can do to get your pregnancy off to the best start, including, diet, exercise, help to quit smoking, and immunisation.  Also, check if your cervical smears are up to date. It is recommended that all women in New Zealand should have a cervical smear every 3 years, starting at 25 years of age, or earlier if there are concerning symptoms.

Relaxation / Stress reduction
Some stress is normal, but studies have found if your stress goes on for a long time or if you’re dealing with a major upheaval in your life, your stress hormones such as cortisol disrupt signaling between the brain and ovaries, lowering the chances of pregnancy. Therefore, reducing and managing stress levels and taking time to relax are important. It is beneficial for couples to talk and listen to each other about their shared struggles. Talk with your partner about your expectations about pregnancy and how they can best support you. It’s also a great time to talk about your hopes and dreams for your baby and your new family.

Relaxation – practice a type of yoga that pairs yoga postures with deep breathing exercises, visualisation techniques, or meditation.
Exercise – working out moderately, such as walking or swimming 2-5 hours a week, lowers stress and boosts fertility.
Diet – focus on maintaining a healthy diet, one downfall of stress is a tendency to eat for emotional comfort and end up overeating.  It is also tempting to load up on processed and sugary foods and consume excess alcohol and caffeine.

Finances
Financial stress may arise in the future, so now is a good time to have a conversation about money and how you will work together to manage your finances. Think about how your finances may change, how much maternity leave you can afford to take, or what expenses you can cut back on if needed.

Smoking, Alcohol, and Recreational Drugs
When you are pregnant if you drink alcohol or take recreational drugs it will be carried to your baby through your bloodstream. Drinking during pregnancy increases the risk of problems for your baby including learning disorders, and behavioural or social problems often showing a little later in life. Smoking during pregnancy is linked to health risks for both the mother and the baby. It is better to stop smoking before you get pregnant but even quitting while you are pregnant will help. Information on how to quit smoking is available from Quitline or speak to your GP or Midwife.

Begin researching midwives 

Choosing a Home Birth Midwife is one of the most important decisions you will make during your pregnancy so your midwife must be someone you feel comfortable, confident, and compatible with.  If you are planning a home birth, it is important to find an experienced home birth midwife, who has the relevant experience to help facilitate an empowering birth experience for you and your whānau. We believe there is a tangible difference between a home birth midwife, and a midwife who offers home birth as an option.

Midwives who are committed, experienced, and knowledgeable about home birth will have more personal and professional resources to draw from to help you birth at home. From their experience, they will also know to trust you and your body to give birth in your way on your terms. The more a woman is empowered to do this, the more satisfying and smooth her birth is likely to be. Recommendations from friends and members of home birth groups are a good place to start when looking for a midwife.  When choosing a midwife you have the right to meet with more than one midwife on a no-obligation basis before making a choice. There is a range of questions you may consider asking a prospective midwife.

GENERAL

• How long have you been in practice?
• What is your birth philosophy?
• What birthing options/locations do you offer?
• How many of your clients have home births?
• How many women do you book each month?
• Who is/are your midwifery partner(s)?
• When will they provide backup?

PREGNANCY CARE

• Where do you provide antenatal visits?
• How often am I seen and what is the process if I need to see you outside of planned visits?
• Do you encourage whānau participation?
• If my pregnancy becomes complicated what are my options and do you remain involved in my care?

LABOUR & BIRTH

• What equipment do you carry?
• How do you support the optimal flow of the birth hormones?
• Will there be a second midwife at the birth and when?
• When might I need to transfer to the hospital? If this happens what role will you play in my care?
• Can my partner be hands on for the birth?

AFTER THE BIRTH

• How often do you visit after the birth?
• How many weeks do you visit after the birth?
• Will you help me to establish breastfeeding?
• Do you work with support groups?

Nutrition

Eating a balanced diet from the main food groups will provide you and your baby with what is needed to be healthy and feel well. Concentrate on plenty of fresh fruit and vegetables, whole grains, low-fat meat and low-fat dairy products, seafood, legumes, eggs, nuts, and seeds. It is important to limit the amount of processed foods you eat and avoid drinks that are high in sugar, salt, or fat. Drinking plenty of water each day will keep you hydrated. There are no hard and fast eating plans that work for every pregnant woman, so it is important to find out what works best for you and speak to a healthcare professional should you have any concerns.

For an average woman, some guides suggest that the number of calories needed to maintain a healthy body weight is around 2,000 kcal (8,400 kJ)  a day. For the first half of your pregnancy, you probably won’t need any additional calories than you did before you became pregnant. Instead, you should focus on choosing nutritional foods that keep your energy up (and foods that don’t make you nauseous, if you experience morning sickness) while supporting your baby’s development. However, during the second half of your pregnancy you will need around an extra 300 – 450 calories a day, if you’re carrying multiples, your daily intake should increase by around an extra 600 calories per day. Bear in mind that we’re all different shapes and sizes, and some of us are more active than others. So any recommendation about the amount of calories you need when you’re pregnant is based on averages.

Food safety is also important during pregnancy. You want to focus on practicing good food hygiene, such as safe handling, storage, and protection of foods from cross-contamination. There are some conditions linked to food contamination and exposure to bacteria such as listeria, salmonella, campylobacter, and e-coli, and toxins such as toxoplasma that can be avoided by taking some food safety steps. However, some foods are best avoided.  The New Zealand Ministry of Health offers a recommended list of foods to be avoided during pregnancy for safety reasons. You may find this list does not reflect your personal or cultural approach to food or the list is too restrictive and difficult to adhere to. It’s worth noting this is a broad list to encompass all possible situations and risk can be managed a little more closely with some discernment.

Being Active

In the first few months of pregnancy, you may feel extra tired as the pregnancy hormones affect your body. Being as active as possible during your pregnancy will help keep you healthy and helps  you to prepare your body for the birth.  Being active for 30 minutes each day can improve your stamina, and suppleness, strengthen your heart and lungs and give you the extra energy and strength needed for the birth. There are many ways to exercise the body, choose activities you enjoy and that match your level of fitness.  You could try yoga for stretching and strengthening, brisk walks, swimming, or doing any activity that is comfortable for you and leaves you with enough breath to talk as you exercise.  Take breaks for a drink and a rest as needed.

Be careful, avoid exercising in hot conditions – stay inside if cooler, or exercise at a less intense level or shorter time period.  Do not exercise to the point of exhaustion. Contact sports are not recommended.

Pelvic Floor Exercises

Your pelvic floor muscles support your bladder, uterus (womb), and bowel. During pregnancy and childbirth, they may become weak.  Doing pelvic floor exercises helps prevent urinary incontinence and uterine prolapse. They can also increase sexual pleasure.

Learning to contract and release these muscles during pregnancy will help during labour and after your baby is born.

• Squeeze and draw in your back passage as if you’re stopping a fart. Squeeze and tighten your vagina like you’re holding a tampon and your bladder as if you’re stopping yourself from weeing.  Hold the squeeze for a few seconds – at first you may only be able to hold the squeeze for 1–2 seconds until your muscles get stronger. Later, try to count to 10. Relax slowly and then repeat about 5–10 times.
• Imagine that this area is an elevator contract the area as above, go up to the second floor, hold it there then move on to the third floor, and so on until the muscles are fully contracted. Then release them gradually.
• Keep breathing normally while you do these exercises. Make sure that you don’t pull in your stomach or squeeze your bottom when you squeeze.  to do this set of exercises 4–6 times a day.
• You can do these exercises lying down, sitting, or standing. With practice they can be done anywhere and at any time, even while you’re watching TV or feeding your baby.
• Avoid doing these exercises while you are having a wee. They may stop you from emptying your bladder completely, which can lead to an infection.

Sleep

Being able to get enough sleep is an essential part of feeling well during your pregnancy, however, it seems at the time you need it most, is a time when you may struggle more to get a good night’s sleep. There are several reasons why your normal sleep pattern may be disturbed during pregnancy. Increased progesterone levels in early pregnancy, zap your energy and can cause you to feel overwhelmed by tiredness, these pregnancy hormones should have settled down by the second trimester. However, you may find other common pregnancy niggles, such as backache, leg cramps, heartburn, needing to pee frequently, and vivid dreams that may begin to interrupt your sleep.

It is recommended that women go to sleep on their side, either left or right, during their third trimester. Sleeping on your side reduces pressure on major blood vessels, which can reduce blood flow to the womb and oxygen supply to the baby. Side sleeping also reduces your risk of stillbirth. It is normal to move about when you sleep, so don’t worry if you wake up and find yourself on your back. If your position has changed to back-lying when waking up in the middle of sleep – don’t worry, simply resettle to sleep on the side again. For more information visit sleeponside.org.nz

To help you get the rest you need during pregnancy try the following tips:

• Avoid fluids at bedtime – Your growing womb puts pressure on your bladder during pregnancy and it is common to need to go to the loo in the middle of the night. To reduce the number of times you wake, drink lots of fluids during the day to stay hydrated, but cut down before going to bed. Also avoid caffeine before bedtime, as this will both keep you awake and increase the urge to pee.
• Settle your stomach – What you eat and when you eat can affect your sleep. Avoid eating big meals just before bedtime as this may increase heartburn and indigestion. Also avoid spicy, acidic, or fried foods before bedtime. If you find yourself waking in the night because you are hungry, try having a small meal before bedtime.
• Get comfortable – As your baby’s birth gets closer, you may find it more difficult to find a comfortable sleeping position. Try supporting your belly with a pillow and put a pillow between your knees. This keeps the pressure off the muscles around your hips and pelvis. If heartburn is a problem, you could try elevating your upper torso a few centimeters to help keep stomach acids where they should be.
• Wind down at bedtime – Take some time to relax as it gets close to your bedtime. Try some relaxation techniques, you can find many relaxation videos, podcasts, and apps online. If you find yourself worrying at night about your pregnancy or the idea of becoming a mother, write down the things that are on your mind. Talk about them with your partner, a friend, or your midwife. This can help you to feel less anxious about your concerns or help you to find practical solutions to them.

Avoid, smoking, drugs, and alcohol

Smoking during pregnancy affects your baby as harmful toxins enter your bloodstream and pass through the placenta to your baby. These toxins put your baby at risk of problems including glue ear, asthma, pre-term birth, and low birth weight. Smoking can also increase the risk of miscarriage and Sudden Unexplained Death in Infancy (SUDI). Smoking is an addiction and it can be challenging to stop, quitting part way through your pregnancy will still have huge benefits for you and your baby

Alcohol is a substance known to cause harm to a developing baby during pregnancy as it is absorbed directly into the bloodstream and travels through the placenta and into the developing baby. There is no known safe level of alcohol consumption during pregnancy, therefore it is recommended that women completely avoid alcohol consumption during pregnancy. Alcohol can have a wide range of different impacts on the developing baby. Fetal alcohol spectrum disorder (FASD) is the diagnostic term used to describe the range of problems that can occur, such as physical growth problems and a range of intellectual disabilities. These conditions are lifelong and there is no cure for them.

Recreational drugs can cause complications during pregnancy and serious problems in the developing fetus and the newborn baby. For pregnant women, injecting recreational drugs increases the risk of infections that can affect or be transmitted to the fetus. These infections include hepatitis and sexually transmitted diseases (including HIV). Drugs such as methamphetamine can cause significant harm to your baby, including brain damage and birth defects. Other drugs such as heroin may cause your baby to be born drug dependent and suffer from withdrawal symptoms. Drug-dependent babies need expert care following birth.

If you can’t stop drinking alcohol or using drugs, talk to your midwife. They are there to support you, not judge you and they will be able to refer you to a local service for further help and support.

• The Alcohol Drug Helpline 0800 787 797 (24 hours a day)
• The Alcohol Drug Helpline free text 8681
• The Alcohol Drug Helpline website
• smokefree.org.nz
• Quitline offers a national service via text and phone

Pregnancy is such a transforming event, emotionally, spiritually, and physically. Throughout a typical pregnancy, your body will undergo significant changes. The physical, emotional, mental, and spiritual impacts will vary between individuals. However, the growth of your baby follows a general trend. The three stages of pregnancy are referred to as trimesters. Each trimester is about three months long.

• 1st trimester – Conception to 13 weeks
• 2nd trimester – 14 weeks to 27 weeks
• 3rd trimester – 28 weeks to 42 weeks

The first trimester of pregnancy covers weeks 0-13. For some of this time, you may not even be aware that you are pregnant. Your pregnancy begins on the first day of the last menstrual period and conception generally happens around fourteen days after that depending on the length of your cycle. Some women can feel the pregnancy from the moment of conception, for others, missing a period can be one of the first signs of pregnancy. If a pregnancy test is taken after your period was due, the findings are likely to be correct. If the result is negative and your period is still late, take another test about a week later. Because of the numerous hormonal changes occurring during this first trimester, most women will detect pregnancy symptoms at some point. Symptoms can include tiredness, morning sickness, breast tenderness, and the need to pass urine more often than usual. Sometimes in early pregnancy a small amount of spotting or bleeding is experienced, this is usually normal and caused by the fertilised egg attaching to the lining of the uterus.

How you may look and feel

• Breast changes –your breasts may swell, feel sensitive, tender, sore, and tingly, and also a darkening of the areola. This is due to the hormone influx and increased blood supply as well as your body creating new glandular tissue to provide breastmilk. Your breast size may change notably during the first trimester, be prepared to buy new bras in a larger size and you may find wireless ones more comfortable.
• Increased urination – You may feel the need to wee more frequently – This is due to both the pressure your uterus puts on your bladder and the increased blood volume in the area.
• Fatigue – feeling tired, having low energy, and wanting to sleep a lot can be normal, especially in the first trimester. This is because your body is working nonstop to support the development of your baby and your placenta.
• Nausea – feeling nauseated and vomiting – known as ‘morning sickness’, can affect you at any time, or all the time. It typically resolves after the first trimester. Extreme nausea lasting the entire pregnancy is called hyperemesis gravidarum and can require medical treatment due to dehydration.
• Mood swings – you may find yourself more emotional or sensitive and not as even-tempered as you usually are. Again, this can be attributed to hormones in your body. Take care and surround yourself with people who will understand.
• It is very normal to feel anxious about the possibility of miscarriage. This most commonly occurs in the early weeks which is why, for most women by the time they progress to the end of their first trimester; they feel they can relax a bit.
• At twelve weeks your uterus will be starting to lift out of your pelvis and a small bump may be visible in your lower tummy. This won’t be obvious to others, though you may start to show earlier if you have had a baby before.

Your Baby’s Development

• Weeks 2 – 4
  Ovulation usually happens about two weeks after your last period began. Conception typically occurs in the fallopian tube and the fertilised embryo typically travels through the fallopian tube to the uterus, which takes around 6 to 12 days. Your body will receive signals to make more estrogen and progesterone once the fertilised egg has nestled into the uterine wall. Throughout your pregnancy, these and other hormones will support your developing baby. As the embryo settles into the uterine lining, some women may experience a minor bleeding episode. Around week 4 the placenta begins to develop and will be essential in producing certain hormones and feeding your infant. The embryo is smaller than a grain of rice, but each of its cells has already been designed to perform a particular task.
• Weeks 5 – 7
  Your baby’s cells have now formed into three layers, each of which will soon develop into different body organs. At 6 weeks their heart, which is about the size of a mustard seed, is now beating and circulating blood. On each side, tiny buds of tissue begin to emerge; these will ultimately develop into the limbs. This week, your baby’s neural tube, which joins its spinal cord and brain, will also close. At 7 weeks, your baby has a shape that resembles a sea horse. This week your baby’s eyes, nose, mouth, and ears are taking shape, and their brain will undergo a huge amount of development, with about 100 new brain cells forming every minute.
• Weeks 8 – 10
  At 8 weeks the passages that will enable air to flow from your baby’s throat to its lungs have formed, and the valves in its heart are already visible. Its lips, eyelids, fingertips, toes, and legs are becoming more distinct. Webbed fingers and toenails are beginning to appear on your baby’s hands and feet. During week 9 the mouth and tongue are currently forming, and the hands, which were previously webbed, are beginning to separate into digits. Your baby has completed the most crucial stage of growth at 10 weeks. Their heart has divided into four chambers and their digestive system continues to develop.
• Weeks 11 – 13
  Although the genitalia of your baby has begun to form, it’s still too early to determine if they are female or male. Their eyes are completely formed, and tooth buds are also developing. Up until about 12 weeks, your baby’s bones have been soft but now they are starting to harden. By this point, all of their internal organs and nervous system pathways have fully formed, from now on they will continue to grow in size and mature. Up until week 13, your baby’s abdominal organs have been developing outside of their skin, but now they will begin moving to their proper positions.
• At the end of the first trimester your baby now has exquisite fingerprints and is about 7.5cm long and weighs about 20g. Midwives can attempt to listen to your baby’s heartbeat during the first trimester, using a handheld Doppler from around the twelve-week mark. However, due to the mother’s uterus still being low in the pelvis, and the baby’s position, and movement, it can be challenging to hear the heartbeat at this point.

Pregnancy is such a transforming event, emotionally, spiritually, and physically. Throughout a typical pregnancy, your body will undergo significant changes. The physical, emotional, mental, and spiritual impacts will vary between individuals. However, the growth of your baby follows a general trend. The three stages of pregnancy are referred to as trimesters. Each trimester is about three months long.

• 1st trimester – Conception to 13 weeks
• 2nd trimester – 14 weeks to 27 weeks
• 3rd trimester – 28 weeks to 42 weeks

Welcome to your second trimester. This covers weeks 14 – 27. The hard task of creating your baby and assisting in its development has already been completed. Its vital organs and bodily systems should be present and prepared to continue developing and maturing. Your baby will grow three to four times in size and start to resemble the small person it will grow into during this trimester. Don’t worry if you still can’t feel anything when you’re poking around on your tummy. How big you are outwardly, at this early stage of your pregnancy and second trimester is not an indication of your baby’s growth or wellbeing. The second trimester is typically a relief for most women. There is nearly a return to their regular level of wellbeing as the nausea and weariness that were so distressing in the beginning seem to fade. However, there are still some significant differences.

How you may look and feel

• Baby bump – it may start becoming harder for you to hide your pregnancy at this point because of the baby bump. Depending on factors such as general size and stature or if you have had children among many other things; when women start to show is quite individual. The uterus is just beginning to rise up from the central pubic bone at the beginning of the second trimester. As it grows larger, it must lift up and out. The next few months will see changes in your shape and size. There’s no way of getting around this.
• Stuffy nose – if you’ve experienced this, it will probably continue for a few more weeks. Try to spend as little time as possible in air-conditioned spaces with low humidity. Breathing can be made easier with a humidifier or a basin of water in the space.
• Braxton Hicks Contractions – they may begin as early as week 26. These are painless uterine contractions that are intended to improve the blood supply to your uterus and get it ready for labour. If you’ve already had a baby, you may be aware of this.
• Amnesia – make a note of where you place things during the coming weeks. Don’t worry that you will misplace your wallet or that you’re losing your marbles. Avoid taking on too much at once, and learn to have a laugh. It helps to be humorous.
• Worrying – you may find yourself fretting in the tiny hours and gentler moments about whether the baby will be okay and how you will manage it if it isn’t. The second trimester is when it becomes clear that there is no turning back. There are no guarantees when it comes to having children, but rest assured that nature is highly intelligent and typically gets it right.
• Think about your diet and if you are eating as well as you could be. You don’t need to eat for two, just really well for one. Expect yourself to start gaining weight through your second trimester. Most women find their weight remains stable in the first trimester or even drops in response to their appetite changes. A healthy weight gain throughout pregnancy for most women, is between 10-12 kilograms.

Your Baby’s Development

• Weeks 14 – 16
  Your baby is about as big as your closed fist. Your baby can swallow during these weeks and will quickly learn to swallow the amniotic fluid and recycle it through its kidneys. This may not seem very appealing, but it’s a crucial way to find out if they’ll have kidney issues. It aids in the growth of their lungs as well. It cycles between periods of rest and activity and is beginning to move pretty actively. All that movement helps muscle growth and the development of the network of nerve connections connecting your baby’s brain, spinal cord, and muscles. Your baby will grow to be about 110g in weight, and 13cm in these weeks.

• Weeks 17 – 19
  Your baby’s legs are growing longer and its trunk will start to straighten out. Your baby’s brows and eyelashes were added this week to go with its naturally hairy physique. Don’t worry, though; unless your baby arrives early, all that lanugo—hair—will be lost. If this is your first pregnancy, you are now likely aware of when your baby is moving around. It is possible to feel motions or a quickening from approximately week 14 if you have previously been pregnant. Its skin is currently developing a vernix caseosa, a white, oily covering that serves as an additional layer of defence for that delicate skin and the baby will now weigh about 260g and measure about 15cm in week 19.

• Weeks 20 – 22
  On ultrasound, you can see your baby’s sex now, if not over the previous few weeks. Your uterus will soon reach your navel and you experience less erratic and unexpected kicks because its limbs and legs appear to be in proportion to one another. They appear to be more powerful and deliberate than they previously were. Get in the habit of chatting to your baby, playing music for it, and having your partner converse with you through your tummy wall because your baby is likely hearing a lot of muddled noises by this point. Doing this pays off because when your baby is born they are more likely to respond to his voice.

• Weeks 23 – 25
  Your baby will gain two times as much weight in the next month. They will put on weight and lay down crucial fat as they fill out to fit their skin. You’ve probably noticed that you’re growing larger at this point. Your baby is breathing by sucking amniotic fluid into and out of its lungs. Moreover, hair is growing in all the appropriate places, including on their head, eyelashes, and eyebrows. In preparation for their first breaths, your baby’s lungs are developing air sacs. Although you are still giving your baby all of their breathing at the moment due to this week’s extensive lung growth, they will soon be able to breathe on their own.

• Weeks 26 – 27
  Your baby’s eyes do have vision, and you could notice that they are more alert while you are outside in the sunshine. They can feel touch through the abdominal wall and can move in reaction to light pressure on the wall of your abdomen. Your baby and placenta are approximately the same size. The past weeks would’ve been very active, with frequent bursts of kicking and stretching. Even though they would almost surely require assistance if they were born this week, your baby is still learning how to breathe. Check to see if your stomach is regularly moving. It might be your child’s hiccups.

Pregnancy is such a transforming event, emotionally, spiritually, and physically. Throughout a typical pregnancy, your body will undergo significant changes. The physical, emotional, mental, and spiritual impacts will vary between individuals. However, the growth of your baby follows a general trend. The three stages of pregnancy are referred to as trimesters. Each trimester is about three months long.

• 1st trimester – Conception to 13 weeks
• 2nd trimester – 14 weeks to 27 weeks
• 3rd trimester – 28 weeks to 42 week

By this time, you most likely feel as though you have accomplished a huge goal. The countdown to when you will deliver your baby officially begins when you enter your third trimester. According to official definitions, the third trimester refers to weeks 28 to 42 of pregnancy. All of your baby’s organs and systems will be getting ready for life outside the womb throughout this trimester. Even though they have been fully formed since 12 weeks, they have grown, matured, and developed significantly since then. The motions of your baby will get stronger, clearer, and less subtle than they have been. As your baby becomes bigger, there won’t be as much area for movement, so you’ll definitely feel kicks and noticeable positional changes.

How you may look and feel

• Baby bump – you will undoubtedly grow larger during the third trimester. Deep breaths are becoming very hard as your tummy expands and grows. You’ll start to feel progressively bloated, out of breath, and swollen, which is really not a good combination. Some pregnant ladies carry their baby discreetly, as if they had slipped a ball under their sweater. Others grow from their front to their back and all the way around, others appear to be spreading. The growth of your baby and your own shape and size really determine this. There is no one right way to look.
• Walking/Balance – your balance may seem shaky, increasing your risk of falling. Take your time walking, especially going up stairs and avoid wearing high heels.
• Fatigue – throughout your third trimester, you’ll feel the effects of caring for your developing baby and get tired more quickly. You could feel worn out and completely sick of being pregnant as your due date approaches. Without a doubt, this will impact your whole feeling and mood. Rest and put your feet up when you can. Don t push yourself. Try to have a daytime rest everyday and nurture your body.
• Concern – you may start to worry more and more about labour and delivery. If you prefer to feel in control and that you have everything under control, the idea of the unknown and letting things play out as they unfold, may not sit well with you.
• Stress – you can genuinely begin to doubt how you’ll manage taking care of a new baby. The idea of taking care of another child may seem daunting if you already have young children who place a lot of demands on you. Discuss the situation with your partner and set up some early support systems among your family and friends.
• Diet – Eat when you are hungry, stop when you are full. You probably won’t feel like big, heavy meals, there’s just not enough room for your stomach to hold much anymore. Remember to drink at least 2 litres of water every day to keep you well hydrated and your mind alert.
• Birth plan – Invest some time and energy into writing up your birth plan. Include your partner’s wishes and how you feel they could best support you. If you are considering having a doula or other support people present, talk with them about how you both see their role. Remember that labour can be unpredictable and despite planning, there are often unforeseen events which can occur.
• Preparation – Get things ready for your baby’s arrival. Wash and fold those tiny clothes and take pleasure in nesting for you little one. Take a moment each day to just sit in your baby’s room and think about how your new life will be when you have your baby. This is a lovely thing to do.
• Complications – difficulties are most likely to arise during the third trimester. It is possible to develop pre-eclampsia, gestational diabetes, hypertension, haemorrhage, or issues with the amniotic fluid. This is one of the causes for the increased frequency of your antenatal exams.

Your Baby’s Development

• Week 28 – 30
  Now that your baby’s head is in proportion to its body, it appears more normal. During these weeks, your baby will grow to weigh about 1.3kg. Their brain has undergone significant development during sleep, and as of this week, it is beginning to experience REM (rapid eye movement) sleep periods. To preserve energy and lay down its fat reserves, sleep occupies a significant portion of its waking hours. Now that your baby’s brain is developing quickly, consume a lot of brain food and go to the fish market. Keep in mind to steer clear of seafood since they may have high mercury levels. Consider fish that are higher up in the food chain and predators of other fish. You should eat these.

• Week 31 – 33
  Sleeping is something that your baby does a lot of. Your stomach may roll when it shifts positions when it is awake. You might feel the occasional elbow or knee poke you while seeing it hiccup away. Your baby may be in a head down position now. In these weeks, your baby will be gaining fat beneath their skin and is now putting on weight faster than they are growing length wise.

• Week 34 – 36
  The skin of your baby is still a bit loose and quite red. Your infant is blinking, moving, and grabbing things now. Of course, it is unaware of what it is doing because conscious thought and purpose are still months away. They also undergo regular cycles of activity and relaxation. The brain of your baby is developing quite quickly. Baby may start to engage with your pelvis this week, and you might feel as though it is lowering. You will have greater breathing room as a result, but more pressure on your bladder.

• Week 37 – 39
  Your baby’s lungs would be able to function normally if it were born right now. It wouldn’t need assistance to breathe; it could do so on its own. From now on, it could be born anytime, so be ready. It has less wrinkled skin and a thicker, more obvious layer of fat beneath it. It begins to reabsorb the vernix that had been covering it. Everything is set to go at this point. Your unborn baby is almost ready for an independent life and is getting set to be born. Its brain is still developing, and it is still adding a little weight. This is typically the time that a scheduled caesarean section delivery will take place.

• Week 40 – 42
  You’re there, prepared to give birth at any time. You’re not alone if you still can’t wrap your head around it; many mothers experience this. The exact reason when labour starts is not totally understood. According to one idea, the baby releases a specific protein, which prompts the mother to begin contracting. As you anxiously await for the day, you may find you have a short fuse, even with your own shadow and feel as though you are going through the longest gestation in human history. Having a baby past their estimated due date implies different things to different people. Some expectant mothers will be at ease about it because they are sure that the baby will arrive at its own pace and happily wait it out. Other people are anxious about it and nervous, unsure and waiting for anything to happen and may feel pressured towards having an induction.

Throughout your pregnancy you will be monitored to ensure you and your baby are healthy and well. This includes regularly checking your blood pressure, urine, the size of your baby ‘bump’ and your baby’s heartbeat. These are to check that your baby is growing as expected and there are no concerns.

In addition to regular monitoring, there are a number of screening tests which are routinely offered to pregnant women. One purpose of the screening tests is to help women avoid more invasive diagnostic testing. Screening tests are undertaken to check for any potential medical conditions and to check baby’s growth and development and how your body is coping with the physical changes and demands of pregnancy. If screening shows that you or your baby may have a condition, you will be offered further tests that will let you know for certain.

Before having any screening tests your midwife will offer you information about the tests and discuss these with you and answer any questions you may have. This allows you to make an informed decision that is right for you and your baby. Giving consent or declining some or all screening is your decision and will be respected.

Things to think about when considering screening or diagnostic tests

• Why is it being done?
• Do you want to know there is a problem?
• Would you terminate the pregnancy if there was a problem?
• How will knowing of a problem affect how you feel about the pregnancy?
• Will knowing of a problem give you the chance to make plans?
• Do you know the risks?

BLOOD TESTS

At your booking visit your midwife will discuss with you and arrange some booking blood tests, if that is something you consent to. These are done to give your midwife some basic information about your health. They will also discuss tests that can be done at the same time to screen for Down syndrome and other conditions.

Booking Blood Tests Include:

• Full blood count and antibody screen – This checks your haemoglobin (iron) levels and sometimes ferritin, to check for anaemia.  A full blood count also examines white blood cell levels, platelets and antibodies.
• Blood group and Rhesus factor – This test determines your blood group and your Rhesus factor. If you are Rh negative, you’ll be offered injections of anti-D immunoglobulin, at times when you may be exposed to your baby’s red blood cells during your pregnancy, such as, after any bleeding in pregnancy, or after a miscarriage and after the birth.
• HBA1C (Glycosylated Heamoglobin) – This checks if you have diabetes or if you are more likely to develop diabetes later in your pregnancy.
• Rubella serology – This is to confirm that you are immune to rubella (also called German measles). While rubella is a rare virus, if contracted during pregnancy it can cause severe birth defects in your baby (eg, blindness, deafness or heart defects). or miscarriage. Non-immune women can consider the option of vaccination AFTER pregnancy.
• Hepatitis B – is a viral infection, and many people are unaware they are carriers as there is often no or mild symptoms. Hepatitis B can be passed onto your baby during the birth through contact with your blood and body fluids, this can happen with a vaginal delivery or Caesarean section. There are very effective treatments that can prevent hepatitis B being passed onto your baby after it is born.
• Syphilis – is a rare sexually transmitted disease, which can cause serious health problems for you and your baby, as the infection can be transmitted from mother to baby through the placenta and can cause a stillbirth or serious problems such or deafness, seizures or birth defects.
• HIV – Testing for HIV is now routinely offered to all pregnant women. If HIV is detected, additional care and support will be offered to minimise the chance of transferring the virus to the baby during birth and breastfeeding, as well as to manage long-term health for the mother.

Your midwife will offer another blood test around 28 weeks to recheck your iron levels, antibodies and this can be done in conjunction with screening for gestational diabetes. Your midwife may also recommend rechecking iron levels and antibodies. This can be done at 36 weeks, if there has been concerns during your pregnancy.

URINE TESTING

A urine sample is recommended at the time of your first blood test to check for urinary tract infection (UTI), which may be present without any symptoms. The presence of bacteria in your urine increases your risk of kidney infections later in pregnancy, if left untreated.

SCREENING FOR DOWN SYNDROME AND OTHER CONDITIONS

First trimester combined screening – This consists of a blood test (MSS1) taken between 9 and 13 weeks + 6 days of pregnancy and an ultrasound scan (nuchal translucency scan) between 11 weeks and 13 weeks + 6 days of pregnancy. By combining these screening tests results with your age and weight, your personal chances of carrying a baby with Down syndrome or other condition is calculated.

Second trimester maternal serum screening – This is a blood test (MSS2) available if you are 14–20 weeks pregnant and the results of a blood test are combined with other information, such as your age and weight, to calculate your personal chances of carrying a baby with Down syndrome or other condition.

One purpose of the screening tests is to help women avoid more invasive diagnostic testing, they will provide an assessment of your chances but won’t give you a definite yes or no answer. The actual result you will receive will say either, ‘increased chance’ or ‘low chance’. A high chance screening result doesn’t mean that your baby has a health issue, and the majority of babies with high chance results will be healthy. If screening shows that there is an increased chance for a genetic condition, your midwife will discuss the result with you and the options available for diagnostic testing if you want this.

PREGNANCY ULTRASOUND SCANS

The two scans routinely offered are the nuchal scan and the anatomy scan. Having a scan and the chance to see your baby is usually exciting, but remember sometimes scans find serious problems, so you should be prepared. Knowing about potential serious defects before birth can be useful, it may also put your mind at ease if you receive a clear scan. However, no test is perfect, not all defects are detected and vice versa not all abnormal ultrasound findings mean there is something wrong with your baby. This situation can be very difficult because it obviously causes parents and whānau to worry about their baby. The ultrasound scans you will be offered in your pregnancy are optional. It is your choice whether you have them or not.

Nuchal translucency scans are part of first trimester combined screening for Down syndrome and other conditions. If you decide to go ahead with this optional screening test, you will be offered a scan between 11 weeks 2 days and 13 weeks 6 days. The nuchal translucency is the measurement of fluid behind your baby’s neck. This result can be used (along with blood tests) to calculate the chance of your baby being born with some genetic conditions such as Down syndrome. This scan also confirms your due date, checks the number of babies and that a heartbeat is present.

Anatomy scans are offered between 18-20 weeks, parts of your baby’s body will be measured to check that they are growing as expected and to look for any anatomical malformations. The position of your placenta will also be checked to ensure it is clear of your cervix. Also, you might be able to find out what sex your baby is at this scan, or you may prefer to wait until your baby is born, best to let the sonographer know either way.

It’s not necessary to have a dating scan early in your pregnancy unless you have an irregular cycle or do not know approximately when your last period was. However, you may need a scan in early pregnancy if you have complications such as bleeding. If your midwife is concerned about your baby’s growth or position in the third trimester, then additional ultrasound scans may be recommended. Routine third trimester scanning of people whose pregnancies are progressing normally does not lead to healthier babies or fewer problems during labour and birth. Scans in late pregnancy have a significant range of error of +/- 15% in estimating your baby’s weight. This means that if a scan estimates your baby weighs 4kg, your baby could actually weigh between 3.4 and 4.6kg.

GESTATIONAL DIABETES SCREENING

Approximately 4% of women develop gestational diabetes during their pregnancy. Diabetes screening in the form of a polycose test is offered when you are 24–28 weeks pregnant, to assess if you are at risk of developing diabetes while you are pregnant. You will be given a drink high in sugar and an hour later some blood is taken. If your blood sugar is higher than the normal range, you may need a further diagnostic test called a Glucose Tolerance Test (GTT). A positive polycose test is not a “panic situation” – about a third of women with a positive polycose test will go on to have gestational diabetes confirmed with a GTT. If you do already have diabetes or you develop diabetes in pregnancy, you will be offered information, treatment and support – including dietary help and staying active.

 GROUP B STREP SCREENING

 Group B strep is a transient bacteria that is harmless for women, but occasionally it can be transferred to babies during the birth process and can cause severe infections. In New Zealand, it is not recommended that all pregnant women be routinely screened for GBS colonization. Instead a clinical risk factor approach is recommended. The risk-based approach recommends that all women with one or more of the following factors be offered intrapartum intravenous antibiotics:

• a previous GBS-infected baby
• GBS bacteriuria of any count during the current pregnancy
• preterm (<37 weeks) labour and imminent birth
• intrapartum fever > 38° C
• membrane rupture > 18 hours

A pregnant woman can be checked for GBS at 35-37 weeks pregnant with a test that involves collecting a swab from the lower vagina and anus, and culturing the sample on a special medium. The test result is usually ready in 2 or 3 days. Unfortunately, there is no accurate rapid screening test to detect the presence of GBS that can be used when a woman goes into labour. A positive culture result means that the mother is colonised with GBS. It does not mean that she has GBS infection, or that her baby will become ill. A recent study has shown that 10% of women with negative screening were actually positive for GBS when in labour, whilst 50% of women with a positive screen result were negative for GBS when in labour.

Pregnancy can be both exciting and overwhelming for you and your partner. Since so much of it is unknown, it can feel both terrifying and exhilarating. Most soon-to-be parents have many questions about the pregnancy itself, such as what to expect. Childbirth education/antenatal classes provide the opportunity to learn more about your pregnancy and can help you to prepare for your baby’s birth and the first few weeks after baby is born.

These programmes can help you and your partner obtain the confidence you need as you prepare for labour and parenthood. The sessions are held in a pleasant and accepting setting where qualified instructors can answer any questions, concerns, or ideas you may have. They also allow you to learn more about what to expect and how to best prepare you for labour and birth. These sessions are also a good way to make friends and form a supportive network with other parents who are expecting babies around the same time as you. These friendships can help you through the first few months with your baby. Many groups continue to meet regularly, and can be great support networks, well into the future. There are alternative options for getting the knowledge and assistance you need if you don’t want to or are unable to attend classes, such as online programmes.

There are a range of publicly funded, free to access pregnancy and parenting education sessions available regionally throughout Aotearoa New Zealand. There are also numerous other private programmes available that charge a fee. There is a diverse range of childbirth education available, which includes programmes that are focused on Kaupapa Māori, Pasifika and Teen parenting. In many regions there are also other courses that pregnant women can attend such as hypnobirthing training, mindfulness focused programmes, and pregnancy yoga. Think about what you hope to gain from childbirth classes so you can find the sort of class that suits you best. To find out about classes near you, check with your midwife to find out what is available in your region.

Most classes offered tend to start when you are around 30 weeks pregnant, however in some regions there may be introductory classes on offer, that focus on early pregnancy care. Places in childbirth classes can get booked up early, so it’s a good idea to start making enquiries early in pregnancy so you can secure a place in the class that you choose. Classes may be held once a week, either during the day or in the evening, for around 2 hours, or some classes may take place over 1 or 2 weekends.

Some of the topics that may be covered in childbirth classes are:

• staying healthy during pregnancy
• what happens during labour and birth
• coping with labour and information about different types of pain relief
• how to help yourself during labour and birth
• relaxation techniques
• information about different kinds of birth and interventions
• making a birth plan and considering the different arrangements for labour and birth
• caring for your baby, including feeding
• your health after the birth
• emotions and feelings and your relationship during pregnancy, birth and after
• how to incorporate your culture and toanga

Home Birth Aotearoa in conjunction with Mamarise have created our education series that is easily and freely accessible.  These video presentations are designed to help educate people who are planning to birth at home or exploring their options. Check them out here.

It can be beneficial and can make all the difference to have a well-prepared birth companion/s with you during your labour and birth. When you choose to give birth at home, you will have more freedom and control over your surroundings and the people you have with you during labour and birth. You have the option of inviting your partner, your family, a friend, a doula, a student midwife, or a combination of these people, along with your other children. Be mindful, having too many people present or the wrong people can distract you and even slow down your labour.

The most crucial thing your birth companion/s can do for you, whomever they may be, is simply to be with you, care for you, remain calm and positive, and encourage you. Your birth companions should be people you trust and make you feel comfortable, want to be there, and be well prepared. If your birth companion has never attended a birth before, they may be anxious or nervous about what will be required of them during labour and delivery. Attending courses together can help them understand what to anticipate during labour and birth. Before the birth, talk with your birth companion/s about your birth plan, so they know what you want them to do and how they can help you, as well as the things you would prefer to do and avoid, so that they can back you up in your choices.

There are some things to think about and discuss with them before the birth, about how they can assist you during labour and birth. Knowing how to assist someone in labour can be challenging if you have never been to a birth. Many people experience a sense of helplessness when they witness a loved one experiencing intense and at times painful contractions. Even though they aren’t the one giving birth physically, their support is essential. The more prepared and at ease they feel, the better they’ll be able to support you.

For your birth companion/s

What you see in the movies often bears no resemblance to the reality of birth.  It is your responsibility to be a composed and comforting presence that helps the mother get through the difficult times she will experience during labour. It’s really beneficial to do some research and become knowledgeable on what to anticipate so that you can provide the mother with the best support possible while also being emotionally ready for yourself. Attending antenatal courses and appointments will help you better understand the basic physiology of labour and birth. Birthing videos, books and podcasts can also be helpful. Ask whānau and friends what it’s like to give birth, and what helped them. 

You need to be aware of the mother’s labour and birth preferences, such as environment, pain relief and where she stands on interventions, and how she envisions her labour to go, so going over these together, is important. This enables you to encourage her decisions and, if required, advocate for her.  Every person giving birth has the legal right to informed consent, but some women find it challenging to communicate their personal preferences while they are giving birth. It is your responsibility to encourage and empower them to make these decisions, and if the mother is unable to voice her preferences at the time of birth, you should assist her in doing so.

A birth companion has a demanding job. You’re giving nonstop assistance, which can be exhausting on both an emotional and physical level. Make sure you look after yourself and you feel prepared. Labour can be long, so remember to eat and drink, rest when you can and you may want to pack some fresh clothes. Seeing people you care about in pain can be intense and distressing, be careful not to project that into her space and have some stress management techniques to use for yourself, like deep breathing. It is important that you remain calm and composed. 

You can be supportive by keeping the birthing woman company in the early labour and doing things like going for walks will help to distract her and also help to pass the time. Be nearby to help them physically, when changing positions or to lean against, support their body weight or simply hold their hand.  You can provide physical touch if they are open to it, be mindful, some labouring women are not comfortable being touched and as labour progresses their preferences may change, so check in with them. Some women giving birth prefer light touch massage/mirimiri because it helps them remain calm and relaxed during contractions, whereas others prefer firmer pressure, such as acupressure to help provide some pain relief during strong contractions. Offer sips of water and small pieces of food, to keep her energy up.

You can also support her mental and emotional needs. By reassuring and encouraging her with your words. Once more, talk with the individual who will be giving birth prior to labour to determine which affirmations, mantra or whakataukī is meaningful to them and will work best for them. Remind her how to use relaxation and breathing techniques, perhaps breathing with her if it helps and let them know what’s happening when the baby is being born, if they can’t see what’s going on. When she is pushing you can reassure her that she’s nearly there and that this is the hardest, but shortest part of her labour and that she will be holding her baby soon.

The act of giving birth is considered sacred by many cultures around the world, and there are many different rituals and traditions surrounding birth. Here in New Zealand, the Māori are known for performing the Tūā and Tohi rituals, where the baby was named and the umbilical cord severed. After this, the baby would be blessed with water in a stream.

In addition to birthing ceremonies, there are also many ceremonies that aim to celebrate the expecting mother and bring her into the fold of motherhood.

In this modern day and age, the ‘ceremony’ that most expecting families partake in is a baby shower. While baby showers can be fun and help you gather the material needs for the baby, it often misses out on the spiritual aspect.

If you want to prepare yourself spiritually and emotionally for embarking on motherhood, you may want to partake in some form of mother blessing ceremony. They come in many different forms and may bless you through a song and include a circle of wise women and mothers. You can completely customise your modern mother blessing and ensure that it empowers you for this significant life change.

By honouring the pregnant woman through ceremony, you acknowledge how important this phase of life is.

Some rituals that you may want to include in your ceremony include:

• Washing the expectant mother’s feet in an act of service.
• Painting henna on the belly to honour the baby.
• Gentle pregnancy massage.
• Smudge sticks and incense to cleanse the space.
• Hanging prayer flags as an act of support.
• Verbal affirmations towards the expectant mother.
• Singing, chanting, or prayer.
• Providing the mother with food.
• Guided meditation to release fears.
• Braiding the mother’s hair and pampering her.
• A beading ceremony
• Red thread bracelets
• Creating a cast of the pregnant belly.

You can include whatever resonates with you in your ceremony and leave out anything that doesn’t.

Hapūtanga and whakawhānau are regarded as tapu in Te Ao Māori. It is through childbirth that whānau, hapū, and iwi are created. Bringing treasured new life into the world involves both the body and soul. While many Māori principles and beliefs are shared throughout Aotearoa, each iwi possesses its own tikanga, so you might want to learn more about the traditions of your own iwi/hapū. Karakia are performed in order to thank Te Ao Wairua and request the protection of the atua, Hineteiwaiwa, during labour and delivery.  Whānau may also like to use other rongo techniques like waiata, taonga poro, and mirimiri. A muka tie made using harakeke fibre, which has antiseptic and antifungal qualities, is used to bind the umbilical cord after pēpi is born. The umbilical cord is then severed using a pito cutting instrument. The pito blade may be made from stone, such as pounamu, or another natural material, like a shell, or scissors.  Any rituals you may want to include as part of your journey to parenthood should be practiced in a way that feels authentic to your whānau, so if you are not familiar with waiata, or your Tane doesn’t have the best voice, maybe you want to look into having recorded waiata playing in the background, maybe loved ones who cannot be present would like to record a song, karakia or some whakataukī for you.