What happens when I get there? When you get out of the elevator you will see the reception desk. The person there will ask for your name and details. This is so that they can find your notes. We must make sure we have the right ones. She will also put a name band around your wrist. This also means that we can make sure we have the most up to date details e.g. you may have changed your mobile phone number. We will ask for your name and your date of birth and check this name band often during your stay. This is to be extra careful that we are looking at your paperwork. You may be asked to take a seat while the midwife in charge is told that you have arrived. She will send a midwife or nurse to meet you and show you to your room. Please tell the person at the desk if you have any bleeding, feel like you need to push in your bottom or anything else which you are worried about. She will also show you where the bathroom is if you need it. Other women might be in the waiting area. Someone who arrives after you might be taken to a room before you. This is because people are there for different reasons just like in an emergency department. How will I know what to do? Your midwife will explain everything to you. If you are in labour she/he will talk to you about how you would like your labour to be. This can change because of how your labour progresses or if we think that baby is getting tired. But if anything changes your midwife is there to help you understand what is happening. Your midwife might ask another midwife to help her: to be with you when she has a meal break to look at the baby heart rate monitor to check a medicine She may also ask a doctor to come and see you if she has any concerns. B & A has specialist doctors working at all times. But if everything is normal it is possible to have labour and birth and not need to see a doctor. Depending on the reason for your visit to B & A the midwife will usually see you first then you may need to wait again to see the doctor. The doctor may have lots of people to see and will also need to deal with any emergencies.

You will probably start to feel your baby moving by around 16 weeks. By about 28 weeks you can start to see a pattern to the movements. It is really important if you feel your baby is not moving as he/she normally does that you do something about it. We know that sometimes babies who change how they move are unwell. Telling a midwife as soon as you are worried can mean that, if baby is unwell, we can help. By a change in movements we mean: no movements less or slower movements than you feel are normal odd movements like really fast or big anything which makes you worried. We know that living every minute of every day means you are the best person to decide if something is not normal with movements. Even if everything is fine when we see you, and baby starts moving normally, it is best to check. It is never a waste of our time. Pamphlet - My Baby's Movements

There are a few reasons why you might see blood. If you are not 20 weeks yet you will be seen in the Emergency Department and possibly the Gynaecology Care Unit. If you are 20 weeks or more you will be seen on B & A. Bleeding is never normal while pregnant but it may not be caused by anything serious. That is why we get you checked over; you and your baby. A show: this is nothing to worry about but can look quite scary. It might be sticky smears when you wipe. It might be a great big snotty lump - or anything in between. The blood will not be runny and may be quite brown. A show is part of the body getting ready for birth but don’t get too excited, it can still be a while before labour starts. Bleeding after sex: please try not to be embarrassed when we ask you about sex – it gives us a clue to why you might be bleeding. Most often this bleed is because your cervix (the part that will open in labour to let baby through) has become a bit raw because of pregnancy changes. Bleeding from the placenta: this is the one we are most worried about because it can make you and your baby feel unwell. Sometimes with this type of bleeding you will have pain or feel like you are having labour pains. This bleeding can be because your placenta (whenua or afterbirth) is near the cervix and the edge has lifted. It may be that an area of the placenta has come away from the side. Pamphlet Placenta Praevia This bleeding can be a little or a lot; bring any pads or towels you have used with you. We need to try and decide how much bleeding there is. If it is down the toilet think about how much it looks like – a teaspoon? A cup? It is almost impossible for you to know why you are bleeding so it is important to check it out. Speak to your midwife or one of our midwives or come straight in.

This is when your baby is bottom first and we turn it to be head first. Click on the pamphlet link and you will see some pictures. It is all done from the outside of your tummy at around 37 weeks. It is only done by a senior doctor and your baby is monitored to make sure he or she is happy. You will be on B & A for about an hour. You will be given a date and time to come. Pamphlet ECV

Every time you have a pregnancy check your blood pressure will be checked. Many women will have low blood pressure most often in early pregnancy and it can make you feel faint. But it is high blood pressure we are checking for. High blood pressure can: be already there before you got pregnant or noticed in early pregnancy - "essential' start in pregnancy and usually towards the halfway point or later - 'gestational' start in pregnancy like gestational but you also have protein in your urine - 'pre-eclampsia' start with essential but then you get pre-eclampsia as well. Why do midwives and doctors worry about high blood pressure? High blood pressure can become dangerous for you and for your unborn baby and that is why it is really important to us. It can cause your baby to: grow very slowly become unwell because his/her blood supply is not as good as it should be and you to: have headaches, flashing lights in your eyes, swelling have a fit (eclamptic seizure) need to stay in hospital before and after baby is born bleed from the placenta before or after the birth need to be on tablets to control the blood pressure. In rare cases, when the blood pressure is very high, women may have a stroke. Although unusual, we want to stop it happening to any woman and her family. We want to see you in B & A so we can: send blood and urine tests which helps us to know what sort of high blood pressure you have and how bad it is check your blood pressure often over a period of time check how your baby is doing start tablets if you need them. Pamphlet - pre-eclampsia

You may be asked to come to B & A to see one of the doctors because your baby is small. Sometimes you will see a doctor for the same reason in one of the antenatal clinics. Some babies do not grow as well as we would expect for your build and ethnicity. A lot of work has gone into software that lets us make a grow chart which tells us the average size for you. Using this we can see how your baby is growing. When a baby is not growing well this is called ‘intrauterine growth restriction’. This can be caused by: too little blood supply to baby through the placenta a problem with the baby. Having screening tests (link) and an anatomy scan around 20 weeks can help tell if there is a problem with baby. After that further scans may be advised (link to OGUS). If there does not seem to be a problem with the baby then the placenta is the likely cause. There are a number of reasons why this happens: you are a smoker – this causes restricted blood flow in parts of the placenta so only part of it works properly. If you stop smoking before 16 weeks you can stop this being the problem you have high blood pressure starting in pregnancy – the blood pressure is because the placenta did not implant well at the beginning you have high blood pressure before pregnancy you have diabetes – not all diabetic women have big babies. For some their baby is really small obesity – some obese women have good size babies but some have growth restricted It can be difficult to feel baby's size and often regular scans are recommended anaemia – this can limit a baby’s growth and so we will try to treat anaemia or low iron stores early drug and alcohol use. If you have had a small baby before you have a higher chance of another unless you have changed something e.g. stopped smoking. We give some women a simple aspirin tablet each day from around 10 weeks of pregnancy until 36 weeks as studies have shown it helps the placenta supply the baby and encourage growth. You may be sent a prescription in the post. Booking late may mean you miss out on the chance to take this. If we find that your baby is small, you will need to have more checks and scans. This is so that we can check that baby is: growing: ask to see where the scanned weight of your baby plots on the grow chart (from the software) in plenty of fluid getting a good blood flow coping well. There may come a point when all is not well and it is time for your baby to be born. This would mean we would either induce (link) your labour or perform a caesarean. This can happen before your due date. If your baby is less than 34 weeks we would try to give you steroids before baby is born. See Premature Labour and Birth.

When we start your labour instead of waiting for your body to start itself it is called induction. There are a few reasons why we would want to this. You are very overdue. Pamphlet - Post dates pregnancy Your baby is not growing as well as he/she should. Your baby is fine now but we are worried that he/she may become unwell if not born soon. There is not a lot of fluid (waters) around baby. If one of our doctors or your midwife thinks that induction is a good idea they will explain the reasons why. Never be afraid to ask questions. Talk to your midwife about what sort of things we do to start labour – she will be able to talk about what is likely for you. It all depends on how many babies you have had before, what sort of births you have had and sometimes how many weeks you are. Pamphlet - Induction of Labour Pamphlet - Induction of Labour in Samoan

Your baby is floating in a special liquid called liquor. Often called 'waters', it is really important for your baby and his/her growth, to practise breathing and even drinking! A double layer of membranes are joined to the placenta to make a flexible, but tough, bag to hold your baby. If a hole is made in the bag it is called rupture of membranes. This is normal when you are within 3 weeks of your due date but if it happens earlier it can cause problems: your baby may be born earlier than expected you may have an infection which has caused the hole you will need to have checks more often for the rest of your pregnancy to make sure there are no signs of infection and your baby is doing ok higher risk of bleeding. If you are less than 34 weeks pregnant we usually: give you antibiotic tablets as this is known to make time until labour longer. You are also less likely to get an infection give you two steroid injections as these help mature baby's lungs give you a weekly steroid injection up until 32 weeks. If you are between 34 and 36.6 weeks the doctors will make a plan for you and your baby.

Your baby is floating in a special liquid called liquor. Often called 'waters', it is really important for your baby and his/her growth, to practise breathing and even drinking! A double layer of membranes are joined to the placenta to make a flexible, but tough, bag to hold your baby. If a hole is made in the bag it is called rupture of membranes. When this happens around the time your baby is due it is normal but there is a risk of infection. Because the bag protects your baby from the outside world we look for any signs of infection in you or baby. We do this by checking your temperature - if you are hot baby will be too. We also listen to baby's heart rate - this can tell us if baby is unwell and a fast heart beat tells us baby is hot. Usually a high temperature means infection. If there are signs of infection, or if it has been between 24 and 48 hours since your waters broke, it is a good idea to have labour started. This is because the risk of infection increases the longer the waters have broken. It does not take long for infection to make both you and baby unwell. For women whose waters have been broken more than 18 hours we will give antibiotics into a vein during labour - usually every 4 hours. This is to protect baby from infection. We start the antibiotics when you go into labour or when you have the first internal - whichever is soonest. For many women labour will start itself but if not we use a hormone gel beside your cervix (opening to the uterus). We give two gels with 6 hours between. If after another 6 hours your labour has not started we will give you a medicine in a drip. The normal colour for liquor is clear or 'straw' coloured although it is sometimes pink. Green liquor means baby has had a poo inside and even if he/she seems happy we think we should not wait to start labour for you. Pamphlet - prelabour rupture of membranes at term

This is the name of a bacterium which is often found on swabs from the vagina. If it is there you would not know – you get no symptoms. If it is in your urine you may have the signs of a urine infection. If we find it on swabs in pregnancy we will not treat you. It comes and goes and treating it does not stop it from coming back. But there are two main times when it is important that you get antibiotics: if it is found on swabs after 34 weeks of pregnancy – because during birth the infection can pass to baby if it is found in urine – all urine infections need to be treated as they can make you really ill and they can lead to premature birth. This will be treated with antibiotic tablets. Why does it not pass to baby in pregnancy? This bacteria does not move upwards. It is baby moving downwards or vaginal examinations which cause the risk. That is why we give you antibiotics into a vein every 4 hours when you go into labour. If your baby does become infected he/she can be very sick. Are there any other reasons to give the antibiotics in labour? Yes, we give them if: your membranes rupture before labour and you are more than 37 weeks; Read more you are in preterm labour and your membranes have ruptured Read More the bacterium has been found in your urine at any time in this pregnancy you have had a baby before who has been infected with this bacteria. We may want to keep you and baby in hospital or the birthing unit longer than you planned. This is to make sure your baby does not show signs of infection. This will all depend on how much of the antibiotic you had before he/she was born. Pamphlet - Group B Streptococcus

There are a few reasons why you might feel pain in pregnancy. When you come to B & A it is our job to find the cause of the pain. We will try to find out if it is: Labour - this can happen before you reach the end of your pregnancy (premature). Babies who are born early can need lots of help at birth. If we know you are in premature labour we can prepare for the birth of your little babe Urine infection - this can be really painful, often in your tummy but also in your back. We will do a urine test and may start you on antibiotics. If a urine infection is not treated it can lead to premature birth. It can make you really sick and you may need to stay in hospital for a few days Pelvis pain - often women come to us in pain and it is caused by pregnancy hormones making your pelvis move more. This is so that you are ready for labour but for some women it can really hurt. Your midwife can refer you to a physiotherapist to help manage this An accident - if you have had a bump to the tummy we would like to see you. Let us check you and your baby are ok so you do not need to worry. You need to be sure that your pain is not caused by a serious problem. Sometimes some exercises or a support belt for your tummy will be the help you need. Often the pain is one of the normal feelings you get as your body copes with carrying another person. Whatever the reason we are here to help.

Sometimes you will go into labour before baby is due. If this is before 37 weeks it is called 'premature'. How we manage this depends on how many weeks into your pregnancy you are. The earlier it is, the more we will need to do to try and make sure baby is as well as possible at birth. We may want to: delay labour - this is done by giving you tablets which stop the muscle of the uterus contracting give steroids - these injections are given to you and pass through to baby making his/her lungs more able to cope with breathing in air take swabs - one of these can help us know if you will go into full labour, the others test for infection. If infection is found we will give you antibiotics to treat it speculum - a speculum is a plastic instrument to let the midwife of doctor look at the cervix (entrance to uterus which opens in labour) give magnesium sulphate - this is a drip which has been used recently as it seems to protect the premature baby's brain pamphlet magnesium sulphate for neuro protection check with the Neonatal Intensive Care Unit to make sure there is a cot for your baby - sometimes we need to send you to another hospital if our unit is full take you to visit the Neonatal Unit if possible. We would normally try to delay labour with medication in order to give you the two steroid injections needed to help baby or to allow us to transfer you to a hospital where there is a neonatal intensive care cot for your premature baby. It is often safer and easier to transport baby inside of you than after he/she arrives. Pamphlet - Premature Labour

If I need some pain relief what can you give me? Pamphlet - pain relief choices Non-medical (non-pharmacological) pain relief Water. We have showers in every birthing room and some baths. Water helps reduce pain and helps you relax Heat packs – We have our own. Safety rules mean we cannot use your wheat bags or hot water bottles Movement and touch. Your midwife will make suggestions of things for you and your supporters to try. If you are on your own, your midwife will be your supporter Music - bring your favourite relaxing music pamphlet non-pharmacologocal Medical pain relief Entenox (gas & air/laughing gas) in every birthing room. We use mouthpieces (not masks) for you to breathe it through Pethidine – this is an injection which goes into a large muscle e.g. your bottom, or into a vein in your hand/arm through a special tube called a luer (venflon) Epidural. We have a 24 hour epidural service. Sometimes you may have to wait if the specialist doctor (anaesthetist) is busy with someone else. pamphlet epidural from anaesthetics Other medicines. There is a small group of women who cannot safely have an epidural but need strong pain relief. Your midwife will call the anaesthetist for you to discuss this

If you are having a planned caesarean you will be admitted to Theatre Admissions and go to theatre from there. This department is on the second floor of the Harley Gray Building to the rear of the Atrium. If you think you are in labour and you are having an elective caesarean section you need to come to B & A to be checked over. Sometimes you will go into labour before the planned date. If this happens we will usually take you to operating theatre early. The caesarean is an operation where your baby is birthed through a cut in the uterus. The uterus is the muscle bag which holds the baby, placenta and the fluid. It is very good at growing and, in the later stages of pregnancy, a lower part or segment will form. This is where the cut is usually made and you may hear the operation called a lower segment caesarean section or LSCS. It is important that everything is kept very clean during any operation to try and stop any infection. This is why we take you to operating theatre. This is a big room with lots of equipment. There will be quite a lot of people too. On average there will be 8 to 10 people, each with their own job to do. One supporter can go with you to the theatre. The bed is narrow and we tilt the bed to the side. This is so you can lie flat without it squashing the blood supply to your baby. Do not worry we will not let you fall. Most women stay awake for their LSCS and have an epidural type anaesthetic which makes you numb from the breasts down. While you may feel some pulling in your tummy, you should be pain free. Once the doctors begin it is a very short time until baby is born. As long as both you and your baby are well after the birth, you can hold him/her skin-to-skin. If you do not feel up to it, your supporter can have baby skin-to-skin. Once the operation is over you will spend up to an hour in the recovery area. Often baby will have his/her first feed there. From here you will go to Maternity Floor. The top to toe check which every baby has soon after birth will be done on the Maternity Floor. Vitamin K is usually offered at this time.

Vaginal birth after caesarean or VBAC is when one of your previous babies was born by caesarean but with this baby you plan a normal vaginal birth. Many women go on to have a normal birth. In your pregnancy one of our specialists will look at why you had the caesarean and advise you if it is a good idea to have a vaginal birth. For some women it is safer to have another caesarean. The risk with a VBAC is that the old scar on the lower segment of your uterus may start to open. If this happens you will have a lot of pain and your baby will become distressed. This only happens in around 1 out of every 200 women having a VBAC. To make sure we spot anything going wrong we will: record baby's heart rate all through your labour keep a check on your pulse rate, blood pressure and pain ask the doctor on duty to come and see you if we have any concerns try to make sure your labour is not too long give your labour care in B & A where help is right there if you need it. The rates of successfully having a vaginal birth are: up to 7 out of 10 who have not had a vaginal birth in the past up to 9 out of 10 who have had a vaginal birth in the past. Pamphlet VBAC