Mimosa Midwifery offer a holistic and evidence based approach to pregnancy care. To help you make informed pregnancy decisions click on the links below to decide what blood tests, ultrasounds and vaccines are right for you and your baby. We have also provided further resources in preparing you for birth and breastfeeding, pregnancy nutrition, and managing common pregnancy ailments.
Informed consent
Mimosa Midwifery respect and support clients right to autonomy, self-efficacy and authority over their own body and care. Maternity information is evidenced based and provided to allow clients to listen, question, consider their own situation and what is right for them in their decision making process.
When a complex decision is needed we encourage clients to use the BRAIN* acronym, particularly where a decision is required which can impact a clients pregnancy, birth or postnatal pathway.
*The BRAIN acronym is a decision making tool for individual situations: What are the Benefits, Risks, Alternatives, Intuition, Nothing, (undecided).
Dr Sarah J. Buckley, MD book Gentle Mothering discusses the BRAN model for gestational diabetes; screening for Group B strep; and induction when pregnancy is “overdue.”
Informed consent and refusal in obstetrics: A practical ethical guide 2017.
Ultrasound & Fetal Monitoring
Mimosa Midwifery request that clients have at least one ultrasound at 20 weeks gestation to check for placental location, and we routinely check babies heart rate during antenatal appointments. If you have any concerns or questions around ultrasounds or fetal monitoring we are always happy to discuss these during your appointments and find an approach that works for you.
ROUTINELY OFFERED SCANS
Dating scan: if you are unsure of your dates or have an irregular cycle.
13 wk ultrasound: Checks your baby’s anatomy, nasal bone, estimates due date, may detect twins, measures nuchal translucency, this is a fluid filled space at the base of the baby’s neck and used as a screening tool which may identify if your baby is at high or low risk for a chromosomal anomaly.
20 wk ultrasound: Examines your baby’s head, chest circumferences, bone length, heart function & organs, placenta location, amniotic fluid around baby and may detect any abnormalities.
The following articles may assist with understanding the use of doppler and ultrasound during pregnancy.
Tests, scans and checks during pregnancy & labour
An overview of ultrasound during pregnancy including what is routinely offered, and the risks and benefits.
Ultrasound scans in pregnancy - Sarah Buckley
Blood tests
Pregnancy blood tests are recommended at the beginning of your pregnancy and again at 28 wks and 36 wks and sometimes for yourself and/or your baby after birth.
The booking blood test check your; pregnancy hormonal levels, exposure to any diseases, your blood group and antibodies*, Haemoglobin, platelet and iron levels, including a mid stream urine test.
If you have any questions or concerns around blood tests during pregnancy, you can discuss with your midwife.
Rh (Rhesus) Negative
There are four blood types, A, B, O & AB. Additionally, on the surface of red blood cells the presence of a protein means you are Rh positive or the absence of a protein means you are Rh negative. 17% of the population are Rh negative.
If a woman is Rh negative and the father of the baby is also Rh negative, nothing further is needed (e.g. A-, A-). However if the father of the baby is Rh positive (A-, A+) your baby may develop a Rhesus positive blood type.
If there is a sensitising event and some of baby’s blood enters the mothers blood stream, her body may create antibodies to attack the unfamiliar Rh positive cells, this may not affect the first pregnancy however it can affect the next pregnancy if antibodies pass through the placenta and result in Haemolytic Disease of the Fetus and Newborn HDFN.
In pregnancy if you are identified as Rh negative it is recommended that you receive Anti-D at 28 and 34 wks of pregnancy. Anti-D is made from the plasma (fluid) part of the blood and is used to prevent the body from making antibodies against the positive cells*.
You can read more about rhesus disease and Anti-D in the following articles
Rhesus D negative in pregnancy 2020
Sara Wickham offers a different perspective on anti-D injections during pregnancy
Maternal Immunisation
Vaccination against hepatitis B, measles, mumps, rubella and varicella is routinely recommended prior to pregnancy. Seasonal influenza and whooping cough/pertussis vaccines are routinely recommended during pregnancy. Your Midwife will request your immunisation history and discuss any questions or concerns you may have around immunisation during pregnancy.
Information regarding the recommended vaccines during pregnancy.
Vaccine safety in Australia 2019 – Pregnant women schedule point.
Group B Strep (GBS)
Your Midwife will offer testing for Group B Strep (GBS) during pregnancy. We recommend reading the following article to find out more about GBS and will discuss further during your antenatal appointments.
The following articles contains more information about Group B Strep.
https://evidencebasedbirth.com/groupbstrep/
Dr Sara Wickham, group-b-strep-resources/
Screening Options
There are a variety of screening options during pregnancy which give an indication of whether your baby is at high or low risk of chromosomal abnormalities, neural tube defects or birth defects. If a screening test indicates that your baby is at high risk of having a health condition you may be offered further diagnostic testing. We recommend having a read through the following links before deciding whether to undergo pregnancy screening tests, and will discuss any tests offered during your antenatal appointments.
MSS: (Maternal Serum Screening) combines a blood test + ultrasound + your age, weight or family history. It can be done in the first or second trimester and is used to identify pregnancies at higher risk of a chromosomal condition such as Down Syndrome.
https://www.vcgs.org.au/tests/maternal-serum-screening
NIPT : (Non-Invasive Pregnancy Test) also known as Percept or Harmony. A highly accurate blood test that can detect chromosomal conditions and the sex of your baby.
* can be taken anytime after 10 wks pregnant and combined with dating scan or 13 wk ultrasound.
https://www.pregnancybirthbaby.org.au/non-invasive-prenatal-testing-nipt
Prepair : Is a pre-pregnancy screening to detect genetic carrier conditions.
https://www.vcgs.org.au/order/tests/658
Amniocentesis : Is a medical procedure which involves using a needle to take a sample of the amniotic fluid around baby. It is offered following a prior screen with abnormal results to obtain a more accurate diagnosis.
Gestational Diabetes Mellitis (GDM)
Your Midwife will offer testing for Gestational Diabetes during pregnancy. The most common test for GDM is the Oral Glucose Tolerance Test (OGTT). Should you decline the OGTT you could also consider self testing your blood glucose levels at home.
You can download our guide to self testing glucose levels at home here.
We recommend reading the following articles to find out more about GDM and will discuss further during antenatal appointments.
GDM beyond the thinking
https://midwifethinking.com/2018/03/20/gestational-diabetes-beyond-the-label/
Diabetes
Diabetes testing in pregnancy
https://www.bellybelly.com.au/pregnancy/routine-testing-gestational-diabetes-necessary
Morning sickness / Hyperemesis Gravidarum
Morning sickness is a very common symptom during early pregnancy and often persists through the first trimester. It is caused by changes in hormones during pregnancy and can make eating difficult. Morning sickness can occur at any time of the day.
Hyperemesis Gravidarum (HG) is diagnosed where a pregnant patient experiences severe and persistent vomiting, usually with electrolyte abnormalities, ketosis and weight loss. It may persist for the duration of a pregnancy and commonly leads to hospitalisation.
We recommend visiting the following links to find out more about treatment pregnancy sickness.
SOME TIPS FOR MANAGING MORNING SICKNESS NATURALLY
Choose foods carefully. Opt for foods that are high protein, low fat and easy to digest, and avoid greasy, spicy and fatty foods. Bland foods, such as potato and toast may be easier to stomach. Ginger can have a settling effect on the stomach. You can slice fresh ginger and infuse as a tea, or add to juices and savoury meals.
Snack often. Before getting out of bed in the morning, eat a few crackers or a piece of dry toast. Snack often throughout the day, rather than eating three larger meals. An empty stomach can make nausea worse.
Drink plenty of fluids. Sip water or coconut water throughout the day.
Pay attention to nausea triggers. Avoid foods or smells that seem to make your nausea worse.
Breathe fresh air. Weather permitting, open the windows in your home and spend some time outdoors each day.
Take care with prenatal vitamins. If you feel queasy after taking prenatal vitamins, take the vitamins with a snack or just before bed. If these steps don't help, you can alter your diet to ensure you get the necessary vitamins to support your wellbeing during pregnancy.
ALTERNATIVE MEDICINE
Acupressure. Firmly placed on the P6 point (the inner side of your arm, in line with your middle finger and one-sixth of the way between your wrist and elbow), relieves nausea for some women.
Acupuncture. With acupuncture, a trained practitioner inserts hair-thin needles into your skin. Acupuncture isn't a proven way to treat morning sickness, but there are many anecdotal accounts of it helping to alleviate symptoms of morning sickness.
Ginger. Herbal ginger supplements can alleviate morning sickness for some women.
Hypnosis. Although there's little research on the topic, some women have found relief from morning sickness through hypnosis.
Aromatherapy. Although there is also little research on the topic, certain scents, normally created using essential oils (aromatherapy), can be beneficial.
Monitoring foetal movement
An active baby in pregnancy is a healthy baby. It’s important to know babies should move regularly right up until your baby is born.
Contact your Midwife ON THE DAY if you are worried about your baby’s movements
Lisa: 0410 692 929
You should expect to first feel your baby move from 16 – 22 weeks into your pregnancy. Mothers often describe their baby’s movement as a flutter, swish, kick or roll. At first your baby will not move very often, however as your pregnancy continues the movements become stronger and are more regular.
HEALTHY BABY MOVEMENTS
An active baby is a healthy baby. A healthy baby will have “normal” movement patterns when they are awake. Babies also have sleep periods where they can sleep around 20 - 40 minutes at a time. It’s important to remember that babies do not move all the time. Being aware of your baby’s movements is both enjoyable and tells us that your baby is healthy. We suggest that you take note of your baby’s unique rhythm from when you start to feel them move. After 34 weeks you should be aware if baby is quieter than usual, or if you are worried. This is important information to share with your midwife.
HOW OFTEN AND WHEN SHOULD YOU CHECK THAT YOUR BABY IS MOVING?
When your baby is awake you can practise feeling for movements. It is often difficult to notice your baby’s movements when you are standing, walking or if you are busy. It is easiest to feel your baby’s movements when you are relaxed and are lying or sitting down. Most babies move around more in the morning and in the evening.
IF YOUR BABY REMAINS QUIET or YOU ARE WORRIED, YOU SHOULD DO THE FOLLOWING:
Find a quiet place to lay or sit down and focus on your baby’s movements for 40 to 60 minutes.
If you feel your babies movements have reduced from their normal rhythm then call you Midwife or your booking hospital.
ALWAYS call us ON THE DAY that you are worried about your baby’s movements and do not wait until the next day.
Visit the following pages for more information about fetal movements.
Unusual foetal activity during pregnancy
Awareness of reduced FM
Perineal massage
The perineum is the area of tissue between the opening of the vagina and the anus. It attaches to the muscles that support your reproductive organs, bowels, and bladder.
Perineal massage involves gently stretching and manipulating the perineal tissue using one or two finger.. The intention is to prepare the perineal tissues to stretch over your baby’s head and body during birth and reduce or prevent tearing. You can perform this massage at home by yourself or with the help of your partner.
Find out more about perineal massage in the following links.
Perineal massage guide by Australian Birth Stories
Nutrition
Pregnancy creates extra demand for certain nutrients, including iron, calcium, iodine and many vitamins. You should aim to maintain a varied diet including fruit and vegetables, breads and cereals, dairy foods for calcium and, most importantly, iron rich foods such as red meats, green leafy vegetables, beans, pumpkin seeds, dried apricots, pistachios, prunes, walnuts, brazil nuts, cashews, almonds, chick peas and kidney beans.
Find out more about nutrition during pregnancy at the following links.
Vitamin D supplementation during pregnancy - clinical trial
How to increase platelets naturally
Maternal vitamin D status during pregnancy and child outcomes
Natural Labor Induction Series: Eating Dates
Antenatal Expressing
During the second trimester, a mother’s breasts begin to make colostrum. Colostrum is the very first milk your baby will receive after birth and contains high amounts of bioactive compounds to give your baby the best possible start to life. Colostrum contains antibodies to protect the baby against disease and infection and immune and growth factors that help to activate a newborn’s immune system, increase gut function, and initiate a healthy gut microbiome. Antenatal expressing of colostrum is the hand expression and collection of colostrum during pregnancy. Expressed colostrum is collected and frozen and used to feed a baby after birth, if required. If not required, there are variety of other uses for stored colostrum.
Colostrum is best stored in 1ml syringes which can be purchased from any pharmacy. Be sure to mark the date on each syringe and adhere to best practice guidelines for storing frozen breastmilk.
Your midwife will discuss antenatal expressing during your appointments and let you know when it is safe to begin expressing.
Find out more about antenatal expressing at the following links.
The La Lache League - Antenatal Expressing
Osteopathy
There will be many changes to your body as your pregnancy progresses and feelings ranging from uncomfortable aches, to severe pain, are common. Osteopathy is a gentle manipulative body work that aims to maintain balance in the body to reduce pain and stress.
Some common pregnancy symptoms which may be alleviated through osteopathy include;
Pelvic, hip or groin pain
Sciatic pain (sciatica)
Headaches or face pain
Carpal Tunnel Syndrome
Middle, upper back and neck pain
Rib cage pain
Difficulty with balancing as the pregnancy progresses
Meditation
Meditation is a wonderful technique at all stages of life and can be very beneficial in reducing stress, anxiety and tension in the body during pregnancy. When techniques such as deep breathing, visualisation, body scanning and mindfulness are practised regularly during pregnancy, it may be more natural to drop into a meditative state during labour.
Below we have suggested some meditation resources that you may find beneficial.
‘Mind The Bump is a free Mindfulness Meditation App to help individuals and couples support their mental and emotional wellbeing in preparation for having a baby and becoming a new parent.’
Insight Timer is another free meditation resource which also has an app. You can find general and pregnancy specific guided meditations and relaxing music playlists.
The free Calm Birth app has three fantastic guided mediations that are around 15 minutes long.
AFFIRMATIONS
Affirmations can be another beautiful way to connect with your baby and relax your body and mind during pregnancy. Repeating affirmations helps to instil a sense of positivity and intention around a particular aspect to your pregnancy, such as changes you are experiencing in your body or any particular worries you may have.
For more information about the use of affirmations during pregnancy please see the following links.
Positive affirmations and mantras for your pregnancy - Lamaze Group
Antenatal anxiety & depression
Each persons experience of pregnancy is different. Along with the physical changes occurring in the body, there are also common emotional and hormonal changes associated with each trimester, such as mood swings, anxiety and excitement.
Most expecting parents experience a degree of anxiety and ‘ups and downs’ during pregnancy. However, some people develop a more pronounced anxiety or lowered mood which can affect their daily life and functioning. When this occurs during pregnancy it is known as antenatal anxiety and/or antenatal depression.
Some common symptoms of antenatal anxiety and depression include;
Panic attacks, including racing heart, palpitations, shortness of breath, or shaking
Persistent, worries or fears, usually focused around concern for the health or wellbeing of baby
Development of obsessive or compulsive behaviours
Sudden mood swings
Feeling constantly sad, low, or crying for no obvious reason
Feeling constantly fatigued
Having little or no interest in the things which you would normally enjoy
Sleeping too much or too little
Loss of libido
Withdrawing from friends and family
Being short tempered or easily frustrated
Finding it difficult to focus, concentrate or remember
Having thoughts of death or suicide, or self-harm.
Experiencing some of these symptoms during pregnancy can be normal, but if you think you may be suffering from antenatal depression or anxiety or are unable to function from day to day, please contact your midwife and let them know how you are feeling.
If you or your partner have any concerns for the immediate wellbeing of you or your baby, please contact Lifeline or PANDA.
Lifeline 13 11 44
PANDA 1300 726 306
You can find more information about antenatal depression and anxiety on the PANDA website.
Prolonged pregnancy (post dates)
Prolonged pregnancy
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1998.tb10047.x/full
Induction of labour balancing risks
https://midwifethinking.com/2016/07/13/induction-of-labour-balancing-risks/
Labour induction for late-term or post-term pregnancy
https://www.clinicalkey.com.au/nursing/#!/content/1-s2.0-S1871519216000317
Premature Rupture of Membranes
Premature rupture of membranes (PROM), commonly referred to as ‘waters breaking’ is a rupture of the amniotic sac prior to labour commencing. Most pregnant women will go into labour soon after the membranes have ruptured. If PROM occurs prior to 37 weeks gestation, it is referred to as preterm premature rupture of membranes (PPROM) and is associated with higher risk to baby.
Below you can find further recommended reading. Your midwife will discuss any questions or concerns you may have.
Pre-labour ROM
https://midwifethinking.com/2017/01/11/pre-labour-rupture-of-membranes-impatience-and-risk/
Pre-labour ROM Induce or wait?
http://www.evidentlycochrane.net/prelabour-rupture-membranes-induce-wait/
Prolonged ROM
https://www.ncbi.nlm.nih.gov/pubmed/9376011/
Books
Some of our favourite pregnancy and birth books are;
‘Birth Like A Feminist’ by Milli Hill
‘The Down To Earth Birth Book’ - Jenny Blyth
‘Gentle Birth, Gentle Mothering’ - Sarah J Buckley
‘Birth With Confidence’ - Rhea Dempsey
‘Beyond The Birth Plan’ - Rhea Dempsey
‘Birth Skills’ - Juju Sundin
Podcasts
Australian Birth Stories is a podcast series interviewing women about their birth experiences. The stories are all Australian and cover a broad range of birth settings. There are over 200 available episodes to listen to!
https://www.australianbirthstories.com/podcast
The Great Birth Rebellion with Mel & B Modern birth practices are stifling women's autonomy, minimising the birth experience and endorsing the medicalisation of birth. The Great Birth Rebellion dismantles western beliefs and management of birth and presents an evidence-based alternative to modern birth practices.
https://www.melaniethemidwife.com/podcasts/the-great-birth-rebellion
Happy Homebirth is a US based podcast series that takes a deep dive into homebirth, interviewing people who birthed at home as well as care providers.
https://www.myhappyhomebirth.com/
Postpartum Stories with Steph is a podcast series sharing candid conversations about the early days and weeks after birth. Postpartum can be messy and chaotic and this gives a sneaky insight into what that time might look like for you and how you can be better prepared.
https://www.postpartumwithsteph.com/