Having a healthy pregnancy

There is no safe level of alcohol intake during pregnancy, so women are advised not to drink any alcohol at all. Even drinking low levels of alcohol in pregnancy can cause problems.  

Drinking alcohol while pregnant can mean your baby is more likely to be:

• born prematurely
• smaller and not so well at birth
• have problems with development, behaviour or physical growth and function.

Alcohol can be a very hard thing to give up. Making the first step to ask for some help can really make a difference for you, your baby and your family/whānau.

If you have concerns about your alcohol drinking, or want help to stop drinking, talk to your GP or midwife or call the Alcohol Drug Helpline on 0800 787 797 or free text 8681 and they will text you back for a free confidential conversation. The helpline is staffed 24/7, is anonymous, and gets you through to a qualified alcohol counsellor or social worker. You can also go to their website alcoholdrughelp.org.nz for more information about their service, and to find local services to contact. 

You can find more information about alcohol and pregnancy at alcohol.org.nz, including a handy set of frequently asked questions. Health Navigator New Zealand also has information about alcohol and pregnancy.

Smoking during pregnancy affects your health and the health of your baby. You risk having complications in pregnancy and:

• losing your baby through miscarriage in earlier pregnancy, or stillbirth
• your baby being born too early and needing extra medical care
• your baby having a low birth weight that could be harmful to your baby’s health
• your baby developing pneumonia and asthma
• your baby dying suddenly in their sleep (also known as Sudden Unexpected Death in Infancy or cot death).

It’s important to try to stop smoking as early as possible in your pregnancy - but it’s never too late to quit for your baby at any stage in pregnancy. There are phone, text and face-to-face services available to help you quit smoking.

The stop smoking service in the Bay of Plenty is Hāpainga Stop Smoking Service. Quitting smoking is easier when you’re not alone, and a stop-smoking support person will give you help and advice. Pregnant women get priority support.

Smokefree support

• Hāpainga Stop Smoking Service – call 0800 427 246 (0800 HĀPAINGA).
• Quitline – call 0800 778 778 or visit quit.org.nz.
• The Ministry of Health has good tips on making your home and car smokefree.

When you are pregnant your immunity is lower than usual, so you have a higher risk of getting food-borne illnesses.

There are two illnesses that can be particularly dangerous for pregnant women: listeria and toxoplasmosis. These two illnesses can be passed on to you and/or your baby, and in extreme cases can cause premature labour, miscarriage or damage to your baby.

• Be careful with handwashing and hygiene in the kitchen. Washing raw foods carefully and avoiding some foods in pregnancy is advised.
• If you travel overseas, be aware that the water is not safe to drink in some countries. Ask your GP for more advice on overseas travel.

The New Zealand Food Safety website has advice on safe eating in pregnancy and a list of foods to avoid.

Most women are first aware of their baby moving when they are between 18–20 weeks pregnant. You may feel your unborn baby’s movements as a kick, flutter, swish or roll. If you have been pregnant before, you may feel movements as early as 16 weeks. If it is your first pregnancy, you may not feel movements until after 20 weeks.

The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same. Importantly, you should continue to feel your baby move right up to the time you go into labour. Your baby should move during labour too.

• From 28 weeks, keep a check on your baby’s health by being aware of their movements. Baby movements are your best signs that your baby is well.
• It is important that you take note of your baby’s movements each day. At the same time each day, spend some time noticing your baby’s usual movement patterns.
• Healthy babies have quiet or sleep times. Quiet times mostly last 20-40 minutes and sometimes up to 90 minutes. During these sleep times you will not usually feel your baby move much. In late pregnancy there should be plenty of active spells between these sleep times, including when labour starts. It is not normal for your baby’s movements to slow down towards the end of pregnancy.
• During your pregnancy you need to be aware of your baby’s individual pattern of movements. It is important to notice any reduction or change in your baby’s movement.

If there are any changes to your baby’s movements you should contact your midwife as soon as possible, as it could be a sign that your baby is unwell.

Contact your midwife if:

• your baby’s movements are slowing down or stopping
• your baby is moving rapidly and then stopping (different to your usual movements).

Don’t wait and worry at home, no one will mind if it is a false alarm.

More information about baby movements in pregnancy

• Movements matter – raising awareness of fetal movements.
• Baby movements in pregnancy.
• Feeling your baby move is a sign that they are well.
• UK Royal College of Obstetricians & Gynaecologists – Your baby’s movements in pregnancy.

Last three months of pregnancy

How you go to sleep in the last three months of pregnancy is important. Stillbirth in the last three months of pregnancy affects about one in every 500 babies. However, research has confirmed that going to sleep on your side halves the risk of stillbirth compared with sleeping on your back.

• From 28 weeks of pregnancy - while baby is inside, sleep on your side.
• If you wake up in the night on your back - don’t worry! This is common, just return to sleeping on your side.
• If you nap during the day, sleep on your side.

Why does sleeping position matter?

We are not sure exactly, but when women lie on their back in late pregnancy the large pregnant womb can put pressure on major blood vessels which reduces blood flow to the uterus and the baby. This can result in lower levels of oxygen in the baby.

Lying on your back is also associated with sleep disturbed breathing (snoring) and sleep apnoea, both of which can be associated with pregnancy complications.

Many pregnancy websites suggest that sleeping on your left side is best. One study reported that the left side may be better for baby than the right but two further studies have shown no difference between left and right sides. Therefore, we recommend that you sleep on either side.

You can try sleeping with a pillow behind your back to increase your chance of staying on your side during the night, but if you wake up on your back don’t worry. The position you fall asleep in is the one in which you have the longest and soundest sleep, and may therefore have more impact on your baby.

For more information visit the Sleep on Side When Baby’s Inside website.

Iodine is found naturally in plants and meat - we need it for normal thyroid gland and brain function. It is very important for babies to get iodine from their mothers during pregnancy and breastfeeding, to support normal growth and development.

NZ soils are lacking in iodine, and even with a well-balanced diet it is hard to get the increased amount of iodine needed during pregnancy. You can buy 150 microgram iodine-only tablets at your pharmacy, or get them on prescription from your midwife or GP, to take during pregnancy and breastfeeding.

Visit the HealthEd website for more information on iodine during pregnancy and breastfeeding.

Vitamin D is needed for strong bones and joints as well as healthy muscle and nerve activity. If you don’t have enough vitamin D during pregnancy, your baby may be born with low vitamin D levels. This can affect how your baby develops.

The sun is the main source of vitamin D. Small amounts of vitamin D can also be found in foods such as oily fish (tuna, sardines and salmon), eggs and some margarines, milks and yoghurts.

Time in the sun is recommended so that your body can make vitamin D. Try to get outside before 10am or after 4pm between September and April, and around the middle of the day between May and August. The lighter your skin, the less time you need to be in the sun to make enough vitamin D. Don’t get sunburnt!

Some people have low levels of vitamin D, called ‘vitamin D deficiency’. If you have darker skin, spend most of your time inside, have liver or kidney disease or are taking certain medicines (such as anticonvulsants), you are at a higher risk of vitamin D deficiency.

If you are worried that you don’t get enough vitamin D, or you have a higher risk of vitamin D deficiency, talk to your midwife or specialist doctor. 

The HealthEd website has more information on vitamin D and healthy eating in pregnancy.

When you are pregnant you need a lot more iron to meet the needs of you and your baby.

Your midwife will ask you to have blood tests during pregnancy (usually three times) to check your iron levels and help ensure you’re getting enough. 

Why iron is important

Iron is needed to make the part of our blood called haemoglobin, which carries oxygen to every cell in our bodies.

Without enough iron you might feel very tired and have headaches, have a lower immunity to sickness, be more at risk if you bleed heavily at birth, and potentially your baby may not grow as well during pregnancy.

How much iron do you need?

Pregnant women need one and a half times as much iron as a non-pregnant woman, and four times as much iron as a man!

How to increase your iron levels

It can be hard to get enough iron from your diet, especially if you start pregnancy without a reserve or stockpile of iron in your body.

If your iron levels are low, your midwife will probably prescribe iron tablets because it’s almost impossible to eat enough iron rich food to boost your iron levels if you are already low in iron, or anaemic. A high iron diet works well alongside other iron treatments.

Iron tablets should be taken without food, with a big glass of water. However, if you get nausea then take the iron tablet with some food, or at night.

Iron may make you constipated, or turn your poo black. The black colour isn’t a worry – but if you are constipated make sure you are eating lots of fibre, like kiwifruit, vegetables and whole grain cereals, and drinking plenty of fluid. Ask your midwife for a gentle laxative if needed.

Supplements such as Spa Tone or Floradix may not have enough iron for treating anaemia.

Visit the New Zealand Nutrition Foundation website for information about iron rich foods.

Intravenous iron infusion

If you are severely anaemic, and especially if you are close to being due or have other risk factors, your midwife may recommend an intravenous (IV) iron infusion. She will refer you to hospital for this.

Some people react to iron infusions, which is why they are are always given in hospital and only for clear clinical reasons.

An iron infusion is an injection of an iron solution into your vein, which provides a rapid way of getting a big dose of iron.

Pregnancy is a time of changes in your body. It’s normal to gain weight during pregnancy due to the growth of the baby, the placenta and fluid around the baby.

Gaining the right amount of weight is important, particularly if you were underweight or obese at the start of your pregnancy. The Ministry of Health has information and recommendations about healthy weight gain during pregnancy, including a BMI tool to help you find your recommended weight gain during pregnancy.

You can expect to eat more food as your pregnancy progresses, but this does not mean that you need to ‘eat for two’. A good appetite and a steady weight gain, especially after the first three months, will usually mean that you are eating enough. The Ministry of Health has some good information about healthy food and drink choices, healthy weight gain and food safety during pregnancy.

Talk to your midwife if you are concerned about your weight or the weight you have gained during pregnancy and they will support and advise you.

The Ministry of Health also has information about being active during pregnancy.

Your baby’s protection starts with you.

Immunisation helps protect you and your unborn baby from serious diseases such as COVID-19, influenza and whooping cough.

Vaccination at any time during pregnancy stimulates your immune system to produce antibodies, reducing your risk of getting sick. The antibodies pass through the placenta into your baby's bloodstream, protecting your baby.

Your GP or health professional can explain how it works at their practice or vaccinating pharmacy - for example whether immunisations take place at a separate location or time from other patients.

It is recommended that all pregnant women have an influenza (flu) vaccination. Flu is not a cold. It can be a dangerous illness that poses a serious risk to the life of a pregnant woman and her baby. 

Catching the flu during pregnancy increases your chances for serious problems such as pneumonia and respiratory failure. For baby, it can affect development in the womb and can lead to premature labour and delivery, or stillbirth.

A range of physical changes during pregnancy, such as changes in immunity, increase your risk of serious flu complications. New Zealand research shows that pregnant women are nearly five times more likely to be hospitalised with flu than women who are not pregnant.

Getting the flu vaccination

Getting the flu vaccine during your pregnancy is the best way to protect you and your baby. Flu vaccinations are free to all pregnant women in New Zealand.

Vaccination any time during the pregnancy stimulates your immune system to produce antibodies, reducing your risk of getting the flu. The antibodies also pass through the placenta into your baby's bloodstream, protecting your baby from the flu for up to six months after birth. 

When is the best time to have a flu vaccination?

You can have the flu vaccination any time during your pregnancy. It is best to get the flu vaccination as early as possible in the flu season (March onwards), to protect yourself against catching the virus while you are pregnant and protect your baby from flu from birth and for the first six months of life.

If you have already had a flu vaccination before December last year, you should be vaccinated again. This is because the vaccine changes each year depending on the type of flu virus circulating – the virus this winter is usually different to last year’s flu virus. You need to make sure you are protected from this year’s virus.

Flu vaccination availability

Flu vaccinations are free to all pregnant women in New Zealand from early March to 31 December each year. Even if there is a shortage of flu vaccines in New Zealand, vaccination is still available and free to all pregnant women as they are a high risk group.

Where to get vaccinated

• Make an appointment at your GP practice to have the vaccination free of charge.
• Ask at your local pharmacy – some pharmacists are registered vaccinators who can vaccinate pregnant women free of charge.

More information about flu vaccination during pregnancy

• Fightflu.co.nz – information for pregnant women.
• Health Navigator New Zealand – influenza vaccine.

It is recommended that all pregnant women are vaccinated against whooping cough (pertussis) between 16 and 38 weeks of pregnancy.

Whooping cough (pertussis) is a highly infectious disease that is spread by coughing and sneezing. It’s caused by bacteria which damage the breathing tubes. Catching whooping cough during pregnancy can be exhausting. 

Whooping cough can also be very serious for babies and children, especially those under one year old. If babies catch whooping cough, they:

• may not be able to feed or breathe properly
• may become so ill they need to go to hospital
• could end up with serious complications such as pneumonia and brain damage.

Whooping cough vaccination

Having a vaccination against whooping cough while pregnant protects you and your baby, by reducing your risk of catching pertussis and passing it on to your baby at delivery. 

When you have the vaccination, you will develop antibodies against the disease that will pass through the placenta into your baby and provide your baby with its own temporary protection against severe disease in the first weeks of life. Your baby will then have their own vaccination at six weeks old to continue their protection.

The vaccination for pregnant women is called Boostrix and comes combined with vaccination against pertussis, tetanus and diphtheria, which are all safe to have during pregnancy.

When to get vaccinated

You should have the vaccine any time between 16-38 weeks of pregnancy. This will ensure there is enough time before birth for high levels of antibodies to pass through the placenta into your baby and provide your baby with its own temporary protection against severe disease.

If you have already had a Boostrix vaccination before you became pregnant, or during a previous pregnancy, you should have another Boostrix vaccination to give your baby protection.

Where to get vaccinated

Boostrix vaccination against whooping cough is free for all pregnant women.

• You can make an appointment to have the vaccination at your GP practice free of charge.
• Ask at your local pharmacy – some pharmacists are registered vaccinators and can vaccinate pregnant women free of charge.

More information about the whooping cough vaccination

• Visit the Ministry of Health website for more information about whooping cough.
• The Immunisation Advisory Centre has more information on the Boostrix vaccine.

Pregnancy, birth and parenting are huge life-changing events for nearly all women and can present challenges. For some families, this is an easy adaptation, and for others it can be difficult. The majority of women, and some men, will have a period during pregnancy where they feel stressed about the upcoming birth, for many different reasons.

Keeping mentally and emotionally healthy

Keeping mentally and emotionally healthy during your pregnancy is important. A free app has been developed in the Waikato called Positively Pregnant which focuses on the emotional and social side of pregnancy.

This app helps you think about and prepare for the emotion and social changes that will happen during your pregnancy and when you become a parent. It gives you resources, strategies and tools to reflect, de-stress and find what works for you and your whānau.

Look for Positively Pregnant in the App Store and Google Play Store. 

Struggling with stress, emotional or mental health?

Pregnancy can trigger mental illness or make existing mental illness worse. You could be experiencing anxiety or low mood and you may have symptoms of tearfulness, lethargy and sleep disturbances. 

The most important thing to do if you experience any mental health concerns during pregnancy is not to suffer alone. Talk to those around you and share your feelings with your partner, family/whānau or friends.   

Where to get help

You should discuss your symptoms and concerns with your midwife or GP. Think about it like this: you would not hesitate to seek help if you had a physical illness during your pregnancy, and the same approach should apply to your mental health.  

Your midwife

Midwives are recommended to ask all women how they are feeling using a screening tool at least once during pregnancy, and again after the baby is born. This screening tool helps screen for mental health symptoms, just like taking your blood pressure helps to screen for physical issues.

GP practice

You can ask for an extended GP appointment with your doctor to discuss mental health concerns and symptoms, where you will have more time than a normal appointment to talk. The service is free for a non-urgent appointment, or there is a fee for an urgent appointment. Please check with your GP practice.

After your GP appointment, your doctor may be able to refer you for counselling with a qualified therapist service (ask your doctor for further information).

Free telephone counselling services

• Talk to a trained counsellor by calling or texting 1737. 1737, Need to talk? is a free 24 hour service.
• Pregnancy Counselling Services is an independent charitable trust offering free a counselling service, emotional support, information and practical help. Call 0800 773 462 (0800 PREGNANT) for free, text 021 289 8787 or visit their website to find out more about support in pregnancy.
• Talk to a trained counsellor on the New Zealand Depression Helpline. Call 0800 111 757 or text 4202 to talk about how you are feeling or ask a question.

Helpful websites

• The Women’s Health Action website covers a broad range of topics, including mental health.
• depression.org.nz
• depression.org.nz/maori/(for Māori)
• depression.org.nz/pasifika/(for Pasifika)
• Mental Health Foundation of New Zealand

Women with more severe symptoms

If your GP or midwife feels that your mental health symptoms are more severe or complex, with your permission they may discuss your case with the perinatal mental health service.

After this consultation, your midwife or GP may put a plan in place for your care, or you may be referred for an appointment and ongoing follow up and support from the perinatal mental health team. This team includes a psychiatrist, psychologist and mental health nurses who specialise in caring for women in pregnancy up until the baby turns one.

Pre-eclampsia is a very serious pregnancy complication that affects 3-7 per cent of women, usually late in pregnancy, but sometimes as early as 20 weeks. If not treated quickly, both your health and your baby’s health is at risk.  

Pre-eclampsia may not have any symptoms in its early stages. Your midwife will check your blood pressure and screen your urine for protein regularly throughout your pregnancy. Raised blood pressure and protein in your urine may suggest pre-eclampsia.

If pre-eclampsia is discovered early, most women still have a healthy baby.

• Know the six major warning signs (below) and get in touch with your midwife as soon as possible if you experience any of them.
• Attend all your antenatal appointments with your midwife to identify any issues early.

Further information about pre-eclampsia can be found here.

The six major warning signs of pre-eclampsia

If you are past 20 weeks pregnancy and start having even one of these warning signs, contact your midwife as soon as possible – do not wait until the following day. She will arrange for you to be checked out.

1. Upper abdominal pain.
2. Feeling unwell, nauseous or throwing up.
3. Blurry vision or seeing flashing lights.
4. Swollen hands and face (not the very normal mild ankle and finger swelling that most women get late in pregnancy).
5. Reduced baby movement or changes in your baby’s movement pattern.

If you have previously gone into labour and given birth at less than 34 weeks, you have a higher risk of the same thing happening in your next pregnancy.

It’s really important that you and the health professionals caring for you take steps early to reduce the risk of another preterm birth in this pregnancy.

Why do some women go into premature labour?

There are many reasons why you may give birth before your due date. However, if you go into premature labour there might not be an obvious reason why. You have a higher risk of premature birth if you:

• have already had a premature baby
• have an ultrasound scan that suggests the neck of your womb (the cervix) does not appear to be tightly closed
• are pregnant with twins or triplets
• have had three or more miscarriages or terminations
• have had previous treatment to your cervix
• smoke cigarettes
• are underweight or very overweight
• have poor dental hygiene
• have a medical condition such as diabetes
• have an infection.

Reduce the risk of another early labour

• Register with a midwife as early as possible in your pregnancy.
• Talk to your midwife about your previous pregnancy and birth experience, and ask about a referral to the hospital antenatal clinic following your 12 week scan. The hospital antenatal clinic will aim to see you at 14 weeks or 16 weeks, depending on the gestational age your previous preterm birth happened. You will be reviewed by the medical team at the clinic. Based on your previous experience of a preterm birth and your current pregnancy and health they will discuss what treatment options are available to you and what monitoring you will need.
• If you smoke it is important to stop smoking as soon as possible in your pregnancy. Smoking greatly increases the risk of going into labour too early. You can talk to your midwife about what support is available or contact our Hāpainga Stop Smoking Service on 0800 427 246 (0800 HĀPAINGA) you will get priority support.
• Alcohol and recreational drug use (such as marijuana, synthetic cannabis and other drugs) is also linked with preterm birth. Talk to your midwife or GP if you have concerns about this.
• Talk to your midwife or GP about getting screened and treated for any urinary or sexually transmitted infection. Untreated infections can increase your chance of having another preterm birth.
• Stay away from people with infections.
• Have recommended vaccinations for whooping cough and influenza to help reduce your chance of having another preterm birth.

Know the signs and symptoms of preterm birth

If you have any of the following signs and symptoms of preterm birth contact your midwife straight away.

• Abnormal vaginal discharge. Watch for vaginal discharge of water or mucus; sometimes there may be a small amount of blood. The breaking of the bag of waters around the baby can cause a gush of fluid. This may be one of the first signs of being in premature labour.
• Bleeding. Vaginal bleeding is never a normal part of pregnancy. A ‘show’ is mucus and blood that occurs before labour starts, and is due to the plug in the neck of the womb (the cervix) coming away as the cervix starts to open.
• Contractions. It can be difficult to tell if contractions are labour contractions or just practice contractions, called Braxton Hicks. Braxton Hicks contractions are not usually regular and while they can be uncomfortable, they do not become progressively stronger or more painful. They can become more noticeable if you have a full bladder. Try going to the toilet – Braxton Hicks contractions may settle down if your bladder is emptied.
• Feeling that something is not quite right. Abdominal cramps, pelvic pressure and lower backache can mean labour is starting. Some women experience nausea and diarrhoea which can cause bowel pain and discomfort.

An urgent assessment can be organised for you and your baby. The earlier premature labour is recognised, the better the chance that it can be stopped, with a better outcome for your baby.