Just found out you're pregnant?

The first step on your pregnancy journey is choosing a midwife to coordinate your maternity care. Your midwife is also known as your lead maternity carer (LMC).

When to register with a midwife

The best time to register with a midwife is in the first trimester of pregnancy (the first 12 weeks) or as early as possible. Register with a midwife as soon as you can, to make sure you are able to access early screening to assess your health, and for you to have early access to any services you may need to monitor you or your baby’s health.

Registering early is most important for women who have a current health condition or had complications in a previous pregnancy.

If you live in a rural area, there aren’t as many local midwives to choose from. This is another reason to look for a midwife as early as possible.

Finding a midwife

It’s important to find a midwife you are comfortable with. It’s a big decision for your birth journey because your midwife will be your key health professional throughout your pregnancy, labour, birth and during those early weeks of motherhood.

Visit the Find Your Midwife website for information about available Bay of Plenty midwives. You can search for midwives in your area and read their profiles to help choose a midwife that feels like a good match for you. You might also like to ask friends and family for recommendations.

Some things to think about when choosing a midwife

The New Zealand College of Midwives has outlined what to look for in a midwife. Here are some other suggestions about things to think about or ask when choosing a midwife.

• If you have a particular birth centre in mind or would like to birth at hospital, does the midwife have an access agreement with that facility? An access agreement means that the midwife can access that facility with you for labour, birth and postnatal care.
• Would you like to explore having a home birth? Does the midwife provide home birth care?
• Most women have contact and care with the same midwife throughout pregnancy, birth and the postnatal period, providing excellent continuity of care. Midwives also have holidays, family commitments and time away. You may want to ask:
  • does the midwife have any planned time away near your due date?
  • who is their back-up midwife?
  • can you meet or talk to the back-up midwife?
  • how can you contact the back-up midwife?
• Ask the midwife about antenatal visits and postnatal care, particularly home visits in the postnatal period if you live in a rural area.
• Some midwives hold certification to monitor and care for you in labour at hospital if you need additional pain relief, such as an epidural. You may want to ask if the midwife has this certification. If they do, it means they can provide your care during labour and help you deliver your baby. If they do not, they may share your care with the hospital team, or transfer your care to the hospital team.

What midwives do

LMC midwives in New Zealand are contracted by the Ministry of Health to provide the following services:

• Explain their role as LMC midwife and the services you will receive.
• Give you the details of their back-up midwife if they are not available for your antenatal care, labour, birth or postnatal care.
• Provide information, education and referrals for screening tests.
• Give you information about the availability of pregnancy and parenting education.
• Document a care plan to be used and updated throughout your pregnancy.
• Inform you about your options for the place of birth and place of postnatal stay after the birth.
• Monitor the progress of pregnancy for you and your baby, including early detection and management of any problems.
• Management of your birth and all maternity care until two hours after delivery.
• Provide postnatal care from birth to 28-42 days after the birth, including:
  • a daily visit while you receive inpatient postnatal care, unless otherwise agreed by you and the maternity facility
  • between 5 and 10 home visits, with a minimum of 7 total visits (and more if clinically needed), including one home visit within 24 hours of discharge from a maternity facility.

If you have previously gone into labour and given birth at less than 34 weeks of pregnancy, you are at 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.  

• 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 after 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 your local Once and For All stop-smoking service.
• 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 and have recommended vaccinations for influenza and whooping cough to help reduce your chance of having another preterm birth.

How scans work

Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining pictures or images from inside the human body. During pregnancy an ultrasound technician uses a transducer on the outside of your abdomen (tummy) to send very high frequency sound waves through your body.

The sound waves are reflected off the internal organs and fetus. The reflections are then processed by special instruments and powerful computers that create a visual image of the organs and fetus.

Sometimes very early scans are done by using a slim transducer inserted into your vagina, instead of over your abdomen.

Why scans are done

You may be offered a scan in the early weeks of pregnancy to confirm dates if you don’t know when your last period was, or a likely date of conception. Because the fetus is very small before 12-14 weeks gestation it can be measured easily and this can estimate the age (length of pregnancy) of the fetus very accurately. You do not have to automatically have a dating scan if you are sure of your last period date.

Between 11 and 14 weeks of pregnancy you will be offered a scan as part of screening for chromosomal abnormalities. Read more about first trimester screening.

Scans are also used to check if a pregnancy is progressing, or if you have had a miscarriage. They can also check if the pregnancy is actually in the uterus. Rarely, a fertilised egg may implant in the uterine (fallopian) tube or elsewhere and this can be life-threatening for the mother.

Do you have to have scans?

Scans are often thought of as a routine and expected part of pregnancy care. However, like all medical investigations the test should only be performed if it will provide information that will improve the outcome for you and/or your baby.

Scans, like all other tests in pregnancy, are offered to you. You don’t have to agree to have any particular test done. It is your choice, and your right to say no. It is also your right to be offered tests, including scans, that may improve outcomes for you and your baby.

How to get a scan

Scans are done by referral from your midwife or GP. Some community ultrasound providers charge for some scans – contact them to ask about the price, or ask when you make the appointment. If you have a scan done at the hospital, there will be no charge to you.

Your midwife or specialist doctor will give you information and support to help you decide whether to have early pregnancy screening tests or not – it is your decision. Talk to them about what’s right for you and your baby.

Blood tests

Most women choose to have blood tests in pregnancy. Usually you will be offered blood tests three times in pregnancy.

• At the beginning – by week 10 your midwife or GP will give you a blood test form. Find out more about early pregnancy screening tests.
• Around 24-26 weeks – retesting your full blood count and antibodies and screening for diabetes.
• At around 36 weeks – a last check of your blood count and antibodies.

Women with pregnancy complications or other health problems may have blood tests more often.

If you like lots of detail, here’s an article about routine laboratory testing during pregnancy. 

Urine tests

You will be asked to do a urine test during antenatal appointments, using a dipstick. The three items most frequently checked for are protein, glucose and markers of a urinary tract infection. Protein in your urine needs investigation as it can be a sign of a pregnancy high blood pressure problem. Glucose can be a sign of diabetes in pregnancy.

Combined screening

Between 9 weeks and 13 weeks and 6 days of pregnancy you can choose to have combined screening. This is a blood test from you and a scan of the baby’s neck fold to measure how thick or translucent it is. These results, combined with details about you such as age, weight, and ethnicity, are used to estimate the chance of your baby having a chromosomal abnormality such as Down syndrome.

If your result shows a higher chance of an abnormality, you can have further testing done to diagnose an abnormality (or you may choose not to). You do not have to have the test, and if further testing does show an abnormality, you can choose what happens next. A termination (abortion) of pregnancy may be offered to you depending on the results and your wishes.

SmartStart provides step-by-step information and support to help you access the right services for you and your baby.

This useful website makes it easy for new parents and parents-to-be to understand and access the different services provided by government agencies and other providers in New Zealand.

You can find out about: 

• registering your baby’s birth
• financial help
• support services
• top baby names.

 You can also log in and save your personal to-do list.

Most women over 40 years old have healthy pregnancies and healthy babies. However, there is a greater chance of having a baby with chromosomal problems such as Down syndrome, having multiple pregnancies, having a miscarriage or stillbirth.

Registering with a midwife as early as possible in pregnancy will ensure you have early access to screening and monitoring of the health of you and your baby.

Stillbirth

Women who are over 40 years old have a higher risk of stillbirth. You can reduce your risk of stillbirth in the following ways.

Be smokefree

Eliminate or reduce your exposure to second-hand smoke and encourage friends and whānau to have a smokefree environment around you. If you smoke, you can get help and support to stop smoking by contacting our Hāpainga Stop Smoking Service on 0800 427 246. Pregnant woman will get priority support.

Have a healthy weight gain during pregnancy

Talk to your midwife about your recommended ideal weight gain during your pregnancy (this will be dependent on your weight at the start of pregnancy). 

Sleep on your side from 28 weeks of pregnancy

Research shows that sleeping on your side halves the risk of stillbirth compared with sleeping on your back.

Check baby movements from 28 weeks of pregnancy

Baby movements are the best sign your baby is well. A change in pattern or slowing down of movements can indicate a problem and you should contact your midwife as soon as possible – do not wait until the next day.

Complications in pregnancy

Women who are over 40 years old have a higher risk of developing complications in pregnancy. Common complications are listed below.

Gestational diabetes (GDM)

If you develop gestational diabetes you will need to have good control of your diabetes and excellent blood glucose levels to reduce the risk of health complications and stillbirth.

High blood pressure

If you develop high blood pressure (hypertension) during pregnancy you will need to be closely monitored. Hypertension during pregnancy can restrict the growth of your baby or increase the risk of stillbirth. Having high blood pressure also increases the risk of pre-eclampsia.

Pre-eclampsia

Pre-eclampsia affects 3-7 per cent of women in the second half of pregnancy. If discovered early you can be monitored and continue to have a normal birth. For some women it can develop into a serious illness, requiring treatment and earlier delivery of their baby.  

Birth choices

Women who are over 40 years old have a higher rate of caesarean section births, because of the higher rate of complications. However, as long as you have a healthy pregnancy there is no reason why you cannot have a normal vaginal birth. Being over 40 years old does not mean you will have your labour induced early (unless you have a medical complication).

If you are over 40 years old and your pregnancy goes beyond 40 weeks you will be monitored closely by your midwife as there is a higher risk of stillbirth. At this stage your midwife will talk to you about planning an induction of labour.

You can talk to your midwife about your choices for the place of birth. If you have a planned induction of labour or caesarean section you will have your baby at either of our hospitals. If you have any complications during your pregnancy whilst at another birthing centre you may be advised to have your baby at hospital.

Most women under 20 years old have healthy pregnancies and healthy babies. However there is a greater chance of having a premature baby, a baby that hasn’t grown well in the uterus (womb), heavy bleeding later in pregnancy and infections that can cause serious problems for your baby.

Registering with a midwife as early as possible in pregnancy will ensure you have early access to screening and monitoring of the health of you and your baby, and give you the best chance of avoiding complications.  

As soon as you find out you’re pregnant, tell someone you trust to help you figure out what to do. The Ministry of Health website has some good information for young pregnant women.

Stillbirth

Women who are under 20 years old have a higher risk of stillbirth. You can reduce your risk of stillbirth in the following ways.

Be smokefree

Eliminate or reduce your exposure to second-hand smoke and encourage friends and whānau to have a smokefree environment around you. If you smoke, you can get help and support to stop smoking by contacting our Hāpainga Stop Smoking Service on 0800 427 246 pregnant woman will get priority support.

Have a healthy weight gain during pregnancy

Talk to your midwife about your recommended ideal weight gain during your pregnancy (this will be dependent on your weight at the start of pregnancy). 

Sleep on your side from 28 weeks of pregnancy

Research shows that sleeping on your side halves the risk of stillbirth compared with sleeping on your back.

Check baby movements from 28 weeks of pregnancy

Baby movements are the best sign your baby is well. A change in pattern or slowing down of movements can indicate a problem and you should contact your midwife as soon as possible – do not wait until the next day.

Complications in pregnancy

Women who are under 20 years old have a higher chance of some complications in pregnancy.

Pre-eclampsia

Pre-eclampsia affects 3-7 per cent of women in the second half of pregnancy. If discovered early you can be monitored and continue to have a normal birth. For some women it can develop into a serious illness, requiring treatment and earlier delivery of their baby.

Premature birth

A baby born before 37 weeks is called premature. Premature babies can be very small, not ready to breathe easily and need to spend lots of time in hospital learning to feed.

Having screening and treatment for infections (including sexually transmitted infections) can help reduce the chance of premature birth.

Call your midwife straight away if you have any symptoms of premature labour, including any bleeding from your vagina, pain that comes like waves in your belly, or waters breaking or leaking.

Help and support for teens

• You can carry on going to school, wānanga or university when you are pregnant. There are teen parent units around the district where you and your baby can get care and help.
• Kiwi Families and Birthright have helpful information.

Primary maternity facilities are designed for well women who have no complications during pregnancy. They’re run and staffed by midwives.

There are no tertiary maternity facilities in the Bay of Plenty. If you have more complex maternity needs which require specialist, multidisciplinary care, that is not available at our hospitals you’ll generally be referred to a maternity facility in Waikato DHB instead.

During your pregnancy you will be making choices about your maternity care. You have autonomy over your own body, this means you have the right to make decisions about procedures, medications and interventions that are recommended for you. In New Zealand there is a “Code of Health and Disability Services Consumers’ Rights”. These are legal rights, one of them includes:  “The right to make an informed choice and give informed consent”

For further information about your legal rights when receiving a health or disability service go to hdc.org.nz

What is informed consent?

Informed consent is the process of talking and asking questions until you have enough information to make a decision about your healthcare options. This includes being informed about the risks of a treatment and procedure and the risks of not having a treatment or procedure. It also includes being informed about alternative options. Informed consent means you have the choice of saying no to having a treatment or a procedure or to change your mind about wanting to go ahead with a treatment or procedure.

To give informed consent, you must know enough about your condition, the benefits and risks of the treatment or procedure your doctor or midwife recommends, and the consequences of not having a treatment or procedure. You must have this information given to you in a language and way that you can easily understand. You should have access to an interpreter if you need one. You also have a right to have someone else with you to provide support while you are talking about your options.

Written and verbal consent

There are some situations were written consent is required - for example if you are to be placed under general anaesthetic or sedation, blood components and/or products are to be used, and always when either party requests it. Ask your midwives/doctor about these situations. At this time you will be asked to read and sign a consent form.

Verbal consent is required in all other circumstances and the discussion and decision should be documented in your clinical record 

Teaching and observers

Our healthcare settings are learning environments where clinical teaching and learning occur as part of day-to-day practice as well as formal teaching. You have a right to consent to or decline involvement in teaching, including the presence of student doctors or midwives during treatment or examination.