Dr D A Ware · Dr G V Price · Dr J A Crane · Dr G A Preest· Dr O Thomas
This section is intended to give information that is specific to our own patients needs and has been written with local guidelines and facilities in mind.
Contraception Smoking & Alcohol Conceiving Infertility Miscarriages Medicines Infections Pregnancy testing Clinic times After delivery
Before conception
Start taking Folic Acid 400mcg (micrograms) a day, before you
conceive. It can be purchased at the Chemist or in supermarkets. This vitamin
can reduce the incidence of deformities called "Neural tube defects" e.g. Spina
Bifida. Many women start taking Folic Acid after discovering that they are
pregnant. In actual fact, the studies only showed a benefit in women already
taking Folic Acid before conception. You should continue taking Folic Acid
for the first 12 weeks of pregnancy, then you can stop. Carefully check the dose
of Folic Acid tablets that you buy. Not all formulations contain the required
amount. If you are taking certain prescribed medicines (e.g. anti epilepsy
tablets) you may be particularly susceptible to Folic Acid deficiency. If you
are taking regular medication, either prescribed or "over the counter", you
should discuss with your Pharmacist or Doctor whether they are safe to take in
pregnancy (see below)
Contraception
If you are using a barrier method e.g. condoms, cap or diaphragm, simply
stop using!
If you have been using the pill injection (Depot Provera) you will know
that it must be repeated every 3 months to provide effective contraceptive
cover. This does not necessarily mean that you will get pregnant at 3 months &
one day! It can take up to a year for your periods to resume and for you to
reach full fertility again.
Women taking the combined oral contraceptive (e.g. Microgynon, Logynon.
Cilest) or the mini pill (e.g. Noriday, Micronor, Femulen, Microval)
simply stop taking their tablets. There is a rumour that you should "come off
the pill for 3 months/1 month/ a year" etc - none of this has any evidence to
support it. The truth is that you can become pregnant the day you stop taking
your pill. If you become pregnant whilst on the pill without realising, you
should stop taking the pill. Some women take the pill for the first few weeks,
because they simply didn't realise that they were pregnant. Though not
recommended, there is no evidence that this causes any harm.
Women who have a coil ("IUCD") or an intrauterine device, should make a double
appointment with the Doctor to have the coil removed. See below for details of
contraception after you have had your baby.
Everyone knows that cigarette smoking causes big problems for both mother
and child.
It's probably better to avoid even small amounts alcohol. We often see women who
have become pregnant after having a binge. While we would not recommend this, it
doesn't seem to produce problems provided it is not repeated!
When is the easiest time to
conceive?
It is said that women have become pregnant at all times of their menstrual cycle. Your most
fertile time is around the time of ovulation. Ovulation is the name given
to the process whereby an egg is released from the ovary (where it has been
inaccessible to spermatozoa) and passes into the fallopian tubes and on to the
uterus (womb) - which is where it is accessible to spermatozoa! If an egg
is not fertilised, then a woman has a bleed or "period" 2 weeks later. In other
words, a period follows 2 weeks after ovulation OR ovulation occurred 2 weeks
before your last period. For women with a 28 day cycle, then this happens to
occur at day 14, which is in between periods. But this is not always the case.
If you have a 35 day cycle, then ovulation occurs 14 days before the period -
which would be around day 21 (i.e. not in the middle between periods). It is
easiest to work out the time of ovulation if your cycle is regular. If your
cycle is irregular, then you can work out when you ovulated in the past
(i.e. 2 weeks before your last period). However, you cannot work out when you
next ovulate because you may not know when your next period is due. There
may be clues, though. A temperature change occurs at ovulation and this may be
detected with a thermometer. An ordinary thermometer is not accurate enough,
you have to get a special "ovulation" thermometer from the Chemist. In addition,
the cervical mucus changes at the time of ovulation. If you have some of this
mucus between your thumb and index finger at the time of ovulation, it will
string out as you separate your fingers. At other times, it will not "string
out". The medical term for this is "Spinnbarkeitt"
Reduced fertility
Most couples conceive within a year of trying. This "average" figure is
based on a woman having 12 periods a year (i.e. a period every 28 days). This
doesn't mean to say that you are abnormal if your cycle is longer. If your
menstrual cycle is longer than 28 days, then what this means is that you will
not have ovulated as many times in a year and it may take a little longer to
conceive. We do not investigate couples for reduced fertility unless they have
been trying to conceive without success for over a year.
After a miscarriage
Miscarriages are, sadly, more common than most people realise. As many as 1
in 5 pregnancies end in miscarriage before the 10th week - some women simply
think that they've had a later, heavier period than normal. Miscarriages are
such a common event that we would not investigate them unless you have had 3 in
a row. There is conflicting advice given by Doctors as to when to conceive after
miscarriage. Some say "straight away", some "after a month", "after your next
period" and some "after a year"! In truth, there is no good evidence for any of
this. A miscarriage can take time to get over, not just physically but
psychologically too. It is probably sensible to have at least one period before
trying again, provided you feel happy to start trying again.
Recurrent Miscarriage (3 or more
miscarriages in a row)
This is defined as three or more consecutive miscarriages and affects 1% of
all women. These are the women whom we investigate. There are many different
potential causes - Genetic factors, anatomical reasons, problems with the cervix
(neck of the womb), infections, hormone problems, "autoimmune" diseases,
clotting disorders and "unexplained". The investigations are used to give us
clues as to the reason for recurrent miscarriage. Sometimes, it is not possible
to detect a reason for recurrent miscarriage and the cause remains unknown. We
would need to refer you to the hospital for most of the investigations. These
investigations may include blood tests to check:
Genetic Karyotyping - That is, an analysis of each partner's genes. If
abnormality is detected, you may be further referred to a Clinical Geneticist (a
specialist in genetic disease - usually based at UHW Hospital, Cardiff)
Antibody and clotting tests - These are called "Antiphospholipid",
"Lupus" and "Anticardiolipin" antibody tests. These blood tests may be
done on 2 separate occasions, 6 weeks apart. Women with persistently
positive tests may be offered treatment with low dose Aspirin and Heparin
(Heparin is a medicine that is given by injection only and it is an
anticoagulant - that is, it "thins" the blood) - BUT this is the subject of
ongoing research. You may have heard of the role of Aspirin in recurrent
miscarriage. A recent trial showed benefit in reducing miscarriage rate in women
with positive antiphospholipid antibodies. They were given 75mg Aspirin at the
time of positive pregnancy tests and this was continued until the 34th week of
pregnancy. When Heparin was added, the outcome was even better. This information
is still being assimilated by Doctors and there are many unanswered questions
relating to effectiveness and optimum duration of treatment. If you want
to know more about this and whether this treatment is suitable for you, you
should discuss this with your specialist.
Pelvic
ultrasound scan - This is done to obtain views of the uterus and
ovaries.
Women taking medicines in pregnancy
What to do if you are taking medicines on a daily basis. Generally speaking,
the medical condition you are treating could cause more problems if left
untreated than the medicines being taken. You are probably putting yourself at
greater risk by not taking your medicine than by taking it. Asthmatics in
particular should not stop any medicines, unless they have discussed the matter
with their Doctor. If you have any concerns, you should discuss the matter with
your Doctor or Pharmacist before trying to get pregnant.
Paracetamol is safe to take in pregnancy at the correct dose.
Infections in pregnancy
We are learning all the time about the effects of viral infections on all
sorts of medical conditions and pregnancy is no different. In an ideal world,
you would lock yourself up in a bubble and keep away from all illness for 9
months, but in reality this is impossible! Many women get coughs and colds
whilst pregnant and it doesn't seem to produce any problems at all. If you have
never had chickenpox before, you should stay away from any infected individuals
(i.e. active current infection) especially during the first trimester (first 3
months) and last trimester (last 3 months).
I think I'm pregnant....
Congratulations! You will
need to go to the chemist or buy one of the pregnancy testing kits to confirm
that you are pregnant. If you really are pregnant, please contact the surgery
reception to make an appointment for "Antenatal Booking Clinic". Most
women come to "Booking clinic" at around 7 to 10 weeks after the last period. At
booking you will see the midwife and you will be given a date for your first
"dating" ultrasound scan. This scan at 10 to 12 weeks will give an accurate
assessment of your expected date of delivery. You will also be offered a later
"anomaly" scan. This may occur at around 16 weeks. This scan will look at the
baby to check that all is well.
The Antenatal clinics are held at both surgeries, depending on which one you
normally visit. You will first see the Midwife (who does 99% of what needs to be
done!) and then you will see one of the Doctors. The Doctor will need to see you
briefly after you have seen the Midwife to listen to your heart & lungs (Pencoed
patients only). Patients who are booked at the Royal Glamorgan Hospital do not
need to see the GP at booking and will only see the midwife. We DO NOT routinely do an internal examination because it is not
considered necessary unless there are exceptional circumstances. You will be
given the opportunity to discuss any concerns relating to your pregnancy with
the Doctor and Midwife.
Antenatal Clinic times
Pencoed: Monday afternoon
Llanharan: Wednesday afternoon
When you are pregnant (and for a year after your delivery) you will be eligible for free NHS prescriptions. The Doctor or Midwife has to sign a form for you to be able to do this. We usually do this at booking. Also, many of the large supermarkets and Boots provide free packs containing many free baby items. Go to their respective information desks for details. If it is your first baby, you will also soon encounter the gymnastic feat involved in getting a baby seat out of the car while sandwiched into a tight parking space. This is a good time to apply for your "Mother & Baby" parking sticker for the car at the supermarket (and wonder at the number of people who park in these areas without young children....!)
After the birth
You will be seen by the Midwife during the first few days at home. The
Doctor will usually visit the first working day after you get home, provided
that we have been informed by the hospital - they usually give you an envelope
when you leave hospital "to give to the GP". This envelope usually contains a
pink form, which is a carbon copy summary of the details of your delivery
(whether there were problems, birth weight etc.). After 6 weeks, you will be invited
to attend for the "6 week check" (these are booked appointments and occur
during antenatal clinic). We no longer do as much at the 6 week check as we used
to. You will be given the opportunity to discuss any problems or concerns
relating to having been pregnant. You will be offered contraceptive advice. If
you are breast feeding, you cannot have the Combined Contraceptive Pill (but the
"mini pill" is fine). You can start the pill after the first month. We do not do
routine smears at the 6 week check and we no longer perform internal
examinations as a routine in an otherwise well woman - it is only done if you
are getting problems. Smears are only done if they are due, but at the
moment, we are deferring smears for a couple of months after delivery (if they
are due) because there is some evidence that smears taken during the first few
weeks after pregnancy can be difficult to read and end up needing to be
repeated. We sometimes do blood tests for anaemia or thyroid disease, but these
are not routine. We are aware that many women feel low after having a baby and
we are always happy to discuss this with you.
We will add to this page, depending on feedback from our patients. We regret that we cannot answer individual or personal questions online.
See also our travel section for advice on travelling and pregnancy.
The information contained on this site is general information which is not in any way intended to replace the specific advice that patients may obtain from their own doctor about individual care.
©Pencoed Medical Centre 1998-2005