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The female sex hormones (oestrogen and progesterone) are produced by the ovaries and control the female menstrual cycle. The egg can live for 24 hours, and the sperm can live for 5 days.
Ovulation happens when an egg is released from one of the ovaries. At the time of ovulation the mucus in the cervix is thinner than usual to let the sperm pass through more easily. Fertilisation takes place in the Fallopian tube when a single sperm and egg meet and fuse together to form a single cell called a zygote.
Within 24 to 36 hours of being fertilised the single cell divides into 2 cells, then 12 hours later into 4 cells and so on.

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HCG is a hormone that is produced when a woman becomes pregnant. This is how a pregnancy test shows that it is positive, as the HCG is present. The most common ways to find out that you are pregnant are the urine test, which can be done at home or can be given by a doctor. Pelvic exams and blood tests can also be done to determine whether a woman is pregnant.

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-Cravings
-Cramping
-Morning Sickness
-Tiredness
-Weight Gain
-Heartburn
-Mood swings

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During this trimester, the woman will have signs of pregnancy and most women will notice that they are pregnant during this trimester.
The hormonal changes affect almost every organ in a woman's body.
The stomach and womb grow to create more space in preparation for the embryo to grow. This will feel like cramping for the woman.
After the 12 Week scan, this is usually the point in which a woman will announce her pregnancy, as it is unlikely that there will be a miscarriage and phantom pregnancy has been ruled out.

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At 4 weeks, the embryo is the size of a poppy seed (2mm). They form into two and then later into three layer. Each of the layers will grow to be different body parts of the embryo.
A heartbeat can be heard from as early as 6 weeks.

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At 8-9 weeks, the embryo is the size of a cherry (22mm). At this point, the face is slowly forming, there is some colour in the eyes, they are forming their major organs and the beginning of their hands and feet are also beginning to form.
Some women have their first scan at this stage.

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At 12 weeks, the foetus is the size of a plum (54mm). At this stage, the foetus is fully formed. All of their organs and structures have formed and will continue to grow and the foetus is moving, although this cannot be felt by the mother yet.
After the 12 Week scan, this is usually the point in which a woman will announce her pregnancy, as it is unlikely that there will be a miscarriage and phantom pregnancy has been ruled out.

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Water Retention- causes swelling of feet and ankles (edema).
Women can feel the foetus moving.
Nosebleeds and nasal congestion.
Breast enlargement and discharge.
Hemorrhoids and varicose veins.
Heartburn, indigestion and constipation.
Backaches.
Walking differently.
Navel pushes out.

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During this trimester, the pregnancy becomes comfortable for the woman. Other people may start to notice the pregnancy. Lots of women take on the 'radiant glow' due to excitement and hormones.

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The foetus is 85mm at this stage. The foetus begins to swallow little bits of amniotic liquid. The kidneys start to work and the swallowed fluid passes back into the amniotic fluid as urine.

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Muscles in the foetus' face can move and facial expressions appear but the foetus cannot control them. Their hands can reach each other and they are able to make a fist.

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Between 16 and 20 weeks, an anatomy scan is done to determine the baby's gender. Some families chose to find out the gender, while others keep it a surprise until the birth.

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At this stage, the foetus' skin is covered in a white greasy substance called vernix.

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Some women will get stretch marks during pregnancy. If so, this will occur between 22-24 weeks.
At 24 weeks, the foetus is able to survive outside of the womb and therefore it is illegal, at this point to abort the foetus.
At 25 weeks the foetus is moving a lot and responds to touch and sound. A very loud sound can make them jump.

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At this stage, the shape of the abdomen changes a few weeks before the onset of labour as the foetus drops towards the opening of the pelvis. The movement of the foetus can be seen from the outside, the navel pushes out and some women experience backaches and they walk differently to accommodate the weight of the foetus. The labour and delivery also take place at the end of this trimester.

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Uterus- organ that the baby grows inside.
Placenta- thick, blood-rich tissue that lines the wall of the uterus.
Umbilical Cord- ropelike structure that connects the embryo to the placenta.
Amniotic Sac- a thin, fluid-filled membrane that surrounds and protects the developing baby.
Ultrasound- test using sound waves to see images of the baby to determine the sex and check development.
Engaged
Transverse
Breech
Contraction
Dilation
Crowning

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At this stage, the foetus will be the size of a cauliflower (36.6cm). The baby is now viable which means it can survive outside of the womb and their lungs would function with medical help if they were born at this stage. The foetus is starting to fill all of the space in the uterus, they can open and close their eyes, they sleep and wake at intervals.
The mother may have leg cramps etc, but these should go after the birth. The mother may also need blood tests to check for anemia. If her blood group is Rhesus negative, she may need an antigen D injection. This injection is always given after the birth of the child, but can sometimes be offered during the pregnancy. If a woman is Rhesus negative, it means that her red blood cells have started fighting against each other. If she does not get the antigen D injection, then the baby could leave something in the womb, which is dangerous if the woman falls pregnant again, it could lead to a miscarriage.

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At this stage, the baby's brain is growing, so their head is getting bigger to accommodate it, their genitals are developing and from now on the baby will gain weight fast- their lungs and digestive tract are almost mature. The foetus can see light outside the womb and may react to a light shone on the mothers stomach.

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At this week, the baby is growing fast- their movements may start to feel wriggly or squirmy. They can move their head from side to side- organs continue to mature.

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At this stage the baby gains a third to a half of their birth weight during the next 7 weeks or up to birth. They are laying down a layer of fat for life outside of the womb. The fatty layer plumps the skin up so it's not wrinkly.
By 33 weeks the baby is probably now head down in the uterus, although some continue to change position.

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At this stage the foetus has fully grown fingernails and toenails, the kidneys are fully developed and the baby is getting very 'snug' in the womb, the mother may get kicked in the ribcage. The uterus has now expanded to 1,000 times it's original volume.

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At this stage the foetus is 2.7-4.1 kgs in weight and 50-53cms long. If there are health issues, then the woman will be started off at this stage of her pregnancy. The mother feels increased pressure in the lower belly as the baby is gradually dropping. The baby's head is engaged in a position for birth. This is called engagement.
Laguno is shed now, and vernix starts to disappear.
The baby swallows anything that is shed and this stays in the bowels after birth.

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At this stage, the baby's organs are well developed. The skull bones are not properly fused. This allows for potential pressure during birth. The mother's cervix softens.
2 hormones (oxytocin and prostaglandin) control the contractions that thin the cervix and expel the baby from the uterus.
A theory into what prompts the production of these is that there is a clock in the placenta.

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Blood stained mucus.
Diarrhoea.
Nausea.
Intense back ache.
Mild contractions.
Urge to go to the toilet.
Waters break- amniotic sac rupture's and water runs out of the vagina.
Hopefully the pregnancy is full term.

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At this stage, the cervix is only 3-4cm dilated, and the woman will usually stay at home, stay active and stay upright and time their contractions and inform their midwife.

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At this stage, the cervix dilates from 4 to 7 cm. Contractions become more regular, the woman is usually invited into hospital, and the cervix usually dilates 1cm per hour for first babies. This stage is the longest part of labour.

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First Stage of Labour- Transitional Stage

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First Stage of Labour- Transitional Stage

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At this stage, the cervix dilates from 7cm to 10cm. The woman will have contractions lasting from 45-60 seconds. She must resist the overwhelming urge to push, because if she does not resist the urge, then it can cause serious tearing. Contractions can slow down. The woman can also experience nausea, vomiting, shaking, shouting and exhaustion.

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At this stage, the cervix is 10cm dilated and the mother is ready to push. Bursts of short, repeated pushes are advised rather than a long push.
The crowning of the baby's head can be seen and a sharp stinging pain can be felt by the mother.

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During the pushing stage, the mother should not push during crowning to avoid tearing. Once the head has passed through the vagina, the baby will begin to turn so that the widest part of the shoulders is at the widest part of the pelvis.
The top of the shoulders then come out, then the rest of the shoulders, followed by the rest of the body.
When the whole of the baby is out, the baby is placed on the mother's chest and the umbilical cord is usually clamped and cut.

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Third Stage of Labour- Placenta Delivery

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Third Stage of Labour- Placenta Delivery

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This is the final stage of labour and it happens after the birth of the baby. Contractions continue and this helps the placenta detach from the uterine wall.
There are two ways to manage this stage of labour:
Active- when you have treatment to make it happen faster.
Physiological- when you have no treatment and this stage happens naturally. This can be managed with the oxytocin injection.
Managed delivery will reduce the chance of haemorrhaging.
Usually, the placenta delivery happens within 30 minutes of the baby being born.
Physiological expulsion may take longer, the cord will not be cut and will wait until the umbilical cord stops pulsing.

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Ideally for labour, the baby is positioned head down, facing your back, with the chin tucked to its chest and the back of the head ready to enter the pelvis. This is called cephalic presentation. Most babies settle into this position with the 32nd and 36th week of pregnancy.
For babies in a different position to this labour can be challenging and will always need close monitoring of mother and baby including foetal heartbeat.
Every effort will be made to turn the baby where possible to allow a normal vaginal birth.

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Antenatal care monitors both the mother and the baby. The intention of this care is to ensure that the mother delivers a healthy baby. Women are encouraged to see their own GP as soon as they think that they may be pregnant. The team to support the woman during antenatal care are:
-midwife
-doctor
-health visitor
-obstetrician

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Early Antenatal Care (first 12 weeks or first trimester)

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Early Antenatal Care (first 12 weeks or first trimester)

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The first appointment during the early antenatal care stage is where the midwife will take blood and urine samples, and gather information on your health and the father of the baby's health and family of both parents.
This is quite a lengthy appointment as the initial paperwork is completed and it is the beginning of the maternity paperwork.
At this stage, cultural differences and personal preferences are adhered to, for example if the woman would prefer a female doctor or home birth. It is important individual requests and preferences are met where possible.

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These tests are carried out at antenatal appointments to check the mothers health. They are there to make sure that any issues are found if they are developed:
-blood pressure checks
-urine tests
-blood tests
-measuring baby's growth (from approx. 24 weeks)
-checking baby's heartbeat

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During each antenatal visit, the mother's blood pressure will be checked to make sure it is normal.
High blood pressure is also known as hypertension. There are three levels of hypertension:
Mild blood pressure- 140/90
Moderate blood pressure- 150/110
Severe blood pressure- 160/110

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Certain substances in a pregnant woman's urine can be a sign of conditions that may cause problems for both mother and baby.
At each antenatal visit, midwives will ask the mother to do urine tests. The midwife is checking for:
-Sugar (sign of gestational diabetes)
-Nitrites and white blood cells (could be a sign of Urinary Tract Infections)- could also lead to early labour.
-Protein (could be a sign of pre-eclampsia)

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Antenatal screening tests include screening for:
-Sickle cell disease and thalassemia.
-Infectious diseases.
-Downs Syndrome (trisomy 18)- 3 copies of chromosome 18 instead of 2 copies- occurs by chance.
-Patau's Syndrome (trims 13)- 3 copies of chromosome 13 instead of 2 copies- hereditary.
-Cystic Fibrosis
-HIV, Syphilis and Hepatitis B.

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Amniocentesis is a diagnostic test for women who may have higher chance of carrying a baby with a genetic chromosomal condition such as Downs Syndrome or Edwards Syndrome.
The test is usually carried out around week 15-20. Doing this any sooner could result in miscarriage.
A sample is taken from the amniotic fluid that surrounds the baby to be tested, a needle is inserted into the abdomen and is guided by an ultrasound. The results of the test will be available around 3 weeks later so that options can be discussed if required.

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Ultrasound uses frequency sound waves to create an image of the baby and surrounding area of the uterus. You can not hear the sound waves, but when they bounce off the baby they create echos which create the black and white image.
The first scan usually occurs between 8 and 14 weeks, this can commonly be known as the 12 week scan or the dating scan. This scan estimates when the baby is due and check for physical development of the baby. Screening can take place for possible conditions.
Between 18 and 20 weeks is the second scan. This is commonly known as the 20 week scan or the anatomy scan.
While genitals formed weeks ago, it is here the baby is more developed and the gender can be identified more easily, as long as the baby is in the correct position.

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(information found from NHS website)
1. First contact with midwife or doctor. They should give you information about:
-folic acid supplements
-nutrition, diet and food hygiene
-lifestyle factors such as smoking, drinking and recreational drug use.
-antenatal screening tests.
You will be told about the risks and benefits of these tests.
Before 10 weeks, screening for sickle cell disease and thalassaemia will be offered.
You must inform your midwife or doctor if:
-you have previously been pregnant and there were any complications during that pregnancy.
-you have diabetes, high blood pressure etc.
-you or anyone in your family have previously had a baby with a health condition.
-there is family history of an inherited condition (cystic fibrosis etc)
-you or your partner are a genetic carrier of an inherited condition.
-you have had fertility treatment and a donor egg or donor sperm.
8-12 Weeks
Your midwife or doctor should:
-give you notes of care
-see if you need additional support or care.
-plan the care you will receive during your pregnancy.
-identify any potential risks with your job.
-measure your weight and height and calculate your body mass index (BMI)
-measure blood pressure.
-check urine for protein
-find out whether you are t risk of gestational diabetes or pre-eclampsia.
-offer screening tests and explain what is involved.
-offer you an ultrasound scan at 8-14 weeks to estimate a due date.
-offer you an ultrasound scan at 18-20 weeks to check the physical development of the baby and check for 11 rare conditions.
-assess your mental health by asking about your mood.
-ask about any past or present severe mental illness or psychiatric treatment.
If you have experienced Female genital mutilation (FGM) then it is important that you inform your doctor or midwife as this can cause serious problems during labour which can be life threatening for both mother and baby.
At 8-14 weeks is the Dating Scan which estimates when the baby is due and screen for possible conditions such as Downs Syndrome.
16 Weeks
At this stage, your doctor or midwife will give information about the 18-20 week ultrasound. They will also:
-review, discuss and record results of any screening tests.
-measure blood pressure and test urine for protein.
-consider iron supplement if you are anaemic.
- from 16 weeks, you will be offered the 'whooping cough vaccine'.
18-20 Weeks
The 20 week scan checks the development of the baby.
Screening for HIV, syphilis and hepatits B is offered. Although these tests are not mandatory, they are recommended.
25 Weeks

If you have not previously had a child then you will have an appointment at this stage.
your midwife or doctor will:
-use a tape ,measure to measure the size of your uterus.
-measure your blood pressure and test your urine for protein.
28 Weeks
Your midwife or doctor will:
-measure the size of your uterus
-measure your blood pressure and test your urine for protein
-offer more screening tests
-offer your first anti-D treatment if you are Rhesus negative.
-consider iron supplement if you are anaemic.
31 Weeks
You will have an appointment at this stage if you have not previously had a baby. Your doctor or midwife will:
-review, discuss and record results of previous screening tests
-measure your uterus
-measure your blood pressure and test your urine for protein.
34 Weeks
Your midwife or doctor will give you information about preparing for labour and birth, including recognising active labour, ways of coping with pain during labour and your birth plan. They will give you information about caesarean section and why it may be needed, what it involves, the risks and benefits and implications of future pregnancies and births. They will also:
-review, discuss and record results of previous screening tests
-measure your uterus
-measure your blood pressure and test your urine for protein.
-offer your second anti-D treatment if you are rhesus negative.
36 Weeks
Your midwife or doctor will give you information about:
-breastfeeding
-caring for your newborn baby
-vitamin K and screening tests for your newborn baby.
-your own health after your baby is born.
-the 'baby blues' and postnatal depression.
They will also:
-measure your uterus
-measure your blood pressure and test your urine for protein.
-check the position of your baby
-offer an external cephalic version (ECV) if your baby is in the breech position.
38 Weeks
Your midwife or doctor will discuss options about what happens if your pregnancy goes over 41 weeks.
They will also:
-measure your uterus
-measure your blood pressure and test your urine for protein.
40 Weeks
If this is your first baby you will have an appointment at 40 weeks
Your midwife or doctor will:
-measure your uterus
-measure your blood pressure and test your urine for protein.
41 Weeks
Your midwife or doctor will:
-measure your uterus
-measure your blood pressure and test your urine for protein.
-offer a membrane sweep.
-discuss the options and choices for induction of labour.
42 Weeks
If you have not had your baby by 42 weeks and have chosen not to have an induction you should be offered increased monitoring of the baby.

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Newborn Screening and Health Checks in the First Year of Life.

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Newborn Screening and Health Checks in the First Year of Life.

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Straight after birth:
After giving birth, the baby will be placed straight onto the mother's chest for skin-to-skin contact  before the cord is cut as this is good for bonding. When the cord is cut, the baby is dried and wrapped in a towel to keep them warm. The mother can continue to hold her baby.
The baby may be covered in blood or white vernix, if the mother would prefer for her baby to be dried and wrapped in a towel before holding them, then she can ask the midwife to do so. Mucus may need to be cleared from the baby's mouth and nose.
Sometimes, a baby may struggle with their breathing. If this is the case, then they will be taken to another part of the room to be given oxygen to help to establish their breathing. They will be taken back to the mother as soon as possible.
The baby will be examined, weighed and measured and they will get a band with the mother's name on.
Vitamin K:
The mother will be offered a vitamin K injection for her baby. This helps to prevent a rare bleeding disorder called haemorrhagic disease of the newborn. The midwife should have discussed the injection with the mother during her pregnancy. If the mother does not want her baby to receive the injection, then the baby can have vitamin K by mouth instead, but they will need future doses unlike the injection.
Stitches:
If the mother has small tears, then they will not get stitches, as they heal better that way. If the mother does however need stitches, she should be able to keep cuddling her baby.
If the mother has a large tear or an episiotomy then she will need stitches. If she has already had an epidural during labour, then it should be able to be topped up, however if she has not, then she should be offered a local anaesthetic. The midwife will help the mother to wash before she is taken to the postnatal ward.
Bleeding after birth:
If the mother bleeds heavily from the vagina after giving birth, it is a rare complication called Postpartum haemorrhage (PPH).
The two types of PPH are:
-primary/immediate- bleeding that happens within 24 hours of giving birth.
-secondary/delayed- bleeding that happens after the first 24 hours and up to 6 weeks after giving birth.
PPH can happen for two of these reasons:
1. because the womb does not contract strongly enough after the birth.
2. because part of the placenta is still in the womb or there is an infection in the lining of the womb (endometritis).
To help to prevent PPH, the mother will be offered an injection of oxytocin as the baby is being born. It stimulates contractions and helps to push out the placenta.

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At birth, the baby's weight and length will be taken and recorded in their health record book.
Their weight will be taken again during the first week of their life. Babies can lose a little bit of weight after birth but this is monitored. The baby's weight will be taken at:
Once a month up to six months of age.
Once every two months from 6-12 months.
Once every three months when baby is 12+ months.

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The following screen tests are offered shortly after birth:
-Newborn physical examination
-Newborn hearing test
-Newborn blood spot screening
If any health issues are identified from these tests, then the appropriate support will be offered.

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The physical examination is done within 72 hours of the birth. The baby's eyes, heart, hips and, if the baby is male, then his testes are examined.
The physical examination is repeated when the baby is 6-8 weeks old as some conditions can take longer to develop and won't show until this time.
Some parts of the physical examination can be uncomfortable for the baby, but it is not painful, and the results of these examinations must always be recorded in the child's health record book.

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The hearing screening usually happens before the mother and baby are discharged from hospital. This screening is done by placing a soft tipped ear piece into the baby's ear and soft clicking sounds are played to see the baby's reactions.
Only 1 or 2 in 1000 babies are born with permanent hearing loss, but support will be offered is any permanent hearing loss is identified.

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The blood spot screening is most commonly known as the heel prick. This usually takes places five days after the birth.
This screening is done by taking 4 drops of blood from the baby's heel and screening it for nine rare but serious health conditions which are:
-sickle cell disease
-cystic fibrosis
-congenital hypothyroidism
-inherited metabolic diseases (phenylketonuria, medium-chain acyl-CoA dehydrogenase deficiency, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1, homocystinuria)
-severe combined immunodeficiency

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Health Checks During The First Year Of Life:

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Health Checks During The First Year Of Life:

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Just before or just after the baby is born, the mother should receive the baby's personal child health record (PCHR). This should be taken to the baby clinic or GP upon every visit.
It is used to record the child's weight, height, vaccinations and any other important information. The mother is able to add information to the book herself, things such as any illnesses, accidents that the child might have or any medication that they are/have taken. It is helpful if the developmental milestones section of the book is up to date.
Reviews:
At each review, the health visitor will discuss the child's development with the mother and ask if she has any concerns. If the baby is gaining weight and the health visitor has no concerns about it, then the baby should be weighed no more than:
-once a month up to six months of age.
-once every two months from 6-12months.
-once every three months over 12months old.
If the baby was born prematurely, then their developmental age is calculated from the original due date not from the date that the mother actually gave birth, until the child is two years old.
The health visiting team will send the mother the 'Ages and Stages Questionnaire' (ASQ-3) which she should fill in before her child's 9-12 month and 2-year development reviews. This is so that the mother can try out some of the activities on the questionnaire with her baby at home where they are comfortable and familiar with their surroundings.
Shortly after birth:
The baby is weighed at birth and then again during their first week of life. The physical examination also takes place at this point. At five and eight days old the baby will have the blood spot screening, and the baby will also have their hearing screening straight after birth.
A midwife and health visitor will support the mother with breastfeeding and caring for her new baby and help her adjust to life as a new parent.
1-2 Weeks:
The health visitor will give the mother advice on the following:
-safe sleeping and the risks of these things not being correct.
-vaccinations.
-feeding the baby (breastfeeding and bottle feeding)
-adjusting to life as a new parent
-the baby's development
6-8 Weeks:
This is when the repeat of the physical examination occurs. The baby's weight, height and head circumference are also measured.
The baby's vaccinations will be discussed with the mother, and she will also be asked how she has been feeling emotionally and physically since giving birth to her baby.
9-12 Months:
The baby should be offered another review at this point, to look at their language, learning, safety, diet and behaviour, among other things. The mother has this opportunity to discuss any concerns she may have.
2-2 and a half years:
At this age, the child will have another health and development review. If the mother has a partner, it is best that they are there too if possible. This can happen at home, baby clinic, at the children's centre or at a nursery, playgroup or childminders if they are attending any of those.
This review will cover:
-development including movement, speech and language, social skills, behaviour, hearing and vision.
-growth, healthy eating and staying active
-managing behaviour and sleeping habits
-tooth brushing and going to dentist
-keeping the child safe
-vaccinations