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Antenatal care is the care and help you receive from health professionals during the course of your pregnancy. It is important you take good care of your health and that of your unborn baby during pregnancy and making the most of the antenatal care available to you is a big part of that .
As soon as you find out you are pregnant, you should get in touch with your GP or midwife to get information on the services and support that are available and to organise antenatal care. This will include:
As part of your antenatal care your midwife will offer you a dating scan that will give you a date for the birth of your baby. They give the opportunity for you to find out more about the care on offer, and also discuss any issues and questions you have.
Antenatal appointments are check-ups to assess the health of you and your baby. They give the opportunity for you to find out more about the care on offer, and also to discuss any issues and questions you have. For more information, see antenatal appointments.
This topic gives an overview of some of the issues that women face during pregnancy. This includes changes to lifestyle, including diet, common health problems, coping with work and antenatal classes.
These issues can also be discussed with your midwife at antenatal appointments.
Your antenatal notes
At your booking appointment, usually the second meeting you have with your midwife, all your details will be entered into a record book. These are your antenatal notes which will be added to at each appointment you have. You will be asked to look after your notes. If you go away from home you should take your notes with you, so if you need medical attention you will have the information that is needed.^^ Back to top
There are a number of things you can do to stay healthy during your pregnancy.
It is important to keep active during your pregnancy. It will help you to adapt to your changing shape and weight gain and also help you get back into shape after birth.
You can continue your normal daily physical exercise for as long as you feel comfortable. However, you should not exhaust yourself and you may need to slow down as your pregnancy progresses. If you were not active before your pregnancy, you should not suddenly take up a strenuous exercise programme.
If you start an aerobic exercise programme, begin with no more than 15 minutes' continuous exercise, three times a week. Increase this gradually to a maximum of 30-minute sessions, four times a week. Inform your instructor that you are pregnant.
Some activities are not suitable when you are pregnant because they carry extra risks, such as falling, or they put too much strain on your joints, including:
You should also avoid lying on your back, especially after 16 weeks, because your bump can press on big blood vessels and make you feel faint.
When you drink, alcohol passes from your blood, through the placenta, to your baby. A baby’s liver is one of the last organs to develop fully and does not mature until the latter half of pregnancy. Your baby cannot process alcohol as well as you can and too much alcohol can seriously affect your baby’s development.
If you are pregnant, or planning to become pregnant, you should try to avoid alcohol completely for the first three months of your pregnancy because there may be an increased risk of miscarriage.
If you choose to drink during your pregnancy, you should not drink more than 1-2 units of alcohol once or twice a week. One unit is equal to half a pint of beer, lager or cider at 3.5%, a single measure of spirit (such as whisky or vodka) at 40% or half a standard (175ml) glass of wine at 11.5%.
You should not get drunk or binge drink while you are pregnant as this can harm your unborn baby. Binge drinking is usually classed as more than six units of alcohol on a single occasion.
Smoking during pregnancy restricts the essential oxygen supply to your baby and increases the risk of it being born underweight or too early. These risks will be reduced if you stop smoking during your pregnancy.
As soon as you stop smoking the carbon monoxide and chemicals clear from your body and your oxygen levels return to normal. You and your baby benefit immediately.
Your midwife or GP should be able to offer advice, information and support to help you stop or cut down on smoking. The NHS Smoking Helpline
, is available on 0800 169 0 169. The helpline is open from 7am and 8pm, 7 days a week (Including bank holidays but excluding Christmas Day) to request an information pack. For more information about NHS Stop Smoking support services, call Stop Smoking Wales on 0800 085 2219.
Consuming high levels of caffeine can cause your baby to have a low birth weight , which can increase the risk of health problems later in life. It can also increase the risk of miscarriage.
You do not have to cut out caffeine completely but you should try not to have more than 200mg per day. This is equivalent to two cups of instant coffee or four (50g) bars of dark chocolate.
Cannabis and other illegal drugs
Cannabis and other illegal drugs, such as ecstasy, cocaine and heroin, can harm your baby. If you use any of these drugs then you should talk to your midwife or GP to get advice to help you stop. If you are a dependent drug user, extra support and treatment is available to help you to come off drugs and keep your baby safe.
If you work during your pregnancy, make sure you know your rights to antenatal care, maternity leave and benefits. More details of these can be found on the Department of Work and Pensions website.
It is also important that you make sure your job is not putting the health of you and your baby at risk. Jobs that involve working with chemicals, X-rays or heavy lifting may not be suitable during pregnancy. If you have any worries you can talk to your maternity team, occupational health nurse, union representative or someone in personnel. The Health and Safety Executive can also give you more information.
If you do carry on working during your pregnancy, you may get very tired, especially in the first and last weeks of your pregnancy. Make sure you try to rest in your lunch break and when you get home in the evening.
There is no evidence that sexual activity is harmful while you are pregnant. However, it is normal for your sex drive to change through your pregnancy and you may want to talk to your partner about this.
Although it is safe, it may not be easy to have sex and you and your partner may have to find different positions that are more comfortable for you both.
Flying is not harmful for you or your baby, but some airlines will not let you fly towards the end of your pregnancy. You should check the terms and conditions of an airline before flying with them.
Long-distance travel (longer than five hours) carries a small risk of thrombosis (blood clots) in pregnant women. If you fly, drink plenty of water to stay hydrated and do the recommended calf exercises. You can buy a pair of support stockings in the pharmacy over the counter, which will reduce leg swelling.
Before you travel, think about your destination. Could you get medical help if you needed it? Are any vaccinations needed which might be harmful to the pregnancy?
Road accidents are among the most common causes of injury in pregnant women. To protect yourself and your baby, always wear your seatbelt with the diagonal strap across your body between your breasts and with the lap belt over your upper thighs. The straps should lie above and below your bump, not over it.
In most cases, if you are well and healthy and take necessary precautions, there should be no reason not to travel.
Some medicines can harm your baby's health but some are safe, for example medication to treat long-term conditions such as asthma, thyroid disease, diabetes and epilepsy. Always check with your GP, midwife or pharmacist before taking any kind of medication.
Use as few over-the-counter medicines as possible during your pregnancy. Your GP should only prescribe you medication where the benefits of taking the medication outweigh the possible risks of not.
Few complementary and alternative therapies have been established as safe during pregnancy. If you do decide to have any kind of complementary treatment contact the Institute for Complementary Medicine first to make sure the practitioner is fully qualified. You should make sure a practitioner knows you are pregnant before having any treatment. Tell your midwife or doctor if you are prescribed any herbal, homeopathic or aromatherapy remedies.
A healthy diet during pregnancy is very important for the development of your baby, and may have long-term beneficial effects for both you and your child.
It is advisable to follow a balanced diet based around the four main food groups:
You should also try to drink plenty of fluids, such as water and fruit juice, as this can help to prevent constipation and nausea.
Vegetarian, vegan and special diets
A varied and balanced vegetarian diet should give you all the nutrients that you and your baby need during pregnancy. However you might find it hard to get enough iron and vitamin B12. You should talk to your midwife or doctor about how to make sure you are getting enough of these nutrients.
If you have a restricted diet, due to a food intolerance such as coeliac disease, or for religious reasons, you may wish to talk to a dietitian who can give you advice on what nutrients you need for you and your baby. Your midwife or doctor can refer you for an appointment.
In addition to a healthy balanced diet, there are a few additions and restrictions to your diet that are recommended during pregnancy:
During pregnancy you should increase your intake of folic acid. Folic acid can help reduce the risk of problems developing with your baby's spine and brain (neutral tube defects), such as spina bifida.
The Department of Health recommends that all women who are trying to get pregnant should take a daily supplement of 400 micrograms a day. This should continue for the first 12 weeks of pregnancy, while your baby's spine is developing.
You can get folic acid tablets from pharmacies, supermarkets, health food stores and on prescription. Natural sources include green leafy vegetables, breakfast cereals and bread.
If you have a family history of neural tube defects, or are taking medication for a condition such as epilepsy, check with your GP if you are planning a pregnancy and before starting to take folic acid because you may need a higher dose.
It is important to get enough vitamin D during your pregnancy, and while you are breastfeeding, to keep your bones healthy and to help with the development of your baby’s bones.
This is especially important for women at risk of vitamin D deficiency; this includes anyone with a South Asian, African, Caribbean or Middle Eastern family origin, those who stay indoors a lot, those who usually cover up their skin when they go outdoors, or those with a diet particularly low in vitamin-D-rich foods.
Foods that contain vitamin D include oily fish, eggs, meat, vitamin-D-fortified margarine and breakfast cereals.
Only a small amount of our vitamin D comes from diet; the best source is sunlight. To ensure you get enough vitamin D it is advised that pregnant women take a daily supplement of 10 micrograms a day. Ask your midwife or doctor about suitable vitamin supplements.
Too much vitamin A during pregnancy can harm your unborn baby. Avoid supplements containing vitamin A and eating liver and liver products, as these are high in vitamin A.
It is recommended that you do not eat shark, marlin or swordfish, and that you limit the amount of tuna you eat while you are pregnant or breastfeeding. These types of fish contain high levels of mercury, which can damage your baby’s developing nervous system. You should not eat more than two tuna steaks or four cans (each 140g drained) of tuna a week.
Peanuts, or food containing peanuts such as peanut butter, are safe to eat during your pregnancy unless you have a peanut allergy or a health professional advises you not to.
Previously, pregnant women were advised to avoid peanuts if there was a history of allergy - such as asthma, eczema or a food allergy – in their immediate family.
However, the latest research shows that there is no evidence to prove that eating peanuts during pregnancy increases the risk of your baby developing a peanut allergy.
Ask your doctor or midwife if you are worried about allergies and food intolerances.
Listeria and salmonella
Some bacterial infections such as listeriosis and salmonella can be picked up from food you eat and can harm your baby. To avoid these infections it is best to follow this advice:
Toxoplasmosis is a disease caused by a common parasite. It does not usually cause any symptoms in healthy people but can cause problems for an unborn baby if an expectant mother becomes infected.
It can be passed on from undercooked or uncooked meats and from the faeces of infected cats, or soil and water contaminated with faeces. To minimise the risk of infection:
Pregnancy can cause many physical and emotional changes. Most of the time these are normal and do not pose any risk to you and your baby, but they may cause you some discomfort. Your GP and midwife can provide more information and support.
Nausea and sickness
Nausea and sickness in the early weeks of pregnancy are normal but usually stop at weeks 12-14 of your pregnancy. Pregnant women experience varying degrees of sickness and nausea and at different times of the day. The reasons for this are not fully understood but it is probably caused by the hormonal changes that happen in the first three months of pregnancy. There are things you can do to help with nausea:
If you are being sick all the time and cannot keep anything down, tell your midwife or doctor. Some pregnant women experience severe nausea and vomiting. This condition is known as hyperemesis gravidarum and needs specialist treatment.
As your baby grows, the hollow in your lower back may become more pronounced, and this can also cause backache. During pregnancy, your ligaments become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.
How to avoid backache:
If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They will be able to give you some advice and may suggest some helpful exercises.
Pelvic joint pain
If during or after your pregnancy you have pain in your pelvic joints when walking, climbing stairs or turning in bed, you could have pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). This is a slight misalignment or stiffness of your pelvic joints, at either the back or front. It affects up to one in four pregnant women. Some women have minor discomfort, others may have much greater immobility.
Ask a member of your maternity team for a referral to a manual physiotherapist, osteopath or chiropractor who is experienced in treating pelvic joint problems.
For more information on how to deal with pelvic joint pain go to the pregnancy care planner.
You may suffer from constipation during your pregnancy. This is usually caused by the hormonal changes in your body and can be relieved by eating more fibre (such as wholegrain cereals and wholemeal breads, fruit, vegetables and pulses), drinking more water and exercising regularly.
Iron supplements can cause constipation. If you are on iron supplements, ask your doctor whether you can manage without them or change to a different type.
Haemorrhoids, also called piles, are swollen veins around the anus that can be itchy, feel sore and make it uncomfortable to go to the toilet.
In pregnancy they are caused by hormones that encourage your veins to relax, and by the increased pressure on your pelvic blood vessels.
Some ointments and creams are available but there is little evidence on how well these work. Your midwife or GP can give you advice on other ways to get rid of and avoid haemorrhoids such as changes to your diet (to prevent constipation), exercise and avoiding standing for long periods of time.
Heartburn and indigestion
Heartburn is a strong burning sensation in your chest. In pregnancy this is caused by the valve between your stomach and the tube leading to your stomach relaxing. This means stomach acid can pass into the tube, causing the burning feeling.
It is often brought on by lying flat, so sleeping propped up can help. Drinking a glass of milk before bed and avoiding eating or drinking a few hours before you go to bed can also help to relieve symptoms.
If symptoms persist you can ask your GP or midwife for advice. They may be able to prescribe an antacid remedy that is safe for you to take while pregnant.
Indigestion can also cause discomfort. It is partly caused by hormonal changes and in later pregnancy by your growing uterus pressing on your stomach. Try eating smaller meals more often. Sit up straight when you are eating, as this takes the pressure off your stomach.
When you are pregnant, changes in levels of the female sex hormones, such as oestrogen, can mean that you are more likely to develop thrush. Thrush is a common vaginal infection, also known as candida or vaginal candidiasis. It causes itching and soreness of the vagina, as well as vaginal discharge, and can make it painful to have sex or pass urine.
Thrush can be treated by using a cream or pessary prescribed by your GP. While you are pregnant you should not treat thrush using a medicine that needs to be swallowed as there is no evidence that these are safe to use by pregnant women.
Most women find they get more vaginal discharge than usual when they are pregnant. This is normal, but if the discharge becomes smelly, yellow or green, or if you experience any pain or soreness in the vaginal area, you may have an infection and should tell your midwife or GP.
Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after delivery.
If you have varicose veins try to:
Incontinence is a common problem during and after pregnancy. Some pregnant women find that they can not prevent small leaks of urine when they cough, sneeze or laugh, or when they move suddenly. Others have more severe incontinence and find they cannot help wetting themselves.
It is usually a temporary problem caused by your pelvic floor muscles relaxing slightly to prepare for your baby’s delivery. Your midwife, doctor or health visitor can give you advice on how to deal with incontinence.
Stretch marks are pink or purplish lines that occur on your abdomen, or sometimes on your thighs and breasts. Not all women get them - it depends on your skin type and how elastic it is. You are more likely to get stretch marks if you gain a lot of weight during your pregnancy.
It is unlikely any creams or oils will help to prevent you from getting stretch marks. After your baby is born, the marks will gradually fade and become less noticeable.^^ Back to top
Basic employment rights
Paid time off for antenatal care
You are entitled to time off work to attend antenatal appointments, including the time it takes to get to your GP, without losing pay.
After your first appointment your employer may ask to see your appointment card and your certificate stating that you are pregnant.
Antenatal care can include parenting and relaxation and parentcraft classes and workshops, although you may need a letter. Your employer may ask to see the certificate from your midwife or GP stating that these are part of your antenatal care.
Health and Safety
Employers have a responsibility to protect the health and safety of their employees.
An employer should do their best to resolve any risks to your health and safety and if necessary offer you a suitable alternative job. If this is not possible your employer should suspend you on full pay as long as is necessary to avoid any risks.
It is sex discrimination if your employer treats you unfairly, dismisses you or selects you for redundancy for any reason linked to pregnancy, childbirth or maternity leave.
As an employee you have the right to 26 weeks of 'ordinary maternity leave' and 26 weeks of 'additional maternity leave'. You should get this regardless of how long you have been with your current employer, how many hours you work, or how much you are paid.
The earliest you can start maternity leave is 11 weeks before the expected week you are due to give birth. To qualify for your maternity leave you must tell your employer you are pregnant, your due date and when you want to start your maternity leave. You need to do this at least 15 weeks before the start of the week the baby is due. If this is not possible, because you did not know you were pregnant, you need to inform them as soon as possible.
For more information on money and work entitlements in pregnancy go to the Directgov website.
Statutory Maternity Pay (SMP)
If you have worked for the same employer for at least 26 weeks before the end of the 15th week before your baby is due and you earn an average of at least £97 a week before tax (if the end of your qualifying week is in the 2010-11 tax year) you may be entitled to Statutory Maternity Pay (SMP).
SMP is paid for up to 39 weeks. You must tell your employer at least 28 days before you want to start claiming your SMP. For the first six weeks you will receive 90% of your average weekly earnings with no upper limit and for the remaining 33 weeks you will receive a standard rate of either £124.88 or 90% of your average gross weekly earnings if 90% is less than £124.88. You will pay tax and National Insurance in the same way.
Your employer may have their own maternity pay scheme, which is known as contractual maternity pay. Details of this may be in your contract of employment or staff hand book. If you do not qualify for SMP then there are other benefits that you may be entitled to. See the Directgov website for more details.
Following the birth of a baby, if you are the father, husband of the mother or the mother’s partner (including same-sex partners), you may be able to take one or two weeks leave from work to care for the baby and support the mother.
You are eligible for paternity leave as long as you expect to have responsibility for bringing up the baby and have worked for the same employer for at least 26 weeks by the 15th week before your baby is due. To qualify you must give your employer the correct notice and take the leave within 56 days of the birth of your child.
Statutory Paternity Pay (SPP) is paid by your employer for the one or two consecutive weeks leave you take. This is currently £124.88 a week or 90% of your average weekly earnings, whichever is less. Some employers have their own paternity leave arrangements, normally included in your contract of employment.
For more information see the paternity leave section of the DirectGov website.^^ Back to top
You may see a number of different professionals during the course of your pregnancy. Below are the people you are most likely to meet:
A midwife is specially trained to look after mothers and their babies throughout pregnancy, labour and after birth. They work in hospitals and in the community.
You will see a midwife each time you have an antenatal appointment and you and your baby will be cared for by midwives on the postnatal ward after you give birth.
You will probably get to know your community midwife before your baby is born and they will visit you at home after you have given birth to help you through the early weeks of motherhood.
Many women choose to go to their GP as soon as they know they are pregnant. Your GP will refer you to a midwife or hospital.
You may need to see your GP while you are pregnant if you get a non-pregnancy-related illness. If your baby is born in hospital, your GP will be notified and you will be invited in for an appointment soon after you return home. You will need to register your new baby with your GP.
An obstetrician is a doctor that specialises in the care of women during pregnancy, labour and straight after birth. If you have a hospital birth you may be under the care of a consultant obstetrician and their team of doctors and other specialists, including midwives.
In some hospital settings you will see a obstetrician regularly, in others you will only see an obstetrician if you are referred for an appointment because of a concern or complication. If everything is straightforward with your birth then a midwife will usually deliver your baby without the help of an obstetrician.
A paediatrician is a doctor that specialises in the care of babies and children. They may check your newborn baby after birth to make sure everything is ok and, if you have a complicated labour, they may be present during the birth. If your baby has any problems, you can talk about these with a paediatrician. If your birth is straightforward you may leave the hospital without seeing a paediatrician at all.
An obstetric physiotherapist is trained to help you cope with the physical changes that pregnancy and childbirth brings to your body. Sometimes they attend antenatal classes to teach exercises, relaxation and breathing techniques and other ways you can help yourself through pregnancy. After you give birth they can recommend postnatal exercises to strengthen your muscles.
Health visitors are nurses specially trained to look after the health of you and your family. After birth they will contact you to arrange a home visit to offer help and support with your newborn baby. After this you may continue to see your health visitor at home, or when you go to your child health clinic, health centre or GP surgery.
You may see a dietitian if you want advice on healthy eating during pregnancy or if you need to follow a special diet, for example if you have gestational diabetes.
Health professionals sometimes have students helping and observing them. Students can be at different stages of their training but will always be supervised.
You can choose not to be seen by a student, but agreeing to be seen helps with their education and may add to your experience of pregnancy.
Antenatal classes are sessions that can help you to prepare for the arrival of your baby. They are a good chance to meet some of the professionals involved in your care, talk about things that are worrying you and ask any questions.
Antenatal classes give you information about labour and birth and the choices available to you and can help you to plan your own birth. As well as being informative, classes are often informal and fun and a chance to make friends with other expectant mothers.
In some areas there may be antenatal classes for women whose first language is not english, for single mums and for younger mums.
The following topics are covered:
When classes start
Classes are available from early on in your pregnancy, but most women start going to classes about eight to ten weeks before their baby is due. Classes are once a week for one or two hours. Some classes are for expectant mothers only and others welcome partners or friends as well.
Classes vary depending on the area you live in. They may be run by your local hospital, community midwife or health visitor, your GP or your health centre. The National Childbirth Trust (NCT) also runs classes across the country. Some antenatal classes are free and others charge a small fee.
Go to the NCT website for more information on the antenatal classes they offer.^^ Back to top
If you are pregnant beyond 41 weeks
If your pregnancy goes on longer than 42 weeks, there is a greater risk of your baby dying in the womb before birth.
If your labour has not started by 41 weeks, your midwife will offer you a membrane sweep. This is vaginal examination that stimulates the neck of your womb (cervix) to produce hormones that may trigger a natural labour.
If your labour still does not start, then your midwife or doctor will suggest a date for your labour to be induced (started off). This is usually done by inserting a gel or pessary into the vagina, or occasionally by using a hormone drip.
If you do not want an induction and your pregnancy carries on beyond 42 weeks, you will be offered ultrasound scans to check everything is ok and your baby’s heartbeat will be monitored regularly.
At around 36 weeks of your pregnancy your midwife or doctor will check your baby’s position in the womb. If your baby is positioned bottom first, known as the breech position, it makes the delivery of your baby more complicated. Your obstetrician and midwife will discuss the best and safest way for you to give birth, but you will probably have to give birth in hospital.
You may be offered a procedure called an external cephalic version, or ECV. This is when the baby is pushed into the normal head-down position by pressing on your belly. If this does not work you will probably be offered a caesarean section. This is the safest method of birth for a breech baby, but there are risks for you. In some cases, for example if the baby is very close to being born, it may be safer to have a vaginal breech birth.
Any labour that starts before the 37th week of pregnancy is classed as premature. Often this happens naturally, although some babies are induced or delivered by caesarean section early because doctors believe this is the safest option.
Sometimes if your contractions start very early you will be given an injection to stop them temporarily. This is so you can have injections of steroids to help your baby’s lungs mature so they will be able to breathe more easily when they are born. This treatment takes about 24 hours to work.
If your baby is delivered early you will be admitted to a hospital with specialist facilities for premature babies. If you think your labour is starting early you should get in touch with your hospital or midwife immediately to make arrangements.^^ Back to top
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