Antenatal parent education

   

To promote a healthy pregnancy, prepare woman for pregnancy, birth and parenting and to build woman’s confidence in her ability to give birth and care for her baby

Do

  • Document antenatal education in antenatal file notes and hand-held record
    • Encourage woman to keep her hand held record, if available
  • First antenatal visit — talk with woman about
    • Pregnancy care options, who will provide care, support person
    • Lifestyle considerations — access to healthy food, exercise, substance use
    • Screening tests in pregnancy
  • At all antenatal visits
    • Talk about information topics and key messages — see below
    • Refer for social and emotional support where needed

Education

Visit Pregnancy, birth and baby and Safer baby bundle websites for resources and information

Nutrition

  • A healthy diet is important before, during and after pregnancy
    • Eat vegetables, fruit, meats, bush tucker, breads/ cereals at 3 meals every day. Include healthy snacks (eg fruit, bread, milk, yoghurt) if hungry
    • Eat foods high in iron (eg meat, kangaroo, fish, chicken, eggs) — eat fruit and vegetables at main meals to increase absorption of iron from food
    • Drink lots of water everyday — aim for at least 2 litres. Avoid tea — it reduces iron absorption from food
  • Encourage taking iodine and folic acid supplements — see Antenatal care
  • Ask about access to healthy foods and kitchen facilities — refer to community programs that provide food and to council or housing services to fix issues
  • Food poisoning can increase risk of miscarriage
    • Wash hands and clean kitchen before preparing food
    • Cook or reheat foods until they are very hot
    • Tell woman to attend clinic if she has flu-like or gastrointestinal illness

Exercise

  • Encourage 30 minutes of moderate physical activity every day — walking, swimming, non-contact sports
    • Avoid strenuous activity, especially if not used to it
    • Exercise in cool part of day — avoid becoming overtired or hot

Medicines: prescribed and over the counter

  • Tell woman to talk to nurse/doctor/ATSIHP before taking any medicines (prescribed, over the counter, illegal) during pregnancy
    • Make sure anyone prescribing medicines knows woman is pregnant or breastfeeding
    • Some medicines and drugs can harm the placenta or baby if taken in pregnancy or while breastfeeding — medical/pharmacist consult if not sure if medicine safe in pregnancy or breastfeeding

Alcohol, smoking and other drugs

  • There is no safe level of alcohol, smoking or other drugs in pregnancy or when breastfeeding
  • Cigarettes and alcohol can increase the risk of pregnancy complications (eg preeclampsia and placental abruption), birth defects, miscarriage, stillbirth, low birth weight, sudden infant death syndrome (SIDS) and risk of baby having chronic diseases when an adult
  • Best to stop before becoming pregnant or early in pregnancy but stopping anytime is good
    • Binge and heavy drinking can put baby at most risk of developmental problems
    • No evidence that 'cutting down' number or strength of cigarettes protects baby — do not recommend as only strategy
    • For medicines to help stop smoking — see Tobacco — Pregnant or breastfeeding women

Chewing tobacco (mingkulpa, pituri)

  • Commercial or native tobacco mixed with wood ash, rolled into ball
  • Chewed or absorbed through skin, behind ear or on lip
  • Increases baby's heart rate
  • Safety in pregnancy not known but risks are thought to be similar to smoking

Mental health and wellbeing

  • Significant emotional changes can occur during and after pregnancy 
  • Look for warning signs — spiritual, emotional and physical symptoms of depression during pregnancy and after baby is born — come to clinic if unwell or unhappy
  • Edinburgh Postnatal Depression Scale (EPDS) at least twice in pregnancy — before 28 weeks and after 36 weeks
  • Screen regularly for early assessment of mental health — eg Kimberley Mum’s Mood Scale
  • For further assessment — see Perinatal depression and anxiety
  • Talk about support services available

Domestic/family violence

  • May increase or be triggered by pregnancy
  • Be aware of signs of domestic/family violence and assess risk — see Family and Domestic Violence
  • Explain that asking about it is routine part of antenatal care
  • Be aware of mandatory reporting requirements in your state/territory
  • Refer to and arrange support services — make sure has a safety plan at all times

Sex in pregnancy

  • Having sex during pregnancy is usually safe for woman and baby — medical/midwife consult if any concerns

Working during pregnancy

  • For most women in most jobs it is safe to continue working during pregnancy
  • Talk about
    • Pregnancy employee entitlements — see Fairwork website
    • Personal concerns about her job (eg working with chemicals)

Birth planning

  • Women living in remote and rural areas without birthing services will be referred to a regional hospital and transferred at 38 weeks or earlier if medical or obstetric complications
  • Will attend hospital midwife assessment when arrives at regional centre then weekly appointments with doctor/midwife until she comes into labour
  • Usually stays in postnatal ward for about 1–5 days (if no complications) then goes to hostel until transport back to community
  • Give information during antenatal period to prepare woman for this including
    • Accommodation in regional centre — hostel accommodation may be available. Provides bedding, public phone, washing machine, might provide meals and transport to and from hospital appointments
    • Organise appropriate escort, preferably female, who can support her. Find out if patient travel scheme will cover support person costs
    • What to bring for herself and her baby — clothes, pads, baby clothes, nappies
    • What to organise at home — childcare for older children, money/finances
    • Reminding woman to attend Centrelink and have 100 points of identification ready

Labour and birthing

  • Provide mother with a copy of and refer to the "Healthy pregnancy, healthy baby" booklet when talking about labour, birth and immediate postnatal period (after the birth)
  • Tell woman most babies are born naturally. Some may need help with vacuum, forceps, caesarian etc — differences in labour will be talked about by midwife
  • Talk about signs labour is starting including
    • 'Show' — small amount of blood and mucus
    • Irregular uterine pains (contractions) 'coming and going'
    • Low back pain
  • Talk about when to go to hospital labour ward
    • Any bleeding or change in foetal movements
    • Painful regular contractions
    • Persistent lower back pain
    • Rupture of membranes
  • Explain that pain relief in labour will be talked about by a midwife
  • Explain that woman might have procedures during birth such as vaginal exam with or without artificial rupture of membranes

After the birth

  • See — Postnatal care of mother and Postnatal care of baby
  • Talk about and encourage breastfeeding — benefits for baby and mother, supports available
  • Talk about looking after baby — if baby is well they usually stay with mother in hospital room and midwife will talk about how to care for baby
  • Talk about personal care
    • Importance of postnatal check for herself and baby
    • Choices for contraception, especially during breastfeeding

Supporting resources

  • Pregnancy, birth and baby website
  • Safer baby in pregnancy bundle
  • Kimberley Mum’s Mood Scale
  • Healthy pregnancy, healthy baby booklet