My Pregnancy Preferences

What does it mean for you?

• You are the expert on what matters to you.
• We build a picture of everything that might affect your pregnancy from medical history, previous experience and family circumstances.
• We will share with you the pros and cons of different options in a way that you understand.
• You decide on the care that is best for you.
• We listen to your views, and care about your choices.
• Your wishes will be respected and recorded.
• Your care will be personalised to meet your needs.
• It’s OK to change your mind.

What can you do to prepare for your appointments?

Think about what is important to you during your pregnancy. Consider any questions you have, for example:

• What are my options?
• What are the benefits and things to think about for these options?
• What help and information do I need to make my decision?

Choosing place of birth

Hopefully you will have seen the Your Choices booklet before you choose where to book your pregnancy. If you haven't, you can ask your midwife for a copy.

Accessing your Personalised Care and Support Plan

North West Anglia NHS Foundation Trust

If you are booked for care at Hinchingbrooke Hospital or Peterborough City Hospital you have access to My Pregnancy Notes. Visit mypregnancynotes.com to register for this service and access it. The My Preferences section is the same as this booklet. You can complete online and discuss with your midwife at your appointments.

Cambridge University Hospitals NHS Foundation Trust

Currently, if you are booked for maternity care at the Rosie Hospital in Cambridge please use the paper version and discuss with your health care professional at each contact. Meanwhile work is taking place to get your Personalised Care and Support Plan available digitally.

Everyone is different with individual needs, and it is important to have the opportunity to make the right decisions for you throughout your maternity journey.

You will be able to find out what your choices are, record your choices, and write down how you are feeling about them. We have created a series of questions to help you work through your options.

It can be beneficial to discuss and share your pregnancy preferences with your midwife, if you wish to do so. It might give you the chance to ask questions, share your thoughts and feelings, and give you both the opportunity to get to know one another.

Your preferences

As your pregnancy progresses, your needs and decisions may change. It is important that you make an informed decision, and if complications arise, you should receive information including recommendations, to help you decide on the right course of action for you.

Your health care professionals will discuss their recommendations by explaining:

1. What the situation is.
2. What is recommended and why.
3. What the possible outcomes would be, with or without this recommendation
4. When the decision should be made.
5. If there are any alternatives available.

Your consent is very important and only if you give consent will they then carry out what has been recommended. You can always ask questions, including any around medical words which might be used.

• B What are the benefits?
• R What are the risks?
• A Are there any alternatives?
• I What does your intuition say?
• N What happens if you do nothing?

How to use the booklet

The booklet is an opportunity for you to complete and navigate your own personal care plan, in partnership with your health care professionals. This can either be handwritten or completed electronically. The resource section has a list of websites for further information. Keep the booklet with you, so you can discuss them with your maternity team at your appointments. Completing these personal care plans will support you in your preferences for pregnancy, birth and parenthood.

About me

In the “about me” section of the booklet, you’re asked to share some information about yourself with your maternity team. This includes your preferred name, your due date, your maternity unit, your intended place of birth, your team’s name your named midwife, your midwife/team contact details, your named obstetric/midwife consultant and any other important contact numbers.

Physical health and wellbeing

In this section you’ll be asked a number of questions. These are:

• If you have any long-term health conditions that may affect your pregnancy
• It is recommended that you discuss pre-existing medical conditions and/or special requirements with your GP, midwife or doctor prior to becoming pregnant or in early pregnancy. You’ll be asked to confirm:
  • If you have discussed my pre-existing medical condition(s) with my maternity team (Yes/No)
  • If you require further support with my medical condition(s) or special needs (Yes/No)
  • If you would like to find out more (Yes/No)

My antenatal appointments

Please be aware that due to the COVID-19 pandemic local hospitals may have visiting restrictions which may change at short notice. Please see hospital websites for the latest information or contact your hospital before attending if you are unsure.

You can bring a partner, family member, friend, doula, social worker or anyone else who you feel will support you. Preferably only bring one person as often the rooms that are used are quite small. You can also go on your own. If you decide to bring someone with you, there will be the opportunity to speak to your midwife privately in case you wish to share something in confidence. If you already have a child, you can bring them too.

You'll be asked:

• If you would like to bring anyone with you
• Who that will be.

While you are pregnant you will see a midwife and/or a doctor (depending on your management plan) for your antenatal care. These antenatal checks can take place in a variety of places including at home, a GP surgery, health centre, hospital or children’s centre (your midwife will let you know which options are available).

• You'll be asked if you have any special requirements that we need to be aware of when planning your antenatal visits such as days to avoid, access requirements etc.

Antenatal classes

The NHS offers free antenatal classes that can help you and your birth partner prepare for your baby’s birth, the chance to meet other people having babies and an opportunity to meet some of your maternity team. These classes are not restricted to first time parents.

Questions you'll be asked.

• Are you interested in attending antenatal classes (Yes/No)
• Are you like more information about antenatal classes (Yes/No)
• Are you making your own arrangements for antenatal classes (Yes/No)

My health

Folic acid and vitamin D

You are advised to take folic acid up until 12 weeks of pregnancy and vitamin D throughout your pregnancy.

You''l be asked:

• If your aware of the advice given around taking supplements (Yes/No)
• If your would like to find out more (Yes/No)
• If you have any other thoughts or feelings about taking supplements?

Foods to avoid

There are some foods that you are advised to avoid while you are pregnant as they can harm you and your baby.

You'll be asked a number of questions:

• Are you aware of what foods to avoid (Yes/No)
• Would like to find out more (Yes/No)
• If you have any other thoughts or feelings about foods to avoid during your pregnancy?

Diet

A balanced and healthy diet is recommended.

You'll be asked a number of questions:

• Are aware of the guidance around a balanced and healthy diet?
• If you're aware of the guidance around a balanced and healthy diet (Yes/No)
• If you would like to find out more (Yes/No)
• If you would like some guidance from my maternity team as I have special circumstances that affect what I can eat (Yes/No)
• Do you have any other thoughts or feelings about your diet during your pregnancy?

Exercise

Remaining active and taking regular exercise is recommended during pregnancy.

You'll be asked a number of questions:

• Are you aware of the recommendations around exercise and staying active (Yes/No)
• Would you like to find out more (Yes/No)
• Would you like some guidance as I have special circumstances that affect my ability to exercise (Yes/No)
• Do you have any other thoughts or feelings about exercise during your pregnancy.

My lifestyle

Nicotine based products, alcohol or recreational drugs should be avoided while you are pregnant as they can harm you and your baby.

You'll be asked:

• Are you aware of the recommendations around alcohol, nicotine and drugs (Yes/No)
•  Would you like to find out more (Yes/No)
• Do you have any other thoughts and feelings about nicotine, alcohol and drugs during your pregnancy?

My wellbeing

Pregnancy and/or becoming a parent can trigger all sorts of feelings and emotions, including feeling down, worried or anxious.

For section you will be asked:

• Have you previously been diagnosed with a mental health condition? (Yes/No)
  • If yes, please provide details
• If you know how to get in contact with someone if I am feeling low or worried (Yes/No)
• Do you have any other thoughts or feelings about your mental health during your pregnancy?

Emotions your partner, family and I should look out for include…

• tearfulness
• feeling irritable or arguing more often
• change in appetite
• racing thoughts
• loss of interest in things I normally like
• having unpleasant thoughts that I can’t control or keep coming back
• repeating actions or developing strict rituals
• feeling overwhelmed
• difficulty concentrating
• problems sleeping or extreme levels of energy
• feeling very anxious
• being so afraid of birth that I don’t want to go through with it
• suicidal feelings or thoughts of self-harm
• lack of feeling towards my unborn baby.

Bonding with your baby during pregnancy helps to build strong connections and will also help with your emotional wellbeing. You can try:

• talking, singing, reading or playing music to your unborn baby
• gently massaging your bump
• pregnancy yoga
• hypnobirthing - a combination of education, breathing and relaxation exercises
• using an app to track your baby’s growth and development
• reading Unicef’s ‘building a happy baby guide’.

Doing these simple things regularly is known to release a hormone called oxytocin, a hormone which can help your baby’s brain develop and makes you feel good.

Additional preferences

You'll be asked:

• Do you have a religious belief or custom I wish to be observed (Yes/No)
  • Do you have anything to note about this?
• Does partner or support person has additional needs (Yes/No)
  • Do you have anything to note about this?
• Do you have special dietary requirements (Yes/No)
  • Do you have anything to note about this?
• Do you have other special requirements that I would like my maternity team to be aware of (Yes/No)
  • Do you have anything to note about this?

Feeding my baby

During your pregnancy, your midwife will discuss with you about bonding with your baby and feeding your baby.

You'll be asked:

• Have you thought about how I would like to feed my baby (Yes/No)
• Would you like to discuss plans for feeding my baby with my midwife (Yes/No)
• Do you have any other thoughts or feelings about feeding your baby?

My pregnancy vaccinations

You will be offered certain vaccinations which are recommended during pregnancy: COVID-19 vaccine, whooping cough vaccine and the flu vaccine (if you are pregnant between September and January/February).

You'll be asked:

• Are you aware of the recommendations around vaccinations (Yes/No)
• Would like to find out more (Yes/No)
• Do you have any other thoughts or feelings about vaccinations?

Preparing for birth

Perineal massage, from 34 weeks onwards, can provide many benefits in preparation for the birth of your baby. For example, it could help to reduce the chances of tearing or requiring an episiotomy.

You'll be asked:

• Are you aware of the advice about perineal massage (Yes/No)
• Would like to find out more (Yes/No)
• Do you have any thoughts or feelings about perineal massage?

It is your choice where you choose to have your baby. Your midwife or doctor will be able to tell you what services are available locally and advise you on any issues to do with your health or pregnancy which may help you decide.

Ask your midwife for the ‘Your Choices’ booklet if you have not already seen it.

I this section you will be asked a number of questions.

• Where would you like to give birth?
  • Home
  • Birth Centre/Unit
  • Delivery Unit/Consultant Led Unit
  • Haven’t decided yet
     
• After having had a discussion with your midwife or doctor, has you choice of where to give birth changed? (Yes/No)
  • Do you understand why? (Yes/No)
  • If so, where to?
     
• Do you have any other comments to make about where you would like to have your baby?

Birth partners

Having someone present who can give you practical and emotional support during your labour will really help you. It is preferable to have the same birth partner(s) throughout the birth. There may be a limit to the number you may have, please check with your midwife first.

In this section you can add information about your birth partner(s) such as their name, contact details and relationship to you:

My maternity team

You may be asked if student midwives and doctors can be present when you have your baby. Some students will observe care, while others may provide care and support. All students will introduce themselves and will always be closely supervised by a qualified midwife or doctor.

You'll be asked:

• Are you happy to have a student present during your labour or birth? Yes/No
• Does the gender of the student matter to you? Yes/No
• Do you have any more comments to add about your maternity team?

My labour

Monitoring is recommended during labour for you and your baby.

A small handheld device, either a Pinard stethoscope or hand-held doppler, may be used every 15 minutes throughout the first stage of labour and then every five minutes during the second stage of labour - this is called Intermittent Fetal Monitoring. This is the recommended form of monitoring for ‘low risk’ births.

Your doctor or midwife may offer electronic fetal monitoring (CTG) if there are any concerns about you or your baby. CTG monitoring is only carried out on Delivery Unit/Consultant Led Unit and consists of two small devices placed on your abdomen to listen to your baby’s heart rate and record contractions, these are held in place by two straps. CTG machines can allow for both wireless and waterproof monitoring.

Do you wish to have…

• Intermittent fetal monitoring
• Continuous electronic fetal monitoring
• No fetal monitoring
• A discussion around fetal monitoring
• Do you have any other thoughts on monitoring your baby?

There are many different ways of promoting comfort when you are in labour. You can use a number of different methods at different times. Some forms of pain relief will be dependent on where you plan to give birth.

To help you feel more comfortable, are you planning to use…

• hypnobirthing
• aromatherapy
• homeopathy
• reflexology
• TENS Machine
• massage
• not sure yet
• birth stool
• birthing ball
• dim lighting
• peanut ball
• water/pool use
• active birth positions
• music

Are you aware of the different methods of medical pain relief that are available?

• gas and air (Entonox)
• opioid injection
• epidural.

Would you like to add any further comments?

You might choose to give birth in a birthing pool. Your midwife will be able to discuss your options with you.

• Would you like, or are you considering a waterbirth? (Yes/No)
• Your comments on a waterbirth (if applicable)

In some circumstances, your midwife or doctor may recommend starting your labour artificially, by way of induction, instead of waiting for it to start naturally (this is known as induction of labour).

• You're aware of why an induction might be recommended (Yes/No)
• You're not sure and I would like to find out more (Yes/No)

During labour, your midwife and/or doctor may offer vaginal examinations to assess your cervix or the position of your baby.

• You would like to avoid vaginal examinations
• You are happy to have vaginal examinations if I feel that they would be useful
• You're am not sure and I would like to find out more.

Vaginal examinations are a routine part of assessing labour progress and will not be undertaken without your consent.

In some circumstances, your midwife or doctor may recommend interventions to assist with your labour, for example hormone (Syntocinon) drip.

• You are aware of why assistance/intervention might be recommended (Yes/No)
• You're not sure and I would like to find out more (Yes/No)

Interventions may be recommended if your labour slows down, or if there are concerns with you or your baby’s health. In some circumstances, your maternity team may recommend a birth assisted by ventouse, forceps or caesarean birth.

• You understand why an assisted birth might be recommended (Yes/No)
• You're not sure and I would like to find out more (Yes/No)

An assisted/caesarean birth may be recommended if it is thought to be the safest way for your baby to be born. Your doctor will discuss this with you and ask for your consent before any procedure is undertaken.

In some circumstances, your midwife or doctor may recommend a cut to the perineum to facilitate your baby's birth (episiotomy).

• I prefer to avoid an episiotomy (Yes/No)
• I am not sure and I would like to find out more (Yes/No)

An episiotomy may be recommended for an assisted birth or if your midwife/ doctor is concerned that your baby needs to be born quickly. Your midwife/doctor will always ask for your consent and you will be given pain relief for this.

Additional requirements

• You have allergies and/or special dietary requirements
• You have religious beliefs and customs that I would like to be observed
• You/your partner have additional needs.

If you have any special requirements, please tell your maternity team as early as possible.

Birth management

After your baby is born, the umbilical cord that connects your baby to your placenta (afterbirth) is clamped and then cut. This is done a few minutes after the birth, as per the NICE guidelines. This allows blood from the placenta to be transferred to the baby and has been shown to be beneficial. If the baby needs help with breathing, the cord may be clamped and cut a little earlier. If your baby is fine then you or one of your birth partners can cut the cord, if you wish to do so.

• Are you aware of delayed cord clamping? (Yes/No)
• What are your thoughts and feelings towards delayed cord clamping?
• Would you like to cut the cord after you give birth? (Yes/No)
• Name of who you would like to cut the cord is.

After your baby is born, the placenta (or afterbirth) will start to come out, this is the third and final stage of labour. This can be either physiological (natural) or actively managed (usually a hormone injection in your leg to help your uterus contract), please discuss your preference with your midwife/doctor.

• What are your initial thoughts about placenta/afterbirth management options?

Having discussed it with your midwife, which method of placenta/afterbirth management have you decided to choose?

• Physiological (natural)
• Active (injection)
• You're not sure

Sometimes the placenta or afterbirth may need to be sent for further analysis after it has been checked e.g. if the baby was premature, there was more than one baby or there were signs of an infection. But in most cases the placenta is disposed of by the hospital or trust as clinical waste. You are able to take the placenta home and dispose of it safely (advice will be given) if you wish.

• You wish to keep the afterbirth/placenta? Yes/No

My baby is born

Skin-to-skin contact with your baby after birth and beyond is recommended for all.

• Are you aware of the benefits of skin-to-skin contact (Yes/No)
• Are you not sure and I would like to find out more (Yes/No)

If you already know the name of your baby or you have a nickname for your baby, please feel free to share it with us if you want to.

• The name/nickname for my baby is:

Immediately after the birth, where possible, you can have your baby lifted straight onto you before the cord is cut so that you can both benefit from skin to skin contact immediately. If you prefer, you can ask the midwife to dry your baby and wrap your baby in a blanket first.

• Would you like to hold your baby immediately after giving birth? (Yes/No)

You may or may not already know the sex of your baby.

• Do you already know the sex of your baby? (Yes/No)
• What sex is your baby? Male/Female/prefer not to say
• Would you like to discover the sex of your baby yourself? (Yes/No)

Vitamin K is usually given to help with blood clotting. Newborn babies have low levels of vitamin K, so it is recommended that your baby be given vitamin K (either by injection or mouth) to reduce their risk of developing a rare bleeding disorder called Vitamin K Deficiency Bleeding (VKDB)

Do you have any initial thoughts around giving your baby vitamin K, if recommended?

After discussion with your midwife, what is your decision about vitamin K if it is recommended?

• Injection
• Oral
• you would not like my baby to receive vitamin K

Your milk provides all the nutrients your baby needs, as well as providing antibodies and friendly bacteria that supports their immune system, protecting them from infection. Some parents choose to breast or chestfeed, or choose to formula feed and some opt for mixed feeding.

To help you feel more comfortable, you are planning to use…

• Breast milk
• Expressed milk
• Formula milk
• Mixed
• Undecided / Need more information.

More about me

Are there any further preferences or is there anything else that is important to you that you would like your maternity team to be aware of in preparation for the birth?

Do you have any further thoughts, feelings or questions that you would like to let your maternity team know about?

 

Please ask your midwife for a copy of the After Your Baby’s Birth Booklet or open the online version of the booklet.

My birth reflections

You may find it useful to talk to someone about your pregnancy or birth. This may be particularly relevant if the labour or birth was difficult or if something unexpected happened.

Your midwife can talk things through with you and they can also refer you to Birth Afterthoughts (this may also be referred to as Birth Reflections) a specialist clinic, or you can self-refer. Details on how to contact Birth Afterthoughts are in the After your baby’s birth booklet.

In this section you will be asked a number of questions.

Using a diary to write down your thoughts, questions and feelings is important and these can be shown to your midwife if you would like.

• Are you aware of how to ask for help/support to talk about your pregnancy/labour/birth should you need it? (Yes/No)
• Do you have any further thoughts, feelings or questions about your experiences during your pregnancy and birth?

My postnatal checks

After your baby is born, you will continue to see a midwife for postnatal checks for a short period. These postnatal checks can take place in a variety of places including at home, health centres or children’s centres (your midwife will let you know which options are available).

• Do you have any special requirements or is there anything else that is important to you that you would like your maternity team to be aware of regarding your postnatal care (such as days to avoid, access requirements etc.)?

Support for you

Health visitor

A health visitor is a registered nurse or midwife that has had extra training and is there to help you, your baby and family to stay healthy. They often run groups that help you meet other parents. A health visitor can help you if you are feeling anxious or worried and give you extra support. Meeting with the health visitor can take place in a variety of places including at home, a GP practice, health centre, or children’s centre (your midwife and health visitor will let you know which options are available).

• Do you have any preferences about where you would like your health visitor appointments to take place?
• If the health visitor has not got in contact by the time your baby is 14 days old, do you know who to contact? (Yes/No)
• My local contact is:

Or contact Cambridgeshire & Peterborough Healthy Child Programme: Call 0300 029 50 50 or Text 07520 649 887

GP

You can register your baby with your GP, this should be done as soon as possible after the birth. Your midwife will be able to advise you on how to do this.

• Are you aware of the process to register your baby with the GP? (Yes/No)

Further support for parents

There are lots of different types of support available to you as a new parent throughout the community. Your midwife and health visitor will be able to discuss what options are available to you in your local area, and may be able to put you in contact with them.

• Are you aware of the support options available to you in the community as a new parent? (Yes/No)
• What support options would you like to go to/ be put in contact with?

NHS.UK is a valuable resource for information. Use the web address www.nhs.uk/conditions/pregnancy-and-baby to find information that will help you to complete your preferences.

My antenatal preferences

• Antenatal classes
• Local offer for Cambridgeshire
• Local offer for Peterborough
• Supplements in pregnancy
• Foods to avoid in pregnancy
• A healthy diet in pregnancy
• Exercise in pregnancy
• Nicotine in pregnancy
• Alcohol and drugs in pregnancy
• Your well-being
• Vaccinations in pregnancy
  • Whooping cough vaccination
  • Flu vaccination
• Perineal massage
• Antenatal classes
  • Start4life
• The stages of labour and birth
• Pain relief in labour
• Water births
  • Birthing pools
  • Water births and labouring in water: questions answered 
• My baby is born
  • Delayed (optimal) cord clamping
  • Vitamin k for newborn babies

My postnatal preferences

Further information on some of the areas discussed and many other topics can be found via the following links

• Support for new parents
• Feeding your baby
  • Breastfeeding
  • Support for parents
• After your baby’s birth leaflet

Urgent and emergency contacts

Your community midwife will provide you with the relevant contact numbers for your local services. For urgent and emergency contacts and any non-urgent concerns about you or your baby you should contact your community midwife, health visitor or GP.

• Call the NHS 111 service or visit NHS 111 online at 111.nhs.uk if you need urgent medical advice or help. This service is available 24 hours a day, 365 days a year
• Call the maternity triage/assessment unit where you gave birth (up to 28 days after birth)
• Speak to your GP
• Go to your urgent treatment centre or minor injury unit
• For serious/life-threatening concerns please call 999 or go to A&E