At the first antenatal care visit, we check if the pregnancy has started well, ideally the first visit should be done during the first 12 weeks of pregnancy and immediately after your family doctor has referred you to the clinic/gynaecologist. However, for  teenage mothers , they can be addressed without a referral from the family doctor.

The first antenatal care visit should be done by a gynaecologist or a family doctor, tests are needed to make sure everything is going well. Your doctor will explain how to properly follow your prenatal care, until the delivery. All pregnant women should have these tests, unless they refuse to have a test; nothing will be done without her permission.

Tests done in the first visit:

• Pregnancy test
• Blood group
• Urine test
• Height and weight
• Blood pressure
• Heart rate
• HIV test
• Syphilis test
• Hepatitis B test
• Complete blood count
• Glucose (blood) sugar test
• Ultrasound

Gynaecologist or family doctor will answer all the questions. The pregnant woman should see the family doctor up to 12 weeks of pregnancy in order to benefit from free antenatal care, and for better monitoring of her pregnancy.

During the first trimester of pregnancy, a series of complications can be assessed and prevented.The pregnant woman should go every month for antenatal consultation until the pregnancy is 32 weeks, then at week 34 and week 36, and weekly after that.

At each visit, the mother and the baby will be checked, the ests  to be done every month include

• Blood pressure
• Heart rate
• Glucose (blood) sugar test
• Haemoglobin
• Urine analysis 
• Fundal height
• Weight
• Foetal heart rate

If there is any problem in those tests, all options will be discussed, and decision-making can be shared with the attending physician.

In the consulting centre, a file called "Personal file of the pregnant woman" will be drawn up. This sheet will aim to keep the results of the investigations and monitoring of  the pregnant woman. The "Perinatal Book"  will be a record of all the Antenatal consultation  with all the results of the analyses and investigations carried out during the pregnancy.

Pregnant women (6/7) can have morning sickness. It is harmless and will improve on its own by mid-pregnancy.

Many tricks can help against morning sickness: getting enough rest (fatigue can worsen nausea),  avoiding foods with a strong aroma and taste, eating dry bread or a simple biscuit before getting out of bed,  small meals and often based on simple foods such as bread, rice, crackers and pasta.

Pregnant women ( around 2/3) can experience gastroesophageal reflux disease (heartburn). This happens when stomach content persistently and regularly flows up into the oesophagus. Heartburn causes discomfort but it is not dangerous.

There are simple measures to feel better: small and frequent meals, meals (dinner) less than 3 hours before sleeping, reducing the consumption of coffee, tea and cola, fats and spices. Take an upright position during meals and support the head and shoulders when sleeping, using a pillow placed under the shoulders.

Constipation is very common during pregnancy. Soft stools can be maintained by drinking 6-8 glasses of water daily and eating more fruits and vegetables and fewer ready-made foods.

Pregnant women should take iron supplements  to help them produce red blood cells. The family doctor will prescribe these tablets. These pills are harmless for the mother and the baby, but, like any medicine, it is important to take them according to the doctor's prescription. These will cause the stool to become dark in colour and may cause constipation. To reduce side effects, iron pills should be taken with food and some water (avoiding tea, juices, milk when administered).

Folic acid is very important for the development of the child's nervous system and heart. It is 100% safe and has no side effects. In Moldova, folic acid tablets should be taken additionally.

Pregnant women should gain between 10 kg and 12.5 kg, but the most significant weight gain occurs in the second half of pregnancy. During prenatal care, weight will be checked.

Fatigue and sleep problems during pregnancy are very common. Sleep may be difficult during pregnancy as you may feel uncomfortable lying down or need to go to the toilet often, especially as your belly grows. Not getting enough sleep is not dangerous, but it can complicate life and increase the risk of having a bad mood and causing some stress.

What works for many women

Get plenty of rest, but also light exercise, such as walking or swimming, and try not to sleep during the day. It is advisable to have a routine that is effective for the pregnant woman and then stick to it.

As the pregnancy progresses, it may be challenging to find a comfortable sleeping position. Sleeping on your left or right side and supporting your stomach with pillows or a pillow between your knees can be a solution.

Physical activity or sports have so many benefits that doctors recommend at least 30 minutes of moderate physical activity per day, most days of the week, for everyone, including pregnant women. Exercise during pregnancy provides a sense of well-being, improves sleep, and reduces aches and pains that occur during pregnancy. It can also prevent and treat high blood glucose (sugar) and high blood pressure and prepare for labour and postpartum recovery.

If you are physically active at work, school or at home, great, but you can try other physical activities as long as they don't cause you discomfort, force you to lie on your back, make you dizzy or pose a high risk from falling or having an accident. Walking, jogging, light running, swimming, cycling, yoga are all fine, and anything else that doesn't pose a risk of unexpected abdominal shock or injury is fine.

Alcohol harms the baby's brain.

Everyone knows that smoking is not good for the mother and the baby. During pregnancy it can be easier to quit smoking, because stopping smoking can solve the problem of nausea and vomiting.

Cannabis and hashish during pregnancy are also harmful, because they can affect the development of the baby's brain, especially if the mother also consumes alcohol.

To consider that some recreational drugs can be discontinued the next day, while for other drugs this can be dangerous.

Nausea and vomiting

Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for nausea relief in early pregnancy, depending on the woman's preferences and available options.

Stomach burns

Advice on nutrition and lifestyle is recommended to prevent and relieve stomach burns during pregnancy - smaller meals and portions,, with healthy products, rich in fibre, the correct position during the meal (sitting upright), etc. Antacids may be given to women with distressing symptoms that are not relieved by lifestyle changes.

Leg cramps

Magnesium, calcium, or non-pharmacological treatment options may be used to relieve leg cramps during pregnancy, depending on the woman's preferences and available options.

Lumbar and pelvic pain

Regular physical activity is recommended throughout pregnancy to prevent back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, braces (lumbar pelvic support belt) and acupuncture, depending on a woman's preferences and available options.

Constipation

Wheat bran or other fibre supplements may be used to relieve constipation during pregnancy, if the condition does not respond to dietary modification, based on the woman's preferences and available options laxatives could be considered, for the use of laxatives ask your doctor.

Varicose veins and edema

Non-pharmacological options such as compression stockings, leg elevation and water immersion may be used to manage varicose veins and edema during pregnancy, based on the woman's preferences and available options.

About 1 in 4 women will have significant problems during pregnancy.

If you have any of the problems listed below, you should call the emergency number 112. If it is necessary to call the ambulance, take with you the perinatal card and the address to the maternity hospital where your attending physician is located or to the nearest maternity hospital.

Here is a list of the signs that require urgent attention

• Seizures, memory loss or loss of consciousness
• Severe headaches
• Blurry vision
• Severe chest pain that does not go away after a minute
• Difficulty breathing that is different from what you usually have
• Heavy bleeding from anywhere or bruising
• Moderate or severe leg pain that does not improve after 10 minutes
• High fever (>38.5oC)
• Bleeding from the vagina, especially red-purple, even if there is no pain and it is only a  light bleeding
• Clear discharge from the vagina, even if there is no pain
• If you cannot feel your baby move after 28 weeks of pregnancy for more than 4 hours while awake
• Severe abdominal pain that does not improve after 1 minute or that comes and goes
• Painful contractions of your uterus that after 1 hour become stronger or more painful
• Severe anxiety, confusion, or severe stress
• Any worry that someone might harm you or your child
• Anything else that worries you

If you live in a place where there is no mobile phone network or if you do not have a mobile phone, you should write the emergency number on a notepad and have it with you at all times.

You can call 112 or the youth hotline 0 800 800 22, available 24/7

Childbirth is easier if you are physically and mentally prepared for it. For fitness, it is helpful to exercise lightly every day, eat healthy, take iron and folic acid supplements if recommended, stop smoking or at least cut down on smoking, stop drinking alcohol and stop using recreational drugs. It is very important for your mental health not to use alcohol or recreational drugs.

Relaxation exercises, questions and finding the right person to support you during labour are also important.

Making a birth plan is a very good idea. The birth plan tells the doctor how the pregnant woman wants to be helped during labour and birth.

Some ideas you may want to include in your birth plan:

• I want to know the name of my doctor and I want her/him to call me by my name (or another name if you prefer).
• I would like my partner or partner(s) to be with me during labour
• The partner or birth support person is .................................
• I want my doctor to treat me with respect and explain things to me in an easy to understand way, even when I'm stressed.
• I want to be able to walk during labour
• I want to be able to drink and eat light food, as I like, during labor
• I want to know all the pain relief options available to me
• I want to hold my baby and I want my baby to be placed on my chest skin to skin as soon as possible
• I want to breastfeed my baby as soon as possible
• I want regular breastfeeding support while I am in maternity
• I want my baby to stay in my room after birth if possible

• Documents required for hospitalisation: identity card, pregnancy card, file with investigations, analyses and ultrasounds during prenatal consultations.
• For hygiene: personal hygiene items (soap, shower gel, shampoo, toothpaste and toothbrush, comb, deodorant, face and body cream, lip balm, sea water spray for the nose, clips, hair elastics, hair brush), toilet paper, towels (one for the face and one for the body), breast pads, larger wet wipes for the face and hands, dry wipes, 2-3 packages of special hygienic absorbents for washing, cream for nipple
• Clothes: two or three nightgowns with an opening in the front, useful for when you will breastfeed, special bra for breastfeeding, a robe (warm) and thick socks (if you give birth in the cold season or you are "cold"), 3–6 pairs of cotton panties; also take some disposable ones, which you can find in the mother and baby section of the big stores, comfortable slippers (for labour hours, when you might walk in the corridors) and rubber slippers (to be able to enter into the bathroom with them), comfortable clothes for the day, clothes for leaving the hospital, make-up kit at the discretion of each mother.
• For the baby: 1 pack of diapers for newborns (size 0) – the baby will need 6-8 diapers a day, 1 large pack of wet wipes for babies, 1 soft towel, shampoo or soap for babies, physiological serum (packaged in single doses) and sterile compresses - they are useful for cleaning the eyes, navel (belly button) and other sensitive areas, new soft cotton clothes (washed and ironed beforehand): body (2–3), hats, t’shirts, trousers or joggers, bodysuits, rompers, gloves (mittens, for baby not to scratch her/his face), socks, booties, a blanket. Appropriate clothing of the baby for ambient temperature is recommended, this should be 1–2 layers more than adults and a hat.

Personal hygiene is a very important factor in regaining physical and mental tone. Hygiene after birth refers to the care of the breasts and also of the intimate areas, as well as the body as a whole.

Vaginal secretions after birth are called lochia (postpartum bleeding), originating from the uterus. On the day of birth, lochia looks like blood and can be pretty abundant.  Women need to use highly resistant hygienic absorbents and will need to be changed regularly. Hand washing is very important before and after the woman changes her pad. If there is presence of clots, which are large in size (e.g. the size of a tomato), you should call the doctor. The bleeding becomes more minor and changes from blood to a yellow or brown discharge that will gradually disappear after 6–8 weeks (longer if it was a caesarean section). breastfeeding causes the uterus to contract. Cramping sensations similar to menstrual pains are also possible. Blood will go out because of the contractions, but with breastfeeding, it will stop quickly after the delivery.

Until the bleeding stops, it is best not to use tampons or menstrual cups, as this could increase the risk of getting an infection.

If there are stitches from a tear or episiotomy (cut), you need to bathe or shower every day to help prevent infection. Take a bath or shower then dry yourself carefully. If the sutures are painful or uncomfortable, women should go to the family doctor. Sutures usually dissolve until the episiotomy (cut) or tear heals. Sometimes sutures need to be removed.

First, the breasts will produce a yellowish liquid called colostrum for the baby. On the third or fourth day, the breasts may feel tight and sensitive as they begin to produce milk. Wearing a nursing bra can help.

To keep your nipples healthy, these 3 tricks are helpful,

• Lubricate the nipples with a few drops of milk after breastfeeding and let them dry (do not wipe them with a towel);
• Change breast pads often. Wetness increases the risk of infection especially if the nipples are cracked.
• Change the nursing bra often and leave the breasts uncovered after each meal for 10-15 minutes.

Before you breastfeed, squeeze your breasts.

You should always wash your hands

• before and after you change the diaper
• after coming into contact with bodily fluids (saliva, vomit, mucus)
• before and after eating
• before and after changing your intimate hygiene products
• before and after using the toilet or after touching surfaces that are dirty or used by several people (knobs, switches, etc.)

The person in charge of taking care of the baby hygiene must have rigorous hand washing. Babies need hygiene because their immune system is not yet ready to face the microbes in the environment. The skin is the "gateway" for a large number of microbes, but we can prevent infections by keeping the skin clean and without irritation.

The first bath of a term, healthy newborn (baby) should be delayed for at least 24 hours after birth. The newborn's first bath after arriving home from the maternity ward, should be done on the day of discharge, even if the umbilical cord has not yet been detached. Until it detaches, it is preferable not to keep the child in the water for more than a few minutes.

For the bath, you must use special soaps or shampoos for newborns (with neutral pH, delicate). The temperature in the bathroom should be approximately 27 - 28°C, that is, 2 - 3 degrees higher than the usual one in the room, and the temperature of the bath water 37 - 38°C. After bathing, the baby must be immediately dried, the eyes, nose, mouth and ears are cleaned.

The baby's clothes should always be clean, and made of natural materials.

The umbilical cord is the baby's lifeline during pregnancy, but it is no longer needed when the baby is born. A few minutes after birth, the cord is clamped and cut close to the umbilical cord. Once deprived of its blood supply, the cord will begin to dry out, harden and turn into the baby's umbilical cord. The cord has no nerves and therefore your baby will not feel any discomfort during this time.

Umbilical cord care

Hand hygiene before and after taking care of the umbilical cord of the baby. The diaper will be folded under the cord to promote drying of the cord and to prevent contamination with urine and faeces. Avoiding touching the umbilical cord, as this will reduce the risk of cross-infection. Avoiding tight clothing to promote air circulation around the cord. The forceps can be left in place as its weight will facilitate separation. You can give your baby a shallow bath using only plain water. Only clean the umbilical cord if it has been contaminated with urine or faeces. Use plain water to do this.

Signs of infection

• redness around the navel area (umbilical cord)
• swelling and tenderness at the site
• any bleeding
• any yellow/green discharge and/or an unpleasant smell.
• your baby may not feed well and become lethargic and have a high temperature.

!!! In the presence of any of these symptoms, it is necessary to notify the doctor immediately because it is possible that the baby needs antibiotics.

Source:

After birth, the mother's body undergoes numerous changes, some of which persist for several weeks (6-8 weeks). Like pregnancy, the changes during this period differ from one person to another.

In the period after birth, an emergency doctor's consultation is indicated when:

• Vaginal bleeding seems to be more abundant as time goes the blood is light red four days after birth or when large blood clots are removed
• Dizziness occurs
• Fever
• There are signs of postpartum depression (the feeling of hopelessness or helplessness    that lasts for several days; dangerous thoughts or hallucinations)
• Foul-smelling vaginal secretions, which acquire a brown colour
• The abdomen is painful
• Acute pains that do not depend on location
• The breasts are painful or red and associated with fever

If mood changes after childbirth last more than 3 weeks and become increasingly pronounced, this is an alarm signal for the attending physician. If not treated in time and properly, postpartum depression has dangerous consequences for both mother and child. Here are the symptoms of postpartum depression:

• Poor general condition
• Intense sadness
• Disinterest in fulfilling family/work obligations
• Sleeping disorders
• Eating disorders (overeating or refusing food)
• Neglecting personal care
• Anxiety, irritability
• Fatigue
• Frequent crying states

Myths related to contraception after birth

Myth 1: You cannot get pregnant if you breastfeed

A woman can become pregnant while breastfeeding, even if her periods have not yet returned. A woman who fully or regularly breastfeeds (the time between two feedings must be less than 4 hours in the day or 6 hours at night) can become pregnant 6 months postpartum, and women who do not fully or that they do not breastfeed can become pregnant 4-6 weeks after giving birth.

Myth 2: You cannot take hormones if you are breastfeeding

Non-hormonal options such as condoms are always available to postpartum women – as are long-acting non-hormonal options such as the IUD. However, several hormonal options could be effective for postpartum women, even if they are breastfeeding.

Myth 3: There is no need to think about contraception immediately after birth

It is best to think about the following contraceptive methods immediately after birth or even before birth. Many women can resume sexual activity 4-6 weeks after giving birth, so it's a good idea to think about contraception methods in advance. To start contraception, the woman does not have to wait until her period returns! She can get pregnant even if her period hasn't returned yet.

Myth 4: If you want another child in the future, long-acting contraceptive options are not an option

Long-acting reversible contraception options, such as the IUD, allow fertility to return in a short time. Although there is an adjustment period, fertility will be restored. It is best for the mother and the child to plan the next pregnancy at least 2 years after the last child is born.

When can you start using contraceptive methods after pregnancy? It depends on which method you want to use and depending on whether you continue breastfeeding or not.

If the woman is fully breastfeeding:

• Lactational amenorrhea - it starts immediately, which means that the woman's body provides her with natural contraception during the first 6 months after birth, if certain conditions are met, although its effectiveness is not 100%.
• Barrier contraception (male, female condoms and spermicides – can be used immediately).
• Hormonal preparations (pills with progestins and implants – immediately, the vaginal ring with progesterone – can be used 4-9 weeks postpartum, injectable contraceptives with progesterone – 6 weeks postpartum).
• Intrauterine device (IUD) with Copper or with hormones (Levonorgestrel) - either can be inserted immediately after birth or after the 4th week postpartum.
• All combined methods of contraception (COC, CIC, patch, IVCC) – after 6 months postpartum.

If the woman is not breastfeeding:

• Lactational amenorrhea – NOT applicable!
• Barrier contraception (male, female condoms and spermicides - can be used immediately.
• Hormonal preparations (pills with progestins and implants – immediately, the vaginal ring with progesterone – if not breastfeeding, the method is not applied, injectable contraceptives with progesterone – if partially breastfeeding, 6 weeks postpartum, but if not breastfeeding – immediately).
• Intrauterine device (IUD) with Copper or hormones (Levonorgestrel) - 4 weeks postpartum.
• All combined contraceptive methods (COC, CIC, patch, IVCC) – if not breastfeeding, at 21 days, but if partially breastfeeding – at 6 weeks postpartum.