When to Call Your Midwife

This is part of a series of blogs looking at what to expect throughout your pregnancy. The previous blog was about what happens at each antenatal appointment.

This blog is about when to call your midwife.

Pregnancy is an exciting time but it can be an anxious and worrying time, particularly if this is your first baby. Your body is changing and you will experience aches and pains.

So when should you call your midwife?

The answer is anytime you want! Our role is to help you through your pregnancy and ensure the health and well-being of you and your baby. If you are ever concerned about anything, you can call your midwife. If it is out of hours or you can’t get hold of your midwife, you can phone triage. It will be open 24/7. If your hospital doesn’t have a triage or you can’t get through, then call labour ward.

Symptoms to look out for

There are certain symptoms in pregnancy that maybe of concern.

Baby’s movements – This is most accurate way of knowing that everything is well with your baby. You will be asked at each antenatal appointment about your baby’s movements. Most women will feel their baby move between 16 and 24 weeks. After that, your baby will develop its own pattern of movements, which is unique to your baby. If the pattern of movements ever change, so increase, decrease or feel different, you must call your midwife or unit urgently. A ‘quiet’ baby maybe having a rest but it could be a sign of fetal distress and must be taken seriously. Old advice such as ‘lie down’ or ‘drink cold water’ are no longer appropriate for changes in fetal movements. For more information on fetal movements, see Kicks Count

Persistent, severe headaches – Mild headaches are a common occurrence in pregnancy. They can be caused by tiredness or dehydration. It is safe to take Paracetamol (not ibuprofen) in pregnancy. If you experience a severe headache that is not relieved by Paracetamol and/or it is accompanied by any visual disturbances (flashing lights; ‘floaters’ in your eyes; seeing ‘stars’; blurred vision) or swelling of your fingers, ankles or face, then go straight to hospital. This could be a sign of pre-eclampsia.

If you experience any visual disturbances in the absence of a headache, still go to hospital to be reviewed.

Slight swelling of ankles, fingers and face can be a normal part of pregnancy. If this comes on suddenly, gets worse and/or you have a headache or visual disturbances, then go to hospital.

Bleeding – Any bleeding in pregnancy should always be assessed. Sometimes women can have small bleeds and the cause isn’t always identified. If you have a low lying placenta, you may experience several episodes of bleeding in pregnancy, but you should go to hospital every time it happens. The bleeding could be coming from the placenta so this needs investigating.

Abdominal pain – This is different to labour contractions. You should go to hospital if you experience abdominal pain that is continuous, feels sharp or that has a sudden onset, especially if accompanied by bleeding. There are many causes of abdominal pain. Urine infections are a common reason. More worrying causes are to do with the placenta and these need to be excluded.

If the pain is coming and going, this is more likely to be labour contractions. If you are over 37 weeks, this is normal. As long as you haven’t got any risk factors (you will be informed if you do) you can stay at home and allow the contractions to become stronger, longer and closer together. You can always call your midwife or triage for further advice in early labour.

Waters leaking/breaking – If you are 37 weeks or more, then the waters breaking will part of your labour starting. If you are less than 37 weeks or the waters are leaking, it can be more significant. When the waters around the baby are intact (this means the membranes that hold the waters, your baby and your placenta are intact) then infection can’t get to your baby from below. Once the waters break/leak, your baby is at risk of infection.

The waters breaking are usually easy to identify as a lot of fluid comes out!

Waters leaking is trickier to notice as women often have increased vaginal discharge in pregnancy therefore it be unclear which it is. It is always better to be cautious. If you can feel fluid coming and your underwear feels damp, speak to your midwife and have this checked out.

You must call your midwife or triage if your waters break or leak. You will be advised to attend the hospital so that this can be confirmed.

Itching – Mild itching in pregnancy can be common. It has several causes – there is an increased blood supply to your skin, your skin is stretching and those pesky hormones are at work! Wearing loose, cool clothing and using a moisturiser can help. You can ask your midwife for further advice on mild itching.

Severe itching, in particular itching of the palms of your hands or soles of your feet may be more serious and are signs to go to hospital. These are indications of a condition called obstetric cholestasis (OC). This is a liver disorder that occurs when there is a build of up bile acids in your body. Bile acids flow from your liver to your stomach to help digest food.

The rise in bile acids and the subsequent itching can be treated but you will be monitored very closely. OC can increase your chance of having a stillbirth. Your obstetric team will plan with you the optimum time for delivery, depending on how well you respond to treatment and your gestation at diagnosis. Induction of labour may be offered around 37-38 weeks of pregnancy but the baby may have to be delivered sooner if you are unwell.

Feeling unwell – Your immunity is decreased in pregnancy so you may find you have cough and colds more frequently and they take longer to resolve. Most of these symptoms can wait until your next midwifery appointment. However, if you have a fever, high temperature, constant vomiting or severe diarrhoea you should ring for advice.

It is human nature to want to Google signs and symptoms and self-diagnose! If you want to look up your symptoms, choose a trusted website such as NHS Choices (my favourite website!). It is accurate, evidence based and will give you good advice.

The next blog will be on the health professionals you may meet in your pregnancy.