Pregnancy and post-natal care

When is the right time to start a family?

The right time to start a family when you feel ready. The information below is to help support you deciding.

We do know that Fertility starts to decline after the age of 35 and the likelihood of complications and birth defects does increase with maternal age.

Having 18 months between pregnancies does improve outcomes but you do need to balance this against age-related fertility decline and what you feel is best.

After a miscarriage, there is no ‘right time’ to start trying to conceive again, but we usually recommend allowing some time for you to physically and emotionally heal and to come to terms with your loss.

It is normal for 80% of couples aged under 40 to conceive within 1 year of trying; half of those who don’t will conceive within 2 years.

How often should we have sex?

Having regular sex means having sex every 2 to 3 days throughout the month. Some couples may try to time having sex with when the woman ovulates (releases an egg). But guidance from the National Institute for Health and Care Excellence (NICE) advises that this can be stressful and it isn’t recommended.

An egg lives for about 12-24 hours after being released. The egg must be fertilised by a sperm during this time for you to get pregnant. Sperm can live for around 5 days inside a woman’s body, so if you’ve had sex in the few days before ovulation, the sperm can ‘wait’ for the egg to be released.

What are the Same Sex Couples & Single Women Eligibility Criteria for NHS funded fertility treatment?

Currently in Cheshire and Merseyside the policy is intended for people who have a possible pathological problem (physical or psychological) to explain their subfertility.

The Clinical Commissioning Group (CCG) will fund subfertility treatment for same sex couples and single women provided there is evidence of proven subfertility, defined as no live birth following artificial insemination (AI) of up to 6 cycles or proven by clinical investigation as per NICE guidance. AI must be undertaken in a clinical setting with an initial clinical assessment and appropriate investigations.

The CCG will not fund the initial AI cycles but will fund access to a clinical consultation to discuss options for attempting conception, further assessment and appropriate treatment.

Do I need to contact Brownlow Health if I want to conceive?

As a rule, you do not need the involvement of a GP or a nurse practitioner if you are planning on conceiving.

However, we would recommend seeking advice if you have any of the conditions as we may need to re-evaluate your health needs or seek specialist advice:

  • Taking prescribed medication.
  • Using illicit drugs, please remember we offer some drug services and alcohol services in-house.
  • Mental health problems.
  • Thyroid disease.
  • Diabetes.
  • Epilepsy.
  • Hypertension.
  • Kidney disease.
  • Asthma.
  • High risk of all previously had blood clots.
  • Cardiac disease.
  • Rheumatological conditions.
  • Inflammatory bowel disease.
  • Haemoglobinopathies.

What can I do to improve my chances of conceiving and increase my chance of healthy pregnancy and a healthy baby?

Folic Acid – taking folic acid before you become pregnant and up to 12 weeks pregnancy will reduce the risk of the baby having a new tube defect by 70%.

We recommend that all women should take folic acid ideally, three months before conception.

Most women only need to take 400mcg of folic acid, which you can buy over-the-counter actual local shops/pharmacy.

Unfortunately, this is not available on NHS prescription.

However, a small group of women will need prescription dose of 5 mg folic acid.

These are women who:

  • Have a positive family history or previous child affected by neural tube defect.
  • Have coeliac disease or other malabsorptive state.
  • Have diabetes.
  • Have a BMI greater than 30.
  • Are on antiepileptic medication.
  • Women with sickle cell anaemia, thalassaemia or thalassaemia trait.

Weight and Diet

It is important to try your best to have a normal BMI (18.5 to 24.9). Even if you struggle having a healthy balanced diet will help.

Risks of being underweight include miscarriage, low birth weight and preterm delivery

Risks of being overweight includes subfertility. miscarriage, gestational diabetes, gestational hypertension/pre-eclampsia, preterm delivery and birth trauma/instrumental delivery, postpartum haemorrhage, thrombosis and infection and stillbirth and foetal problems (e.g. congenital abnormalities).

If you have had bariatric surgery, we recommend using reliable contraception until weight loss has plateaued – usually 12 months after the procedure.

You can calculate your BMI using the link below:

https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

Smoking

We recommend stopping smoking before becoming pregnant due to the risks associated with it.

These risks include:

  • Spontaneous abortion, stillbirth and preterm birth.
  • Intrauterine growth retardation.
  • Placental abruption.
  • Cleft lip and palate.

If you need help, you can seek support from the local Smoke Free service. If you become pregnant please let them know, as there is extra support available.

Alcohol

It is recommended trying to conceive avoid alcohol altogether. The reason for this, is because alcohol can travel through the placenta into the baby.

We do know alcohol increases the risk of:

  • Miscarriage and low birth weight.
  • Foetal alcohol spectrum disorders (affecting around 2.3% of births) characterised by:
  • Neurocognitive problems.
  • Developmental delay and behavioural issues.
  • Congenital malformations.

Risk of harm is likely to be low if a woman has drunk a small amount of alcohol in very early pregnancy.

Vaccination and screening

Prior to conceiving it is worthwhile checking you are up-to-date with cervical screening and sexually transmitted infections screening.

Women who are from the Mediterranean, Middle East, Asia and sub- Sahara Africa may wish to consider requesting a haemoglobinopathy test if you are at risk or have a family history of these conditions, for example sickle-cell disease or thalassaemia.

It may be worth checking if you are up-to-date on your MMR or eligible for Varicella (Chicken Pox) and Hepatitis B vaccination.

If you recently travelled to a country with Zika you should avoid conceiving three months after the last possible exposure for men, or two months for women travellers. Read more here.

Useful resources if you are planning a pregnancy

Tommy’s in partnership with NHS, public health England, the Royal College of obstetrics and gynaecology, Institute for women’s health and Kings College London

https://www.tommys.org/pregnancy-information/planning-pregnancy

Planning your pregnancy – NHS guide

https://www.nhs.uk/conditions/pregnancy-and-baby/planning-pregnancy/

Planning a pregnancy – Sexwise

https://www.sexwise.fpa.org.uk/planning-pregnancy

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