failure and foetal distress during labour. Raised blood pressure may be a sign of toxaemia, where both the mother and the baby can have problems later, or can simply be due to the usual hypertension arising from pregnancy itself, which may or may not need treating.
Blood Tests. At several times in the pregnancy a blood sample is taken and checked for blood type, antibodies, cell count, anaemia, rubella immune status, hepatitis B and C, syphilis, AFP (Alpha Fetoprotein), spina bifida, hydrocephalus, blood sugar and ketones. A sample may again be taken later in the pregnancy to check for infections, proteins (a sign of toxaemia) and glucose tolerance (sign of possible diabetes).
Urine Testing. Used to confirm pregnancy, check protein levels, detection of diabetes.
Vaginal Swab. Used to test for STDs and bacterial infections.
Foetal Heart Rate. Is routinely checked from about 14 weeks onwards by listening through the abdominal wall with either the old fashioned midwife’s ear trumpet (Pinard Horn) or the new hi-tech ultrasound.
Ultrasound. A very high frequency scan used to “view” the foetus in the womb. Gel is rubbed over the abdomen and a transmitter / sensor is mapped across the uterus. Routinely done from 18 weeks, follow ups are becoming more commonplace, sometimes up to 3 more during the pregnancy. Used to check size, development and position of baby; placenta position; multiple pregnancies. Many foetal defects can be detected with ultrasound but some need further confirmation by amniocentesis. Ultrasound is also used in the case of suspected miscarriage or unexplained bleeding to ascertain whether the baby is still alive.
Amniocentesis. A test that examines the genetic makeup of the unborn child. A sample of the amniotic fluid that surrounds the baby is taken by inserting a needle through the maternal abdominal and uterine wall. The sample is then cultured in the laboratory and examined microscopically. This test cannot be performed until at least 16 weeks of pregnancy and culturing and examination can take up to another 2 weeks. If a genetic abnormality is detected, a woman will be offered termination by induced labour at 18 weeks or older, whereby the foetus is born vaginally but usually dead.
Chorionic Villus Sampling (CVS). Foetal cells are obtained by harvesting a small portion of the outer layer of the placenta. Similar to amniocen-tesis, a small tube is inserted into the uterus either via the abdominal wall or the cervix. This test is usually performed from 11 - 12 weeks of pregnancy. Culturing and examination of the cells is quicker than for amniocentesis, so if undesired abnormalities are detected, termination is then offered by the suction method under anaesthetic.
Nuchal Fold Test. Performed at 11 - 13 weeks. A specialised ultrasound test designed to measure the fluid at the back of the foetus’s neck. Increased levels of fluid may indicate Downs Syndrome however, any preliminary diagnosis is not conclusive, and confirmation of any suspected abnormality cannot be determined until a follow up CVS or amniocentesis.
Maternal Serum Screening (MSS). A special blood test taken from the mother between 15 and 17 weeks to test for the likelihood of Downs Syndrome, Neural Tube Defect (Spina Bifida), Hydrocephaly (fluid in the brain), Anencephaly (small or incomplete brain). Ultrasound is usually used in conjunction with this and if a higher risk than normal is found, then CVS or amniocentesis is recommended.
In the last weeks of pregnancy both mother and baby will be closely monitored for any signs of ill health or increased birthing risks. Whilst a great majority of women go into labour spontaneously, presently, on average, 25% of labours in Australia are induced, ranging from up to 30% in private hospital patients down to 9% in small public hospitals. These are very high figures by world standards as the World Health Organisation goal is 10%. As will be explained later in Chapter 5 – Birthing, and as the statistics clearly show, induction of labour creates a greater chance of subsequent birthing complica-tions and medical intervention(10). The phenome-non is well known (even in obstetric circles) as “the cascade of intervention”.
The reasons most often contributing to induction are as follows:
• Past the estimated due date (EDD). What constitutes “overdue” varies from