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Baby love

Once people decide they are ready to have a baby – or find themselves pregnant – pharmacy teams can quickly become a trusted source of help, advice and support.

After years of taking steps to prevent pregnancy, making the mental and physical switch to try for a baby can leave people realising they don’t actually know as much about fertility and conception as they thought.

Luckily, there’s plenty of advice pharmacy teams can give to support them on this journey.

Focus on fertility

Getting pregnant is not always as simple as stopping contraception or having more frequent sex. Although about 84 per cent of couples will conceive naturally within a year if they have regular unprotected sex (every two or three days) – according to NHS data – around one in seven couples may have difficulty conceiving.

Infertility is usually only diagnosed when a couple have not managed to conceive after a year of trying, and there can be a variety of issues that may cause fertility issues in men and women.

The most common causes of infertility in women include:

  • Lack of regular ovulation (the monthly release of an egg)
  • Blocked or damaged fallopian tubes
  • Endometriosis – where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb
  • Non-cancerous growths called fibroids in or around the womb, which may prevent a fertilised egg attaching itself in the womb or block a fallopian tube.

The most common causes of infertility in men include:

  • A very low sperm count or no sperm at all
  • Sperm that are not moving properly
  • Abnormal sperm – sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an egg.

There are also several health and lifestyle factors that can affect a woman’s chances of getting pregnant. For example:

  • Having a BMI of 30 or over reduces fertility; and in women, being overweight or severely underweight can affect ovulation
  • Sexually transmitted infections, including chlamydia, can affect fertility
  • Smoking (including passive smoking) affects the chance of conceiving and can reduce semen quality
  • Drinking more than 14 units of alcohol a week can affect the quality of sperm, as well as risk the health of the unborn baby
  • Exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men
  • Stress may affect ovulation and sperm production.

In the UK, unexplained infertility accounts for around one in four cases where people can’t get pregnant and a cause cannot be identified in either partner.

Thankfully, addressing these points can help people improve their chances of getting pregnant, and pharmacy teams are well-placed to give advice and support here too.

The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who have not conceived after two years of having regular unprotected sex should talk to their doctor about in vitro fertilisation (IVF) treatment. NHS advice is that people should see their GP if they have not conceived after a year of trying, and women aged 36 and over, and anyone who’s already aware they may have fertility problems, should see their GP sooner.

App support

Fertility tracking apps track the dates of menstrual periods to help forecast the ovulation window and improve chances of getting pregnant:

Apps to track pregnancy week by week:

Pregnancy timeline

The period of pregnancy is spilt into three trimesters, which involve different developmental stages for the baby, and a variety of interventions and touch points with healthcare professionals.

The first trimester begins on the first day of the mother’s last period and lasts until the end of week 12. During these three months the fertilised egg rapidly divides into layers of cells and implants in the wall of the womb where it carries on growing. These layers of cells become an embryo, which is what the baby is called at this stage. By six weeks, a heartbeat can usually be heard and by the end of week 12 the baby’s bones, muscles and all the organs of the body have formed.

The second trimester is from week 13 to week 28 – roughly months four, five and six. As well as feeling and looking more pregnant during these weeks, the baby will begin to move.

The third trimester is from week 29 to week 40 – months seven, eight and nine. The baby continues to grow, and the mother will have more checks with their midwife to keep an eye on the baby’s health.

Where to give birth

As well as the common choice of giving birth in a hospital maternity unit, there are other options of where to have a baby, such as giving birth at home, or in a birth centre or unit run by midwives.

There are pros and cons to each, and parents-to-be will need to carefully consider the risks, although some options won’t be available to everyone depending on their specific needs and also where they live. Healthy mothers with no complications are considered low risk and could choose any of these locations, but the NHS recommends those with medical conditions who may need extra treatment during labour are safest in hospital.

Pharmacy teams can support parents-to-be to explore their birthing options by signposting them to talk to their midwife, and they can also get information from children’s centres, their GP, and local maternity units.

More information on how to choose where to give birth is available at: birthrights.org.uk/factsheets/choice-of-place-of-birth.

As is so often the case in community pharmacy, every interaction that teams have with parents-to-be – especially those who are very young and may not already be regular pharmacy customers – is an opportunity to improve outcomes for them, and for their future children.

Miscarriage and stillbirth

An estimated one in four pregnancies ends in miscarriage – the natural death/end of a pregnancy before 24 weeks’ gestation. Most of those happen in the first 12 or 13 weeks of pregnancy, but about two per cent happen between 14 weeks and 23 weeks and six days. A loss after that time is called a stillbirth.

The NHS estimates that around one in 200 births are stillbirths and the charity Sands says 15 babies die before, during or shortly after birth every day in the UK.

Other kinds of loss include:

  • Ectopic pregnancy – a pregnancy which implants outside the uterus, most often in a fallopian tube. These pregnancies cannot survive, can be life-threatening and may also reduce future fertility
  • Molar pregnancy – a pregnancy with too few or too many chromosomes and in which the pregnancy cannot develop but the lining of the uterus does. There is a risk of these cells causing choriocarcinoma so specialist follow-up is required.

“All of these losses can have significant impact on women and their partners,” says Ruth Bender Atik, national director of The Miscarriage Association. “For most people who have experienced pregnancy or baby loss, being pregnant after loss is almost always a time of very high anxiety. Many will seek advice on over-the-counter medications or supplements they can take before or during their next pregnancy to reduce the risk, and it will be important for pharmacy staff to enquire gently what, if anything, they are taking already and to seek advice from the pharmacist when in doubt.”

NHS advice is that people who are pregnant or trying to get pregnant take folic acid until being 12 weeks pregnant. Nitin Makadia, service development pharmacist, recommends “400mcg as standard, but some women will need the 5mg strength on prescription”.

Miscarriage support and information:

Common conditions in pregnancy

Pregnancy hormones can slow down the digestive process, and the growing baby often puts pressure on the stomach, pushing its contents upwards. This manifests predominantly as gastro-oesophageal reflux disease (GORD) and can be treated as such. Pharmacy teams can offer customers lifestyle advice to help manage the condition, such as:

  • Eating smaller meals more frequently (every three hours), avoiding eating late at night, eating healthily and avoiding alcohol, caffeine, fruit juices and carbonated drinks, chocolate, and fatty and spicy foods
  • Keeping a food diary to identify triggers
  • Avoiding excessive weight gain and maintaining regular physical activity
  • Sleeping on the left side rather than on the right or on your back
  • Stopping smoking.

“Antacids and alginates are recommended as first-line treatments if symptoms are not controlled adequately by lifestyle changes”, says Jacquie Lee, Numark medication safety officer and information pharmacist, “and pharmacy teams should advise people to avoid taking antacids within two hours of iron or folate supplements, as antacids can affect absorption of other medication”.

Urinary incontinence is common in pregnancy, where small amounts of urine leak very easily from coughing, sneezing, laughing or just moving. This is usually caused because the pelvic floor muscles are starting to relax in preparation for the delivery of the baby. The baby’s head will also be pressing against the bladder as it grows.

“There are a few things pharmacy teams can provide advice with,” says Nitin Makadia, service development pharmacist:

  • Encourage exercises to strengthen the pelvic floor muscles, which will also be important in managing incontinence after the baby is born. The NHS website has videos to help with this. Visit: nhs.uk and search ‘pelvic floor’
  • Drink plenty of water, avoid caffeinated drinks and don’t drink late in the evening close to bedtime. It is important that pregnant women do not reduce the fluid intake in a bid to avoid urinary incontinence, as drinking water remains very important in pregnancy, and drinking less can also cause constipation that can put extra pressure on the pelvic floor muscles
  • Pain or blood in the urine should be checked with a doctor within 24 hours.

Most people experience changes in their skin, hair and nails during pregnancy, with most of these expected and go away post-partum.

“Changes may include dark patches on the face (melasma), dark lines on the abdomen (linea nigra) or itchiness during the third trimester”, says Jacquie, “so pharmacy teams can suggest lotions and cream to help keep the skin moisturised, as well as providing advice on keeping out of direct sunlight. People who develop itchiness will also need to be referred to a doctor as antihistamines can be prescribed but cannot be sold over the counter”.

There are a couple of changes that happen in pregnancy that can lead to varicose (swollen) veins. Hormones relax the muscles, this time in the walls of the blood vessels, and the body also produces more blood to support the developing baby, which puts extra strain on the veins.

“Varicose veins can feel uncomfortable, but they are not harmful themselves”, says Nitin, “and there are plenty of things you can advise pregnant women to do to help ease the pressure on the veins”. He suggests:

  • Avoiding standing for long periods of time. Where this is not possible, walking on the spot or doing calf raises, lifting the heels to shift the weight to the toes and back down again
  • Sitting with legs supported in a raised position will ease the pressure of the blood in the veins. Avoid crossing legs as this is thought to increase the risk of getting blood clots
  • Sleeping with legs slightly raised with pillows under the ankles
  • Compression tights can be very helpful
  • Generally staying active and avoiding gaining too much weight will also help with blood flow and ease pressure on the veins.

Stretch marks are narrow, streak-like lines that can develop on the surface of the skin as a result of the skin stretching to accommodate the growing baby. They are common in pregnancy, affecting around eight out of 10 people.

“Pharmacy teams can advise pregnant customers on how to minimise stretch marks by trying not to put on too much weight, as an above-average weight gain can increase the likelihood of stretch marks”, says Jacquie. “Creams and lotions can keep skin moisturised and make stretch marks look better but there is no evidence that they will prevent or even lessen stretch marks.”

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