Preparing for the next pregnancy (Healthier Pregnancies, Better Lives')

As readers of the Parenting across Scotland e-newsletter, it is likely you are already a parent and/or work with parents. Many people who have a child or children will become birth parents again, whether in the near or more distant future.

We live in a society in which avoiding pregnancy – or being pregnant – are the only two states given serious time and attention. Too often, there is an equally important stage in between contraception and conception that is overlooked. That is the time and opportunity to prepare for pregnancy.

Everybody who will become a birth parent desires the same three positive outcomes: a safe pregnancy, a healthy baby, and a thriving family. And yet, at least one in four pregnancies in Scotland do not result in prospective parents actually getting what they most wanted. Instead, they experience miscarriages, stillbirths, neonatal deaths, therapeutic terminations or lifelong birth defects.

The good news is that many – albeit far from all – of these adverse outcomes are preventable. The bad news is that they are so often not, in fact, prevented. A large proportion of these preventable problems can only be avoided by pre-pregnancy (preconception) action.

For example, it is common for a prospective mother to arrive at her first antenatal appointment (first booking) usually at eight to 12 weeks, saying: ‘I have heard that taking folic acid is good to do during pregnancy. Should I start that now?While there is no harm in starting then, the opportunity to prevent neural tube defects is already completely lost. That’s because the neural tubes – which become the brain, spinal column and central nervous system – are completely formed (or malformed) by the end of week four.

Spina Bifida is one result of an NTD-pregnancy. More often, so are all the other adverse pregnancy outcomes noted earlier. The same is true about teratogenic medications, such as valproate, (which create a risk of birth defects). These must be replaced with a safer, effective alternative well before a pregnancy begins.

The key is preparing well for pregnancy. For people who already have at least one child, this is referred to as interconception health, education, counselling and care. This is also a great chance to learn the lessons from past pregnancies and to apply them to future ones.

The Queen’s Nursing Institute Scotland (QNIS) started the ‘Healthier Pregnancies, Better Lives’ programme just over a year ago. It will transition from a programme to a coalition (which PAS member groups are welcome to join) until preconception/interconception health, education, counselling and care become a respected, understood ‘part of the fabric’ of Scottish society.

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