Pregnancy: your questions, answered

The first sign to suspect pregnancy is a missed period. Contrary to popular myths, physical symptoms will not tell you before that — so wait until the period is missed.

The first test to do is a urine pregnancy test. If it is positive, your pregnancy is confirmed. A urine test can read negative if it is done too early; in that case a blood test called serum beta HCG will confirm it, because it turns positive even earlier than the urine test.

An ultrasound scan should be done at least after six weeks. By then the urine test is already positive, so a scan is not the test for identifying an early pregnancy.

Read moreConfirming a pregnancy: signs, urine tests and scans

The first step once you identify the pregnancy is to inform your midwife. She will visit you and advise you what to do and where to attend clinic.

If you and your pregnancy are healthy, with no complications such as pain or vaginal bleeding, there is no need to see an obstetrician immediately — you can wait until seven to eight weeks for your first visit. At that visit an ultrasound scan can confirm the pregnancy, where it is situated, the fetal heartbeat, and that the baby is alive and growing well.

If you have concerns such as pain or bleeding, or any previous medical issues, see the obstetrician early so they can be sorted out.

Read moreA healthy early pregnancy: what to do first

The due date is usually calculated from the first day of your last regular menstrual period. We add 280 days — forty weeks — to get the expected date of delivery.

That calculation assumes a regular 28-day cycle, so it is accurate only if your cycles are regular. If your cycle length is different, the date is adjusted accordingly and is less accurate.

Dates are usually corrected using an early ultrasound scan.

Read moreWork out your due date

Many women have bleeding in early pregnancy. It isn't "normal" as such, but if it settles and the baby goes on growing well, it will not affect the baby's health.

It may be implantation bleeding, which happens around the time the period would have been due, or it may be unexplained bleeding that needs evaluation.

Any bleeding in early pregnancy needs to be checked with an ultrasound scan, to confirm the baby is healthy and all is well.

Read moreEarly pregnancy bleeding, explained

Morning sickness can be managed easily with medication. But if it isn't severe, you may not need any — changing how you take your diet and your usual habits can be enough.

If it is severe enough to disturb your daily activities, seek help. The medicines used to stop vomiting are safe for both mother and baby, so there is no need to worry about taking them if you truly need them.

In early pregnancy the hormone progesterone rises, and its effects are usually felt as tiredness, a feeling of breathing fast, or a feeling of having a cold or a raised temperature.

These are normal symptoms of the rising pregnancy hormones, and not a cause for worry.

This is a common myth. You do not need to eat for two. The baby weighs only about three kilograms at delivery, so at most you would eat a little more than usual — essentially the same amount you are eating now.

The aim is not to increase the quantity of what you eat, but to improve its quality.

Read moreEating well in pregnancy

Avoid unpasteurised milk, and raw or half-cooked meat. These can cause infections that are harmful to the baby.

Read moreEating well in pregnancy

Contrary to popular myths, papaya and pineapple are not harmful to the growing baby. Any fruit or vegetable taken in the moderate amounts you usually eat is not harmful.

That said, anything in very large quantities is not going to be good — so don't take too much fruit, or too much food. But having any fruit in the amount you usually take is not harmful.

Having tea and coffee occasionally is not harmful. Too much caffeine is not good, but one or two cups of coffee a day is not going to be an issue.

You can continue the exercises you are used to doing, but don't start new exercises during pregnancy.

Staying active throughout the pregnancy is helpful for a healthy pregnancy and an uncomplicated labour and delivery.

Unless your doctor or healthcare provider has specifically told you not to, it is safe.

There are occasions where you will be asked not to — for example if the placenta is situated low in the womb, which we call placenta praevia, or if there is a risk of infection when the cervix is open or the waters have broken. In those cases, follow your healthcare provider's advice.

Read moreSex during pregnancy: what's safe

You can travel during pregnancy, unless you have medical issues where you are advised not to.

Travel is usually safe once the viability of the pregnancy is confirmed by an ultrasound scan in the first three months, and it stays safe until the later stages of pregnancy, when there is a risk of suddenly going into labour.

Read moreAir travel during pregnancy

Most of your usual medications should continue during pregnancy. But you must inform your doctor that you are pregnant, because there are some medications that should be avoided in pregnancy and can harm the baby.

Do not take that decision yourself. See your doctor, tell them you are pregnant, and if you are already taking medicines you can be given a safe alternative.

A word about alternative medicines: we are not sure of the ingredients in them, so we are not in a position to advise you whether they are safe or not. For those, you should consult the provider who prescribed them.

Read moreParacetamol in pregnancy: myths, facts and safe use

Ultrasound scans are safe during pregnancy. An ultrasound scan uses sound waves above the frequency you can hear, so it is quite safe for babies — you do not have to worry about ultrasound scans.

With X-rays, there are issues if you are exposed to higher amounts of radiation. But plain X-rays, and even CT scans, can be done during pregnancy while the baby is shielded.

So if your doctor decides you need an X-ray, tell the radiographer that you are pregnant, and they will take precautions to make sure your baby is safe.

Generally, hair treatments and colours are considered safe during pregnancy.

The only issue that can happen is if you develop an allergic reaction to one of them. As a simple precaution, try to stick to the brand or product you were using before you became pregnant, so you can be more confident it won't give you a reaction.

Sleeping position starts to matter as your tummy grows, particularly from around twenty-eight weeks.

Sleeping on your back can reduce the blood supply to the womb, which then affects the baby's nutrition and oxygen supply. It can also affect the mother herself, though usually not significantly.

Settle to sleep on your side — either left or right. If you wake up on your back, simply turn over, without worrying.

As long as the pregnancy is healthy and you are healthy, you can continue your normal work. In fact, being active during pregnancy is beneficial for you and the baby.

So we do not recommend resting or keeping away from your normal work during pregnancy — unless there is a medical complication where your doctor recommends rest.

There are some routine vaccinations offered to pregnant women. The one done routinely in Sri Lanka is tetanus toxoid, which protects you and your newborn baby against tetanus.

If there is an epidemic of a particular virus — such as COVID-19 or flu — and there is a need, your doctor will advise whether you should have that vaccine. These are not part of the routine immunisation programme in Sri Lanka at the moment.

Read moreInfluenza in pregnancy

You can attend your routine dental check-up during pregnancy. If your dentist recommends any dental treatment where it is necessary, you can undergo it without any issues — it will not affect you or the baby.

When you need to undergo a procedure, we recommend doing it after twelve weeks. The first trimester is usually avoided unless it is really indicated.

There are several blood tests you will undergo during pregnancy.

• Haemoglobin level — to detect whether you are anaemic, meaning your blood is thin, or normal.
• Blood group and rhesus status.
• Infection screening, such as HIV and syphilis, to make sure the baby is safe.
• Blood sugar screening — within the first twelve weeks your blood sugar is checked after a meal, and at about twenty-four weeks we do an OGTT, where you are given a dose of glucose to drink and the blood sugar levels are checked.
• Thyroid function tests, sometimes.

If you have any previous medical issues, we will add further tests to monitor those conditions.

Read moreIron in pregnancy: what to take and why

• Around 8 weeks — the dating scanWe measure the length of the baby, compare it with the normal range, and assess the baby's age. If that matches the date calculated from your last period, we go by your dates; if it doesn't match, we calculate the expected date of delivery from the measurement. This scan also confirms that the baby is growing inside the womb, that the baby is healthy with a normal heart rate, and whether it is a single baby or a multiple pregnancy.
• 11 to 13 weeks — the early anomaly or NT scanThe baby's anatomy can be seen clearly — the head, the limbs, the heart. It can sometimes indicate whether the baby has genetic issues such as Down syndrome, but it is not a confirmatory test.
• Around 20 weeks — the detailed scanA structural survey of all the ultrasonically visible organs of the baby, to make sure everything is fine. At this scan you can also see whether the baby is a boy or a girl, along with growth measurements, and we locate the placenta and check the amniotic fluid level.
• Around 28 weeksTo check that growth is fine, the placenta is in a normal position, the amniotic fluid level is fine, and the baby is well.
• Around 36 weeksAgain for growth, the baby's wellbeing, and the position — whether the head is down or not.

Read moreThe dating scan: your first ultrasound

Ultrasound scans are not harmful. We do not use radiation — the technology uses sound waves, above the range of human hearing. Since it is just sound waves and not radiation, it will not cause any radiation damage to the tissues.

That said, frequent scanning is not necessary, so we do only the necessary scans — at most one scan every two weeks in a growth-restricted baby. Sometimes, if the baby needs frequent surveillance, we do Doppler scans every third day, but not the complete detailed scan. Those are extreme situations.

Usually, you will have a scan about once in two months, or once a month.

We can clearly identify if the baby is small by doing an ultrasound scan. But usually you need more than one scan to say whether the baby is genuinely small, or whether there is an issue with growth — because all babies are not the same, and there are babies who are healthy but small.

So we monitor the growth with ultrasound scans to see whether the baby's growth is static or not improving. That is how we detect growth restriction. One scan alone is not enough to say the baby's growth is not good, but ultrasound will definitely identify whether the baby is growing well or not.

If the scan says the baby is small, that could be a normal, healthy small baby; a sick baby with restricted growth; or a condition called fetal growth restriction, where the baby's nutrition and oxygen supply from the placenta is not adequate.

Read moreSmall for gestational age babies

Down syndrome screening is not routinely recommended for all mothers. But if you are at high risk of having a baby with genetic issues, you can have a genetic test.

• NIPT — a blood test where we check the fetal DNA, the baby's DNA in your blood, to detect any abnormal genetic composition. It predicts whether the baby is going to have a chromosomal abnormality such as Down syndrome.
• The NT scan at around eleven to thirteen weeks, where the measurement of the nuchal translucency can predict whether the baby is at high risk of a condition like Down syndrome. Again, that is only a prediction.
• The 20-week detailed anomaly scan, which can show some structural abnormalities related to genetic conditions.

We do not routinely recommend genetic screening in Sri Lanka unless you are at high risk, because medical termination for fetal anomalies is not legal at the moment.

Read moreWhat the 20-week scan and NIPT can tell you

It varies, depending on a lot of factors — whether it is a first pregnancy, how thick the fat layer on your tummy is, and the individual baby's behaviour.

Usually, first-time mothers feel movements at around twenty weeks. In a second or third pregnancy, you may feel the movements earlier.

Each baby is different. With regard to the number of movements you feel in a day, your baby is unique — so you do not have to rely on a specific number.

As the pregnancy goes along, you become familiar with your own baby's pattern of movements. If the usual pattern is there, you do not have to worry.

If the usual amount of movement your baby has in a day is reduced, that is something to be concerned about — irrespective of the number of movements you feel.

It is quite normal for the baby to have reduced movements in early pregnancy. If you are at around twenty weeks and you do not feel movements, that is not something to be concerned about.

But as the baby grows, you should feel the normal pattern of movements. If you feel movements are less, that is the one thing you can monitor to tell how healthy the baby is — so it is something to worry about.

If you feel the movements are less, it is always better to go and ask for help. When you come to hospital we can check the baby's heartbeat and monitor it with a heart rate monitor, and make sure the baby is healthy.

Yes, that is normal. When there is an increased amount of fetal movements, that is not something to be concerned about. It is quite normal for the baby to have occasional active spells.

The main sign is that you will get contractions, and you will feel them. Contractions are usually painful when labour starts.

Sometimes the waters can break, and then you will feel a gush of water coming through the vagina.

Frequent contractions, pain, and any leakage of water — those are the signs that you should go to hospital.

Read morePreparing for a normal vaginal delivery

If you have symptoms like pain, leakage of water, or frequent contractions, those are the signs that you are going into labour, and you need to attend hospital.

There are other occasions when you need to go: if the baby is not moving well, or if you are feeling unwell — whatever the reason, if you feel that you are not well.

Go to hospital immediately if you have high fever, headache, changes in your vision such as visual disturbance or flashes, or swelling of the body.

And if there is no sign of labour by your due date, contact your healthcare provider and ask when to attend hospital.

Read moreYour maternity hospital bag: a Sri Lankan checklist

There are a number of pain relief options available.

• Simple analgesics — paracetamol, or paracetamol and codeine. These are the simplest options available.
• Injectable analgesics — the strong opioid analgesics.
• Analgesic gases for inhalation.
• An epidural, which gives complete, or almost complete, pain relief.

The epidural is a procedure where an epidural catheter is inserted and the analgesia given by a professional. So you need to be admitted to a hospital with the facilities for that method of pain relief.

A caesarean section is a surgical procedure, done when a normal delivery is not safe for either the mother or the baby.

Your doctor will decide, and will let you know when there is an indication to do a caesarean section for the safety of your baby or yourself.

Going into labour after a previous caesarean section carries some risks. It should therefore be carefully assessed and decided with your healthcare provider, as to whether it would be safe for you to go for a vaginal delivery.

It is certainly possible when everything is normal and the risks are minimal.

By about thirty-eight to thirty-nine weeks the baby is mature enough to be born, and delivering then is perfectly fine.

After full maturity, each extra day inside the womb carries a small added risk, so the safe cut-off is usually forty-one to forty-two weeks. Waiting longer does not improve things for the baby; it only raises the risk slightly.

So you can wait for labour to start on its own, or discuss induction of labour with your doctor.

The first few days will be a time when you enjoy the company of your baby — a good time. You will establish breastfeeding and enjoy the happiness of having the baby.

But some issues can come up. Your psychological state can change immediately after delivery, as the pregnancy hormones change, so you may feel low or your mood may shift. You will need support from your partner and your family.

If you have had a caesarean section, this is the time you are recovering from a major operation. You will have some pain, and the effects of the spinal anaesthesia may last for a while. If a catheter is in place, it will be removed and normal urination established. You will also start a normal diet.