Patient guide

What should I bring?

• The first day of your last period
• Earlier test, ultrasound and Pap results
• A list of medicines, supplements and herbal remedies
• Details of past operations and pregnancies
• For fertility checks, both partners’ tests

What will I be asked?

You are asked about the regularity of your periods, bleeding between periods, past pregnancies and miscarriages, health conditions, family history and contraception. Some questions are private. Plain answers help the diagnosis, and you can raise anything that worries you.

The examination

Every examination is explained first and happens only with your consent. If an internal examination is needed, you can say what makes you uncomfortable, have someone with you, or ask to stop at any moment. Slow breathing helps your muscles stay relaxed.

Write down your questions

Much is forgotten in the consulting room. Note your questions beforehand, and if you do not understand something, ask again.

The first pregnancy visit

It is best to start early. You are asked about your health, past pregnancies and the date of your last period, your blood pressure and urine are checked, and your blood group and basic tests are requested. Tests for inherited blood disorders and for infections such as hepatitis B, HIV and syphilis may also be requested during your care.

First trimester

• A scan at weeks 11 to 14 to date the pregnancy and count the babies
• Screening for Down’s, Edwards’ and Patau’s syndromes, if you wish

Second trimester

• A scan at weeks 18 to 21 to check how the baby’s body is formed
• First movements felt between weeks 16 and 24
• A blood sugar test, if your doctor thinks it necessary

Third trimester

• Checks of blood pressure, urine and the baby’s growth
• A talk about how and where you will give birth
• A review of the signs of labour

The number of visits depends on your situation and is usually higher in a first pregnancy. Your doctor gives you the exact schedule.

A few practical points

• Keep your pregnancy notes and results with you at all times
• Call between visits if you are worried
• Do not start or stop any medicine or supplement without advice

The pregnancy and birth page has more detail.

Signs that labour is starting

• Regular contractions or tightenings
• A sticky pink discharge from the vagina
• Backache
• An urge to go to the toilet, from the baby’s head pressing down
• Your waters breaking

Practice contractions can happen in the last weeks. They are usually painless and stay short. Real contractions get longer, stronger and closer together.

When should I call?

Call if you think you are in labour or contractions come every five minutes or more often. Report these at once, even in the middle of the night:

• Your waters breaking
• Vaginal bleeding
• Your baby moving less
• Possible labour before week 37
• A contraction lasting more than two minutes, or six or more in ten minutes

If you feel the baby is coming now and have a strong urge to push, call 115.

Arrange things in advance

Know where and whom to call. Keep your pregnancy notes, results and ID within reach, and plan your route to the maternity unit. Ask the office which centre to use.

If a caesarean is planned

A planned caesarean is usually done from week 39. Get instructions from your doctor about fasting and your medicines on the day.

Bleeding

Bleeding after birth is normal. It is heavy at first, lasts a few weeks, then turns brown, lessens and stops. Use pads, not tampons. Bleeding may increase a little during breastfeeding, with cramps. Tell your doctor if you pass large clots.

Stitches

Wash stitches from a vaginal birth every day with plain warm water and pat dry gently. To avoid constipation, eat fruit and vegetables, drink water and try not to strain.

The caesarean wound

Most women go home one to two days after a caesarean. Gently clean and dry the wound each day, wear loose clothes, and until you are comfortable and your doctor agrees, do not drive or lift anything heavier than your baby. This is usually about six weeks. A gentle daily walk lowers the risk of clots.

How you feel

In the first days after birth, feeling low, anxious or irritable is very common and usually passes within two weeks. If it continues or gets worse, it may be postnatal depression. This is common and gets better with treatment. It can begin up to a year after birth. Asking for help does not make you a bad mother.

When should I call at once?

• Heavy bleeding or large clots
• Redness, discharge or a bad smell from a wound, or a fever
• A severe headache, blurred vision or pain below the ribs, because pre-eclampsia can happen after birth too
• Thoughts of harming yourself or your baby, for which you should get help at once

Before surgery

Ask why this operation is advised, what the alternatives are and what will change afterwards. If you plan a pregnancy, be sure to say so. Get your fasting instructions and ask which medicines, especially blood thinners, must be stopped. Do not stop anything yourself. If you smoke, stop.

Arrange for someone to take you home, because you cannot drive after a laparoscopy.

After a laparoscopy

Most people go home the same day or the next. Nausea, tiredness, a sore throat, bloating, tummy pain and shoulder pain are common. If it was only to diagnose a condition, recovery usually takes up to ten days and returning to work may take up to three weeks. If you had surgery, full recovery may take 6 to 8 weeks.

After a hysterectomy

• Walk a little the day after surgery to prevent clots
• You may leave 1 to 4 days after a vaginal or laparoscopic operation, and up to 5 days after an abdominal one
• Recovery from abdominal surgery takes about 6 to 8 weeks
• Do not lift anything heavy during this time
• Light bleeding and discharge for up to 6 weeks are normal
• Drink water and eat fruit and vegetables to avoid constipation

When should I call?

Call if you have heavy bleeding or clots, a fever, a red or pus-filled wound, worsening pain, or pain and swelling in a leg. Shortness of breath or chest pain is urgent: call 115.

Help at home

The patient support network can arrange nursing, dressings and medicine delivery in Tabriz.

Call 115 or go to the emergency department

In pregnancy, or if you could be pregnant:

• Bleeding with severe tummy pain, or heavy bleeding that soaks a pad quickly
• Pain in the tip of the shoulder
• Dizziness, weakness or fainting
• Sudden severe tummy pain with paleness

These can be signs of an ectopic pregnancy, which can be dangerous, even if you have not done a pregnancy test yet.

After birth:

• Heavy bleeding or large clots
• Thoughts of harming yourself or your baby

At any time:

• Sudden severe pelvic pain, especially with nausea or vomiting. A twisted or ruptured ovarian cyst is one cause

Call your doctor or maternity unit at once

Do not wait until tomorrow, even in the middle of the night.

• Your baby is moving less, has stopped moving or the pattern has changed
• A severe headache that simple painkillers do not ease, blurred vision or flashing lights, pain below the ribs, sudden swelling of the face, hands or feet
• Your waters break
• Possible labour before week 37
• Very long contractions, or contractions with no break

Get checked the same day

• Spotting or light bleeding in pregnancy
• Unusual discharge or fluid leaking from the vagina
• Fever, burning urine or foul-smelling discharge after surgery or birth

Remember

Bleeding in pregnancy does not always mean something serious, but you cannot tell that yourself. If you are not sure, call.

115 is Iran’s emergency number. The support number is for arranging care and does not replace it.