Parenting & New Baby Advice Blog

Archive for the ‘Pregnancy’ Category

Putting the thought of baby gifts and parties out of your mind, you may have thought about what happens when your baby first enters the world.

At first sight, your newborn may not be quite what you had expected. For the first half minute or so, his skin might be bluish grey, and he may appear lifeless. That may be a shock if you are not expecting it, but this is the color of all babies in the uterus. As your baby begins breathing and more oxygen enters his body, his color will turn pinker or ruddier-first the head and body, then the arms and legs, and last the feet and hands.

Your baby will be soaking wet, streaked with blood, and smeared with vernix, a white sticky substance... Some babies have a great deal of vernix all over their bodies, and some have only small amounts, only in the creases and folds. Vernix is almost like a hand cream, in that it protects the baby’s skin while he is floating in amniotic fluid.

His face may be swollen and he might have long fingernails. You may also be surprised by the size of your baby’s genitals. The size and color subside in a few days, when their genitals take on a more normal appearance.

Immediate Care

Even though most babies do not really need it, care-givers routinely suction babies noses and mouths very soon after birth to remove excess amniotic fluid and mucous. In fact, sometimes they begin suctioning when only the baby’s head is out. It is done with a rubber bulb syringe or with a little jar and tube called a mucous trap. The mucous trap is used if the baby’s airway seems to be very congested or if the baby was under stress during labor and breathing problems are anticipated at the time of birth.

Your baby’s umbilical cord will be clamped in two places close to his abdomen. Then the cord will be cut between the two clamps. Sometimes the father cuts the cord. Otherwise, the doctor does it. Even though there is a spurt of blood when the cord is cut, neither you or your baby will feel it at all, since there are no nerves in the umbilical cord. Then your baby will be either be placed on your abdomen or taken to a special warm bed in the corner of the room for examination and other care. If he is placed on your abdomen, you will feel the warm, wet baby on your now soft belly. Many women find this a very pleasant sensation.

Your baby is dried off by rubbing briskly with soft towels to keep him from getting a chill [a major concern of your doctor]. Your baby will be wrapped in a warm blanket or two, and his head will be covered. In fact, it is a very good idea to have a warm little hat to place on the baby’s head as soon as possible after the birth because the baby’s head is such a large part of his body that a lot of heat can be lost through it.

You may enjoy this related article: Multiple Births

Since the 1970s, remarkable improvements in ultrasound technology have opened a real "window on the womb." Ultrasound consists of high-frequency sound waves that are bounced off the baby to give a photographic picture of the fetus. Unlike X-rays, which have much higher powers of penetration, ultrasound will identify soft tissues. Thus, it can give a complete picture of the growing baby and is a very useful diagnostic tool.

An ultrasound scan may be used to date the pregnancy, and thereafter used as needed in hospitals with the equipment. If not, women who may be at special risk because of problems with a previous pregnancy, or who would like to have a scan, can often be referred to a hospital where it can be performed. The pregnancy can be very accurately dated at around 16 weeks by measuring the circumference of the baby’s head. This knowledge is useful in avoiding problems later if the mother is unsure of her dates and does not know when the baby is due.

The scan can locate the position of the placenta, which can be helpful if there is any bleeding later in pregnancy, and it can be used to check that the baby has no major physical abnormalities such as anencephaly. Ultrasound can show congenital heart defects, kidney disease and other severe abnormalities. Ultrasound can also detect if the mother is expecting more than one baby.

There has been some controversy about the safety of ultrasound, which has concerned some women. They are not sure whether they should accept a scan. Ultrasound has now been in use for many years without any evidence of harmful effects to the baby. All indications are that the benefits of having ultrasound outweigh any potential risk. Not least is the benefit of reassurance given to many women on seeing their baby is alive and well, particularly those who have waited a long time to have a baby or who have experienced a miscarriage. However, a large study carried out in the United States by the National Institutes of Health on 15,000 women with a low risk of problems in pregnancy showed that while detection of twins and malformations was increased, and pregnancy could be dated more accurately, the outcome-in terms of healthy babies-was not improved when ultrasound was employed. There was no difference in the rate of fetal or neonatal death or subsequent illness. Rates for preterm births, for the outcomes of postdate pregnancies and for low-birth-weight babies were similar for those who had had ultrasound and those who had not. Although the percentage of abnormal fetuses detected in the group who had ultrasound was three times higher, the termination rate was about the same in both groups.

So, while ultrasound is of undoubted benefit to women at high risk or in special situations where a problem is detected, its routine benefits are unproved for now. Ultrasound can help some mothers anxious about their pregnancies by reassuring them, but can also create anxieties for others: "Towards the end of my pregnancy they started to worry about whether my baby was growing as he should. I don’t know what started it, but once they got this idea into their heads they wouldn’t leave me alone. I was in and out of the hospital having my blood pressure taken and having ultrasound scan after scan. My blood pressure was up-with worry, no doubt-and they couldn’t decide what to do. They said they would have to induce the baby early to make sure that all would be well. Then they changed their minds and decided to wait. I was in the hospital for the last few weeks of the pregnancy and, of course, the baby decided to be late. I was two weeks overdue before they decided induce the birth. By then I was so desperate I said, ‘Yes.’ It was a terrible birth, ending with an emergency Cesarean, and when he was born he was 7 pounds, 1 ounce. He didn’t look overdue. I asked my doctor later, ‘So what happened with this small baby?’ There was nothing wrong at all! My worries were for nothing. They said they couldn’t explain it but he had appeared small on the scan. So much for all their wonderful technology!" Some women-and doctors and midwives, too-feel that, with the increased reliance on new technology, many of the old skills in obstetrics are being lost: "I had shared care and I noticed a tremendous difference between my visits to the well-baby clinic and my visits to my very experienced doctor. At the clinic, people seemed to poke and probe for a long time and suggested that I have another scan to see the baby was growing OK. When I went to my doctor, she examined me very quickly and said, ‘Oh, this baby’s doing fine, I think he weighs about 4 pounds now.’ I asked how she knew and she just said, ‘Experience.’ In the clinic, I feel like you only see the junior staff, with the senior staff called for special occasions. No wonder you don’t always get the best care and they give you all kinds of unnecessary tests!"

Having an Ultrasound Scan.

An ultrasound scan is a simple, noninvasive procedure. In early pregnancy you are usually asked to drink a lot of water an hour or two before your appointment and not to empty your bladder. This pushes the womb up in the pelvis and will give the ultrasound operator a clearer view. You will be asked to lie down on a couch and remove any clothing that covers your abdomen. A cold gel is rubbed over the abdomen to enable the ultrasound operator to move the scanner smoothly over the area. As she does so you will see the baby’s outline appear on the television screen and you will also see the fetal movements.

It can be difficult to interpret what you are seeing, so ask if you are not told. The operator can freeze the picture at any time and point out things to you without exposing the baby to any more sound waves than necessary. You will usually be able to see the baby’s head, the arms and legs moving around, and some of the internal organs at work. You may even be able to see the baby sucking his thumb. Eventually, couples look forward to finding out the gender of their baby (and can give friends and family an idea of what types of baby gifts to look for.)

"The woman took a lot of time to explain to me what she was looking for and what she could see. I found all of it so reassuring. She pointed out the heart beating, the cord and the placenta, the kidneys and the spine and showed me how much he was moving around." Other women find the process unnerving, especially if nothing is explained. "No one said anything to me and I was afraid to ask in case anything was wrong. She kept on looking at everything and taking measurements and I started to get very jumpy. Then she suddenly got up and said, 'I just want to get a second opinion on this,’ and I was terrified. I thought, ‘This is it. Something’s really wrong.’ I was in tears. Someone else came back and they were both looking at the screen, still not saying anything to me. ‘What is it, what is wrong?’ I finally asked. ‘Nothing’s wrong, I’m just checking these measurements,’ she said. I felt as if I weren’t a person-just a scientific toy." Usually the baby’s father is welcome to come and watch the process and see the baby on the screen. Many dads find this is a very positive experience, not only because they are able to give support, but also because the baby becomes real to them in an even more dramatic way than to the woman: "It was hard for me to take in that she was pregnant until I saw the baby on the screen. It was fantastic-it made it come alive for me."

If you enjoyed this article, you might also like this post on Preparing For A New Baby: A How To Guide.

Taking a step aside to the normal baby talk of baby receiving blankets and toys, let's talk about the chance of having a difficult delivery.

Normally the baby is born with the head down, facing backwards, so the widest part of the baby’s head passes through the widest part of the pelvis. The baby’s head pressing down on the cervix helps it dilate, and the baby rotates as it is born, helping the body slip out behind the head.

Some babies, however, are born in a different position. This normally causes problems in labor. A posterior presentation means that the baby faces forward; its spine can press against the mother’s as it moves down, causing her pain and slowing labor. And because the widest part of the baby’s head is passing through the narrowest part of the pelvis, the baby can get stuck here more easily, again prolonging labor and sometimes requiring the use of forceps.

A breech birth occurs when the baby does not turn, so that the head is not born first; breech babies are normally born buttocks-first, occasionally feet-first. About four births in a hundred are breech. Most breech births are straightforward, though you are most likely to need intervention, especially in a first birth. Many women are advised to have an epidural; usually the baby’s head is delivered with forceps to protect it, and you are likely to have an episiotomy to help the baby’s head out. If you wind up needing an emergency Cesarean, the epidural will already be set up.

Medical Intervention

Over the past decade or two, hospitals have increasingly used a variety of techniques that have revolutionized the process of childbirth. Most of these are intended to save lives, and frequently they do. However, many interventions have become routine in some hospitals, thus interfering with the birth process for many mothers who are not at risk. Hospitals are now more likely to discuss any possible intervention with you. You should make your views clear, although obviously everyone involved should accept that intervention may be necessary in case of an emergency.

Episiotomy

An episiotomy is a small incision made in the perineum, the skin between the vagina and the anus, to enlarge the vaginal opening and help the delivery of the baby’s head. The cut is made with scissors under a local anesthetic when the baby’s head comes into view. Done properly, the perineum will have stretched very thin and the cut can be made with a minimum of damage and bleeding. An episiotomy should not be necessary in a normal delivery, and you can ask not to have one if you prefer.

However, there is some controversy over whether it is better to have a small episiotomy or risk tearing the perineum when the baby’s head is born. Some feel that a small tear is better and heals more rapidly, while others believe it is easier to sew up a clean cut. You should not be in great pain when the stitches are put in; if you are, ask to have more local anesthetic.

Related Article:

Preparing For A Second Baby

Being pregnant doesn't mean being fat. It doesn't have to mean being tired all the time, nor does it mean looking dumpy and saggy as a new mother. The way you feel [terrific or fatigued] and the way you look [sleek or bulgy] depend to a great extent to what actions you take during pregnancy regarding diet and exercise. By eating a wide variety of wholesome foods and by exercising aerobically on a regular basis, you can maintain or improve your fitness and health during this time of extra demands on your body.

Decide how you want to look and feel after delivery. Then accept the challenge of making necessary changes in eating and exercise. That's the first step. Look at your schedule and make changes to include sensible eating and an exercise program. The two go hand in hand. Just because you are pregnant doesn't mean you're fragile. Give your exercise program top priority. Plan your day around your exercise program, not the other way around.

This section describes a safe and effected fitness program for pregnant women at any level of fitness. The emphasis is on aerobic exercise, with some discussion of the other important components of a complete fitness program- stretching and strengthening exercises.

Starting an Exercise Program for the First Time

Becoming fit during pregnancy requires safe, regular, sustained, moderate exercise-not embarking on a new sport or doing strenuous workouts. Even if you have never exercised regularly before, you can safety begin a workout program during pregnancy. The safest and most productive activities during pregnancy [especially for the woman exercising for the first time] are swimming and brisk walking. They are best because can usually be continued until almost the day of delivery, and carry little risk of injury that would prevent further exercising. All you need before beginning is a sound program, appropriate clothing, and a health clearance from your personal physician.

Guide for Safe and Effective Exercise

For anyone engaged in an exercise program, it is important to know if you are under or overworking your heart. If you under work your heart muscle, you won't build stamina or endurance. If you are overworking your heart, you could become short of breath, dizzy, nauseated, or faint.

During pregnancy, it is especially important not to overwork. There are many internal body changes taking place that require oxygen and energy. In addition to the fact that you are growing a whole new person! That is why you should learn how to measure your body's responses to exercise.

One sign of overworking aerobically is shortness of breath. If you are working at just the right pace, you should be able to carry on a normal conversation while exercising [the" talk test"]. But, to be more accurate, you can learn to use your own pulse to tell you exactly how your body is responding to exercise.

Taking Your Pulse

Your pulse varies according to your activity level. It is lowest when you are least active. It also varies to response to illness and emotions. Your pulse can tell you about your physical fitness level, too. The more fit you are, the lower your resting pulse rate. Most women have a resting pulse rate of seventy-two, to eighty beats per minute [bpm], but this may decrease as their level of fitness improves. During pregnancy, the resting pulse normally varies within the same day and from day to day. As pregnancy advances, the pulse rate increases just slightly.

There are many pulse locations you can use, including the ones at your temples, your wrists and inside your upper arms. Do not use the carotid artery, [the pulse at the side of your throat]. Pressing this artery often alters the pulse beat, giving an inaccurate reading. Also, if you should accidentally press too hard or "massage" your neck trying to locate the pulse [especially during a workout], you may alter or decrease blood flow to the brain, making yourself feel faint or dizzy. Never take your pulse with your thumb. There is a pulse in your thumb and it is easy to confuse that pulse with the one in the artery you are trying to measure.

For practice, try to find the pulse in your wrist right now. To locate it, look on the thumb side, just below the small round bone on the side. Press firmly with your index and middle fingers. You should feel it beating. If not, get up and move briskly around the room for a couple of minutes and try it again. Practice several times during non-exercise times to become proficient at locating and counting your pulse.

Pulse Monitoring During your Workout

Three or four times during your workout, monitor your pulse. If you are attending an aerobic dance or exercise class with an instructor, monitor your own pulse whether or not the instructor has the entire class doing it. You should check your pulse after each aerobic dance or exercise segment, approximately every four minutes. After a while, you will be able to' read your body" and will know when your pulse is at the right level. You will then be able to check your pulse less frequently. But at first, be consistent in checking your pulse often.

Try to keep moving while you check your pulse. It will take practice at becoming proficient at doing this, but it is very important. Each time you stand still to take your pulse, it drops or changes. At the same time, the blood has a tendency to pool in the lower part of your body, affecting the blood pressure, and you may become dizzy or lightheaded. So keep moving to get an accurate pulse. [Of course if biking is your aerobic activity, you will have to stop to take your pulse. "No- hands" biking is not a good idea! Try jogging in place to keep your pulse rate up.

The most precise way to count your pulse is with a digital watch turned face up on the inside of your left wrist. Place the index and middle fingers of your right hand on your left wrist, finding your pulse beat. Keep moving as you begin counting [to yourself] how many times you feel the beat. The first beat is called zero, then one, two, three, and so on. For six seconds count each beat. Then simply place a zero after the number of your count. For example if your count is twelve your pulse is 120 bpm.

Finding Your Target Heart Rate Zone

Which pulse range is right for you? In order to improve your heart muscle and receive the other benefits of exercise, you must keep your pulse within your individual "target" heart rate zone. This target zone [in pregnancy and until approximately twelve weeks after delivery] is achieved when the heart is beating at between sixty and seventy percent of your safe maximum attainable heart rate [SHR].

A formula is used to determine each person's target zone. 220 [which is considered the highest pulse] minus your age equals your SHR Multiply that by sixty or seventy percent to get the limits of your target zone. The chart that follows contains the target zones for pregnant women and new mothers of all ages. Use it to determine your own target zone. If you cannot carry on a conversation in your target zone, you should reduce your activity, lowering your pulse to the level at which you are able to converse comfortably.

Use your target zone to help you regulate your activity during exercise. If your pulse is below your target zone, you need to work harder. If it is above your target zone, you are working too hard for your fitness level; you need to slow your activity to slow your pulse down to your target zone.

Target Heart Rate Zones for Pregnant Women and New Mothers

*Target heart rate is calculated at sixty percent to seventy percent of the safe maximum attainable heart rate. In pregnancy, maximum heart rate should never exceed 140 beats per minute.

Stamina and endurance are achieved sooner by working at the lower end of your target zone, nor the higher. Therefore, don't try to rush yourself to fitness by overworking, because it doesn't work and could cause harm.

Remember that your target zone is just for you. If you haven't exercised regularly before, you may have to do very little to zoom your pulse up. The more fit you become, the harder you will have to work to get your pulse in the target zone. Do not compare yourself with others; there is no norm to achieve. Each pregnant woman should work at her own individual level.

Memorize the low and high numbers of your target zone. If you are above the high number, you need to slow yourself down-by walking, pedaling your bicycle more slowly, or reducing the vigor of your arm and leg movements. Unless you believe you are going to collapse or faint, do not stop moving or sit down. Keep yourself moving until your pulse drops to your target zone and you are ready to resume exercising.

If at any time during exercise you begin feeling faint, dizzy, lightheaded, nauseated, clammy or cold even though you are sweating or extremely fatigued, stop exercising, but walk around for a while and then have a seat. If you are in a structured class, talk with the instructor before leaving-let her know you are feeling unwell. She may want to keep her eye on you for a bit, or she may want to help you seek medical assistance. Also, see your physician before resuming exercise. These are warning signs. Listen to your body. There may be a very simple cause or one that is complicated and serious. Your physician, not your fitness instructor, or you should determine the cause.

It’s almost certain that every parent trying to find a good day care situation has thought of the sexual abuse that has been reported in the media. How do you know that you are leaving your child in a safe place and what are the different options? 

Breastfeeding can be a problem of convenience, though for some working women who are adaptable and willing to experiment, it is possible to have the best of both worlds-working and nursing. Your success will depend on your working conditions, your day care arrangements, your milk supply, and other factors. The tiniest of babies can be incredibly flexible, and you may be able to nurse the baby in the evenings and on the weekends when you are at home and have your caregiver feed the baby bottles of formula or your expressed breast milk. Your breast milk can be safely stored by refrigerating it for up to twenty-four hours or freezing it for two weeks. An occasional woman is lucky enough to find as a caregiver a nursing mother who will feed her infant charge as well as her own baby. 

First, consider your child’s needs. Some centers may expect your child to play quietly all day, others may provide a pre-school atmosphere with structured activities. Consider how many children will be there during the day, large groups may not work well for a shy, easily “lost” child. The point here is that the “ideal” daycare situation will be different for each child. One one-year old may be ready for a structured pre-school type day care center, while another may be much happier staying with a neighbor. 

Consider your needs. What hours will you need care, and what location will be the most convenient? And don’t forget to consider how much you can afford. 

The most difficult problem is leaving a baby only a few weeks old is that of finding adequate care for him of her while you are gone. Most new mothers who return to work leave their babies with trusted and competent relatives. If you do not have family members who can provide this care, you my have trouble finding a sitter or day care center that will accept responsibility for such a young baby, and charges will probably be higher than they would for an older baby.