Parenting & New Baby Advice Blog

Archive for the ‘Pregnancy’ Category

Conception occurs two weeks after the women’s last menstrual period. The egg and the sperm fuse to produce one cell. In the first three months, or trimester, the embryo takes shape and all the organs are formed. In the last six months, the fetus grows and matures.

In the first weeks after conception, the single cell rapidly divides into many cells. A hollow ball of cells is formed and becomes attached to the womb. Some of the cells will become the placenta; the rest will become the embryo. The latter group of cells develops into a four-layered disc. Each layer will be converted into different areas of the body. The outer layer of ectoderm, for example will develop into skin, hair, nails and the nervous system. The inner layer, or endoderm, will develop into the intestines and lungs. The middle layers will develop into the heart, bones, and muscles.

By three weeks after fertilization, or about one week after the first period is missed, the embryo already is one-tenth of an inch long and has an oval shape. In the next few weeks, it becomes more curved in shape and a head and tail are discernable. The beginning of the spinal cord and brain take shape. A tubular heart begins to form. Tiny eyes can be seen. Arms and legs begin to bud.

By the fourth week after fertilization, traces of all the organs of the body are present. Bulges that become the ears and nose appear. The gut is formed from blind pouches within the embryo; these push forward, creating an opening in the head that will become the mouth. A crude face begins to take shape. At this point, the embryo is only one quarter of an inch long.

The embryo is called a fetus at the seventh or eighth week. It has grown to be the length of one inch; the head is disproportionately large because of the size of the developing brain, while the abdomen seems large because of the growing liver. Fingers and toes appear. The rudiments of all the hormone- producing glands-the pituitary, thyroid, and the adrenal glands-are present. Amazingly, the tiny heart begins to beat.

By the end of the third month, the fetus is two to three inches long and weighs less than an ounce. Nails form on the fingers and toes. The bones begin to calcify. The male or female sex organs begin to develop. The tooth buds form in the mouth. The fetus begins to make breathing movements and starts to swallow amniotic fluid. The muscles in the intestines begin to contract and relax, as if digesting food. Skeletal muscles begin to work as well, so the fetus can move to response to local pressure.

Although the organs are present by the end of the first trimester, the fetus is not yet able to live outside the mother’s body. The second trimester is devoted to primarily to maturation of the organs. By the fourth month, the fetus moves spontaneously but is too small for the mother to feel. The fetus is four to five inches long and weighs three ounces.

By the fifth month, however, the baby is six inches long and weighs one half pound, and is strong enough to make his presence felt. The mother’s perception of the baby’s movement is known as quickening. In the fifth or sixth month, the body becomes covered in fine hair, or lanugo and coarse hair appears on the head.

The baby is fully developed by the beginning of the third trimester. The last three months, therefore, are devoted to growth. The baby is about ten inches long and weighs one to two pounds by the seventh month. The skin is red, wrinkled and thin. It becomes covered in vernix, a thick, whit, sticky material composed of skin cells, ` and oily skin secretions. If the baby were born at this time, he would have a fifty percent chance of survival, provided he received appropriate medical care. Babies born this early can respond to taste, light, and sound.

If the baby is born in the eighth month of gestation, his chance of survival increases to ninety percent. By this time, he is ten to twelve inches long and weighs three to four pounds.

The final preparations for independent existence occur during the ninth month. Surfactant, a substance that lines the lungs and allows them to expand easily, develops. Fat is stored, and its deposition under the skin smoothes out the wrinkles. Much of the lanugo disappears.

By the final month of pregnancy, the fetus is usually fourteen to sixteen inches long and weighs seven to eight pounds. He is large and strong enough for the next step-birth and independent life. That one cell has come a long way, from embryo, to fetus, to newborn baby.

You’ve made the decision to have a baby. Your menstrual period is late. Should you be elated or is cautious optimism in order? You may suspect you are pregnant by the way you feel, or your doctor may suspect it by findings on a physical exam. But symptoms and signs are just suggestive-the possibility that you are pregnant should be confirmed by a urine or blood test. If the result of one of these tests is positive, you can start rejoicing.

In the first few weeks after conceiving, you may notice changes in your body and in the way you feel. A late menstrual period is often the first hint you are pregnant. However many other conditions, from stress to infections, can delay the onset of menses, so a late period is not a reliable sign until at least two weeks after the expected date. On the other hand, you can have spotting while pregnant, so the presence of some bleeding doesn’t eliminate the possibility.

You may notice some fatigue in the first weeks. You may experience nausea or vomiting, especially in the morning, a week or two after your missed period. Your breasts may have some tingling or tenderness and may even enlarge. The areolae [the area around the nipples] may darken. If you have been having trouble getting pregnant and are recording your basal body temperature, you may find that your temperature continues to be elevated. Just as with a late period, all of these signs and symptoms, if they occur at all, can be contributed to other causes. By themselves, they do not prove, just suggest, that you are pregnant.

If you go to see your doctor when your period is two weeks late, he may find physical changes that suggests you are pregnant. Your vagina and cervix may be blue to a purplish color because of increased blood flow. This is known as Chadwick’s sign. The uterus may feel softer, larger, and rounder. Your doctor may be able to feel intermittent contractions called Braxton-Hicks contractions, even though you may not recognize them.

Many women know they are pregnant before they see their obstetrician, however, because they run a pregnancy test themselves at home. Non-prescription home pregnancy tests are available in any pharmacy and cost about ten dollars. These tests are designed to detect the presence in the urine of the human chorionic gonadotropin [HCG], a hormone produced by the embryo shortly after fertilization.

Home pregnancy tests on the market today vary in sensitivity. Some can detect HCG one day after the missed period. Others require one to two weeks. Some tests must be done on a urine test obtained in the morning, when the concentrations of HCG are the highest; others can be performed on any urine specimen. Some react within ten minutes, but others require one to two hours. No matter which test you use, if the directions are followed carefully, the results are ninety to ninety-five percent accurate.

The tests are easy to perform. You add a few drops of urine to a test tube containing a protein, called an antibody that reacts specifically with HCG. If you are pregnant and HCG is present in the urine, it will bind to the antibody, forming a complex. If you are not pregnant and no HCG is present, the antibody will remain free in the solution. Different chemical reactions are used in the different test kits to indicate whether a complex or a free antibody is present. Positive tests are usually indicated either by a formation of a circle at the bottom of the tube or by a color change in the solution.

Even though these tests are extremely sensitive, there are a few other things that, when present in the urine will cause a positive test result even though the woman is not pregnant. Luteinizing hormone [LH] is one of the hormones that regulate the menstrual cycle. It can cross-react with HCG and give a positive test result. Ordinarily, it is not present in the urine in detectable amounts. However, menopausal women have a high level of LH and can have a positive test result. Women with protein in their urine can have a similar reaction. Protein may be present because of infection or kidney disease, or because certain medications such as tranquilizers, thyroid medications, and anti seizure drugs, have been taken. More common than a false- positive test result is a false-negative one-that is, the test result is negative even though the woman is pregnant. This usually occurs when the test is done too early after the missed period, when the level of HCG is too low to be detected. Low levels of HCG may also be caused by an ectopic pregnancy [a pregnancy that develops outside the uterus], if the first test is negative and your period doesn’t start, repeat the test in five to ten days. If it is still negative, consult your doctor.

If you go to your doctor two or three weeks after your missed period, he or she will probably perform a pregnancy test on your urine that is similar to the home pregnancy tests. The “rabbit test” is no longer used because of the greater speed, convenience, and accuracy of modern tests.

If your doctor needs to know if you are pregnant at a time before the urine test can be used, or if he or she suspects a false-negative result, a blood test that is more sensitive and specific may be used. It measures a part of the HCG molecule known as the beta-subunit. Since LH doesn’t have a beta-subunit, this test can distinguish between LH and HCG because it can measure very small amounts of HCG. It can be used to diagnose pregnancy before a missed period [by seven to nine days after fertilization] or to diagnose a tubal pregnancy [one that develops in one of the fallopian tubes]. This test takes longer [twenty-four to forty-eight hours] to complete, and it is more expensive because it requires special equipment and personnel. Therefore it is not used routinely to diagnose pregnancy.

When you know for sure that you are pregnant, the next question will undoubtedly be “When will my baby be born?” Delivery usually occurs 280 days after the first day of the last menstrual period. An easier way to calculate the delivery, or due date, is to count back three months from the first day of your last period and add seven days. Most women don’t give birth on the exact date, but eighty-five percent do within two weeks of it; delivery is earlier for ten percent and later for five percent. As your pregnancy progresses, your due date can be double-checked by the timing of certain events. For example, the baby’s heart is usually heard at ten to twelve weeks. The level at which the top of the uterus can be palpitated by the doctor can also be used; at twenty-four weeks, for example, it is usually at the umbilicus [navel]. If your obstetrician performs an ultrasound study, a measurement of the baby can be taken and compared with standard tables to estimate gestational age.

Discovering you are pregnant is an exciting moment. The next nine months will be filled with excitement both for you and your family as the changes of pregnancy takes place.

Our attitudes towards pregnancy and childbirth form over a lifetime shape by the values and beliefs of our families and our culture. The way a baby is born reflects not only personal and family beliefs, but also, the prevailing cultural attitudes.

Since the turn of the century, the ways of birth has undergone continuous change, as has society itself. When you talk to your mother and grandmother about childbearing beliefs and practices when they were having children, they probably will not tell you it was wonderful. In the good old day” Most people believe that childbirth today is better managed than it was one or two generations ago.

In looking back, we see that until the mid-1930’s childbirth was truly dangerous. High percentages of women and their infants died during or soon after childbirth. Determined to correct this persistent problem, organized medicine took many steps to lower mortality rates.  A new medical specialty called obstetrics, was founded, and an aggressive effort was made to eliminate risky practices [for example, lack of cleanliness and infection control, and overuse of drugs to speed up labor and obliterate pain] and to improve the training of physicians. Prenatal care also gained recognition for its benefits in preventing death. Childbirth moved from home to hospital with the promise of more efficient and controlled conditions for birth.

With these efforts, along with general improvement in public health [for example, improved working conditions, public sanitation, family nutrition, and better control of some chronic illnesses], came a reduction in the danger of death in childbirth.

The 1940’s brought such advances as antibiotics and blood banks, as well as improvements in surgical techniques and anesthesia, which further increased the safety of childbirth.

But by the 1950;s, routine maternity care originally designed to improve safety, had become almost too rigid; for example, the fear of infection, a major killer of mothers and babies, led to such practices as taking away all a woman’s personal belongings when she entered the hospital, shaving all hr pubic hair, administering large uncomfortable enemas, prohibited fathers and other love ones from entering the maternity area, keeping babies in nurseries away from their mothers, and handling babies as little as possible. Bottle-feeding was believed more sanitary and superior in almost every way to breast-feeding.

In addition, heavy use of pain medications took away mother’s ability to control their behavior and to understand and remember labor. They often remained drugged and sleepy for hours or even days after birth.

In response to these hospital routines, women protested that such practices were not necessary or beneficial; and they began seeking other, more satisfying ways to give birth. Fortunately, concerned and enlightened joined them in their quest.

Thus began the natural childbirth movement and the movement of toward family centered maternity care. The 1960’s was a time when national and international organizations were founded to make these changes. Women and men wrote and read books describing more humane, satisfying ways to give birth. Mothers attended childbirth classes, involved their loved ones in their support and care, breast-fed their babies and spent more time while in the hospital caring for their babies.

These improvements in care and safety have continued until the present. As the individuality of each woman was recognized, so was the uniqueness of each labor. It became clear that not all women need or want the same kind of care.

The 1970’s saw the re-emergence of the mid-wife as a popular and trusted caregiver for healthy women wanting more participation in their own care, more emphasis on prevention of problems, and more recognition of their emotional needs. This was also the time when alternative settings for birth-at home, or in a birthing center-surged in popularity.

Hospitals also joined the ranks, offering more flexible family-centered care and more comfortable home-like rooms for birth. The role of the physician changed from being in complete control of the birth to being more sensitive and responsive to each woman’s needs and wishes.

All this is to say that today there are many different approaches to maternity care. There is no single correct way. In this chapter we will describe and discuss many of these choices to help you decide what kind of care you think will be best for yourself during your pregnancy and birth.

Informed Consent

There is one concept that you should understand because it is an important principal underlying health-care in the
United States, and
Canada today. The legal concept of informed consent designates the patient as the decision maker in medical care.

What is informed consent? It means simply that a patient understands and agrees to any treatment or procedure that is done for medical purposes. Her care-giver is legally responsible for giving her full information about any procedure before her consents to it. This is because there are often risks as well as benefits associated with medical treatments, and the patient [who has the greatest stake in the decision] has the right and responsibility to decide whether the risks are worth taking.

The principles underlying informed consent are really the features of any good relationship between patient and physician. Discussion, understanding, and agreement are the hallmarks of optimal care. Many of us, however, feel we do not know enough to have an intelligent discussion with our caregivers, and are a little insecure trying to do it. There is no need to feel that way, however, and the following general guidelines for discussion may give you more confidence in discussing your care.

1        If your care-giver [doctor or midwife] suggests a test, a treatment, or procedure, the first thing you should know is why.

a.      Is it because you have or may have a problem? If so, what is the problem, and why does it need to be detected and treated? How likely is it that you have the problem-one chance in ten? In a hundred? In a thousand?

b.      Is it a routine procedure or your care-giver always uses? Why?

2        Then you want to know about the procedure itself. What is it, how is it done, and what does it cost?

3        What are the benefits and advantages of the test or procedure and how will the results influence your care-giver’s management? In other words, what will happen next if a test result is positive or a procedure or a treatment is done?

4        What are the risks and disadvantages of the test, procedure or treatment? How reliable or successful is it? Is it painful? What problems can it cause and how often?

5        What are the alternatives to the test, procedure, or treatment [including doing nothing]? The risks and benefits and the advantages and disadvantages or the alternatives should be discussed also.

When you have discussed these issues, then you can make an informed decision.

All this may seem very complex and time consuming. It occasionally is, especially if it is a major procedure or you have a serious condition. Usually, however, this kind of discussion is fairly straightforward and not to time consumed, especially when care-givers are in the habit of informing their patients or clients as they go along, discussing what they are doing and why.

Of course, there are situations when it is not possible to become fully informed. If a mother is in an emergency situation, or if she is unable to comprehend the facts due to medication or illness, then a family member is consulted for consent or the care-giver simply does the procedure because of the need for speed.

The concept of informed consent is based on the principle that you have not only the right but the responsibility to make decisions regarding your care. This is not to say that you have to make these decisions all by yourself. Besides asking your care-giver what he or she thinks ought to be done, consult family, friends, consumer groups, childbirth educators, or other care-givers for help.

By choosing your care-giver and the place where you will give birth, you will have made the two choices that will most greatly affect your birth experience. Besides those, however, there are others that also make a big difference. For example your choice of childbirth classes will influence your feelings of confidence and readiness as you approach the birth and early parenthood.

The idea of formal classes to prepare women and their partners for childbirth came to
North America in the early 1960’s when the work of Grantly Dick-Read, an English obstetrician, became publicized. Dick-Read was the real pioneer of natural childbirth techniques in the Western world. As a young man in the 1920’s and 1930’s, he presented a new approach to childbirth management. He used education, relaxation, slow abdominal breathing, and caring labor support to combat the three-way cycle of fear, tension and pain that fed on itself and escalated during labor to the point where the woman had to be heavily medicated. His belief that childbirth pain is unnatural and unnecessary guided him in the development of the Read method.

In
France in the 1940’s and 1059’s, Fernand Lamaze developed another quite different system of childbirth preparation, which was widely practiced in
France and later in
North America. Lamaze called his method psycho prophylaxis-literally “mental prevention”. He emphasized complex distraction methods and the dominant role of a professional “couch” to reduce a laboring woman’s pain.

Both the Read and the Lamaze methods thrived, although there has always been some competition and rivalry among proponents of the two different methods. They thrived because they appeared at a time in our history when many women were heavily drugged and unconscious through labor and delivery. These methods of “natural” childbirth appealed to women who wished to be more in control during labor.

Childbirth education has evolved over the years, with major modifications contributed by prominent childbirth educators and obstetricians. Among them is Robert Bradley, the American obstetrician who brought the father into the birth situation as a labor couch. Fathers had traditionally prohibited from attending births, but Dr. Bradley felt not only the father’s presence was his right, but also that his role as labor couch was an appropriate one for him to play helping his wife through the labor process.

Sheila Kitzinger, A well known British anthropologist and childbirth educator brought a woman’s perspective to childbirth preparation emphasizing body awareness. Innovative relaxation techniques and breathing patterns will harmonize the intensity of a woman’s contractions. Rather than distracting the woman from her labor pain, Ms. Kitzinger said that labor pain is nothing to fear; it is pain with a purpose. By accepting her pain and working with it, a woman can cope successfully and reap great psychological rewards from her active participation.

The popularity of natural childbirth led to the founding of several national and international organizations devoted to promoting family centered maternity care, parent participation in childbirth, and childbirth education classes. The International Childbirth Education Association, [C.F.A.] the American Society for Psycho prophylaxis in Obstetrics [A.S.P.O.], and theAmericanAcademy of Husband-Coached Childbirth [A.A.H.C.C.] were founded in the early 1960’s to give parents a greater voice in maternity care. A closely related issue, the promotion of breastfeeding, became the cause of La Leche League International [L.L.L.I.], also founded in the early 1960’s. These organizations and others contributed to effective change in maternity care in favor of more consumer involvement and choice.

In the 1070’s, Dr. Frederic Leboyer drew our attention to the newborn baby and what he or she goes through during the birth process. He promoted “birth without violence”, or gentle birth. He said that the baby should be helped to a gentle and calm transition from life in the uterus to life outside the mother’s body. He advocated a warm, quiet room with dim lights for the birth and a warm bath for the baby shortly after birth.

Also during the 1970’s, the term “bonding” was coined after it was discovered that when newborn babies stayed with their mothers for extended periods of time, the behavior of the mothers seemed to be more loving and maternal than that of mothers whose babies spent more time in the nursery. The work of Leboyer and others focused the attention of parents and caregivers on the early care of the newborn and early introduction between parents and newborns.

In the 1980’s, investigators with training in psychotherapy focused on the heeling potential [and, conversely, the attention for emotional trauma] of the profound experience of childbirth, and incorporated counseling and stress reduction measures into childbirth preparation. Some have urged more spontaneity and less emphasis on intellectual preparation and prescribed responses to labor contractions. Childbirth education continues to evolve as we learn more as people’s taste’s change and as maternity care changes.

Finding the right childbirth classes for you may require some comparison shopping. Some classes only teach one method [Lamaze or Bradley, for example].Others provide a broader, more individualized preparation, drawing from these methods and other innovations to provide a framework of relaxation techniques, patterned breathing, massage, visualization, music, sound, and other pain reduction methods, along with guidelines for adapting them to suit the individual. The goal of these classes is to enable women and their partners to discover their own style for labor.

Many communities have independent, consumer-based childbirth education groups that provide classes. Most hospitals and some groups of physicians or midwives also sponsor childbirth classes for their patients or clients.

When you become pregnant or suspect that you are your first decision will be what care-giver to go to [the word care-giver refers to a person-physician or midwife-who cares for pregnant and laboring women]. This decision is more important than most people realize. Care-givers may differ vastly in their philosophies and beliefs about pregnancy and birth and in their level of skill. This section provides a description of the specialists who provide maternity care and the type of care after. You will also find a list of questions to ask as a way to help you decide if a care-giver will be right for you.

Physicians

Medical doctors [those with a Doctor of Medicine or M.D. degree] provide most of the maternal care in
North America. All medical doctors have completed college and medical school; most have further residency training. Those who care for pregnant women specialize in perinatology, obstetrics and gynecology, or family medicine.

Obstetrician-gynecologists provide most of the maternity care in the
United States, while in
Canada it is the general practitioners and family physicians. In order to become a specialist in obstetrics, a physician has to pass a board certified examination administered by the

American
College of Obstetricians and Gynecologists or the Royal College of Obstetricians and Gynecologists in
Canada.

The most highly specialized obstetrician is the perinatologist. Beyond medical school and obstetrics residency, the perinatologist takes further training in the care of high-risk pregnant women, those who have underlying illnesses, such as diabetes, heart disease, and high blood pressure, and those who have complications during their pregnancies or who had complications with previous pregnancies. Perinatologists tend to practice in large cities. Most of their patients are referred to them with complications requiring not only their special expertise but also the facilities of a large hospital with all the latest technology.

Family physicians care for pregnant women as well as other family members, from infancy through old age. They tend to refer difficult maternity cases to obstetricians or perinatologists. While the family physician is the practitioner who provides most of the maternity care in
Canada, the number of family physicians in the
United States who provide maternity care is relatively small and seems to be decreasing.  People who choose family physicians for their maternity care appreciate the fact that the physician can take care of them throughout pregnancy and birth and then continue to care for the baby and family members.

Osteopathic physicians [those with a Doctor of Osteopathy or D. O. degree] also provide maternity care and care for the entire family. Osteopaths differ from medical doctors in training and practice and have about the same legal scope of practice.

Midwives

The other large category of care-giver is the midwife. In many countries of the world, midwives are the primary care-givers for pregnant and laboring women. In
North America their place is not as well established. All states have provisions for the legal practice of midwifery. In
Canada, most provinces have active midwifery promotion groups who have made significant efforts in establishing midwifery as a legal form of maternity care.

The emphasis of the midwife’s training is that birth is a normal physiologic event. They learn methods for supporting and promoting women’s physical and emotional health to optimize the reproductive process. The care they give consists of thorough physical assessment and prevention of complications through education in self-care, emotional support and nurturing of the woman throughout her pregnancy and labor. Midwives do not care for women with complications of pregnancy, underlying illnesses, or other high risk conditions. Should any of these problems arise; a midwife will refer the woman to an obstetrician.

Within the broad category of midwife, there are several subcategories. In the
United States certified nurse midwives are the most numerous. They are registered nurses who have taken additional one or two years of training in midwifery. Many receive master’s degrees when they complete their nurse-midwifery training. They usually practice in close cooperation with physicians in hospitals, birthing centers, and the home setting. Nurse-midwives are certified after passing an examination administered by the

American
College of Nurse-Midwives.

In some states other types of midwives are recognized and are licensed to provide maternity care. Licensed midwives practice in at least seven states. They receive training that is more compatible with that in midwifery training programs in
Europe. They are called direct-entry midwives and do not necessarily possess a background in nursing. They usually have received some college education followed by a two or three year program in midwifery training. At present most midwives practice outside the hospital providing care for home-births and birthing center births. Their orientation and pattern of care are similar to those of nurse-midwives.

In addition, lay midwives, sometimes called empirical midwives, practice in a number of states. Most of them have received informal training-apprenticeship to an experienced midwife, participation in short courses or study groups, or extensive independent study. Their qualifications, experience and standard of care vary; some practice within the law, and others practice without legal sanction. Lay midwives emphasize the spiritual aspects of birth, as well as the physiologic and psychosocial.

Above and beyond the physical benefits, there are many emotional and social benefits to be gained from joining an exercise program, especially for pregnant women and new mothers. Pregnancy fitness classes build a marvelous sense of camaraderie and support. They help you keep your sense of humor about your rapidly changing body and bolster your commitment to exercise because pf the structure and community spirit.

In evaluating a pregnancy fitness program, use the following checklist questions:

1. Do the women consult their physician before enrolling in the exercise class? Do they have to present their physician’s consent in writing before participating in the first class?
2. Are they told that if they have any bleeding, cramping and other symptoms, they should stop the exercise or activity and consult their physician immediately?
3. Do the exercise classes start with a warm-up period consisting of mild to moderate stretching and light exercise?
4. Do the exercise classes’ end with a cool down period consisting of less strenuous exercises and stretching or relaxation exercises?
5. Do the exercises stress correct posture and body alignment?
6. Do the exercises avoid severe stretching? [ligaments in pregnancy loosen and joints are less stable]
7. Are participants encouraged to breathe deeply and not hold their breath during the floor exercise?
8. Do the exercises include calf- stretches to help prevent and help treat leg cramps?
9. Are pelvic floor [Kegel] exercises incorporated into the class exercise/
10. Are abdominal strengthening exercises included? [they should not be strenuous] are the women told to protect their lower backs during these exercises by doing a pelvic lift and by using slow, controlled moves? Is there prolonged exercising while lying on the back? [Such a movement should be maintained for one minute at the maximum, by the clock, and then the position should be changed].
11. Do the classes include aerobic or cardiovascular exercises [twenty minutes at the maximum] along with muscle strengthening and stretching? [If not, the class is incomplete].
12. Is the exercise program pulse monitored? If not, why not?
13. Are the women taught correct body mechanics and energy saving techniques [for example, for lifting, walking, standing, sitting, cleaning and getting out of bed]?
14. Are any exercises done with the women on their hands and knees? [This is an excellent position to relieve back pressure and to increase circulation to both mother and fetus. Abdominal and hip exercises can be done in this position. The abdomen should be kept tight-don’t let the baby hang down.].
15. Are exercises included to strengthen the pectoral muscles? [This is important to lend support to the breasts, and to aid in lifting the baby later.]
16. Does the class include exercises to stretch inner thigh muscles and to limber up the hip joints [which will allow a woman to be more comfortable in the lithotomic position - on the back with the feet up and knees spread wide apart-if it is used during delivery.]?
17. Are shoulder stretches or relaxation exercises taught? Did the instructor complete a training program to qualify her to teach exercises? Where? How long was it?
18. How long has she been teaching pregnancy fitness classes?
19. Who designed the exercise program? Who is responsible for safety?
20. What is the cost of the exercise program? How many classes are included in a series?

Just what are the risks of giving birth outside the hospital? There are two classifications of risk: true obstetric emergencies, and other conditions that might require a less critical transfer to the hospital for assistance with the birth.

Even though true emergency conditions are uncommon, they are factors that must be considered by anyone who is contemplating an out-of hospital birth. It should also be remembered that even in a normal pregnancy and labor, unexpected situations could arise after delivery. For example, respiratory distress or cardiovascular problems of the newborn infant are true emergencies that can best be dealt with in a hospital setting.

Non-Emergencies Requiring Transfer to the Hospital

Women are also transferred to the hospital for conditions that are non-emergent in nature. Sometimes, if a complication [such as anemia, high blood pressure, diabetes, twin pregnancy, or breech presentation] is discovered during pregnancy, the woman is no longer a candidate for out-of hospital birth. If labor is prolonged, or if it looks as though the mother pain medication, forceps assistance, or other intervention, she is transferred to the hospital. Under these circumstances, the transfer is not an emergency, and there is usually time to try various solutions and, if necessary, decide whether and when to go to the hospital. While it is never pleasant to give up plans for an out-of-hospital birth, and transfer is uncomfortable and worrisome for the parents, it is not usually associated with danger to either mother or baby. Of women who choose out-of –hospital birth, approximately fifteen to twenty-five percent of first time mothers and five to fifteen percent of second time mothers are transferred to the hospital during labor or after delivery. The possibility should be considered when parents are deciding on the merits of out-of-hospital birth.

When inquiring about out-of-hospital birth services, find out what drugs and technology they use in their birth practices such as pain medications, intravenous fluids, oxygen, and fetal monitoring. Ask what emergency equipment they have with them for all births. You will want to know about the backup hospital and the backup or consultant physicians. You should know about transfer arrangements. For example, is an ambulance available? Or are the automobiles of the staff and clients the usual transportation in case of transfer? How far away is the backup hospital?

Advantages of Out-of-Hospital Births

The advantages of out-of-hospital births are that parents may have more control over their birthing experience. There are few routines that must be followed. Parents have the freedom to move around, visit with friends, or go outside the home, and do household activities and other things during labor as much as they like. In addition, few interventions are used. Contact with the baby after birth is unlimited and in accordance with the parent’s wishes.

Women who choose birthing centers often find a sense of community and fellowship. Classes and social gatherings are often held at the birthing center, contributing to a sense of security and friendliness. Women who choose home births tend to find great appeal in the familiarity of their own surroundings.

The costs associated with home births are by far the lowest of the tree environments, birthing centers cost less than hospitals. For those parents where finances are an important issue need to look into the actual costs involved in all three options.

Many uninsured people with low incomes find home births the only affordable option. But if a planned home birth winds up as a transfer to the hospital, it may turn out to be more expensive than a planned hospital birth.

Some health insurance policies do not cover home birth or birthing center care, even though it is much less expensive. If you have insurance, make sure to investigate ahead of time the possibility of being reimbursed for those expenses.

Disadvantages ofOut-of
Hospital BirthThe major disadvantages of out-of-hospital birth are primarily related to the lack of available appropriate medical care should emergencies occur. Such situations can arise quickly, for example, hemorrhage, seizures, mucous aspiration, or any severe fetal or maternal complication that might place either baby or mother in jeopardy. The value of proximity to the full range of modern medical care should not be underestimated.

You can begin the search for classes by asking your care-giver, your friend with babies, or the hospital’s maternity department for suggestions. Then call and ask the providers of childbirth education to describe their classes. Find out who the teachers are. Is it possible to interview the teacher before registering in a class? You can learn a lot in a brief phone conversation. Is the teacher an independent certified childbirth educator who sub-contracts her services? Or is she an employee of a hospital or group? Does she belong to one of the local and national organizations of childbirth educators?

Ask about the teacher’s qualifications. Some sponsors require a medical background, such as nursing or physical therapy. Others require a college degree, sometimes in a related field, such as psychology, social work, education, or biology. Some have no specific educational requirements. Many sponsors require that their teachers have a child. In addition to background requirements, most teachers have received training in childbirth education. Training may be minimal [for example, the teacher may be required only to observe a series of classes] or it may be rigorous. Certification by one of the national or international childbirth education organizations may be required. Some community childbirth education organizations provide their own training and require their own certification. The certification process may include classroom sessions or workshops, written work, examinations, observation of childbirth classes, attendance at births, and teaching under supervision.

Find out the number of classes in a series. They range from about four weekly classes to as many as twelve. Classes may last from one and a half to two and a half hours. What topics are covered? [Possible topics include self-care in pregnancy, preparation for normal and complicated childbirth, caesarean birth, newborn care, breastfeeding and bottle-feeding, and the beginnings of parenthood]. You should know how much time is spent on learning and practicing techniques for coping with labor, such as relaxation, breathing patterns, massage techniques, and methods of visualization and focus.

How large are the classes? Classes may range in size from private sessions for one or two couples to very large classes for forty or fifty couples. A small, intimate class may be important to you, or you may prefer a more diverse larger group. If the group is large does the teacher have one or more assistants to provide more personal contact with the students? Is there room for everyone on the floor? Is personal contact by phone or private consultation available if you wish it?

Will there be a reunion of the group after the babies have been born? If so, it indicates the teacher is aware of the importance of the group support. It also shows the teacher has an interest in following up on her students.

Specialized Classes

In many communities specialized classes are offered-for example, early pregnancy classes, home-birth classes, refresher classes [a shortened series for those who have had childbirth classes during a previous pregnancy], cesarean preparation classes, classes for single mothers, lesbians, parents with a language barrier, parents with impaired hearing or vision, and teen parents, classes for women planning on giving up their babies for adoption, classes on vaginal birth after a previous cesarean, sibling preparation classes for other children in the family, grandparent classes, adoptive parent classes, and breastfeeding classes. Postpartum classes for parents with their infants are also offered in many communities.

Professional and Other Labor Support

Professional staffs provide one kind of support during labor; their expertise and perspectives give a woman confidence that she may not otherwise feel. But professionals are also busy with other responsibilities, such as recording information  in the chart, listening to fetal heart tones, taking blood pressure, doing vaginal exams, placing electronic fetal monitors and intravenous tubes, preparing for delivery, and even caring for other women at the same time. Nurses may not be able to supply much emotional support because of the other demands on them. Today many women are also supported through labor by one or more loved ones. In addition to a nurse or midwife. These support people, if prepared, can do things the nurse does not do-foe example, give the woman continuous, loving encouragement, help with creature comforts, like rubbing her back, mopping her brow, and bringing her water and juice, and will help with relaxation and with techniques for coping with labor.

Pregnancy will be an experience full of growth, change enrichment, and challenge. It is a time when you as a couple will confront your fears and expectations about becoming parents and will begin to determine your own parenting style.

Although there are certain similarities in all pregnancies, each pregnancy is special. Shifts in your body image, changes in your hormones and your attitude towards cultural pressures and expectations will all combine to make your pregnancy unique.

Each of the physical landmarks of a pregnancy is accompanied by specific physiological issues that will affect your perception of that particular part of your pregnancy. For example, if your pregnancy was planned and wished for, you and your partner will respond with joy and anticipation to the news that you have conceived. If the pregnancy was unexpected, you will initially have mixed feelings about it.

Interactions between your body and your mind will occur throughout your pregnancy. For example, a high level of stress in your life or negative feelings about being pregnant may contribute to some of the nausea that occurs in the first trimester [Three months]. Conversely, the nausea and vomiting may make you feel less than enthusiastic about your pregnancy. The important thing to remember is that because of this interaction between mind and body during pregnancy, trying to maintain a positive outlook may actually alleviate some physical ills.

Dreams during Pregnancy

During pregnancy you may find that you are much more vulnerable to certain fears and concerns. For example, pregnant women are often more anxious about the possibility of bodily harm. Things ordinarily taken for granted, such as riding in a car, or engaging in sports, may provoke some anxiety. These anxieties may surface in your dreams. Dreams may be realistic representations of your fears, or they may take the form of surrealistic nightmares. Dreaming about your worries is normal and may help you to deal with them during the day. Be reassured that dreams do not represent life as it is-or as it will be once the baby is born.

There is a progression in changing themes in dreams that may occur throughout your pregnancy. Dreams about pregnancy and babies often begin in the first trimester. Uncertainties about your role as a mother may surface in dreams about not being able to care properly for your baby. Such dreams are normal.

Pregnant women often dream about being trapped, and in many ways this is a direct representation of fears and concerns about the future. Especially if you have worked outside the home, you may be frightened about what having a baby will do to your ability to continue your outside interests.

Many mothers-to-be dream about having a child of one sex or the other. These dreams may reflect your preference for a child of a particular sex, as well as your concerns about your own sexual identity.

Another common theme in dreams is looking foe a child or having lost a child. These dreams usually occur during the end of the pregnancy when you begin to anticipate the delivery of your child. In reality a loss is about to occur; the loss of the fetus who will become your baby.

Assault is another theme that may occur in your dreams about pregnancy, reflecting your worries that if you were to be assaulted or injured, the consequences may be harmful to your baby, as well as to yourself. Also as the pregnancy continues and your body enlarges, you may worry that you will not be able to react quickly in a dangerous situation.

Perhaps the most relevant anxiety about assault that a pregnant woman has to deal with is the loss of control over her body. Clearly, you are not in control of your body’s changes during pregnancy. Especially for a first time mother. These assault dreams may reflect your fears about what your labor and delivery will be like. Then, too, the assault dreams may reflect your feelings about the “stranger” that is within your body.

Remember that having these frightening dreams is normal and should not worry you. In fact, because of the love you feel for the baby inside you, your concerns about his or her fragility, as reflected in your dreams, are not at all unusual.

As a father-to-be, you may also undergo a psychological process during a pregnancy. Although there is no physiologic basis for this, it is nevertheless very real and to some degree, predictable. A father-to-be, particularly in the third trimester, may feel a need for a creative outlet. You may want to paint or decorate the nursery, make a cradle, or begin a garden as a way of becoming involved in the forthcoming birth.

Men, as well as women, bring to a pregnancy their own emotional “baggage” as well as the echoes of their childhood fantasies about the mechanics and significance of pregnancy, birth and parenthood. How the father-to-be perceived his own parents can directly affect his feelings about becoming a parent himself. For some men, being able to father a child may also create a heightened self-esteem regarding their masculinity. Conversely if there were previous losses or a history of infertility, the father-to-be may see the creation of life as a fragile phenomenon.

Impending fatherhood also seems to bring with it all the memories and emotions of a man’s relationship with his father. In some ways becoming a father means giving up the idea of being a son. It also means reconciling the experience that one had as a child with being a father. It seems that these feelings are stronger during the pregnancy than the months following the birth of the child.

During most men’s childhoods there was little emphasis on learning fathering functions, except perhaps the provider role. Television and cartoons from the 1950’s and early 1960’s portrayed fathers as helpless and inadequate in handling a young child. Women were seen as having the primary duty of raising their children.

For fathers-to-be there is no internal reality-no physical changes to feel. You must rely on your partner’s reports about her feelings in experiencing the pregnancy. Perhaps not until fetal movements are obvious will you perceive the fetus as a growing child, and often this does not occur until the seventh month of gestation. Participating in prenatal visits may be a way to allow greater awareness of the reality of pregnancy. If an ultrasound study is indicated, viewing the ultrasound scans can be an invaluable experience because on the screen you will have visual conformation of the existence of your baby.

Pregnancy can elicit feelings even in a man who has had previous children. It provides an opportunity to think about the kind of father he has already been to the children that he has, as well as the increasing responsibility he will be facing. If the father-to-be is proud of his prior fathering experience, and if the new child is wanted, he may feel extremely happy about the new pregnancy.

It is still rare for men to admit openly that they have concerns, fears, and perhaps ambivalent feelings about their partners’ pregnancies, yet, those feelings are nearly universal. Studies indicate that more than one out of ten men will have psychogenic [having an emotional or psychological origin] physical symptoms in relation to a pregnancy. These symptoms tend to appear by the beginning of the second trimester of pregnancy. There may also be increased feelings of anxiety and depression.

The relationship between you and your partner may also undergo profound changes from your perspective. Previously, you may have had a sense of predictability in your partner’s reactions, but her reactions may change significantly during the pregnancy. You may also have significant feelings about the changes in her body proportions, as well as her shifting sexuality. While you are wrestling with the feelings of added responsibilities of fatherhood, you may have to simultaneously “mother” your wife. This is particularly true in our culture, where the extended family is often not ready to provide support.

The father-to-be’s task during the first trimester include both acceptance of the pregnancy and provision of some emotional support for his wife. Many men are ecstatic about being perspective fathers, but some may be frightened by this as well. The mother-to-be has a role of shaping her partner’s attitude and initial reaction, but mutual support, open lines of communication, and reassurance are the responsibilities of both partners.

By the end of the first trimester the obligations of becoming a father may weigh on you. You may reevaluate your job, salary and savings. It is important for you and your partner to begin talking to each other about your fantasies, anxieties, and expectations at this time.

During the second trimester, you will be able to feel the baby moving. Concerns about sexual activity any begin during this time, and obtaining reassurance from the doctor can be very important. On the other hand, a man may not be sexually attracted to a woman’s body that seems to be so different from the woman he married. It is critical that you and your partner talk about your sex life, if you are having problems adjusting to the pregnancy.

During the third trimester, many couples experience a renewal of their relationship in a romantic bond that may have been missing during the previous few months. However, the woman’s increasing size may present an obstacle for comfortable sexual activity. A physician or childbirth educator may be able to offer some suggestions for coping with this temporary problem.

If you participate in a prepared childbirth class, you may have some heightened concerns about your ability to coach during labor. Again, talking with men who have previously had this experience can be valuable. Often, childbirth education classes provide this opportunity.

Just as it was assumed in the 1950’s that no father could adequately participate in the labor and delivery experience. It is now assumed that most fathers should. If you, however, feel that you will not be able to participate in the labor and delivery, this should be discussed and resolved prior to the event. Further, you should not feel that your decision is in any way wrong.