Parenting & New Baby Advice Blog

Archive for the ‘Pregnancy’ Category

The change from a microscopic cell to a seven pound baby requires substantial alterations in the body of the mother carrying the baby as well. However, while the baby changes most rapidly in the first few weeks, the mother undergoes her most dramatic changes in the later stages of pregnancy. In the first six weeks, the mother's physical changes are due primarily to alterations in hormone levels. These changes are subtle, and she may not even realize she is pregnant. She may have few symptoms or may easily attribute them to other causes. After this time, the mother's physical changes are partly dependent on the growth of the baby and become more noticeable as the baby gets larger and larger. Although the most obvious changes occur in the uterus and abdomen, almost all of the organs in her body are altered.

When a woman becomes pregnant, her uterus is the part of her body that is affected first and that undergoes the most significant changes. It increases to five or six times its original size, twenty times its original weight, and one thousand times its initial capacity. The amount of muscle, connective and elastic tissue, blood vessels, and nerves increases.

The shape changes from elongated to oval by the second month, to round by mid-gestation, then back through oval to elongate at term. The uterus softens beginning at the sixth week. It changes position as it increases in size, ascending into the abdomen by the fourth month and eventually reaching to the liver. It also becomes more contractile, with irregular, painless, Braxton-Hicks contractions beginning in the first trimester. These contractions may be felt in the last weeks of pregnancy, when they are known as false labor.

Other parts of the reproductive system change along with the uterus, the cervix and vagina have increased blood supply, which causes a darkening in color. This is apparent by the sixth week. The amount of the elastic tissue increases to prepare the way for the stretching that will be required during delivery. Secretions increase, and a mucous plug develops in the cervix. The fallopian tubes, ovaries, and ligaments supporting the uterus all enlarge and elongate. The ovaries, of course, cease to ovulate.

During the fourth month, the uterus will grow into the abdomen, causing the abdominal wall to expand to accommodate it. The connective and elastic tissues are stretched and straitened, creating thin areas called striae [stretch marks]. Unfortunately, while the color of the striae may fade, scars remain after delivery. In fifty percent of women, striae will develop in the third trimester. Late in pregnancy, the internal pressure from the large uterus may even cause the muscles of the abdominal wall to separate.

A woman's breasts must undergo many changes during pregnancy to be able to produce milk. In the first two months, the breasts may feel sore or full. They will increase in size, and veins may become visible on the surface. Striae can develop. The nipples also increase in size and usually darken in color. By mid-pregnancy, colostrums [a thick, yellowish fluid] can be expressed, but milk is not produced until after delivery.

Since the baby is being fed by the mother's blood supply and the mother's enlarging reproductive organs require more blood flow, the amount of blood must also increase. During pregnancy, blood volume expands by twenty-five to forty percent, but the number of red blood cells [the oxygen carrying component of blood] increases to a lesser extent. Therefore pregnant women are generally anemic-that is, their blood's oxygen-carrying ability is somewhat decreased.

To pump an increased amount of blood through the body, the heart must work slightly harder, the heart pumps more blood per beat and beats slightly faster. Heart murmurs attributed to the flow through the heart may develop.

The blood vessels are also affected by pregnancy. The enlarging uterus pressing on veins in the pelvis, increasing the pressure in the veins from the legs. The increased pressure causes the leg veins to enlarge producing varicosities [areas of enlargement]. It may also cause fluid to leak out of the veins and into the tissues, causing swelling of the feet and ankles. Late in pregnancy, the uterus can also compress a major vein, the vena cava, in some women when they lie on their backs; if this occurs, blood is prevented from returning to the heart and a feeling of faintness results.

The enlarging uterus not only pushes forward on the abdominal wall and down on the pelvic veins, but it also pushes up on the bottom of the rib cage and on the diaphragm [the muscle that stretches across the bottom of the chest cavity and assists in breathing]. The rib cage widens, and most women breathe slightly faster. Some feel short of breath.

Urination and digestion are also affected during pregnancy. The urinary tract is changed both by pressure from the uterus and by hormonal influences. The uterus presses against the bladder, which may cause a pregnant woman to urinate more frequently. Hormones cause the ureters [the tubes conducting urine from the kidneys to the bladder] to distend and the flow of urine in them to slow. The sluggish urine flow predisposes a pregnant woman to infection. Hormones, along with the increased blood volume, also causes the kidneys to filter more blood, however, the kidneys may not reabsorb sugar and protein efficiently because of this increased workload, and these substances may spill into the urine. Since the presence of sugar in the urine can also be caused by diabetes and the presence of protein can be caused by infection, most doctors screen the urine frequently during pregnancy and may do other tests if any abnormality is found.

The changes in digestion during pregnancy are well known and frequently kidded about. A pregnant woman craving for pickles and ice-cream has been the premise of many a joke. Women may have unusual cravings, and may also notice changes in the senses of smell and taste, which may cause them to alter eating habits. During pregnancy women often produce more saliva and the saliva will be more acidic, which promotes tooth decay. The gums are more sensitive and may bleed easily. In the first trimester, a woman may have morning sickness characterized by vomiting and a poor appetite. She may also be constipated. One of the pregnancy hormones causes the muscles of the digestive tract to relax, and they therefore pass digesting food more slowly through the intestines. In addition, the uterus can press on the colon, inhibiting passage of feces. Similar mechanisms produce heartburn. The muscles at the junction of the esophagus and the stomach relax and the uterus presses on the stomach from below, causing the stomach contents to flow back into the esophagus. In late pregnancy, the stomach may even be pushed up into the chest, producing a hiatal hernia.

A number of changes are necessary in the structures supporting the uterus to stabilize it as it grows. The ligaments in the pelvis and abdomen stretch to accommodate the uterus, in late pregnancy the upper part of the spine bends backward to compensate for the enlarging abdomen. Hormones loosen the joints of the pelvis in preparation for childbirth.

Hormonal influences are also responsible for changes in the skin. Pigmentation of the nipples, vulva [the external genital organs], the center of the lower part of the abdomen, and the umbilicus increases. Darkening across the face may appear; this is known as chloasma, or the mask of pregnancy. Hormones can also cause reddening of the palms and the appearance of small red spots on the skin; these are nests of blood vessels, which are known as spider nevi or telangiectasias. Sweat and all glands also become more productive.

One of the most important changes during pregnancy is the increase in metabolism, which is necessary to provide nourishment to the fetus .A woman must eat more in order to supply adequate protein, carbohydrates, and fat to the fetus and her own enlarging body. Most women gain about twenty-five pounds, three pounds in the first trimester, and ten to twelve pounds in each of the second and third trimesters. The placenta, fetus and amniotic fluid and the increased volume of blood and breast and urine tissue account for twenty pounds of that weight gain. The rest of the weight is fat and extra fluid. A pregnant woman must also take in more vitamins and minerals for the growing of the fetus. Calcium, which is needed for developing bones, and iron, which is used to make new blood cells, generally needs to be ingested in greater amounts from the fourth month of pregnancy on.

The physical changes during pregnancy are miraculous. Amazingly, though, the physical alterations in the mother reverse after birth, and her body returns to its normal state. For the new baby, however, the process of change that started nine months before has just begun.

Cigarettes

Cigarette smoking poses a serious threat to the well being of your developing baby. Mothers that smoke have smaller babies than mothers who do not smoke. Smoking is also associated with a greater incidence of miscarriage, prematurity, stillbirth, and death of the baby soon after birth. According to congressional testimony of members of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, nearly fourteen thousand prenatal deaths per year are attributable to smoking by pregnant women. Further smoking by mothers has been shown to be associated with impaired intellectual and physical in their children.

Still, if you have always smoked it may be difficult to stop during pregnancy. If you cannot stop entirely, just cutting down is helpful since the harmful effects of smoking are close related.

The following tips may help you cut down or quit smoking.

1. Cut down on the number of cigarettes you smoke each day. Try to continue to reduce the number of cigarettes a little more each week.
2. Cut each cigarette in half and smoke only the half with the filter.
3. Choose a brand that is lowest in tar and nicotine.
4. Take fewer puffs on each cigarette you smoke.
5. Use a water filter, which can be purchased at the drugstore.
6. Consider entering a program designed to help you quit. The American Lung Association can help you find one.

If you cut down on your smoking or quit altogether during your pregnancy, try not to resume the habit after having your new baby. Children of smokers have been shown to have a greater susceptibility to respiratory diseases.

Marijuana

Marijuana use has been associated with pulmonary cancer. It has been shown to have negative effects on memory and can cause menstrual irregularities.

Studies in animals have shown that the active ingredient in marijuana crosses the placenta and accumulates in the fetus. Effects on the offspring include intrauterine growth retardation, low birth weight, and changes in secondary sex characteristics. In humans, precipitate labor [which ends with rapid expulsion of the fetus]; prolonged labor, low birth weight, prematurity and a greater risk of fetal distress have been associated with marijuana use.

Cocaine

Cocaine has profound effects on the mother and her fetus. It causes an increase in maternal heart rate,; constriction of the blood vessels of the placenta, allowing less blood to reach the fetus; increased secretion of stress hormones, which cause constriction of uterine blood vessels and increased uterine contractility.

It has been difficult for researchers to isolate the effects of cocaine since so many users take others as well. However, cocaine use is also thought to be related to a high incidence of spontaneous abortion and to placenta abruption. Infants whose mothers use cocaine have a difficult time adjusting to environmental stimuli after birth and may be addicted to the drug.

Alcohol

Heavy drinking during pregnancy [more than five or six drinks daily] puts the baby at risk for fetal alcohol syndrome. Affected babies are born with physical malformations, including microcephaly [abnormally small head], certain heart defects and often subsequent mental retardation.

Even moderate [one or two drinks per day] and social [three or four drinks per day] drinking have been associated with problems. Some research points to a higher miscarriage rate among women who drink moderately. Other studies associate this level of drinking with a more frequent occurrence of birth defects and lower birth weights.

No safe level of alcohol has been established yet. As a result it is probably best to take a cautious approach to alcohol consumption by abstaining or drinking very little and very infrequently. Probably the best way to handle social situations is to choose a non-alcoholic substitute, such as tomato juice, sparkling water, or fruit juice.

Other Medications and Drugs

Pregnancy is a time for prudent use of drugs. Since no drug has been proved safe for the unborn child, and some of the drugs have been proved unsafe, you will want to be cautious about the medications you take. Drugs and medication include any of the over the counter remedies you may buy as well as prescriptions authorized by your doctor. Your doctor can help you to decide when medications are indicated for you during pregnancy.

Your pregnancy involves very many people besides yourself and your new baby. Your family, of course, is affected. You may have a Lamaze teacher and an exercise instructor. And you will certainly have a doctor; your obstetrician is a partner in your pregnancy. He or she will have the responsibility for you and your baby's health, so you want to be sure the doctor is qualified and competent. In addition, he or she will intimately participate in a very special event in your life-you want someone with whom you can cooperate and feel comfortable.

Finding the right obstetrician may take some work. You may need to talk to people and visit a few doctors before you are satisfied. You can get recommendations from many different sources. Friends and relatives may suggest their obstetricians. Another doctor, such as your internist, may provide a name. Maternity nurses, or obstetrical residents [doctors in training], at your local hospital often know which obstetricians in the community are good. You can ask the department of obstetrics and gynecology at the nearest university hospital for the names of graduates, or faculty members who work n your area. If these avenues fail, try contacting a childbirth education group, such as the International Childbirth Educational Association, or a local Lamaze instructor.

When you have the name of an obstetrician who sounds promising, your next step is to find more information about her. To be sure she is a competent doctor, check out her training. An obstetrician should have completed an obstetrics residency at a registered hospital and should be certified by the American Board of Obstetrics and Gynecology.

Next, find out which hospital she is affiliated with the hospital should be accredited by the Joint Commission on Accreditation of Hospitals [JCAH]. Find out whether the hospital is a teaching institution. If it is, be sure you understand how residents will participate in your delivery. The hospital should be covenant for you, and it should have the facilities you want or need for your delivery. Some hospitals have only the traditional separate labor and delivery rooms. Others have elaborate birthing centers. If you are at risk for having problems during pregnancy or delivery, the hospital should have an infant intensive care nursery.

Find out about the people the doctor works with. If she works with a group of doctors, they probably take turns being on call at night, if you go into labor on a night your doctor is not on call, will she come in or will one of her partners perform the delivery? If one of her partners may deliver your baby, you will have to be sure that you are comfortable with the other members of the group and that they have the same attitudes towards childbirth as your doctor. Otherwise, the delivery you so carefully planned may be changed at the last minute. Some obstetricians employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement.

Finally, don't be afraid to ask about finances. Be sure your insurance will cover the doctor's charges and find out how and when payment is expected. Find out what happens to the charges if there are any complications.

When you have collected your information, you are ready for your first meeting with the doctor. It is a good idea for Dad to accompany you so he can ask questions and form an opinion of the doctor as well. If you haven't been seeing an internist or gynecologist regularly, it is a good idea to choose an obstetrician before you conceive; arrange a pre-pregnancy appointment to make sure there are no medical conditions that make pregnancy inadvisable at the time. If you have been receiving regular medical care, your first appointment should occur as soon as you think that you are pregnant, usually two weeks after the missed period. During the first visit the doctor will take a complete medical history including discussion of past and present illnesses and past pregnancies. A complete physical exam, not only a pelvic exam, should be done. You should have an opportunity to discuss with the doctor issues about your pregnancy and delivery. Be prepared for this part of your visit. Make a list of questions you want to ask. The obstetrician should be willing to answer any questions and discuss the type of care you will receive. She should be flexible about issues that are important to you, but if she feels that something you want will compromise your care, she should be willing to explain to you why.

You will want to talk about pregnancy and delivery. Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby's development. Discuss with the doctor what you should eat. How many more calories will you need? How does she feel about you drinking coffee or other caffeinated beverages? What about alcohol consumption? She will probably recommend vitamins and calcium supplements. Discuss with her how much exercise you should get. Would she recommend an aerobics class? Find out what you should do if you become ill. What medicines can you take and what should you avoid? An obstetrician can monitor a pregnancy with blood tests, urine tests, ultrasound studies and amniocentesis. What does she think is appropriate for you?

There are many decisions regarding delivery that should be made beforehand. You need to decide where you want to give birth-in a regular delivery room or in a birthing center. If you want your husband or other children there, be sure your doctor agrees. If you have strong opinions about the medical treatment during labor and delivery, be sure to discuss them with your doctor. For example, some women do not want an intravenous line, anesthesia or an episiotomy [a surgical incision to enlarge the external opening to the birth canal and make delivery easier]. Fetal monitoring is another topic you wish to inquire about. You may want to find out your doctor's opinions about inducing labor and cesareans. Ask her how many cesareans she performs. If her rate is high, try to find out why. Does she have a high risk population or is she just quick to operate?

By the time you are finished discussing all of these topics, you should have a good idea how well you like the obstetrician. Do you feel at ease with her? While you may not agree on very subject, you should feel confident that you can develop a working relationship and that you can discuss a problem and reach a compromise that will be satisfactory for both of you.

Finding an obstetrician may be easy, or it may require an extensive search. Because the doctor plays such an important role in your life at this time, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and baby delivery will be as safe and as joyful as possible.

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.