Parenting & New Baby Advice Blog

Archive for the ‘Pregnancy’ Category

While your friends and family members are eagerly brainstorming baby gift ideas, your body is going to be busy making some drastic changes! 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 discernible. 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 smooths 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 and browsing baby clothes.

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.

Continue eating a good quality diet just as you did during pregnancy.  If you are not breastfeeding, your nutrient and calorie needs will be the same as they were before you became pregnant.  If you are breastfeeding, or if you’re anemic or recovering from a cesarean delivery, special nutritional management is most certainly in order.

Take a creative approach to nutrition, choosing foods that take little or no preparation.  Fresh organic fruit, raw vegetables, melted cheese on toast, cottage cheese for breakfast, and yogurt with sunflower seeds or granola are quick and nutritious.  Broiled meats and fish are faster to prepare than casseroles and can be prepared whenever you have time to eat.

Let friends and family help you by providing nutritious meals during the early months after childbirth.  Meals that can be frozen are especially helpful since you can pull them out of the freezer for use on those occasional difficult days. And of course fresh fruit gift baskets don't hurt either.

Nurture yourself by taking time to sit and eat your meals.  Eating on the run or standing to eat makes you feel you have not had a meal; this habit contributes to fatigue.  Place your baby in a swing or infant seat so that your hands are free.  If your baby needs to be close to you, an infant backpack or sling is helpful.  Or you may wait to eat until your baby’s quiet time or when she is asleep.

Constipation is a common and unpleasant postpartum complaint.  You can relieve constipation by:

• Getting some form of daily exercise, such as walking.
• Making sure you have adequate dietary fiber.  Bran muffins, high fiber cereals, and lots of fruits and vegetables will help.
• Drinking prune juice on an empty stomach followed by several cups of hot water, tea, or other hot beverage. [This works wonders for many mothers]
• Drinking to quench your thirst, which ensures that you are getting the fluids you need.  Two or thee quarts of fluids a day is generally recommended.

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 days. Most people believed 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 to their little infant gifts. 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. So put the itty bitty adorable baby clothes aside, and take a second to consider taking a childbirth class.

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 the American Academy 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.