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Pregnancy / Childbirth

Introduction

As every mom will tell you, there is nothing quite like finding out you’re pregnant. This long anticipated time, from your first knowledge of pregnancy, through the first few months of your baby’s life, is supposed to be magical-filled with relief, joy, and, of course, overwhelming love.

But for many pregnant women and new mothers, the word that best describes this time is "overwhelming." Between all the hormonal changes, sleep deprivation, and the hard work of simply figuring out how to take care of your baby, many women start to feel like they’re in over their heads.

Pregnancy and Your Body

 

There is no greater wonder than pregnancy. The miracle of the union of the egg and sperm still eludes scientists in many ways and the changes in a woman’s body, both before and after birth, are astounding. Although nine months may seem like a long time, it is really quite short when you consider all the changes that occur. Equally remarkable is that after a pregnancy and breastfeeding, the mother’s body can return to something close to its pre-pregnancy state.

Knowing as much as possible about these changes will help you to understand what you are feeling and noticing about your body throughout the pregnancy and after delivery. When you know what to expect, and understand what is normal and what may be abnormal, you will no doubt be more relaxed. If you ever have a question, never hesitate to consult with your physician. Even if it is only reassurance that you are given, it is important to know that you and your baby are healthy.

Menstrual Function

The first change that signals a pregnancy is the cessation of menstruation. During a monthly ovulatory cycle, hormones fluctuate on a cycle. But when you’re pregnant, estrogen and progesterone are produced constantly, which prevents the shedding of the uterine lining. Approximately one percent of women have some abnormal bleeding early in pregnancy and a woman can mistake this for a period. In approximately half of these cases, the bleeding will eventually abate and the pregnancy will proceed normally.

However, bleeding in the first trimester may also be a sign of an abnormal pregnancy, such as an ectopic pregnancy or an incipient miscarriage. Later on in the pregnancy, bleeding may indicate a problem with the placenta or premature labor. If you experience any bleeding, you should notify your obstetrician.

Uterine changes

The non-pregnant uterus is a small, pear-shaped organ, slightly larger than the size of a fist. During pregnancy, it is transformed from a firm, muscular organ that weighs about 70 grams (one tenth of a pound) to a large, thin-walled structure that weighs approximately 1100 grams (two pounds) without the baby, placenta, and amniotic fluid.

The increase in size starts very early in pregnancy. By the 12th week (when a woman is entering the fourth month), the uterus rises up and out of the pelvis and can now be felt if one presses in the middle of her lower abdomen.

Since it is a muscular organ, the uterus will intermittently and irregularly contract throughout pregnancy. Many women can perceive a dull ache, pressure, or a pulling sensation from very early in the pregnancy. Early on, these are usually unnoticeable; however, some women are aware of these painless contractions throughout the entire pregnancy. During the final months, it is entirely normal to feel occasional contractions. In the final weeks, these contractions may become more regular and are commonly referred to as "false labor" or Braxton-Hicks contractions. As a woman approaches true labor, the pattern becomes more regular, frequent, forceful, and painful.

The hormonal changes that pregnancy causes result in a number of secretions from both the cervix and vagina. As a result, some women notice an increase in a white, thick discharge. This is perfectly normal.

However, you should consult your obstetrician if this discharge has either a yellow or tan coloration, a foul odor, is blood-tinged, or causes discomfort or itching. Also remember that a watery discharge may indicate a small leak of amniotic fluid. If you ever suspect that you have ruptured your membranes ("broken your bag of water"), you must report this to your obstetrician.

Breast changes

The breasts start to change very early on in pregnancy. Some women even say that feelings of heaviness, tenderness, and tingling allow them to suspect a pregnancy even before they have missed a period. Due to increased blood flow, the breasts enlarge dramatically during the first eight weeks of pregnancy and then continue to grow at a slower rate throughout the rest of the pregnancy.

The nipple and the areolae (the circular pigmented areas that encircle the nipples) also enlarge and grow deeper in color. During the latter half of pregnancy, colostrum (a thick yellow fluid) may leak or be expressed from the nipples. Colostrum is also secreted in modest amounts during the first five days after delivery. This is a high-protein liquid that contains minerals and antibodies and has little sugar or fat.

Weight changes

It is necessary to gain weight during a pregnancy. There is no set amount of weight that should be gained; it depends greatly on your pre-pregnancy weight.

In general, women who are overweight should not gain as much as women who are normal weight. Women who are underweight probably should make an extra effort to gain more pounds. Though many women are concerned about weight gain during pregnancy, it represents a positive energy balance that is essential to allow normal growth and development of a baby.

Many studies have found a higher incidence of miscarriage, premature deliveries, stillbirths, newborn deaths, and birth defects (especially of the central nervous system) when maternal nutrition is severely compromised.

For women in developed nations like the United States and Canada, the recommended weight gain is between 25-30 pounds. In general, a few pounds are added in the first trimester (the first three months of pregnancy), followed by a slow and steady increase during the remainder of pregnancy (approximately two pounds per month).

In the earlier part of pregnancy, most of the weight gain reflects growth of the mother. During the final three months, most of the weight comes from the growth of the baby and placenta and the buildup of amniotic fluid. By the time a woman has completed the 40 weeks of pregnancy, half of the accumulated weight is attributable to the uterus, baby, and breasts and the remainder is the increased body fluid and additional fat stores.

Unless you are one of those women who suffer from "morning sickness, " you will probably notice an increase in your usual appetite. This generally occurs early in pregnancy and normally results in around 200 extra calories per day. To maintain a normal pregnancy, the recommended daily allowance (RDA) calls for an additional 300 calories per day during pregnancy.

This increase in food is required not only for the growth of the baby and mother, but also for the increased energy that is required for the pregnant woman to move around. Though some experts have linked strenuous exercise to premature labor, most women remain active throughout pregnancy, either through fitness regimes or simple work-related activities, which is safe as long as it’s moderate. Just keep in mind that if you are exercising you may have to increase your caloric intake even more.

Nutrition

A healthy pregnancy is dependent on a well-balanced diet, supplemented with certain vitamins and minerals. Blood loss always occurs during delivery and it is essential to get iron supplementation during the pregnancy to prevent anemia when the baby is born.

Anemia is very common in women who have not taken additional iron, particularly those women who have a number of pregnancies over a short period of time. Folic acid (folate) is also necessary to prevent anemia.

It is also a good idea to take vitamin supplements that contain folic acid before you even become pregnant. This has been found to decrease the likelihood of a birth defect known as neural tube defects. Folic acid can be found in all prenatal vitamins.

Remember also that approximately 1200-1500 mg of calcium per day is needed for the development of the baby’s skeleton. To assure that you are receiving an adequate amount of calcium, you should estimate how much you’re getting from your diet and then receive the rest in the form of supplements.

Most of the other vitamin and mineral requirements of pregnancy are sufficiently supplied by a well-balanced diet and prenatal vitamins. Some women adhere to alternative dietary practices such as vegetarianism. If this is the case, you should consult a knowledgeable nutritionist.

"Megadosing" with vitamins should also be discouraged. There is little scientific evidence that consuming excessive amounts of vitamins and minerals is beneficial to overall health. In fact, it may be harmful. For example, taking large quantities of Vitamin A has been associated with certain birth defects.

Digestive System Changes

The earliest and most dreaded change in the digestive system is the nausea of pregnancy, or "morning sickness." Approximately half of pregnant women experience some degree of nausea, with or without vomiting. It appears early and usually disappears by the fourth month.

Simple remedies are to eat frequent, small, bland meals, to nibble on dry crackers, and to have a small snack before bedtime. Occasionally women require medications and even hospitalization to treat severe nausea and vomiting conditions.

Dietary cravings (such as the infamous penchant for pickles and ice cream) can occur during pregnancy as can aversions to certain foods. The distaste for certain foods may be a result of nausea or heartburn. Heartburn is also quite common during pregnancy and is most likely caused by a combination of factors; the change in the stomach’s location by the enlarged uterus and progesterone’s tendency to relax the sphincter muscle (valve) between the stomach and esophagus, thus permitting reflux of food and other stomach contents.

Constipation during pregnancy is another common complaint. It occurs for a number of reasons. As the uterus enlarges, it acts as a mechanical obstruction, preventing easy passage of stool. The relaxation of the muscular wall of the intestines, which is caused by progesterone, reduces intestinal motility. Finally, iron supplementation, though necessary, adds further to the problem. It is helpful to remain physically active, drink a lot of fluids, and increase the amount of fruits, vegetables, and salads you’re eating.

Occasionally stool softeners are necessary, but strong laxatives and enemas should not be used during pregnancy. Discussing these symptoms with your healthcare provider will help assure that you are resolving the situation safely.

Hemorrhoids can also plague women during pregnancy and can be quite aggravated after delivery. In general they occur as a result of constipation. The uterus can also compress the blood vessels, preventing normal flow of blood and causing the hemorrhoidal veins to swell. This can cause pain and bleeding, especially during bowel movements.

Avoiding constipation, along with local measures to decrease the pain and swelling (sitting in warm water or applying warm compresses, suppositories, local pain medication, and wiping with a non-irritating towel) are effective in most women.

Urinary System

Since the bladder sits right on top of the uterus, it is of no surprise that it will be sensitive to the changes in uterine size. Early in pregnancy, most women will report the need to urinate more frequently as the upward growth of the uterus exerts pressure on the bladder. This sensation tends to resolve during mid-pregnancy and then recurs during the final few months.

Night time urination is also common as the woman approaches term. You may also experience slight bladder leakage late in pregnancy or post-delivery. Because it can be sporadic, you may want to use some form of daily protection, like pads or pantiliners.

Since urinary frequency can also be a sign of a urinary tract infection and pregnant women are more prone to bladder infections, your healthcare provider may obtain urine cultures during the course of your pregnancy. Bladder infections need to be treated promptly in pregnancy to prevent a related kidney infection.

Cardiovascular System

During pregnancy, both the heart rate and the amount of blood pumped with each heartbeat increases. These two changes make your cardiovascular system perform more efficiently. This is vitally important because the heart not only has to handle the increased blood volume that normally occurs with pregnancy, but it also maintains adequate circulation to the uterus and growing baby.

Despite the fact that the heart seems to be "working overtime" and that total blood volume increases, blood pressure actually falls during mid-pregnancy. In the final months of pregnancy, the blood pressure will slowly rise again and return to pre-pregnant levels. It is abnormal for the blood pressure to be higher during pregnancy than when a woman is not pregnant.

For the heart to perform its function, it relies on normal return of blood flow. But the enlarging uterus can interfere with this by obstructing the large vein that returns blood to the heart (the vena cava). The uterus may also compress the aorta, the major artery that delivers oxygenated blood to the uterus and baby. The compression of these major blood vessels does not occur when you are standing.

However this is quite common if a pregnant woman lies flat on her back. When pregnant, you should be aware of this fact and always try to recline with a slight tilt of your body to the left. This will shift the uterus off of the aorta and vena cava.

Respiratory System

During pregnancy, the increased circulation of estrogen increases the amount of fluid and blood in the throat as well as in the lining of the nasal airways. This results in a greater amount of mucus. These changes may make pregnant women prone to more frequent nosebleeds and to a feeling of nasal stuffiness that might be misinterpreted as a chronic cold.

Up to 70% of pregnant women will also complain of shortness of breath, or a sensation that they are unable to get enough oxygen. This occurs most commonly in the third and fourth months of pregnancy. Unless she has true lung disease, it is difficult to explain these symptoms because pregnant women really do receive adequate amounts of oxygen. In fact, the actual amount of air that is inspired and expired with each breath ("tidal volume") is greater now than in the non-pregnant state. Some experts suspect that some women are aware of the increase in tidal volume and may perceive it as shortness of breath.

Skin

All of the circulating hormones can also result in the appearance of " spider angiomas," a raised, red mark on the skin that can have a somewhat spidery look. Many women will also notice that the palms of their hands have a red glow. Both are more common in Caucasian women than those with darker skin colors.

Localized darkening of the skin is also quite common, especially the breast nipples, umbilicus (the belly button), and a line that extends from the umbilicus down to the pubic hair line (the linea nigra).

Some women also develop an irregular, blotchy hyper-pigmentation on their face in a "mask-like" pattern.If you have existing nevi (birthmarks), keep in mind that they may also darken during pregnancy.In most cases, these skin changes will fade after delivery,although they may never completely disappear.

The Eye

The cornea, or lining of the eye, thickens during pregnancy and reverts back to normal by about six weeks postpartum. This change in the cornea is probably the reason why so many women report an inability to wear contact lenses comfortably during pregnancy.

Common Questions

Can I exercise during pregnancy?

Pregnancy is not the time to initiate a new exercise regime. However, if you have engaged in a regular fitness program before conceiving, you can safely continue as long as there are no pregnancy complications.

There are certain situations when it would be prudent to limit activity, such as multiple gestations (twins, triplets, etc), preterm labor, high blood pressure, or if the baby is found not to be growing appropriately. When exercising, it is important to remain well hydrated and to avoid overheating. Therefore, be sure to drink a lot of fluid to replace what is lost, dress in cool, comfortable clothes, and avoid excessive heat. Finally, as your uterus enlarges, your posture is changed and your center of gravity is altered. Pregnant women are less steady on their feet and thus more prone to fall. To prevent injury, you may need to modify the type of exercise as your pregnancy advances.

Can I travel during pregnancy?

Traveling, including flying, is safe during pregnancy. Since sitting for long periods of time predisposes to pooling of blood in the leg veins, you should be more conscientious about intermittently getting up and taking short walks.
One concern regarding travel is finding yourself in a position where familiar and competent obstetric care may be unavailable if an emergency should arise. Another consideration is that travel to certain areas of the world requires immunizations or medications to prevent various infections. It is advisable to consult your obstetrician and probably a specialist in infectious diseases to confirm that the medications and vaccinations are safe during pregnancy and to question whether the illnesses would have any long-lasting effect on your baby.

Can I continue to have sex during my pregnancy?

It is generally believed that sexual intercourse is not harmful during a pregnancy. There are some studies that suggest that preterm rupture of the membranes, infection, and preterm labor are more likely among women who have intercourse, but this is not a consistent finding among all studies. Certain circumstances are deemed high-risk and in these cases sexual intercourse should be discouraged, such as in women who are at greater risk of preterm labor and rupture of the membranes and women who experience strong uterine contractions after intercourse.

Can I drink alcohol during pregnancy?

Alcohol is now recognized as one of the most potent, known teratogens (a substance that can cause birth defects). Infants that are exposed to alcohol in utero are at risk for Fetal Alcohol Syndrome, a condition that is associated with poor growth, heart defects, facial abnormalities, and mental retardation.

In fact, alcohol ingestion is the most common identifiable cause of mental retardation. In general, studies demonstrate that the more severely affected children are born to women who drink the most. However, other studies have demonstrated that even rare drinking can be associated with abnormalities in children. Since it is impossible to define a safe amount of alcohol consumption during pregnancy, the current recommendations are to completely abstain from alcohol.

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