This is an exciting time for you¨having a baby growing and developing inside you is an incredible experience! This database will help you understand and enjoy your pregnancy. You will learn what is going on in your body and how your baby is growing and changing.
One focus of this database is to help you see how your actions and activities affect your health and well-being and that of your growing baby. If you're aware of how a particular test at a particular time, such as an X-ray, will affect the growing baby, you may decide on another course of action. If you understand how taking a certain drug can harm your baby or cause long-lasting effects, you may decide not to use it. If you know a poor diet can cause heartburn or nausea in you or delayed growth in your baby, you may choose to eat nutritiously. If you are aware of how much your actions affect your pregnancy, you may be able to choose wisely, free yourself from worry and enjoy your pregnancy more.
Material in this database is divided into weeks of pregnancy. Illustrations help you see clearly how you and your baby are changing and growing each week. General topics are discussed each week, such as how big your baby is and how big you are. Areas of special concern are also discussed.
The information in this database is not meant to take the place of any discussion with your physician. Be sure you discuss any and all concerns with him or her. Use this material as a starting place in your dialogue with your medical-care provider. It may help you put your concerns or interests into words.
When Is Your Baby Due?
The beginning of a pregnancy is actually figured from the beginning of your last menstrual period. That means, for your doctor's computational purposes, you are pregnant 2 weeks before you actually conceive! This can be confusing, so let's examine it more closely.
Figuring Your Due Date
Most women don't know the exact date of conception, but they are usually aware of the beginning of their last period. This is the point from which a pregnancy is dated. For most women, the fertile time of the month (ovulation) is around the middle of their monthly cycle or about 2 weeks before the beginning of their next period.
Pregnancy lasts about 280 days, or 40 weeks from the beginning of the last menstrual period. You can calculate your due date by counting 280 days from the first day of bleeding of your last period. Or count back 3 months from the date of your last period and add 7 days. This also gives you the approximate date of delivery. For example, if your last period began on February 20, your due date is November 27.
Calculating a pregnancy this way gives the gestational age or menstrual age. This is how most doctors and nurses keep track of time during pregnancy. It is different from ovulatory age or fertilization age, which is 2 weeks shorter and dates from the actual date of conception.
Many people count the time during pregnancy by using weeks. It's really the easiest way. But it can be confusing to remember to begin counting from when your period starts and that you don't become pregnant until about 2 weeks later. For example, if your doctor says you're 10 weeks pregnant (from your last period), conception occurred 8 weeks ago.
You may hear references to your stage of pregnancy by trimester. Trimesters divide pregnancy into three periods, each about 13 weeks long. This helps group together developmental stages. For example, your baby's body structure is largely formed and his or her organ systems develop during the first trimester. Most miscarriages occur during the first trimester. During the third trimester, most maternal problems with pregnancy-induced hypertension or pre-eclampsia occur.
You may even hear about lunar months, referring to a complete cycle of the moon, which is 28 days. Because pregnancy is 280 days from the beginning of your period to your due date, pregnancy lasts 10 lunar months.
In this database, pregnancy is based on a 40-week timetable. Using this method, you actually become pregnant during the third week. Details of your pregnancy are discussed week by week beginning with Week 3. Your due date is the end of the 40th week.
Each weekly discussion includes the actual age of your growing baby. For example, under Week 8 you'll see:
Week 8 (gestational age)
Age of Fetus¨6 Weeks (fertilization age)
In this way, you'll know how old your developing baby is at any point in pregnancy.
It's important to understand a due date is only an estimate, not an exact date. Only 1 out of 20 women delivers on her due date. It's a mistake to count on a particular day (your due date or an earlier date). You may see that day come and go, and still not have your baby. Think of your due date as a goal¨a time to look forward to and to prepare for. It's helpful to know you're making progress. Understanding how time is recorded during pregnancy helps.
No matter how you count the time of your pregnancy, it's going to last as long as it's going to last. But a miracle is happening¨a living human being is growing and developing inside you! Enjoy this wonderful time in your life.
Your Menstrual Cycle
Menstruation is the normal, periodic discharge of blood, mucus and cellular debris from the cavity of the uterus. The usual interval for menstruation is 28 days, but this can vary widely and still be considered normal. The duration and amount of menstrual flow can also vary; the usual duration is 4 to 6 days.
Two important cycles actually occur at the same time¨the ovarian cycle and the endometrial cycle. The ovarian cycle provides an egg for fertilization. The endometrial cycle provides a suitable site for implantation of the fertilized egg inside your uterus. Because endometrial changes are regulated by hormones made in the ovary, the two cycles are intimately related.
The ovarian cycle produces an egg (ovum) for fertilization. There are about 2-million eggs in a newborn girl at birth. This decreases to about 400,000 in girls just before puberty. The maximum number of eggs is actually present before birth. When a female fetus is about 5 months old (4 months before birth), she has about 6.8-million eggs.
Some women (about 25%) experience lower abdominal pain or discomfort on or about the day of ovulation, called mittelschmerz. It is believed to be caused by irritation from fluid or blood from the follicle when it ruptures. The presence or absence of this symptom is not considered proof that ovulation did or did not occur.
Your Health Can Affect Your Pregnancy
Your good health is one of the most important factors in your pregnancy. Good nutrition, proper exercise, sufficient rest and attention to how you care for yourself all affect your pregnancy. Throughout this database, I provide information about medications you may take, medical tests you may need, over-the-counter substances you might use and many other areas that may concern you. This information is presented so you will be aware of how your actions affect your health and the health of your developing baby.
The health care you receive can also affect your pregnancy and how well you tolerate being pregnant. Good health care is important to the development and well-being of your baby.
Your Healthcare Provider
You have many choices when it comes time to choose your healthcare provider. An obstetrician is a doctor who specializes in the care of pregnant women, including delivering babies. Obstetricians are MDs (medical doctors who have graduated from an accredited medical school and have fulfilled the requirements for a medical license) or DOs (doctors of osteopathic medicine who have graduated from an accredited school of osteopathic medicine and have fulfilled the requirements for a medical license). Both have completed further training after medical school (residency).
Obstetricians who specialize in high-risk pregnancies are perinatologists. Few women require a perinatologist (1 out of 10). Ask your doctor if you need to see a specialist, if you're concerned about past health problems. Some women choose a family practitioner because he or she is the family doctor. In some cases, an obstetrician may not be available because a community is small or in a remote area. The family practitioner often serves as your internist, obstetrician/gynecologist and pediatrician. Many family practitioners deliver babies and are very experienced. If problems arise, a family practitioner may need to refer you to an obstetrician for your prenatal care. This also may be the case if a Cesarean section is required for delivery of your baby.
Pregnant women sometimes choose certified nurse-midwives for their care. A certified nurse-midwife is a trained professional who cares for women who are at low risk. A certified nurse-midwife delivers low-risk, uncomplicated pregnancies. These professionals are registered nurses with additional training and certification in nurse-midwifery. They require the immediate availability of a physician, in case complications arise.
Communication Is Important
It's important to be able to communicate well with your healthcare provider. Pregnancy and delivery are very individual experiences. You need to be able to ask your doctor any questions you have.
˛ What about natural childbirth? Does your doctor believe in it?
˛ Are there routines he or she performs on every patient? Does everyone ˘get÷ an enema, fetal monitor or more?
˛ Who covers patient care for your doctor when he or she is away?
˛ Are there other doctors you will meet or who will take care of you?
Express your concerns and talk about whatever is important to you. Your doctor has experience involving hundreds or thousands of deliveries and is drawing on this for your well-being. Your doctor has to consider what is best for you and your baby while he or she tries to honor any ˘special÷ requests you may have. Don't be afraid to ask any question; your doctor has probably already heard it. It may be that a request is unwise or risky for you, but it's important to ask about it ahead of time. If a request is possible, then you can plan for it together, barring unforeseen developments.
Finding the Right Caregiver for You
How do you find someone who ˘fits the bill÷? If you already have an obstetrician you're happy with, you may be all set. If you don't, call your local medical society. Ask for references to professionals who are taking new patients for pregnancy.
An added credential is board certification. Not all doctors who deliver babies are board-certified. It is not a requirement. Board certification means your doctor has put in extra time preparing for and taking exams to qualify him or her to care for pregnant women and to deliver their babies.
Board certification is administered by the American Board of Obstetrics and Gynecology, under the direction of the American College of Obstetricians and Gynecologists. If your doctor has passed his or her boards, it is often indicated by the initials F.A.C.O.G. after the doctor's name. This means he or she is a Fellow of the American College of Obstetricians and Gynecologists. Your local medical society can also give you this information.
There are other ways to find a caregiver with whom you are happy. Ask friends who have recently had a baby about their experiences. Ask the opinion of a labor-delivery nurse at your local hospital. Various publications, such as the Directory of Medical Specialties or the Directory of the American Medical Association, are available at most U. S. libraries. In Canada, refer to the Canadian Medical Directory. Another doctor, such as a pediatrician or internist, may also provide a reference.
How Your Actions Affect Your Baby's Development
It's never too early to start thinking about how your activities and actions can affect your growing baby. Many substances you normally use may have adverse effects on the baby you carry. These substances include drugs, tobacco, alcohol and caffeine. Below is a discussion on drug abuse, cigarette smoking and alcohol use. Any of these activities can harm a developing baby.
Drug Use and Abuse
Drug abuse is more common today in our society than it once was, and drug abuse in pregnancy is occurring more frequently. Unfortunately, it affects a second, innocent party¨the unborn baby. A baby exposed to drugs before birth can be affected developmentally or ˘born with a habit.÷
˘Drug abuse÷ most often refers to drugs prohibited by law, but it can also include the use of legal substances, such as alcohol, caffeine and tobacco. Legal medications, such as benzodiazepines (Valiumź) or barbiturates, may also have harmful effects.
Dependence on a particular drug may be physical, psychological or both. Physical dependence implies the drug must be taken to avoid unpleasant withdrawal symptoms. It does not necessarily mean addiction or drug abuse. For example, many caffeine users develop withdrawal symptoms if they stop drinking coffee, but they are not considered drug abusers or drug addicts. Psychological dependence means the user has an emotional need for a drug or medication. This need can be more compelling than a physical need and can provide the stimulus for continued drug use.
Many drug abusers primarily desire the enjoyable or pleasurable effects of a drug. They may develop a tolerance for it after continued use, requiring higher amounts of the medication to achieve the same effects.
Another trend in drug abuse is the use of more than one drug at a time. This is done in an attempt to heighten the effect of a particular agent or to avoid its undesirable effects.
Can drug use affect a pregnancy? The answer is a definite ˘Yes!÷ We know certain drugs can damage an unborn baby. In some cases, a woman who abuses drugs is more prone to certain complications of pregnancy. Nutritional deficiencies are common with the use of certain substances. Maternal anemia and fetal-growth retardation are also problems, and pre-eclampsia may be more likely.
Opioids, agents derived from opium and synthetic compounds with similar actions, produce euphoria, drowsiness or sleepiness and decreased sensitivity to pain. Habitual use often leads to physical dependence. Morphine, heroin, Demerolź and codeine all belong to this group. These drugs are associated with a variety of congenital abnormalities and complications of pregnancy that are difficult to separate from poor nutrition and lack of prenatal care. Women who use opioids during pregnancy are often at high risk for premature labor, intrauterine-growth retardation, pre-eclampsia and other problems. A baby born to a mother who uses opioids may experience withdrawal symptoms after birth.
A high incidence of sexually transmitted diseases and other infectious diseases may be part of the picture with drug abuse. Intravenous drug use is associated with hepatitis, endocarditis and acquired-immune-deficiency syndrome (AIDS). Any of these can present serious problems during pregnancy. Women with drug problems may not seek prenatal care.
Hallucinogens, such as LSD, mescaline and peyote, are still used but not as commonly as several years ago. Phencyclidine (PCP; angel dust) is a powerful hallucinogen that can cause psychotic episodes. It causes abnormal development in some animals and possibly humans, although this has not definitely been proved.
Marijuana and hashish contain tetrahydrocannabinol (THC). Studies have shown that THC crosses the placenta and enters the baby's system. Exposure can cause problems, including attention deficit, memory problems and impaired decision-making ability in children. These problems can appear in a child between 3 and 12 years of age.
Information about effects of a specific drug on a human pregnancy comes from cases of exposure before the pregnancy is discovered. These ˘case reports÷ help researchers understand possible harmful effects but leave gaps in our knowledge. For this reason, it can be difficult or impossible to make exact statements about particular drugs and their effects.
Cocaine (and crack) has become a popular recreational drug. A large number of women use it. Cocaine use is an increasingly common complication of pregnancy. Often the drug is consumed over a long period, such as several days. During this time, very little is eaten or drunk, which can have dangerous consequences for an unborn baby. Cocaine intoxication may be associated with convulsions, arrhythmias, hypertension and hyperthermia in the mother-to-be. Continual or repeated use of cocaine can affect maternal nutrition and temperature control, which can be damaging to the baby. Cocaine use has been linked to miscarriage, placental abruption and congenital defects¨important reasons for concern about its use during pregnancy. (Also see Week 4.)
Barbiturates may be associated with birth defects, although a cause-and-effect relationship has not been proved. Withdrawal in a newborn infant, along with poor feeding, seizures and other problems, has been seen.
Benzodiazepines include tranquilizing agents, such as diazepam (Valiumź) and chlordiazepoxide (Libriumź), along with newer agents. Several studies have related the use of these drugs to an increase in congenital malformations.
If you use drugs, be honest with your doctor. Ask questions about drugs and drug use. Tell your doctor about anything you take that may affect your baby.
The victim of drug use is your baby. A drug problem may have serious consequences that can be best dealt with if they are known about in advance.
Smoking cigarettes has harmful effects on a pregnancy. A pregnant woman who smokes 20 cigarettes a day (one pack) inhales tobacco smoke more than 11,000 times during an average pregnancy.
Tobacco smoke contains many harmful substances¨nicotine, carbon monoxide, hydrogen cyanide, tars, resins and some cancer-causing agents (carcinogens). These substances may be responsible singly or together for damaging your developing baby.
Scientific evidence has shown smoking during pregnancy increases the risk of fetal death or fetal damage. Smoking interferes with a woman's absorption of vitamins B and C and folic acid. Lack of folic acid can result in neural-tube defects and increases the risk of pregnancy-related complications in a mother-to-be. (See Week 3.)
For more than 20 years, we have known infants born to mothers who smoke weigh less by about 7 ounces (200g). That is why cigarette packages carry a warning to women about smoking during pregnancy. Decreased birth weight is directly related to the number of cigarettes the expectant mother smoked. These effects don't appear in her other babies if the mother doesn't smoke with other pregnancies. There is a direct relationship between smoking and impaired fetal growth.
Children born to mothers who smoked during pregnancy have been observed to have lower IQ scores and increased incidence of reading disorders than children of nonsmokers. The incidence of minimal-brain-dysfunction syndrome (hyperactivity) has also been reported higher among children of mothers who smoked during pregnancy.
Cigarette smoking during pregnancy increases the risk of miscarriage and fetal death or death of a baby soon after birth. The risk is also directly related to the number of cigarettes the pregnant woman smokes. The risk may increase as much as 35% in a woman who smokes more than one pack of cigarettes a day.
Smoking also increases the incidence of serious complications in a mother-to-be. An example of this is placental abruption, discussed in detail in Week 33. The risk of developing placental abruption increases by almost 25% in moderate smokers and more than 65% in heavy smokers.
Placenta previa, discussed in Week 35, also occurs more frequently among smokers. The rate of occurrence increases by 25% in moderate smokers and 90% in heavy smokers.
Known or suspected harmful effects to general health from smoking are numerous and include increased risk of:
˛ pulmonary diseases, such as chronic bronchitis, emphysema and cancer
˛ cardiovascular diseases, including ischemic heart disease, peripheral vascular disease or arteriosclerosis
˛ bladder cancer
˛ peptic-ulcer disease
In addition, smokers have a mortality rate 30% to 80% higher than nonsmokers.
What can you do? The answer sounds simple but isn't¨quit smoking. In more realistic terms, a woman who smokes during pregnancy will benefit from reducing or stopping cigarette use before or during pregnancy; so will her developing baby. Some studies indicate a nonsmoker and her unborn baby exposed to secondary smoke (cigarette smoke in the environment) are exposed to nicotine and other harmful substances.
Perhaps pregnancy can serve as good motivation for everyone in the family to stop smoking!
Alcohol Use in Pregnancy
Alcohol use by a pregnant woman carries risk. Moderate drinking has been linked to an increased chance of miscarriage. Excessive alcohol consumption during pregnancy often results in fetal abnormalities. Chronic use of alcohol in pregnancy can lead to abnormal fetal development called fetal alcohol syndrome (FAS).
FAS is characterized by growth retardation before and after birth, and defects in limbs, the heart and facial characteristics of children born to women who are alcoholic. Facial characteristics are recognizable¨the nose is upturned and short, the upper jawbone is flat and the eyes look ˘different.÷ An FAS child may also have behavioral problems.
FAS children often have impaired speech, and their fine and gross motor functions are impaired. The perinatal (time before, during and immediately after birth) mortality rate is 15% to 20%.
Most studies indicate women would have to drink four to five drinks a day for FAS to occur. But mild abnormalities have been associated with two drinks a day (1 ounce of alcohol). This has led many researchers to conclude there is no safe level of alcohol consumption during pregnancy. For this reason, all alcoholic beverages in the United States carry warning labels similar to those on cigarette packages. The warning advises women to avoid alcohol during pregnancy because of the possibility of fetal problems, including fetal alcohol syndrome.
Taking drugs with alcohol increases the chances of damaging a baby. Analgesics, antidepressants and anticonvulsants cause the most concern.
Some researchers have suggested the father's heavy alcohol consumption prior to conception may also result in fetal alcohol syndrome. Alcohol intake by the father has been blamed for intrauterine-growth retardation.
As a precaution, be very careful about over-the-counter cough and cold remedies you may use. Many contain alcohol¨some as much as 25%!
Some women want to know if they can drink socially. There is a great deal of disagreement about it because there is no known safe level of alcohol consumption during pregnancy. Why take chances? For the health and well-being of your developing baby, abstain from alcohol during pregnancy. Responsibility for preventing these problems rests squarely on your shoulders!
Hepatitis in Pregnancy
Hepatitis is a viral infection of the liver. It is one of the most serious infections that can occur during pregnancy. Hepatitis B is responsible for nearly half of the cases of hepatitis in the United States. It is transmitted by sexual contact and reuse of hypodermic needles. Those at risk for contracting hepatitis B include people with a history of intravenous drug use, a history of sexually transmitted diseases or exposure to people or blood products that contain hepatitis B. The B type can be transmitted to the developing fetus of a pregnant woman.
Hepatitis symptoms include nausea, flulike symptoms and pain in around the liver or upper-right abdomen. A person with hepatitis may appear yellow or jaundiced, and urine may be darker than normal. Diagnosis of hepatitis is made by blood tests.
In most areas, women are tested for hepatitis B at the beginning of pregnancy. If you test positive, your baby may receive immune globulin (antibodies to fight hepatitis) following delivery. It is now recommended that all newborns receive hepatitis vaccine shortly after birth. Ask your pediatrician if this vaccine is available in your area.
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