Tuesday, June 4, 2013

Some General Early Pregnancy Information and Advice

I started writing this as the second in my Childbirth Choices Series, and found that I was bursting with information to share about pregnancy, especially the early days. (Hey, I've done it four times, after all!) It doesn't seem to fit into the framework of the Childbirth Choices Series, but I wanted to make the information available. If you are thinking about trying to conceive or you've just found out you're pregnant, this post will probably be very informative. I've organized it by topic, so you can skip around to the specific questions you may have; you could also just read it top to bottom, of course, or come back and revisit sections as you go along. This would be especially good to read before your first provider appointment, since there will likely be some time before your first meeting. Often, you won't be seen until you are about eight or nine weeks along. If you are still trying to decide on a provider (and I hope my Childbirth Choices Series Part I post is helpful in that regard), you may try calling a few providers and asking if you can schedule a "meet and greet" before your first appointment - or even before you're pregnant - so that you can get a feel for their personality, the way their office is run, and ask any questions you have about their policies and practice.

Remember, also, that if after your first appointment you find that you're not comfortable with the person you met - for whatever reason! - you can switch to someone else. Your provider works for you, and you're under no obligation to remain with the practitioner you see initially.

Let's look at some common questions first-time parents have.

**Please note that I am not a medical provider  or practitioner. This advice is based on personal experience and research only. If you have any concerns, please contact your maternity care provider or general physician.**

How is my due date calculated? How "far along" am I?

In the early 19th century, a German obstetrician named Franz Naegele came up with a rule for estimating when a woman can expect to go into labor. The calculation is 280 days (40 weeks) from the first day of the woman's last menstrual period. This measurement is still used today as the standard calculation of your EDD - your estimated due date. If you know the date that your last period began, you simply count 40 weeks from that date on a calendar. Wherever your finger lands, that's your EDD. You can also find dozens of calculators on the internet that can help you do this. Just type "due date calculator" into your favorite search engine and one will pop right up. These will typically simply ask you for the date your last period started and then return your estimated due date. If you don't know the exact date of your last period, or you have a very irregular cycle, it may be difficult to estimate your due date. Some women have a sense of when they conceived. You can also use this date to find out your due date. Simply count 38 weeks from that date. If you really have no idea, then your provider can use a transvaginal ultrasound at your first appointment to take a look at the fetus and estimate its gestational age based on its size and development. From the gestational age, they can calculate a due date.

Please remember that 40 weeks is an estimate, a convenient and standard measurement to gauge the length and health of the pregnancy. Many, many pregnancies progress beyond the 40-week point, and it is normal to continue even on to 42 weeks without complications or danger to you or your baby. Your provider will want to monitor you and the baby if your pregnancy goes "post-dates" or overdue (beyond the EDD), but you should be aware that the average first pregnancy may run as long as 41.5 weeks. A "full term" pregnancy is considered one that runs to at least 38 weeks before the spontaneous labor begins.

Some definitions before we continue:

LMP - Last Menstrual Period - Use this date to find out how long you've been pregnant. Count the number of weeks and days since the first day of your last period. For example, if your last period began on January 15 and it's now April 1, you are 10 weeks and 5 days pregnant, often abbreviated 10w5d. Also use this date to find out your EDD by counting 40 weeks from that date.

EDD - Estimated Due Date - The date 40 weeks from your LMP, or a date chosen based on the measurements obtained in an early transvaginal ultrasound.

Transvaginal ultrasound - Your provider may use a special ultrasound machine to confirm and date your pregnancy. This machine has a computer screen and a probe that she or he will insert into your vagina. The probe emits sound waves which bounce off structures inside your body, creating a picture on the screen. Your provider will use this to find the developing fetus in your uterus. You will be able to see the heart beating, and the provider will take measurements to estimate the age and size of the fetus. These estimates will be compared to the EDD based on your LMP (if you know it), and your due date may be revised if there is a large discrepancy between the two estimates. An ultrasound may also be used if any problems are suspected, to check the placement of the pregnancy (ensure that it's in the uterus and not in the Fallopian tube, which called an ectopic pregnancy and is life-threatening to the mother), and to view the heart beat, since it cannot be heard externally early in the pregnancy. Your provider will likely print off a few pictures for you to keep. At about 8 to 9 weeks, the baby will look like a peanut in the ultrasound picture.

Gestational Age - The gestational age is how "old" your baby is inside the womb. "Gestation" is the length of the pregnancy. So the gestational age of your baby is how long you've been pregnant. 
So, when someone asks you how far along you are, you can give them the number of weeks and days since your LMP, if you want. You can also estimate how many months until your due date and subtract that from nine if you want to give a more vague answer. So, if you're due at the end of October and it's now mid-May, you can say that you're about four months along. (There are five months from May to October. Nine minus five is four.)

This can be confusing, because you aren't actually pregnant yet when your period starts (obviously). Your date of conception is hard to guess. Even if you had intercourse exactly once in the past few months, and know this exact date, that is probably not the date of conception, since it can take one to five days for the sperm to encounter and fertilize the egg. Since the LMP is a more exact date, it is easier to calculate from that point. Especially if you have an irregular cycle, you may have no real idea of when you actually ovulated.

Spontaneous labor - Most of the time, your labor will begin on its own when your baby is ready to come and your body is ready for birth. When you go into labor without any assistance or intervention from medications, this is called "spontaneous labor." Spontaneous labor after 38 weeks is considered a full-term pregnancy, and your baby should be fully grown and ready to face life outside the womb. If you go into labor before 38 weeks, your baby may be considered premature and may need medical assistance in the early days of life. If the labor begins very early in the pregnancy, your provider may recommend attempting to stop the contractions and take measures to put off the birth as long as it is possible and safe for you and the baby to do so.

When should I announce my pregnancy?

You may want to wait some time before you announce your pregnancy. This is normal and expected, and the reason is simple: miscarriages in the early weeks are quite common, occurring in about 10 to 25% of pregnancies. I don't want to sound negative or tempt fate, but if you've happily announced your pregnancy to everyone you know, only to suffer a miscarriage, it is no fun to have to figure out who knows and go back and tell everyone "never mind." Not to mention the pain of having someone asking when you're due or how far along you are now because they didn't get the message. Most women wait until at least the first prenatal appointment, when the health of the pregnancy can be assessed, or even until after about 12 or 13 weeks, when the risk of miscarriage drops considerably. And, some families choose to wait until the pregnancy starts to show, which can be as late as four or five months, or even longer depending on how you're carrying. You may want to choose a trusted family member or friend to tell sooner in order to get support and advice, especially if it's your first pregnancy.

What are the early symptoms of pregnancy? What can I do to feel better? How long does morning sickness last?

Here is a list of symptoms you may or may not experience in the first few months of pregnancy. Some women experience all of these, while others experience none. You may also experience symptoms that are not on this list. They may or may not be caused by the pregnancy. We tend to attribute anything "weird" to the fact that we're pregnant, even if it's actually just something we ate!
  • fatigue
  • insomnia
  • constipation
  • frequent need to pee
  • nausea and/or vomiting
  • heartburn
  • food aversions (feeling disgusted by eating or smelling certain foods that you'd normally enjoy)
  • food cravings (sudden overwhelming desire to eat certain foods or types of foods)
  • increased appetite
  • decreased appetite (if you're feeling especially nauseous)
  • sore/tender breasts
  • sensitive/sore nipples
  • irritability or mood swings
  • a feeling of tugging or pulling in your lower abdomen
  • lower abdominal pains or uterine cramping
  • low back pain
  • vaginal dryness or itching
  • increased vaginal discharge
  • vaginal yeast infection or bacterial vaginal infection
  • stuffy nose
  • heightened sense of smell
  • bizarre and vivid dreams
  • decreased libido
Morning Sickness

The hallmark of early pregnancy is, of course, "morning sickness." Morning sickness affects many women in the first three months or so of pregnancy and is usually characterized by nausea (the feeling that you're going to throw up) and/or vomiting, especially in the morning or on an empty stomach. (You typically experience it more in the morning because your stomach is empty.) If you talk to other women who have been pregnant, or you look on the internet, you'll find numerous "remedies" for morning sickness. Like hiccups remedies, some of these work for some people, while others simply suffer no matter what they try. 

Here are some general tips for managing mild to moderate morning sickness that I've found helpful through four pregnancies:
  • Eat! Even though you don't feel like it, the nausea is usually worse on an empty stomach. If you can eat a few crackers or something before the nausea sets in, sometimes you can head it off.
  • Stay hydrated! The nausea is worse when you're dehydrated. Also, if you are vomiting more than once or twice a day, you're probably losing fluids, and you need to make sure you're replenishing them.
  • Some foods help some women find relief from nausea. These include ginger, almonds, ginger ale, crackers, or toast.
  • Motion sickness wrist bands help some women.
  • Eat what you crave. This may sound odd, but sometimes you'll feel better if you just eat what you feel like eating (unless you are craving a non-food item, such as chalk, dirt, or ice. This is called "pica," and can be indicative of a vitamin or mineral deficiency. If you experience pica, contact your provider).
For most women, morning sickness goes away around 14 or 15 weeks of pregnancy, when you enter the second trimester and your hormonal balance changes. Some women find that they are sick for most or all of their pregnancy. If you feel you are experiencing excessive morning sickness, especially if you are losing weight, you may want to contact your provider for advice or an earlier examination.

Hyperemesis Gravidarum

For some, perhaps 2% of pregnant women, "morning sickness" is very severe. They may vomit multiple times a day, experience rapid or severe weight loss due to inability to keep down any food, extreme nausea, and severe dehydration due to inability to keep fluids down. This can be very dangerous to you and to your growing baby. These symptoms may last well beyond the first three months and may even continue throughout the pregnancy. Excessive vomiting in pregnancy is a medical condition called Hyperemesis Gravidarum (HG), which literally means "excessive vomiting of pregnancy". If you are experiencing these symptoms, contact your provider. Some women respond well to anti-nausea or anti-vomiting (antiemetic) medications, while others may require stronger interventions such as IV fluids or even hospitalization. If you have or think you have HG, you may find www.helpher.org helpful for information and support.

What is a trimester? What trimester am I in? What kind of symptoms can I expect in each trimester?

Pregnancy is about nine months long and is divided into three approximately three-month segments, called "trimesters." Each trimester has certain characteristics, and as you move from one trimester into the next, you will probably be able to tell that you've entered a new "phase."

The First Trimester

The first trimester runs for the first 12 to 14 weeks of the pregnancy. Your pregnancy may not show yet, but you may experience some of the symptoms listed above as "early" symptoms of pregnancy. (Some of these symptoms may continue on and off throughout the pregnancy.)

Many early pregnancy symptoms will be similar to the symptoms you experience just before or during your period. I don't want to scare you with that list. Like I said, you may experience some or all of these symptoms. You may not have any of them, and some lucky few will have all of them. They may come and go throughout the weeks. And sometimes they may be there but not bother you that much, or you'll get used to it. The absence or presence of any or all of these symptoms is not a measure of how healthy your pregnancy is.

Toward the end of the first trimester, or perhaps early in the second trimester, your care provider will be able to start listening to your baby's heartbeat externally using a stethoscope or Doppler machine. It is fun and reassuring to hear the heartbeat thump-thumping away at each prenatal visit!

The Second Trimester

The second trimester runs from about 12-14 to 28-30 weeks of pregnancy, the middle three months. The second trimester is usually the most pleasant phase of pregnancy. Your body will start producing hormones that give you a sense of well-being and excitement about your pregnancy. Many of the early symptoms will fade, especially morning sickness for most women, and you should have more energy. Your pregnancy will likely start to show sometime in the second trimester (if it doesn't show already), and you'll probably begin to tell people about it. You should find that some of the insomnia fades as well. Your strange and vivid dreams may continue, as will your enhanced sense of smell and some other symptoms. By the beginning of the second trimester, your breasts have begun manufacturing and storing colostrum, the early milk that will nourish your baby for the first three or four days after birth. Some women may experience a small amount of colostrum leakage, seen as a yellow crust on the nipple or in your bra, although this doesn't typically start until the third trimester, if it happens at all (all of these scenarios are normal). Your breasts may still be tender. You may find you have an increased libido (which should please your partner) in the second trimester as well, and your breasts will likely have become noticeably bigger.

In the second trimester and forward, you'll want to avoid lying flat on your back for long periods of time. The uterus is getting bigger and heavier and will put pressure on the vena cava, a major vein carrying blood from the lower half of your body back to the heart. You may start to feel light-headed or uncomfortable if you lie on your back. Lying on your left side is the best position for maximizing blood flow. If you find you've rolled onto your back while sleeping, don't panic! Just roll to one side or the other (preferably the left side) once you become aware of your position.

Try not to overeat. Especially when or if your morning sickness goes away, you may find that you are hungrier than you're used to being. You are expected to gain some weight during pregnancy - up to 25-35 pounds by the end. I'm not here to tell you to diet or starve yourself, and I'm not able to give you specific nutritional advice. But be aware that you are not actually "eating for two" - pregnancy consumes approximately 300 more calories per day than you would need if you were not pregnant, so plan your meals accordingly.

The best part of the second trimester is that at some point you'll start to feel the baby moving and kicking. You can start feeling this as early as 14-15 weeks and as late as 22 weeks, depending on your size, how you're carrying, the baby's position, and the location of your placenta. (If the placenta is anterior - in the front - then it will block the sensation of kicking until the kicks become stronger.) At first, these "kicks" will feel like little twitches in your abdomen. Most women compare them to feeling like gas bubbles or minor muscle spasms. After a while, they'll become unmistakable as coming from the baby, and you'll enjoy knowing that your baby is busy in there. Your provider may ask you to do "kick counts," which just means to make sure you feel 10 movements in one hour each day, just to make sure the baby is okay. If you go a day without feeling any movement, you may want to try drinking a glass of ice water or orange juice and paying close attention. It may be that you were just distracted from baby's movements, and a glass of cold, cold water or orange juice will encourage the baby to move around so you can be sure everything's okay. Your provider will tell you at what point you should call if you are concerned about a lack of movement.

Sometime during the second or third trimester, you may become aware of mild but strong contractions, usually not painful, in your uterus. Since early pregnancy, your uterus has starting contracting occasionally to "warm up" for the big day. These contractions are normal and are called "Braxton-Hicks" contractions. If these become strong or bothersome, you may want to try drinking at least three glasses of water and then lying down on your left side for a while. Sometimes you may experience strong contractions if you are dehydrated and/or tired. If you experience four or more strong contractions in one hour, or the contractions develop into a regular pattern that lasts for more than one hour after you've made sure you're hydrated and rested, you should contact your care provider to see if you need to have your cervix checked or what your next step should be.

The Third Trimester

The third trimester is the final three months of the pregnancy, running from 28-30 weeks to the onset of labor or delivery of the baby, generally between 38 and 42 weeks. The third trimester is can be fairly uncomfortable. Your belly is getting bigger and your baby is getting heavier, which may cause more aches and pains, especially in your back and legs. Your fatigue and insomnia may return, partly because you find it more difficult to get comfortable in bed. You may experience some swelling in your hands, feet, and ankles. You will probably need to pee more often, because the baby is putting pressure on your bladder. You may also experience pain and pressure in your pelvis or hips. During pregnancy, your body releases a hormone called relaxin that causes your joints to loosen up so that your pelvis can expand for delivery of the baby. This can cause other joints, such as your hips, knees, ankles, and wrists, to also become more injury prone. You may find that you have to stand up more carefully or that you develop soreness in your wrists, especially if you work at a repetitive motion job such as typing. It is fairly common to experience carpal tunnel syndrome, for example, during pregnancy.

In the third trimester, you'll want to pay close attention to your posture. When you stand up straight, you don't want to allow your back to curve inward too much - this will cause your lower back to hurt more. Let your bottom drop a bit to rotate your hips toward your back slightly. You'll know when it feels right. Also, if you wear a shoe that has a slightly raised heel (about 1 to 2 inches), this can be quite comfortable. There are products that can help support your belly if your back hurts badly as well. When you sleep, you can stick a pillow between your legs when you lie on your side, and you can support your back and belly with pillows as well to find more comfort.

Can I exercise when I'm pregnant?

Yes! If you had a regular exercise routine before you became pregnant, you can probably continue with this routine during your pregnancy. You may need to modify some of your activities depending on how strenuous they are or how much pressure they put on your abdomen. Some activities may become impossible, impractical, or dangerous to the baby due to potential falls, such as biking or horseback riding. If you're a runner, you will want to be careful, as your balance will be affected by the changes in your center of gravity as your baby grows. Swimming is excellent exercise while pregnant, as are yoga (with modified poses for pregnancy), pilates (again, modified for pregnancy), and walking. If you have not had a regular exercise routine before becoming pregnant, don't start something intense or strenuous that your body is not used to doing. Starting a walking routine or some other type of low-impact, low-stress exercise is very beneficial both for weight management and your overall health and feelings of well-being. In addition, being active during your pregnancy will help settle the baby into a good position for labor and delivery.

When you exercise, pay attention to what your body is telling you. Make sure you don't allow yourself to overheat and stay well hydrated. If you find you are getting sore or tired, stop. You may not be able to do as much or exercise for as long as you could before you became pregnant. If you find that you are having contractions, stop, drink two or three glasses of water, and lie down on your left side for a while. Contractions are usually triggered by exhaustion and dehydration, and if it is not time for you to give birth, you need to heed your body's message that you need to rest. If you notice any vaginal bleeding, stop what you're doing and call your care provider. If you have any questions or concerns about your exercise routine while pregnant, talk to your care provider.

When should I contact my provider?

Any time you have a concern, you should feel comfortable calling your provider. Your provider should also give you some general guidelines as to when you should definitely call. These may include (but are not limited to)*:

  • regular contractions, at least four in one hour lasting at least 30 seconds each
  • vaginal bleeding (some light spotting in the early days is fairly normal, but heavy bleeding is not)
  • excessive vomiting, inability to keep food or liquids down
  • severe abdominal cramping or back pain
  • sudden severe headache and vision changes
  • sudden swelling in the ankles and hands
  • lack of movement from the baby for 24 hours after you've started feeling regular kicking
*Please remember that I am not a licensed medical professional and cannot give you specific medical advice. If you have any concerns about your pregnancy or you want to know if something you are experiencing is normal, please contact your provider!

What should I stop eating? What should I start eating?

For the most part, you can maintain your usual diet while pregnant. You want to make sure you're getting enough vitamins and minerals, especially B vitamins, folic acid, calcium, and Vitamin D. Taking a prenatal vitamin or other vitamin supplements can help. Since pregnancy can make you prone to constipation, make sure you drink enough water and get plenty of fiber. If you're not sure whether you need to make specific changes to your diet, of course speak with your care provider. You may find that you're hungrier than you normally would be. Building another human takes calories, but pregnancy typically takes only about 300 more calories than you'd need in a day if you weren't pregnant. This means you don't need to increase your food intake by much - you are certainly not eating for two. The bulk of those extra calories should be from healthy foods, if possible!

There are a few foods to think about minimizing or eliminating while pregnant. While your system may be strong enough to handle food-borne toxins and bacteria, your baby's may not be. Foods that you may want to avoid for this reason include unpasteurized soft cheeses, processed deli meats, and raw sushi (you can still eat vegetable sushi or sushi made with cooked fish). Tuna and salmon tend to contain high amounts of mercury, which may negatively affect your baby's development. Mercury is toxic and can cause brain damage in high doses, especially to the developing brain of a fetus. Mercury is considered to have a cumulative effect, meaning that the more of it you consume, the more you store in your body. For that reason, it is recommended that pregnant women eat no more than one to two 5-ounce cans of tuna per week. If you're nervous about mercury, you can simply avoid tuna, but do eat other fish if you can, because the fish oils are very, very good for you and your baby! Plenty of other fish are quite safe (when cooked, of course!), such as cod, haddock, tilapia, and mahi mahi.

What medications can I take while pregnant? Do I need to stop taking the medications I'm on?

As I am not a doctor or pharmacist, I can't speak about specific medications. However, it is useful to know that there are certain medications that are considered safe during pregnancy. Personally, I try to avoid taking anything unless I absolutely have to, but sometimes that headache or backache is just too much, or you have a bacterial infection, or you can't sleep because your nose is soooo stuffy or you can't stop coughing. In those cases, if less medication-oriented remedies don't help, you can contact your care provider for suggestions. In the past, I've had doctors and midwives tell me it's safe to take Tylenol (as directed on the bottle), Benadryl, and certain decongestants and expectorants. I've also taken certain antibiotics for sinus infections and UTI's during pregnancy. There are definitely medications that have been proven to be harmful to the fetus, and there are some that are suspected to be harmful. For example, ibuprofen (Advil/Motrin) is not generally considered safe during pregnancy.

If you are on a medication for a chronic condition such as a psychiatric disorder, high blood pressure, diabetes, or asthma, talk with your prescribing doctor and your care provider as soon as you find out you're pregnant - or even sooner if you're planning to become pregnant - to see if what you are taking is safe for the baby. You may have to weigh the relatives risks and benefits of taking a medication if it is essential for your own physical or mental health, and that is something you'll have to discuss with your doctor(s).

Why do I need to take a prenatal vitamin? Can I take a regular multivitamin instead?

It is important that you get enough folic acid while pregnant to prevent neural tube defects in your baby. The most well-known type of neural tube defect is spina bifida, which can cause severe disabilities or death in your baby. Taking 800mcg (micrograms) of folic acid daily can prevent spina bifida and other related disorders. Prenatal vitamins are specifically formulated with extra folic acid and a balance of other vitamins and minerals that you need as a pregnant woman. If you can't tolerate your prenatal vitamin (and they do make some women feel sick), you can talk to your care provider about taking a regular or gummie multivitamin or even a children's multivitamin, or you can ask if there are other options available. You will also want to make sure you are getting enough iron in your diet to prevent anemia. If you are having trouble with muscle cramps, a calcium-magnesium supplement can help as well.

What can you tell me about using alcohol and cigarettes while pregnant?

The general rule with alcohol during pregnancy is don't drink alcohol. This is because it is not known what the threshold alcohol intake is before it begins to affect the baby's development. For some women, it appears that just one drink can cause problems, especially if she has a history of heavy alcohol use. In my view, and in the view of most practitioners, it's easy enough to simply not drink alcohol and not take the chance. Fetal alcohol syndrome is real, and it's permanent, and it's preventable. In Europe, you'll find a slightly more relaxed attitude toward alcohol during pregnancy, but this is something you'll have to discuss with your care provider and do your own research on.

As far as cigarettes, smoking during pregnancy can cause a host of problems for your developing baby as well. Because smoking reduces oxygen to your baby, smoking during pregnancy can cause your baby to be of low birth weight, which may cause long-term problems. Smoking may also contribute to preterm birth, which can mean lengthy hospital stays and lifelong health problems as well. Smoking during pregnancy also increases the baby's risk of asthma and other breathing problems as well as the risk of SIDS (sudden infant death syndrome, also known as "crib death"). Nicotine may also cross the placenta and affect the baby's brain development. If you can quit, that would be the best option. If you're finding it too stressful to quit cold turkey, speak with your care provider about getting support and help with quitting, and try to cut back as much as you can, or go as long as possible between cigarettes to maximize the oxygen your baby gets.

Do you have other questions about early pregnancy you'd like answered? Comment below!

1 comment:

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