Googly, Woogly, Woosh!

The first 40 days after delivery are important as might be told by your family members, if you just had delivered a baby.

The first 40 days are known as a confinement period which means a time when you recuperate, gain strength and bond with your new baby. It's quite natural to feel that this period is too long and either you may want to get out of the house before that or you may find the practices during these days are too restrictive.

Every moment of this precious period must be enjoyed the fullest by utilizing maximum time you get for yourself and your newborn baby before setting up yourself in the mad rush of life again. As your body will be going through a lot of transition during these first few days of motherhood, here is how you can make the most of your confinement time to help you recover well.

Quick Recovery

It all depends on your birth experience. You may feel well again fairly soon after the birth, but if you had a caesarean or an assisted birth, it can take a long time before you become free from any aches and pains.

The best practice is to allow your body to heal at its own pace. It is pretty under your own control which can be done by resting, eating well and looking out for the signs of an infection or other postnatal complication.

With a newborn, rest may not be something that can be easily managed as the little one probably wants to be fed every two hours throughout the day and night. There is also a tendency to pass urine and motions quite frequently in the newborns. This is why confinement is such a popular postnatal practice advised by the experts.

Post-natal Depression and its Management

Giving birth is an amazing achievement, and every mum responds in her own way. The new mother may either feel alert and happy - physically, mentally, and emotionally or she may feel bruised and battered, exhausted, disappointed and even depressed.

Post-natal depression or baby blues is a common accompaniment feature of delivery, which is reflected in the form of severe mood swings, sadness and guilt.

The most important first step in managing postnatal depression is recognizing the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.

However, to benefit from this, it's important for you to talk to those close to you and explain how you feel. Bottling everything up can give rise to strain in your inter-relationships, particularly with your partner, who may feel ignored

Support and advice from social workers, counselors or self-help groups can provide good advice about how to cope with the effects of postnatal depression, and connecting with other women suffering with the same emotional disturbance is very reassuring and relieving.

Exercise

Exercise has been proven to help depression, and it's one of the main treatments for mild depression. It should be conducted under the supervision of a qualified fitness trainer. 

Treatments

Psychological therapies are usually recommended as the first line of treatment for mild-to-moderate postnatal depression for women with no previous history of mental health conditions. Some common ones are enlisted below:

  • Guided self-help
  • Talking therapies
  • Cognitive behavioral therapy (CBT)
  • Interpersonal therapy

Consult your doctor and speak out all of you concerns. With the right treatment, you will feel better again.

Post-natal Breast and Nipple care

After birth, the breasts of the mother become larger and heavier, and may become tender as they start making milk. Here are some of the tips for caring and protecting your breast after delivery:

  • Always wear a cotton nursing bra which can allow you to use one breast at a time. It can also help in massaging the breast if it is required.
  • A bra without an underwire is highly recommended.
    In order to protect the breast leaking, breast cotton pads must be used.
  • If there is severe engorgement, then a warm shower or warm hot towels just before the breastfeeding helps in easing the flow.
  • Warm compresses on your breasts before feedings, and cool compresses after feedings help in removing the tenderness.
  • Try not to use soap or any other harsh chemicals on the nipple as it can contaminate the milk and can be taken inside by the baby.
  • If your nipples feel sore, try changing your breastfeeding position and get help to make sure your baby is latching on correctly.

Eating well Post-delivery

Good nutrition is critical in the post-natal period to help you recover and keep up with the demands of motherhood. Whether you are breastfeeding or bottle feeding, proper nutrition is important for your recovery from childbirth and are prerequisite for maintaining adequate milk supply, therefore, be sure to include plenty of calcium, protein, iron, zinc, and vitamins A, C, and E in your diet to aid in your full recovery and help you maintain your strength.  An extra benefit of eating a healthy diet is that proper nutrition will help you cope better with the inevitable fatigue that the new demands of motherhood bring on.
Most mothers require roughly 500 extra calories per day during lactation to keep up with the demands of breastfeeding.  Remember, the baby will take nutrients from your body; so be sure to eat well so you can support you and your baby.  Dieting during lactation is not appropriate because you need to recover and your baby needs proper nutrition.  While breastfeeding, you can still lose weight if you eat a balanced, healthy diet adequate in calories and nutrients.

Remember to focus on the following in your diet:

Calcium:  Your calcium stores were depleted during pregnancy to help your baby grow and develop.  Make sure to eat plenty of calcium rich foods to replenish your stores.
Omega 3s:  Omega 3 fatty-acids are critical for your baby’s brain and eye development.  If you are breastfeeding, try to incorporate foods high in omega 3s, such as salmon, sardines, walnuts, chia and flaxseed.  They also play a role in the weight loss.
Antioxidants:  Eat plenty of fruits and vegetables to get the necessary antioxidants to help keep your body as healthy as possible. Antioxidants scavenge free radicals, preventing cellular damage involved in aging, cancer, and a variety of other diseases.
B-Vitamins:  Eat plenty of whole grains and dark greens to ensure your body gets the B-vitamins it needs to maintain proper metabolic pathways.  B vitamins play an important role in carbohydrate metabolism, red blood cell formation, and work to promote healthy nerves.
Fluids:  Make sure to drink a lot of fluid (water especially), because if you are breastfeeding, then you may be depleting your fluids through the milk which you are producing.  
Avoid alcohol, caffeine, smoking, and medications:  Most everything you eat or drink goes directly to your baby through breast milk, so always be careful and avoid alcohol, caffeine and smoking. Try to avoid self-medications.
Exercise:  Consult your doctor before opting for any exercise program.

Emotions and Pregnancy!

“Plenty of attention is given to the physical changes and discomforts in a woman's body during pregnancy, but the emotional changes she could be experiencing may not always get discussed. In addition to her physical health, a woman's emotional well-being and her mental outlook can also play important roles in pregnancy.”

During the nine months, a woman's moods and emotions can range from the highs of feeling overjoyed and excited about having a baby to the lows of feeling impatient, worried and terrified as the delivery and motherhood approaches. Pregnancy can also bring up other issues, such as difficult family relationships, insecurities and unrealistic personal expectations, which may have previously been suppressed or ignored. In many ways it's helpful that a woman and her partner have almost a year to adjust to the realities of becoming parents.

Pregnancy is a huge transition in a woman's life, and it involves a complex mix of emotions, both good and bad. At the body level, the hormones estrogen and progesterone are ramping up, and some women are more sensitive to progesterone changes and this may make them more irritable.

There are also practical concerns when bringing a new life into this world, such as being prepared financially for an addition to the family or living on one income, if a woman decides not to work outside the home.

Pregnancy can be an exciting time but it's also very stressful, and that can cause emotions to run high. It is advised that women should be aware of their thoughts and feelings, and also find a place to talk about them and work through them. Here are some common emotions a woman may experience during her pregnancy and after she delivers:

Mood swings

Pregnancy is a transition point in a woman's life and during any time of transition, a person's emotions can be up and down. Whether it's described as moodiness, irritability or crabbiness, pregnancy can bring a roller coaster of emotions. Some women's emotions don't change that much when they are expecting, but it's not unusual for women to have mood swings, especially during the early and late stages of pregnancy.

It's not entirely clear why these mood changes occur because a number of different changes are happening in a woman's body at this time, and they are all tied in to her emotions. One probable reason may be a flood of hormones. Some women are sensitive to changes in estrogen, while others are affected by increases in progesterone or rising levels of stress hormones.

Fear

Fear is another common emotion during pregnancy. In the first trimester, a woman might be afraid of having a miscarriage or doing something that will affect her baby's health; in her second trimester, she might start to question whether she will be a good mother and be frightened by the enormous responsibilities of caring for a newborn. By the end of her pregnancy, a woman might be scared of the pain of labor or that something could go wrong during delivery.

Having some fear is normal, but a woman needs to recognize when a fear is getting stuck in her head or whether she can cope with it.

Anxiety

Often anxiety and fear can go hand in hand and the fear of uncertainty that often comes with pregnancy can lead to anxious thoughts.

Anxiety is a normal emotion and people have it for a reason. On a biological level, both the anxiety and fear systems in the brain ramp up during pregnancy, which helps make sure that a woman keeps her baby safe, cared for and protected after she gives birth. If a woman has had anxiety in the past, she is more at risk of having it during her pregnancy because of the high levels of stress going on.

Forgetfulness

The mental fogginess and occasional memory lapses that cause a woman's keys to be misplaced and cell phone to go missing has sometimes been described as "pregnancy brain" or "baby brain." (These same symptoms are referred to as "mommy brain" or "momnesia" after giving birth.)

Some research has suggested that fuzzy thinking and forgetfulness before and after birth may be a result of hormonal fluctuations, especially higher levels of progesterone, sleep deprivation or the stress of adjusting to a major life transition.

There's some evidence that the hippocampus, the part of the brain involved in memory, may change during pregnancy. With all that's going on in a woman's body and mind when she is pregnant, it makes sense that she may not be remembering some things, but it might be that a mother-to-be is prioritizing things differently and doing more multitasking.

Weepiness

Some women may find themselves crying at a sappy pet commercial, bursting into tears after throwing up in early pregnancy, or getting misty eyed after looking at baby clothes.

Women may cry more easily and frequently when they're expecting and in the early stages of new motherhood because pregnancy involves a complex mix of emotions, and as humans, sometimes tearfulness is how our emotions come out, and such fluctuating hormone levels may contribute to crying spells.

If a woman has been crying a lot and it doesn't seem to let up, it may be a symptom of depression.

Body image issues

During the second and third trimesters, as a woman's baby bump becomes more visible and she gains more weight, she may feel dissatisfied with her body and its appearance, and this may affect her self-esteem.

Some pregnant women marvel at their rapidly changing bodies and feel radiant and vibrant, while others worry about the weight gain and regaining their figures after delivering. These changes to a woman's looks, shape and perceived attractiveness may bring up a complicated mix of feelings.

Nesting instinct

Research has shown that there are changes in the brain of pregnant women wherein towards the end of pregnancy, the reward system in the brain ramps up in preparation for the baby's arrival, and this helps make parenting a rewarding experience.

There are also social activities and preparations for motherhood, such as attending a baby shower, baby-proofing the house and decorating the nursery, which can all lead to a nesting instinct. Some women may feel a strong urge to cook, clean and organize during the third trimester as a way to mentally prepare for the major changes a new baby will bring and to feel more in control of the situation.

Postpartum depression

It was once thought that being pregnant was protective against depression and also prevented other psychiatric illnesses because of high estrogen levels, but now its known that this is not the case. A pregnant woman has a similar risk of becoming depressed as a woman who is not having a baby.

The postpartum period is a particularly vulnerable time for women, especially for depression. The risk for postpartum depression may increase due to a sharp drop in estrogen and progesterone after giving birth and also because a new mother may not be sleeping or eating well.

In the first few days after giving birth, up to 80 percent of women may experience the "baby blues," which includes symptoms such as feeling sad, anxious, moody, weepy or overwhelmed, difficulty sleeping and a lack of appetite. These symptoms usually go away two weeks after delivering.

But if a woman has more severe symptoms that last more than two weeks, such as feeling numb, extremely sad or angry, or lacking interest in her baby, or she is having thoughts that life is not worth living or of hurting her baby, she needs to reach out and seek help. These are all signs of postpartum depression. Mothers who have just had a baby need to make time for self-care, whether that means taking a shower or going for a walk. What's really important when taking care of others is to make sure a woman builds in some time to take care of herself.

For women who are experiencing depression or anxiety before or after their baby is born, there is a mix of treatments for these medical conditions, including talk therapy, support groups as well as safe medications.

How can you manage such emotions?

Try to remind yourself that emotional upheaval is normal right now. That said, making a conscious effort to nurture yourself can help you stay on an even keel during turbulent times.

Take it easy. Resist the urge to tackle as many chores as you can before the baby comes. You may think you need to stencil bunnies on the nursery walls, reorganize all the closets, or put in serious overtime before going on maternity leave, but you don't. Put yourself at the top of your to-do list instead. After all, pampering yourself is an essential part of taking care of your baby.

Bond with your partner. Expressing how you're feeling while reassuring your partner of your love will go a long way toward nurturing your relationship. Make sure you're spending plenty of time together, and even go on a vacation if you can. Strengthen your connection now, so you can really be there for one another after the baby comes.

Do something that makes you feel good. This might mean carving out some special time for you and your partner. Or it might mean taking time alone to do something just for you: Take a nap, go for a walk, get a prenatal massage, or see a movie with a friend.

Talk it out. Air your worries about the future with understanding friends. Just putting your concerns into words often helps you get a handle on them or gives you insight into solutions. Keep the lines of communication open between you and your partner, and make it a two-way street: In addition to pouring out your feelings, listen to your partner, too.

Manage your stress. Rather than let the frustration in your life build up, find ways to decompress. Get plenty of sleep, eat well, exercise, and have some fun. Identify sources of stress in your life and change what you can, such as trimming your to-do list. If you still find that anxiety is creeping in, try taking a pregnancy yoga class, practicing meditation or other relaxation techniques, or consulting a professional counselor.

What if I can't shake my moodiness?
If your mood swings are becoming more frequent or more intense, or if they last longer than two weeks, talk to your practitioner and ask for a referral to a counselor. If you notice that your anxiety is interfering with your ability to function in your daily life, you may be suffering from an anxiety disorder. And if your mood swings become more frequent and intense, you may have bipolar disorder, a condition in which you alternate between periods of depression and mania.

If you suspect that you have any of these conditions, it's crucial to get professional help and treatment while you're pregnant because any untreated emotional health problems can affect your baby's physical well-being and increase your risk of preterm labor and postpartum depression. Both psychotherapy and medication can be very effective for treating these conditions so that you and your baby can be well during pregnancy and afterward.

Get Yourself Immunized First to Immunize Your Baby!

Congratulations on your pregnancy! You're eating right, getting extra rest and taking your prenatal vitamins. After all, you want to do everything you can to ensure a healthy baby! But have you given any thought to protecting yourself and your baby against infection? 

The vaccines you get before and during pregnancy not only play an important role in protecting your health but safeguard your baby's health too. Your immunity is your baby's first line of defense against certain serious illnesses. So if you're pregnant or planning a pregnancy, now is the time to make sure your vaccinations are up to date.

But not all vaccines are safe to get during pregnancy. Vaccines come in three forms: live virus, dead virus, and toxoids (harmless, chemically altered proteins drawn from bacteria). Pregnant women shouldn't get live virus vaccines, such as the combined measles, mumps, and rubella vaccine (MMR), because there's a slight chance these will harm the unborn baby. Vaccines made from dead viruses, such as the flu shot, and toxoid vaccines, such as the tetanus/diphtheria/pertussis (Tdap) shot, are safe. Here's a rundown of what you need to know about vaccinations before, during, and after pregnancy.

The Shots which are Safe during Pregnancy?

The Tetanus Toxoid (TT) vaccine is given during your pregnancy to prevent the risk of tetanus to you as well as your unborn baby. Tetanus is a life-threatening bacterial disease that is caused by the toxin of a bacterium called Clostridium tetani.

Tetanus bacteria enter the body through an open wound. It affects a person's nervous system and can be fatal if left untreated. It is preventable through immunisation. Antibodies formed in your body, after the vaccination, are passed on to your baby and protect her as well for a few months after birth.

Pregnancy Recommendations

In your first pregnancy, your doctor will recommend at least two doses of the TT vaccine, the first dose in the third trimester, usually in the seventh month of pregnancy and the second dose is given at least four weeks after the first. Some doctors prefer to give three doses that are four weeks apart, starting at 28 weeks of pregnancy. If your second pregnancy is within two years of your first, your doctor will check your vaccination history. If you received both TT vaccines in your previous pregnancy, she will recommend only a booster dose. If there is a larger gap between your first and second pregnancy your doctor will assess your situation and decide the schedule for you.

Flu shot: Flu shot for all women who got pregnant during the flu season, which is November through March is highly recommended. The flu shot is made of dead viruses, so it's safe for both you and baby. But FluMist, a nasal-spray vaccine made from live viruses should be completely avoided.

The best time to get a flu shot is in October or November, before the flu season is in full swing. And because flu strains change every year, the vaccine does too -- so don't rely on last year's shot to get you through this year's season.

Moms-to-be who come down with the flu, especially during the second half of pregnancy, are more likely than other women to suffer severe symptoms or complications such as pneumonia. Even a moderate case of the flu can make you feel miserable, resulting in fever, headaches, muscle pain, sore throat, and coughing. Most of these symptoms last about four days, although coughing and fatigue can drag on for two weeks or longer.

If you do get the flu, contact your doctor, get plenty of rest, and drink lots of fluids. Tell your doctor if you're not feeling better after several days or if you have trouble breathing, as this can be a sign of more serious complications such as pneumonia.

Fortunately, although the flu can be a real drag for you, it's unlikely to harm your baby.

Tetanus/diphtheria/pertussis shot (Tdap) : Tdap can be given at any point during pregnancy, though the preferred time frame is between 27 and 36 weeks of gestation. The vaccine is made with toxoids, so it's safe to get during pregnancy.

Tetanus, also called lockjaw, is a disease of the central nervous system that causes painful muscle spasms and convulsions. The bacterium that causes tetanus can be found in soil and in animal waste. It can enter the bloodstream through a cut in the skin, so follow up with your doctor if you get a deep or dirty wound. If contracted during pregnancy, tetanus can cause fetal death.

Diphtheria is a respiratory infection that can cause breathing problems, paralysis, coma, and even death. It's now rare in today’s time, but you need a booster shot every 10 years; otherwise your immunity is likely to wane.

Pertussis, an extremely contagious bacterial disease, can be fatal in infants and is characterized by a deep, hacking cough and a high-pitched "whoop" sound.

What Other Vaccines Should You Consider Before or During Pregnancy?

Your job or lifestyle can make you more susceptible to specific illnesses, as can certain chronic health conditions, such as diabetes. If you fall into one of these categories, your doctor may recommend additional vaccinations before or during pregnancy.

Hepatitis B vaccine: It's safe to get this shot when you're pregnant, and if you're a healthcare worker or you live with someone who has the disease, consider vaccination.

Hepatitis B is a viral infection that causes liver inflammation, nausea, fatigue, and jaundice (yellowing of the skin and eyes). In some cases, it can cause chronic liver disease, liver cancer, and death. A pregnant woman with hepatitis B can pass the infection to her baby during delivery, and without prompt treatment, the baby has a high risk of contracting serious liver diseases as an adult.

“The CDC recommends that all pregnant women be screened for hepatitis B because it's possible to have it without knowing.”

Hepatitis A vaccine: This vaccine protects against a liver disease that spreads through contaminated food or water. Symptoms include fever, fatigue, and nausea. It isn't usually as serious as the B version of the disease, and the illness won't affect an unborn baby most of the time. In rare cases, hepatitis A may contribute to premature labor and infection in the newborn.

If you're traveling to a developing country or if you work with the virus in a laboratory setting, you should discuss vaccination with your doctor.

Pneumococcal vaccine: If you have a specific chronic condition, such as diabetes or kidney disease, your doctor may recommend the pneumococcal vaccine, which protects against some forms of pneumonia.

What Vaccines Should You Get Post-Pregnancy?

Now is the time to catch up on any vaccines you may have been unable to get during pregnancy or before becoming pregnant, such as the MMR and chickenpox vaccines. Moms who are breastfeeding can get vaccinated according to a normal adult vaccination schedule.

As mentioned above, if you're due for a Td booster and didn't get one during pregnancy, the latest recommendation is to get Tdap, which includes pertussis, also known as whooping cough.

What If you're Allergic to a Vaccine?

Serious reactions to vaccines are rare. However, your doctor may tell you to skip certain shots if you have an allergy to a substance they contain. Those who are allergic, for example, to baker's yeast (used in making bread) shouldn't get the hepatitis B vaccine; those with a severe egg allergy should avoid the flu shot; and people with a severe allergy to gelatin shouldn't get the measles, mumps, and rubella or varicella vaccine. If you're skipping any shots, you should discuss alternate ways to prevent illness with your doctor.

Anti D Vaccine

Most people are rhesus-D positive, which means the surface of their red blood cells contains a protein called the D antigen. But others might be rhesus negative or known as RhD negative.

If you are RhD negative but your baby has inherited a rhesus positive status from its father, then your blood and your baby's blood may be incompatible. If your blood then comes into contact, an immune response is triggered and you will develop antibodies that fight against your baby's blood as though it were a foreign invader. This process is called sensitisation. It's unusual for maternal and foetal blood to mix during pregnancy, and sensitisation does not normally occur until birth. But once the antibodies are created, they do not leave your blood system and so, if you have a second pregnancy where your baby is rhesus positive, the antibodies can cross the placenta and attack and destroy the baby's blood cells causing rhesus disease.

The good news is that there is a simple way to prevent sensitisation during pregnancy. Anti-D immunoglobulin can be given whenever there is a risk of sensitisation (such as after a fall, bump or invasive medical procedures). It can also be given routinely in the third trimester for all women who are RhD negative. Anti-D neutralises the D antigen in foetal blood so maternal blood (ie yours) does not detect it and produce antibodies to fight it.

After your baby is born, a blood sample from the umbilical cord can be taken and tested for the D antigen. If the baby is RhD positive, another anti-D injection should be given within 72 hours to minimise the risk of sensitisation.

Pregnancy and Exercise: Mommy “I want to move”

Exercising during pregnancy can help “would be mothers” to stay in shape and prepares her for labor and delivery. Though, pregnancy seems a perfect time to sit back and relax as you might feel more tired than usual, your back might ache, and your ankles might be swollen. But guess what? There's more to pregnancy and exercise than skipping it entirely. Unless you're experiencing serious complications, sitting around won't help. In fact, pregnancy can be a great time to get active — even if you haven't exercised in a while.

Why exercise during pregnancy?

During pregnancy, exercise can:

  • Ease or prevent back pain and other discomforts.
  • Boost your mood and energy levels.
  • Help you sleep better.
  • Prevent excess weight gain.
  • Increase stamina and muscle strength.

Exercise during pregnancy might also reduce the risk of gestational diabetes and pregnancy-related hypertension and might help in reducing the symptoms of postpartum depression. In addition, it might reduce the risk of fetal macrosomia (a condition in which the baby weight exceeds more than 8 pounds or 4000g). 

Pregnancy and exercise: Getting the “OK” from your doctor

Before you begin an exercise program during pregnancy, ensure an “ok” from your doctor. Although exercise during pregnancy is generally good for both mother and baby, your doctor might advise you not to exercise if you have any of these conditions: 

  • Some forms of heart and lung disease.
  • Pregnancy-related high blood pressure.
  • Cervical problems.
  • Vaginal bleeding.
  • Risk factors for preterm labor such as history of preterm labor or multiple pregnancies.

How to commence

For most pregnant women, at least 30 minutes of moderate exercise is recommended at most, if not all, days of the week.

Walking is recommended as a great exercise for beginners as it provides moderate aerobic conditioning with minimal stress on the joints. Other good choices include swimming, low-impact aerobics and cycling on a stationary bike. Strength training is also OK as long as lifting very heavy weights is avoided.

Remember to warm up and cool down. Drink plenty of fluids to stay hydrated, and be careful to avoid overheating. The pregnant woman should be able to carry on a conversation while exercising and if speaking normally is not possible while working out then it suggests that she is probably pushing herself too hard.

Follow these guidelines:

  • If you haven't exercised for a while.

Begin with as little as five minutes of physical activity a day and gradually build up to 10 minutes, 15 minutes, and so on, until you reach at least 30 minutes a day.

  • If you exercised before pregnancy.

You can probably continue to work out at the same level while you're pregnant — as long as you're feeling comfortable and your doctor says it's OK.

 

 

 

 

Prenatal Tests @ Second Trimester

It's the second trimester, and you've known you are pregnant for some time now. But what can you expect yourself? What tests will you get during the fourth, fifth and sixth months of pregnancy? At an early prenatal visit, you may be asked if you would like genetic testing. Or, if you are aware of a genetic condition in your family or your partner's, you or your partner may opt to get tested before conceiving. Also, your health care professional will talk with you about a variety of prenatal tests to assess the health of the fetus. It's up to you which ones you have done or want to do. For instance, if you have no intention of terminating the pregnancy if the tests do find a problem, you may want to skip them. However, even then, you may want to have the test so you can prepare yourself emotionally for the possibility of having a special-needs child.

While the tests may get a bit more complicated, it is only because your baby is getting more complex. He or she is growing steadily, forming features that are some combination of you and your mate. While you may have gotten an initial ultrasound during the first trimester to confirm your baby's basic health, it is during the second trimester that an ultrasound may confirm whether your baby is a boy or a girl. Also, this ultrasound will probably be the first in which you can see your baby's features in profile.

Remember, although there is a slight risk of complications with some of these tests, they are routinely
performed to help ensure good health for you and your baby. Talk to your health care provider to learn more details about the risks and benefits of these prenatal exams.

There are two types of prenatal tests:

  1. Screening tests
  2. Diagnostic tests

Prenatal screening is meant to identify women at an increased risk for the pregnancy to be affected by a disease and Diagnostic prenatal testing is used to confirm whether or not a pregnancy is affected by a given condition.

Serum screening test: This is performed with a blood sample and is usually done between weeks 15 and 18 of the pregnancy (as measured from the start of the most recent menstrual period). The test estimates your risk of having a baby with:

  • An open neural tube defect. When the neural tube fails to close, the baby is born with an opening in the head (anencephaly) or spinal cord (spina bifida). Babies with anencephaly are stillborn or die soon after birth; those with spina bifida need surgery and may be paralyzed. The severity of spina bifida can vary greatly. One way to reduce your risk of having a child with a neural tube defect is to take folic acid (400 micrograms per day) before conception.
  • Down syndrome (also called trisomy 21). An extra copy of chromosome 21 causes Down syndrome characterized by mental retardation, certain facial features and sometimes heart defects.
  • Trisomy 18. An extra copy of chromosome 18 causes this syndrome, which usually proves fatal during the first year of the baby's life and is associated with severe mental retardation

The blood screen also known as triple test does not look directly at genetic material but instead measures four substances— alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin and Inhibin A—to determine whether you are at increased risk of having a baby with one of these disorders. During the second trimester, you will probably be encouraged to take a so-called triple test, a blood test that checks these three hormone and the protein levels (Inhibin A) in your blood. It is quick and relatively painless, involving nothing more than giving a vial of blood. A similar exam called the quad test may also be performed at that time.

An important part of the triple test is the alpha-fetoprotein screening (MSAFP) test. The MSAFP, which is usually performed between weeks 15 and 20, checks the level of alpha-fetoprotein in your bloodstream. Alpha-fetoprotein is a key indicator of fetal health. All women are typically given this test; it is not just
for at-risk pregnancies. If your triple test results come back abnormal, you will be offered an amniocentesis to provide more definitive results. Both tests are typically taken between the 15th and 20th weeks of pregnancy.

A key fact to remember is that this test does not diagnose the disorders—it only screens for the substances and shows if there is an increased risk of a disorder. Further testing is always suggested to make a diagnosis.

Nuchal translucency screening test: A newer type of prenatal screening test that can be done in the first trimester is becoming much more common, although it's still not offered everywhere. This test assesses the risk for the fetus to have Down syndrome or trisomy 18. The first trimester screening has two parts and both should both be performed between weeks nine and 13 of gestation. One part tests levels of maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in the mother's blood. The other measures the nuchal thickening (measure of fetal neck thickness) through a specialized ultrasound. This test detects 85 percent of fetuses with Down syndrome and approximately 90 percent with trisomy 18.

However, remember that it is a screening test and still requires a confirmatory chorionic villous sampling (CVS) or amniocentesis to make the definite diagnosis. However, the primary benefit of this screening test is that it can be performed earlier in the pregnancy and is much less invasive than a CVS or amniocentesis.

Next steps after receiving abnormal screening results

A screening test does not diagnose a condition. It should not be used to make decisions for treatment or pregnancy termination, but rather should be used to determine whether the mother wishes to have diagnostic prenatal testing performed.

If a screening test indicates a higher-than-average risk, your health care professional may want to perform a basic ultrasound, which can help determine the gestational age of the fetus and show if a woman is carrying twins. If either of these factors accounts for the abnormal screen test result, no further testing is needed. Otherwise, a more detailed ultrasound examination may be performed, which allows a look at the baby's brain and spinal cord, as well as other parts of the body. This ultrasound can often identify an open neural tube defect or other malformation associated with an abnormal screening test.

Your health care provider may suggest you consider either amniocentesis or CVS. Both are diagnostic tests to determine whether the fetus actually has the disorder in question.

Amniocentesis is performed more frequently and should be the choice if you're at risk for having a child with neural tube defects (CVS doesn't detect neural tube defects).

Amniocentesis
It is not recommended for all women—mainly due to the fact that the test is invasive and carries a small risk of miscarriage—but it is generally administered to those who are at increased risk for genetic and chromosomal problems. This prenatal screening enables your health care professional to examine fetal cells in the amniotic fluid for any chromosomal abnormalities.

If you are 35 or older when you're due to have your baby, your health care professional will likely discuss the risks of chromosomal abnormalities based on your age and recommend this test. That's because women over 35 have a higher risk of having a baby with Down's syndrome.

An amniocentesis is also recommended if you've already had a child with certain birth defects, or if you have a family or personal history that puts you at risk for certain inherited diseases. You might choose to have this test if you had abnormal blood tests that suggest there might be a problem.

Amniocentesis can diagnose numerous conditions, but as these tests are very expensive, so talk with your health care professional about which ones are necessary based on your history and risk factors.

During an amniocentesis, the doctor inserts a needle through your abdomen into the amniotic sac and removes a small amount of amniotic fluid. The doctor uses ultrasound to guide the needle and avoid inserting it into the placenta. The test can be performed on an outpatient basis in a health care professional's office or in a hospital.

It can be done at any gestational age after 11 weeks, but when it's performed for genetic studies, amniocentesis is usually done between 15 and 17 weeks

If you have amniocentesis, a doctor will use a needle to withdraw a sample of amniotic fluid (the fluid surrounding the fetus) for analysis. The procedure is typically performed during the second trimester, at 15 to 18 weeks.

Amniocentesis or CVS is offered for high-risk pregnancies, which could include any of the following: 

  • you will be 35 years of age or older at delivery
  • your family has a known genetic disorder
  • you have had a previous child with a birth defect
  • you and your partner are carriers of the same recessive disorder
  • other indications as directed by your obstetrician

CVS: It is performed at 10 to 12 weeks of gestation and involves analyzing a sample of placental tissue. A thin tube inserted through the vagina and cervix, or the abdomen, and is used to suction out a small tissue sample from the placenta. However, unlike amniocentesis, CVS cannot be used to test for neural tube defects, such as spina bifida and anencephaly. Therefore, it's usually recommended that a woman undergoing CVS also have the prenatal blood test called the maternal serum alpha fetoprotein (MSAFP) screening test, at about 16 to18 weeks of pregnancy.

CVS is more attractive to some women because it can be done earlier than amniocentesis. Amniocentesis and CVS can be used to prenatally diagnose many, but not all, genetic disorders. 

“Every prenatal screening and diagnostic test has its benefits, risks and limitations. It is very important to discuss these testing options with your doctor and, if possible, a genetic counselor.”

The ideal time for many tests is of course before you get pregnant. If you are planning a pregnancy, preconception genetic counseling can be quite helpful because it offers an opportunity to make decisions without the pressure of an advancing pregnancy. Potential risks for the planned fetus can be identified and testing strategies can be pursued.

Anemia of Pregnancy

Anemia is a medical condition in which there is not enough healthy red blood cells to carry oxygen to the tissues in the body. When the tissues do not receive an adequate amount of oxygen, many organs and functions are affected. Anemia during pregnancy is especially a concern because it is associated with low birth weight, premature birth and maternal mortality.

During pregnancy, the body produces more blood to support the growth of your baby. If you're not getting enough iron or certain other nutrients, your body might not be able to produce the amount of red blood cells it needs to make this additional blood. It's normal to have mild anemia when you are pregnant. But you may develop severe anemia from low iron or vitamin levels or from other reasons.

Anemia can leave you feeling tired and weak. If it is severe but goes untreated, it can increase your risk of serious complications like preterm delivery.

Here's what you need to know about the causes, symptoms, and treatment of anemia during pregnancy.

Types of Anemia during Pregnancy

Several types of anemia can develop during pregnancy. These include:

  • Iron-deficiency anemia
  • Folate-deficiency anemia
  • Vitamin B12 deficiency

Here's why these types of anemia may develop:

Iron deficiency anemia- Iron deficiency is the most common cause of anemia in pregnancy.

Iron is a mineral found in the red blood cells and is used to carry oxygen from the lungs to the rest of the body, as well as helps the muscles store and use oxygen. This type of anemia occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin. That's a protein in red blood cells which carries oxygen from the lungs to the rest of the body. When too little iron is produced, the body can become fatigued and have a lowered resistance to infection. 

In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout the body.

Folate deficiency anemia- Folate is the vitamin found naturally in certain foods like green leafy vegetables A type of B vitamin, the body needs folate to produce new cells, including healthy red blood cells.

During pregnancy, women need extra folate. Folic acid is a common supplement taken by pregnant women, but it can also be found in fortified foods such as cereals, leafy vegetables, bananas, melons, and legumes. A diet lacking folic acid can lead to a reduced number of red blood cells in the body, therefore leading to a deficiency. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body.

Folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities (spina bifida) and low birth weight.

Vitamin B12 deficiency- The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead to preterm labor.

Symptoms of Anemia during Pregnancy

Symptoms of anemia during pregnancy can be mild at first and often go unnoticed. However, as it progresses, the symptoms will worsen. It is also important to note that some symptoms can be due to a different cause other than anemia, so talking with your doctor is important.

The most common symptoms of anemia during pregnancy are:

  • Pale skin, lips, and nails
  • Feeling tired or weak
  • Dizziness
  • Shortness of breath
  • Rapid heartbeat
  • Trouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the symptoms are ones that you might have while pregnant even if you're not anemic. So be sure to get routine blood tests to check for anemia at your prenatal appointments.

Risks of Anemia in Pregnancy

Severe or untreated iron-deficiency anemia during pregnancy can increase your risk of having:

  • A preterm or low-birth-weight baby
  • A blood transfusion (if you lose a significant amount of blood during delivery)
  • Postpartum depression
  • A baby with anemia
  • A child with developmental delays

Untreated folate deficiency can increase your risk of having a:

  • Preterm or low-birth-weight baby
  • Baby with a serious birth defect of the spine or brain (neural tube defects)
  • Untreated vitamin B12 deficiency can also raise your risk of having a baby with neural tube defects.

Risk Factors for Anemia in Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual. But the risk is higher if you:

  • Are pregnant with multiples (more than one child)
  • Have had two pregnancies close together
  • Vomit a lot because of morning sickness
  • Are a pregnant teenager
  • Don't eat enough foods that are rich in iron
  • Had anemia before you became pregnant 

Tests for Anemia

During your first prenatal appointment, you'll get a blood test so your doctor can check whether you have anemia. Blood tests typically include:

  • Hemoglobin test. It measures the amount of hemoglobin an iron-rich protein in red blood cells that carries oxygen from the lungs to tissues in the body.
  • Hematocrit test. It measures the percentage of red blood cells in a sample of blood.

If you have lower than normal levels of hemoglobin or hematocrit, you may have iron-deficiency anemia. Your doctor may check other blood tests to determine if you have iron deficiency or another cause for your anemia.

Even if you don't have anemia at the beginning of your pregnancy, your doctor will most likely recommend that you get another blood test to check for anemia in your second or third trimester.

Treatment for Anemia

If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.

In addition, you'll be asked to return for another blood test after a specific period of time so your doctor can check that your hemoglobin and hematocrit levels are improving.

To treat vitamin B12 deficiency, your doctor may recommend that you take a vitamin B12 supplement.

The doctor may also recommend that you include more animal foods in your diet, such as: meat, egg, dairy products.

Preventing Anemia

To prevent anemia during pregnancy, make sure you get enough iron. Eat well-balanced meals and add more foods that are high in iron to your diet.

Aim for at least three servings a day of iron-rich foods, such as:

  • lean red meat, poultry, and fish
  • leafy, dark green vegetables (such as spinach, broccoli, and kale)
  • iron-enriched cereals and grains
  • beans, lentils, and tofu
  • nuts and seeds
  • eggs

Foods that are high in vitamin C can help your body absorb more iron. These include:

  • citrus fruits and juices
  • strawberries
  • kiwis
  • tomatoes
  • bell peppers

Try eating those foods at the same time that you eat iron-rich foods. For example, you could drink a glass of orange juice and eat an iron-fortified cereal for breakfast.

Also, choose foods that are high in folate to help prevent folate deficiency. These include:

  • leafy green vegetables
  • citrus fruits and juices
  • dried beans
  • breads and cereals fortified with folic acid

Follow your doctor's instructions for taking a prenatal vitamin that contains a sufficient amount of iron and folic acid.

Vegetarians and vegans should talk with their doctor about whether they should take a vitamin B12 supplement when they're pregnant and breastfeeding.

Getting Ready For a New Change!

Getting a healthy start on your pregnancy can do a lot to ensure that you have a smooth nine months ahead of you. The earlier you find out that you are pregnant, the better. Taking a pregnancy test is the only surefire way to know, but there are earlier signs of pregnancy that can help you decide if you should take the test!

You may have missed a period or perhaps observing spotting or bleeding between six and 12 days after conception which hints towards the embryo becomes implanted in your uterine wall. This is known as implantation bleeding and is one of the first signs of pregnancy.



After that, your periods will likely become delayed or stop altogether. This is when most women suspect pregnancy. However, some women continue to experience bleeding even while pregnant, though it is rarely like a normal period. Because of that, you shouldn't wait for menstruation to end as the only sign you need a pregnancy test.

You may notice that your breasts are tender, sore, tingly or fuller than usual. This usually sets in one or two weeks after conception. Additionally, your areolas—or the skin around your nipples—may become darker due to hormonal changes.

Morning sickness is another telltale sign of pregnancy. This can occur two to eight weeks after implantation. Nausea tends to happen because elevated hormone levels may cause food to empty the stomach slowly. Also, pregnancy may make you more sensitive to smells, making certain odors more likely to trigger nausea.

If you've been feeling overwhelmingly sleepy or tired lately, this may be a symptom that you have successfully conceived. While it's true that many conditions or factors can cause fatigue, pregnant women tend to experience this due to changes in hormone levels, blood sugar, blood pressure and higher blood production.

You've probably heard that pregnant women have strange food cravings, and this is no wives' tale. Like many other symptoms of pregnancy, your unusual cravings can be chalked up to fluctuating hormones. Conversely, these changes may cause aversions to certain foods or beverages, such as coffee or fatty foods. Keep in mind that every pregnancy is different and you may or may not experience the symptoms mentioned here.

What’s there in second phase?

Now that your fertilized egg has made its way to your uterus, things are really starting to get interesting!

This cluster of cells is dividing into two parts: one that will form an embryo and the other a placenta. The embryo will eventually turn into a fetus, but for now it's about the size of a very small freckle, and the amniotic sac is forming around it. Encapsulating the tiny new life is the placenta, which will help deliver nutrients to your developing baby and carry away waste.

Embryos have three layers, which will ultimately make up specialized organs and body parts. The innermost layer is the endoderm. This part will become your child's digestive system, liver and lungs. The second layer is the mesoderm, and it is the early stages of a heart, sex organs, bones, kidneys and muscles. The outermost layer is known as the ectoderm, which will comprise the nervous system, skin, hair and eyes.

As all of these important little details are developing, you may just now be suspecting that you’ve successfully conceived. Because you're going to need a doctor to confirm your pregnancy even after receiving a positive at-home test, week four may be a good time to choose a health care professional.

Choosing a health care professional is an important decision, so you may want to talk to family and friends about their recommendations, as well as conduct interviews with prospective health care providers.

HOW FAR ALONG ARE YOU?

OK, now that you've calmed down some from the initial excitement, wiped out the pregnancy shelf at your local bookstore, and made a down payment on a new maternity wardrobe, it's time to focus on the most important thing here: your health and the baby's health.

Your first assignment: Pick up the phone and call your doctor, nurse practitioner, or midwife—whomever you plan to see throughout your pregnancy and delivery—and make an appointment. It's time to begin prenatal care!

It is observed that babies of mothers who don't get prenatal care are three times more likely to have a low birth weight and five times more likely to die than babies born to mothers who do get care. Need any better reason?

The First Visit and Beyond

In a normal pregnancy, you will see your health care professional every month until about the sixth month; then every two weeks during the seventh and eighth months, and then weekly until labor.

During the first visit, your health care professional will take a full health history, including a history of any previous pregnancies. You will also receive a full physical exam, including a pelvic exam and Pap test in most cases, and will be weighed and measured and have your blood pressure taken. Your health care provider should also test for any sexually transmitted infections.

You will get a due date, officially called the "estimated date of delivery," typically 266 days from the first day of your last period if you have regular menstrual cycles. Otherwise it is customary to assign the due date based on ultrasound.

During every future visit, you will be weighed, have your belly measured and blood pressure taken, have your urine tested for protein or sugar (signs of potential complications), and, most exciting, hear your baby's heart beat.

First Trimester Issues

So how are you feeling? If you're like most women, the answer is exhausted and nauseous. Let's deal with the fatigue first.

Do you have any idea what your body is doing right now? It is building a home that can nourish and protect that baby for the next nine months—that is, the placenta. This is really hard work. It takes a lot of energy—your energy. So stop being superwoman for once and listen to what your body is telling you.

That means :

  • Napping on the weekends and when you get home from work.
  • Slowing down at work if possible.
  • Putting your feet up as much as possible.
  • Turning over housework, cooking, errands, etc., to your partner, friend or a professional agency—or just letting things go for a while.

 

Now, about that nausea or morning sickness, which is not confined to morning only, but for many women it lasts all day. You may never throw up—just feel like you're occasionally (or continually) seasick—or you may throw up every morning as soon as your feet hit the floor. Don't worry! This is normal. There is even some evidence that the nausea is nature's way of protecting the baby from potentially harmful foods. Most morning sickness disappears by the end of the first trimester.
Until then:

  • Eat small meals throughout the day so you're never too full or too hungry.
  • Avoid rich, spicy, greasy or fatty foods, and foods whose smells bother you.
  • Eat more carbohydrates (plain baked potato, white rice or dry toast).
  • Eat bland foods when you feel nauseous (saltine crackers, gelatin desserts, popsicles, chicken broth, ginger ale). Keep some crackers by your bed and eat one before you get up.
  • Use acupressure wristbands.
  • Take additional vitamin B6 (25 mg three times a day), which some studies find can help with nausea.
  • If your prenatal vitamins make your nausea worse, talk to your health care provider about prescribing a vitamin without iron.

Some women experience a severe form of morning sickness called hyperemesis gravidarum. If you experience any of the following, you may have more than just "morning sickness" and should call your health care professional:

  • You have lost more than two pounds
  • You vomit blood (which can appear bright red or black)
  • You have vomited more than four times in one day
  • You have not been able to keep fluids down for more than one day 

Eating Right throughout Pregnancy 

You know you're supposed to follow a "healthy" diet during pregnancy (think lots of fruit and veggies, low-fat forms of protein, high fiber, etc). But do you know why?

Beyond the obvious—maintaining enough calories to keep you healthy and ensure the baby keeps growing—we're learning that in-utero nutrition, including whether the mother is overweight or has pregnancy-related diabetes, can impact a child's health throughout his life.