pregnancy and childbirth
For general information regarding your stage of pregnancy
Soon after you suspect that you're pregnant, your body will confirm your suspicions. While the symptoms differ in each woman, here are nine early signs of pregnancy:
1. Fatigue – you no longer have stamina for usual activities, such as walking up a hill or staying awake until midnight. This is because your body is demanding huge amounts of energy to make the changes for pregnancy.
2. Nausea and vomiting – morning sickness may be confused with the flu or feeling like you're "coming down with something." You may feel queasy, have nausea all day long, or vomit and have dry heaves.
3. Missed menstrual period. While nonpregnancy-related issues, such as stress, can cause you to miss a period, this is a first sign of pregnancy, too.
4. Slight staining or spotting. Bleeding at the time of implantation can be mistaken for menstruation. Some women have bleeding in the early months of pregnancy at the time when they would have menstruated.
5. Aversions to odors, alcohol, and smoke. Once you are pregnant, baby-protective mechanisms click in. You will notice how coffee, alcohol, and cigarette smoke make you ill.
6. Food cravings. Once you become pregnant, you may mysteriously crave foods that you seldom ate before. Your tastes may change from sweet to salty or vice versa.
7. Breast changes. The changes are similar to premenstrual feelings in your breasts only more dramatic: nipples tingle, breasts feel tender and fuller, the areola begins to darken, and tiny glands on the areola enlarge.
8. Crampy pelvic discomfort. This discomfort may be felt throughout the lower abdomen and pelvis. (A sharp one-sided pain is not normal and your doctor should be notified.)
9. Frequent urination. From the beginning, you will urinate more often due to pregnancy hormones. (Later on, you will have frequent urination because of pressure on the bladder from the enlarging uterus.)
1. Hypersensitivity to odors. Certain strong smells—garlic, fish, or coffee—may "go right to your stomach," and trigger instant nausea. Some pregnant women complain that usual household odors that didn't bother them pre-pregnancy become intensely unpleasant.
- The family dog may smell more "doggy."
- A favorite perfume may turn your stomach.
- Favorite foods—broccoli, cauliflower, and fish—may set off the gag response.
- Normal masculine odors of your husband may repulse you.
2. Aversion to certain foods. Sometimes you will be unable to eat certain foods (meat, greens, milk) without gagging. At other times, only a few foods are palatable. Chances are your "cravings" will actually be for the few things you can stand to eat.
3. Afternoon, evening, or midnight sickness. The intestinal upsets of pregnancy can occur at anytime of the day or night and in any month of your pregnancy. The most common feelings include slight seasickness, feelings of breathlessness, dizziness, a sense of being suffocated, the dry heaves, and the full-blown whoopsies.
4. Constipation. Pregnancy hormones slow the action of your intestines. The slowing of your intestines plus their competition with the expanding uterus for room to work may leave you feeling constipated.
Finding Dr. Right is not always easy. Ideally, you want a doctor who views you as a participant during the birthing process—not as a patient. Before you choose this healthcare profession, consider the following:
- Talk to friends or other health-care professionals and ask for recommendations.
- Narrow your list to several candidates, and then make an appointment to interview these physicians. (Let the receptionist know this is for an interview only so you are not charged.) Be sure the candidates you choose are listed on your insurance plan.
- Visit this doctor with your spouse and bring a list of important questions you want to ask. Talk to office personnel when you get to the appointment. Ask about the doctor's call schedule, vacation plans, accepted insurance plans, fees, hospital affiliations, and if the doctor is in solo practice, who covers for him or her.
- If there is time, chat with expectant moms in the waiting room to get a sense of the doctor's birthing philosophies.
- As you leave the interview, make sure you will have an "informed partnership." You want to know how this doctor approaches birth, and how the doctor manages birth. Is birth considered a healthy, normal process? Or is the doctor rigid and overly technical or medical in discussion and philosophy? Look for a balance between natural methods of pain control and medical management, as well as a supportive presence.
- Be flexible. Sometimes the unexpected happens during the birth process. Remind yourself that being able to "go with the flow" is vital to birthing a healthy baby.
1. What hospitals are you affiliated with? Some hospitals are high-tech, others are high-touch, still others are both.
2. What is your call schedule? Who covers for you, how often, and what are these doctors' birthing philosophies?
3. Can I exercise during pregnancy? If so, when should I slow down or stop?
4. How much weight can I safely gain? How much is too much?
5. Can I use a professional labor support person at the birth? Does your office provide referrals?
6. What is your recommended schedule for prenatal visits?
7. Do you believe in walking or changing positions during labor or will I be stuck in the horizontal position?
8. What are routine procedures during labor? Are ultrasound, intravenous fluids, and electronic fetal monitoring used?
9. What are your views on episiotomy? Is this routine or as needed?
10. What type of payment plan do you have? How does the insurance company participate?
If your pregnancy begins low-risk and stays that way, you may prefer a high touch, low-tech birth with a midwife. If you are in good health, had no complications with previous births, and the medical system in your community is set up for midwife-attended births, then this alternative may be a consideration. When interviewing a midwife, ask the following questions:
- Where did you receive your education in midwifery? Are you also a nurse?
- Are you certified and by whom? Are you licensed?
- How long have you practiced? How many births have you attended?
- May I have the names of several mothers as references?
- Who is your backup doctor? May I meet this person ahead of time?
- What percentage of time is this doctor called in to assist?
- How long will it take the doctor to get to me in case of emergency?
- Who covers if you are on vacation or with another mother?
- Do you carry a pager?
- At what point during labor do I call you?
- What arrangements do you have to transport a home birthing mother or baby to the hospital if necessary?
- Are you certified in newborn resuscitation?
- Are you experienced at manually turning a baby who is presenting in a posterior position?
- What are you fees? Is the doctor's fee included in the fee I pay you?
- Do you offer postpartum care?
Are You Really Pregnant? Take a Test and Find Out!Most hopeful moms-to-be want to know if they are pregnant. In most cases, you can know for sure as soon as one week after conception. When implantation occurs, the developing placenta begins to produce the hormone HCGChuman chorionic gonadotropin. This hormone is detectable as early as one week after conception in your blood and 7 to 10 days after conception in your urine.
The urine test is performed in your doctor's office or at home (if you follow the directions on a home pregnancy kit). A very early test may register negative if your body has not yet produced enough HCG to be detected. A repeat test a few days or week later may come out positive. By the way, a home pregnancy test is nearly 100 percent positive within 7 to 10 days after conception. Whether your test registers positive or negative, if you think you are pregnant, take care of yourself and your baby as if you were pregnant.
A few drops of blood can let you know if you are pregnant as early as one week after conception. This blood test is performed in your doctor's office or a laboratory. Within a day or two, you will have the final results. The test is nearly 100 percent accurate, depending on no laboratory error.
At some time during your pregnancy your doctor will mention a certain test, such as a blood test, an ultrasound, or an amniocentesis. You may wonder if this test is really safe or even necessary. You deserve answers to these questions! After all, you are a key partner in making these decisions. Here are some basic facts about three common tests.
The AFP screen is the most commonly available prenatal screening test for birth defects. AFP, a natural substance produced by baby's liver, normally enters the mother's bloodstream during pregnancy. Maternal levels of AFP are elevated if the mother is carrying a baby with a neural tube defect, NTD, (the vertebrae that normally enclose the spinal cord fail to develop), because AFP leaks out of an open spinal column. These defects include spina bifida (in which the spinal cord is not enclosed in the spinal column, often cause paralysis from the waist down) and anencephaly (in which baby's brain is either severely underdeveloped or doesn't develop at all). AFP levels are lower than normal if the baby has Down syndrome or another chromosomal defect.
The AFP screen is performed on a small amount of blood taken from the mother's arm. This common test is safe and is done between the sixteenth and eighteenth week of pregnancy. You will know the score within one week.
While the AFP screen is safe, it can be traumatic and lead to unnecessary worries. A confirmed positive test will be followed by other tests, which carry greater risks and anxiety, and in most cases, you find out there was nothing to worry about in the first place (or nothing you want to do about it anyway).
To decide whether or not to have a prenatal screening test for birth defects, consider these questions:Would the results matter to you?Would you change the course of your pregnancy? Are the results of the test going to create or alleviate anxiety?Would having the test or not having the test worry you more or less?Would knowing about a birth defect before hand dampen the joy of your pregnancy?If so, would it be better for you to have the time to prepare to handle a special needs baby?
Keep in mind that this screening is not very accurate. Ninety-five to ninety- eight percent of "positive high" or "positive low" AFPs turn out to be false (i.e., the baby has neither a chromosomal abnormality nor a neural tube defect). If your AFP test is abnormally high or abnormally low, your healthcare provider may recommend that you have further tests, such as an ultrasound and/or amniocentesis.
A new test, called the "triple screen" (also known as the "prenatal risk profile" or "expanded AFP"), is used to screen for birth defects. The triple screen measures the following:Maternal levels of AFPHCG, human chorionic gonadotropin, which is elevated if mother is carrying a baby with some chromosomal abnormalitiesStroll, a byproduct of the hormone estrogen, which is lower if mother is carrying a baby with some chromosomal abnormalities
The triple screen raises the accuracy from twenty-five percent with the AFP alone to 60 percent. The triple screen may detect 70 percent of Down syndrome babies in women over age thirty-five, and sixty percent in women under age thirty-five.
Amniocentesis provides a lot of valuable genetic information, but it is not without risk to mother and baby. Therefore, parents and practitioners must exercise a high level of responsibility in deciding whether or not to have this prenatal test.
This test tells a lot about the genetic makeup of your baby and reveals more common genetic defects. Amniocentesis is usually performed between the 12th and the 16th week, after the last menstrual period when there is enough fluid surrounding the baby that a sample is possible. Amniocentesis may also be performed in the last eight weeks of pregnancy. It takes a week or two to get the results on chromosomal abnormalities (and the baby's sex). Results on conditions such as spinal defects, Hunter's Syndrome, and Tay-sachs Disease are available the next day.
Using ultrasound to locate an area where baby and placenta are not in the way, the doctor inserts a long needle through the skin on the abdomen into the uterus and withdraws some amniotic fluid. These materials are then sent to genetic and biochemical laboratories for analysis. The whole procedure takes around thirty minutes.
The material obtained in amniocentesis reveals the gender of the baby, his or her chromosomal make-up, the maturity of the baby (especially the lungs) and whether or not he or she may have certain inherited diseases. There are various reasons your doctor may recommend amniocentesis such as if you already have a previous child with a genetic abnormality, inherited genetic disorder or other disease; if your AFP levels are high; or if you are over 35. While it is safe, it is not without a slight risk of damage to the organs of the baby, placenta, and umbilical cord, though ultrasound guidance reduces this risk considerably. There also is a 1 in 200 chance of inducing a miscarriage with amniocentesis.
CVS provides more genetic and biochemical information than amniocentesis and can be performed earlier in pregnancy and with quicker results. Yet CVS carries a slightly higher risk of damage to the baby than amniocentesis does. So, this higher-yield-higher-risk procedure demands even greater responsibility in making the decision to have the test.
CVS is usually performed between the eighth and twelfth week after the last menstrual period. It is most beneficial when your doctor needs a faster decision than could be obtained by amniocentesis.
There are two methods of performing CVS—transabdominal and transcervical, depending on the safest in your pregnancy. Both approaches depend on ultrasound and results are usually available within 48 hours to one week.
- Transabdominal - a needle is inserted through the abdomen into the uterus to obtain a small amount of tissue from the chorionic villi (finger-like projections of tissue that surround the baby in the early weeks and ultimately form the placenta).
- Transcervical - a catheter is inserted through the vagina and cervix and into the uterus near where the placenta is forming.
Even though CVS provides information earlier in pregnancy than amniocentesis, it carries a risk of miscarriage that is 2 to 4 times higher, depending on the expertise of the physician. Vaginal bleeding frequently occurs following CVS. Studies also suggest a possible increased risk of limb deformities, and CVS may cause a decrease in the amniotic fluid production.
Gestational glucose intolerance is detected during pregnancy with the glucose tolerance test (GTT). This test is usually recommended around 24-28 weeks, and may be repeated around 32-34 weeks in mothers with high-risk pregnancies.
By identifying gestational glucose intolerance during pregnancy, the mother can alter her diet to keep her blood sugar from getting too high. Gestational glucose intolerance is more common in overweight women, older women, those with a family history of diabetes, or women who have previously delivered a baby weighing more than nine pounds.
The GTT is done at your doctor's office. You drink a glass of sweet liquid called glucola (it tastes like sweetened Coke or Pepsi) on an empty stomach, and then your blood sugar is checked one hour later. (An alternative to drinking the sugar-loaded liquid is to measure the blood sugar 1-2 hours after a big meal.) The result of the GTT should be available within a few hours. After ingesting the test "meal," it's important to stay active (e.g. walking) so your body has a better chance of metabolizing the sugar load than if you just sit there waiting to have your blood drawn.
If this one-hour screening test turns out to show high blood sugar, the doctor may recommend a more accurate three-hour test. Only around 15 percent of women with abnormal one-hour GTT will have an abnormal three-hour GTT test. If the three-hour test is abnormal, the doctor may recommend a diabetic diet throughout the rest of pregnancy. New research questions the value of routine screening for gestational glucose intolerance. A 1990 study of 1,307 women (533 of whom were not screened and 774 who were screened) showed that screening resulted in more tests and worry during pregnancy and a significantly higher cesarean rate in the screened mothers, but it did not decrease the number of large infants. These researchers concluded that the routine use of GTT caused more worry than the benefits derived. Discuss with your practitioner whether or not the GTT is necessary in your particular pregnancy.
SECOND MONTH
During the second month of pregnancy, most women "feel" pregnant with at least a little bit of nausea and fatigue. By now the hormone levels necessary for growing your uterus and your baby are elevated, causing an emotional and physical metamorphosis that is pretty much beyond your control. Embrace these rapid changes. Remind yourself that your experience, while temporary, is very unique—you're the only one to carry this particular child. When you consider that you are creating another life in just nine short months, the inconvenience and discomfort become secondary.
Your mind and body will tell you you're pregnant long before anyone else notices. During these early months you may become more introspective as you consider the miracle going on inside you and the changes ahead. It's easy to feel preoccupied even at work, especially if this is your first pregnancy.
Many of the emotions you felt in the first month intensify during the second and continue to be as unsettled as your stomach. Adjusting to the idea of pregnancy invading your body takes time. It is normal to feel both happy about growing a baby and anxious about the toll pregnancy takes on your mind, body, and lifestyle. Many mothers report feeling some antipathy toward their babies for making them so sick. It's nothing to feel guilty about. (You won't hold it against your baby when he's born!) No matter how much you love your baby now; you're bound to hate feeling nauseated. Three key emotional changes include:
1. Overly sensitive and touchy. With your mind preoccupied with all the issues of pregnancy, little things that didn't bother you previously now set you off, and you may find yourself overreacting to trivial nuisances. Where you previously tolerated quirks in your mate's personality, there may be days when you just can't stand some of the things he does. Or you may go to pieces if he is ten minutes late getting home from work. A dog barking or the doorbell ringing may startle you. Daily tasks can seem mountainous when you're tired, nauseous, and awash in ambivalence. Take this touchiness as a signal from your body, telling you to do what you can to clear your environment of things that disturb your peace. Of course, you can't tell your mate or your three-year-old to move out for a few months, but you can be sure to get enough rest, to spend time each day relaxing your body and mind, and to ask for peace and quiet when you need it.
2. Upset for no reason. As the excitement and newness of the pregnancy begin to wear off and you settle into the reality of pregnant family life, you are likely to feel less tolerant of the normal upsets of family living. At the same time, your mate may become less understanding. The pregnancy may not seem very real to him yet, and he may not understand that you no longer have the energy to do what you did two months ago. Your sexual desire is waning; it's hard to feel sexy when you're tired, nauseated, and concerned about your changing body. This may further frustrate your spouse, making matters worse. Remind him (tactfully) that you are pregnant, and even though he can't see the changes in your body, you can certainly feel them. Also, tell him that there's hope: "the books says" you'll be feeling better in another month or two.
3. Feeling dependent. Prior to being pregnant you may have been used to a relatively independent lifestyle at work and at home. You were used to doing things for everyone else and being on the receiving end of the thanks and the strokes from others. Now you are one who needs to be cared for, and being on the needy end of a relationship can trouble your self-esteem.
The most common physical effects of pregnancy women typically experience during the second month include:
The nausea and morning
The occasional bouts of tiredness you experienced in your first month may now give way to total exhaustion. Last month you wanted to rest; this month you have to rest! Your hours of rest must increase. If the time is not spent sleeping, at least you may need to be off your feet.
Many women describe this fatigue as "bone-deep." This feeling is nature's way of compelling a busy woman to slow down and direct her energy where it is needed. You may find that you have to walk more slowly and you get out of breath more easily, even during normal walking. For your own sake and your baby's, listen to your body's message and rest as much as you can. If you have a demanding job, a demanding spouse, or a demanding toddler, leave work early, order take-out, or plug in the Sesame Street videos and sack out on the couch.
Your breasts will declare that you are pregnant long before your abdomen does. They are likely to feel slightly sore and swollen at first; the earliest sensations are similar to those you may be used to feeling in the second half of your menstrual period, only stronger. Then the buxom look of pregnancy begins. And your breasts are noticeably larger. Breasts typically increase one-cup size during the first trimester, and another one during the rest of the pregnancy. (The most dramatic increase in breast size will occur between two and four days postpartum when, due to the surge of milk-producing hormones and swelling in the tissues, your breasts seem to grow overnight!) Breast changes alone account for three pounds of your weight gain during pregnancy. Small-breasted women will notice these changes more, and first-time pregnant mothers may notice them more than they might in subsequent pregnancies. The tenderness in your breasts is most noticeable during the first three months and, like most discomforts of pregnancy, is less bothersome after the first trimester.
What Causes Breast Changes? Breast changes are caused, as you might expect, by a surge of hormones that stimulate the growth of milk glands and increase the blood flow to the breasts in order to nourish these glands. As the hormones are doing their work, you may notice throbbing sensations throughout your breasts. Your breasts may feel tingly, sore, warm, fuller, or more sensitive to touch. You may experience occasional shooting pains in your breasts that occur off and on for five minutes. You'll probably notice that your areola enlarge and darken, and that the tiny glands on the areola that secrete lubricating, antibacterial oil become more noticeable, resulting in a bumpier look. The veins on your breasts may also become more noticeable, like rivers and tributaries branching out over your breasts to deliver increased blood.
Although the rest of your body will eventually return to normal after pregnancy, your breasts will never be quite the same. They will acquire a different shape, going from your previous upward curviness to maternal, soft, global fullness. You may keep a bit of the buxom look you have while you are breastfeeding, or your breasts may actually seem smaller than you remember being. Bear in mind that these changes are due to pregnancy, and will occur whether or not you opt to breastfeed. Be kind to your breasts during pregnancy. Enjoy the comfort of frequent, warm showers and a breast massage if that helps. If you are concerned about sagging, you can help the skin and muscles around your breast tissue by wearing a supportive bra throughout your pregnancy (even at night if you need it.
Dry, itchy skin is common later in pregnancy, especially on an expanding abdomen, but many women report this symptom in their second month. Some experience overall dryness; others mention specific areas, such as the palms of the hands and soles of the feet that feel itchy. If you experience uncomfortable skin symptoms, avoid strong soaps and cleansers that rob your skin of natural oils. You might also try bathing instead of showering, as the constant pounding of hot water against skin may be irritating and drying. Some mothers prefer showering because spending too long in bath water can also rob the skin of natural oils.
Now would be a good time to pretty up your bathroom, since you will be spending a lot of time there in the months to come. Your growing uterus resides next to your bladder and definitely makes its presence felt on a regular basis. Though you will continue to urinate more frequently throughout your pregnancy, the urge to urinate is typically most noticeable during the first three months, before your uterus grows higher out of your pelvis; uterine pressure on even an empty bladder may trigger the urge to go. You can diminish this urge somewhat by emptying your bladder as much as possible when you do urinate (bear down three times and lean forward as you do so). Try the Kegel exercises to help add control.
You may also notice that it takes you longer to urinate. Be sure not to confuse the normal need to urinate more frequently with the symptoms of cystitis, a bladder infection that many women are prone to during pregnancy. Signs of cystitis include a noticeable change in urination pattern, accompanied by an increase in frequency, painful urination, an accelerated urge to urinate (whether it's necessary or not), and occasionally a fever.
If you suspect you may have a bladder infection, your doctor will need to check your urine for bacteria. Call your doctor's office and ask for instructions on how to do a "clean-catch midstream urine" sample, what type of sterile container to use, and where to bring the sample.
The composition and volume of saliva change during pregnancy. You may notice that your saliva tastes different and that there is more of it. Some women experience an annoying relationship between morning sickness and saliva production. For some, the increase in saliva triggers the nausea; for others, the nausea triggers the saliva. This excess salivation usually subsides by the end of the third month. If the taste bothers you, try sucking on a mint.
The need to urinate more frequently when pregnant means you'll have to drink more fluids. Thirst is your body's normal signal that you and your baby need more fluids. The increased water you drink helps your kidneys rid your body of the extra waste products produced by the baby. You also need more fluids because your blood volume increases to 40 percent when you are pregnant. In addition, your baby needs fluids to fill his or her growing swimming pool (the amniotic sac).
Most women are prone to constipation throughout their pregnancy. Early in pregnancy you can again blame pregnancy hormones, which slow the movement of food through your intestines. In physiologic jargon, this change is called decreased gastrointestinal motility. The slower passage of food and fluid allows more fluid to be absorbed (perhaps another one of nature's ways of ensuring that you get the necessary fluids into your system). The combination of reduced motility of the intestines and firmer waste products (since more fluid has been absorbed) contributes to constipation. In later pregnancy, the pressure of your enlarging uterus on the large intestine further hinders the passage of stools. The good news is you can outwit this uncomfortable effect of your hormones by eating foods that increase the water content of your bowel movements and foods that naturally travel faster through your intestines.
1. Increase fiber. Fiber ("roughage") passes through your intestines undigested and acts like a sponge, soaking up fluid. Increased fluid helps your stools move faster. It also helps you to pass them more easily. Include more:
- Fruits, especially prunes, pears, figs, and apricots
- Vegetables, especially crunchy vegetables such as carrots, zucchini, cucumbers, and celery
- Psyllium (a natural bran-like stool softener, available at nutrition stores)
- Whole grains, such as 100 percent bran and multi-grain bread
- Legumes, beans, and peas
2. Increase fluids. If you increase the fiber in your diet, you must correspondingly increase the volume of fluids; too much fiber and too little fluid can actually aggravate constipation by making your stools even firmer. If you love juice, switch to nectar (prune, pear, apricot), which is not only high in water, but also higher in fiber than plain juice. But make sure to get an additional six to eight glasses of water a day, too.
3. Increase exercise. Getting your whole body moving gets your intestines moving. Regular exercise seems to keep all your physiologic systems more regular, and your intestines are no exception.
4. Obey your urges. One of the conveniences of modern living is that people are seldom more than a few steps from a bathroom, but busy pregnant women may not take the time to empty their bowels when their intestines tell them to. As with most of your body's communication systems, however, unanswered signals soon lose their communication value. When you need to go, go; otherwise, your intestinal muscles get lazy, the signals get weaker, and constipation gets worse.
The same intestinal changes that contribute to constipation also may cause you to feel full of gas. As your pregnancy advances, this bloated feeling intensifies, because your growing uterus and your ballooning intestines are competing for room.
1. Keep your bowels moving. Avoid constipation, which contributes to bloating and gas.
2. Eat slowly. When you eat and drink fast, you gulp air. The more air you swallow, the more air your already sluggish intestines must deal with. Chew your food long and well. The better the upper end of your digestive tract does its food-processing job, the easier it will be on the lower end.
3. Eat non-gassy foods. Your intestines will tell you what they like and what they don't. Common gas-producing foods include cabbage, broccoli, cauliflower, Brussels sprouts, beans, green peppers, and carbonated beverages.
4. Avoid fried and greasy foods. High-fat foods can also contribute to your bloated feeling because they are very hard to digest, and stay in your intestines a long time.
5. Eat like a baby. Eating small, frequent meals is more intestine-friendly than taking three big daily meals. Most pregnant women feel the most comfortable "grazing," eating 5 to 6 mini meals at regular intervals each day.
Shortly after eating, and sometimes even between meals, many pregnant women belch and burp frequently and experience a burning, irritating sensation just below their breastbone. Pregnancy hormones are to blame as they cause an overall slowdown of the intestines, relax the stomach muscles, and delay the time it takes for food and gastric acids to be passed from the stomach. Thus, food and acids sit in your stomach longer than they used to. Pregnancy hormones also relax the protective muscles located at the entrance to the stomach which normally act as a protective band, preventing foods and acids from traveling back into the lower end of the esophagus when the stomach contracts. The medical name for this condition is gastroesophageal reflux (GER). (So what you have is really "esophagus burn," not "heartburn.") GER also produces the vague, uncomfortable sensation of "indigestion." Later on, as your uterus grows and begins pressing upward, pressure on your intestines and stomach, may make "heartburn" even more aggravating.
7 STRATEGIES TO EASE HEARTBURN DURING PREGNANCY
1. Eat small, frequent feedings to avoid stomach overload.
2. Use gravity to help keep the food down. Avoid lying flat immediately after eating better to sit up for at least a half-hour.
3. Later in pregnancy many women surprisingly claim relief from heartburn when assuming the hands and knees position, which takes advantage of gravity to pull the uterus away from the stomach and allows the stomach contents to move more easily into the intestines rather than refluxing up into the esophagus.
4. Keep a list of which foods aggravate your heartburn and avoid them (i.e., spicy or greasy foods).
5. Avoid fatty foods that take a long time to digest.
6. Milk, cream, or low-fat ice cream taken right before a meal may coat your stomach and relieve some of the acid burn.
7. Calcium-containing and low-salt antacids taken just before meals may help. Avoid drinking large amounts of liquid with meals. Use only commercial antacids made with calcium.
Even though you don't yet "show," you may begin to feel larger in the waist this month. It's normal to feel larger before you begin to look larger; while your uterus is only slightly bigger, your abdomen may be somewhat distended because of bloated bowels and a slight weight gain. As your waistband tightens, you will need to make adjustments in both your clothing and in your attitude toward your body. This is the first step in coming to terms with your pregnant body image.
THIRD MONTH
At three months, many women find the unpleasant physical reminders of pregnancy (the constant tiredness and ravages of morning sickness) begin to lessen, and although they haven't begun to "show," their jeans are feeling a little snug. (Women with second or third babies often begin to show earlier than first timers.)
By the third month you're also likely to be tiring of the sort of limbo you've been in when it comes to receiving sympathy and help. During the first trimester you have felt pregnant – tired, nauseated, grouchy, short-tempered, and generally on an emotional roller coaster – even though your body has not yet revealed what's going on inside. Accordingly, many friends, relatives, and especially your spouse may not have been offering you either the sympathy you want or the help you need.
The emotional ups and downs of the first two months often continue into the third month. The good news is that the level of pregnancy hormones in your blood will probably peak during this month, meaning at least their side effects won't get any worse. For most women, the "constant" PMS feeling will begin to diminish by the end of twelve weeks. Other feelings you may have include:
- An inner confidence. The fear of miscarriage, so prevalent in the first two months, now lessens a lot, since miscarriages most often occur within the first eight weeks. If you've had a previous miscarriage, you may enter the third month with a sigh of relief and allow yourself to feel a surge of maternal love and hopefulness that you may have held back in case this baby didn't make it. It is in this month that most women begin to feel confident that they really are going to go on to deliver a healthy baby.
- A need to be alone. Throughout much of the first trimester, but especially at its end, many women report that they just want to be alone. Perhaps this is another one of nature's messages to slow down, retreat, and consider yourself first. It's also a sign that you are ready to become acquainted with the little life that's growing inside you.
- Concerns about weight gain. In the first two months you may have worried less about weight gain than you do now. Chances are you were just happy you could keep any food down at all. (Women who experience more than their fair share of nausea and food aversions during the first two months may not begin to gain weight until the third month.) Now that you are craving food more, and able to keep most of it down, it's normal to become conscious of the weight this extra food is going to put on.
- Worries about coping. If you are one of the few women whose pregnancy sickness does not begin to diminish by the end of this month, you may wonder how you are ever going to get through the next six. Even the sickest women usually experience some relief by the end of four months, so hang in there. Keep in mind though, as your pregnancy progresses, you'll feel more pregnant.
- Antsy. It's common at this stage of pregnancy to feel eager to get into "real" pregnancy, where you look pregnant and feel the baby moving. Waiting is especially hard if you're feeling out of sorts.
Your continually rising hormones and your growing baby continue to make their presence felt. Nausea, vomiting, heartburn, and constipation often continue during the third month, but typically begin to subside by the end of this month. In addition to these familiar discomforts, you may have some new physical experiences.
- Abdominal discomfort. Even though you don't yet show, you will begin to feel that something important is going on in your pelvis. You may feel a fullness in your lower abdomen. You may also notice mild stabbing pains when you suddenly change positions, going say from lying to sitting, or sitting to standing. As your uterus grows it stretches its supporting ligaments, causing these twitches of pain on both sides of your waist. Gradually easing into changes of position lessens the sudden stretching of these ligaments, and the accompanying pains. During the first trimester, uterine ligament discomfort tends to be sporadic, mild, and more of a nuisance or discomfort than truly painful. In the second and third trimester, the enlarging uterus may further stretch these ligaments, causing these pains to intensify. As your pregnancy progresses, you will learn which is the best position to assume to relieve these pains.
- Between clothing sizes. From the third to the fifth months you may find nothing fits. Your regular clothing and underwear feel too tight, but you look silly in maternity clothes. Buy some comfortable non-maternity pants and skirts one-size larger and with elastic waistbands. You'll wear them again after the baby is born.
- Hearing life. By the 12th week, you and your doctor may be able to hear your baby's heartbeat using an ultrasound device (called a Doptone) to detect your baby's heartbeat. Baby's heartbeat is about twice as fast as yours, and sounds like rapid-fire "swoosh, swoosh." You may have expected to hear a faint twittering and not the loud booming sounds that the ultrasound will reveal. You will be amazed how strong your baby's heart sounds. Remember, it's magnified many times.
- Breast changes. Your breasts are continuing to gear themselves up to feed your baby after birth. By the end of this month your nipples will probably have enlarged considerably and, as the milk ducts enlarge, and the pigmented area around your nipple may seem to take up half your breast. Getting used to the different feel and look of your breasts and realizing the importance of these changes will prepare you for the more pregnant look that is soon to come to the rest of you. If you are anxious about adjusting to your new body image and don't look forward to that fuller look, now is a good time to work through those feelings.
Welcome to the second trimester! While you probably think about your pregnancy in terms of months, your doctor measures your growth in weeks, and at week thirteen you cross that magic divide into what many practitioners see as the "golden period" of pregnancy. Though some women still have occasional "green" days, especially in the fourth month, most report that in their middle trimester daylong nausea subsides and their appetite for food – and sex – returns. Most mothers also get much of their energy back this trimester.
The fourth month marks the beginning of more rapid growth for you and for baby, as your more rapid weight gain will begin to reflect. This month you will probably begin to look pregnant, and your expanding bust and waistline will mean you are most comfortable in the maternity wear that just a month ago seemed impossibly big. And, even though the intense emotional and physical challenges of the first trimester have begun to dissipate, the next few months will call for adjustments of their own.
Most women find the second trimester to be a more emotionally stable time than the first. The surge in pregnancy hormones that took you by surprise in the early months now levels off, as do your emotions. You'll probably find your reactions to events a bit less dramatic now. Even better, most moms we talked with told us their fourth month feelings were usually happier. Other feelings you may have include:
Just as the side effects of a medication lessen when you become accustomed to the dose, the side effects of pregnancy hormones begin to lessen as your body adjusts to their presence. During these middle months, most pregnant
Vaginal yeast infections may recur throughout your pregnancy. While irritating to you, they are harmless to your baby, although a baby can pick up a yeast infection while traveling through the vagina during birth. Yeast can cause a mild infection of the mucous membranes of baby's mouth, called thrush, which generally appears around a week after delivery. Thrush can spread to the mother's nipples and cause pain and tenderness during feedings. Occasionally, a harmless yeast dermatitis may also develop in the newborn and can be treated easily with over-the-counter anti-fungal creams. (See Self-help Methods to Reduce the Frequency of Yeast Infections)
SIXTH MONTH
During the sixth month (21 to 25 weeks), the fun of pregnancy is in full bloom. You will continue to grow at a rate of about a pound a week. (That would sound alarming if you weren't also growing a baby!) Expect to gain 4 to 5 pounds, with one whole pound of that going directly to the baby, not you. Your uterus reaches above the level of your navel this month, and the bulge extrudes in all its glory. (Anyone still wondering "is she, or isn't she?" now knows for sure.) As you gaze at your new profile in a mirror, you'll be amazed at how much you've expanded in a month. You'll feel stronger and your baby will alert you with more frequent kicks; your mate and other children will be able to feel them now, too.
As you see yourself grow larger and feel the baby's kicking, wiggling presence much of the time, the reality that you are responsible for another human being's life sinks in. This realization may awaken deep feelings about yourself and the rest of your life. You will experience that the sixth month of pregnancy is a time of many changes including:
A time of reflection. The natural turning inward of pregnancy often brings with it a journey to the past. You may rerun scenes from your childhood, pleasant and unpleasant, and wonder how your mother's mothering will influence yours. You may even begin to think about unhappy incidents in your past, unresolved problems or other "baggage" that never was properly unloaded. While pregnancy is a good time to consider the blessings and challenges in your life and how they will affect your parenting, it's not a time to be consumed by a problem past.
A time of inner healing and joy. Pregnancy often gives women deeper insight into themselves and many mothers see pregnancy as a window of opportunity for healing their psychological selves. Yet this is not the time to dwell on gut-wrenching psychological problems to the extent that an arduous quest for inner healing overshadows the joy of your pregnancy.
A time of introspection—but don't obsess on problems. For some women pregnancy is not a good time for plumbing the depths of their psyche. While many can use heightened emotional awareness to their advantage (for career changes, for example, or shifting priorities), some find that pregnancy causes their emotions to play tricks on them, even to the point where they imagine problems where there are none. If you feel yourself getting in too deep, discuss these concerns with your practitioner and seek some balanced professional counseling, if necessary.
A time to build relationships. One area where a thorough soul- searching can reap some constructive change in your life during pregnancy has to do with family relationships and dynamics. Moving into the adult role of parenthood, for example, opens the door for making new connections with your own mom or dad. If you've been estranged from your parents, this may be the time to make-up. If you have a good relationship with your parents and in-laws you may find that it deepens as you share your pregnancy with them.
A time to develop patience. While over half of your pregnancy is behind you, there are still nearly a hundred l-o-n-g days ahead. There will be many times when you will truly enjoy everything about being pregnant; there will also be days when you just want to get it over with. Along with this impatience may come a bit of boredom. Any slowdown in your activity – from job to hobbies to sports – may leave you with time on your hands. You can take advantage of this slower time to read, walk, or just rest.
A time to contemplate. Pregnancy brings a season in which busy women can learn to enjoy a more contemplative life. Consider learning to meditate. While you can keep yourself busy catching up on photo albums or learning a language, remember that you are entering a new, rather un-intellectual, phase of life. Practice listening – to the wind or your own heart. Sooner than you think you will have an infant to feed, a crawling baby to watch, a toddler to play with. If you are able to have a peaceful pregnancy, you and baby will be healthier because you will have learned to be content with a slower pace.
A time of acceptance. During pregnancy you've had to be so vigilant, watching everything you eat, not taking aspirin for a headache, or anything for a stuffy nose. And there's still a long stretch of more of the same. Your body is being taken over by another person. You may delight in the privilege of carrying this person, yet wonder why you have to endure many discomforts. You're tired of conking out at night, leaving you with precious little time for yourself, let alone for your mate. You're probably even tired of being noticed and fawned over – it can be irritating to be talked to all the time as if your only function in life is to gestate.
A time to slow down. Not only will your mind tell you to slow down by the end of the second trimester, your body will force you to do so. On the days you overdo it; you will know it. After a busy day, you will need some catch-up rest that evening or the next day. Exhaustion is your body's reminder that there is just not enough energy, emotional or physical, to continue a busy lifestyle and grow a baby. If you feel you need to keep busy to get through your pregnancy, try to balance physical exertion with rest; mental stimulation with mindless relaxation; work that makes the time fly with leisure that allows your mind and body to catch up.
Toward the end of the middle trimester most women continue to feel delight in being big enough to look pregnant, but not yet so large that their bodies become unwieldy. They usually feel relatively well. Nevertheless, as you round the bend into the last trimester you may begin to get a hint of the discomforts to come. Here are some new physical changes you may feel:
If the origin of those faint little flutters were previously in doubt, now there's no question. You are feeling life. The gentle, butterfly-wing flicks of last month are now becoming definite jabs. If you feel the baby kicking several places at once just remember little thumper has shoulders, elbows, knees, and hands that may all stretch out at once in a uterus in which there is still room enough to maneuver. If your children have not yet felt baby move, get ready for those curious little hands on your abdomen. Once your children feel the kicks, they will continue to get a "kick" out of it and may eagerly anticipate baby's active times – usually before you go to bed or upon awakening in the morning.
Besides feeling more movement, you can now see it. You may be sitting at your desk and look down periodically to see something pounce from beneath your clothes. If you lie on your back you can watch areas of the bulge "bubble up" from beneath. It's natural to respond to these movements by placing your hand above the punch site, acknowledging what you felt. Next month this magnificent sight will be even more noticeable.
Toward the end of the middle trimester and throughout the last one many women are awakened by knot-like cramps in their calf muscles or feet. These cramps are sometimes blamed on an electrolyte imbalance of calcium, phosphorus, magnesium, and potassium. An additional explanation is the decreased circulation to the most active muscles in your legs. Pressure of the uterus on major blood vessels, as well as standing, sitting, or lying for a long time, can slow blood supply to these muscles, causing them to cramp up.
1. Massage the muscle. These cramps can be extremely uncomfortable and often awaken you with a painful startle. When the cramp occurs, you can massage the cramped muscle or have your mate rub it to promote circulation.
2. Walk it off. Walk if you can. Getting up and moving around works the best.
3. Stretch it out. If the cramp is severe, lie in bed, grab the toes of your hurting leg, and pull them back toward your head while keeping your knee straight and as close to the mattress as you can. Remember to stretch gradually, avoiding lunging or bouncing movements, which only aggravate the cramp and may even injure the muscles. If your tummy bulge prevents you from bending forward enough to grab your toes, simply straighten your leg out, pressing the back of your knee into the mattress, flexing your toes toward your head.
4. Try supplements. While a calcium-phosphorus imbalance is unlikely to be the cause of your leg cramps, if exercises don't work to relieve leg cramps, you might want to give your calcium supplements a try. Consult with your healthcare provider about taking extra calcium tablets (calcium carbonate) that do not contain phosphorus. In a recent study, women who took magnesium tablets daily experienced less leg cramps. Unless your practitioner advises, it is not safe to eat a low-phosphorus diet while pregnant.
5. Exercise the muscles. The following exercises will help to relieve cramps when they happen, and if you do them faithfully, may prevent them.
- Standing calf stretch. Place the leg with the cramped muscles a foot or so behind your other leg. While keeping your back straight, gently bend the knee on the non-cramped leg so you lean forward, while keeping the cramped leg straight and its heel to the floor. (The forward leg also keeps its heel to the floor.) Don't bounce; just stretch gently. You may find it easier to balance if you press your hands or forearms against the wall while doing this stretching exercise.
- Wall push-ups. Place your hands flat against the wall and step back until your arms are fully extended. Keeping your feet flat on the floor and your back straight, lean in toward the wall while bending your elbows. You should feel your calf muscles stretch comfortably. If it's too much of a stretch, stand closer to the wall.
- Sitting leg stretches. Sitting on the floor, stretch one leg out to the side, foot flexed. Fold your other leg in, foot toward your crotch. While keeping your outstretched leg straight, bend forward and reach toward your toe. Hold this stretched position for a few seconds. Switch sides and repeat. Don't point your toes straight out and pull your heel toward you since that contracts the muscles that are already cramped.
Another occupational side effect of pregnancy is numbness or tingling in the hands. This pins-and-needles or burning sensation usually involves the thumb, first two fingers, and half of the ring finger, and may be accompanied by pain in the wrist that can shoot all the way up to the shoulder. Sometimes you may feel soreness when you press the inner surface of your wrist. This condition is known as carpal tunnel syndrome. Carpal tunnel syndrome is caused by excess fluid that collects around the narrow carpal tunnel beneath the wrist. The nerves pass through this tunnel on the way to your hand, and pressure from the fluid makes them numb or tingly. Carpal tunnel symptoms are likely to occur during the night, after a daylong accumulation of fluid in the wrists, or when you wake up in the morning, especially if you sleep with your arm under your head.
- To ease carpal tunnel discomfort, try the following tips:
- Rest your hands more during the day.
- Avoid activities that aggravate the tingling, such as turning your wrist to pour, or anything that involves repetitive wrist movements.
- If you work on a computer, type with your wrists in the neutral position, flexed slightly down, rather than with your wrists curved up. Use a wrist rest to help you maintain this position.
- At night elevate the affected hand or hands on a pillow.
- Wear a plastic splint at night to immobilize your wrist in a neutral position. Look for these in the drug store. If needed, your doctor can prescribe a splint that is custom-fitted to your wrist.
- If the pain is particularly aggravating and persistent, a specialist can immediately relieve the discomfort with periodic cortisone injections, which are safe during pregnancy.
No, you don't have a hernia. There are two large bands of muscles that run down the middle of your abdomen from your ribs to your pelvic bone. As your uterus grows it stretches these muscles and pushes them apart, and you may notice that your skin "pooches" out in the area where these muscles have separated. If you run your fingers along the middle of your abdomen between the muscles you may feel a soft gap where the muscles have separated, and this separation may become more pronounced in the next trimester. Sit-ups are inadvisable during pregnancy, even early on. Your abdominal muscles simply don't have the strength once this separation starts, even though you may not notice it until your uterus gets large enough to make the separation obvious. By several months after delivery, your rectus muscles come back together and fill in the gap, though most women have less and less abdominal tone with each subsequent pregnancy.
When you sneeze, cough, or belly laugh, your diaphragm contracts and pushes your abdominal contents and uterus down onto your bladder, causing you to dribble urine if your bladder is full or your pelvic floor muscles are weak. To avoid this nuisance, keep your bladder as empty as possible. Urinate frequently and get into the habit of triple voiding: every time you urinate, bear down three extra times to empty your bladder as completely as you can. Also, to lessen the force on your diaphragm, be sure to open your mouth when you cough or sneeze; keeping your mouth closed causes pressure to build up in your chest and aggravates the problem. As soon as you deliver the little person who takes up space in your abdomen your bladder will have more room to expand. In the meantime, a mini pad or a panty liner may be necessary. To strengthen the muscles that control urination practice Kegel exercises. Contract and release these muscles between urination times as if you imagine you are trying to stop urinating. Don't use Kegel exercises while urinating, as this might prevent you from emptying your bladder thoroughly, worsening pregnancy incontinence.
Hemorrhoids, which are varicose veins in the rectum, are the source of this annoyance. The increased blood volume of pregnancy and the pressure of the enlarging uterus on pelvic structures can cause the veins in the rectal wall or around the anal opening to enlarge into pea or grape-sized clusters that bulge out, bleed, itch, and sting, especially during the passage of a hard bowel movement. Swollen blood vessels that occur inside the rectum – internal hemorrhoids – may bleed, but are usually not painful. Besides rectal discomfort, one of the first signs of hemorrhoids is fresh, red blood on the toilet tissue you wipe with. Although rectal blood is nearly always nothing more than harmless but irritating hemorrhoids, you should report this symptom to your healthcare provider who can confirm the diagnosis with an exam. Though they can occur at any time, hemorrhoids usually appear toward the end of the second trimester and worsen during the third trimester. They are often at their worst immediately postpartum, after the pushing during delivery, but they shrink after that.
- Avoid sitting for long periods of time, especially on hard surfaces, and sleeping on your back because the weight of the uterus presses on the major blood vessels behind it, causing the blood return from these rectal veins to be even more sluggish.
- Practice your Kegel exercises at least fifty times a day. Tightening your pelvic floor muscles, especially those around your rectum, will strengthen the anus and the tissue around it, and prevent the stagnation of blood in this area.
- Keep your bowel movements frequent and loose. Eat a fiber-rich diet, drink a lot of fluids, and use a natural stool softener, if necessary.
- Use soft scent-and-dye-free toilet tissue. Use a baby wipe when necessary. (They're cheaper than the adult towelettes).
- Avoid putting undue pressure on your rectal muscles by straining during a bowel movement. Wipe gently, using more of a patting motion than a rubbing one. When bathing, cleanse your rectal area with a handheld shower instead of vigorous rubbing with a washcloth.
- Apply cool or cold compresses: crushed ice in a clean sock will shrink the vessels and alleviate the pain. Lie on a thick towel to keep water from soaking your sheet.
- To relieve itching, take a short soak in a warm bath to which a half-cup of baking soda has been added. (While warm water can soothe an itchy bottom, it can also dilate blood vessels and further aggravate bleeding, so don't stay in more than a few minutes.)
- Place a cotton ball or gauze pad soaked in cool witch hazel (or any other medicated pad recommended by your healthcare provider) against the hemorrhoid to help shrink it and ease the discomfort.
- If you must sit on a very sore bottom, buy a rubber donut to place on your sitting surface. Yet some women find the donut aggravating by putting pressure on the buttocks. Alternately, sit on a pillow, or lean to one side while sitting.
- Check with your doctor before using an over-the-counter medication as some of these can be absorbed through the rectal tissue and into the bloodstream, yet there is little evidence that these ointments are dangerous to baby.
You may occasionally feel shooting pains, tingling, or numbness in your lower back, buttocks, outer thighs, or legs. These occur when relaxing pelvic joints, the baby's head (or your enlarging uterus) presses on the major nerves that run from the backbone through the pelvis and toward each leg. Sudden, sharp pain that begins deep in the buttock on one side and travels down the back of that leg is due to pressure on the sciatic nerve in your lower back, hence its name sciatica; it is aggravated by lifting, bending, or even walking. Tingling numbness and pain along the outer thigh is caused by stretching of the femoral nerve to the leg. Rest and a change of position that shifts the pelvic pressure away from these nerves should alleviate the pains. These pains can be very debilitating for some women. They are so variable from woman to woman because of individual differences in pelvic bone structure and shape.
Varicose veins are just another of the many side effects of being pregnant. The hormones of pregnancy relax the muscular walls of veins, causing them to enlarge. These vessels need to expand to accommodate the extra blood volume of pregnancy. Legs are particularly likely to host varicose veins because the expanding uterus presses on the major blood vessels beneath it, and this puts pressure on the veins of the pelvis, sometimes causing blood to pool in the legs. Hemorrhoids are a type of enlarged vein, and you may notice bulging veins along your vulva. Whether or not you develop varicose veins during pregnancy is mostly a matter of heredity. If you notice that an area around the visible veins of your lower leg has become increasingly painful, red, swollen, warm, or tender, a vein may have become infected; a condition called thrombophlebitis, which is very serious; elevate your leg and notify your healthcare provider.
1. Avoid standing or sitting for long periods of time. Don't cross your legs while sitting. If you must be stationary, promote circulation by doing leg and foot exercises and walking around periodically to encourage circulation in your legs.
2. Elevate your feet as high as possible when you sit. Lie and sleep on your left side.
3. Wear loose clothing. Avoid tight pants, waistbands, garters and socks, and any other clothing that may restrict circulation.
4. Wear support hose. Put them on even before you get out of bed in the morning, before gravity gives your veins a chance to pop out. Avoid calf- length support stockings since the band at the top may constrict blood return.
The middle trimester is over, the final trimester begins, and your thoughts turn toward giving birth. During this month your baby gains at least a pound. You may gain anywhere from 3 to 5 pounds, and your uterus grows to midway between your navel and your rib cage. Naturally, your bigger baby makes herself felt in a bigger way. You may be awakened by a punch to the ribs, or find yourself staring in awe at the basketball-like hump where your abdomen used to be. By the seventh month, your body demands you make lifestyle changes, whether you want to or not. You are simply too pregnant to go about your business at your previous pace. The waddle so characteristic of pregnant women creeps into your walk. Bending over to tie your
The third trimester is an emotionally easier time. By now you have learned that pregnancy can be both unspeakably wonderful and incredibly challenging, and you have become used to handling these mixed emotions. Thus, many of the emotional and physical "growing pains" of pregnancy are now behind you, and the emotions that lie ahead are mainly those directly involved with delivering a baby. Here are some typical feelings women may experience in the seventh month:
You may experience a natural high quite unlike anything you've ever felt, a combination of feeling special and proud, and wanting the whole world to acknowledge how important you are. Savor every moment of these worry-free times. Sooner or later a thump in the ribs, a stitch in the side, an irritating itch somewhere, or an attack of heartburn will pull you out of pregnancy heaven down to earth-mother reality.
Preoccupation with your pregnancy and the approaching birth causes many women to be a bit spacey and prone to daydreaming. You may forget important events, such as birthdays and appointments. You may stop in the middle of a sentence, unable to remember the point you were trying to make, and what's even more amazing, you don't care because the point you were trying to make doesn't seem that important anyway. You may have to consult your calendar hourly, or post notes to yourself in places where you can't miss them, such as the steering wheel of your car, the refrigerator, or the bathroom mirror.
You've been through a lot and still have a lot of work ahead of you. You are not a "bad" mother for wanting time out. Think of them as rehearsals for the low points of parenthood, the days when you will feel like resigning, even though that's not really an option (and one you wouldn't take if it were offered).
Many women feel a renewed desire this month to tie up loose ends at work, organize the photo albums, clean out closets, or catch up on social obligations. Often the nesting instinct, the desire to wallpaper the nursery and scrub the house for the baby, kicks in this month, though others do not show this obsession with getting things in order until the eighth or ninth month. While it's true you have more energy now than in the last two months, don't overdo it. Remember, your first priority is making sure you have the energy you need to take care of yourself and grow your baby. To do this, you will need to become good at delegating. You might as well begin delegating responsibilities to your mate now; in the first few weeks after the baby arrives, his help will be crucial to your survival.
You may be halfway through your series of childbirth classes before you think seriously about your birth philosophy and begin to consider the many birthing options available to you. It's easy to be confused by all these choices and to feel burdened by the pressure to make them.
HEART-POUNDING
Throughout your pregnancy, as you already know, blood volume steadily increases to accommodate the body's increasing need for oxygen and nourishment. By the third trimester you have forty-five percent more blood than you started with. Your heart has to work harder to pump this extra fluid: your heart rate increases by around ten beats per minute and the heart pumps about thirty percent more blood with each beat. These changes peak during mid-pregnancy when you may be able to feel your heart working harder; many women feel "heart-pounding" sensations during the second half of pregnancy, especially when they exercise or change position suddenly.
The heart's occasional pounding is a normal response to the major circulatory changes that take place during pregnancy. Yet, it is also a signal that your heart, at the moment, is working too hard. The more fit you are, the better your heart adjusts to the extra demands of pregnancy. If the pounding increases noticeably during exercise, slow down. Rise from lying to sitting, or from sitting to standing more slowly. These heart-pounding sensations will disappear within a few weeks after birth, as your heart rate slows and your circulatory system returns to its pre-pregnant state.
During pregnancy the circulatory system, like the respiratory system, is incredibly efficient, ensuring that both you and your baby receive the extra-oxygenated blood you need. Your lung capacity increases, and you may actually add a few inches to the size of your rib cage. While you may notice that you breathe slightly faster while pregnant, you may not know that you are breathing more efficiently, exhaling and inhaling more air during each breath. At times during your pregnancy you may feel short of breath. These feelings of breathlessness do not mean that you or your baby is lacking oxygen. It just means there is less room for your lungs to expand and your body is protesting this aggravation a bit. Most of the time you are not even conscious that you are breathing more deeply, but sometimes you may catch yourself sighing, which is another way, your body helps you take an extra deep breath.
Don't worry if you wake up in the morning with a swollen face, especially the eyelids. The normal facial puffiness of pregnancy is due to the accumulation of extra fluid beneath thin tissue. During the day gravity usually drains the face of this extra fluid. Unless puffy eyelids are accompanied by rapid weight gain and excessive swelling all over your body, just accept the swelling as another of pregnancy's harmless changes in your body.
The combination of your unwieldy body, relaxed ligaments, and forgetful mind may cause you to stumble on curb corners, trip over toys, or drop your fork in the middle of a meal. Your ungraceful gait cannot be entirely attributed to the 20 or more pounds you have gained. Your waddle and your klutziness are also a result of the loose and waterlogged ligaments in your hand, pelvic, and leg joints. Realize that you have temporarily lost your nimbleness in both feet and fingers, and be extra cautious. Pay more attention, for example, when using scissors, lifting a hot skillet, or carrying a toddler down steps.
The nightly "kick fest" continues. Studies show babies kick most frequently during the seventh month and kick more often in the night and early morning hours (from midnight to six a.m.). Of course, babies' limbs are longer and stronger now, so the punches are more powerful. Don't worry that those periodic, annoying jabs in the ribs might get worse in the months to come. The increasingly crowded living conditions in the womb will soon take some of the leverage out of baby's punches. Studies have shown that babies move less in the final two months than they do during this month.
Besides the kicks and shiftings you love to feel (though not necessarily at 3 a.m.), you may notice fetal hiccups early in the third trimester – short, spasmodic blips in your lower abdomen. Hiccups are usually short-lived, so by the time you've hollered for your mate to "come feel this" and he finally gets there, they will probably have stopped. Hiccups often occur around the same time each day, so you may be able to catch another performance soon. These sudden new twitches may take you by surprise, but they don't bother baby, and most mothers just think they feel funny.
Your body needs a lot of extra fluid to nourish a healthy pregnancy. The hormones of pregnancy naturally cause you to be thirsty and drink more water. These same hormones make sure your body uses this extra fluid to refill baby's amniotic pool, increase water levels in your circulating blood, making it easier for your kidneys to wash away waste, and furnish baby's needs for fluid in his or her own growing body. The demand for fluid is so great that your body will take it as needed from the intestines, contributing to constipation. By the end of your pregnancy you are carrying around an extra ten quarts, or twenty pounds, of fluid.
Most women with healthy pregnancies will notice some fluid accumulation, especially in the third trimester. Anytime from the fifth or sixth month onward, you can expect to lug around heavier hands, legs, and feet, the areas where gravity causes fluid to settle by the end of the day. Add to the effects of gravity the fact that a growing uterus slows the circulation in the legs, and it's no surprise many women gain a shoe size by the end of the day.
What's Normal, What's Not? Some women retain more fluid during their pregnancy than others. Basically, if you are feeling fine and both your body and your baby are growing normally, your body is carrying just the right amount of extra fluid for you and your baby.
Signs that swelling is normal:
- The swelling shifts with gravity, with different areas of your body being swollen at different times of the day. (This is called gravity edema.) And the swelling in your legs and ankles lessens after elevating your feet for an hour.
- You are gaining weight normally. A sudden, unexplained weight gain might indicate a problem (see below).
- Your diet is adequate and balanced.
- Your blood pressure is within normal limits.
- Urine checks at your healthcare provider's office do not show protein in the urine.
Signs that swelling is not normal:
- Fluid retention that is excessive and builds up rapidly may be a sign of a problem, such as toxemia or preeclampsia, especially if it's accompanied by these signs:
- The swelling in your legs is excessive – pressing on the swollen areas with a finger leaves a noticeable dent (called pitting edema), and the swelling doesn't lessen after elevating your legs for an hour.
- You are gaining too much weight too fast.
- Your blood pressure is high.
- Your diet is inadequate.
- Your urine shows excessive protein.
- You are generally feeling unwell and/or your baby is not growing normally.
Normal swelling can be a nuisance and contribute to fatigue at the end of the day, especially tired legs and feet. Try these tips:
- Avoid standing or sitting for long periods of time. If you need to stand or sit for more than an hour at a stretch, exercise your legs and feet. Don't cross your legs when you sit, as this can restrict circulation in your legs.
- Elevate swollen feet for an hour, especially at the end of the day; the swelling should diminish a bit.
- Relax in a rocking chair while flexing your feet against a footstool. This movement promotes circulation in your legs. A rocking chair will be on your "must have" list for when the baby arrives, so you might as well get it now and start enjoying it.
- Walk, swim, or ride a stationary bike. All three are excellent for increasing circulation to your arms and legs.
- Avoid sleeping on your back. Sleeping on your side takes the pressure of your weighty uterus off the major blood vessels and promotes better blood return from your legs.
- Wear loose clothing. Avoid tight bands on pants, socks, or any other clothing, as they can restrict circulation.
- Elevate your feet on a stool during the day and on a pillow at night.
- Elevate your hands when sitting.
- Enjoy a healthy diet. Drink at least eight 8-ounce glasses of liquid daily, especially in hot, humid weather.
Make sure that you have adequate amounts of protein in your diet, and use salt to taste. Do not go on a fluid- or salt-restricted diet unless your healthcare provider advises because you have a specific medical indication. Drinking less fluid will not alleviate the swelling, and your body needs salt for a healthy pregnancy. To check if you are drinking enough water each day, notice the color of your urine. If your urine is almost colorless or slightly yellow, chances are you are drinking enough fluid. If your urine is concentrated to a darker color, like apple juice, this may be a sign of underhydration.
During the third trimester breathlessness increases in both frequency and intensity as your expanding uterus limits the ability of your lungs to expand with each breath. To compensate for cramping your breathing space from below, pregnancy hormones stimulate you to breathe more often and more efficiently, just to make sure you and your baby are getting the oxygen you need. Here are seven ways to increase the efficiency and capacity of your breathing and to cope with feelings of breathlessness during the third trimester:
1. Change position as soon as you feel breathless.
2. Slow down when you feel short of breath. Listen to your body's signals that you are exceeding your limits.
3. Try breathing exercises to raise your rib cage and promote more chest breathing (deep abdominal breathing obviously becomes more difficult as your uterus grows).
- Stand up (this will relieve some of the pressure on your diaphragm):
- Inhale deeply while raising your arms outward to the sides and upward.
- Exhale slowly as you bring your arms back down to your sides.
- Raise and lower your head as you inhale and exhale.
- To be sure you are breathing more into your chest than down into the abdomen, check for rib cage expansion by placing your hands on the sides of your rib cage.
- Make your ribs push out against your hands as you inhale deeply. Focus on how this deep chest breathing feels so that you can switch to it whenever the crowding of your uterus on your lungs makes abdominal breathing more difficult.
4. Practice breathing for labor: slow, deep, relaxed breathing rather than shallow panting. (This is the type of breathing used throughout labor if you are learning the Bradley method. If you are using the Lamaze method this is the type of breathing you'll be doing throughout much of the active stage of labor.)
5. Exercise regularly. Aerobic exercise, began early in your pregnancy, improves the efficiency of both the respiratory and the circulatory systems.
6. Experiment with sitting and sleeping positions that help you breathe more easily. Sitting in a straight chair using correct posture – chest lifted, shoulders back – is easier on the lungs than sitting slumped over in a recliner. Sleep semi-reclined, propped up on pillows. Or try elevating your head with an extra pillow while sleeping in the side-lying position.
7. Know when to seek help. If you experience sudden, severe shortness of breath accompanied by chest pain, rapid breathing, or a much more rapid pulse, or severe chest pain while taking a deep breath, seek medical attention immediately. This could be a signal that a blood clot has dislodged and settled in your lungs – a rare, but serious problem.
More than 50 percent of moms-to-be complain of back pain in the last half of pregnancy. Back muscles get a triple whammy during pregnancy: your ligaments, which are relaxing to allow for easier passage of the baby through the pelvis, are looser all over, putting more strain on your muscles, especially those supporting your spine; your overstretched abdominal muscles force you to rely more on your back to support your weight; and the change in your posture and the curvature of your spine as you compensate for your front-heavy body creates still more work for the back muscles. In the third trimester especially, these overworked muscles and back ligaments will protest in pain.
1. Perform simple low-impact aerobic exercises such as swimming and biking to strengthen abdominal and lower back muscles.
2. Wear sensible shoes. Both high heels and totally flat shoes can strain back muscles. Try shoes with wide, medium-height heels (no higher than two inches) for dress, and walking shoes for casual wear.
3. Avoid jogging on hard surfaces, such as concrete or asphalt, which can be jarring to the spine. Instead of jogging try fast walking, and on natural surfaces like grass, earth or sand, which are easier on the muscles and joints than pounding a hard surface.
4. Don't twist your spine. When you stand or sleep be sure your shoulders and hips are aligned. Avoid awkward reaches, such as getting a heavy box down from the top of a closet or lifting a sleeping toddler from a car seat. If you must under undertake activities that call for awkward lifting, see if you can rethink the job. Consider unbuckling a toddler's car seat, for example, and turning the seat toward you before you lift your child out.
5. Avoid sitting or standing for long periods of time. When you do sit, use a footstool to raise your knees a bit higher than your hips and take pressure off your lower back. If you must stand in one position for a while, put one foot forward and place most of your weight on it for a few minutes, then switch your weight to the other foot. Better yet, prop the forward foot up on a stool, telephone book, drawer, or cabinet ledge.
6. Sleep on your side, and frequently shift sleeping positions.
1. Rest. Usually, simply resting strained muscles will ease the pain.
2. Soak in warm water. Try soaking in warm water or standing in the shower with a jet of warm water focused on the painful area.
3. Pack the back. Many mothers swear by a hot or cold pack (or alternating both) on the painful area. If baby pressing against your spine seems to be the cause of pain, as is common during the final month, try the knee-chest position for a while.
4. Massage it. Ask your mate to give you a back massage. Practice these back massages now so he can later become a useful masseur to help ease the pain of back labor.
1. Frequent urination. As your growing uterus increases pressure on your bladder, you will need to urinate more frequently. Be sure to urinate as often as you feel the urge and completely empty your bladder. Do not hold your urine in, as this may increase your chances of developing a urinary tract infection or even trigger premature contractions.
2. More breast changes. Your breasts continue to enlarge and you may start leaking a thick, yellowish milk, called colostrum.
3. Vaginal pain. An occasional sharp pain in your vaginal area is normal due to the pressure on your cervix.
4. Pelvic pains. You may experience sharp pains and a feeling of pressure in your pelvic area, especially when you lift your leg up to get out of bed or put on your underwear. These are most likely due to the shifting of your pelvic bones and the loosening of the ligaments attached to these bones in preparation for the little passenger that will soon be coming through. The more pregnancies you have, the more you may experience these pelvic sensations.
5. Groin pain. You may notice a sudden sharp pain when you laugh, cough, sneeze, twist, change position, or reach for something. This is caused by stretching of the ligaments that attach your uterus to your pelvis. Adjusting and changing position will ease this pain.
6. Frequent thirst. This is your body's signal that you need to drink a lot of water to keep up with your body's increased fluid demands this trimester. Drink to your thirst's content, and then some.
7. Feeling faint. After you have been standing or active for a long time, or when you rise too quickly, you may experience a faint or dizzy feeling similar to what you felt in the first trimester. Sit or lie down immediately. Low blood sugar can contribute to this light-headed feeling, so be sure to snack frequently. Resting, eating nutritious food, and avoiding sudden moves to the upright position will lessen faintness.
8. More vaginal discharge. Expect more whitish, vaginal discharge, enough to necessitate the use of panty liners.
9. Frequent heartburn. During the second trimester you may have had a reprieve from the heartburn of the first few months, but now that burning feeling reappears. This trimester it is more the result of upward pressure of the growing uterus than of pregnancy hormones. Propping yourself upright during sleep; eating small, frequent meals; and keeping yourself upright after a meal should help.
10. Constipation. Your enlarging uterus and its growing occupant seem to push your intestines aside, contributing to constipation. Your increasing need for water elsewhere in your body may steal needed fluid from your intestines, also leading to constipation. Be sure you drink at least eight 8- ounce glasses of water a day.
During the third trimester normal Braxton-Hicks contractions increase in frequency and intensity. They may even become uncomfortable and cause you to worry that you are going into premature labor. How to tell if it's preterm labor: True labor contractions show a definite pattern. Employ the 1-5-1 formula: if your contractions last at least one minute, are five minutes (or less) apart, and continue for at least one hour you are, most likely, in labor. (This would mean you should alert your healthcare provider immediately.) Braxton-Hicks contractions come and go and don't settle into a regular pattern. Don't forget to practice relaxing and breathing with these trial-run contractions.
Around ninety percent of mothers carry their babies to term (which means at least 37 weeks), so your chances of delivering a mature baby are excellent. Most of the causes of premature delivery are beyond your control, quirks such as an incompetent cervix, placental abnormalities, or an irritable uterus. Your healthcare provider will have already discussed with you any of the more obvious risk factors – structural abnormalities of the uterus, multiple babies, and chronic maternal illness, such as diabetes and high blood pressure.
However, mothers with no risk factors can go into premature labor without a known cause. Many times this premature labor can be stopped with medication. Even if you do deliver your baby prematurely, modern advances in newborn intensive care mean the chances are good that a baby of at least 28 weeks gestation will survive and thrive.
1. Avail yourself of good prenatal care.
2. Don't smoke. Quit before conception if you can.
3. Avoid alcohol consumption.
4. Eat nutritiously and gain the right amount of weight for you.
5. Avoid illegal drug use and use of over-the-counter medications not approved by your healthcare provider.
6. Avoid chronic, unresolved stress throughout your pregnancy.
If any of these possible signs of premature labor occur, stop whatever you are doing and call your healthcare provider. Sit or lie down while you wait to hear what he or she advises.
1. Your membranes rupture and amniotic fluid either trickles or gushes from your vagina.
2. Contractions that you may have previously thought were normal Braxton- Hicks contractions now become more intense and more regular.
3. Sudden onset of low back pain or crampy pressure in your pelvic area; a feeling that you have not felt before.
High risk is just a medical term that obstetricians use to describe mothers who have a higher than average risk of having health problems during their pregnancy or birth, or of delivering a baby with problems. Common risk factors are insulin-dependent diabetes, high blood pressure, or signs of premature labor. This term only reflects a statistical probability that a problem may occur in your pregnancy or with your baby; it is not an absolute prediction, and you, in fact, may have no problems at all.
We prefer the term "high-responsibility" pregnancy. Our term means more than using specialized, more attentive medical care and a high-tech hospital; it implies that you must take greater responsibility for your own care and for your own birth decisions. Instead of resigning yourself to the high-risk label by becoming a passive patient and leaving all the birth decisions up to your doctor, become a high responsibility mother. Take an even more active part in the birth partnership. You need to be more informed, more responsible, and more involved in decision-making than the average mother, and you need to take better care of yourself.
The first question you should ask your doctor after you are classified as "high risk" is what specific things should you do to lower your risk.
Letting children share the birth experience is a wonderful way to begin family bonding. A valuable resource for further reading is: Children at Birth, by Margie and Jay Hathaway, Academy Publications, Box 5224, Sherman Oaks, CA, 91413; also available on video. Here are 8 factors to consider:
1. The age of your child. In our experience, children over three can understand the emotions of labor and respect the dignity of birth. For some children under three the intensity of birth may be more than they can understand or cope with. Younger children do fine at home birth because they are in their familiar environment and can more freely come and go.
2. The temperament of your child. Only you know how much raw emotion your child can take. Will your child be frightened by the normal theatrics of labor – your groans, your red face, your bleeding, and the fact that mommy appears to be unhappy and in distress? How will your child cope with the restrictions of the hospital or other birthplace?
3. Your ability to tune out your child and focus on your birth. You must be allowed to concentrate on delivering a baby and not be distracted by the demands of other children. Will you be able to ignore the distractions of having your child there and focus on your labor? (If your child is attending your birth and is diverting some of your energy away from the work you need to do, by all means have him escorted out of the delivery room.)
4. Provide familiar caregivers for your children (other than your partner) so that each child is someone else's only responsibility.
5. Tell your children ahead of time what the birthing room rules will be, and what behavior you expect of them. Impress upon them how you want them there, but also how you need them to behave so that "mommy can do her hard work to push our baby out."
6. You'll need a plan for where your child will be cared for throughout labor, which could be quite a long time by three-year-old standards. One way to solve this dilemma is to stay home for most of your labor. Once things are moving along you go ahead to the hospital. Then have your child and the child's caregiver come after you've been assessed and are settled.
7. Prepare your children for what they can expect to see, and in terms they can understand: "Mommy may yell or cry, and you may hear some groaning noises that you've never heard before (demonstrate some of these noises). It's okay, the noise just means mommy's working real hard to push our baby out."
8. Prepare your children for being bored during periods in labor when nothing seems to be happening. You may want to bring them in only toward the end of labor.
At any time during pregnancy complications can confine you to your bed for days, weeks, even months. While the occasional mother may welcome this doctor-mandated time off her feet, for most women all rest and no work or play is not a vacation.
Complications that banish a pregnant woman to bed in the first half of pregnancy are unexplained bleeding and the threat of an impending miscarriage; in the second half of pregnancy the most common reason for bed rest is the threat of preterm labor. Other reasons for prescribed bed rest later in pregnancy are high blood pressure, preeclampsia, incompetent cervix, premature rupture of membranes, and chronic heart disease.
Doctors prescribe bed rest for problem pregnancies for a number of reasons. The less active mother is likely to have a less active uterus. Bed rest decreases the pressure of baby on the cervix, thus reducing the likelihood of premature cervical stretching and contractions. Rest increases blood flow to the placenta, and thus improves the delivery of nutrients and oxygen to baby. Rest is likely to reduce a mother's high blood pressure.
Around 20 percent of mothers are confined to a week or more in bed at some time during their pregnancy. In many cases, being ordered to bed comes as a shock neither a woman nor her employer is prepared for. Following a visit or call to your doctor, your whole agenda is put on hold for days, weeks, or months. Even if you are in the middle of a household move or a big project at work, you go to bed because the stakes are so high.
While most women willingly abide by the doctors' orders for bed rest, for many it's an unwelcome inconvenience. There are always so many other things to do in addition to growing a baby. Yet when you consider that you will have plenty of other chances to do those things, but only one chance to complete this pregnancy, being in bed for nearly 24 hours a day can be managed. Here are eight ways to cope with your confinement and actually enjoy it.
1. Know exactly what you may and may not do. Be sure you understand what your healthcare provider means by bed rest. There's nothing worse than spending half the morning wondering if you can take a shower. You can pretty much figure that bed rest means refraining from the more "active" activities that go on in bed – no sex, no orgasm. But check to be sure you know whether your doctor recommends total bed rest, which means sponge baths in bed and bedpans, or whether you get the luxury of bathroom privileges and an occasional walk to the kitchen. Ask if you can slowly walk up and down stairs, or if you are confined to one floor. Bear in mind that most doctors over prescribe the degree of bed rest, realizing that most human beings do not easily adapt to such drastic changes in lifestyle and will occasionally cheat. Find out if your doctor thinks mental stress is a problem. Can you deal with office work over the phone? While you won't want jumping children using your bed as a trampoline, can they stay in the room with you for much of the day?
2. Set up a comfortable nest. If you have to stay in bed you might as well create a bed you like to stay in. Have your bed placed near or facing a window so you have fresh air and a view. Put anything you'll need within arms' reach on a table next to your bed. Use a cordless phone or one with a long cord if the phone jack isn't near your bed. Keep address books, phone books, your journal and all kinds of reading material on an adjacent table. Move the television or the stereo into the bedroom. Buy or rent a small refrigerator for your bedside snacks. Be kind to your recumbent body. Place a foam egg-crate contoured pad on top of your mattress.
3. Think positively. Rather than dwell on what you're missing, think about what you are enjoying. Even if you find yourself feeling bored and depressed, these feelings will eventually subside, and you will have happy days again. Focus on what you are doing for your baby, and on the benefits to you of resting and relaxing. The good thing about the emotions of pregnancy is that downs are usually followed by ups.
4. Realize your feelings are normal. With so much time to just sit and think, your emotions are likely to run wild. You may worry about the baby's health and survival, fret about how your husband and kids are coping, be bored with too little to do, feel anxious about things you should be doing, and dislike feeling dependent. You may feel angry and disappointed about the course of your pregnancy. You grow impatient, as the days get longer. You'll probably feel tempted to cheat. Each day in bed will bring on new emotions to work through, yet continuing to focus on the goal of your pregnancy will overcome these anxieties and keep you in bed as long as you need to stay there.
5. Seek your mate's help. This may be the first time in your life that your mate waits on you and seems to get very little in return – except, of course, that you are growing his baby. Prolonged bed rest during pregnancy can bring couples together or tear them apart. Abstaining from sex and curtailing the activities that you usually do together doesn't help a marriage that may already be stressed. Expect stress on your marriage for these reasons and because your husband is now holding down two jobs: taking care of you, and bringing home the bacon. Yet, if you are creative, a lot of bedside romance can take place: candlelight dinners followed by a video movie, breakfast in bed, and daily massages that promote circulation, and feel so good. Being cared for by a sensitive mate can add a new depth to your relationship. And for a spouse turned waiter, masseur, entertainer, and cook, this could be the first time in his life that he has had to put someone else's needs ahead of his own – good preparation for becoming a father.
6. Keep fit while in bed. With your doctor's okay, you could do some exercises in bed, such as leg lifts, calf stretches, and upper arm exercises with light weights. Exercising helps promote circulation, as well as keeping your muscles (including your heart) in shape.
7. Pamper yourself. Staying in bed does not mean denying yourself all the pleasures of life. Hire a massage therapist (or ask a friend) to give you a head to toe massage at least once a week. See if your hairdresser will come to your bedside.
8. Bond with your baby. Many women on prolonged bed rest face a dilemma: though this would seem an ideal time to contemplate the miracle of pregnancy and to really bond with the baby, the usual reason for being on prolonged bed rest is the very real possibility of losing the baby. So some women find that even though they have plenty of time to think about and plan for the baby, they have difficulty doing so because of their fear of losing the baby. Remember that the vast majority of women who are confined to bed go on to deliver babies who survive and thrive. And the few who don't, never regret loving the little person who was briefly part of their lives.
9. Get support. Ask your practitioner to give you the phone numbers of other mothers similarly confined to bed. Sometimes you can talk each other through a particularly dull day. Or contact a support group called Sidelines (714-497-2265), which maintains a national hotline of volunteers who offer support and match you with other bedridden moms-to-be. This group is the brainchild of a California mother who was confined to bed during her high-risk pregnancies and figured out a way to use her free time for the good of other women in her circumstances. Ask these experienced bedresters for practical suggestions on what helped them cope. Mothers who have laid in bed for six straight weeks or more will give you ideas on how to pass the time.
Your sex life changes again in late pregnancy. In the third trimester a woman is often preoccupied with her imminent birthing and mothering role. Her husband may find that his own feelings are undergoing a metamorphosis; his wife's body is not just exciting and different – it is the harbinger of imminent change. Women focus on birthing and nurturing the baby; men focus on their new roles as father and (at least temporarily) sole breadwinner. Your mate may be worried that he's losing you to motherhood. Both of you may experience ambivalence about the changes ahead. All these anxieties can get both your minds temporarily off sex.
Nevertheless, couples do engage in sex late in pregnancy. As you grow, your sexual relations will out of physical necessity become more creative. Desire can be the mother (or perhaps, in this case, the father) of invention. You will have to experiment with workable and comfortable positions for intercourse. The man-on-top position is usually the most awkward –- it is difficult, literally, to get over the hump – and least comfortable; penetration is deepest in this position and the man's weight on the woman's abdomen and breasts, while not harmful for baby, is uncomfortable for mother. Besides, in the last few months, women are often uncomfortable lying on their backs for anything. Experiment with these alternatives that allow the woman to control the depth of penetration and the amount of weight she bears.
- Woman on top
- Man on top, but with his weight supported on his arms
- Couple side-lying front-to-front or back-to-front (woman raises her upper leg and supports it with pillows)
- Rear entry (woman on hands and knees with partner behind her)
Use whatever position pleasures you both the most. Expect sex in the last months to be less passionate, less frequent, less athletic, but more inventive. If the desire for sex overrides your physical discomforts and your mental distractions, you will discover new ways of coming together.
Most dads aren't cut out to be labor coaches. So, who provides the missing link? Consider a labor support person. This woman, and probably a mother herself, brings the relaxed, natural approach of the midwife to a traditional hospital birth. Her presence means a mother does not have to rely solely on her husband for help in dealing with pain – she can instead enjoy his emotional support and love at a time that is special, but stressful, for them both.
Though a friend can certainly be a labor support person, mothers typically have the best results when they hire a professional labor assistant (or PLA, also called a labor support doula or a monitrice). Here are the benefits of using a labor support person:
- PLA provides comfort and companionship to the laboring mother.
- PLA has special obstetrical training, either as a midwife, obstetrical nurse, or educated laywoman
- Her knowledge of and experience with birthing, and her sole focus on the mother's needs make her a unique and, to our minds, indispensable part of a hospital birthing team.
- The PLA coaches, counsels, supports, and anchors a laboring woman, helping the process move more quickly and comfortably.
- She, along with the hospital staff, acts as an advocate for the parents' wishes, freeing mom and dad to focus on the labor and impending birth.
- Woman-supported labors are shorter (by as much as 50 percent) and more natural than non-supported hospital labors. (In one study 18 percent of unsupported but only 8 percent of supported mothers had cesareans; fewer supported mothers had epidurals, episiotomies, and perineal tears.)
- PLA's are often instrumental if mothers choose to avoid interventions (such as I.V.'s, epidurals, and internal fetal monitoring).
- PLA's are especially valuable in high-risk pregnancies where the necessary use of such technology makes natural methods of pain control much harder to use.
As you enter month eight, your mind and your body will likely turn toward birth. Your uterus has grown to reach your breastbone and rib cage. You are now so big you can't imagine getting bigger, but you and baby still have some growing to do. Baby, who begins this month sixteen inches long and weighing around 3.5 pounds, will probably gain half a pound and half an inch each week from now until delivery day.
1. A greater desire for pregnancy to be over. Even though you've come a long way, two more months to D-day (Delivery Day) seems like an eternity. This normal impatience is likely to get worse, especially since there are so many questions that will be answered only on delivery day: Is baby (really) a he or she? What does she look like? What color will his hair and eyes be? How will she act? What will I feel when I meet him? How will her father react? As much as you want to see your little one, as much as you want your body back, you still have a lot of baby growing to do – two more months of adding the finishing touches to this little person. Remind yourself that this is the last chance you'll have for a while to sleep in, go to a movie without paying a sitter, make love without possible interruption. Make the most of this special time.
2. The urge to imagine. As your pregnancy progresses, the imaginings you've been having all along seem more real. You may imagine your baby, or picture the baby and your other children playing together. You probably think about baby's personality now, as much as his or her looks. Feeling baby kick is usually the trigger for these imaginings. Sometimes they really run wild and you start fast-forwarding your imaginary tape, picturing what your child will be like in school, as a teenager, even as a grown person. You'll likely begin to formulate ideas about the kind of person you want your child to be. Fantasizing about your child's life will also trigger vivid replays of your own childhood. As they reflect, many women begin to feel closer to their mothers, feeling anew the love that was behind typical childhood scenes, such as eating breakfast together each morning, or being told to wear a coat.
3. Driven to replay a previous birth. If you've given birth before, you may begin to think a lot about your previous birth, recalling both pleasant and unpleasant events. How will this labor and delivery be different? Will it hurt more or less? Will it be shorter or longer? This is also a good time to mull over the lessons you learned from your previous labor and delivery. What do you want to do the same this time? What do you want to do differently? Will you use the same pain-relieving techniques? Channel any worry you have into more practice of relaxation skills, and talk to a few friends who can encourage you. If you can't stop worrying about this birth see a professional to reduce your fear.
4. Increased superstitions. Even if you've never been a superstitious person, you may start looking for omens. A black cat crosses your path and you worry about what that means. Then all the baby catalogs start coming – your name is already on multiple mailing lists, and your baby isn't even born yet. You can't bring yourself to buy baby's layette because something bad may happen to baby. Not all mothers feel superstitious; the ones who do probably tend to worry about many things. Guard against letting this form of worry disturb your peace.
5. Heightened worries about baby's health. By now you have undoubtedly been on the receiving end of many comments from well-meaning mothers who simply must tell you what could go wrong. Your practitioner may unintentionally magnify these health worries. That's his or her job; good doctors and midwives believe that you should be informed about all the possibilities. Consider those "worst case scenarios" just that: rare happenings that are unlikely to happen to you or your baby. If negative conversation like this disturbs your peace during your prenatal visits, tell your practitioner so.
6. Increased worries about weight gain. If you are obsessed with weight and get depressed after every monthly weigh-in, just stop looking at the scale. Ask the doctor and the nurses not to tell you how much you weigh unless there is a medical reason to do so. As long as you are feeling well and your baby is growing normally, don't worry about your weight. And certainly don't think about going on a diet now. If your doctor doesn't say anything to you, you can assume you're at the right weight for you. Focus on nutritious eating habits rather than the scale. The number on the scale is not an absolute since your body undergoes rapid fluid shifts. Fluid retention can be higher on the day (or hour) of your checkup.
7. Greater sense of relief. Especially if you were preoccupied with worry about going into premature labor, you now can take comfort knowing that your baby would, with a lot of medical help, probably survive if born now. In fact, by the end of the eighth month most babies have achieved sufficient lung development to enable them to breathe on their own. And many premature babies born at this stage experience very few complications. (Babies born earlier than 36 weeks often need a few days to a week or so of assistance with their breathing while their lungs mature. )
8. A desire to be a good mother. Many mothers report serious ambivalence about parenthood this month. One day you may feel excited about the big event soon to happen. Another day you may feel incredibly nervous about the tremendous changes the birth of your baby will bring to your family. All these feelings are normal, and are not unlike the emotional highs and lows of motherhood: there will be times when you love being a parent, and there will be times when you wonder what you've gotten yourself into. One very common, but unnecessary, concern that nearly all mothers have throughout pregnancy, but most strongly near the end, is whether they will be good mothers. They hear about this mysterious "mother's intuition" that is somehow supposed to be in the hospital gift pack, along with the baby oil and diapers. Be assured that you will develop this mother's intuition. Your hormones helped you grow this baby, and they will charge your system after birth to give you clear insights into becoming a good enough mother for your baby.
There is one word that describes how you feel in month eight: BIG. Your belly is big. Your baby is getting big. You're beginning to have problems getting around. Chances are you're taking these problems in stride because you know you have only another month or two more to deal with them. Here are more feelings you may have:
- More intense Braxton-Hicks contractions. These normal contractions can feel like strong bands tightening across your uterus, making the uterus feel hard. At this month, a few Braxton-Hicks contractions may occur every hour. Many times you will wonder, "Could this be it?" Probably not. Your uterus is still just warming up for the real contractions at the end of next month. Use these prelabor contractions to practice your relaxation and natural pain-relieving techniques. Condition yourself to relax, not tense up, with each contraction.
- Stronger kicks. You may begin to feel fewer but stronger kicks. Studies show that women often feel half the number of kicks in the eighth month compared to the seventh. In the final month or two each kick may be a downright pain in the ribs, gut, bladder, groin, back, or wherever else your growing baby feels like stretching out. And you begin to feel movement at both ends of baby – feet kicking up against your ribs, for example, while the head is pushing down on your pelvis.
- A greater need to rest. Even when your body is not tired, your brain may tell you to take it easy. Having your mental signals anticipate your physical needs may take you by surprise. Your legs may not hurt, nor are you out of breath, yet something inside says, "Sit down. " Listen to your mind, even when your body says to keep going.
- Frequent night waking. There are several reasons for night waking in the final months. One is that your sleep cycles change, and you may experience more REM sleep – a sleep state in which you dream more and awaken more easily. Also, your enlarging uterus makes it difficult to sleep. It presses upward on your stomach, causing heartburn, and downward on your bladder, necessitating frequent nighttime trips to the bathroom. And babies in the womb seem to have their days and nights mixed up as daytime motion lulls baby to sleep. Then when you rest, baby awakens, stretches, and awakens you up by knocking on your insides. Most mothers find sleeping on their side supported by pillows to be the most comfortable. If heartburn is a problem, try sleeping slightly upright on several pillows.
- Read the section on sleeping during pregnancy
- Try catnapping during the day.
- Go to bed earlier. You may crave time for yourself after a hectic day, but make yourself retire at least an hour earlier than usual. The energy payoff will be worth the lost reading or TV time.
- If leg cramps awaken you, try a before-bed massage and the leg-cramp exercises.
- If indigestion or shortness of breath keeps you awake, try sleeping slightly upright, propped up on pillows.
- Try the sleep position illustrated below.
- Change sleeping positions whenever you are awakened by discomfort, especially if you experience pelvic pains from stretching of the uterus, or pressure of the uterus on the pelvic nerves.
- If itchy skin wakes you up, make sure you use soothing lotion to massage the sensitive spots before bed.
- To help yourself fall asleep, practice the relaxation techniques you are learning in childbirth
class . Try visual imagery and imagine yourself floating in water, or swinging back and forth on a swing. Practicing relaxation techniques to get to sleep quickly will make it easier for you to relax when your labor begins. The ability to rest or sleep even momentarily between contractions is an important energy-saving aid during early labor.
It takes a lot of pushing and stretching to move a baby the size of a melon through a cervical opening that starts out as the size of a kidney bean. Muscles don't flex or tissues stretch without letting your body know it. Contrary to popular belief, it's usually not the contracting uterine muscles that produce the pain. Like any muscle, uterine muscles don't hurt unless they are forced to work in a way they were not designed to. Yet when a muscle is overly tired, the natural chemistry and electrical activity within the muscle tissues get out of balance. These physiological changes produce pain.
Most childbirth pain originates in the stretching of the cervix, vagina, and surrounding tissues as baby passes through. During labor the uterus doesn't squeeze baby out; what really happens is the uterine contractions work to pull the cervical muscle up out of the way so that the baby's head can then be pushed through. (Think of a turtleneck sweater being slowly stretched as you pull it over your head. ) The muscles and ligaments in the pelvis are richly supplied with pressure and pain receptors in the nerves, so the stretching produces powerful sensations that may be interpreted as pain, especially if there is tension in the surrounding muscles.
In order to manage childbirth pain well you need to understand how your body processes pain and how your mind perceives it. The contraction begins, tissues stretch, and the tiny pressure receptors in the nerves are stimulated, sending lightning-fast impulses along the nerves to the spinal cord. Pain receptors are stimulated as well if the surrounding muscles are tense. In the spinal cord these impulses must pass through a sort of gate that can stop some impulses and allow others to pass through into the brain, where they could be registered as pain. So you can influence pain at three sites: where it's produced in the first place, at the gate in the spinal cord, and in the brain where the pain is perceived. In working out your own techniques for pain management, you will want to employ pain-relief measures that can control pain at all three of these sites.
To do this, you can practice relaxation techniques to keep your muscles from getting tired and tense. And you can use efficient positions for labors that keep your muscles working in the way they were designed to. Next, you can close the gate in the spinal cord so the cars can't get through. A pleasant touch stimulus, such as massage, sends positive impulses that can block the transmission of pain impulses through the spinal cord. You can also cause gridlock at the gate by sending through a lot of competing vehicles, such as impulses from music, specific mental imagery, or counterpressure. Finally, you can fill up the receptor sites in the brain so that the pain-cars have no place to park. Blocking access to this third pain-perception site is how pain- relieving drugs work. You can achieve the same effect naturally by manufacturing your body's own painkillers, endorphins.
1. Forget your fears. There is a connection between fear and pain. The efficiency of the magnificent uterine muscle depends upon your hormonal, circulatory, and nervous systems all working together. Fear upsets the balance of these three systems. Fear and anxiety cause your body to produce excess stress hormones that counteract the helpful hormones your body produces to enhance the labor process and relieve discomfort. This results in increased pain and a longer labor. Fear also causes physiologic reactions that reduce blood flow and thus oxygen supply to the uterus. An oxygen-deprived muscle tires quickly, and a tired muscle is a hurting muscle.
2. Address your fears. What specifically do you fear about birth? Do you fear the pain, for example, having had negative experiences with pain in the past? Do you fear having a cesarean or needing an episiotomy? Are you afraid that you will lose control midway through labor? Do you have fears about problems with the baby? List all your fears and alongside each one write what you can do to avoid having the fear come true. Realize, too, that some events and outcomes are beyond your power to change, and resolve not to worry about things you cannot change.
3. Be informed. The more you know, the less afraid you will be. While no two mothers' labors are alike, and each birth a woman experiences is different from the last one, childbirth does follow a general outline. There are sensations (aka "pains") that will always occur between the first contraction and the final delivery of a baby. If you understand what happens and why, and what it probably will feel like, you will not be taken by surprise. Having a sense of what to expect – and when it will end – helps most mothers feel confident that they can handle labor and delivery. A good childbirth class can help you understand what happens and why. There is no class that can tell you what it will feel like specifically to you, because this will depend on each woman's particular situation and her ability to cooperate with the forces of labor. Women can easily be taken by surprise at the intensity of labor. Some decide they do not like it one bit and wind up resisting the forces when fear takes hold.
4. Employ a professional labor support person. An experienced woman, called a PLA, will help you interpret your sensations during labor, offer suggestions for managing your pain, and help you understand and participate in any medical decisions.
5. Surround yourself with fearless birth attendants. Fear is contagious. Be sure you do not allow any fear mongers in the labor room. Don't think that this is the time to finally prove something to your mother; if she has a fearful attitude about labor, better she watch your birth on video afterward than be in the birthing room infecting you with her fears. (Many men, including fathers-to-be, are afraid of birth. They don't understand it, and they find it very upsetting when their mate hurts and they can't "fix" it. It helps to inoculate your mate against fear so that he won't pass the bug onto you. Prepare your partner for the normal sights and sounds of labor. Tell him what may happen if events don't go as planned. A calm birth attendant can give your mate a much-needed break and help him keep focused on his job, which is to support you and share in the birth experience, not to protect you from this perfectly normal process. )
6. Avoid fearful replays. Don't carry scary baggage from your past into the delivery room. Birth has a way of stirring up uncomfortable memories of previous traumatic labors or even of a past sexual assault.
7. Take responsibility for your birth decisions. While a painless childbirth is as rare as a sleep-through-the-night newborn, most pain in childbirth is under your influence – if you are ready for it.
8. Choose your practitioner wisely. Does your doctor or midwife take an active role in teaching you about the birth process and helping you to trust your body to give birth? After each visit do you leave believing your birth will go right? Or does this person create a fearful mindset about birth, filling your mind with all the possibilities of what could go wrong?
9. Understand labor and the birth process. Do you know what happens during contractions, what it is those "pains" actually do? Do you understand how being upright and changing positions during labor can influence how you experience contractions?
10. Understand which technological tools (such as electronic fetal monitoring) are likely to be used during your labor. Are you confident that you are knowledgeable enough to participate in decisions about the use of technology in your labor?
11. Be aware of the options available for medical pain relief, such as drugs and epidural anesthesia.
12. Understand the importance of releasing and surrendering to your body during labor. Are you determined to assume whatever position works for you rather than tensing up, resisting the labor process, or becoming a passive patient and spending a lot of time in the horizontal position?
13. Learn to relax your birthing muscles. Relax is more than just an empty word for helpless bystanders to throw at a mother who is experiencing the most intense physical work of her life. But relax is what you must do to help the work progress. Relaxing all of your other muscles while only your uterus contracts eases the discomfort and speeds the progress of labor. If there is tension anywhere in your body, especially in your face and neck, this tension will spread to the pelvic muscles that need to stay loose during a contraction. Tense muscles hurt more than relaxed ones and they tire sooner. Chemical changes within an exhausted, tense muscle actually lowers the muscle's pain threshold, and you hurt more than if the muscle were working unopposed. When tight muscles resist the relentless, involuntary contractions of your uterus, the result is pain. Exhausted muscles soon lead to an exhausted mind, increasing your awareness of pain and decreasing your ability to cope with it.
14. Learn to relax to balance your hormones for birth. Two sets of hormones help you labor efficiently. Adrenal hormones (also called stress hormones) give your body the extra power it needs in situations that call for tremendous effort, like labor and birth. These hormones are often referred to as the "fight or flight" hormones, and are there for the body's protection. During labor your body needs enough of these stress hormones to help you work hard, but not so many that your body becomes anxious and distressed, causing your mind and muscles to work inefficiently. Stress hormones may even divert blood from the hardworking uterus to the vital organs of the brain, heart, and kidney.
15. Relax to boost endorphins. Another kind of hormone also works for you during labor – natural pain-relieving hormones, known as endorphins. (The word comes from endogenous, meaning produced in the body, and morphine, a chemical that blocks pain). These are your body's natural narcotics, helping to relax you when you're stressed and relieving pain when you're hurt. These physiologic labor assistants are produced in the nerve cells. They attach to pain receptor sites on the nerve cell, where they blunt the sensation of pain. Strenuous exercise increases endorphin levels, and endorphins enter your system automatically during the strenuous exercise of labor, as long as you don't do anything to block them. (Tensing up blocks endorphin release. ) Levels are highest in the second stage of labor (pushing) when contractions are most intense. Relaxing will allow these natural pain- relievers to work for you. Fear and anxiety can increase your levels of stress hormones and counteract the relaxing effects of endorphins. Endorphins stimulate the secretion of prolactin, the relaxing and "mothering" hormone that regulates milk production and gives you a psychological boost toward enjoyment of mothering. Studies have shown that endorphin levels are increased by laughter.
To practice relaxation with your partner, you need to be very comfortable. Collect a bunch of pillows and teach your partner where you like them. Do these exercises in various positions: standing and leaning against your partner, a wall or a piece of furniture, sitting down, lying on your side, and even on all- fours.
1. Tense, and then relax muscle groups. Check your whole body for muscle tension: a furrowed forehead, clenched fists, and a tight mouth are the easiest ones to spot. Then practice releasing each group of muscles from head to toe systematically. Tense, and then relax each muscle group to help you identify the two different states. When your partner cues you with "contraction," think, "relax and release. " Then feel these tight muscles loosen.
2. Practice touch relaxation. This conditions you to expect pleasure rather than pain to follow tension. Find out which touches and what kind of massage relax you best. Do the same head to toe progression as above. Tense each muscle group, and then have your partner apply a warm, relaxed touch to that area as your cue to release the tension. This means you don't have to keep hearing the verbal cue "relax," which eventually becomes irritating. Another goal is to be able to relax a tense muscle when your partner puts just the right touch on that spot before it begins to hurt. Practice: "I hurt here – you press hard (or stroke or touch here). "
3. Use visualization to relax. A clear mind filled with soothing scenes relaxes a laboring body – at least between contractions. It also encourages the production of labor-enhancing endorphins that can help your labor progress. Sports psychologists use mental imagery or visualization to help athletes perform. Follow these steps to use visualization for relaxation during labor:
- Determine the thoughts and scenes you find most relaxing and practice meditating on them frequently throughout the day, especially in the final month of pregnancy. You may find the following scenes helpful: rolling waves, waterfalls, meandering streams, walking along the beach with your mate.
- Think about appropriate images for use during contractions. When a contraction begins, picture your uterus "hugging" your baby and pulling itself up over his or her adorable little head. During the dilating stage, imagine your cervix getting thinner and more open with each contraction.
- Change scenes from painful to pleasant. Grab the pain as if it were a big glob of modeling clay, massage it into a tiny ball, wrap it up, put it in a helium balloon, and imagine it leaving your body and floating up into the sky.
- Between and during the more painful contractions, imagine the prize rather than the pain you have to go through to get it. Picture yourself reaching down as your baby comes out, assisting your birth attendant in placing your baby on your abdomen, and nestling your child against your breasts.
Remember your high school physics: place an object in water and the force of buoyancy equal to its weight lifts it up. To simplify Archimedes' principle, let's put it this way: water gives a pregnant mother a lift. Buoyancy feels like weightlessness. With less weight to support and less muscle tension, your body feels less pain and saves energy for where it is needed – your hardworking uterus.
1. Water relieves. Muscles that weigh less tire less and hurt less. Also, the counterpressure of water can ease the pain of sore muscles, especially during back labor. Recall our earlier discussion about relieving pain by filling the nervous system with pleasant sensations so there's less room left over for painful ones? Being in water is like a continuous body massage, stimulating all the touch receptors in the skin. It would take thousands of gentle fingertips to touch as many skin receptors as the water does when you soak in a nice warm bath.
2. Water relaxes. Immersing most of your body in a warm tub soothes your mind and body, reduces stress hormones, and allows your body's natural relaxing and pain-relieving hormones to take over.
3. Water releases. Changing positions and going with the flow of labor are the most important natural pain relievers and labor enhancers a woman can use. Being in water lets this happen more naturally and easily. Many women laboring on terra firma describe feeling rooted to one spot, afraid to move at all, lest it hurt more. A woman in water is free to float with her body supported until she finds the position that best eases her discomfort. Being in water also seems to free her mind, so she can tap into her deepest instincts and let tension float away. Next time you're in a swimming pool see if this doesn't ring true. Notice how you are free to move your body and clear your mind.
Some hospital maternity suites and birth centers have jacuzzi-sized labor tubs. If the hospital of your choice does not offer one, ask for it. This is just one more way in which women can influence how birth business is done. An alternative is to rent one; check with local midwives or childbirth organizations for information. The tub should be large enough to bring out the mermaid in you – at least 5. 5 feet wide. It's not only being in water that eases the discomforts of labor; it's the freedom to move that gives you the greatest benefit.
Have the water at bath-water temperature, which is usually around your body temperature. Try lounging on your back or side, or kneeling forward on all fours so that the water covers your uterus, at least up to your nipple line. Enter the tub when the intensity of your contractions tells you that you need some relief. For most women the best time to take the plunge is between 5 and 8 centimeters dilatation, when active labor is in full swing. You may also find water labor especially comforting during transition – the most intense stage of labor. The freestyle movements of mother help baby to find the path of least resistance (and least pain). Lying in a labor tub can also be used to accelerate a slow labor. The splashing of the water on your nipples can trigger the release of contraction-stimulating hormones. And water is very effective in easing a fast- and-heavy labor, where the contractions threaten to overwhelm you.
If your labor stalls while you are comfortably floating in the water, get out and walk or squat on land to get your labor going again; re-enter the tub once labor gets going. Be sure to enter and exit the water between contractions and with assistance, so you don't slip. When you feel the urge to push, it's time to get dry. (Babies have been born into the water when there was suddenly no time to exit or because a mother was so comfortable she could not bring herself to leave the water. Babies do just fine, as long as they are lifted up out of the water and placed in mother's arms without delay. Baby simply goes from water to water and doesn't take a breath until his face meets the air. )
Unless your birth attendant advises you otherwise, it's safe to use water labor even after your membranes have ruptured. That's when contractions usually get more intense and you really need the relief of water. Maternity centers with much experience in water labor (and water birth) report no increased rate of infection in women using water after their membranes have ruptured, as long as the mothers are in active labor and proper infection control hygiene is followed.
It is rarely necessary to leave the water for routine tests. If you need an I. V. , a heparin-lock can be used in the veins of your hand, covered with a waterproof plastic bag, and sealed with a rubber band. If intermittent fetal monitoring is necessary, let it be done on a part of your abdomen that you can lift above the water; place a plastic bag over the handheld monitor if you aren't using monitors designed for underwater use.
If your hospital or birth center does not offer a labor tub or you're unable to rent one, at least try sitting in a regular tub or taking a shower. A jet of warm water is often especially effective in easing back labor. Don't expect all the pain of labor to float away into the water. Yet our personal experience and that of other women who have used labor pools suggest that water is one of the most wonderful laborsaving devices available.
A soothing massage, a caring caress, a passionate kiss, even a simple foot rub can be blissful relief to a laboring mother. By stroking the receptor-rich skin and kneading the pressure receptors beneath the skin, you bombard the brain with pleasant stimuli, leaving less room for painful ones.
You won't really know where or how to ask your partner to rub or press till labor day is underway. Yet in the final months some practice rub downs to relieve backache or to help you relax during Braxton-Hicks contractions, and will help prepare you both for labor, when the right touch really counts. Tell your partner that a lot of prenatal practice will condition his hand muscles so they won't tire so easily on the big day.
Using pure plant oil or massage lotion, try different strokes in different areas of the body: firm caressing with the fingertips is preferred on the face and scalp; deep pressure and kneading is welcome for large muscles, such as the shoulders, thighs, buttocks, calves, and feet. Try counterpressure with the heel of your hand for easing the pain in lower back muscles.
The last couple months are not only an opportunity to work out massage strokes that you like, it's also a chance to weed out those you don't. For example, stroking down in the direction of body hair growth is pleasant, whereas light stroking upward, against the hair shaft, may irritate a laboring woman. Help your partner learn the intensity and rhythm of the pressure you enjoy. When you massage him, show him what you like so he'll learn by being on the receiving end.
1. Breathe naturally between contractions, as you do when you are falling asleep.
2. When a contraction begins, inhale deeply and slowly through your nose, and then slowly exhale through your mouth in a long, steady stream. As you breathe out, let your facial muscles relax and your limbs go limp as you imagine the tension leaving your body. Think of this exhalation as a long sigh of release.
3. As the contraction peaks, remind yourself to continue breathing at a relaxed, comfortable rate.
4. Ask your partner to remind you to slow down if you start breathing too fast in response to an intense contraction. Have him take slow, relaxed breaths along with you.
5. If you still find yourself breathing too fast, stop for a minute and take a deep breath, followed by a long, drawn-out blow, as if you are blowing off steam. Do this periodically to remind yourself to slow down.
6. Partners should watch the mother's breathing patterns for cues as to how she is coping. Slow, deep, rhythmic breathing shows that she is handling her contractions well. Fast, spasmodic breathing communicates tension and anxiety. Use massage, model proper breathing, or suggest a change of position.
7. Don't pant. Panting is not natural for humans. (Dogs and cats in labor pant because they don't sweat. It's their way of releasing body heat. ) Panting not only exhausts you, it lessens your oxygen intake and may lead to hyperventilation.
8. Don't hyperventilate. Breathing too fast and too heavily blows off too much carbon dioxide, causing you to feel light-headed and have tingling sensations in your fingers, toes, and face. Some women tend to hyperventilate during the height of intense contractions and need caring reminders to relax their breathing. If you start to hyperventilate, breathe in through your nose and out through your mouth, as slowly as you can.
9. Don't hold your breath. Even during the strain of pushing, the blue in the face, blood-vessel-popping breath holding you see in movies is not only exhausting, but deprives you and your baby of much-needed oxygen.
1. Bring music to birth by. Studies show that mothers using music during labor required fewer pain-relieving drugs than mothers who did not listen to music, because music stimulates a mother's body to release endorphins, the natural pain-relieving and relaxing hormones. Play a medley of already-tested favorites, taking care to choose songs whose rhythms relax rather than rev up your system. Along with your favorite tapes or CD's, bring along a player and fresh batteries.
2. Sit on a birth ball. This is a 28-inch physiotherapy ball, which naturally relaxes the pelvic muscles when you sit on it.
3. Try a beanbag chair. When you shop, try out various beanbag chairs until you find a squishy nest that you can imagine yourself sinking into during early labor. (Never put a baby in a beanbag chair. )
4. Bring along pillows and foam wedges. You will need at least four pillows at the hospital. Thick, tapered foam wedges, available as leftovers at upholstery shops, make relaxing back supports for sitting; a thinner one can be used as a cushion between the bed and your abdomen when side-lying.
5. Try hot and cold packs. Hot packs improve blood flow to tissues; cold packs lessen pain perception in these tissues. You will need both kinds. A hot water bottle or a rubber surgical glove filled with warm water is a fine hot-pack to nestle against your lower abdomen, groin, or thigh to relieve achy muscles, or just to relax you. Packs of frozen veggies, covered with a cloth, work well as cold packs to soothe a hot forehead or numb an aching back.
6. Consult the experts. Be sure to experiment with your bag of tricks at home to see what you think will work. Once you're in labor, try all sorts of combinations – cold pack, counter pressure, all-fours position; side-lying, hot pack, and massage; cold pack here, hot pack there, support with a wedge. You never know what will work until you try it.
Complete pain relief without risk is a promise no doctor can deliver. While today's analgesics and anesthetics are better and safer than ever, there is no such thing as a perfect pain reliever—one that works, yet is perfectly safe for mother and baby. By understanding what obstetrical drugs are available, what benefits and risks they carry, and how to use them wisely, you will best be able to decide which, if any of them, you want to use.
If only there were a perfect analgesic (meaning painkiller) that would act on only the pain pathways in mother and didn't cross over the placenta to baby. Unfortunately, there is no such panacea. When narcotics relieve mother's body of pain, they also affect baby. An additional concern about narcotics is their effect on the mind, impairing the ability to focus. When combined with natural pain relievers, however, properly used medical pain relievers can get a laboring woman back on track by providing temporary relief, which allows her to rest and recharge. Here is what every mother-to-be should know about choosing and using narcotic pain relievers.
How narcotics work. Narcotic analgesics (such as Demerol, morphine, Nubain, Stadol, and Fentanyl) relieve pain by blocking the pain receptors in the brain. Analgesics affect different persons differently. Not only does the degree of pain relief narcotics provide vary from woman to woman, so do the mental and emotional side effects. Some mothers feel a lot of relief within 20 minutes of the shot, some report only slight relief. Others report little pain relief, claiming the foggy mind was worse than a hurting body. Some women enjoy the euphoria narcotics can cause; a floaty feeling that helps them take their mind off their labor. Other mothers find narcotics compromise their ability to make decisions that benefit their labor progress. If a mother's mind is too muddled to participate in managing her labor with movement and changes of position, her labor may be prolonged, as will her pain. Narcotics can also make you feel very sleepy, so much so that you sleep between contractions and wake only as each one peaks, unable to focus and stay "on top" of the contractions.
How narcotics affect baby. When mother gets a drug, baby gets it, too. Let's follow a typical narcotic from the time it's injected into mother to delivery and postpartum, to see how it can affect baby. Within 30 seconds after a narcotic is injected into mother intravenously, it enters baby's circulatory system at around 70 percent of its concentration in mother's blood. Since babies can't talk and tell us how these drugs make them feel, we can only guess from studying external effects. Electronic fetal monitor tracings of babies whose mothers received narcotics during labor show heart rate patterns that differ from normal. Babies' brain wave tracings (electroencephalograms – EEG) change, as do their respiratory movements. Depending on the type, dose, and timing of the drug, babies born under the influence of narcotics sometimes show respiratory depression and require temporary assistance to stimulate their breathing. They may also be a bit groggy as they first enter the world. Bonding may be affected; a drugged mother and a drugged baby don't make a good first impression on each other. These newborns are also slower at learning how to breastfeed. Narcotics given during labor have been detected in babies' bloodstreams up to eight weeks after birth.
How to use narcotics wisely during your labor. You may enter the delivery room studied up on drugs, have mustered up all the alternatives to using them, and still conclude, with your birth attendants, that it would be in the best interest of you and your baby and the progress of your labor to get some medical pain relief. Here are the safest and most effective ways to use analgesics during your labor:
- Select the right drug. With the assistance of your mate and your labor support person, discuss with your doctor or anesthesiologist which drug is best for your particular labor situation. Which one is likely to give you the quickest, most effective pain relief with minimal effects on your baby? In our experience, Nubain is the most effective in taking the edge off the pain, and has the fewest number of side effects.
- Select the right time. Analgesics given too early can slow the progress of labor. In the early stages of labor, narcotics are known to decrease the strength of contractions and slow dilatation of the cervix. If given too late, they can depress baby's breathing. The best time to administer narcotics is when your labor is very active (6-8 centimeters), just before you enter transition, or if your contractions become so overwhelming that you are losing control. Because the effect of narcotics on a newborn's nervous and respiratory system peaks around two hours after they are given, doctors prefer not to give these drugs within two hours of when they expect you to deliver. They want to give the drug time to wear off, at least to the point that it does not compromise baby's ability to breathe after birth. Thus, physicians do not feel it is safe to give narcotics to the mother once the pushing stage has begun. Fortunately, once you have the urge to push, your need for medical pain relief will be greatly diminished. Don't worry, however, if a situation arises in which you must have a narcotic pain reliever during the pushing stage; baby can be given an injection of a narcotic blocker (Narcan) immediately after birth, which at least reverses the effect of the drug on baby's ability to breathe.
- Select the right route. Getting the drug intravenously gives you relief more quickly than an intramuscular injection. Intravenous drugs also wear off faster. After an intravenous injection a mother usually feels some relief within 5-10 minutes; this relief may last around an hour. Intramuscular injections, on the other hand, typically take half an hour to an hour to reach full effect, but the relief may last 3-4 hours. In either case, some mothers notice that the second dose is not as effective as the first. Most women choose the intravenous route; if labor pain is overwhelming enough to require medical relief, you want it to happen fast, and you probably also need intravenous fluids. Request a Heparin-lock, which allows you to move from your bed and to adjust positions more easily, rather than being tethered to a bedside intravenous bottle.
Many women want to hug their doctors for giving them epidurals during labor. The epidural has made most other methods of pain relief obsolete – and has even done away with the belief that you must experience pain to birth a baby. Yet before you grab for this magic medicine, inform yourself about its benefits and risks.
Before you receive an epidural, you will get a liter of intravenous fluids to build up your blood volume and prevent the decrease in blood pressure that sometimes accompanies an epidural.
Your doctor or anesthesiologist will then ask you to sit or lie on your side and curl into the knee-chest position to round your lower back. This widens the space between the vertebrae, making it easier to find the right area for injection. As your doctor or nurse scrubs your lower back with an antiseptic solution, it will feel cold. Next, you will feel a slight stinging sensation as the doctor injects some local anesthetic under your skin to numb the area. When the area is sufficiently numb, he or she will insert a larger needle into the epidural space and inject a test dose to determine if the needle is in the right place and ensure that you are not allergic to the medication. Once the needle is properly inserted, the doctor threads a plastic catheter through the needle into the epidural space and removes the needle, leaving the flexible catheter in place. The pain reliever you and your doctor have decided on is then fed into the catheter. A few minutes later you may feel a shooting sensation, like an electric shock, down one leg. Within five minutes you are likely to begin to feel numb from your navel down, or you may notice that your legs are feeling warm and/or tingly. Within 10-20 minutes the lower half of your body will feel partially or completely numb, depending on the type of medicine used, and the pain of contractions will subside. The exact level of loss of sensation cannot be predicted precisely. Most mothers experience numbness from the navel down, some experience loss of sensation as high as the nipples. A few mothers notice some patchy areas on their skin where they can still feel sensations.
This is the point where most women sing the praises of the epidural, yet this is also the instant at which a woman becomes more of a patient than a participant. Yes, once the pain is relieved you can rest and recoup your energy. But because the lower half of your body can't move, you will need assistance changing positions. Since the sensation to empty your bladder is impaired, a nurse will insert a urinary catheter to take away urine. Because of the possibility of the epidural lowering your blood pressure, the nurse will monitor your blood pressure every two to five minute until it is stable, and then every fifteen minutes. To keep the pain relief even on both sides of your body, the nurse will turn you from side to side. To be sure baby is handling the epidural well, you will be hooked up to an electronic fetal monitor. You will also notice that the doctor or nurse periodically rubs the skin of your abdomen, checking to be sure the drug is giving you sufficient pain relief, but not ascending high enough to interfere with your breathing. Now comes the juggling act of getting you just enough anesthetic to give you pain relief and help you manage your labor, but not so much that it interferes with your labor.
1. A continuous epidural means that a bedside pump continuously infuses your dura with pain-relieving medication. The continuous epidural is the most common type of epidural used because it offers constant pain relief. Unlike an intermittent epidural (see next option), blood pressure is more stable, and a lower dose of medication is needed overall.
2. With an intermittent epidural the medicine is injected periodically as needed, allowing mothers to juggle the level of pain they can tolerate with the degree of movement they desire. Some mothers do not like the roller coaster effect of intermittent injections.
3. Mix and match. The anesthesiologist can mix medicines (anesthetics and analgesics) to match the degree of sensation and movement you want, but there is no guarantee you will get the exact pain relief or movement you desire. Women react differently to pain-relieving medications.
4. Patient-controlled epidural anesthesia (PCEA) allows the mother to self-regulate the amount of relief she receives by pressing a button that allows a preset computer-controlled amount of medication to be injected into the epidural tubing. With PCEA some mothers actually use less medicine, some more, but at least you have a choice.
5. New epidurals. Both mothers and doctors have long dreamed of an epidural that would allow women to enjoy sensation and movement during labor, but without the pain. Dubbed "walking epidurals," these types of analgesia would allow the mother to stand, kneel, squat, and maybe even walk with support.
6. Spinal analgesia or a "walking spinal. " The newest pain reliever in the anesthesiologist's bag of tricks is technically not an epidural, but is known as spinal analgesia or a "walking spinal. " A small amount of narcotic is injected directly into the spinal fluid (not the surrounding dura) in a small enough dose to ease the pain of labor but still allow movement. Mothers can walk with assistance, shower, sit, stand, or squat.
7. Low-dose epidurals. Dubbed "epi-lite," these low-dose narcotic-only or combination narcotic-anesthetic epidurals are designed to relieve some of the pain of labor so an exhausted mother can at least relax enough to get a second wind for pushing. We call epi-lite the "best of both worlds" pain reliever because it relieves much of the pain yet allows you to have some sensation of what's going on in your body and some movement during childbirth.
1. Failure to progress accounts for around 30 percent of cesarean deliveries. It means that labor doesn't progress according to the usual timetable. For various reasons the cervix does not open enough and/or the baby does not descend. Some cases of failure to progress cannot be avoided, such as a very short cord. Most cases, though, are due to inadequate support for the laboring woman and violation of the basic physiology of labor. Of all the reasons for a cesarean, "failure to progress" is the most under your control. No other system in your body "fails" 25 percent of the time. Why should your "delivery" system? Emotional and physical support for the mother, walking during labor, upright pushing, along with the prudent use of medication and technology will help labor progress by increasing the efficiency of uterine contractions rather than interfering with them.
2. Repeat cesarean, meaning you had one previously, is the most common reason for a surgical birth, and this is under your influence as well.
3. Fetal distress is the third most common situation leading to a cesarean delivery. Fetal heart patterns on the electronic fetal monitor may suggest that baby's well-being is in jeopardy unless he or she is delivered quickly. A fetal heart rate that is higher or lower than average is a sign that baby may not be getting enough oxygen or is not recovering well from the decreased heart rate that is normal during contractions. While some of the reasons babies receive insufficient oxygen are beyond your influence, choices you make in labor help determine your baby's well-being.
4. Cephalopelvic disproportion (CPD) is another reason for surgical births. Baby is too big to pass through the pelvic outlet. Laboring and delivering in a more upright position, namely squatting, can enlarge the pelvic outlet, often allowing even a small mommy to deliver a big baby
1. Inform yourself. There are support groups for mothers who need help grieving about their previous cesarean and are adamant about doing everything within their power to avoid another one. Attend these meetings, and talk to other mothers who have delivered vaginally after a previous cesarean. Besides providing you with practical suggestions during your pregnancy and labor that will increase your chances of delivering vaginally, the information you obtain from this group can empower you to have an easier and more efficient labor.
2. Eat right. Overeating may cause you to gain too much weight and your blood sugar to be too high. Both of these factors increase your chances of having a baby too large to be delivered vaginally.
3. Exercise regularly. In-shape women have faster labors and lower weight gains than couch potatoes.
4. Employ a professional labor assistant. Studies show that mothers who use a professional labor assistant (PLA) are much less likely to have a surgical birth.
5. Be upright. Back lying is the position for surgical birth; the more time you spend on your back, the more likely you are to have one.
6. Get moving. Avoid spending most of your time lying in bed wired to monitors – like a surgical patient. When you get moving, your labor will, too.
7. Trust your body. Believe that your delivery system will work. Believe that your pelvic passages are designed to birth your baby. A fear that you can't go through with the delivery can be a self-fulfilling prophecy, since fear frightens the uterus into not working efficiently. Surround yourself with positive advisors. Even if your family tree or circle of friends is full of cesarean deliveries, know that you can beat these statistics.
Studies show that breech babies have a lower risk of birth injury and newborn complications if delivered surgically rather than vaginally. The main concern in the vaginal delivery of a breech newborn is that, with the feet or buttocks presenting first, the head will not have enough time to mold itself to the pelvic canal and may get stuck once the rest of the body is out. Also, a breech delivery can cause damage to the major nerves leading to the arms and hands. Both of these complications are less likely when baby presents buttocks first rather than feet first (frank breech). Prolapse of the umbilical cord (the cord slips through the cervix before baby's body and gets pinched), an emergency requiring an immediate cesarean delivery, is more common in all breech deliveries.
Baby's being in the breech position does not mean you absolutely must have a cesarean birth. The American College of Obstetricians and Gynecologists officially sanctions vaginal births for breech babies as safe in selective situations. Your doctor will weigh the risks of the surgical versus the vaginal birth and recommend the course of action that is best in your situation. Here are some of the alternatives to explore with your doctor that may make it possible to deliver your breech baby vaginally:
- Consider the possibility that your baby might turn. Around half of all babies start out bottom down early in pregnancy. Most turn head-down by 32-34 weeks. For some unknown reason, three to four percent of babies never turn head- down.
- If your baby hasn't turned on her own by 36-37 weeks, your doctor (or a specialist you are referred to) can attempt a maneuver called external version, in which he or she manipulates your abdomen to turn baby into the head-down position. External version is successful 60 to 70 percent of the time (40-50 percent for first pregnancies), but some babies turn back and require a second attempt.
- Search out a doctor who has experience in vaginal delivery of breech babies. He or she will most likely be affiliated with a hospital that has the technology and support staff to properly care for the baby should a complication occur. Obstetricians and hospital centers with a lot of experience in vaginal breech deliveries usually follow the American College of Obstetricians and Gynecologists Guidelines for breech delivery.
A newborn baby can contract herpes during passage through an infected birth canal, so it is considered prudent obstetrical medicine to deliver all babies whose mothers have active herpes at the time of delivery via cesarean section. Herpes infections are life threatening in newborns. If you have herpes, your doctor may do monthly or weekly vaginal cultures throughout your pregnancy to monitor your body's response to the stress of pregnancy (stress can cause genital herpes to flare up). Women with prior herpes outbreaks actually pass some immunity to their newborns. Women who acquire herpes for the first time during their pregnancy and have active sores at the time of delivery pose the greatest risk of infecting their babies. When you begin labor, your doctor may judge that it is safe for you to deliver vaginally if he or she sees no new herpes sores. If, however, your vaginal cultures continue to show herpes throughout your pregnancy, or you have herpes sores when you begin labor, you will need a surgical delivery.
1. Ask your doctor for a spinal or epidural anesthetic so you can be awake for the birth.
2. Have your partner sit next to you at the head of the operating table. If he's hesitant, remind him that the actual procedure takes place behind a sterile curtain. He won't see anything upsetting.
3. Ask your obstetrician to lift baby high enough so you can see him or her right after delivery. It is a beautiful sight to see your newborn lifted "up and out" during a cesarean birth.
4. Immediately after your baby is delivered and quickly checked over (temperature, breathing and pulse, and heart rates are stable) ask that baby be brought to you to be held and hugged. You may need some help since you may be a bit groggy and one arm may be immobilized for an intravenous. This mother- father-baby bonding time, though brief, is an ideal time for pictures, and the anesthesiologist or attending pediatrician will often act as photographer for you.
5. While your uterus and abdomen are being stitched closed (this takes about 30 minutes) and the operation completed, your husband should accompany baby to the nursery so he or she will not be alone with strangers. This extra father- baby bonding time will have a deep impact on both of them.
6. To decrease postoperative pain, ask your anesthesiologist about using a long-acting analgesic called Duramorph , given in the anesthetic tubing. This do-it-yourself analgesia, called "patient-controlled analgesia" (PCA), is set up so you can administer your own medication through your intravenous. Just turn the pump on and off, as you need relief. This medication is safe for your breastfeeding baby.
7. In most cases baby can be brought to your bedside within an hour or two of surgery. If your husband or a nurse is present in the room and baby is healthy, it's even possible for a cesarean-birthed baby to room in with mother. The best postoperative "pain reliever" is an "injection" of baby in your arms.
You will spend most of your ninth month "in labor." Of course, this extended labor will not be as powerful as the labor you will experience on the day or so leading up to delivery. It's more obstetrically correct to talk of "labor month" rather than "labor day." Throughout the weeks prior to delivery, your mind and body will get ready for one of the most memorable events in your life – the birth of your baby.
Take all the emotions you've felt over the past eight months, intensify them, and you've got an idea of what you can expect emotionally during month nine. You may be tired of being big, tired of being tired, and very ready to get the pregnancy over with. Your preoccupation with the upcoming birth and change in your lifestyle can mean more emotional ups and downs, but the inevitability of what's ahead may make it easier for you to cope. Most women report they feel:
Many women do not want a pregnancy to end. Ambivalence over no longer being pregnant can lead to anxiety about making the transition from pregnancy to parenthood, especially if you are a person who doesn't handle transitions well. Realize that grieving the loss of your pregnancy is a very real need. Give yourself the time and space to do it now – you'll be too busy once baby comes.
Anticipate being more touchy this month, and bothered by well-meaning but insensitive comments. You may feel more irritable toward your spouse, impatient with your children, and provoked by little things that normally wouldn't faze you. It's normal to be irritated and overwhelmed by all this advice and to wish people would just leave you alone and let you have (and rear) your baby your way. You may find yourself becoming very protective of your peace. This is nature's way of protecting you from outside influences that may distract you from the higher-priority event that is soon to come, conserving your energy for what's ahead. If a bit of advice is headed your way, go ahead and temporarily zone out. Even better, stay away from people who make you nervous.
You sometimes lie awake at night going over everything in your head. In your desire to be super-prepared, you make lists so you don't have to worry about forgetting anything, but then you worry about what you may have forgotten to put on the list in the first place. (Keep a pad and pencil next to your bed so you can jot it down and relax back to sleep.) Remember, anything you have forgotten will probably turn out not be so important after all.
Even if you've prepared for this event for the past nine months, it's normal to have second thoughts. Obviously, there is no turning back, and billions of women before you have gone through labor, including your mother. If this is your first baby, fear of the unknown naturally leads to dread. Let your mind work through these thoughts early in the ninth month before your body is asked to do a very strenuous job. The more you trust that your body knows what to do, the more your mind will relax.
Nature often provides you with a nice burst of energy to go along with the urge to prepare your home for the important newcomer. A day of yielding to this energy spurt may provide you with a healthy diversion from the boredom of those endless last weeks. It puts you in control and gives you a sense of accomplishment. But don't overdo it. Even though this nesting instinct may be common among females of the animal kingdom, human mothers don't really need a clean and sanitized nest. Don't let yourself get carried away; you'll end up overtired. Many of these tasks can be done by someone else or gradually after D- day, with baby snuggled in a baby sling sleeping peacefully.
FEELING BIGGERYou may find the muscles in your abdomen hurt from working so hard to support your belly, or that your crotch and thigh bones ache when you walk. In the first week or two of the ninth month, enjoy your bigger silhouette in the mirror because your baby will soon be dropping lower into your pelvis, and the bulge will change. You may wonder how you are going to lug yourself around for another month.
Many mothers find themselves physically exhausted this month. You may be tired of dragging a top-and-front heavy body up and down stairs. Even getting up off the sofa can leave you out of breath. First-time moms will be getting used to a pattern they've never experienced before -- light sleep. Nursing the baby, seeing that older children are covered with blankets, comforting during nightmares, sitting up through illnesses, reassuring a wakeful one – all these things dictate light sleeping for a number of years.
Even though your baby may gain a couple pounds during this month, your weight may increase only slightly, stay the same, or actually drop by a pound or two. Weight loss in the final month is usually due to a decrease in the amount of amniotic fluid, as hormones begin shifting fluid around in your body. You produce less amniotic fluid, and the increased frequency of urination may lead to an overall drop in total body water, and therefore a decrease in your weight.
You may not be able to get comfortable – anywhere. You're not comfortable sitting, standing, or lying in one position for more than a few minutes at a time, and have great difficulty finding the right position for sleep. Short, frequent naps are a necessity this month. So are the relaxation techniques you've been practicing.
Two of the more common annoyances of earlier months, breathlessness and heartburn, often ease during the ninth month. Yet you'll need to urinate more frequently as baby's head begins to press more on your bladder. And while the upper digestive tract may feel better, the crowded lower tract may once again feel constipated and bloated.
As your baby descends into your pelvic cavity, you may find yourself prone to sharp, stabbing pains at the base of your spine or in the middle of your pelvic bone, making it uncomfortable to walk. The increased pelvic aches and pains of the ninth month are most likely due to the relaxation and stretching of your pelvic ligaments in preparation for the job to come. You can ease these discomforts by changing positions. Continue to exercise gently every day. If you cannot walk or exercise without pain, a chiropractor experienced in working on pregnant bodies can give you some gentle pelvic adjustments to get your hips back in balance. It is our personal theory that chiropractic attention in pregnancy not only helps avoid or relieve back pain, but also can affect your labor by helping your back and pelvic structures be better prepared to handle the stresses of labor and birth.
Babies move even less in the ninth month than they did in the eighth, but what these movements lack in frequency they make up in power. You may feel hard kicks in your ribs and punches in your pelvis. Sometimes it may even feel like baby is moving his hands or feet into your vagina – a very odd sensation.
During the ninth month some women feel stiff all over, the way they imagine that arthritic, elderly people feel. Baby's head pressing against the nerves and blood vessels in the pelvis may also cause cramps in the thighs. Like the pelvic aches and pains, these changes are due to the influence of pregnancy hormones on the ligaments of all of your joints. The overall loosening of your ligaments has been known to cause the knees and wrists to feel weak, too, making even light lifting tricky and walking less inviting. However, movement keeps your body tuned up and once you get started on your daily walk the aches and pain will diminish.
1. Be informed. During your childbirth classes you will learn a lot about the anatomy and physiology of labor, especially how the uterus contracts and how your baby turns and bends as he or she navigates the winding road of your pelvic passages. Be sure you understand the importance of relaxation, the labor-stalling effects of fear, and how your hormones work and what you can do to help them work better.
2. Understand medical technology. Inform yourself before labor-day about the wise use of technology and medications during labor. While technology is often life-and laborsaving, it's meant to help your labor progress, not interfere with it. A well-timed epidural, as discussed in month eight, can help an exhausted mother rest and get a second wind, accelerating labor in the long run. On the other hand, the wrong medication or the right one given at the wrong time can interfere with the progress of labor. If you need an intravenous, request a heparin-lock, which will allow you to be mobile, rather than tethered to a bedside I.V. pole. If you need electronic fetal monitoring, ask if it can be done intermittently. If for medical reasons you need continuous electronic fetal monitoring, request telemetry, which keeps you mobile.
3. Be fit. Here's when those hours of pelvic tilts and tailor squats, daily walks, swimming, or stationary cycling really pay off. Pre-toned and pre- stretched muscles are likely to work better for you.
4. Be rested. It's not only hard work that pushes a baby out; it's efficient work. Fortunately, nature provides two breaks for laboring women. The first is during early labor, when contractions are not so difficult to deal with. The second type of break is continual -- those little respites between contractions. Even when labor is at its most intense, there is time between the end of one contraction and the beginning of the next. If you are laboring at home, retreat into a quiet place, take the phone off the hook, and go to sleep, or at least get some rest. During early labor in the hospital, keep your environment restful.
5. Remember to rest between contractions, especially early in labor, when these breaks last five minutes or more. Click into the relaxation techniques you have rehearsed. Even during active labor, when breaks may last only two to three minutes, we have seen veteran mothers use their relaxation techniques so effectively that they are able to momentarily "zone out," as if they are on another planet, and even snore between pushes in the second stage. Don't spend your time between contractions worrying about what the next one will feel like. This will make the pain worse. Fear intensifies pain perception.
6. Think R, R, R. Between contractions think Rest, Relaxation, and Recumbency.
7. Be nourished. A hard-working uterus and the muscles around it need a lot of energy from food and hydration from drinks. Doctors used to discourage eating or drinking during labor in case the mother needed a general anesthesia for a cesarean delivery, relying instead on intravenous fluids to hydrate and provide energy. Since most mothers who end up with a surgical birth now elect to be awake and thus receive an epidural or spinal anesthetic, keeping an empty stomach during labor is not as important as it once was. In the unlikely event that general anesthesia is necessary for emergency delivery, the concern is that you might vomit while you are unconscious and then inhale your stomach contents into your lungs. For this reason, it is preferred that laboring women ingest small amounts of quickly digestible foods. Eating heavily is also likely to make you uncomfortable.
8. Be quiet. You don't have to be like a mother cat and retreat to the closet to have your baby, but you must design a peaceful birthing environment for yourself. Birth attendants (partner, friends, nurses) need to respect your privacy during contractions, so you can concentrate on your work, and between contractions, so you can rest. This is where your mate comes in. Give him the job of peacekeeper, pledged to banish chattering, noisy, and interfering people from your labor room, and to protect the privacy and the dignity of this event.
9. Lighten up. Create your own labor-enhancing environment: dimmed lights, relaxing music, and whatever people and things you need to manage and progress in your labor. Laughter boost endorphins—stay light!
10. Be romantic. The hormones released during lovemaking also enhance labor; endorphins create pleasurable feelings during sex and also relax mother beautifully for birth. Nipple stimulation, by the mother, by her mate, or from water splashing on nipples during a soak in the tub, releases the contraction- intensifying hormone, oxytocin. A well timed kiss, a caressing cuddle, a sensual massage can all get your birthing hormones working for you. These labor- enhancing hormones also counteract anxiety that may cause your labor to slow rather than progress.
11. Be positive. A negative birthing environment is no help to a laboring mother. Banish negative people from the delivery room. You don't want to hear someone else's war stories, comments about how they couldn't progress either, or their labor-strategy comparisons in which you are the clear loser.
12. Be comfortable. Pamper yourself with as many labor-enhancing amenities as you can think of—your favorite music, soft pillows and delicacies to nibble on. Take a shower, soak in the tub, and keep your masseur busy with the touches you need for peace and comfort. If your hospital offers them, take advantage of the new "birthing beds" that can be adjusted to support you in comfort and in your style of labor and delivery.
13. Be progressive. The top labor aid is a professional labor assistant. Several women whose births we attended brought along their own collection of 3x5 cards containing encouraging quips to relax and empower them. If you like this idea, collect memorable lines from birth books, verses from poems or scriptures, or humorous limericks. Hearing a lovely verse read by your lover may be just what you need to help you relax between contractions.
14. Be vocal. Reserve your etiquette for dinner parties; you needn't be embarrassed about the sounds you make in labor. Many women find power and comfort in letting go with a yell, a prolonged moan or gutsy grunt when the going gets tough. These sometimes-involuntary gut sounds vocalize your release of tension and are a powerful way of mustering up inner energy to get through a really tough contraction. The low-pitched, long groan (gut sounds called "sounding") are releasing and energizing. High-pitched, sharp sudden yells are body tensing and frightening. Be sure to prepare your partner for the sounds you are likely to make.
15. Be mobile. In order to take advantage of your body's natural ability to guide you to the best positions for labor and delivery, however, you may have to first go through a bit of cultural deprogramming. In fact, studies show that women who are not culturally locked into the horizontal birthing mindset tend to assume any of eight different positions during the course of their labor, and most of these are upright, semi-upright, or moving.
16. Be upright. Most women, if left to their own devices, labor in an upright or semi-upright position. When you're upright, gravity helps baby descend. When you try to labor on your back, not only does gravity pull the baby toward your back, but your uterus is now forced to push baby uphill. What's worse, the uterus can now compress major blood vessels that run along the spine, reducing blood flow to the uterus and causing the contractions to become less efficient. When you are upright, your pelvic joints, relaxed by the hormones of pregnancy, are better able to shift and accommodate the little passenger with the large head and broad shoulders. Being upright also allows a more natural stretching of the birth-canal tissues making tears less likely.
- Eat early. Eat to store up energy early in labor. When labor gets hard and heavy your stomach may not cooperate.
- Eat often. Grazing (eating small, frequent meals or snacks) is much more friendlier to a squeamish tummy than a big meal.
- Eat high-energy food. During early labor load your system with complex carbohydrates (grains and pasta) that are stomach-friendly and that will provide a slow, steady, release of energy over the hours of hard work to follow. In later labor, nibble on or drink simple carbohydrates that leave the stomach quickly and provide quick bursts of energy: fruits, juices, honey. Some mothers nibble on energy bars during labor.
- Eat foods that are stomach-friendly. Some mothers experience nausea during labor and find eating and drinking unappetizing. Nevertheless, they need to eat. So bring along foods and drinks that were proven favorites during your early, nauseous months of pregnancy. Foods you tolerated then are the ones you are most likely to be able to digest now. Avoid fatty and fried foods, gassy foods, and carbonated beverages –there is enough work going on inside you without making the intestines labor, too.
- Drink, drink, and drink. Avoid becoming dehydrated, which depletes your energy, upsets your body's physiology, and slows labor. Pre-load your tank with at least 8 ounces of water per hour in early labor, and sip between contractions. Be sure to bring at least two water bottles with your favorite fluid to the hospital; place them within easy reach at your bedside. Many mothers in our practice have used a time-tested recipe they call "laborade," which is a healthy version of the familiar drink of athletes. It provides carbohydrates, electrolytes, and minerals to help keep your body chemistry balanced.
- 1/3 cup lemon juice
- 1/3 cup honey
- 1/4 - 1/2 tsp. Salt
- 1/4 tsp. baking soda
- 1-2 calcium tablets, crushed,Add enough water to make one quart. You can add an additional eight ounces of water for a milder flavor, or you can flavor this blend with your favorite juice.
- Consider intravenous "feedings." If you are too nauseated to eat or drink and your practitioner feels that you are becoming dehydrated, he or she may recommend giving you intravenous fluids. This can perk up a stalled labor or an exhausted mom. An additional benefit: more fluids mean more trips to the bathroom, which, because of the walking and squatting, are themselves, labor stimulators.
1. Squatting. You may wonder why you should squat when you could be lying comfortably on your side in bed. Squatting benefits mother and baby. It widens the pelvic openings, relieves back pain, speeds the progress of labor, relaxes perineal muscles so that they are less likely to tear, improves oxygen supply to the baby, and even facilitates delivery of the placenta. If you have practiced squatting a lot during pregnancy, it will be easier during labor. If you try squatting down right now, you can probably feel where your upper leg bones, the femora, are attached to your pelvic bones. When you squat, the leg bones actually act like levers to widen your pelvic outlet by twenty to thirty percent. Squatting gives your baby a straighter route through a wider passage, creating the easiest path for moving baby through your pelvis. (Women who have short second stages will choose not to squat.)
2. Kneeling. Kneeling is helpful to ease overwhelming contractions, relieve back pain, or turn a posterior baby. It is also a position that helps you improvise, and can lead to the kneel-squat, kneeling on all fours, or the knee-chest position.
3. Sitting. The sitting position widens the pelvis, but not as much as squatting does. The most labor-efficient position is sit-squatting on a low stool. Alternatives are to sit astride a toilet seat, chair, or a birth ball you may have practiced on. If you must stay in bed because you've had a pain medication, you can sit astride the birthing bed.
4. Standing and leaning. Since your labor is likely to progress more quickly and efficiently if you walk a lot, you may find yourself upright during an intense contraction. Try stopping and leaning against the wall or your birth partner, or resting your head against pillows on a table.
5. Side-lying. Even though moving and being upright helps your labor progress, it is not humanly possible to be upright during your whole labor. Your hard-working body will need some rest, and if you don't get it, it may stop doing its job so well. Best to be upright, in varying positions, during active labor contractions, but to rest as much as possible during early labor and between contractions. Lie on your left side. Support your body with at least five pillows: one or two under your head, one supporting your top knee, one behind your back, and another under the bulge.
During your ninth month your eagerness to deliver yourself of this bulge and hold in your arms the precious life you have been growing may make you think every twinge from your uterus is "it." It usually isn't "it," and days or weeks will have to pass before you get to touch your baby. Some mothers start their labor with a bang – suddenly, undoubtedly, powerfully – and progress fast. Others ease into labor slowly, sometimes unconvincingly, and progress gradually, yet efficiently. Some tired moms will have a labor that starts, stops, goes in spurts and pauses, and drags on for days. It's easy to be confused by all the terms: "false labor," "real labor," "prelabor"; the list goes on. While every mother's labor and delivery are as individual as her pregnancy, these are the usual stages most women go through when delivery time is approaching.
1. Dropping. Some time during the final few weeks you may notice that your baby has moved down lower in your abdomen. Most first-timers notice their babies dropping within two weeks of delivery, though some mothers "drop" as many as four weeks before D-day. Second-time mothers often find their babies do not drop lower until labor begins, because mom's pelvic muscles have already been stretched, and no warm-up is needed. Baby's head settling into the pelvis is also called "lightening" (because the lower-riding load seems smaller and lighter) or "engagement" (since baby's head engages the pelvic opening). Whether baby "drops," "lightens," or "engages," you will feel and look different. Your breasts probably no longer touch the top of your abdomen. You might be able to sense baby's head resting just beneath the middle of your pelvic bone.
2. Frequent urination. Now that baby's head lies closer to your bladder you may be going to the bathroom more often.
3. Low backache. As baby gets heavier and drops lower, count on some aches or pains in your lower back and pelvis as your uterine and pelvic ligaments are stretched even more.
4. Stronger Braxton-Hicks contractions. You may notice that your warm- up contractions go from feeling uncomfortable to being rather painful like menstrual cramps. Even though these prelabor contractions are not as strong as labor contractions, they are strong enough to be starting the work of thinning out, or effacing, your cervix from a thick-walled cone to a thin-walled cup. While these contractions will get even stronger just prior to labor, they can continue this way, on and off, for a week or two before labor starts. They become less intense when you change position or start walking.
5. Diarrhea. Birth hormones acting on your intestines may cause abdominal cramps and loose, frequent bowel movements -- nature's enema, emptying your intestines to make more room for baby's passage. Those same hormones can also make you feel nauseated.
6. Increased vaginal discharge. You may notice more egg white or pink- tinged vaginal discharge. This differs from the "bloody show."
7. Bloody show. The combination of baby's head descending into the pelvic cavity and the prelabor contractions thinning the cervix can "uncork" the mucus plug that previously sealed the cervix. The consistency of this mucus varies from stringy to thick and gooey. Some women notice the one-time passing of an obvious mucus plug; others simply notice increased blood-tinged vaginal discharge. Some of the tiny blood vessels in your cervix break as your cervix thins, so you may see anything from a pink to a brownish-red-tinged teaspoonful of bloody mucous. If your discharge shows more blood than mucus – like a menstrual period or a lot of bright-red blood -- report this to your practitioner immediately. Once you notice a bloody show, you are likely to begin labor within three days, but some mothers hang on for another week or two.
8. Bag of waters breaking. Only 1 in 10 mothers experience their bag of waters breaking prior to labor. For most mothers this doesn't happen until they are well into labor. If your water breaks before labor has started, plan on your labor starting intensely within the next few minutes or hours, or at least within the next day.
You're officially in active labor when your cervix is four centimeters dilated. Some women can stay just shy of this stage of dilatation for days or a week or two before they experience consistently regular, hard contractions. So we will arbitrarily say your labor has begun when your contractions become regular and increasingly intense, and you are likely to see your baby within a day.
We do not find the terms "true" and "false" labor helpful, nor accurate, since there is no such thing as a "false" labor contraction. As discussed, all those prelabor Braxton-Hicks contractions you've had for weeks and months have been toning the uterus, adjusting baby's position, and effacing your cervix, all preparing for the day you're going to labor a baby out. Instead, we find it helpful to divide contractions into preparing-the-passage-for-baby contractions (prelabor contractions) and delivering-baby contractions (labor contractions). Many women, especially first-timers, can't pinpoint the exact moment labor contractions begin. Labor contractions can seem like prelabor ones at first. After the fact, of course, mothers can look back and say, "Oh yes, that was when they started." Once active labor is well underway, you'll no longer doubt that this will end except with the delivery of your baby. Here's how to tell the difference.
Prelabor contractions (also called "false" contractions):
- Are irregular, following no discernable pattern for more than a few hours.
- Are non-progressive: don't become stronger, longer, or more frequent.
- Are felt most in front, in the lower abdomen.
- Vary from painless to mildly uncomfortable; feel more like pressure than pain.
- Become less intense and less uncomfortable if you change position or walk, lie down, or take a hot bath or shower.
- Make your uterus feel like a hard ball.
Labor contractions (also called "real" or "true" contractions):
- Follow a regular pattern. (Timing is seldom precise to the minute.)
- Are progressive: become stronger, longer, and more frequent. The contractions get longer and the intervals between them shorter.
- Are felt most in the lower abdomen and radiate around to the lower back.
- Vary from uncomfortable pressure to a grabbing, pulling pain, which can usually be managed, even lessened, by conscious release of tension in the rest of your muscles.
- Don't change if you lie down or change position; may be intensified by walking.
- Are usually accompanied by a "bloody show."
1. Be a "gopher." Encourage your wife to rest in whatever nest she has prepared while you serve her food and drink.
2. Offer massages and back rubs and whatever physical and emotional support she requests.
3. Be brave. This is a stressful time, but you will be so thrilled when you hold your very own son or daughter. This little person and his mom will be very dependent on your steady, calm, supportive presence in the weeks and months to come.
- Early phase. For most women the latent phase is the easiest part of labor; it's also the longest. In this early phase, contractions can range from 5 to 30 minutes apart and last from 30-45 seconds. The early phase of labor lasts an average of eight hours for first-timers, but it can vary from a few hours to a few days. During early labor your cervix thins out, becoming from 50-90 percent effaced. It also dilates, reaching 3-4 centimeters by the end of early labor.
- Active phase. Contractions in the active phase usually occur every 3- 5 minutes and last 45-60 seconds. Women often describe active labor contractions as waves starting at the top of the uterus and going to the bottom, or from the back radiating around to the front. This is also the phase of labor when your membranes are most likely to rupture and produce a gush of fluid as your water breaks. This phase of the first stage of labor lasts on average of 3-4 hours. Your cervix completely effaces and you dilate from 4 to 8 centimeters. Baby's head descends lower into your pelvis, which often breaks the membranes and releases the amniotic fluid with a gush. Your brain responds to your increased discomfort by releasing endorphins, your body's natural pain-relievers.
- Transition phase. Transition means you are moving from the first stage of labor – stretching the pelvic passages open -- into the second stage, pushing baby out. Transition is the most intense phase of your entire labor, but the good news is it's the shortest, usually lasting only 15 minutes to an hour and a half. Many women do not experience more than 10 or 20 contractions during transition. Transition contractions are more frequent than those of active labor -- 1-3 minutes apart – and will last at least a minute or a minute and a half. Your cervix dilates the final few centimeters during transition
Helping to push the baby out. Your contractions may now be less painful and are further apart, around 3-5 minutes from the beginning of one to the beginning of the next. Once transition ends, your cervix is fully dilated, and baby's head begins to descend into the birth canal. You may feel an uncontrollable urge to bear down. As you push your baby through the birth canal you may feel an alarming sensation of tearing momentarily as your vaginal tissues stretch to accommodate baby's head. The average length of the pushing stage is from one to one and a half hours in first-time moms. Your cervix, fully dilated after transition, allows baby's head to enter the birth canal. As baby's head stretches the vaginal and pelvic floor muscles, microscopic receptors in these tissues trigger the urge to bear down. They also signal your system to release more oxytocin, the hormone that stimulates uterine contractions. These two natural stimulants work together to push baby out.
Crowning – baby's head appears. After you push for a while your labia will begin to bulge – visible results of your work. Soon your birth attendant can see a puckered little scalp appearing as you bear down, then retreating when the contraction stops, to reappear with the next one. When your birth attendant announces, "Baby's starting to crown" your perineum gradually begins stretching until eventually your vaginal opening fits like a crown around baby's head. Once baby's head rounds the corner and ducks under your pelvic bone, it won't be able to slip back anymore. As your labia and perineum become more stretched, you will feel a stinging, burning sensation like a "ring of fire." This stinging feeling is your body's signal to stop pushing for a moment. In a matter of minutes the pressure of baby's head naturally numbs the nerves in the skin and the burning sensation will stop.
Once baby crowns, your birth attendant may advise you not to push, but rather to ease baby's head out slowly to avoid tearing your internal tissues or your perineum. As baby's head begins to stretch the skin of your perineum, some practitioners will decide to do an episiotomy. Be sure you have made your episiotomy wishes known ahead of time. A few more contractions and the baby slithers out into the hands of your birth attendant or onto the bed.
Your healthcare provider will suction mucous out of baby's nose and mouth if necessary, rub baby's back to stimulate a breath (you'll then hear baby's first cry!), and then drape baby over your belly tummy-to-tummy where a quick check-up for Apgar score is done. The cord will be cut (some dads want to do the honors) and your baby is ready to meet you. Sometimes baby may need some special care such as suctioning meconium, stimulating respirations, or administering oxygen, in order to make a healthy transition into life outside the womb.
Delivery of the placenta. You will feel some cramping and even a weak pushing sensation as somewhat milder contractions help deliver the placenta. If you had an episiotomy or tore, your birth attendant may have a bit of stitching to do. Your uterus continues contracting, both to expel the placenta and to clamp down on the blood vessels to stop the bleeding. If there's a problem, you may receive an injection of pitocin and ergot to help contract the uterus and stop the bleeding more quickly. A birth attendant may massage your uterus to help it contract and make sure it stays firm. Delivery of the placenta may take from five to thirty minutes.
1. Push when your body tells you. As soon as you have the overwhelming urge to push, bear down. This urge may come at the beginning of a contraction, or well into a contraction.
2. Push properly. Research validates what many mothers do instinctively: short, frequent pushes conserve your energy, preserve blood vessels in your face, deliver more blood to your uterus, enhance contractions, and deliver more oxygen to baby. After five or six seconds of bearing down to your maximum intensity, blow the air completely out of your lungs. Then inhale quickly, filling your lungs with enough new air for the next push.
3. Assume the best position for pushing. Lying on your back is the worst position for pushing; upright squatting is the best. Squatting widens your pelvis and takes advantage of gravity so baby can move down and out faster.
4. Take your time. New studies suggest that it is the intense and prolonged bearing down during the pushing stage that can deprive baby of oxygen, not the length of the second stage itself. Don't be alarmed if you hear the bleeps on the electronic fetal monitor slow down during your contractions, as long as they bounce back to normal after the contraction is over; baby's heart rate normally slows down during contractions and recovers between them.
5. Rest between pushes. When your contraction is over, ease into a position that lets you rest. Suck on some ice chips, listen to soft music, keep your room and attendants quiet, and use whatever relaxation techniques you need to drift into your own calm world.
6. Protect your perineum. The first few urges to push may take you by surprise, prompting you to tense instead of relax your pelvic floor muscles. Here's where your Kegel and relaxation exercises really pay off.
MONTH TEN - THE POSTPARTUM PERIOD
Thrilled and excited. This is a big moment in your life, a natural high. You may find it hard to sleep, hard to think of anyone but your baby. You and your partner may feel compelled to tell your birth story to anyone who will listen. If there are things that happened that you are still a little confused about, talk them over with your doctor or midwife.
Overwhelmed. The full-time care of a tiny baby is a critically important 24-hour-a-day job, and it's yours now. The job begins when you're already worn out from labor and birth, and it may be months before you get more than three or four hours sleep at a stretch.
Let down. Lows often follow emotional highs. It's natural to feel a bit of a letdown, especially with the new challenges you're facing. You may also feel a twinge of sadness about no longer being pregnant. And even though you are his primary caregiver, you now have to share the baby with your partner, family, and friends.
Weepy. "Baby blues" are probably the result of sudden changes in your life and in your hormones. They strike a few days after the birth. You may feel anxious and worried about your ability to care for your baby, and you may feel guilty about having all these feelings. You should feel better in a few days, especially if you are being well cared for and have lots of support.
"Feeling beat up." You've just been through the most strenuous work of your life. Nearly every muscle, joint, and organ of your body has worked overtime to push the baby out. It's no wonder you feel the effects from head to toe. Depending on the length and intensity of your labor and whether you had a vaginal or surgical birth, expect your body to feel the effects of delivery for at least a few weeks. Your eyes may be bloodshot due to broken blood vessels from intense pushing. You may also have popped a few blood vessels in your face. Your baby's face may have similar marks, but these "spider marks" on baby's face will clear up within a few days; yours may take a few weeks. In the days after birth, you may look and feel washed out, pale, and exhausted.
Feeling faint. For a day or so after delivery it's usual to feel lightheaded and dizzy, especially when changing position from lying to sitting, or sitting to standing. You may feel woozy and wobbly when you walk. The end of pregnancy brings a sudden shift in blood volume and total body fluid; it takes a while for your cardiovascular system to adapt and compensate for changes in position. Until this lightheaded stage subsides (usually after a day), you may need to seek assistance when getting out of bed or walking.
Shivers and shakes. Immediately after delivery many women experience chills and whole-body shakes, probably due to a resetting of the body's temperature regulating system after a long bout of hard work. Rest and ask for warm blankets to cover yourself. These chills should subside within a few hours after delivery.
Bleeding and vaginal discharge. For days, sometimes weeks, after birth, the uterus continues to discharge leftover blood and tissue, called lochia. In the first few days the lochia is usually red, in an amount comparable to a heavy menstrual period, and it may contain a few clots. Toward the end of the first week the amount of lochia usually decreases and it becomes reddish- brown and thinner. In the next few weeks this discharge changes from pinkish to yellowish-white, and you will find yourself changing fewer pads. Any activity that increases the emptying of the uterus, such as standing, walking, or breastfeeding, will also increase the amount of discharge.
- Rest
- Soak in a warm bath.
- Get frequent massages, especially on sore muscles.
- Replenish your body's need for fuel by eating and drinking nutritious foods.
- Hold your baby a lot to get your mind off your body.
- If bleeding continues to be bright red and continues to be a large amount. With each day postpartum the amount of your vaginal discharge should decrease and it should become less bloody.
- If after the first few days you are still soaking a sanitary pad with blood every hour for more than four hours at a time, call your doctor.
- If after a week or so of gradually lessening bleeding, you notice a sudden rush of blood that is bright red and that soaks more than one sanitary pad.
- Passage of golf-ball size clots anytime after the first day. Passing clots the size of a grape is normal for the first few days.
- If the lochia has a persistent foul-smelling odor. Normally, it should have no odor or smell like menstrual blood.
- You're experiencing increasing faintness, paleness, feel cold and clammy, and your heart is racing.
- If the bleeding worries you, don't hesitate to call your doctor.
If you experience heavy and worrisome bleeding, lie flat and place an ice pack over your uterus just above the center of your pubic bone while waiting for a return call from your doctor or while en route to the emergency room. Or place the ice pack against the episiotomy site if the pain and bleeding seem to be coming from there. Usual causes of bleeding are failure of the uterus to contract sufficiently, retained fragments of placenta, or infection. Your doctor will examine you to see if any of these problems have occurred or if what you are experiencing is just normal postpartum vaginal discharge.
Even after birth the uterus must continue contracting to get back to its original size. Uterine contractions also help to pinch off the blood vessels in the uterine lining to control postpartum bleeding. For a few hours after delivery, these contractions may be regular and intense. They will decrease in frequency and intensity over the next few weeks. Afterpains may resemble menstrual cramps or the Braxton-Hicks contractions you experienced in the final few months of pregnancy. They intensify during breastfeeding, since sucking stimulates the release of oxytocin. This hormone is nature's way of contracting the uterus and stopping bleeding. Birth attendants often suggest mothers encourage their baby to suck right after delivery to help the uterus contract.
Afterpains are not usually very intense following a first delivery, but they will be quite noticeable after subsequent births. To cope with the discomfort, use whatever relaxation techniques worked for you during labor. This will help make breastfeeding more comfortable.
- Drink lots of fluids, at least two 8-ounce glasses of liquid (water or juice) immediately after delivery.
- Run the water in the sink. Hearing running water gives your system the same idea.
- Relax your pelvic floor muscles.
- Be upright. Stand or walk. Allow gravity to help you urinate.
- Try to relax your pelvic floor muscles as you try to urinate. Try to relax your whole body.
- Soak your bottom in a warm tub, and urinate right there if that's more comfortable for you.
- The nurse may massage your bladder (if it's enlarged) to get it going.
- If your perineum has raw spots from a cut or a tear, ask for a "peri-bottle" (a plastic squeeze bottle). Fill it with warm water and squirt it onto your perineum as you urinate. The water will dilute the urine and lessen the burning.
Leaking urine. It's normal to leak a few drops of urine when you cough, sneeze, or laugh. This "stress incontinence" is a temporary nuisance that occurs while your bladder and pelvic organs are rearranging themselves back to their pre-pregnancy positions. Wear a sanitary pad for a few weeks until this annoyance subsides.
Profuse sweating. Another way your body gets rid of the excess fluids accumulated during your pregnancy is by perspiring more, especially at night. For the first night or two wear cotton clothing to absorb the perspiration and cover your sheet and pillow with a towel to absorb the night sweats. Excessive sweating is most prominent during the first week and gradually subsides by the end of the first month.
Painful perineum. Your sensitive perineum has been stretched to the limit and it may possibly have been bruised or torn. If it has been cut into, it's bound to smart. Ask the nurse to instruct you on "peri-care". Heat increases blood flow and promotes healing; cold numbs pain and decreases swelling. Both measures are necessary to heal a traumatized perineum. The nurse will tuck an ice pack up against your perineum as soon as possible (it will feel so good). She will advise you about soaking in a warm bath and show you how to squirt warm or cool water over your perineum, using a "peri-bottle." Try using cool witch hazel pads between your perineum and the sanitary pad.
Constipation. Your bowels may be as reluctant to work as your bladder is, and for similar reasons. The muscles involved in passing a stool may have been traumatized during passage of the baby. Drugs and anesthetics temporarily cause the intestines to be a bit sluggish; and your bowels were probably emptied naturally by the normal "diarrhea" that normally precedes birth. Besides these physical causes for problems with bowel movements, many mothers have a psychological reluctance to do any pushing with their perineal muscles, either for fear of hurting these tissues or because of a desire to rest them. Yet the sooner you get your intestines moving, the better you will feel. (See )
Gas and bloating. The bowel sluggishness that contributes to constipation also may make you feel gassy, especially if you are recovering from a cesarean section. Drinking and eating frequently, but in smaller amounts, and getting your body moving again, will ease these discomforts.
In the first couple of days postpartum you will notice only slight changes in your breasts. You may even wonder where all the milk is supposed to come from, as you produce only small amounts of the first milk, called colostrum. But then, around the third day, you may suddenly awake with breasts the size of a melon, and nearly as hard. You find that you've grown two-cup sizes overnight. This is breast engorgement. Some mothers find that their breasts become suddenly and painfully engorged, while others, especially those whose babies have been nursing frequently and effectively since birth, experience only a gradual increase in breast fullness. Yes, it's hormones at work again; as estrogen and progesterone levels drop in the days after birth, prolactin -- the milk-making hormone -- takes over. As the breasts begin to do their work, the tissues swell, partly with milk and partly with other fluids. These dramatic breast changes may not have been part of the lovely, peaceful breastfeeding experience you envisioned during pregnancy. After your baby learns to latch on properly and your breasts settle into a comfortable balance of milk production where supply equals demand, you will be well on your way to a gratifying, nurturing experience. If your breasts seem too full for baby to latch-on properly, use a breast pump or hand expression to soften your areola enough that your baby can latch onto more than just your nipple. The best remedy for engorgement is frequent breastfeeding. Nothing relieves breast fullness as quickly as a baby who is nursing well. Frequent feedings will also bring your milk supply in line with your baby's demands
Sore nipples. Most sore nipples are the result of a baby who is not latching-on to the breast correctly. When a baby latches and sucks effectively, your nipple goes to the back of his mouth, away from the tongue and gum action that can irritate skin. Sore nipples are not an inevitable part of breastfeeding. If your nipples are starting to get sore, you need to pay some attention to what's going on during feedings. While you may want to call in some helpers (a knowledgeable nurse, a lactation consultant, an experienced friend, or a La Leche League Leader) for expert advice, you are the expert on your baby.
- Be sure to break the suction before removing baby from the breast. Press down on the breast tissue, or slide your index finger inside his mouth between his gums. "Popping" a baby off the breast hurts!
- Nurse on the least sore side first. Nipple pain usually lessens as the milk begins to flow. Switch to the other side after you notice signs of the milk ejection reflex, i.e., milk dripping from the other nipple, a tingling sensation in your breasts, and a change in the baby's suck and swallow rhythm.
- Try stimulating the milk ejection reflex before you put your baby to the breast, using warm compresses, massage, or gentle pumping.
- Breastfeed frequently -- every two hours or so during the day. This will lessen engorgement and make it easier for baby to latch on.
- Let your nipples air-dry between feedings. Express a few drops of milk and let them dry on the nipple. The immunities in your milk will help heal your skin.
- Use a purified lanolin product (such as Lansinoh) on your nipples between feedings to keep the skin moist so it will heal more quickly. Avoid using preparations that must be wiped off (ouch!) before feeding the baby.
- Wear an all-cotton bra that fits well, or go braless under a cotton tee shirt. Avoid bras with plastic or synthetic linings that hold moisture against the skin.
- Nursing pads with plastic in them can aggravate sore nipples. If a pad sticks to your breast, moisten it with water to release it and avoid skin damage.
- Walk. Moving your body is likely to move your bowels.
- Drink plenty of fluids.
- Eat and drink natural laxatives, nectar (prune, pear, apricot), fresh fruits, whole grains, and vegetables. Avoid caffeine-containing foods and beverages, such as chocolate, coffee, and colas.
- Relax. Don't worry that passing a bowel movement will pop your stitches. While straining may not be friendly to your hemorrhoids, you can start using your perineal muscles as you did before delivery.
- Figure out your daily basic caloric needs. This means the number of calories of balanced nutrition you can consume to maintain your feeling of well being yet not gain weight. Remember, most breastfeeding mothers will need approximately 500 extra calories for lactation. Most postpartum mothers can eat around 2,000 nutritious calories per day and still expect a gradual weight loss
- Exercise one hour a day. This could be something as simple as walking briskly while carrying baby in a sling. Brisk walking or swimming for one hour burns off around 400 calories. This exercise plus abstaining from one unnutritious treat each day (one chocolate chip cookie is around 100 calories) means you have a deficit of 500 calories each day or 3,500 calories per week -- enough to lose one pound of body fat. Gradual weight loss is best during breastfeeding. Burning off fat quickly is not safe because the body stores pesticides and other contaminants in fat. Quick weight loss releases these contaminants into your milk.
- Breastfeeding women often experience their greatest weight loss between three and six months postpartum, when they are producing a lot of milk for their babies. So don't get frustrated if the pounds aren't coming off at first.
- Chart your weight loss, and tailor your exercise and eating habits to reach the goal you set.
- Invest in some nice, comfortable clothes that fit your postpartum figure. If you focus only on getting back into the jeans you were wearing nine months ago, you could get very depressed. And no one wants to keep on wearing maternity clothes for weeks after the birth. Some pants or leggings with an elastic waist and a few colorful tops will help you feel better about your still-changing body. Two-piece outfits that are easy to breastfeed in will make it easier for you to get out and around with your baby.
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