Pregnancy and Birth

Overview:

Pregnancy is the time taken for a fetus to develop inside a woman’s womb. Sometimes, if more than one embryo develops inside the uterus at the same time, it is known as a multiple pregnancy. It typically lasts for 40 weeks from the last menstrual period (LMP). A woman can get pregnant through sexual intercourse or by Assisted Reproductive Technology (ART).

How to Get Pregnant Tips:

1. Ovulation: Ovulation is the process where an egg is released from the ovaries. Ovulation normally occurs between the 11th to 21st day of your menstrual cycle. If you have sexual intercourse around the ovulation period, the chances of sperm fertilizing the egg increase many folds. To know when you ovulate, chart your basal body temperature (BBT). You can also use over-the-counter ovulation predictor kit or ovulation calculator to know when you are ovulating.
2. Weight: Being overweight or underweight may affect the hormonal balance and disrupt ovulation. Your BMI (body mass index) should be between 18.5 to 24.9. Walking, swimming, yoga, etc., can be done to stay fit.
3. Stress management: Stress can make it harder for you to get pregnant. Try meditation, yoga, and acupuncture to de-stress yourself.
4. Treat medical conditions: Medical conditions like diabetes, hypertension, asthma, etc., can affect your chances of getting pregnant. So, consult your doctor and get them treated to increase your chance of conceiving.
5. His health: Men can also improve their reproductive health by quitting smoking, eating healthy, stress management, limiting alcohol consumption, etc.
6. Folic acid: Folic acid prevents neural birth defects. Neural birth defects like spina bifida affect the baby’s brain and spinal cord. So, taking 400 mcg of Folic acid from at least a month before conception might reduce the incidence of such defects.

Signs of Ovulation:

• A rise in the basal body temperature. You can note the change in temperature by measuring your BBT every morning with a thermometer. Before ovulation, a women’s BBT is between 36.1 to 36.4 degree Celsius, and after ovulation, it rises to 37 degrees.

• Levels of luteinizing hormone (LH) is higher. It can be measured using an ovulation kit.

• The cervical mucus appears thin and clear.

• Tender breasts.

• Bloating.

• Spotting.

Early Signs of Pregnancy:

A few symptoms of pregnancy are noticeable early on, these symptoms include:

• Missed period.
• Tiredness.
• Frequent urination.
• Tender breast.
• Nausea.
• Vomiting.
• Abdominal cramps.

Pregnancy Tests:

If you develop any of the above symptoms, it is best you get a pregnancy test done. Pregnancy tests usually detect the presence of hCG (human chorionic gonadotropin) hormone in the blood and urine. This hormone is produced after implantation.

The various pregnancy tests available are:

1. Urine Test: It can be either done at home or in a doctor’s office. It is best to wait a week after a missed period to take this test. A chemical in the pregnancy strip changes color when it comes in contact with hCG hormone. Many pregnancy test strips are available over-the-counter, and you can follow the instructions provided with the kit.
2. Blood Test: Blood tests are more accurate than the urine test, and can detect pregnancy as early as 6 to 6 days after ovulation. A quantitative or a qualitative hCG test can be carried out. Qualitative Blood hCG Test -This just detects the presence of hCG in the blood, and gives a yes or no result. Quantitative Blood hCG Test - It measures the levels of hCG hormone in the blood. This test is very accurate and can even detect smaller amounts of hCG in the blood.
3. Ultrasound: Depending on the blood test results, your doctor will conduct an ultrasound or sonogram around the 6 to 8 weeks of pregnancy. You can see the developing embryo in this ultrasound image.

Stages of Pregnancy:

Pregnancy is divided into three trimesters, the first, second, and the third trimesters.

First Trimester:

Weeks 1 to 12 is the first trimester. It includes the process of fertilization, that is the process of sperm and ova forming an embryo in the fallopian tube. This embryo then travels down and reaches the uterus and gets attached to the wall of the uterus (implantation). This is the period where the embryo and placenta start to grow in the womb.By around 4 to 5 weeks, your baby’s heart, brain, and spinal cord start forming. Arm and leg buds can be seen. By 8 weeks, all major organs and external body structures start forming. The developing heart begins to beat in a regular rhythm. The umbilical cord is clearly visible, and the fetus is an inch long and looks more like a human. And by the 12th week, the nerves and muscles form and work together. The external sex organs start developing, and the eyelids close to protect the developing eyes. At the end of 12 weeks, the fetus is approximately 3 inches long.

Symptoms Experienced During the First Trimester:

Your body undergoes many changes, and hormonal changes affect almost all the organs of your body. The first sign of pregnancy is your periods stopping. The symptoms of pregnancy can start from the first week itself, but some women might not feel any discomfort at all.

The signs are:

• Tiredness.

• Swollen and tender breasts.

• Morning sickness.

• Mood swings.

• Frequent urination.

• Headache.

• Abdominal cramps.

• Heartburn.

• Food cravings.

Second Trimester:

Weeks 13 to 28 is the second trimester. Majority of pregnant women find this trimester easier than the first. The baby starts growing, and your abdomen and uterus expand with it. By the end of this trimester, you can feel your baby move inside you.Generally, by the end of the 16th week, muscle and bone grow and form a complete skeleton, and transparent skin begins to form. The baby’s first bowel movement (meconium) develops in their intestinal tract. By the 20th week, the developing fetus is covered with fine hair (lanugo). The baby becomes more active, and you can feel slight fluttering movements. Eyebrows, eyelashes, and nails form. At 24 weeks, the bone marrow starts making blood cells. Fingerprints, footprints, and taste buds develop. Hair starts growing, and the sex organs develop. By the end of the second trimester, the fetus is approximately 12 inches long.

Symptoms Experienced During the Second Trimester:

• To make room for the growing baby, you may undergo the following body changes:Pain in the back, abdomen, and thigh.

• Stretch marks.

• The skin around the nipples darken.

• A line can be seen from the belly button to the pubic hair.

• The skin over the cheeks, lips, forehead, and nose get dark in patches.

• Tingling feeling in the hands.

• Itching of the palm, sole, and abdomen.

• Your ankles, finger, and face might get swollen.

Third Trimester:

Weeks 29 to 40 is the third trimester. It is the final stage of pregnancy. As the baby grows, it might put more pressure on your internal organs. You might have difficulty breathing and might urinate frequently. These problems should go away after you give birth.By the 32nd week, your baby’s bones are soft but fully formed. As a result, their kicks and jabs are more forceful. The fine hair covering their body falls off. The eyes open and close and can sense changes in light. At 36 weeks, the body fat increases and protective wax coating (vernix) gets thicker. Your baby is about 16 to 19 inches long. At 39 weeks, your baby is considered full-term. The baby’s organs are fully formed and can function on their own.

Symptoms Experienced During the Third Trimester:

The discomforts felt during the second trimester may continue, also the following symptoms may be present:

• Frequent urination.

• Shortness of breath.

• Heartburn.

• Hemorrhoids.

• Breasts may leak pre-milk called colostrum.

• Contractions (false labor).

Labor and Delivery:

Due Date: The due date or estimated date of delivery (EDD) is the expected date of delivery for pregnant women. A normal pregnancy lasts for 280 days, and it is calculated from the last menstrual period (LMP).

Signs of Labor:

Normal labor starts as early as three weeks before or two weeks after the due date. The following are the signs of labor:

1. As the baby’s head drops down into the pelvis, your belly might look lower. You will find it easy to breathe.
2. Frequent urination as the baby presses on the bladder.
3. Brownish mucus plug is discharged from the cervix.
4. Frequent bowel movement.
5. When the amniotic sac surrounding the baby ruptures, fluid can be seen leaking from the vagina. It usually occurs 24 hours before women go into labor.
6. Contractions which occur less than 10 minutes apart is a sign of labor.

Types of Delivery:

1. Vaginal Delivery - Vaginal delivery is the oldest, most common, and the safest kind of birth. It may or may not be assisted with pain medications or epidural injection. In certain circumstances, when the baby is unable to emerge out entirely, and if the mother is tired, then vaginal delivery is assisted with the help of a forceps (forceps delivery) or vacuum (Vacuum extraction).
2. Cesarean section (C-section) - If any complications arise during vaginal delivery, c-section is done. In this method, the abdomen is surgically opened by placing a c shaped cut, and the baby is delivered by surgically cutting into the uterus.Once a woman has a cesarean delivery, all future deliveries are performed by c-section, as there is a change of the uterus rupturing during vaginal delivery. But nowadays, depending on how your previous c-section was performed, you might have a chance to give birth vaginally this time!

Complications During Pregnancy:

Some of the difficulties seen during pregnancy are:

• Gestational diabetes – Women with no previous history of diabetes, develop high blood sugar during the gestational period.

• Hyperemesis gravidarum – Severe and persistent vomiting is called hyperemesis gravidarum. It can cause dehydration and weight loss.

• Pelvic girdle pain – It is a disorder that causes pain due to the instability and limited mobility of the pelvic joints.

• High blood pressure – High blood pressure during pregnancy is called gestational hypertension. Blood pressure above 160/110 is called preeclampsia.

• Anemia – The levels of hemoglobin is low in most of the pregnant women during the third trimester.

• Deep vein thrombosis (DVT) – DVT is the formation of blood clot in the deep veins, mostly the veins of the leg. It can be fatal.

• Peripartum cardiomyopathy – It is the decrease in the heart function during the last months of pregnancy.

• Hypothyroidism – Hashimoto’s disease causes the mother’s thyroid not to function properly and might cause severe congenital disabilities in the child.

• Ectopic pregnancy – When the fertilized embryo gets attached outside the uterus, it is called ectopic pregnancy.

• Miscarriage – Loss of pregnancy in the first 20 weeks is called a miscarriage.Placental abruption – The separation of the placenta from the uterine wall is called placental abruption.

• Placenta previa – It is when the placenta gets attached near or over the cervical opening in the uterus.

• Placenta accreta– It occurs when the placenta gets abnormally attached to the muscular layer of the uterine wall.

• Perinatal infections – As the developing fetus has no immune system, pathogens can cross the placental barrier and cause infections.

• Premature labor - If your cervix starts to dilate and you have regular contractions before you reach 37 weeks, it is known as premature labor.

Pregnancy is a significant time during a woman's life. It is crucial to take care of yourself during these 9 months, as any changes in the health will have a direct effect on the developing fetus. Always take medicines under medical supervision, as many drugs can cause side effects to the baby. Go for regular checkups and eat healthily!

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