Read an Excerpt
Countdown to Baby
Answers to the 100 Most Asked Questions About Pregnancy & Childbirth
By Susan P. Warhus, Jack Kusler Addicus Books, Inc.
Copyright © 2004 Susan P. Warhus, M.D.
All rights reserved.
ISBN: 978-1-940495-48-4
CHAPTER 1
Getting Organized
Congratulations, you're pregnant! What an exciting time in your life! Now that you're pregnant, you have lots of things on your mind and many things to do. Be assured that it is perfectly normal to experience a wide range of emotions. Some days you may be bursting with delight and excitement; at other times you may feel frightened and overwhelmed. You can reduce some of the stress you might be feeling by getting organized and making some important decisions. Your top priority right now is to establish excellent prenatal care for yourself and your unborn baby. You need to find the best doctor (or midwife) to care for you during your pregnancy and upcoming delivery. You also need to review diet, exercise, and other lifestyle habits that are important to maintain during your pregnancy.
You are about to embark on your amazing journey toward motherhood, and your life will never again be quite the same. Best wishes to you during your pregnancy. It is such a special time.
1. How is my due date calculated?
Your due date is calculated based on the first day of your last menstrual cycle. That's why it's important to keep a record of your periods when you are trying to get pregnant. You become pregnant when your body is ovulating. Ovulation is the releasing of an egg from one of your ovaries. The egg can only be fertilized within twenty-four to thirty-six hours of ovulation. If you have intercourse during ovulation time, there is a good chance that one of the millions of sperm released during your partner's ejaculation will fertilize your egg. Most women cycle approximately every 28 days and ovulate on or about day 14. The easiest way to determine your menstrual or fertility cycle is to begin counting on the first day of your period; this is day one. Continue to count each day until you reach day 14. For most women, day 14 is ovulation day and the most likely day for you to become pregnant. After day 14, continue to count each day. If you are pregnant, you won't have another period. If you are not pregnant, continue to count (usually until about day 28) until your next period begins and the cycle starts all over again with day one.
The due date of a full-term pregnancy is based on 40 weeks from the first day of your last period. Another way of looking at it is to say that your due date is about 38 weeks after conception. However, the medical profession uses the 40 weeks from your last period method. Those little gestational wheels used to calculate due dates that you see in your doctor's office are based on the same 40-week term method. Ask your doctor to show you how it works.
In some cases, it may be difficult to determine your due date. Perhaps you don't remember when your last period was, or maybe your periods are irregular. In these cases, the doctor will often order an ultrasound to assist in determining the due date.
2. When should I tell my family and friends that I am pregnant?
The decision to tell others about your pregnancy is entirely up to you. Most women immediately share the news with spouse, partner, or a close friend. This is usually a good idea because it enables you to discuss your excitement and share your concerns with a close and supportive person in your life. However, before you announce the big news to your entire family and all your friends, and coworkers, you may want to consider a few important issues.
Many women prefer to know that the fetus is viable before telling others. This may be especially true if you have had miscarriages or ectopic pregnancies in the past. Once you have heard or seen the fetal heartbeat, there is a greater than 95 percent chance that the fetus will not miscarry. Waiting until you have that reassurance allows you to avoid the difficulty and sadness of having to announce that a miscarriage has occurred.
Some women, especially those over thirty-five, prefer to know that the baby's genetic makeup is normal prior to announcing news of their pregnancy. (If you are age thirty-five or older, your baby has a slightly increased chance of having genetic abnormalities.) If test results show a genetic abnormality, the woman has the option to confidentially terminate her pregnancy.
On the other hand, some women enjoy sharing the big news with everyone right away. By immediately announcing your pregnancy to your group of family and friends, you are able to celebrate your happiness with all of them. Should a miscarriage or problem occur, you would also receive sympathy and encouragement from a large support system.
Once the news of your pregnancy becomes widespread, prepare yourself for a barrage of advice, warnings, and stories. When it comes to pregnancy and childbirth, just about every woman considers herself an expert and has a story to tell. Even though their comments are made out of love and concern for you, eventually these remarks may cause you undue worry and concern. Perhaps your well-intentioned friend doesn't remember the entire story, or maybe technology has changed since a particular incident happened. The important thing for you to do is establish a close relationship with a caring and communicative doctor. Your health provider, who knows you and your situation, is best qualified to address your concerns and questions. Your doctor is there to care for you and also to comfort and reassure you through the entire pregnancy and childbirth experience.
3. What changes in my diet, exercise, and lifestyle should I make?
In a perfect world, you would maintain an ideal, healthy lifestyle and have absolutely no vices or bad habits. That would mean that you don't smoke and you've avoided all alcohol, medication, and drug use. It would also mean that you eat a well-balanced diet, exercise in moderation two to three times each week, and take one prenatal vitamin per day. Honestly, that is rarely the situation. Once you find out that you're pregnant, immediately stop the use of all tobacco, alcohol, or drugs and do your best to eat a healthy diet. If you are already participating in an exercise program, it's fine to continue. However, most experts agree that pregnancy is not a good time to begin a vigorous exercise routine, because your body is already going through so many other important changes. If you were taking prenatal vitamins prior to becoming pregnant, it's fine to continue. Otherwise, they will be prescribed for you at your first prenatal visit.
Prior to finding out that you are pregnant, you may have done some things that are now causing you anxiety and concern. For example, perhaps you had a couple of alcoholic beverages, smoked cigarettes, or used certain types of medication. It's important to let your doctor know this during your first prenatal visit. That's because the doctor may want to order an ultrasound or watch your pregnancy more closely for signs of possible miscarriage.
Many studies have indicated that use of alcohol, tobacco, or drugs in the first days of pregnancy usually results in an "all or nothing" outcome. That means it is possible that the embryo could suffer a devastating blow from those unhealthy toxins, and a miscarriage could result. However it is more common that absolutely nothing happens to the embryo because it has not yet become established enough with your own blood supply. It is extremely reassuring to know that in these types of circumstances, the embryo is rarely injured.
For the remainder of your pregnancy, as baby's blood supply becomes more incorporated with your own, it is essential for baby's growth and development that you maintain healthy lifestyle habits.
Avoid Tobacco, Alcohol, Drugs
These toxins can be damaging to you and especially devastating to your fetus. Smoking can cause the following complications:
• low birth weight
• preterm birth
• vaginal bleeding
• placental abruption (placenta separates from uterus)
These are all harmful to the fetus. I've heard women say, "I'm going to keep smoking because I want to deliver a small baby. That way, delivery won't be so painful." The truth is, smoking during pregnancy doesn't make the baby petite; it can seriously influence the fetus's growth pattern and blood supply. Usually the fetal head continues to grow normally while the growth of the rest of the fetus's body is slowed. The medical term for this is intrauterine growth retardation (IUGR). Quitting smoking completely is best. If you can't quit smoking entirely, then cut back to as few cigarettes as possible. Talk to your doctor for advice and options.
Alcohol can cause the following complications:
• lowered heart rate for you and the baby
• fetal alcohol syndrome
• mental retardation
• various physical abnormalities
Since it is unknown exactly how much alcohol causes fetal alcohol syndrome, the safest course is not to consume any alcohol at all during pregnancy.
Use of other drugs can cause the following complications:
• vaginal bleeding
• placental abruption (placenta separates from uterus)
• preterm birth
• low birth weight
• major birth defects
• drug dependency in baby (irritable, crying baby)
• fetal death
If you have a drug problem, please confide in your doctor to get help.
Diet
Especially during the first trimester, it is normal not to feel very hungry. Sometimes you may have cravings for certain foods. It is important to drink eight glasses of water each day and attempt to make healthy food choices. Your fetus needs certain nutrients to grow and develop properly. The foods that you eat are the fetus's primary source of vitamins and minerals. It's best to follow a well-balanced food plan. The USDA food pyramid recommends the daily servings, listed below, during pregnancy.
It is also a good idea to reduce your intake of foods loaded with sugar, such as soda, cakes, pies, ice cream, and candy. Most pregnant women prefer eating five or six small meals each day rather than the traditional three meals per day. Eating small, frequent meals helps to prevent heartburn and indigestion because your stomach doesn't get so full. Also, your sugar levels stay more even, so you feel better. Remember to consume an additional 300 calories per day over your usual prepregnancy calorie intake.
During pregnancy it is best to avoid eating raw fish or raw meat because of their potential for harboring bacteria or parasites. In the worst case, these organisms could cause harm to the fetus. In other cases, they could cause you to have nausea, vomiting, and diarrhea. Not only is this miserable for you, but it may lead to dehydration and reduced nutrition for the fetus.
Certain cooked fish, including shark, swordfish, king mackerel, and tuna, could contain high levels of mercury that may lead to damage of the nervous system. They should be avoided.
Brie, feta, Camembert, and other soft cheeses are at high risk for containing bacteria called listeria. According to the FDA, listeria can pose serious health risks for pregnant women.
For more information on key nutrients that both you and your baby need, see the Appendix on page 152.
Exercise
Exercise during pregnancy can be helpful. However, if you are not used to exercising, be sure to begin cautiously and slowly. If you already have an established exercise routine, you may continue with it, keeping the following considerations in mind.
Listen to your body and don't overdo it. Talk with your doctor to make sure he or she has no objections to your participation in pregnancy-safe exercises. If you have certain health conditions such as high blood pressure, preterm labor, or vaginal bleeding, your doctor may advise against exercise.
Assuming your doctor has cleared you for a pregnancy exercise program, you will begin to notice many benefits. Exercise will give you more energy, decrease aches and discomforts, decrease bloating, make you feel stronger, and help you sleep better. Overall, you should feel much better about your body and yourself.
4. How do I select the best doctor to deliver my baby?
The best way to find a good doctor is through word of mouth. Ask your friends, coworkers, and neighbors for recommendations. If you are new to the community, call a local hospital's labor and delivery department and ask the nurses whom they recommend. Once you have gathered a list of names, you need to narrow it down. Unfortunately in today's society, your insurance company may dictate which doctors and which hospitals you may select, so be sure to check your insurance book listing. You may also narrow the list by location or by gender of the doctor, if you desire.
When you have just two or three names, you may select one from that list to become your doctor and set up your first prenatal appointment. When calling to schedule your first appointment, have your calendar handy, your health insurance card available, and the date of your last menstrual period, if known.
If you'd rather interview several doctors before narrowing your list, that can sometimes be arranged. Some doctors provide an OB consultation appointment at no charge. Others charge a regular office visit fee. Here are some examples of questions that you may want to ask when selecting your OB/GYN physician.
While the answers to the questions are important, the most crucial point is that you feel comfortable with the doctor. You need to feel that the doctor you select is competent, trustworthy, and open to communication.
Occasionally, after establishing care with the physician, you may decide that you don't feel comfortable with the physician after all. If this occurs, evaluate the situation thoroughly and seriously consider changing physicians. After all, your pregnancy and the birth of your baby are very special times in your life. You deserve to have the best experience possible.
5. What about having a midwife deliver my baby?
Some women prefer a midwife to provide their pregnancy care and to deliver their baby. Midwives, who frequently began their career as nurses, have obtained graduate education in midwifery that prepared them to independently manage the reproductive care of women who do not have medical or pregnancy-related problems. Some also share a practice with a physician and co-manage the care of women who have some health risks. Since they do not perform surgery (Cesarean sections) or treat major health problems, midwives always have a back-up physician available for consultation or referral.
Midwives view pregnancy and birth as a natural process and provide patient education, as well as physical and emotional support, to assist their patients in understanding and working with the changes that occur during this life event. Like physicians, midwives provide prenatal care, manage and evaluate your progress in labor, deliver your baby, and provide post-pregnancy care, including contraception.
Midwives provide care in a variety of settings. Although a few perform home births, the majority of midwives work in hospitals or birthing centers. You can locate midwives in your geographic area by searching the web site of the American College of Nurse Midwives (ACNM), www.midwife.org.
Unlike physicians, midwives do not have the training to care for patients with medical conditions or complicated pregnancies. Therefore, if you are diabetic, are carrying multiple fetuses, have high blood pressure, or have other medical conditions, you should be under the care of a physician. Midwives do not have the skills to perform deliveries that require additional expertise, such as vacuum, forceps, or C-section deliveries. Also, if you had a C-section in the past, there is a small chance that your old uterine scar could rupture during labor. In this situation, your chances for requiring the technical expertise of a physician are greater than those of a woman who has delivered vaginally in the past. That's why a physician is recommended over a midwife in certain cases.
However if you are a healthy low-risk patient without any known medical or pregnancy-related problems, a midwife may be a good option for you. Midwives are well-trained, highly skilled, and extremely capable of caring for you and your normal vaginal delivery. In addition, midwives often provide additional emotional and physical support to you before, during, and after your childbirth process. You also benefit from the midwife's physician backup, should an unexpected emergency or event occur.
Assuming that a midwife is still a good option for you, be sure to check with your hospital and health insurance provider to ensure that midwife services are allowed and covered.
When selecting a midwife, you should have an understanding abut the different kinds of midwives. Their education and training can vary greatly. In the United States, the two main categories of midwives are the Certified Nurse-Midwife (CNM) and the lay (direct-entry midwife).
(Continues...)
Excerpted from Countdown to Baby by Susan P. Warhus, Jack Kusler. Copyright © 2004 Susan P. Warhus, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
