Pregnancy

-Erma Bombeck
Welcome to motherhood! The excitement has just begun as you have discovered that you are pregnant. Needless to say that the birth of a baby completely changes a woman\’s life and certainly changes her viewpoint of herself and also her viewpoint of the world.

This is the stage when you may have lots of questions regarding your diet, medical tests to be done, morning sickness and other related issues. This article will help give answers to all your queries:

PREGNANCY SYMPTOMS

A missed menstrual period is often considered by women as the sign of pregnancy. But other related symptoms and signs are also experienced by most women in the early stages of pregnancy. You should remember that all women will not experience all of these symptoms or have the symptoms to the same degree. Even the same woman can experience different types of symptoms in a subsequent pregnancy than she had in previous pregnancies. The most common pregnancy symptoms in the first trimester are as follows:

Missed period
A missed menstrual period is the most common sign of pregnancy. Sometimes a pregnant woman may still experience some bleeding or spotting around the time of the expected period. This small amount of bleeding is noticed at the time of the expected menstrual period. This happens when the fertilized egg attaches to the uterine wall and is termed as implantation bleeding.

Breast swelling, tenderness, and pain
Breast swelling, breast tenderness, or pain are also associated with early pregnancy. These symptoms are often similar to the sensations in the breasts in the days before an expected menstrual period. Women may also have a feeling of heaviness or fullness in the breasts. These symptoms are visible in some women as early as one to two weeks after conception. Women may also find a deepening of the color of the area surrounding the nipple (called the areola) and/or a dark line advancing from the middle of the central abdomen to the pubic area. This is clinically termed as the linea nigra. Some degree of darkening of the areola persists even after pregnancy in many women, but the linea nigra disappears in the months following delivery of the baby.

Nausea and vomiting
Nausea and vomiting are also common symptoms in early pregnancy. Traditionally known as\”morning sickness,\” the nausea and vomiting associated with early pregnancy can be experienced at any time of the day or night. It may occur at any moment between the 2nd and 8th weeks of pregnancy. Most women who have morning sickness get nausea and vomiting about one month after conception, but it may develop sooner in some women.

Fatigue and tiredness
Fatigue and tiredness are very common symptoms experienced by many women in the early stages of pregnancy. The cause of this fatigue is believed to be associated with the rising levels of the progesterone hormone; but the reason is not fully determined. Fatigue is another common symptom related to pregnancy. This may occur in the first weeks after conception.

Abdominal bloating
Some women may have feelings of abdominal enlargement or bloating, but the weight gain is not much in the first trimester of pregnancy. In this early stage of pregnancy a weight gain of about one pound per month is normal. Sometimes women may also feel mild abdominal cramping during the early weeks of pregnancy, which is similar to the cramping that occurs before or during the menstrual period.

Frequent urination
In the early stages of pregnancy, a woman may feel the need to urinate frequently, especially at night, and she may even leak urine with a cough, sneeze, or laugh. The increased desire to urinate may be due to both physical and hormonal causes. Once the embryo has implanted in the uterus, it begins to produce the hormone called human Chorionic Gonadotrophin (hCG), which stimulates frequent urination.

Elevated basal body temperature
A continuous elevated basal body temperature (the oral temperature measured in the morning, before arising from bed) is another symptom of early pregnancy. An elevation in the basal body temperature occurs shortly after the ovulation and persists until the next menstrual period occurs. If the elevated basal body temperature persists beyond the time of the expected menstrual period, there is nothing to worry because it is only another sign of early pregnancy.

Melasma (darkening of the skin)
Some women may also develop a \”mask of pregnancy\” in the first trimester which refers to a darkening of the skin on the forehead, bridge of the nose, upper lip, or cheekbones. The darkened skin is visible on both sides of the face. Doctors call this melasma or chloasma. This symptom is more common in darker-skinned women than those with lighter skin. Melasma is also seen in some conditions apart from pregnancy. Women who have a family history of melasma are more prone to develop this \”mask of pregnancy\”.

Mood swings and stress(darkening of the skin)
Mood swings and stress are common symptoms among women in the early stages of pregnancy. Most women, in the early stages of pregnancy, come across feelings of heightened emotions or even crying spells. The rapid changes in hormone levels are supposed to be the cause of these sudden changes in mood. Pregnant women may also experience more rapid and drastic changes in their state of mind.

PREGNANCY TESTS

If you assume that you are pregnant then you have to go for pregnancy test either at home or in laboratory to determine if you are pregnant or not. You can also access test kits from a medical stores without a prescription. These home use kits measure a hormone called human chorionic gonadotropin (hCG) in your urine. However, these tests are qualitative, the results may come out either positive or negative for pregnancy.

Urine Pregnancy Test
The simplest way to confirm if you are pregnant is to purchase a pregnancy testing kit available in drug stores and test your urine 2 weeks after a missed period or earlier. It detects the presence of pregnancy hormone (hCG) in your urine. The first urine specimen of the day is suitable for testing as it contains more concentration of pregnancy hormone. This test can be done in a few minutes and only one or two drops of urine is required for this test. If the urine changes its color, the test result is positive. But the test may show an incorrect result. Often false – negative results can denote ectopic (tubal) pregnancy.

Blood Pregnancy test

Blood pregnancy test is the most expensive at the same time most sensitive and reliable of all pregnancy tests. The basic blood test to confirm pregnancy is known as the radio Immuno Assay (RIA) or beta subunit HCG. This test is often followed in case of pregnancy complications – a suspected tubal pregnancy. But it can also be performed to confirm if a woman has become pregnant before the missed period. To enable the test a blood sample is first taken and the test result usually takes about 1 hour. This test can also measure approximately how far your pregnancy has progressed in weeks.

Pelvic Exam
If the urine test shows positive result, or if you observe any symptoms of pregnancy even if the urine test is negative, you must consult an experienced gynecologist. The pelvic exam is done normally after 6 weeks from the last menstrual period, to confirm pregnancy. In this method, the doctor inserts two fingers into the vagina alongside the cervix and presses the lower abdomen with another hand to direct the pelvic organs towards the examining fingers. If your abdominal and vaginal muscles are quite relaxed, the exam will be more comfortable and thorough. The pelvic exam is mainly followed in early pregnancy with a purpose to measure the size of the uterus, tubes and ovaries. Your gynecologist determines how many weeks you have been pregnant on the basis of the uterine enlargements which is initially detectable about 4 weeks after conception. Besides uterine enlargement he also examines your uterine softening and a slight bluish colorization of the cervix indicative of pregnancy.

COMPLAINTS BY TRIMESTER

*TRIMESTERS*	*COMPLAINTS*
First Trimester (week 1 – week 12)	Nausea Vomiting Watering of mouth Heaviness of breasts/tingling sensation over breasts Sometimes increased frequency of urine if uterus is placed backwards Tired feeling, early exhaustion
Second Trimester (week 13- week27)	Pain beside the stomach due to stretching of the uterine muscles Itchy feeling all over the body (generally due to salt retention) Swelling over feet Discoloration of nipples and sometimes the face Dark line over abdomen.
Third Trimester (week28- week40)	Hindered flow of urine Pain over pubis due to decent of the baby\’s head in the pelvic cavity Swelling over feet Extreme itching over stomach Increased frequency of urination Vaginal discharge – sticky but less in quantity.

MORNING SICKNESS

Nausea and morning sickness in pregnancy, in contrary to its name, may occur any time of the day or night. It is a very common symptom; up to 70% of pregnant women go through this stage. It can be more severe in a first pregnancy.
Morning sickness is caused by elevated levels of certain hormones, especially during the first 14 weeks.

These hormones tell upon the whole digestive system, resulting in waves of nausea, vomiting, constipation and gas. Estrogen, particularly, may cause special sensitivity to odors and slightly unpleasant smells grow more powerful, even sickening. Nausea and vomiting may also occur due to emotional stress and fatigue. It starts at 4 to 8 weeks of conception and subsides by 14 to 16 weeks. But some women may suffer from nausea and vomiting throughout their entire pregnancy period. Rarely, nausea and vomiting may become so severe that a pregnant woman cannot sustain appropriate nutrition, which can cause weight loss, dehydration, liver damage, and can even be life threatening to the mother and or her baby, if neglected. This severe condition is called hyperemesis gravidarum. This affects about 1 in every 300 pregnant women.

REMEDIES FOR MORNING SICKNESS
1. Small, Frequent Meals

Intake of lighter meals more often throughout the day can help you lessen your nausea. It is suggested to avoid having your stomach totally empty or full. Both can make the situation worse. If nausea gives you real trouble when you first wake up, go for a box of soda crackers on your night-stand and nibbling on them or sipping weak tea before getting out of bed. Rising slowly in the morning, instead of jumping out of bed and rushing out the door, will reduce morning sickness and also light-headedness.

2. More Sleep

Fatigue is very common in early pregnancy and it can contribute well to nausea. So extra sleep and relaxation are advised. Short naps and sound sleep at night will help to curb the situation.

3. Wristbands

Wristbands can often provide relief from morning sickness. These are 1-inch elastic bands worn on both wrists that exert pressure on the inner wrist. It has been observed that pregnant women wearing acupressure wristbands had significantly less suffered from frequency and severity of nausea and vomiting during pregnancy.

4. Herbal Remedies

A considerable amount of pregnant women are turning to herbal remedies to combat with morning sickness.

Herbs like chamomile, peppermint, garlic, aloe, Echinacea, pumpkin seed, ginseng and raspberry leaf are helpful enough to reduce the symptoms of morning sickness. Ginger root is another natural remedy becoming quite popular. Red raspberry leaves are safe to use during pregnancy. Chamomile can help with gas, bloating and indigestion. Although these herbs can reduce nausea during pregnancy in some women, they must be used cautiously.

5. Unpleasant Smells & Foods

A pregnant woman should avoid the sight, smell and taste of unpleasant foods that make you nauseous. Never force yourself to take foods that don\’t appeal you.

6. Vitamin B6 (less iron)

A prenatal vitamin supplement containing vitamin B6. Research reveals that intake of a multivitamin containing vitamin B6 during the first six weeks of pregnancy significantly reduces nausea.
Iron supplements (or multivitamins with iron) can also alleviate nausea. This is why doctors seldom advise temporarily discontinuing iron supplements or switching prenatal vitamins for this reason.
You must be able to restart taking iron supplements in the second and third trimesters, as long as your morning sickness has disappeared. Remember; don\’t ever take any medicine for morning sickness without first consulting your doctor.

7. Fluids

It is important to take plenty of fluids, especially when you’re losing them through vomiting. Milk shakes, smoothies, fruit juices, soups, broths, bouillons and even an occasional popsicle in the morning may be beneficial and easier to get down than solids. Fresh fruit and some vegetables, rich with water content also make a good, healthy snack.

STAGES OF PREGNANCY

FIRST MONTH
Your Baby

During this first month of pregnancy, your baby is about the size of a dime. He has eyes, mouth and head and his legs and arms are in growing stage. Now his heart has begun to beat and his lungs have begun to develop. He is only about half an inch long at the end of this month of pregnancy.

Changes in your life:

It may sound odd but in fact it\’s a great idea to start exercise now as it helps you develop good muscle tone, and increase strength and endurance. It also helps you manage the extra weight you\’ll put on or even prevent you putting on more weight if you\’re already overweight. It makes you fit for labour, and makes getting your figure back after birth easier too. It is essential to choose a safe, reasonably vigorous activity, such as: walking and swimming when you\’re pregnant.

You might also want to attempt some easy yoga stretches. There are special classes adapted for pregnancy; but be sure that the yoga instructors who teach you are qualified enough to instruct pregnant women and, if it isn\’t a class especially for pregnant women, let the instructor know that you are pregnant. You must be aware of your limits and don\’t overdo it if you are new to exercise.

SECOND MONTH
Your Baby

All of your baby\’s organs have appeared now. He has also become about an inch long and weighs approximately an ounce. Your baby weighs at this stage, under 10 g – a fraction of an ounce but is poised for fast growth. All the body parts are now present, including arms, legs, eyes, genitals and other organs, though they\’re yet to develop completely. The tiny tail is vanishing and so many changes have taken place that your baby has changed from an embryo to a fetus.

Changes in your life

Nausea, associated with pregnancy, usually starts from this month of your pregnancy. While some women experience very little morning sickness others may have it all day for most of their pregnancy. You may also experience facial break outs, fatigue, the discomfort of sore breasts, and a tendency to urinate more often because of the change in hormones needed to maintain your pregnancy. All these are normal and at the same time annoying; but they\’re simply a part of being pregnant so they won\’t last forever.

In early pregnancy, many women often come across mood swings – ecstatic to be pregnant one moment and in tears at the prospect of parenthood the very next moment. The silliest things can turn you off and your partner including friends, colleagues and family. But they will be relieved to know that it\’s very common to have mood swings at this stage. A combination of surging hormones and worries about pregnancy and parenthood can also aggravate vivid dreams or insomnia. So, try to relax and take time to unwind. It’ll be good to practice for the months to come. Though they\’re unsettling, emotional ups and downs can continue throughout your pregnancy and well after your baby\’s birth so try to accept the situation you are in when you\’re bound to feel fragile occasionally.

This is the time to have your first prenatal visit this month. Make sure that you take prenatal vitamins as soon as you discover early pregnancy symptoms and confirm it. Folic acid and calcium are very important for the growth of your baby and help prevent birth defects. You should eat well at every stage of pregnancy so that your baby receives all the nutrients she needs for her development. Little regular meals and regular drinks can prevent indigestion and enable you to combat nausea and fatigue. It helps to eat a wide range of foods, particularly if you are vegetarian. Try to take enough rest and consult your physician if sickness is making your life wretched or if you really can\’t keep anything down. Distraction can help. So, think about the sort of antenatal care and birth you\’d like. Though you\’re not likely to have gained much weight, parts of your body, such as breasts, are certainly growing. Your blood volume is not likely to increase but by the end of pregnancy, you\’ll surely have 45 to 50 per cent more blood running through your veins to meet the demands of your baby.

THIRD MONTH
Your Baby

You can hear your baby\’s heartbeat through a stethoscope now. It’s nice to know that your baby has fingers, toes and soft nails. By the end of this month of pregnancy, he is four inches long and weighs a little over an ounce. Your baby\’s face is changing too- the eyes, which appeared both sides of his head have come closer together and his ears are almost in their normal position. This is the time for rapid growth and maturity of the tissues and organs that have already formed in his body. Your baby\’s intestines, which start out as a large swelling in the umbilical cord, will be slowly moving into the abdominal cavity by now.

Changes in your life

Physically you may not look pregnant unless this is your first issue, but you may feel very tired and sick – not necessarily in the mornings so cosset yourself. Pregnancy hormones can also make women suffer from headaches and back problems such as sciatica and, unfortunately, these hormones also prepare the ideal environment for vaginal thrush.

Staying active can denote a healthier pregnancy and a faster recovery after the birth. Follow some work outs but don\’t overdo it. Choose a safe exercise schedule recommended throughout pregnancy and make sure you don\’t get too hot.

In early days, how you sit and even the activities you choose to do in pregnancy can make the difference in helping your baby to get into a good position for birth later on and it mean that you have the stamina for an active birth. However, it’s good to start thinking about these things now so that you can get into good habits. You must try these cool ways to stay healthy, especially when it is hot and humid outside.

As you are close to the end of the first 3 months of pregnancy – your first trimester, your uterus is about the size of a musk melon, almost big enough to fill your pelvis. You can also feel your uterus just above the middle of your pubic bone. Though you probably won\’t be in need to increase a dress size for several more weeks yet, you may observe your waist thickening gradually.

Your baby needs calcium to grow healthy bones, teeth, and muscles now. It will keep them strong in years to come. Remember, you\’re her only source for this mineral. If you don\’t consume enough calcium through food or supplements, your baby will simply filter what she needs from your bones which can endanger your own health. So, you should enhance your calcium intake with calcium enriched recipes.

FOURTH MONTH
Your Baby

Hair growth is really big news this week! Hair seems to grow not only on his head and brows but all over his body. This is covered in an ultrafine down, called lanugo, which typically disappears before birth. Some muscles also become activate.

Changes in your life

Now your nausea will be on the decline and you\’ll soon be feeling full of life. You\’re possibly feeling calmed as the danger of miscarriage has now dropped dramatically. It might be difficult to believe if you\’re still in the throes of morning sickness, but you\’ll soon recover your appetite. Just make sure any meat you eat is properly cooked to reduce any chance of toxoplasmosis. No semi-cooked meats or rare steaks are allowed to you, and take care at barbecues. Most women find the second three months the easiest stage of pregnancy as you can expect sound sleep and your bump isn\’t too big to hinder your actions. Try to make the most of these energetic middle months to enjoy the activities like swimming, walking and low-impact aerobics.

Hunger is another possible symptom of pregnancy. Although you\’re eating for two you do not need to eat too much; rather, you should eat a little more than usual. You seem to gain a few pounds this month.

Feeling the baby move is one of the most exciting experiences of a mother. Most of the women detect quickening, as it\’s called, between 16 and 20 weeks. It’s amazing to feel these first wiggles as a flutter low down in your tummy. Once you understand it\’s actually your baby turning somersaults, you must not forget to tell your doctor at your next visit. Some women may feel the baby move later or less often than others. But there\’s no need to worry if you haven\’t noticed quickening yet.

By this time, your doctor may recommend an antenatal test to screen for birth defects. The multiple marker screening tests, which estimates levels of alpha-fetoprotein (AFP) among other things, is usually done between 15 and 20 weeks. Amniocentesis is often suggested for women over 35 and those with a history of birth defects. It\’s usually performed at around 14 to 18 weeks. Both these tests for chromosomal abnormalities are not essential and your doctor can explain the implications of these tests, if necessary.

Your immune system is slightly hampered when you\’re pregnant so you may have observed that you\’ve had more coughs and colds than you normally would. Although, they are irritating and tiring, you can relax as these sniffles won\’t harm your baby. Other infections that you may come across while you are pregnant include genital herpes, chicken pox or rubella. Any of these can cause problems for your unborn baby depending on the stage of pregnancy when you get afflicted with it. Shingles won\’t harm your baby but you should avoid other pregnant women.

You are more likely to gain at least 2.2 kg by the end of the fourth month, maybe as much as 4.5 kg. Your uterus is in growing stage and you might feel pangs due to the ligament stretching in your abdomen. Though these pains are usually transitory your growing uterus will exert extra strain on your back.

FIFTH MONTH
Your Baby

If you have an ultrasound during the fifth month of pregnancy and your baby is awake, you can see her hand moving towards the mouth or the mouth open. The radiologist may detect if you are having a boy or a girl! At the end of the fifth month of pregnancy your baby becomes approximately ten inches long and weighs about a pound. Your baby possibly has reached 15 cm from crown to rump by now, and she can both feel and hear. It’s said that at this moment, all she can hear is your heartbeat and flow of your digestive system but soon she\’ll be able to detect sound outside the womb and identify your voice.

Changes in your life

You are now full of energy and some will say you blush. The fatigued feeling may reduce. But you may feel a little bloated this month of pregnancy. Constipation may also occur this month. So drink more water.

You may also find that the areola (the darkish area around your nipples), is getting larger as your breasts expand. Although it’s a harmless side effect of pregnancy it may last as long as 12 months after the baby born. You may have also noticed other skin changes including linea nigra and the mask of pregnancy; both of which will fade after the baby is born.

SIXTH MONTH
Your Baby

Your baby has become much more active now, rolling from side to side and turning upside down and back. He also begins to suck his thumb! At the end of the sixth month of pregnancy your baby has grown approximately 12 inches long and weighs about a pound and a half.

Changes in your life

By this time your uterus has grown well into your abdomen – the top of it perhaps reaches your belly button. From now on it starts growing at about a centimeter per week.
You may also notice some pain in your lower abdomen. It\’s nothing to be worried about as it\’s just the stretching of your muscles and ligaments supporting your bump.

You may also feel out of breath, huffing and puffing up a short flight of stairs. But some breathlessness is normal and may become a little worse day by day as your expanding uterus pushes up against your lungs, but you should consult your doctor if the situation gets out of hand. Also, take care if you\’re receiving enough iron. Your baby needs it to make red blood cells. Babies born to mothers who are low in iron are likely to be small. A good iron level also helps decrease bleeding at the birth. It’s almost not possible to get too much from food alone, as long as you\’re not overeating. Iron-rich foods include lean red meat, poultry, fish, lentils, spinach, green leafy vegetables and iron-fortified cereals.

It\’s difficult to be elegant when you\’re pregnant so don’t worry if you find yourself getting clumsier these days. You\’re putting on more weight, and your centre of gravity has also changed with your growing uterus, and your fingers, toes, and other joints are all loosening due to pregnancy hormones.

You may find your gum bleeding when you brush your teeth along with nosebleeds. This is a common pregnancy complaint. Pregnancy hormones can also make your gums swell and become inflamed, leading to frequent bleeding, especially when you clean your teeth. So brush and floss regularly but do it softly.

Most women have monthly antenatal appointments. It’ll be good if your partner can manage time to come along when one is scheduled. Not only he will be able to hear first-hand how things are going, he can also clear his doubts.

You may notice pale red streaks (known as striae, or stretch marks) on your tummy, hips, buttocks and breasts. Lots of women have very inflamed skin as well. These all happen just because of pregnancy hormones that make your skin dry and stretching over a growing bump doesn\’t facilitate. Applying creams may make you feel more comfortable and soothe the itchy sensation but it won\’t help get rid of stretch marks and is unlikely to prevent them. Stretch marks are common at this stage of pregnancy and will fade to silvery white marks after you give birth.

You may also find your eyes becoming more sensitive to light, feeling gritty and dry. This is a perfectly normal pregnancy symptom called dry-eye. In order to alleviate your discomfort and add moisture to the eyes, you can use an artificial tears solution available from pharmacies.

SEVENTH MONTH
Your Baby

Your baby is now able to open his eyes and turn his head following the source of any continuous bright light. His fingernails are budding, and fat layers starts forming as he gets ready for life outside the womb. If you like the thought of interacting with your baby while he\’s still in the womb, singing and reading to your baby may work.

Changes in your life

You may experience cramps in your feet or legs due to the deficiency of calcium. So, take your prenatal vitamins regularly. You may detect swelling in your hands and feet during this period. Braxton Hicks contractions are one of the common symptoms at this stage.

Sleep may not be sound any more if you\’re having nightmares. These are common because when you sleep, you keep worrying about pregnancy and impending motherhood in your subconscious mind. Your growing bump may also make cause difficulty to get into a relaxed position. Therefore, doctors recommend getting into the habit of sleeping on your side rather than your back.

Now you may experience a slight increase in your blood pressure, which is normal. But if your weight suddenly increases, or your vision blurs, and your hands and feet swell significantly, you may have pre-eclampsia. Go to your gynecologist immediately if you come across any of these symptoms.

Most women gain an average of 5 kg during this time.

You may waver between two mixed feeling of having been pregnant and an irresolute state of mind as you may feel you are not ready for this. Don’t worry; remember, you’re not the only woman to get pregnant.

Sharing experiences with other women in your antenatal class can be encouraging. If you\’ve chosen a hospital where you plan to give birth to your baby, speak to your doctor if it is possible to arrange a tour. This may give you an idea on what to expect. However, not all hospitals will be willing to permit a tour, so take information first.

EIGHTH MONTH
Your Baby

From now on, your baby will start gaining weight fast. His lungs and digestive tract are almost matured and he\’s perhaps been able to open and shut his eyes for a while now and can see inside you. Your baby\’s movements are also changing by time which may seem less frequent and less forceful as she\’s running out of room in your uterus and can\’t turn somersaults any more but can move her head from side to side, her organs are continuing to mature and a layer of fat is being laid down beneath her skin. If you are going to give birth to a boy, his testicles have probably moved into his scrotum. Sometimes, one or both testicles don\’t get into position until after birth but there is no need to worry because undescended testicles often correct themselves before the first birthday.

Changes in your life

Perhaps you feel rather uncomfortable around the eighth month of pregnancy and feel prepared to have the baby. Heartburn and indigestion are apparent. You may also experience short of breath. The tired feelings that you had experienced early in pregnancy return now. If you face a trouble in sleeping you can place a pillow between your knees and sleep on your side. If your baby disturbs you by kicking while you sleep, turn to the other side because most babies favor one side over the other.

You may notice your swollen feet, hands, face, and ankles. This water retention called oedema is often worse in warm weather and later in the day. Surprisingly, drinking more and more water will help minimize the effect. But if the swellings appear severe and you start to have headaches, call on your doctor straightaway, because these are sometimes symptoms of pre-eclampsia.

You may also have an itchy sensation or numbness in your pelvis – it\’s nothing but the pressure of the baby on the nerves. This may not subside until your baby\’s born, so you can only try the relaxation, positions and massage learned in your antenatal classes to help you cope with the discomfort. If you feel very uncomfortable, tell this to your doctor.

This is the time when you may feel like running out of room as your uterus has expanded to 1,000 times its original volume and reaches up under your ribs. You\’ve probably put on between 11.5 and 13.5 kg weight but now onwards you\’ll gain little or no more weight until your due date.

If you\’ve already taken your maternity leave, make use of it and take regular afternoon rest. It\’s the time to practise the breathing technique you\’ve learned, too. Go for a pedicure while you\’ve got time off and if your hair is thicker and more shiny than usual, it may need tidying up more frequently.

NINTH MONTH
Your Baby

Your baby\’s growing big. He is so cozy in your womb now she isn\’t moving around as much. By the end of this week, your pregnancy will have come full term which means your baby can be born any day now and it’s really good news to a mum. Usually, babies born before 37 weeks are called premature or pre-term, and those who born after 42 weeks are post-mature or post-term. All babies are different but in general a 37-week-old weighs about 2.86 kgs.Your baby is now ready to welcome the world outside her mother’s womb. At this point, the average full-term newborn is still developing a layer of fat so that she can control body temperature after birth. Most babies weigh between 2.7 and 4.3 kg at birth and boys tend to be a little heavier than girls. Now all your baby\’s organs are developed and in place though her lungs need time to reach full maturity.

Changes in your life

You may feel truly energetic a few days before you begin labor. Your baby\’s head will put pressure in your pelvic area sending you to the bathroom more.
Breathing should become easier by this time. The mucus plug will eject this month which indicates labor is eminent. This also indicates that labor may be hours, days or as long as two weeks away.

You can also feel increased pressure in your lower abdomen and notice gradual dropping of your baby. This is known as lightening or engagement. Now your lungs and stomach will ultimately get a chance to stretch a bit; consequently breathing and eating become easier. However, walking may become ever more uncomfortable – some women even say it feels as if the baby is going to fall out. But there is no need to worry, this can’t happen after all. You may also feel the need to go for a wee all the time. However, practising your pelvic floor exercises can be helpful.

The next couple of weeks are just a waiting game. Enjoy as much as possible this time before the baby arrives. Now the only motto is: eat well and get plenty of rest. If you need help to overcome the late pregnancy blues, you can always look forward to and find out what your newborn will be like.

Possibly you are feeling huge and uncomfortable during these final weeks. Try to take the whole situation easily as this may be your last chance to do so for quite a while. You can see a film, read a book that has nothing to deal with pregnancy or babies, have your hair or nails done or just spend time with your partner. This may help distract your mind and reduce your tension.

These last few days will perhaps seem longer than the last nine months. Most doctors prefer waiting 10-14 days after your due date before considering your baby overdue and inducing labour. In the meantime, you and your partner might try relieving the tension getting yourself indulged in a little love-making – sex may prove useful to get labor started. If it doesn\’t, your doctor may recommend a membrane sweep so that labor starts naturally. If this is your first baby, your labour may be long and slow, but it is possible to speed things up both naturally and by intervention from your doctor.

THINGS TO AVOID IN PREGNANCY

When you are pregnant, there are quite a few instructions you should abide by in order to avoid risks that can complicate or even terminate a pregnancy. Any type of infection or harmful substance you are exposed to can pass through the placenta to your baby and cause a real harm.

There are some foods you should avoid during your pregnancy, as well as other dangers that can endanger your baby’s life.
Toxoplasmosis
Raw meat and animal feces contain organism that causes toxoplasmosis. When you are pregnant, you should wash your hands properly after preparing meats for cooking. Make sure your meat has an internal temperature of at least 140 degrees Fahrenheit or 54 degrees Celsius, with juices running clear. Employ someone else to look after the dog and change the cat boxes. If your neighbour keeps cats, you must use gloves when gardening to prevent potential exposure to cat feces.

Take care if your cow or goat\’s milk has been pasteurized, ultra-heat-treated or sterilized. If you live on a farm, avoid coming in contact with baby lambs, lactating ewes or ewes that have recently given birth.

Food Safety
Botulism is a severe form of food poisoning. It can be a great threat to you and also your baby. Always eat fresh foods. Once meat is thawed, avoid refreezing it again. Do not eat foods kept in room temperature for a long time. Try to avoid fast food restaurants when you are pregnant, and avoid eating food from cans that appear scratched or expanded.

Listeriosis
Salmonella is one of the most common causes of food poisoning. It can cause vomiting and diarrhea, risking both infection in baby and dehydration in a mother. Raw eggs are most likely to carry salmonella. Avoid raw cookie dough, it tastes good but it can be dangerous for you and your baby.

Salmonella
Listeria is a bacterium that will cause flu-like symptoms in you but can cause stillbirth or birth defects in your baby. Avoid pates and soft cheeses such as brie, blue cheese and camembert during your pregnancy. Because all of these contain considerable amount of Listeria. It is better to reheat leftovers until they are steaming hot to kill active Listeria.

Salmonella
Cook your eggs well, and avoid béarnaise sauces in restaurants. Cleanse your hands properly after handling raw chicken, and be sure your chicken is cooked well. Make a note of it that your poultry should be completely defrosted before you cook it. Also avoid eating rare beef because it may contain salmonella as well.

Unpasteurized Milk and Juices

You should not drink fresh milk or juices that have not been heat treated. Always check your labels to confirm if they are pasteurized, sterilized or ultra-heat-treated.

Sushi
Raw seafood can contain bacteria, injurious to both you and your baby. If wish to eat sushi while pregnant, choose ingredients such as cooked shrimp or well-cleaned vegetables. Do not eat raw seafood or shellfish while you are pregnant.

During pregnancy, some foods that you relish may be harmful to eat. While some may contain high levels of certain chemicals and harmful bacteria that can cause serious side effects on your baby, some foods may contain Listeria, salmonella, E. coli and methyl mercury, which may cause some serious harm to your unborn baby.

X-Rays
X-rays are a threat to the safety of your growing baby. If you are asked to get an x-ray, let your doctor know that you are pregnant or that there may be a chance of you expecting. Also inform your dentist that it’s not possible for you to have x-rays until you give birth to your baby.

Second Hand Smoke
Smoking during your pregnancy can harm your fetus and even lead to miscarriage. But passive smoking is just as dangerous. If you have family members or friends that smoke, be sure they leave your house before lighting up a cigar or you should avoid be around the people who do. In addition, if your job exposes you to second-hand smoke, make sure if there is another place you can work in until you have delivered your baby.

Alcohol
It’s important to remember that even the least amount of alcohol you drink will transmit through the placenta to your baby. Some women have a feeling that it is safe to have a drink occasionally when they are pregnant. OB/GYN\’s are unable to find the level of alcohol that will be dangerous to your fetus. So, it is intelligent enough to avoid alcohol completely.

Drinking Coffee
Caffeine can also prove harmful to your baby. Limit your intake of caffeine to no more than two caffeinated drinks per day and this includes coffee, tea, hot chocolate and sodas.

PREGNANCY AND SMOKING

Smoking when you\’re pregnant is strictly prohibited. Many women these days indulge in smoking but you should avoid it to give birth to a healthy child.

THINGS TO FOLLOW IN FIRST TRIMESTER
For some women, quitting smoking will never prove easier than in early pregnancy when they develop a sudden aversion to cigarettes. If you can stop smoking now, you can alleviate your chances of miscarriage and it may also reduce the chance of affecting your baby\’s development.

Still it is best to stop smoking before you become pregnant, but stopping now is also a very smart choice and your chances of having a healthy baby are good.

THINGS TO FOLLOW IN SECOND TRIMESTER
If you manage to stop smoking now, you can lessen your chances of developing complications such as placenta previa going into pre-term labor and even stillbirth. If you tried to stop smoking in your first trimester, but didn\’t make it, it’s the time to reduce the number of cigarettes you smoke each day, at least for the sake of your baby. Every cigarette you don\’t smoke is going to help your baby in the long run.

THINGS TO FOLLOW IN THIRD TRIMESTER
It is not too late to quite smoking. If you succeed to stop now, you can still improve your chances of giving birth to a full-term, normal birth-weight baby. Decreased birth-weight is directly proportionate to the number of cigarettes you smoke. It’s evident that there is a direct relationship between smoking and impaired fetal growth. By quitting now, you can also ensure better your odds of not loosing your baby to SIDS. Sooner you do it, is better. But avoid smoking even in the last month can help preserve oxygen flow to your baby during delivery.

HERE IS A CHART THAT INDICATES WHAT YOU SHOULD DO AND WHAT YOU SHOULD AVOID DOING:

Dos	Don\’ts
Get regular medical exams Take prenatal vitamins Eat plenty of protein Eat well and get plenty of exercise Get enough fat in your diet Just focus on your baby and avoid negative thoughts Take care of yourself while traveling You should get the RDA (Recommended Daily Allowance) for Folic Acid. Sleep well Do Kegal Exercises Check your immunity to German Measles (Rubella) Consult your gynecologist if complications arise Take adequate Calcium	Should not smoke or be around people who do Should avoid alcohol Should not consume illegal drugs Avoid caffeine Avoid contact with reptiles Avoid tick bites Should not eat junk foods Should not use electric blanket Should not use water bed Avoid X-rays Avoid stress Should avoid raising your body temperature Should not expose yourself to pesticides

Dos

Don\’ts

Get regular medical exams
Take prenatal vitamins
Eat plenty of protein
Eat well and get plenty of exercise
Get enough fat in your diet
Just focus on your baby and avoid negative thoughts
Take care of yourself while traveling
You should get the RDA (Recommended Daily Allowance) for Folic Acid.
Sleep well
Do Kegal Exercises
Check your immunity to German Measles (Rubella)
Consult your gynecologist if complications arise
Take adequate Calcium

Should not smoke or be around people who do
Should avoid alcohol
Should not consume illegal drugs
Avoid caffeine
Avoid contact with reptiles
Avoid tick bites
Should not eat junk foods
Should not use electric blanket
Should not use water bed
Avoid X-rays
Avoid stress
Should avoid raising your body temperature
Should not expose yourself to pesticides

PREGNANCY AND ILLNESSES

WHAT IF I GET CHICKEN POX WHILE PREGNANT?
If a pregnant woman gets infected with the Chicken Pox virus, she and her baby are at risk. While it can develop into pneumonia for the mother, her baby can have birth defects including defects of muscle, bones, malformed or paralyzed limbs, a smaller than normal head, blindness, seizures or mental retardation.

If a pregnant woman comes in contact with someone who has Chicken Pox, she should consult her doctor immediately. An injection is useful to keep her and her baby safe.

If a pregnant woman has had Chicken Pox before pregnancy there is nothing to worry.

HOW CAN TOXOPLASMOSIS AFFECT PREGNANCY?
Toxoplasmosis is an infection caused by parasites from uncooked meat or from contact with the feces of a cat. It can lead to a serious condition for a pregnant woman. Because the symptoms that resemble the flu is hard to diagnose. A blood test is available to verify if toxoplasmosis is present.

FIFTH DISEASE AND PREGNANCY

Fifth Disease also called erythema infectiosum is a mild common childhood infection. It is spread by airborne respiratory droplets. Its symptoms include:

Flushed cheek rash on the face as mild fever
Headache
Sore throat
Joint pain which usually accompanies other symptoms

Although most babies are not affected by this disease but if one gets affected, it can be serious as it disrupts the baby\’s ability to produce red blood cells which leads to dangerous forms of anemia, heart failure and in some cases infant death. There is a blood test that can determine if a woman has the disease but is not widely available.

If you are pregnant and have been exposed to Fifth Disease you should consult your doctor without delay.

PREGNANCY COMPLICATIONS

Group b strep, gestational diabetes and toxemia can complicate a normal pregnancy and should be considered seriously when diagnosis is confirmed by a health care provider.

TOXEMIA (PRE ECLAMPSIA)
Toxemia or Pre eclampsia in pregnancy can lead to a serious condition and usually occurs in the third trimester of pregnancy. Although the cause of toxemia is unknown, the symptoms include protein in urine, visual disturbance, high blood pressure and swelling.

More advanced symptoms hint visual disturbance, severe headaches, abdominal pain and convulsions. If you or someone you know is pregnant and has any of these symptoms a physician should be consulted without delay.

GESTATIONAL DIABETES
One of the most common complications or conditions of pregnancy includes gestational diabetes. Most pregnant women are examined for it around the 26th week of pregnancy. If one has a family history of diabetes she is more likely to get gestational diabetes. If you test positive, a strict diet will be prescribed and close observation is necessary during the pregnancy.

GROUP B STREP (GBS)
Group B Strep (GBS) is not related to a pregnancy complication or condition that is dangerous to most people. However, during pregnancy it can arouse complications and endanger the lives of newborn babies

Group B Strep (streptococcus) lives in the gastrointestinal tract of men and women under normal circumstances. At intermittent times it can travel from the Intestinal tract to the vagina of a woman during pregnancy, and cause a newborn baby to fall ill with a bacterial infection caused by Group B Step (GBS). An infant’s life is at stake until approximately 3 months of age. A woman who is in labor and about to deliver is usually swabbed to detect if the bacteria is present in the vagina at the time of delivery. If it is present, antibiotics will be prescribed to the mother and the baby at birth.

A newborn complication also includes meningitis, sepsis, and pneumonia. But most of them survive and do well if treated on time and develop normally. A small percentage of babies with GBS will not survive. It is found in a study in Britain that about 100 babies out of 700 who were diagnosed with Group B Strep did not survive.

PREGNANT: NUTRITION

Food habit has an impact on one’s health as well as on an unborn baby’s growth.

Many doctors suggest if a woman is lacking certain vitamins and minerals, her unborn baby will suffer as well. Therefore her nutritional deficiencies may lead to deficiencies in her baby.

During pregnancy, you will need to eat an extra 300 calories per day.

In case a pregnant woman does not eat healthy, it can lead to low birth weight, nutritional deficiencies, birth defects and even mental retardation.

CALORIES
If you are pregnant with multiples, your caloric intake needs to be increased, depending on your doctor or midwife\’s recommendations. However, since your calories don\’t increase that much, those extra few calories are very essential. For this, you must pay extra attention to the quality and variety of foods you eat; along with a suitable prenatal vitamin supplement to your daily routine. It’s even better to add a multivitamin supplement prior to your pregnancy.

Eating a variety of nutritious foods will definitely ensure that you eat enough calories for you and your child. But try to avoid \”empty\” calories, such as junk food, which will fill you up, but ultimately lacks nutritional value.

During pregnancy, your energy needs to be increased by at least 15%. The additional calories and nutrients will provide you increased energy. This is always welcome during pregnancy. Good eating habits will also result in a more congenial 9 months with less complications and discomforts due to heartburn, constipation, fatigue and many other common pregnancy complaints.

Eating healthy during pregnancy also ensures a quicker recovery after delivery as your body is in better condition. This makes it easier for your body to heal and recover from childbirth.

CHOOSE YOUR FOOD WISELY

During pregnancy, you should eat at least 7 servings every day of fresh fruits and vegetables (three servings of fruit and four of vegetables).

A serving of fruit should include:

1/2 cup chopped, cooked, dried or canned fruit (without syrup)
1 medium apple, banana, orange or pear
3/4 cup fruit juice
1/2 cup unsweetened applesauce or 3/4 cup grapes.

A serving of vegetables should include:

1 medium-sized baked potato
1/2 cup vegetables (cooked or raw) such as broccoli or carrots
3/4 cup vegetable juice or 1 cup raw leafy salad greens

{Eat fresh fruits and vegetables whenever possible (organic is best)}

WHOLE-GRAIN BREADS, CEREALS AND PASTA

A pregnant woman needs 6-11 servings of whole grain breads, cereals and pasta every day. A serving might be:

1/2 cup cooked pasta
1/2 cup cooked whole-grain cereal
1/2 cup brown or wild rice
1 large corn tortilla
1 slice whole-grain bread
1/2 bagel
About 2 cups ready-to-eat cereal
1 medium muffin
1/2 hot dog or hamburger bun or 4 small crackers.

MEATS, FISH AND BEANS
3 to 4servings of meats, fish and beans every day is required.
A serving might be:

2 tablespoons peanut butter
1/2 cup cooked (dry) beans
1/2 cup tofu
1/3 cup nuts,
2 -3 ounces cooked lean meat
Poultry or fish (a piece of chicken or a hamburger patty about the size of the palm of your hand) or 2 cooked eggs.

There are specific fish a pregnant woman needs to avoid and others that need to be eaten in minimal amounts.

MILK AND DAIRY

During pregnancy milk and dairy products are also important for you and your growing baby. At least 4 servings of milk and dairy products every day is suggested.

A serving might be:

2 cups low-fat cottage cheese
1 cup milk
1 cup buttermilk
1 cup yogurt or 1 3/4 cup low-fat yogurt
2 ounces processed cheese (like American)
1 cup pudding or custard
1 ounce grated cheese (like Parmesan or Romano)
1 1/2 ounces natural cheese (like cheddar)
1 1/2 cups ice cream or frozen yogurt.

WHY IRON IS IMPORTANT
Iron is essential for the development of healthy red blood cells and to meet the demand created by your increased blood volume.

When you are pregnant, your blood supply increases to supply nutrition to your growing baby. Without sufficient amount of iron, your baby will collect his or her supply from you. This iron deficiency may cause anemia, which may leave you feeling very weary.

Moreover, iron carries oxygen in muscles which helps them function properly. Iron-rich foods include lean red meat, clams, oysters, shrimp, egg yolk, sardines, legumes (peas, kidney beans, lima beans, soybeans and lentils), pumpkin, potatoes in their skin, broccoli, collard and turnip greens, dried fruits, berries, enriched or fortified breads and cereals and molasses.

As it’s difficult to get enough iron from foods alone, you may benefit from taking an iron supplement (especially during the second and third trimesters). Consult your doctor or a midwife before taking any supplements.

WHY PROTEIN IS IMPORTANT?

Protein provides resources for building and growing tissues and muscles, including the placenta, and your blood, as well as your baby\’s.

Protein also helps build your baby\’s brain’s cells and is an essential part of proper brain development. Protein is found in animal and dairy products including meat, fish, eggs, cheese, yogurt, milk and cottage cheese.

Other sources of protein are dried beans, tofu, nuts, seeds, cereals, pasta, broccoli, leafy green vegetables, peas and grains.

WHY CALCIUM IS IMPORTANT?
Calcium is a very important nutrient that makes your baby’s bones strong. During the third trimester, the need for calcium is the highest. This is the time when your baby\’s bones develop and strengthen. Besides proper bone formation for your baby, adequate amounts of calcium helps preserve your bone strength too.

If you aren\’t taking enough calcium in your diet, the calcium needed by your developing baby is drawn from your bones that lead to osteoporosis later in life. Osteoporosis causes alarming thinning of your bones, causing weak, brittle bones that can easily be broken. Getting enough calcium during pregnancy also lessens your risk of developing pregnancy induced hypertension (pre eclampsia) significantly.

The best sources of calcium are dairy foods including milk, cheese, yogurt and pudding. Other sources of calcium are dark green leafy vegetables (such as broccoli and spinach), dried peas and beans, calcium-added orange juice, nuts, seeds, tofu and even seafood.

WHY WATER IS IMPORTANT?

It is very essential to consume extra fluids, especially water, during pregnancy. Water can prevent some common pregnancy discomforts, such as constipation, hemorrhoids, excessive swelling (edema) and even urinary tract infections (UTIs).

Consuming sufficient water will also help prevent you from becoming dehydrated. Dehydration during pregnancy, particularly during the third trimester, can lead to uterine contractions and also preterm labor. The extra fluid in your body will cooperate with making amniotic fluid and will feed your increased blood volume. You should drink at least 8-ounce glasses of water every day.

WHY FOLIC ACID IS IMPORTANT?
Folic acid is a water-soluble B-complex vitamin which is found in most prenatal vitamins. It is essential for women who are trying to conceive or who are already pregnant to prevent abnormalities in an unborn baby.

Folic acid, when taken before becoming pregnant or during the first several weeks of pregnancy does the same. It can help prevent serious birth defects of the brain and spine.

The risk of neural tube defects such as spina bifida(occurs when the spinal column doesn\’t close) and anencephaly (occurs when the neural tube doesn\’t close, leaving incomplete brain and spinal cord development) can be cut down by well over 50%, when a woman consumes the adequate amount of folic acid prior to conception and early in the first trimester.

Sources of folic acid include: fruits and vegetables including oranges, orange juice, pineapple juice, raspberries, blackberries, strawberries, papaya, grapefruit, cantaloupe, honeydew melon, spinach, iceberg and romaine lettuce, asparagus, cauliflower, broccoli, raw celery, cabbage, winter squash, peas and corn. Other sources of folic acid are kidney beans, lentils, tofu, peanuts and peanut butter. Other foods that contain added folic acid include many grain products such as flour, rice, pasta and cornmeal.

women of childbearing age are recommended to get 200-400 micrograms of folic acid a day; (this is particularly because many pregnancy are unplanned) and no less than 400 micrograms starting at least one month prior to and during pregnancy, if possible. However, you shouldn\’t take more than 1,000 micrograms (or 1 milligram) of folic acid, without your doctor or midwife\’s consent.

If you\’ve previously given birth to a child with neural tube defects, your doctor or midwife may suggest a much larger dose of folic acid (sometimes as much as 4,000 micrograms or 4 milligrams) daily at least one month before a subsequent pregnancy.

Folic acid supplements well ensure that you\’re getting enough folic acid, especially if you\’re a strict vegetarian. Most prenatal vitamins contain an adequate amount of folic acid, but do check the label to be on the safe side. Your vitamins need to contain 400 micrograms (400 mcg) or 100% of the Daily Value (DV) of folic acid.