Pregnancy

Pregnancy is divided up into 3 trimesters, consisting of 3 months each and lasting approximently 40 weeks or 280 days. Each trimester has it's own "flavor", body changes and concerns. In the first three months of pregnancy, the first trimester, your baby's major organ's are forming. It is also during this time that the risk of miscarriage is greatest. During the next three months, the second trimester, your baby will grow from about 4 inches to almost a foot in length. The second trimester is usually referred to as the "golden trimester" as sickness and exhaustion are over with and you are not yet big enough to feel cumbersome. By the third trimester, the last three months of pregnancy, your baby will grow rapidly, gaining about a half pound a week and reaching on average 20 inches in length. As you near your due date, you may feel early contractions, your baby will move lower in your uterus and your cervix will begin to soften all in preparation for labor and delivery!


First Trimester:
Week 1 To Week 13

Your journey to motherhood is underway. During the first 3 months of pregnancy, or the first trimester, there are many changes happening to you. As your body adjusts to the growing baby, you may experience nausea, fatigue, backaches, mood swings, and stress. Just remember that these things are normal during pregnancy and especially the first trimester. Most of these discomforts will go away as your pregnancy progresses, so try not to worry about them. Just as each woman is different, so is each pregnancy. When you are tired, get some rest. If you feel stressed, try to find a way to relax. Accept that your normal routine is changing.

Choosing a health care provider and the place you desire to give birth is among the first steps to consider in these early stages. Scheduling your first prenatal visit with your desired health care provider is very important during the first few weeks of your first trimester. Your health care provider will perform several tests to check the health of both you and your baby. Your health care provider will also be able to answer questions about any fears or concerns you might have, and tell you what you can do to make your pregnancy as easy as possible. You'll need to know what types of exercises you can do, what you should eat for a healthy pregnancy, and what you might need to avoid during this time. Pay attention to what your body is telling you and listen to your health care provider's advice. This is an exciting time, and it is important to understand what you should expect during your pregnancy.

Your partner in your pregnancy is also going through emotional changes. A major concern for most couples is how having a baby is going to affect their relationship. Communication during pregnancy is critical because little misunderstandings and events can easily be blown out of proportion. You need to let your partner know how you are feeling and you should be aware that he probably needs some support as well. Include your partner in prenatal visits as it is a good way to make him feel a part of your pregnancy.

Second Trimester:
Week 14 To Week 27

The second trimester of pregnancy encompasses weeks 14 through 27. Although most women undergo many of the same physical changes during this time, no two pregnancies are alike. For many women the middle three months are the best part of pregnancy; they tend to be a time of high energy and good feelings. The tiredness and nausea of the past few weeks has faded and the risk of miscarriage has been greatly reduced. Now is the time you can begin to make specific plans for the baby soon to enter your life.

These next few months will bring about a great many changes in you, some of them quite noticeable. You will begin to put on weight now, with the majority of it gained over the next three months. Althought the average weight gain is considered to be between 25-35 pounds, consult your health care provider for the correct amount you should be gaining based on your body type. The second trimester of pregnancy may involve test-taking anxiety for some women, although some tests are considered routine. If you are over 35 years of age or are in need of some form of genetic screening the tests performed will be more intensive. Usually by the 14th week of pregnancy your health care provider will use a special listening device, called a doptone, to hear your baby's heartbeat. Somewhere between the 16th and 20th weeks you'll also feel the baby's first fluttery movements. Now is the time you'll also want to think about childbirth classes and philosophies. You should explore options concerning maternity leave for you after the baby arrives and to look into childcare option if you will be returning to work. The second trimester; however, is not always problem free. A new set of of symptoms and sensations are common during this time, as well as potenial problems and high risk complications.

Your partner realizes, paricularly in the second trimester, that yes you are indeed pregnant and he will be a father. There may come times that he finds you voluptuous and sexy and other times he simply finds you fat. Some men are facinated with the physical process of pregnancy from beginning to end, others are less so. All of these reactions are normal. And this is the trimester that your partner can feel the baby move for the first time, which can evoke deep and intense feelings from him, ranging from panic to exhiliration. If your partner has not been going to regular prenatal check ups, he should consider to do so now. By attending these appointments, he will be more informed and feel more a part of the process of your pregnancy.

Third Trimester:
Week 28 To Week 40

The third trimester of pregnancy generally spans weeks 28 through 40, though healthy babies may be born a bit sooner or later. You will probably be feeling a combination of excitement as the birth approaches, mixed with an increasing desire to hurry things along. As you are now carrying a large weight around, you will experience a number of symptoms related specifically to your increasing size. By now your uterus, which used to weigh about 50 grams, will be carrying your baby, the placenta and up to about a litre of amniotic fluid, so it is little wonder that you will be feeling a bit uncomfortable.

During this trimester, you should begin preparing for labor. Prepare your labor and hospital bag. Finish your birth plan and make sure your health care provider and the place where you are delivering have both received a copy. Contacting a doula, usually around week 28, to be present at your birth is also an option for those who want or need experienced labor support.

Usually around week 29, your health care provider will change the schedule of your prenatal visits from monthly to every two weeks. After week 36, your prenatal visits will be scheduled once every week until delivery. Toward the later weeks of the pregnancy (approximately the 38th week), a pelvic examination will be performed to determine the dilation and effacement of the cervix. Your health care provider will also check for braxton hicks contractions, discuss preterm labor and labor and delivery procedures.

It's natural for your thoughts to turn now to the plans that need to be made. For instance, it's time to choose your baby's first physician! Whether you choose a pediatrician or a family practise physician, check with your insurance plan to be sure the physician's services are covered. Many doctors offer a "get acquainted" office visit before the birth. It is also time to start preparing in ernest for your impending arrival. The purchase of baby essentials is recommended now as postpartum recovery and new baby anxiety can be quite stressful. The third trimester is also a time to finish up paperwork related to maternity leave, discussing when or if you'll be returning to work with your employers and finding adequate childcare. Daycares usually have waiting lists and if you're in the prospects for a nanny, you'll want enough time to interview the right candidate!

Like the rest of your pregnancy, you'll experience the third trimester in your own way. Your spouse by now will be quite comfortable with the idea of being an expectant father, but not quite ready for parenthood. He may be fantasizing and worrying about what kind of father he'll be, which is natural and a good way to prepare himself. He may find himself worrying about your safety and health during these final few months and wondering about the whole labor and delivery process. As long as he has had some sort of preparation classes on the process of childbirth, it's really the only thing he can do to prepare.

Labor and Delivery

Toward the end of your pregnancy, you eagerly await the arrival of your child as the culmination of nine months of careful planning and preparation draws to a close. If this is your first child, you may feel a mixture of excitement and nervousness when you think about the delivery. This jumble of emotions is completely normal and natural. As your due date draws near, you'll want to know exactly when labor will start and when your baby will be born. But although the process of labor is well understood, no one knows exactly why it starts, and your health care provider won't be able to predict either the start of labor or how long it will last.

When you notice the first subtle early signs of labor, you should begin to finalize plans for the care of other children, arrange your transportation to the hospital, and call your health care provider for last-minute instructions. Because admission procedures can be time consuming, pre-registering at your place of birth before you go into labor can greatly cut down the time it takes in getting admitted. For most women giving birth for the first time, labor will usually last between 12 and 24 hours, with an average of 14 hours. However, for women who have given birth before, labor usually averages only 6 hours. Even though every labor is different the stages and phases of events remains the same.

Despite best laid plans for the "perfect" labor and delivery, sometimes medical intervention is needed when complications arise. It's important to be familiar with some of these interventions because even though you may never need them, you can maintain a sense of emotional control by asking questions, challenging assumptions about routine procedures, and openly sharing your hopes and fears with your partner and your heath care provider.

Even when you think you've mastered the art of breathing, practised various labor positions and are relatively free from the fear of labor, being knowledgeable about medications used for labor pain is a must. Whatever medication you decide to you, if any, depends on your informed preferences, your health care provider's recommendations and what is available at your medical facility. Be sure that you remain flexible in regards to pain medication in labor because you may need to change your mind if things don't go as you intended.

Recovery from labor depends on the length of the labor, whether medications were used, if a surgical birth was needed and on how well the mother coped with labor. Usually within a few hours after the delivery of the baby, you will be moved to a postpartum unit in a hospital or released from a birth center. The firmness of your uterus is checked, your lower abdomen will be massaged, the amount of blood loss will be monitored and your temperature and blood pressure will be routinely checked. Since breastfeeding is usually initiated in the delivery room, breasts and nipples will be checked and breastfeeding will begin in ernest. If a surgical birth was used, pain medication is given usually the first 48 hours to help the mother cope with having major surgery on her abdonmen.

Signs of Labor

The beginning of labor is a very individual thing. Some women don't even realize they are in the first stage of labor, mistaking it for gas, heartburn, backache, or indigestion. There are signs that labor has begun. They do not necessarily occur in any particular order and they may occur in a different order with each pregnancy.

Lightening
This is when your "baby drops.'' You may feel as if your baby has dropped lower into your abdomen. Your clothes may fit differently. You may find it easier to breathe, but may need to urinate more often. This can happen a few weeks to a few hours before labor starts.

Bloody Show
This is also called "show'' or "mucus plug.'' It is a thick plug of mucus that forms in your cervix (bottom part of your uterus) during pregnancy. As your cervix gets softer and starts to open, this mucus plug will come out. You will see clear, pink, or slightly bloody mucus coming from your vagina. This may happen up to 3 days before labor begins or at the start of labor.

Rupture of Membranes
This is when your "water breaks.'' The bag of waters, or amniotic fluid, is the water-like sack that surrounds your baby during pregnancy. When it leaks or breaks, you may feel a slow trickle from your vagina or a sudden gush of warm fluid. This may happen several hours before labor starts or any time during labor.

Call your doctor immediately when your membrane or "bag of waters" breaks or when your contractions are regular and 15 minutes apart. For the first child the doctor will probably tell you to come to the hospital when they are 5 minutes apart. Don't worry that you may not make it; the first stage of labor is about 8-12 hours long for a first baby. Generally speaking, if you have had at least one baby your labor will be shorter than with the first.

Energy Burst
You may have a burst of energy several days before labor begins.

Stages of Labor

Once your labor has begun, you will begin to experience "contractions". The contractions you feel are the tightening and relaxing of the uterine muscles as it prepares to send your baby into the world. The contractions will cause your cervix to become thinned and stretchy. It will be 100% thinned (or effaced) and 10 cm open (dilated) when it is time for the baby to be born.

Stage One (Contractions & Dilating)

The process of labor is broken down into three stages. The first stage when all the contractions and dilating and stretching take place is split up into three phases: Early, Active, and Transition.

Early Labor — In early labor you may experience mild contractions that are anywhere from five minutes to thirty minutes apart. Pain is a subjective thing, so everyone will feel differently about their contractions and their pain. Work with your coach, nurse and physician to help you deal with your pain management throughout your labor. You should be aware of all options available to you today to help you work through your labor. These include both medical and non-medical methods. The important thing is that you as the patient are comfortable with your labor experience. During this early labor phase you may experience backache, mild diarrhea, anxiety, and or excitement. During this stage in labor, most women can walk around, take a warm shower or bath, or engage in breathing patterns to relax. Your support person can participate by keeping you company, giving you a back massage, offering words of encouragement, or keeping a log for you of your contractions (how far apart they are and how long they last). You should try to rate their intensity on a scale of 1-10 to help guide you with your progression of labor.

Active Labor — As you progress to active labor, you will notice an increase in the length and intensity of your contractions. The cervix is really beginning to open up now, and you may hear the medical team say you are 4-7 cm along. Remember that the goal is 10 cm. The baby is actively trying to get in position to be born. Women say that during this time they may feel stronger and longer contractions, more back pain, and may feel the need to concentrate on the process at hand. The support person can continue to provide encouragement, use a moist towel to help keep lips and mouth wet, and provide comfort measures such as massage or music.

Transition Phase — As you enter the transition phase, the contractions are more intense, and your cervix should become fully dilated to 10 cm. The baby is applying pressure to the mothers bottom area and you may have an overwhelming desire to push against that pressure. Do not push until the medical team instructs you to do so. If it is neccessary for you to stop pushing, use breathing patterns and your support person to help you through the feelings of pressure and discomfort. Women go through many emotional moments during the transition phase of labor. It is not uncommon to have mood swings, hot flashes, and a desire to give up and go home. It then becomes the important role of the support person to talk them through this and give the mom the encouragement she needs to finish the job and deliver the baby.

Stage Two (Delivery of the Baby)

As you move from stage one transition to stage two, you probably will experience a lot of pressure in your bottom area. The urges to push are strong and it actually feels helpful to many women to begin pushing as they are now active participants in the process. It may be hard, but try and rest between contractions saving your strength for pushing the baby out during contractions. Many women get a "second wind" prior to delivery to help them get through this second stage of labor. Your support person can help you find the most comfortable position, continue to offer encouragement, and help you focus on your breathing. Your medical team will help guide you through the process of pushing and successfully delivering your baby. Once your baby is born, savor the moment, for you will only get that once in a lifetime with each child you deliver.

Stage Three (Delivery of the Placenta)

The last stage of labor is stage three or delivery of the placenta. The contractions will help your uterus expel the placental contents. You may have some bleeding, feelings of chills or exhaustion. The baby's medical team will clean your baby and do a physical assessment to confirm everything is okay. If you have some peritoneal tears, your physician will use this time to do your episiotomy repair. Your nurse will massage your uterus and will be checking it frequently over the next several hours to make sure it is hard and that you are not experiencing any excessive bleeding.

Postpartum Recovery

You've waited nine long months, suffered through labor and delivery, and finally your baby is here. Your body went through some tremendous changes to nuture this new life, and it will go through more changes as your body recovers, heals and readies itself to sustain your baby nutritionally. Some physical changes such as bleeding, breast changes and perineum care are finished before your postpartum check up but c-section recovery, baby blues or postpartum depression and weight loss may take a little time. Ask your health care provider any questions or concerns you may have during your postpartum recovery. Talk with other moms. Enjoy your new baby. and remember postpartum recovery means different things for different women.

Bleeding

Bleeding after birth is called lochia. The heaviest is about 12 hours after delivery and then it lessens. In the first three days, clots of blood may be passed, often after a contraction of the uterus (afterbirth pains) and this is perfectly normal. If your lochia continues to be heavy or increases after a few days past delivery, let your health care provider know. You may have retained a small piece of tissue and this is preventing the uterus from contracting and clamping off those blood vessels. If no infection or retained tissue is found and you are still bleeding rather heavily, your health care provider will prescribe a drug to help your uterus contract more forcefully.

Breast Changes

After delivery, your breasts will begin milk production. As more blood is circulated through the breast tissue, the breasts swell, harden and become warm. This is known as engorgement. The breasts first produce a substance called colostrum, a watery substance that is high in antibodies. After the third day postpartum, milk production will begin. If your breasts are not emptied through feeding, they will become tender and swollen. For those women not breastfeeding, wearing a tight bra lined with cold green cabbage leaves will decrease milk production. Change the leaves periodically every 3 to 4 hours and within a few days the breast tenderness and fullness will subside. Your health care provider can also prescribe medication to stop milk production.

Perineum Care

Torn areas and episiotomies are stitched with dissolvable stitches and heal quite quickly. Sitz baths and witch hazel compresses help ease swelling and effectively cool the area. If you feel any type of pain, an infection may be present. Please discuss this with your health care provider.

C-Section Recovery

Each woman will recover a little differently, as this is major surgery. The incision is about six inches long and located at the top of your pubic hair. The incision may be held together with steri-strips and staples or dissolving sutures. Most women feel a burning or pulling sensation there for about a week. Numbness of the incision site can last up to six weeks or longer. Most women need some form of pain medication during the first 24 hours. You will be up and moving as soon as you're able to. After 2-3 days the steri-strips and staples will be removed and you will be released. It can take up to six weeks for the tissue to be mended but up to six months for the scar to fade. Fatigue lasts longer after a section than with a vaginal delivery, often for several weeks. Resting as much as possible can help your body heal. If you notice any sign of infection, oozing fluid or have abdominal pain, please consult your health care provider.

Postpartum Depression

Following the birth of a baby, a wide range of emotions are considered normal. Often there are feelings of excitement and joy, along with relief, the long months of waiting are finally over! Mothers may also feel overwhelmed, anxious, and uncertain. Regardless of how well you prepared or how much you looked forward to your baby's birth, this first year may include some unexpected ups and downs. Time, patience, and the support of loved ones are all helpful during this time of adjustment. Sometimes, however, women may still experience emotions that are bewildering, unsettling, even frightening. These more confusing emotions can be classified in three ways: Baby blues, Postpartum Depression and Postpartum Psychosis

Baby Blues

The "blues" are extremely common during the first few days after delivery, usually appearing suddenly on the third or fourth day. Fifty to seventy-five percent of new mothers experience this letdown after the emotionally charged experience of giving birth.

Postpartum Depression

Symptoms may include crying for no apparent reason, irritability, impatience, restlessness, and anxiety. This is the most common, least severe, and the most well-known of all postpartum reactions. Symptoms are briefly unpleasant and usually disappear on their own, often as quickly as they came.
Although one in ten new mothers experiences various degrees of postpartum depression, it still remains one of the least well-known of postpartum reactions. It can occur within days of the delivery or appear gradually, sometimes up to a year later.

Symptoms may include:
nervousness and anxiety
sluggishness, exhaustion
sadness, hopelessness
appetite and sleep disturbances
poor concentration, memory loss, confusion
over-concern for baby
uncontrollable crying
lack of interest in baby
feelings of guilt or inadequacy
fear of harming themselves or baby

A woman suffering from postpartum depression may experience one or more of these symptoms in any combination. They may be changeable, with good days alternating with bad. Symptoms may range from mild to severe.

Postpartum Psychosis

Postpartum psychosis is the most severe disturbance. It is also quite rare, with about one in one thousand woman suffering symptoms, usually within the first two weeks after delivery. Symptoms are very exaggerated and may include insomnia, hallucinations, agitation and bizarre feelings and behavior. Postpartum psychosis is a serious emergency and requires immediate medical attention.

Treatment

Treatment for postpartum distress varies with the type and severity of the symptoms. In some less severe cases, the symptoms disappear on their own. In more severe cases, medication and therapy are very helpful. Regardless of the type or severity of the disturbance, these symptoms are temporary and treatable with support and skilled professional help. The "ideal" treatment plan includes: medical evaluation, psychiatric evaluation, psychotherapy, and participation in a support group for education and continuing support.

Weight Loss

Within a few days after delivery, a woman loses two or three pounds of fluid, about 2 pounds from the shrinking of the uterus and several pounds fom the baby and amniotic fluid. Even after this weight loss, most women still weigh more than they did before the pregnancy. The remaining weight is stored as fat; you can lose this by proper dieting and excerise.

Many women lose the remaining pounds slowly by watching their calories and getting regular exercise. The caloric requirements for a non-breastfeeding mother are between 1500 and 2000 calories per day. A breastfeeding mother requires more calories, about 2000 to 2300, including plenty of protein. You do not have to drink milk to produce it, but it is important to get enough calcium and to drink plenty of fluids.