Choices: A Pregnancy Guide
By William Cutrer, M.D.
Choices: A Pregnancy Guide
© 2010 William R. Cutrer and Sandra L. Glahn
Published by Aspire Productions at Smashwords
www.aspire2.com
All rights reserved
ISBN 0-9722379-1-7
This book is filled with factual but general medical information. It is not intended as a guide to diagnose or treat medical or psychological problems without regard for the individual patient’s unique medical history and needs. If medical, psychological, or other expert assistance is required, the reader should seek the services of a personal physician or certified counselor.
Scripture taken from the NET Bible. Copyright © 1996-2005 by Biblical Studies Press, L.L.C. and the authors. All rights reserved.
Dedication
With gratitude to God for the precious family
my eyes have been blessed to see, I dedicate this book
to my dear wife Jane;
our children Bill, Jennie, and Bob, their spouses;
our grandchildren, Emily, Zachary, Madeline Jane,
Abigail, and the sweet one on the way.
Therefore choose life so that you and your descendants may live!
(Deuteronomy 30:19)
Table of Contents
Chapter One: What Your Baby Looks Like at…
Chapter Two: I’m Pregnant: Am I Going to Have a Baby?
Chapter Three: A Womb with Two Views: The Early Months
Chapter Four: The Middle Months Second Trimester: Baby Putting on the Moves
Chapter Five: The Final Months Third Trimester: Twenty-eight Weeks to Delivery
Chapter Six: Happy Birth Day: Birth Options: Labor and Delivery
Chapter Seven: Respect Yourself, Your Body, and Your Sexuality
Chapter Eight: Contraception and Family Planning
Chapter Nine: Is Abortion an Option?
Chapter Ten: After the Abortion
Chapter Eleven: What about Adoption?
Chapter Twelve: Parenting Your Child
Chapter Thirteen: Dear Birthmother: Another Choice
Appendix
Chapter One:
What Your Baby Looks Like at…
How Baby looks when Mom’s period is three weeks late
Your Pregnancy Companion
Angela, 22, was a full-time student at a local community college. After a semester in which she’d been with several partners, she took a home pregnancy test that confirmed she was pregnant. She made an appointment at the clinic because she didn’t have insurance so she couldn’t afford to see her usual doctor.
Yamilla, 41, was married with three kids. She suspected she was pregnant and was worried because her husband had been adamant that he did not want more children. Her pregnancy test at the clinic was positive.
LaToya, 17, came to the clinic suspecting she was pregnant and assuming we did abortions. We gave her a free test, which confirmed that she was indeed pregnant. Then we did a sonogram and saw the baby’s heartbeat. After that she had a lot of questions.
I met these women and many like them in my position as medical director at A Woman’s Choice Clinic. I’m Dr. Bill Cutrer, but most of my patients call me Dr. Bill. I’ve been an ob-gyn doctor for twenty-five years. During that time, I’ve had the privilege of delivering nearly five thousand babies and caring for tens of thousands of women as they came to me seeking assistance in meeting their health needs. I chose a career in ob-gyn because I love making pregnancy as safe as possible for women and delivering their babies.
You probably have lots of questions. Maybe you even have some fears and confusion about how your pregnancy will affect your life. You may be hearing advice from many sources. Some people tell you to abort; some tell you to carry to term; perhaps others suggest that you make an adoption plan for your baby. Fortunately you don’t have to make any decisions at this moment. You can choose to read this book, give the decision lots of thought and prayer, and then decide what is best in the long-term for you and your baby. Each of your options will remain available to you for days, even weeks. So settle into a comfortable chair and take a deep breath.
I’ll try honestly and openly to answer the most common questions and address your concerns and fears. I’ll try to help you make the choice that’s best both for you and for your baby. The choices you make now will remain with you for the rest of your life, so it’s important that you take the time to understand what is happening. You also need to know about the many resources available to you, including the pregnancy resource centers.
As I mentioned, I serve as a medical director for such a center—A Woman’s Choice, a pregnancy resource center in Louisville, Kentucky, and before that, the Dallas Pregnancy Resource Center in Texas. It has been my privilege to aid many of the women in our community who, like you, have found themselves facing unexpected and perhaps unwanted pregnancies. I hope that if you are faced with a complicated pregnancy situation, you will find peace of mind and rest for your soul. Having served as a physician, a pastor, and now a professor, I would like to walk beside you as doctor, counselor, teacher, and friend as you think through your choices.
[Jesus said:] "”Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke on you and learn from me, because I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy to bear, and my load is not hard to carry.” (Matthew 11:28–29).
Chapter Two:
I’m Pregnant?! Am I Going to Have a Baby?
Terri, 19, was frightened when she arrived at the clinic. She was pretty sure she was pregnant, and she knew her boyfriend, the baby’s father, might leave her once he knew.
Often women who can’t remember when they had their last period or women with irregular periods enter our center seeking pregnancy testing. We offer such testing free of charge. As a result, we are often the first to know of the situation, and we’re the first who are able to offer guidance and support.
A positive test indicates pregnancy for sure. The tests are imperfect, but they are quite sensitive. However, you can test negative if you are too early in the pregnancy. Tests can also indicate that there’s no pregnancy if they’re performed incorrectly. But when the test is positive, almost without exception, a pregnancy has begun.
A simple urine sample is all that is required and it takes only a few minutes to determine the result. Once a test is positive (meaning the patient is pregnant), it’s important to determine how many weeks pregnant the patient is. When is the baby due? Is it growing normally? Has the pregnancy begun in a good location inside the womb (uterus)? These are important questions that can usually be answered quickly with the assistance of an ultrasound machine.
Ultrasound (also called sonogram or “sono”) is a marvelous technique that uses a sound wave, much like the sonar in a submarine, to send out a sound signal. The part of the machine that rests on your tummy, also “listens” for the rebounding sound wave. The machine looks something like a mobile computer, about the size of a small end table with a TV on it. We can’t hear or feel the sound waves. Ultrasound is totally painless. The reflected sounds project an image on the screen, which we can see. The sound wave is emitted from a hand piece called the “transducer,” which is placed on your belly. You may feel some pressure, especially if your bladder is full. Using the transducer, we can see and even photograph the uterus, the gestational sac (the fluid bubble the baby is in), and the baby himself or herself. Depending on how far along you are in your pregnancy, measurements can be made with great accuracy to determine when the baby is due.
Personnel trained to perform ultrasound can also determine the presence of twins, as well as whether the pregnancy is where it belongs (inside the uterus) or doesn’t belong (outside the uterus). If the pregnancy is located outside the uterus, a dangerous condition is present. It’s called an ectopic or “tubal” pregnancy. A diagnosis of ectopic pregnancy might require an immediate trip to an emergency room, but fortunately such a diagnosis is a fairly rare occurrence.
A much more common occurrence is a pregnancy that isn’t growing properly or an early pregnancy that has died, making a miscarriage inevitable. The ultrasound can determine such a situation with great precision. Miscarriages occur perhaps as often as one in three pregnancies, and they sometimes require a surgical procedure called a D&C (Dilation and Curettage) to remove any remaining tissue and allow the mother to recover physically, though the emotional recovery may take some time.
Normal pregnancies cause enormous emotional changes even when the baby is desperately desired and planned for. When the pregnancy does not work out properly, there can be a confusing assortment of symptoms ranging from grief to relief—sometimes even both. If you have a miscarriage, don’t be surprised if your feelings are far stronger than you imagined they might be, even if you just found out about the pregnancy or didn’t really want to be pregnant.
For most women a positive pregnancy test and a normal ultrasound do indeed mean “you are going to have a baby!” To such women this book is directed, though I will briefly address the other situations. This guidebook is to help you along the wonderful journey of motherhood. I am excited by the thought that you who are reading these words may choose to embrace pregnancy as a profoundly meaningful experience for you and your unborn child.
“While pregnancy brings an abundance of physical and emotional issues, the process also contains a spiritual dimension that can’t be ignored. If you’re expecting a child, you can expect the process to impact you spiritually” –Daniel, an expectant father
Besides my training as a physician, I am also an ordained minister. I will tell you up front that I cherish every human life. The tiny baby growing inside you is a precious human being made in the image of God. He or she has been entrusted to you and to us as health care providers, so that together we might create an environment that is favorable to your health and to the baby’s healthy growth.
Pregnancy changes everything. From your toenails to each hair on your head, your body undergoes changes. This book will help you anticipate and understand what is happening inside and outside your body.
As I mentioned, I believe every baby is precious in the sight of God. Others might tell you that the pregnancy is just a potential life, or a mass of tissue, or a ball of cells. Some may try to dehumanize your baby, referring to him or her using words such as pre-embryo, embryo, or fetus. While these terms are medically useful, they tend to make us think that the baby is less than human, not a real person.
Often people use such words so that any decision to destroy the baby, to terminate the pregnancy, might seem easier. But in your heart you know you are carrying your baby, not another woman’s baby, and nothing other than a baby. The child is as much your baby as any you will ever carry. And your baby is much more than a ball of tissue—he or she is a gift. And not just any gift, but a gift from God.
In the chapters ahead we’ll consider each trimester of pregnancy, labor, delivery, and what comes afterward. We’ll also discuss abstinence, contraception, abortion, adoption, and other important topics. But for right now, know that your baby is precious.
Perhaps you would prefer to talk to a trained counselor either by phone or in person about the decisions you are facing. Phone numbers for organizations that can help you find resources in your area are listed in the appendix.
I sought the Lord's help and he answered me; he delivered me from all my fears. (Psalm 34:4)
Chapter Three:
A Womb with Two Views: The Early Months
Mom’s View of the First Trimester
What’s a Trimester?
Pregnancy is divided into thirds.
The first trimester is from conception to twelve weeks
The second trimester is from twelve to twenty-eight weeks.
The third trimester is from twenty-eight weeks to delivery.
You have had a positive test. What now? You know your life is about to change, but what exactly should you expect?
Symptoms. Some of the earliest signs of pregnancy include a general queasy feeling and overall fatigue—feeling tired, droopy, and lacking in energy. The overpowering thought is, “Just let me sleep!” No foods sound good, and strong smells may bring on nausea. This is quite normal for pregnancy. Many women also first suspect pregnancy when they notice a slight swelling of their breasts along with tenderness. The rapidly increasing hormone levels of early pregnancy are responsible for many changes, including wide mood swings. You may think, “I don’t feel like myself. I’m teary over seemingly small things, and I’m having trouble controlling my temper.” These responses tend to even out as the pregnancy progresses, and for most women the nausea and occasional vomiting disappear by about the third month. Of course the most obvious sign of pregnancy is the absence of a menstrual period, though many women spot or have a light flow occasionally, even while pregnant.
The first thing I noticed was when my boyfriend tried to hug me. Ouch! Those babies are tender. And they seem bigger.
Toothpaste, bacon cooking, my favorite perfume—everything makes me sick to my stomach—even nachos and spaghetti, my favorite foods. I can’t even sit at the table.
Morning sickness. As mentioned, many women find in their first weeks of pregnancy that nausea makes it difficult to want to eat anything. Due to the hormone changes during this time, especially the hormone produced by the baby’s support structures (HCG or Human Chorionic Gonadotropin), many women feel queasy and some can’t keep any food down. We often refer to this nausea and vomiting of early pregnancy as “morning sickness.”
Not every woman has morning sickness, and there’s no rule that says it must occur in the morning. Some women are sick all day, and their nausea is triggered by anything—strong smells, tastes, and sometimes for no apparent reason. For most who suffer from morning sickness, symptoms subside after the first trimester, but occasionally they persist into the middle of pregnancy.
It has always been my feeling that if a pregnant woman could stay hydrated, we could keep her out of the hospital and the baby would do fine. For some women that means Popsicles, soft drinks, Gatorade—anything with water and calories.
One patient, a nurse, when she came for her first visit, had been so sick for so long that I sent her straight to the hospital. We gave her IV fluids to “top up the tank” and then got control of her nausea and vomiting with some medicines. She did just fine, as did her baby—who is now in college. Such cases are quite rare, which is why they are so memorable.
If you are having trouble keeping down any food, call your doctor’s office. And try the simple things first. Dry crackers or toast eaten before getting out of bed can help, as do certain types of tea, especially peppermint and ginger. Some patients survive on odd foods such as cereal, toaster pastries, or peanut butter and jelly. Check with your doctor.
Some medications (for example, Phenergan and Zofran) offer considerable relief and make hospitalization for hyperemesis gravidarum (major vomiting in pregnancy) rare. And despite their use to treat morning sickness, these medications may be taken throughout the day as needed.
The absolute only thing I could eat without throwing up was Kraft macaroni and cheese. The first ten weeks that’s all I ate, but my doctor said my weight was acceptable, and if that was the best I could do, it beat going to the hospital.
`In summary during the first months of pregnancy you will probably experience nausea, fatigue, breast swelling, and breast tenderness. You will not yet have much of a tummy “pooch,” so your center of gravity and lower back are usually free of any discomfort at this point.
Select and Visit Your Doctor
Throughout your pregnancy you will need good medical care. You are strongly encouraged to see a physician during your first trimester. So how do you find a good doctor or clinic?
Usually the best option is to work with your own family doctor, if you have one. If he or she doesn’t deliver babies (isn’t an obstetrician or in family practice), ask for a referral to a respected colleague. If you don’t have a doctor, check with family and friends. And allow me to recommend another marvelous resource: Pregnancy Resource Centers (PRCs). Perhaps you obtained this book through a PRC. The workers at such centers can help you find a doctor or clinic that will care for you and work with you on financial and insurance concerns. The PRC clinic staffs are ready to help you and can make referrals to people who will give you excellent care—whether private physicians, clinics, or university hospitals.
If this is your first pregnancy and you haven’t yet seen your doctor, let me share from the other side of the desk what goes on at the medical office and why.
Your health-care team may involve nurses, nurse practitioners, midwives, and/or doctors. Usually you’ll speak first with the receptionist by telephone to set up your appointment. He or she will likely ask the date of your last period or how far along you are in your pregnancy, if you know. This will help the staff decide how quickly you need to be seen. You will probably be asked if you’ve had any unusual symptoms such as cramping or bleeding.
Cramping or bleeding. While bleeding is never normal, it is fairly common. It doesn’t necessarily mean anything is wrong with you or your baby. Almost half of all pregnant women have some spotting or bloody discharge, and most of these women go on to experience normal deliveries. As we understand things medically, conception takes place in the fallopian tubes (see diagram below). The baby is a one-celled creature who begins to divide and grow rapidly. Over the next two or three days the baby advances down the tube to reach the uterus. There it travels freely for another three or four days before coming to rest and implanting into the uterine wall. This implantation event involves the embryo and the supporting tissues burrowing into the lush wall of the uterus in search of a good, nutritious blood supply. Sometimes during this process the growing tissue hits a blood vessel and causes a bit of spotting. This is a fairly common cause of first-trimester bleeding.
For many women, particularly with their first pregnancy, the growing baby and supporting tissues cause mild, menstrual-like cramps by stretching the uterus. Again, this is quite common and considered normal.
Severe, hard cramps, however, or bleeding that exceeds that of a normal period can indicate a problem pregnancy—either an impending miscarriage or a tubal pregnancy. If you experience hard cramps or significant bleeding, call your doctor. If you are unsure whether your symptoms are significant, call your doctor’s office or answering service. The person at the other end of the phone can assess by amount of flow (number of pads) or your sense of the pain whether you need to go to the emergency room or can go to the doctor’s office. Perhaps they will even have you wait until the next day. If you haven’t yet found a doctor, you need to go to the local hospital emergency room where a doctor can evaluate your symptoms.
The practice in my office for mild cramping or light spotting in early pregnancy was called temporary pelvic rest, which meant that the patient was to be off her feet and go to bed with no exercise, lifting, or intercourse for forty-eight hours. If we had any doubt or if she experienced any change in symptoms, we would see her immediately. While no studies have ever proven that pelvic rest changes anything, reclining improves blood flow to the pelvis, and taking it easy for a day or two certainly does no harm. You will be advised to call back if there are any changes, and you should feel free to do so. You doctor’s office wants you to do well, and they want to head off any problems before they become too serious.
What to expect at your first appointment. Besides determining when the baby is due, the staff at the doctor’s office will try to assess your health and any risk factors that may complicate a pregnancy. So a thorough medical history will be necessary. Many offices obtain this information through a questionnaire, but some use interview questions asked by the nurse or other staff member. In either case the doctor will complete the chart by exploring more deeply answers you gave to any questions that raise medical concerns.
History. Your previous obstetrical experience is important. How many pregnancies have you had? How many births? Have you had any abortions or miscarriages? Answers to these questions provide a better understanding of your medical and obstetrical history. Past surgeries, particularly abdominal or pelvic surgeries, can be important. Of course you should mention any surgeries, including dental surgery, tonsillectomies, or ear tubes, but the most important ones would be perhaps an appendectomy or surgery for ovarian problems such as cysts. Your response to various anesthetic agents or other medicines used during your previous surgical procedures can provide guidelines or warnings (if you had bad reactions) as to what treatment plans would be best for you.
Believe it or not, your family history is quite helpful as well. A history of diabetes, hypertension, or other chronic illness may alert your doctor to be on the lookout for these concerns earlier than he or she otherwise might. Other history concerning obstetrical problems, twinning, especially large babies, and/or difficulty with vaginal deliveries can also add information that might be useful.
Likewise any specific allergies to medications, or sensitivity, even to simple medicines such as asthma medication, can guide your doctor’s thinking as he or she cares for you.
Examination. After giving this information on your medical history, you will have an examination that will include your weight (almost nobody wants to get weighed, but it is a very helpful way to follow certain aspects of your pregnancy). At this appointment your blood pressure will also be measured. Pregnancy can cause some remarkable problems with blood pressure, so yours will be checked at each visit and monitored closely, even in a normal pregnancy.
Next, you will be asked to provide a urine specimen. This is not for another pregnancy test. Your urine will be checked at virtually every visit for protein, so we can monitor you for a problem called pregnancy-induced hypertension (PIH) or pre-eclampsia. The urine test will also show glucose (sugar) in the urine if you have or are developing diabetes. After all this, you will be taken into an exam room, told to undress completely, and asked to slip into a gown.
Most new patients at the first visit get a thorough physical exam unless they’ve had one recently by the same doctor. Many obstetricians know the chances are good that you will not see any other doctor all year, so they will check everything—perhaps eyes, ears, throat, and neck for any problems. They will probably listen to the lungs for any signs of difficulty with air movement (asthma, congestion, infection), and to the heart for rhythm problems or even a murmur. Understand that a heart murmur is just a sound that comes from the heart when the blood is flowing across one of the four valves. Many pregnant women have a normal flow murmur created by the increasing blood volume caused by pregnancy. This type is nothing to worry about. On rare occasions the doctor may hear a murmur that sounds different from the norm, and he may refer you to a cardiologist for an echocardiogram (ultrasound of the heart). Most of the findings require no treatment, only careful observation, but we are always cautious with pregnant women.
Next is the abdominal exam. The doctor will look for anything unusual, such as enlarged organs (other than the uterus, which is supposed to be enlarging), masses, or tenderness. As the pregnancy progresses, your doctor will actually check the size of the uterus by measuring from the pubic bone to the top of the uterus. It’s easy to follow the baby’s growth this way. The ultrasound measurements are reserved for specific indications or suspicions of problems.
Last is the pelvic exam. You knew this was coming eventually, didn’t you? It involves having you put your feet in the stirrups and slide down the table until it feels like you are almost going to fall off. Then the doctor will evaluate the exterior portion of the genitals looking for any abnormalities, infections, masses, and/or discharges that suggest problems. An instrument called a speculum is then inserted into the vagina to provide some visibility of the cervix. No, we can’t see the baby, and that’s a good thing. Your baby is safely contained within the uterus. All we see is the cervix, the doorway to the womb. We then obtain a Pap smear (named after Dr. Papanicalau, who first developed the technique). The Pap smear involves the gentle scraping of the cervix to obtain some of the cells. These are sent to the lab and there determined to be normal, pre-cancerous, or even cancerous. It takes a few days to get the results of the Pap smear, and usually women during the childbearing years are at low risk for any problems.
Next the doctor will do a bimanual (“both hands”) exam. With two fingers in the vagina and the other hand on top of your tummy, the doctor can feel the size and shape of the uterus. Also he or she can feel the ovaries (unless you are further along than twelve weeks) and any abnormalities. In this way the doctor can assess how far the pregnancy has progressed and can confirm that all the structures feel normal in size and shape. If there is any discrepancy or concern, an ultrasound is ordered to verify that all is well.
The doctor will then do an examination of the pelvic bony architecture. That’s to see if there is enough room to birth a normal-sized baby that approaches the pelvis in a good position. Even a normal pelvis can prove too small if the baby gets too big or tries to deliver in an awkward position. So this information is helpful.
Finally the doctor may do a rectal exam to check for any unusual growths, tumors, or blood. This isn’t particularly comfortable, but it takes only a few seconds.
Once all this information is gathered, the doctor may visit with you in the exam room or invite you back to the office to explain the findings, discuss the obstetrical care, and answer your questions. If your pregnancy is about ten weeks along, he or she may listen with a small instrument called a Doppler and try to hear the baby’s heartbeat through your tummy. This is an exciting time. If you have been to a pregnancy resource center first before going to your doctor, you may have heard the heartbeat already. You may have even actually seen your baby and the heart beating. Even after all these years, hearing a baby’s heartbeat for the first time still thrills me.
Tests to Expect at the Beginning
Test to determine blood Type (A, B, AB, or O; Rh positive or Rh negative)
Screen for antibodies to the Rh factor
Rubella – test for German measles
VDRL – test for syphilis
HepBsAg – test for a type of hepatitis
HIV – test for the virus that causes AIDs
Pap smear – test to rule out cancer of the cervix
Tests for sexually transmitted infections (STIs)
CBC – complete blood count; checking for anemia, evidence of infection
Hgb electrophoresis– test for sickle cell or other blood disorder
PPD – test for tuberculosis (TB)
PAPP-A – test for placental function
Thyroid screening – check for iodine deficiency to cut risk of ADHD
Not every patient in every community needs all these tests. Sometimes your own medical history will direct your doctor to order something specific or to decide if one or more of these is unnecessary.
Medical information. Your medical team will need to find out some important details early in your pregnancy so they can provide you with the best of care. They will want to determine your blood count (to be sure you aren’t anemic), your blood type, and any history of diabetes or elevated blood pressure. They will also want to know about your past pregnancies, including any complications with the actual pregnancy or the delivery. These bits of information can help your health-care team know best how to help you throughout your pregnancy.
They will also need to know if you are taking any medications. Remarkably, babies handle most medicines pretty well. Most over-the-counter medications, including cough preparations (Sudafed, Actifed, Robitussin, Tylenol, aspirin, Motrin) don’t seem to cause problems. And most antibiotics are considered safe, although few scientific studies can be performed on pregnant women. Most pain medicines, including codeine preparations, Darvon, and codeine derivatives, seem quite safe. But when you initially make contact with your doctor or clinic, tell them what you are taking presently and have taken previously, so they can advise you specifically.
Drugs. What effect do street drugs have on a developing baby? This is a commonly asked question. While you should discontinue the use of all medications taken without your doctor’s permission, you might have questions and fears about some drugs taken before you knew you were pregnant. While it’s strongly recommended that pregnant patients stop using marijuana, amphetamines, cocaine, and its derivatives, none of these if taken prior to pregnancy or stopped early in the pregnancy seems to increase significantly the number of birth defects. If these drugs are stopped early in the pregnancy, there are usually no problems noted in the child’s development. The effects of some of these substances on your health and the baby are significant, however. They may elevate the heart rate and blood pressure in such a way that adequate blood flow, oxygen, and nutrition to the baby can be compromised. Check with your doctor about the best way to quit safely and quickly.
Okay to take as directed: Tylenol, aspirin, most antibiotics, many cold remedies.
Avoid: Tobacco, alcohol, street drugs, medications you haven’t cleared with your doctor, caffeine. Also avoid changing the cat litter box.
Tobacco. Tobacco has been shown to cause health problems for the mother, but the problems are even more significant for the baby if use is prolonged. So if you smoke, discuss this with your doctor. He or she will need to know how many cigarettes per day you smoke. Your medical team can help you stop smoking, which is very important for your sake and the baby’s.
Maternal smoking increases the risks of miscarriage, stillbirth, low birth weight, severe health problems, and neonatal death.
Maternal smoking doubles, maybe triples, the risk of sudden infant death syndrome (SIDS).
Growing evidence suggests that maternal smoking during pregnancy may be associated with deficits in intellectual ability and behavioral problems in children. (Source: Web site of the Alberta Alcohol and Drug Abuse Commission, “Smoking and Pregnancy.)
Alcohol. Alcohol use during pregnancy can have a devastating effect on the child, causing a variety of disorders. So if you drink, stop immediately. Alert your doctor to the situation if you have been drinking alcoholic beverages regularly or heavily. You may need some help quitting. Having had a few drinks or glasses of wine in early pregnancy doesn’t mean your baby has been damaged, but discuss the specifics of your alcohol intake with your doctor and make changes right away.
“One of the most severe effects of drinking during pregnancy is fetal alcohol syndrome (FAS), one of the leading preventable causes of mental retardation and birth defects. FAS children are characterized by abnormal facial features, growth deficiencies, and central nervous system problems. People with this lifelong disorder may have problems with learning, memory, attention span, communication, vision, and/or hearing. These problems often lead to difficulties in school and problems getting along with others. FAS is 100 percent preventable—if a woman does not drink alcohol while she is pregnant.” (Source: Web site of the Centers for Disease Control, “Fetal Alcohol Syndrome,” August 5, 2004.)
X-rays. It is possible to get too many x-rays during an early pregnancy, but it isn’t likely. Most dentists taking x-rays use lead shields on their patients, even if the patients are men. But if you have had multiple abdominal x-rays (such as an upper GI and kidney studies), it is possible that the radiation may cause problems with the baby. With alternate sources of information in place of x-rays, such as sound waves and MRIs (Magnetic Resonance Imaging), it is possible to obtain the necessary diagnostic information for most patients without using x-rays or by at least limiting the use of x-rays.
Cancer treatments—chemotherapy and radiation. For the rare patient with cancer who has received chemotherapy or radiation therapy while pregnant, the doctor can evaluate the specifics of your treatment in terms of its potential harm to your baby.
Myths. Let me put to rest some of the common myths circulating about everyday things that are reported to be dangerous in pregnancy. Hopefully, these will eliminate a few worries:
Is it okay to use cell phones? Yes.
What about microwaves? No danger (unless you squeeze yourself inside the microwave and turn it on).
Heating pads or heating blankets? These pose problems only if you cover yourself entirely in them and the temperature reaches more than 103 degrees.
Hot tubs? These pose a potential problem only if the temperature is higher than 103 degrees and you submerse yourself to the chin. Most people sitting in a hot tub leave their chests, arms, and heads out, which allows for heat dissipation. That means the core temperature, where the baby is, doesn’t really change.
Is it safe to fly in an airplane? Pressurized commercial aircraft are safe, as far as we know, even during early pregnancies. We do restrict pregnant women later in pregnancy because of the fear of premature delivery. (It’s difficult to find room to deliver at thirty-five thousand feet, and there are definitely no epidurals available.)
I heard that if I raise my hands above my head during pregnancy the baby will be born with the cord around the neck or even choke.
Is this true? Actually, no. Though this is a widely quoted claim, there is no evidence to support it.
What’s good for you?
Exercise. Exercise is good, but it should be done in moderation. That means keeping your pulse rate under 110 or so. If you aren’t any good at checking your pulse, use the talk test. That is, can you talk with a friend while you are exercising? If you can carry on a reasonable conversation without being so short of breath that you can’t squeak out more than a word or two without gasping, you’re probably okay. The best exercises in pregnancy are the ones you like to do and will do regularly. Weight-independent exercises (such as the stationary bicycle, swimming, pool walking, and water aerobics) are excellent, no matter how large you become. As the pregnancy progresses, there is a weight shift forward, which causes a bit more strain on the lower back. As a result, walking and jogging might cause more discomfort. In addition, the stomach and breasts enlarge, making the low back and “bounce” discomfort considerable. However, walking is certainly the easiest form of exercise for most. So get good shoes, stay well hydrated, and ask your doctor about any specific reasons why exercise might be a problem for you. If a mother has had symptoms of pre-term labor or multiple pregnancies (twins or triplets), we often restrict her activity. Also certain complicated pregnancies such as those with placental problems, bleeding, and/or high blood pressure might also require the mothers to restrict their exercise.
I didn’t let pregnancy stop me from being fit. I even asked my doctor if I could run a marathon while I was pregnant.
Exercise in moderation is commendable, but the energy required to run 26.2 miles and the challenge of keeping well hydrated make marathoning during pregnancy unwise.
Nutrition: How is your diet? Are you eating well? Do you thrive on pizza but neglect fruits and vegetables? If you eat cereal, do you buy brands loaded with sugar? The average number of calories per day that you’ll need will increase with pregnancy (good news!), but you should also choose your foods wisely, if you can. Avoid high-fat foods and fried foods, such as French fries, potato chips, and donuts, and replace them with pretzels and fresh fruit.
One of the most important things you can do for yourself and your baby is to begin right now thinking about nutrition. Consider what you eat and drink for your own welfare and the essential building blocks for your baby’s health. Some of my patients believed that in pregnancy they were eating for two…adults. And their weight gain showed it. You are indeed eating for two. The baby is totally dependent on your food choices. Speaking of food, it might interest you to know that the baby, particularly in the first trimester, weighs only a few ounces—about the same as four quarters.
Pregnancy does require an increase in the number of calories you consume. The calorie is the measure of energy stored in various foods that can be burned by the body’s growth and metabolism. A normal pregnancy (one baby, not twins) requires an additional three hundred calories per day—added to the normal need of about two thousand calories per day. To put that in perspective you can get three hundred calories with an extra glass of milk and piece of fruit, or an egg boiled or poached plus a piece of fruit, or a bowl of cereal plus a piece of fruit. You noticed the emphasis on that piece of fruit, right?
The keys to a good diet are balance, variety, and proper preparation. Perhaps it will help you find balance if you think in terms of food groups. First let’s consider carbohydrates.
Carbohydrates. “Carbs” have gotten a bad reputation lately with some of the popular weight-loss diets. Some restaurants even offer low-carb options on their menus. Yet carbohydrates are actually marvelous and rather low in calories. Each gram of carbohydrate has only four calories, whereas each gram of fat has nine calories. So you can eat twice as much carbohydrate as fat to get the same amount of calories. The problem with carbohydrates really comes from the stuff we put on our potatoes, noodles, and rice. All the butter and creamy sauces make them much less healthy. Carbohydrates are essential to the body, enabling each of us to metabolize or utilize the calories we take in. That’s why the low-carb diets work: they deprive the body’s machinery of the fuel to actually process all the protein and fat, so the body is “starved” for lack of this essential nutrient. That may be okay when you are not pregnant, but you and your baby will thrive with a proper intake of unrefined carbohydrates. The refining process required in making white bread and white noodles steals much of the nutritional value, leaving only the calories. So find some nice wheat, rye, or other dark bread. Try sweet potatoes and brown rice. You’ll get many more vitamins for the same amount of food.
Protein. The next group, protein, provides essential building blocks for both you and your baby. Protein is found in meat, poultry, fish, eggs, and even milk. Every day you need some protein. About six ounces will provide your basic need. That’s the equivalent to a piece of meat or chicken the size of a deck of playing cards.
Preparation of the food is important, too. Bake it or broil it, even grill it. But avoid frying your meat, chicken, or fish. That way you will get the good protein without unnecessary fat. I know fried food tastes great, and I’m not asking you to avoid ever frying anything. But do consider what you eat each time you sit down, or stand up, to munch.
Fruits and vegetables. Most of my patients haven’t enjoyed the fruit group enough. But fruits have many marvelous vitamins and minerals, taste great, and provide complex carbohydrates. Fruit is fabulous. Find what you like and be sure to get it daily, along with the vegetables. About four portions per day is right. You can mix and match your fruits and vegetables, but enjoy a good variety. A glass of juice counts as a portion, too.
Vegetables, particularly fresh and steamed, contain wonderful minerals and vitamins without too many calories. When it comes to veggies, enjoy whatever your appetite calls for. They contain only four calories per gram. Just a note, though: Despite the fact that a tomato is in this category, you can’t count ketchup as a portion.
Dairy products. Milk, cheese, and yogurt can provide most of the calcium requirement as well as good amounts of protein. A word of caution here though: Many adults have lactose intolerance and drinking milk is for them sheer agony. Without the enzyme to digest the lactose sugar in dairy products, the intestinal tract revolts. If this is true in your case, you will experience bloating, cramping, gas, and diarrhea. Just what a pregnant woman needs, right? There are special milk products, however, that have been designed with the lactase enzyme included, as well as cheeses made from soy. These won’t cause the bad reaction. About two or three glasses of milk or the equivalent will cover the calcium needs and add to your protein portion.
Oils and fats. Most of us consume more than enough fat and oil. We like our fried food, butter, and dressings. And these all contribute to the day’s calorie count. Yet some oils, fish oils in particular, actually contain compounds that are beneficial to the body. So I’m not recommending that you avoid oils and fats entirely. Just think before you eat. Ask yourself, “Does everything have to be fried? Must I slather butter on everything?” Use butter, margarine, and oils sparingly and you should be fine.
Sweets. My favorite food group! Unfortunately sweets provide only empty calories. So be careful. Still, life deserves an occasional treat. Just don’t make chocolate the centerpiece at every meal. Consider your desserts. Perhaps a piece of fruit would be perfect most times, and every once in a while, treat yourself.
Think about what you are putting into your mouth. Do eat a good breakfast. Eat lunch and dinner as well, with an eye to balance. Get a variety of proteins, carbohydrates, fruits, and vegetables. Bake it, broil it; don’t fry when possible. Add in some healthy snacks during the day, such as crackers and cheese or that piece of fruit, so you aren’t starving when meal time comes.
As the pregnancy progresses, your tummy will push your stomach up to your chest and you may feel full after just a few bites. Avoid eating a big meal right before bedtime or you will have heartburn that will keep you awake much of the night. Keep some crackers and cheese or peanut butter by the bedside for when you wake up at 3 a.m. to use the bathroom and feel like you haven’t eaten in days. A light snack can really hit the spot and not hurt the growth curve for you or your child.
Vitamin supplements. Taking vitamin supplements is generally a good idea, especially during pregnancy. If our diets were perfect, we wouldn’t need vitamins, but most of us enjoy processed foods, fast foods, and fried foods—all of which often lack essential vitamins and minerals. For pregnant patients we are especially concerned about the B vitamins and calcium. Folic acid and perhaps vitamin B6 seem to offer some protection against certain spinal defects when taken prior to conception and perhaps if started early in pregnancy. Calcium is an essential mineral required to build those baby bones. Phosphorus, iodine (found in table salt), zinc, magnesium, and fluoride (in most city water) are also important to the developing infant. I recommend a vitamin supplement with minerals as a safety net.
Now that we’ve considered the pregnancy from your perspective, let’s take a look at the baby’s world during the first trimester.
Look Ma! Two Hands!
A Baby’s-Eye View of the First Months
The
process of human development from conception through the first twelve
weeks is absolutely amazing. Imagine! At one point you yourself were
smaller than the dot at the end of this sentence.
In normal circumstances the sperm locates the egg out in the fallopian tube (see sketch near the beginning of this chapter). A lone sperm penetrates the egg’s outer shell-like layer. Normal human eggs also have a cluster of tiny cells surrounding and protecting them. These are called cumulus cells, and sperm have to fight their way through, digesting these barrier cells with enzymes they carry in the sperm heads. In fact if these enzymes are lacking, the sperm will fail in their attempts to fertilize and conception will not happen. But in a normal situation, a single sperm penetrates the egg and somehow the cellular mechanism within the egg knows that this has happened. As a result, suddenly the outer layer becomes like a brick wall to any other sperm. No more can get in—which is a good thing! This moment of egg penetration is the first step in the process of fertilization. The genetic material from the daddy combines with the genetic material from the mommy and together they form a new person. This is called syngamy. Then the brand new person begins to grow.
The resulting one-celled human being (zygote) divides and becomes two. The two become four, and so on. By seven days there may be a hundred to one hundred fifty cells making up a cluster or hollow ball of cells called a blastocyst. Within the larger ball is a small collection of cells called the embryonic poll. These cells will form the baby. Picture a basketball with about twenty golf balls inside. The outer shell of cells (the basketball) make up all the supporting tissue for the pregnancy—the placenta, the membranes (amnion and chorion, which is the bag of water within which the baby grows); the inner cell group (golf balls) form the three layers that become the different tissues forming the baby.
It is remarkable to think that each of us began this way as a single cell, with one complete set of chromosomes, becoming a fully formed and unique human being. (While it’s true that twins share identical genetic material if they come from the same zygote, they also have subtle differences that make them unique as well.) From this very moment of syngamy, you are carrying a baby, a human person—nothing less.
The blastocyst may float around for a couple of days inside the uterus before finding the place to implant. The remarkable process of implantation has the tiny human being burrowing into the wall of the uterus to find nutrition, and the growth process continues.
By three weeks after syngamy (that event we usually call conception) the baby has a beating heart. With the latest technology our ultrasound machines can help us actually see a baby’s heart beating by five and a half to six weeks from the last menstrual period (in a woman with a regular twenty-eight-day cycle) or about four weeks after conception. By then we can see the head, the body, the limbs, and even see the baby moving. It’s breathtaking for the new moms at our clinic. Most of the women who visit our clinic are already a week or more late getting their periods. So for most who will read this book, the baby is already well formed and probably has a beating heart.
Between the sixth and twelfth weeks we see growth and maturing inside and out as the baby develops some of the nervous system, brain waves, and the ability to respond to pain. He or she also exhibits some general activity. By ten weeks the baby is usually big enough for the heart beat to be audible with the external Doppler, even if a sonogram machine isn’t available.
What happens in those early weeks?
Even in the earliest weeks the baby grows rapidly. During the first trimester he or she progresses from that first cell to over one hundred fifty cells within one week. Once the baby has implanted in the uterus, we can watch his growth using an ultrasound machine. By five weeks we can see the sac of fluid inside the uterus. The baby forms inside this sac. The first visible structure is the yolk sac, a nutrition source for the baby that looks like a ring. I often tell my patients that what we see first is a diamond ring, and the baby is the precious diamond. That’s because at the earliest stages the yolk sac is bigger than the baby (what we call the “fetal pole,” because that is the end of the yolk sac where the baby is developing). So when using ultrasound, we find the yolk sac and then focus around the rim until we see the tiny white streak where we see a heart beating. I am describing it as it appears on the screen. Actually it is not at all a white streak, but the early form of a tiny human being.
The baby continues to grow quickly so that by six to seven weeks, we can tell which end is the head and where the arms and legs are developing. By ten weeks he or she is still small enough to fit into the palm of your hand. Yet he or she is fully formed with recognizable arms, legs, fingers, and toes. Even the sex organs are developing, though it’s too soon to see at this stage whether it’s a boy or a girl.
The marvel of the baby’s growth—such an incredibly important and complex developmental time—is worth considering week by week. Now that we’ve given a general summary, we’re going to look at more specifics of Baby’s development. He experiences a continual growth process from his first cell to his birthday, with certain fairly predictable milestones along the way. We’ve already discussed fertilization to implantation, so let’s move ahead from there.
Most doctors talk in terms of weeks, referring to the number of weeks from your last menstrual period. We know the baby is not really four weeks old when we say you are four weeks’ pregnant. It’s just easier to count from the period, if you remember when it was. So let’s consider development on a week-by-week basis.
Week Four. Week four is the week when your period is due. The baby is actually only two weeks old by the time you might begin suspecting you’re pregnant.
At week four, the baby is about 1/25 of an inch long, but he or she is already complex. Remember the blastocyst—that ball with the group of cells making up the baby on the inside? Division within that ball happens so that cells separate the “baby” part from the cells that will be the placenta and membranes. Within the cells that form the baby, we see specialization into three distinct layers. The endoderm (inside) will form the internal organs, such as the pancreas, stomach, liver, bladder, and the inside layer of the intestine. The mesoderm (middle) layer forms the muscle, cartilage and bone, and blood vessels (including the heart). And the ectoderm (outer) layer forms the brain, spinal cord, skin, and hair. The cells are already grouping according to their future function. Amazing!
Week Five. Baby is now 1/20 of an inch long, measured from head to buttocks (crown to rump length). That’s smaller than the thickness of a dime, but already things are developing. You can tell by ultrasound which end is the head, and you can see where the eyes and ear locations are. By the end of the fifth week, the heart motion is visible on the ultrasound. You can actually see it moving.
Week Six. Baby is now 1/12 to 1/6 of an inch long, which is as thick as a dime. The baby appears curved like a shrimp, with a prominent head end and a tapering hind end. The brain is already forming, and blood vessel tubes inside the body are twisting and bending to form the baby’s actual heart shape. The backbone and some internal organs are now visible on ultrasound. The arm and leg buds are appearing. The limbs develop from the inside out and grow out like branches of a tree. They look almost like paddles at first. Then they grow longer. Soon fingers and toes are visible, and they separate into individual digits. Joints at the elbow and wrist become evident a bit later in the pregnancy.
Week Seven. Baby now measures about 1/3 of an inch. That’s about the size of a grain of rice. The arm and leg buds have reached out to form hands and feet (see photo). The lenses of the eyes are forming, and nostrils are developing. In an ultrasound picture, Baby looks more and more like a tiny person. The chambers of the heart are separating and functioning and the internal organs are beginning to work.
Week Eight. Baby is now one-half inch long. Now instead of being the size of a dime’s thickness, the baby is about the size of a dime’s width if we measure from crown to rump. The head still seems to be the largest part of the baby. The nose, jaw, and tongue are recognizable on ultrasound, as is movement! You can see your baby move his arms and legs. You can watch as she stretches or relaxes. You can’t yet feel motion, but it is amazing to see your baby flexing his new muscles. Bone is replacing cartilage and joints are becoming visible. Baby is growing rapidly and exploring his world.
Week Nine. The baby now weighs one gram. When you consider that there are 454 grams in one pound, that’s lighter than a feather. So where is all your weight coming from? The fluid. Your body is adding extra blood volume. So don’t get concerned. At this stage, using ultrasound you may see fingers and toes moving, stretching, and coiling. Baby may even move his mouth for you.
Week Ten. Your baby now weights about one-fifth of an ounce and measures between 1-1/4 to 1-2/3 inches. Medically your baby is now called a “fetus” instead of an “embryo.” Nothing magical has happened to cause this change. It’s just another stage, like childhood, adolescence, or adulthood—part of the normal growth process. Facial features are truly exciting now. Lips and tongue move, and sometimes babies look like they’re smiling. The lungs are developing, the intestines are moving, and Baby has more pronounced joints, fingers, and toes. Though your child would fit easily into the palm of your hand, if you were to hold him or her, you would have no difficulty recognizing that this really is a baby. All the parts are visible—arms, legs, fingers, toes, and a sweet face that responds.
Week
Eleven. Your baby will be two
inches long by the end of this week. The placenta is maturing and
taking over the supply of nutrition and oxygen. For some weeks the
baby has been sustained by what we call a yolk sac, that very early
structure we talked about. You might see the baby yawn or smile and
make a swallowing or even a breathing motion. Fingernails start
growing and thin hair growth begins. The lids are growing over the
eyes to cover and protect them. The intestines actually develop
outside the tummy in the umbilical cord. Then, as the baby gets
bigger, the intestines twist and slide inside the baby’s tummy. If
you get an ultrasound around this time, you may see the bulge in the
umbilical cord where it attaches to the baby. This is normal. We all
started this way.
Week Twelve.
Your baby is two-and-a-half inches long
and may weigh up to half an ounce—really growing now. The external
sex organs would be evident if you looked directly at the baby, but
ultrasound viewing still isn’t quite precise enough for predictions
at this stage. This is a fun time to watch the baby’s facial
expressions and movement as this tiny human being delights in
new-found mobility.
Three-dimensional imaging has revealed that during the twelfth week
babies appear to walk and leap in the womb.
Week Thirteen. Your baby is now two and two-thirds to three inches long from head to bottom. That is serious growth. Baby can hear and respond to sound, though the ear structures are still developing and maturing. Baby is completely formed now, but the organs are immature. So his or her life could not be sustained independently outside the womb’s protective environment.
Week Fourteen. Baby grows to four inches by this week and weighs one ounce. (That’s about what twelve pennies weigh.) This week marks the beginning of the second trimester. The placenta is now fully responsible for supplying the oxygen needs and all nutrients to the baby. Baby is breathing, moving, and doing other activities. External sex organs are sometimes visible by now with the ultrasound (though I like to wait a bit longer before making predictions).
Baby’s
Weight
Sixteen weeks Baby weighs about one-half pound
Twenty weeks Baby weighs about three-quarters of a pound
Twenty-two weeks Baby weighs about one pound
Twenty-eight weeks Baby is now over two pounds
I will give you thanks because your deeds are awesome and amazing. You knew me thoroughly; my bones were not hidden from you,
when I was made in secret and sewed together in the depths of the earth. Your eyes saw me when I was inside the womb. All the days ordained for me were recorded in your scroll
before one of them came into existence. (Psalm 139:14–16)
Chapter Four:
The Middle Months
Second Trimester: Baby Putting on the Moves
Maybe we could buy a larger pair of pants?
In
the second trimester many things change. For most women, energy
returns. The feeling that you could sleep twenty-two out of every
twenty-four hours subsides and you feel good. Appetite returns,
nausea disappears for most, and the baby and your tummy are of sizes
that are manageable for the most part. In this trimester you begin to
“show,” and total strangers may start asking when you’re due.
They may even reach out to touch your tummy. Don’t feel obligated
to share more than you are comfortable with. Most people mean well
but may fail to understand that this may be a private, personal time
for you.