PREGNANCY SYMPTOMS: WHAT TO EXPECT THE THIRD TRIMESTER

Almost there! The third trimester is full of expectation, as the moment you will hold the baby in your arms approaches. But the excitement comes with a lot of uncomfortable symptoms…

The third trimester lasts from the 7th through the 9th month of pregnancy, that is, from week 28 till the moment you give birth, usually around week 40. This period can be challenging and tiring, as your womb grows and creates a lot of discomfort. Most of the symptoms you will experience are those that appeared during the second trimester, although they will be more intense now: back pain, leg swelling, sleep problems, itchy skin…

But keep a positive attitude! Read this list with the most common symptoms of the last three months of pregnancy and learn what you can do to relieve them. We will focus on the symptoms that appear during the third trimester, or that are somewhat different now. This is what you can expect:

1) Abdominal muscle separation

As your uterus grows, it pushes against the abdominal wall and stretches its muscles (the ‘six pack’ muscles), which will start separating in the middle and cause a bulge, or gap  in the middle of the abdomen. This condition, called diastasis recti abdominis, is more evident when the abdominal muscles are tense, such as during coughing or getting up from a lying down position. Diastasis recti can cause lower back pain, making it difficult to carry out certain activities, such as lifting objects.

Not all women develop abdominal muscle separation; you are more likely to get it if you are older than 35 years-old, have a multiple pregnancy or carry a large baby, or have repeated pregnancies.

What can you do about it:

  • Muscle separation lessens in the months that follow delivery, although some degree of separation may remain. Certain exercises will help you regain abdominal strength after childbirth.
  • During pregnancy, avoid aggressive abdominal exercises (such as sit-ups), which may provoke or worsen diastasis recti.
  • If abdominal muscle weakness associated with diastasis recti is interfering with your daily activities, seek the advice of your care provider or a specialized physiotherapist, who can indicate certain strength and postural correction exercises.

2) Breast leakage

By the end of pregnancy, you may notice a yellowish fluid leaking from your nipples, and this is normal. This substance, called colostrum, will nourish your baby in the first few days after birth.

While some women leak quite a lot of colostrum, others don’t leak at all. Leaking won’t make any difference to how much milk you will produce once your baby is born.

What can you do about it:

  • If you just leak a few drops, then you don’t need to do anything. But if it bothers you, you may wear nursing pads inside your bra to absorb the milk.
  • You should call your doctor or midwife if the nipple discharge becomes bloodstained.

3) Carpal tunnel syndrome

Tingling, numbness, weakness and pain in the hands during the last trimester are usually caused by a condition called carpal tunnel syndrome (CTS).

CTS is common in pregnancy, and happens due to the fluid retention in the tissues of the wrist, which in turn squeezes a nerve (the median nerve), that runs down to your hand and fingers. Women that keep doing forceful or repetitive hand and finger movements (such as long hours at a computer, or the use of vibrating equipment) may have worse symptoms.

What can you do about it:

CTS usually disappears without treatment after childbirth, when pregnancy-related fluid buildup is relieved. In the meantime, you may try the following:

  • Avoid activities that may be causing symptoms.
  • Wear a wrist splint to keep your wrist straight, especially at night, when the symptoms can be more bothersome.
  • Do exercises to stretch and strengthen the muscles in the hand and arm.
  • Alternative therapies, such as acupuncture might help relieve hand pain.
  • If nothing works, talk to your doctor, who may prescribe certain medications.
  • Surgery is the last resort treatment, but unless CTS become intolerable, it will be delayed until after birth.

4) Dreams and nightmares

You knew about the sleep problems during pregnancy. But you may get surprised, even disturbed when you start getting frequent and vivid dreams, occasionally nightmares; you may also realize that you remember your dreams more clearly.

The exact reason of these changes in the dream pattern is not clear, but they seem to be related to hormonal and emotional factors, as well as the frequent sleep disruptions that come with pregnancy (read more here).

What can you do about it:

  • If your dreams are just more frequent or more vivid, you will just have to cope with them.
  • However, if you have frequent nightmares, that are too disturbing, don’t let you sleep or cause you intense anxiety, you may consider sharing them with a friend, your doctor, or a therapist.

5) Clumsiness, waddling

You may have noticed that, as pregnancy progresses, you get clumsier: things fall from you hands, you bump into doors, you may accidentally fall down! It is not just you, clumsiness is normal in pregnancy and is related to many factors: you are heavier and your growing womb changes the center of gravity, making it more difficult to move; your “pregnancy brain” makes it harder for you to concentrate on your activities; in addition, a hormone called relaxin relaxes all the joints in your body. Therefore, you won’t have the balance or dexterity you used to have.

The same reasons explain why, at the end of pregnancy, you will start waddling, which in turn will make you even clumsier!

What can you do about it:

Clumsiness is normal and there is not much you can do to prevent it. However, it is important that you take measures to protect yourself -and others- from accidents:

  • Avoid situations where you have a high risk of falling, such as standing on a ladder, using stairs, riding a bicycle, etc.
  • Wear comfortable shoes, that should not be neither too flat or too high (read more here).
  • Pay attention whenever you walk on wet, icy, or uneven surfaces.
  • Avoid gaining too much weight, which will make clumsiness much worse.
  • Call your doctor if, besides clumsy, you feel dizzy or lightheaded, your have blurred vision, headache, or any pain.

6) Emotional changes

As you get closer to childbirth, your anticipation grows, so do your anxiety, fears and concerns! Besides all the hormonal-related emotional changes, you may start getting worried about the delivery itself, as well as all the changes the baby will bring, your role as a parent, etc (see here).

What can you do about it:

  • Stay calm, mild physical activity can help (read here), eat well (here), indulge yourself with a beauty treatment! (here).
  • Taking childbirth classes can help you feel more prepared to face labor and delivery.
  • Discuss your emotions and fears with your doctor or midwife.
  • Sharing your feelings with friends, your partner or other moms-to-be can be very helpful.
  • Nevertheless, if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life you must discuss it with your doctor.

7) Fatigue

Forget the energy you had during the second trimester: fatigue is back! Carrying extra weight, waking up several times during the night to go to the bathroom, and dealing with the anxiety of preparing for a baby can all decrease your energy level.

What can you do about it:

  • Eat healthy, frequent and small meals: it’s a good idea to keep with you healthy snacks that you can grab whenever you feel out of energy.
  • If you work, take regular, small breaks; you may even consider taking a quick nap!
  • Light exercise can make you feel more energetic: walking, swimming or prenatal yoga are good options, but listen to your body! Don’t force yourself.
  • Check with your doctor if you feel extremely tired, so that she/he may do some blood test to rule out anemia or other problems.

8) Forgetfulness (“Pregnancy brain”)

It’s not a myth: intense forgetfulness, known as “pregnancy brain” is a normal symptom of pregnancy, which nevertheless can be very annoying!

It is mostly related to pregnancy hormones, but sleep disturbances and fatigue can make it worse.

What can you do about it:

Don’t worry! Your brain will work normally again after delivery. Well, sort of, as you will have to deal with the sleepless nights while taking care of your baby 😉

In the meantime, these tips may help:

  • Stay organized! Write down what you need to do, technology may help: reminders on your phone or to-do lists in your computer will make it easier.
  • Ask for help: cut down on what you’re responsible for by delegating some jobs to others.
  • Eat well: certain foods may boost your memory: eating plenty of choline-rich foods and DHA-rich foods during pregnancy may help boost your -and your baby’s- brain function.

9) Frequent urination, urinary incontinence

As your baby grows, the pressure on your bladder increases, causing a constant feeling you need to go to pee. This may be worse during the night, because when you lie down, the fluids you retained in your legs and feet during the day make its way back into your bloodstream and eventually into your bladder.

Many women also experience stress urinary incontinence, that is, they lose some urine when they cough, laugh, sneeze, lift heavy objects, or exercise.

What can you do about it:

To reduce frequent urination:

  • Avoid beverages that contain caffein, which has diuretic effect.
  • It’s not a good idea to cut down on fluids, as your body needs plenty of them during pregnancy. Instead, you may reduce fluid intake in the hours before you go to bed.
  • Lean forward when you urinate: this helps empty out your bladder better.

To avoid incontinence:

  • Empty your bladder before exercising.
  • Wear a panty liner to catch any unexpected leakage.
  • Kegel exercises, which strengthen the muscles of the pelvic floor, can also help minimize stress incontinence.

You should inform your doctor or midwife if you feel pain or burning with urination, if your see blood when you wipe or if you feel the urge to pee even when you produce just a few drops at a time. These could be signs of a urinary tract infection (UTI).

10) Heartburn

Another symptom you may have experienced during the first three months of pregnancy, got better during the second trimester but now came back! While the heartburn you experienced during the first trimester was hormone-related, now your enlarged uterus is to blame, as it crowds the abdomen, pushing the stomach acids upward.

What can you do about it:

  • Eat small, frequent meals, don’t eat too much before going to bed.
  • Avoid too spicy, greasy, acidic or sweet foods.
  • Don’t lie flat, sleep with two or more pillows to have your head at a higher level than your body.
  • Call your doctor if you can’t cope with heartburn, who can prescribe you an antiacid medication that is safe for pregnancy.

11) Pelvic pain

Once you’re in your third trimester, you may experience pain and pressure in your pelvic region, as the weight of your growing fetus presses down on certain nerves that run into the legs; for the same reason you may also feel tingling, numbness and pain along the outer thigh; which can be very annoying for some women.

Relaxed pelvic joints are a common cause of pelvic pain: toward the end of your pregnancy the hormone relaxin helps the ligaments become loose in preparation for childbirth. This hormone can also loosen your pelvic joint, and even cause it to separate a bit. It’s common to feel pain near your pubic bone, and you may also feel like your legs are unstable. This is called Symphysis pubic dysfunction (SPD).

Your fetus’s head can also to rub your tailbone, causing tailbone pain and pressure. The condition is called coccydynia and occasionally the pain can be very intense.

Braxton Hicks contractions can also cause pressure and tightening in the pelvis (see below). Constipation also can cause pelvic pain or discomfort (see here).

What can you do about it:

Be patient! Once your baby is born, all the pressure-related symptoms will be gone; in addition, relaxin production will cease and the joints will be firm again, easing your pain. In the meantime:

  • Get plenty of rest;  a change of position that shifts the pelvic pressure away from the nerves responsible for the pain should provide some relief.
  • Avoid lifting heavy things.
  • Warm compresses on the painful the area may ease soreness.
  • Pelvic support belts can help stabilize the area.
  • If the pain is severe enough, ask your doctor about painkillers.

12) Swelling

During the second trimester some women experience some swelling of the ankles and feet. Now, swelling – or edema will be also evident in the hands, face and upper legs.

Swelling is normal and is caused by the excess blood and fluids your body produces to meet the baby’s needs. This extra fluid will also soften the body and help it expand as the baby grows, and prepare the joints and tissues to open more easily during delivery.

Swelling is usually worse with warm weather, if you stand up for long periods of time, if you consume too much caffeine or salty foods, or if your diet is low in potassium.

What can you do about it:

  • Reduce salt intake, avoid adding extra salt to meals.
  • Avoid caffeine consumption.
  • Eat foods high in potassium (such as bananas).
  • Minimize outdoor time when it’s hot.
  • Avoid long periods of standing or sitting.
  • Move regularly your feet, or keep your legs elevated while sitting.
  • Wear comfortable shoes (read more here).
  • Avoid clothes that are tight around your wrists or ankles.
  • Wear supportive tights or stockings.
  • Get plenty of rest, swimming may also help.
  • Use cold compresses on swollen areas.

13) Shortness of breath

As your pregnancy progresses you may start feeling breathless after minimal amounts of physical exertion, or even when talking!

Mild breathlessness is totally normal; during early pregnancy is due to pregnancy hormones, which make you take more and deeper breaths, so that you get additional oxygen for the baby. But in the third trimester, shortness of breath  is mostly related to your expanding uterus putting pressure on the lungs and diaphragm, making it harder to take a deep breath.

What can you do about it:

  • Don’t overdo it with your daily activities or while exercising; when you feel breathless, slow down.
  • Make room for your lungs to take air: stand up straight, don’t sit down for long periods of time, sleep propped up on pillows.
  • If the shortness of breath is severe, you have chest pain or a quick pulse, call your doctor immediately.

14) Vaginal discharge

Increased vaginal secretions are completely normal and start during the first trimester. These discharge helps prevent infections travelling up from the vagina to the womb.Towards the end of pregnancy, the amount of discharge increases and can be confused with urine; close to delivery it may even contain streaks of thick mucus and some blood (this is called “bloody show”; we will discuss more about it in another post). Vaginal secretions should be white or clear, and should not smell unpleasant.

What can you do about it:

  • You may wear panty liners, but do not use tampons.
  • Prefer cotton underwear, avoid string or thongs that may cause intense rubbing, which together with the increased discharge can favor yeast or other infections.
  • Avoid vaginal douching (which is never a good idea, but especially during pregnancy).
  • Pay attention to washes and wipes that could be irritating, increasing your chances of a vaginal infection.
  • Call your doctor or midwife if you have discharge that is yellow, green or foul-smelling, if you have intense itching or burning, symptoms that may show that you have a vaginal infection. Likewise, call your healthcare provider if you have a lot of watery, vaginal discharge, which may signal that you broke your water bag.

15) Vulvar varicose veins

If you feel something “like worms” on your genital area, together with some pressure, swelling of discomfort in the vulva, don’t panic! These are dilated vulvar veins and occur due to the increased blood flow to the area, and the pressure the growing uterus puts on the veins of your lower body. Vulvar varicosities are seen quite often during pregnancy, either alone or with varicose veins of the legs, or hemorrhoids. Long periods of standing, exercise and sex can aggravate them. Occasionally though, they are completely asymptomatic, and the only way you’ll know you have them is because your doctor tells you.

What can you do about it:

Most of the times, vulvar varicosities don’t affect your mode of delivery, and they go away on their own after birth. If they are bothersome, you may try the following:

  • Wear support garment specifically designed for vulvar varicosities.
  • Avoid standing for long periods of time.
  • Swimming helps lift the baby from the pelvis and improves blood flow, relieving your pain.
  • Elevate your hips slightly when lying down to promote circulation; you may place a folded towel beneath your hips.
  • Cold compresses applied to your vulva may ease discomfort.

What else to expect

Baby movements

  • During the second trimester and beginning of the third, your baby has plenty of room in the womb, so most likely you will feel pushing, swirling, twisting, and kicking. But as he/she grows bigger, there is less space for movement; thus probably you won’t get the punches and kicks you were used to. Instead, you’ll feel more wiggles, stretches and turns. Although by the end of pregnancy mobility may be reduced when he gets engaged in the pelvis, the baby should keep moving until the moment he is born.
  • Keep in mind though that the baby is not constantly on the move: there are times when she sleeps. Towards the end of your pregnancy, the baby rests for about 20 minutes at a time, but occasionally the rest periods may be as long as 50 or 75 minutes.
  • Although you may have read or heard you need to count the baby’s kicks, there is a huge variation among babies, and no normal values for baby’s kicks have been determined; therefore, a written record of your baby’s movements is not necessary. Since every baby has a different pattern of waking and sleeping, what is important is to follow up on your baby’s own pattern of movements. If you notice a change in your baby’s pattern of movements, or are worried at any stage, contact your midwife or doctor, so that they can check the baby’s wellbeing with certain specific tests.
  • At some point you may not be sure whether you felt your baby kicking. Keep in mind that you’re more likely to be aware of your baby’s movements when you’re lying down rather than sitting or standing. Therefore, in the doubt, have a snack, particularly something sweet, lie down on your side and wait. You may also try making some noise, or playing loud music. If your baby starts moving around, most likely everything is fine.

But you should contact your midwife or doctor right away if you notice any of the following:

  • You don’t feel several movements while lying on your side for two hours.
  • Your baby doesn’t start to move in response to noise or some other stimulus.
  • There’s a big decrease in your baby’s movements, or a gradual decrease over several days.

Weight gain

  • You should aim for a weight gain of about 1-2 kg per month during your third trimester, but it is not unusual to lose 1 or 2 kilos by the end of pregnancy, as your stomach gets compressed by the baby and you get a feeling of fullness even with small meals. In total, you should have put on about 12 kg (8-16 kg). However, your doctor may recommend that you gain more or less weight if you started out your pregnancy underweight or overweight.
  • It is very important that your weight gain doesn’t exceed these limits, as it may lead to several complications in pregnancy and delivery, such as high blood pressure, gestational diabetes, backache or delivery complications due to increased fetus weight. Not to mention that it will be more difficult to get back to your pre-pregnancy weight…

Braxton Hicks contractions

  • Pressure or tightening in the pelvis that comes and goes could be contractions, but if they’re sporadic and not painful, they’re most likely Braxton Hicks contractions. They usually begin as early as the second trimester; however, they are most commonly experienced in the third trimester.
  • Braxton Hicks are also called “practice contractions” because they are a preparation for labor. They are irregular in intensity and frequency, usually painless or just uncomfortable (although sometimes they may be painful).
  • As Braxton Hicks intensify close to the time of delivery, they are often referred to as “false labor” and they may help prepare the uterus for delivery. These practice contractions may be more intense or frequent when you are too tired, your baby is very active, after sex or due to dehydration.

If you are not sure whether the contractions you feel are true or false labor, try the following:

  • Lie down, get some rest and wait.
  • Take a warm shower or bath.
  • Drink some fluids.

If none of these steps works at any stage of pregnancy; or if you are less that 37 weeks pregnant and you have contractions every 15 minutes or closer that persist over two hours, contact your health care provider.

Signs of Labor

When getting closer to the due date, most certainly you will start wondering: What are the signs labor is coming? How will it feel? and mainly: Will I understand when it’s time? A post answering these questions will follow soon… Stay tuned!

When to worry

Any of these symptoms could be a sign that something is wrong with your pregnancy. Call your doctor right away if you experience any of these symptoms:

  • Severe abdominal pain or cramping
  • Severe nausea or vomiting
  • Bleeding
  • Severe dizziness or fainting
  • Rapid weight gain or intense swelling
  • Fever (unrelated to a cold)
  • Pain or burning during urination
  • Watery vaginal discharge
  • Abundant green, yellow, foul-smelling discharge.

This list of not exhaustive; do not hesitate to contact your healthcare provider for any other symptom you are unsure whether it’s normal or not.

References

  • NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
  • HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

Photo credits

Intro: Flickr.com; 1) lifeopedia.com; 2) sheknows.com; 3) momjunction.com; 4) answerforsleep.com; 5) health.com; 6) Flickr.com; 7) healthymamabrand.com; 8) healthywomen.org; 9) intimina.com; 10) baby-pedia.com; 11) onlymyhealth.com; 12) medicmagic.net; 13) dnaindia.com; 14) pinterest.com; 15) amazon.com; Baby movements: babycenter.ca; Weight gain: parenthub.com.au; Braxton Hicks: birthcentered.com; When to worry: herb.co

HOME BIRTH: SMART CHOICE OR RISKY BUSINESS? (Part 3)

In the Part 1 of Home birth: Smart choice or risky business? we analyzed the issues of personal satisfaction, maternal safety and baby’s risks. Part 2 dealt with hospital transfers, water birth and the situation in the Netherlands. Check out the last three reasons women choose home birth, and read the final conclusion to decide whether home birth is a clever or a dangerous option…

7) Home birth is cheap

home-birth-call-the-midwifeHome birth is cheaper… provided that no transfer is needed and nothing goes wrong

Cost-effectiveness is an important issue in every country with an organized health system. Countries like England or the Netherlands, where the National Health System (NHS) covers the cost of deliveries, have calculated that is cheaper that women deliver at home, avoiding a more expensive hospital admission. For example, the UK NHS “prices” home birth £1066 and birth at a hospital £1631. The economical factor is one of the reasons certain professional organizations support home labor, such as the Royal College of Obstetrics and Gynaecologists (RCOG) which states that: “home birth is the most cost-effective place for delivery”.

But this cost analysis has been challenged, as it does not take in consideration the high transport rates; in fact, a Dutch report calculates a general 3-fold increase of costs in patients transported during labor, when the costs of the midwife, the transport system, the obstetrician and the hospital are included. In addition, the costs derived from the maintenance of an adequate transport system (ambulances and trained staff) should not be neglected. Assuming increased neonatal risks, admissions to the neonatal intensive care unit, the lifetime costs of supporting neurologically disabled children and potentially increased professional liability costs resulting from a complicated home birth can potentially inflate the costs.

Indicative of these unexpected expenses is the article Home birth: What the hell was I thinking?  A journalist from The Guardian went on a mission following a home birth. After managing to deliver her child at home, both the woman and her baby had a complication and needed to be transferred to a hospital. Since the baby and the mother were not allowed to be in the same ambulance, two ambulances were required…

Regarding the costs arising from a private home birth, the situation varies in different countries; in the USA home births are not covered by health insurances, and a couple is expected to pay $1500 to 4500 to the midwife. Hospital births can range from $3,296 to 37,227, although they are usually covered totally or partially by the insurance. Of note: a doctor gets paid about $2500-4000, same as a midwife. Ιn Europe, a couple is expected to pay about 2000-3000 €; recently the Italian newspaper La Stampa published the article Home birth: a 3000 €  luxury that does not convince doctors.

8) “Birth is not a disease, it’s a natural thing. Mother nature can’t go wrong”

home-birth-birth-in-natureUnassisted childbirth: don’t try this at home – or anywhere else

Indeed, Mother nature is great. If you think about it, the whole process of labor and delivery seems to be so perfect, almost magical… But “natural” is not a synonym of “risk-free”. Sometimes Mother nature can play strange games. We may believe we have everything under control, but things may flip just in a second: think earthquakes, or tsunamis… Exactly the same thing applies to childbirth: even when someone seems to be “low risk”, disaster can strike without any warning …

Childbirth is inherently dangerous,” writes in her blog Amy Tuteur, an American obstetrician gynecologist. “In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood”. Finally, she adds: “Why does childbirth seem so safe? Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90 per cent and the maternal mortality rate 99 per cent over the past 100 years.”

The absolute confidence in a woman body’s ability to deliver is expressed by supporters of unassisted childbirth (UC), the “hard core” version of home birth, which, although practised already since the 70s, it has lately seen a resurgence. Also known as freebirth, DIY (do-it-yourself) birth, unhindered birth, or unassisted home birth, it refers to women that intentionally deliver without the assistance of a physician or midwife; they may be completely alone (“solo birth”) or assisted by a lay person, such as the spouse, family, friend, or a non-professional birth attendant. There are no data on safety of UC, except that coming from a religious group in Indiana (USA) that found a perinatal mortality rate 2,7 times higher, and a maternal mortality rate 97 times higher than the state average.

Among the most famous UC advocates is Janet Fraser who, ironically, lost her baby after five days of home labour; in spite of that she continues to advocate for freebirth. In fact, UC is not endorsed by any scientific organization, as it is considered too dangerous. According to André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada (SOGC):“Freebirth is the equivalent of playing Russian roulette with your child”.

9) I have the right to deliver wherever I want

home-birth-collageA home birth oxymoron: right to privacy vs. social media exposure

This is a very complex issue with ethical and legal connotations, which has originated intense debate among experts. Even scientific organizations differ in their recommendations. For example, The American College of Obstetricians and Gynecologists, until recently opposed to home births, has decided to temper its position: “…hospitals and birthing centers are the safest setting for birth, but it respects the right of a woman to make a medically informed decision about delivery.” On the other side, the American College of Nurse-Midwives (ACNM) maintains that “every family has a right to experience child birth in an environment where human dignity, self-determination, and the family’s cultural context are respected” and that “every woman has a right to an informed choice regarding place of birth and access to safe home birth services”. Let’s analyze the ethical and legal aspects of home birth:

Ethical issues

These are some of the ethicals dilemmas related to home birth:

Mother vs child safety. Although hospital birth seems to increase maternal interventions in all studies (apparently without increasing severe risk), the baby’s safety remains a subject of debate; taking though in consideration all the studies, there seems to be increased risk for the baby. Let’s take for example the Birthplace study (which is in somewhere in the middle). This study found that, particularly for first time mothers, the baby’s risk is 3 times higher (of which more that half of the cases are death and brain damage). Is it ethically acceptable for a woman to value her birth experience over her baby’s welfare? Is maternal emotional wellbeing so important to justify risking the baby’s health?

Respect for dignity and privacy. “Dignity” may have a different meaning for each person. Some home births supporters feel that the presence of a doctor and the hospital staff make them feel “degraded”; moreover “for some women the possibility of the loss of privacy is a major issue, because privacy is a valued possession”.

Is it not contradictory that so many women, zealous advocates of home birth and their right to privacy, do not hesitate to publish their home birth photographs and videos -some of them with incredible details- in every social media site, where they are exposed to the eyes of millions of people?

Self-determination. In order to make truly informed decisions about childbirth options, women need to be informed of what they are and have the possibility to discuss them. Is it ethical to offer the option of home birth knowing that there is increased risk for her baby? 

In theory, the person informing the pregnant woman should inform her objectively and avoid being paternalistic. The problem is that, informed decision-making implies accurate assessment of risks and benefits, but the safety of home birth remains debatable. Is it possible to inform objectively a pregnant woman about home birth? Or the information will be biased according to the health care provider beliefs or experiences?

Other possible ethical issues:

  • In the home birth situation, are a woman’s reproductive rights and medical responsibility incompatible with each other?
  • Where do a woman’s rights end and medical responsibility begins, especially considering that the physician is also responsible for the baby’s welfare?
  • In case of a baby adverse outcome that could have been prevented in a hospital setting, what will be the psychological consequences for the couple?
  • What is the psychological burden of a home birth in a family’s older children witnessing a home birth? What if a complication occur in their presence?

Legal issues

Legal issues can affect a woman’s decision to give birth at home in different countries. In certain places, home births are restricted, and even possibly criminally punishable, and family homes have been turned into crime scenes when women who have opted for homebirths experienced complications. In others countries, there are no regulating laws.

In Europe, the European Court of Human Rights (ECtHR) ruled in 2010 that Hungary had violated Article 8 of the European Convention on Human Rights (ECHR) because it had interfered with a woman’s right to choose where to give birth. Ms Ternovszky wanted to give birth at home but argued that she was prevented from doing so because a government decree dissuaded health care professionals from assisting home births. This case was the first decision by an international human rights organization on the right to choose the circumstances of giving birth, and was heralded by home birth advocates across Europe.

However, in a recent case against the Czech Republic, the Human rights judges decided that national authorities of each country has “considerable room for manoeuvre” when regulating home births, a matter for which there is no European consensus and which involves complex issues of health-care policy as well as allocation of State resources.

So, is home birth a smart choice or a risky business?

The Monty Python satirize the medicalisation of childbirth in The Meaning of Life

As an obstetrician who supports natural birth, I hear many times the women’s complaints about the excessive medicalization of childbirth. And I feel that sometimes they are right. However, being a mother myself, I never regretted my choice of a hospital birth for my children. After having helped so many women deliver their babies, I have seen many times complications that were totally unpredictable. Occasionally, these sudden complications are so serious, that we have to run -literally- from the delivery room to the operating room to save the baby or the mother! Therefore, even when having skilled professionals attending your home birth, even in countries with very organized structures, the distance to a hospital can prove fatal. Is for this reason that, in my opinion, a hospital birth is without any doubt the best choice for every woman. A birthing center attached to a hospital may also be a good choice.

True, the studies results are controversial, but for me “almost as safe as a hospital birth” is not enough to make me change my mind.

True also, a hospital birth is related to more epidurals, cesarean sections, instrumental deliveries and episiotomies. Regarding the epidural, if you can do it without one, that’s great! But sometimes labor pain is unbearable, and it’s not uncommon to see women without any pain relief who, when the moment to push comes, they are so exhausted and their pain is so overwhelming that they literally lose it. On the contrary, women with an epidural can be more focused and relaxed. The bottom line is: natural birth is not for everybody. And women don’t have to feel guilty because they chose to have an epidural. It’s better to have nice memories of your birth, and for that the epidural can help!

Whether too many cesareans sections are being done is a topic more controversial than home birth itself, and it would deserve a separate article. But what I can say is that, when cesarean sections are done in a judicious way by a conscious physician, they can save your life and your baby’s life. Since hospital births result in better neonatal outcome, it is clear to me that most interventions are an inevitable trade-off to save more babies or to avoid severe damage. The same goes for the controversial fetal monitoring, which may lead to more cesarean sections, it may not decrease perinatal mortality, but it reduces by 50% the risk of  brain damage. Personally, I would do anything in my power to reduce the chances of having a brain damaged baby.

Of course, a lot that should be done -and can be done- to improve hospital birth: create home-like conditions to help women be relaxed and empowered, allow women to walk during labor, give them possibility to push and deliver in any position they wish, avoid unnecessary interventions such as systematic episiotomies, etc. I believe that some efforts are slowly being done worldwide, but we still have a long way to go!

In conclusion, a woman has the right to choose where to deliver; however, until the risks are clarified, maternal wellbeing may undermine the child’s welfare. Therefore, in my opinion, a natural hospital birth is the safest choice. Natural hospital birth IS possible! You just need motivation and a supportive team…

Hospitals should increase their efforts to provide women with a friendly environment so they can deliver their babies in comfort and total safety. Every baby is precious, every mother is precious!

Photo credits

7) screenterrier.blogspot.gr; 8) news.com.au; 9) vimeo.com, Wikimedia Commons, thebirthhour.com, Flickr.comvimeo.com, homebirthaustralia.orgmindfulmamabirth.comFlickr.comhuffingtonpost.co.uklifedaily.com

HOME BIRTH: SMART CHOICE OR RISKY BUSINESS? (Part 2)

In the first part of this article we analyzed three important issues related to home birth: personal satisfaction, the mother’s safety and the baby’s risks. Check out the next three reasons women choose a home birth…

4) “I plan to have a home birth, but if something should happen I will go to a hospital

home-birth-preparing-for-home-birthEven when properly prepared for a home birth, transfer to a hospital is commonly required

As previously mentioned, hospital transportation is a common event: about 1 out of 2 first time mothers and 2 out of 10 second or subsequent time mothers need to be transferred to a hospital; moreover, hospital transfer is almost always perceived by the couple as a negative and disruptive experience (see part 1).

The need for transportation to a hospital can occur before, during of after birth, and can be related to the mother, the baby or both. The top reasons may vary in different countries, although prolonged labour is the first cause of transfer in almost every study, followed by pain relief or the midwife’s unavailability at the onset of labor.

In the UK, the most common reasons for transfer are:

  • Prolonged labour (32.4%)
  • Meconium staining (12.2%)
  • Repair of a perineal tear (10.9%)
  • Abnormal fetal heart rate (7.0%)
  • Retained placenta (7.0%)
  • Request for regional analgesia (epidural, spinal) (5.1%)
  • Neonatal concerns (postpartum) (5.1%)
  • Others (20.1%)
Australian Caroline Lovell died of complications after giving birth to her daughter in a pool. Justice found that her death was preventable.

Home birth activist Caroline Lovell died of complications after giving birth her second child at home. Her death was preventable, justice says.

Other reasons include:

During labor: maternal fever, fetal malpresentation, shoulder dystocia (baby’s shoulders getting stuck inside the mother), cord prolapse, uterine rupture, acute bleeding, placental abruption, vasa previa, acute sepsis.

After birth: tears of the vagina or cervix, sphincter rupture, uterine atony, placenta accreta, increta, or percreta.

Baby-related (post partum): unexpected very low or very high birthweight, neonatal depression, signs of respiratory distress, unexpected malformations, acute sepsis.

These are some important facts to keep in mind:

  • Maternal and fetal necessity for transport is often impossible to predict.
  • For unpredictable, extremely sudden complications, even rapid transport may not prevent the baby or the woman from death or severe harm, such as shoulder dystocia, sudden cardiopulmonary arrest, or maternal exsaguination (bleeding to death, read Caroline Lovell story here).
  • Women with severe hemorrhage  may already be in shock when arriving at a hospital. Even though the adequate treatment can be immediately instituted, death may nevertheless occur.
  • Perinatal mortality is higher when transport to the hospital is required.

5) At home I can have a water birth

home-birth-poolThe latest years there has been an increasing demand for water birth

Immersion in water during labor and delivery, although available for several decades, has seen a greatly renewed interest the latest years. In fact, even certain hospitals and birth centers have incorporated birth pools to their facilities. The results of studies analyzing maternal and fetal benefits and risks of water birth are inconsistent, and many times contradictory. The American College of Obstetricians and Gynecologists (ACOG) has just reviewed the subject and a few days ago (November 2016) published an updated statement. What are then the proposed pros and cons of water birth?

home-birth-waterbirth-babyThe benefits

For the mother. A Cochrane study  found the following results:

  • Less need for regional analgesia (epidural, spinal, or paracervical; studies show a slight reduction, RR 0.90; 95% CI 0.82–0.99)
  • Shorter duration of the first stage of labor (32.4 minutes shorter in water immersion)
  • Improvement in satisfaction among those women delivering in water.
  • Studies results are contradictory regarding the reduced occurrence perineal tears (including third-degree and fourth-degree lacerations) and need for episiotomy.
  • One study found less antepartum transfers to hospitals, both from home and midwifery birth units.

Other possible benefits: Increased feelings of relaxation, warmth, privacy, improved ability to maintain control during labor (here, here, here).

For the babySupporters of water birth believe that the transition to the outside world is less traumatic for babies born in water as the warm water of the pool may feel like the amniotic fluid; thus water-born babies are supposedly calmer than babies born in air. In fact, no benefits for the newborn were found with maternal immersion during labor or delivery, neither in 2 systematic reviews including 12 studies and 29 studies respectively, neither in the 2009 Cochrane systematic review, or any individual trials included in ACOG’s review.

home-birth-water-birth-realThe risks

For the mother. ACOG’s review did not find increased risk for maternal infections or postpartum hemorrhage. However, this conclusion must be tempered by the lack of data on rare serious outcomes, such as severe morbidity and mortality.

For the baby. Most studies found that immersion during labor does not increase fetal or neonatal risk. However, concerns have been expressed that immersion during delivery may predispose the infant to potentially serious neonatal complications. Several studies have reported several serious adverse outcomes among neonates delivered in water, these include :

  • Infection: cases of severe infections with certain bacteria, mainly Pseudomonas aeruginosa (here, here) and Legionella pneumophila (here, here, here, here) have been observed, some of which were fatal. The bacteria causing infections my come from the woman’s body, the water or the pool itself. Recently, a fatal infection by a virus (adenovirus) was reported in a baby born from a mother with gastroenteritis giving birth in a pool.
  • Water aspiration (drowning or near-drowning): it has been claimed that babies delivered into the water do not breathe or swallow water because of the protective “diving reflex”; however, it has been demonstrated that in compromised newborns the diving reflex is overridden, leading to gasping and aspiration of water. Actually,  it seems that even healthy babies may be at risk of water aspiration, which may result in hyponatremia and seizures.
  • Umbilical cord avulsion (cord “snapping” or cord rupture): this complication may happen in 1 out of 288 water births and occurs when the baby is lifted out of the water; in some instances the affected newborns have required intensive care unit admission and transfusion.

Other possible inconvenients:home-birth-bloody-water-birth

  • The mess: setting a pool at home may be messy and even challenging in certain situations, such as living in a small apartment.
  • Unpleasant environment: women may feel uncomfortable about accidentally defecating in the pool; which, as stated above, may also predispose the baby to severe infections.
  • Disappointment with pain relief: for some women, immersion in water is not enough to relieve pain.
  • Monitoring and emergencies: it may be difficult to quantify blood loss (see photo); in cases of concern about the baby’s heartbeat, monitoring may be difficult; moreover, in the event of a severe maternal complication (such as fainting or heavy hemorrhage) it may be difficult to move the pregnant woman out of the water.

Several professional organizations, including the Royal College of Obstetricians and Gynaecologists and the American College of Nurse–Midwives, support healthy women with uncomplicated pregnancies laboring and giving birth in water. According to ACOG, immersion in water during the first stage of labor may have benefits for the mother and may be offered to healthy women with uncomplicated pregnancies; however, there are insufficient data regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, “it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water”. The British National Institute for Health and Care Excellence (NICE) recommendations are in agreement with the ACOG.

6) In the Netherlands women have been delivering at home for more than fifty years

home-birth-netherlands-1948The Netherlands has the highest percentage of home births in the Western world

The Netherlands is a country with a long tradition of home birth, with well-trained midwifes, organized transport system and short distances to hospitals. However, it is one of the few countries in the world where the incidence of home births is decreasing: in 1965, two-thirds of Dutch births took place at home, but that figure has dropped to about 20% in 2013. Moreover, Dutch women have to pay an extra amount (around €250) when deciding for a “nonindicated hospital birth” under the guidance of an obstetrician or a midwife (here). According to Professor Simone Buitendijk, head of the child health programme at the Netherlands Organisation for Applied Scientific Research, “… home birth rates have dropped like a stone. Soon, there will not be enough demand to justify the infrastructure” she says. “Then the system will collapse – and let there be no misunderstanding: we won’t be able to rebuild it”.

This drop in home births seems to be related to the increasing awareness of the media, patients, and obstetricians about the risks of home birth (here). Even more skepticism originated the results of the Euro-Peristat studythe Netherlands is one of the countries with the worst perinatal outcomes of Western Europe.

 

Read the third part here:  Home birth: smart choice or risky business? (Part 3)

Photo credits

4) birthbootcamp.com, dailymail.co.uk; 5) flickr.commthoodwomenshealth.compopsugar.comgravidanzaonline.it; 6) currystrumpet.com

HOME BIRTH: SMART CHOICE OR RISKY BUSINESS? (Part 1)

home-birth-bw-flickr-resized

Home births have been, for a long time now, the subject of endless controversy and polarized discussions among physicians, midwives and strongly opinionated women. Indeed, the idea of giving birth at home sounds attractive. With the growing  interest for an “all natural” lifestyle, natural home birth looks like a logical way to go. What’s more, celebrities are doing itand midwives are becoming a status symbol!

home-birth-gisele-pregnant-resizedEven mass media has embraced the trend: since 2008, when the documentary The business of being born was aired in the USA many women were “converted” to fanatic home birth supporters. This documentary follows a New York midwife who delivers babies at home, while it “uncovers” -what they consider- the major business childbirth has become for doctors and hospitals. In the UK, the series Call the midwife, with its empathetic view of midwives have experts hoping that “it will spark a resurgence in home births…as women see the holistic care that midwives can deliver”.

home-birth-business-of-being-bornAnd all this “campaign” seems to have worked! Home births have seen a considerable increase in many countries, including the USA, Canada, UK and Australia.

So why the fuss about giving birth at home? Why do women want to deliver like in the 1900s? The answer to these questions is not straightforward…

While reviewing the bibliography on home birth, I realized how massive the amount of information on this subject is, both in scientific and lay sites, and how contradictory it becomes sometimes…

If you are considering home birth, check out this article where I analyze the reasons women choose to have their child at home. In order to simplify reading, I divided it in three parts; read all three so that you can make your responsible and educated choice.

1) “A delivery at home is a wonderful experience”

                          Satisfaction is home birth’s raison d’être

There is no doubt that birth is a unique, life-changing experience for every woman, and no one can deny the importance of the emotional and psychological aspects of a bringing a child to the world. As mentioned earlier, the reasons women choose a home birth are many: some women feel that the privacy of their home will make them feel more comfortable, less stressed out, and with more control of their own labor. Others find that being surrounded by friends, relatives, or their older children is of utmost importance. Finally, many woman choose home birth out of curiosity, as they have heard so many stories about amazing, empowering, ecstatic, or even “orgasmic” home births. Actually, personal satisfaction seems to be the main reason women want to deliver at home.

home-birth-transfer-primiparousBut is home birth always this pleasurable, fantastic experience women expect?  Unfortunately, this is not always the case. According to Birthplace, a recent British study, a high percentage of women will need a hospital transfer: up to 45% of first-time mums (nulliparous) and 13% of second and subsequent time mothers (multiparous) were transferred to a hospital. Similar figures are reported in the Netherlands, a country with a long tradition of home birth: 49% of primiparous and 17% of multiparous women are transported during labor. Most of the times, transfer to a hospital is not a great experience for the couple, as their expectations for a home birth are not fulfilled; this has been uniformly demonstrated by several studies from different countries (such as Sweden, Netherlands and Belgium). Moreover, a Dutch study evaluating women’s views of their birth experience 3 years after the event revealed persistent levels of frustration, including serious psychologic problems, in transported women compared with those who delivered at a hospital.

home-birth-transfer-multiparous

There is another fact we should not ignore: labor is inherently painful. Even though at home women may be more comfortable and this may result in less pain, sometimes it may be impossible to cope with pain and an epidural may be necessary. Pain relief is actually one of the most common reasons for transport to the hospital, since pain can become overwhelming, In fact, a recent study showed that inability to control labor pain may increase the risk of developing postpartum depression.

2) “Home births are safe for the mother”

home-birth-painfulHome births result in less interventions, including pain relief…

Besides personal satisfaction, another common reason women choose home birth is because it’s less invasive. The dreadful “cascade of events“, that is, one intervention leading to another during a hospital birth fills with terror most home birth supporters. Indeed, almost every study shows that home births are associated with less interventions as compared to hospital births. The term “interventions” includes: epidural anesthesia, ventouse or forceps delivery, cesarean section and episiotomy (see also here, here and here).

Another controversial intervention that has gained a bad reputation among home birth supporters is continuous fetal monitoring, as they think that it is not needed, it gets in the way of the natural birthing process and it increases interventions such as cesarean section and forceps delivery. But what is the scientific evidence on this subject? According to a Cochrane review, the use of fetal monitoring increases the cesarean delivery rate, vacuum and forceps operative vaginal delivery; in addition, fetal monitoring does not seem to reduce perinatal mortality, neither cerebral palsy risk; however, it reduces by 50% the risk of neonatal seizures, that is, of brain damage.

home-birth-helpBut while some women may experience fetal monitoring, episiotomy or vacuum delivery as a traumatic experience, others may not get particularly bothered by an episiotomy -and many will feel blessed by the epidural “intervention”. So maybe a more important question is: What about severe maternal complications and maternal deaths? In regard to this matter, there is not much information, and the studies’ conclusions are contradictory. A Dutch study  looked at “severe acute maternal morbidity” (such as admission to intensive care unit, uterine rupture, blood transfusion, etc) and found that women who delivered their first baby at home had the same risk with women delivering at a hospital, but parous women had increased risk of postpartum hemorrhage and blood transfusion when delivering at a hospital; however, another study, also from the Netherlands, did not confirm these findings. Therefore, a hospital birth leads to more interventions, but it does not seem to increase the risk of serious maternal complications. Regarding maternal deaths, they are a rare event; thus it is not possible to draw conclusions from the studies.

There is something that every woman considering home birth should understand: the studies results apply only to very low-risk pregnancies. Higher risk women, such as those with twin pregnancies, previous cesarean sections, prematures, post term pregnancies, were excluded from most studies, although it is no secret that they are also having home births (it’s easy to realize it just by checking the social media…). It is certain that for these women the risks is much higher, not only for them, but also for their babies.

3) Home births are safe for the baby

A healthy baby and a healthy mother are supposed to be a birth’s ultimate goal…

Studies analyzing the baby’s risk yield completely different results according to the country they were done, but they also differ in different areas of the same country, or according to the scientist analyzing the data! In here, I mention the most important studies evaluating neonatal risk by country of origin:

home-birth-canada-babyCanada: A recent study showed that planned home birth was not associated with a difference in serious adverse neonatal outcomes as compared to hospital births (Hutton et al, 2016). This study was limited to the Ontario area, had very strict inclusion criteria and high transport rates (see below).

home-birth-dutch-pregnantThe Netherlands: The Netherlands are usually considered the “gold standard” due to their long tradition in home births. In 2009, de Jonge  showed that home birth does not increase the risk of perinatal mortality and severe perinatal morbidity among low-risk women. However, some aspects of this paper may have underestimated the risk (e.g.,  paediatric data on intensive care admissions was missing for 50% of non-teaching hospitals, among others). In fact, a subsequent Dutch study showed that infants of pregnant woman at low risk under the supervision of a midwife had 2,3 times higher risk of perinatal death than infants of pregnant women at high risk  under the supervision of an obstetrician. Moreover, infants of women who were referred by a midwife to an obstetrician during labor had a 3,66 times higher risk of delivery related perinatal death than women who started labor supervised by an obstetrician (See below for more details on home births in the Netherlands).

home-birth-british-babyEngland: A 2011 large study, the Birthplace study showed that, for low-risk women,  home birth had 60% higher chances of “baby events”. The events included death (13%), neonatal encephalopathy (brain damage due to lack of oxygen, 46%), meconium aspiration syndrome (the baby swallows stools, a sign of suffering, 30%), brachial plexus injury (damage of the nerves of the arm, 8%), fractured humerus or clavicle (4%); if the analysis was restricted only to nulliparous women, this risk was almost 3 times higher. For multiparous women (2 or more children), there were no significant differences in the incidence of adverse outcome by planned place of birth.

home-birth-australian-babyAustralia: in a paper by Kennare et al, although there were no differences in perinatal mortality, home birth was associated with 7-times higher risk of intrapartum death, and 27-times higher risk of death from intrapartum asphyxia (lack of oxygen). Interesting enough, one of the authors (Dr. Keirse) was the chairperson of the working party that developed the Policy for Planned Birth at Home in South Australia.

home-birth-american-babyUSA: The largest American study comparing home and hospital births was published in 2013, including data on more than 13 million births. This study indicated that babies born at home are 10 times more likely to be born dead and have almost 4 times higher risk to have neonatal seizures or serious neurological dysfunction (that is, brain damage) when compared to babies born in hospitals. Moreover, the risk of stillbirth in women delivering their first baby at home was 14 times the risk of hospital births. Dr. Grunebaum, one of the authors, explains that most likely the risks are even higher than that: “… the outcomes for patients whose care began out of the hospital but were then transferred to the hospital due to complications are reported as hospital deliveries. If the data were corrected, the risk of out-of-hospital delivery is likely to be much greater.” Another American study confirmed these findings, which, contrary to the British study, showed that the neonatal outcome was worse both for nulliparous and multiparous delivering at home.

home-birth-international-babyPooled data from USA, Australia, Switzerland, Netherlands, Sweden, Canada & UK: A study by Wax et al. showed that home births are associated with a risk of neonatal death three times higher as compared to hospital births. The results of this study led the reputed medical journal The Lancet to write an editorial stating “Home birth: proceed with caution”. Wax’s study though was highly criticized on methodological grounds.

Why such a disparity in the results of the different studies?

There are many possible explanations:

  • The lack of randomized trials, as it is not possible to force women to deliver at home or at a hospital against their will. It is clear from different studies that women delivering at home are different from those delivering at hospitals (usually home birthers are more educated and come from a more socioeconomically advantaged area); populations may also differ from country to country.
  • Underreport. In many home births studies there are missing data; in others home births that were transferred to hospitals are included in the hospital group.
  • Midwives’ training. In most European countries and Canada, home births are attended only by midwives or physicians; midwives have a university degree and undergo intensive training. In most states of the United States, besides certified nurse midwives (with formation equivalent to European midwives), births are also attended by “direct-entry midwives” with no university degree and diverse training; the only requirement for them to practice is a high school degree.home-birth-all-babies
  • Eligibility criteria for a home birth. Studies with good outcome had very strict inclusion criteria for home birth, that is, they excluded women with twin pregnancies, preterm labor, preeclampsia, etc.
  • Transport rates. Best outcome was associated with a very high transportation rate: about 40-50% for nulliparous, 10-20% for multiparous. On the contrary, the US studies -with more adverse results- report overall transportation rates of about 10%.
  • Efficiency of transport system, midwives’ integration to hospitals. Rapid availability of ambulances -such as the so-called Obstetric flying squad in the UK- and hospitals in tight collaboration with midwives working in the community seem to be essential. But even so, some complications may not be solved, even by the most efficient form of transport.
  • Distance to the hospital. Although shorter distance to hospital seems to be crucial, even this may not prevent certain complications. Hospitals have what is called the “decision to incision” rule, that is, the maximum time that should pass between the decision to make an emergency cesarean section and the time it is actually done. This rule is 20 or 30 minutes, according to different countries. It is clear that this time frame cannot be achieved with home birth, not even with close distance to a hospital.

 

Read the second part here:  Home birth: smart choice or risky business? (Part 2)

Photo Credits:

Intro: Flickr.comPinterest.comWikipedia.org; 1) Gettyimages.comwhich.co.ukwhich.co.uk; 2) booshparrot.com, herb.co; 3) Flickr.commoveoneinc.com, Pinterest.com, sheknows.com, blogqpot.combabynames.allparenting.com,  mercatornet.comlaineygossip.com

PREGNANCY SYMPTOMS: WHAT TO EXPECT THE SECOND TRIMESTER

You just made it through the first trimester of your pregnancy! Congratulations!

The second trimester – which lasts from the beginning of week 14 through the end of week 27- is for most women, the easiest of all three: the annoying symptoms of the first trimester usually disappear and you feel full of energy again! In addition, you will be less heavy, tired and anxious than during the third trimester…

The fact that you feel better doesn’t mean that nothing is going on! Your baby grows very fast during this period, and your body is working incessantly; thus you will notice many changes…

From all the symptoms you had during the first trimester (see here), many will disappear, other persist and some new will show up.

These symptoms usually disappear or ease during the second trimester:

  • 2nd trimester B&Wnausea and vomits,
  • food aversions,
  • heartburn,
  • frequent urination,
  • acne.

These are symptoms that may persist:

  • dizziness,
  • bleeding of gums and nose,
  • stuffy nose,
  • vaginal discharge,
  • headache,
  • constipation,
  • food cravings.

In this article we will focus on the symptoms that make their appearance during the second trimester, or that are somewhat different now. Here is what you can expect:

1) Backache

While back pain during the first trimester is mostly related to mild uterine cramping, as pregnancy progresses it’s caused by weight gain and  the shift of your center of gravity as a result of the growing uterus. Thus, you gradually adjust your posture, which results in back pain or strain.

What can you do about it:

  • avoid standing up for long periods of time,
  • sit up straight; use a chair with good back support,
  • sleep on your side; a pillow tucked between your legs may help,
  • avoid carrying anything heavy,
  • wear comfortable, low-heeled shoes with good arch support (read more here),
  • a heating pad may provide some relief,
  • if you feel really uncomfortable you may have a pregnancy massage.

If these measures don’t work or if the pain is strong, call your doctor, who can prescribe you a pain medication suitable for pregnancy.

2) Breast enlargement

2nd trimester breastsWhile the tenderness and swelling you experienced during the first trimester usually wear off by now, your breast will keep growing in preparation for breastfeeding. You may occasionally have some leakage of milk.

What can you do about it:

  • wear a support bra; most likely you will need a bigger size,
  • avoid lacy or wired bras.

3) Emotional changes

2nd trimester emotional prenatal yogaAs pregnancy progresses your body changes, so do your emotions! Your hormones certainly play a role, but it’s not only that: there is so much going on! So it’s natural to be worried or anxious at times, or to have mood swings (see here).

You will most likely feel less tired and with more energy than before, so enjoy your pregnancy! Start preparing yourself for the coming of your baby, you can learn more about labor and delivery. Focus on healthy lifestyle regarding nutrition (read here) and physical activity (here). This may be also a good time to indulge yourself with a trip, or some vacations! (see here).

Some women experience increased sexual desire during this period of pregnancy (more info here); others may feel unattractive as the womb grows. Spoil yourself with some beauty treatments! (read more here).

Although mood swings are an inextricable part of pregnancy, keep in mind that if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life you must discuss it with your doctor.

4) Hair changes

2nd trimester hairHormonal changes during pregnancy favour hair growth. This may be great for the hair on your head, which usually becomes thicker, but not so great for hair growing on your face, arms or back!

What can you do about it: 

  • Shaving, tweezing and waxing are safe options, although not always easy to implement as your belly grows!
  • Regarding laser, electrolysis and depilatory creams the experts’ opinions are divided (read more here).

You may discuss with your doctor which is the best technique for you.

5) Hemorrhoids

2nd trimester hemorrhoidsMost women will feel, at some point in their pregnancy, some soft lumps around the anus. In fact, hemorrhoids are swollen veins, which enlarge in pregnancy due to the increased pressure exerted by the growing uterus.

Although sometimes hemorrhoids are asymptomatic, the can be itchy, or painful; they may eventually bleed.

What can you do about it:

  • avoid constipation – they will get worse,
  • you may try a sitz bath (that is, you sit in warm water),
  • if they are too uncomfortable, you may ask your doctor about a hemorrhoid ointment.

6) Leg cramps

2nd trimester leg crampsPainful leg muscle contractions typically affect the calf, foot or both; they are common during pregnancy, and usually occur at night.

The exact cause of leg cramps isn’t clear; possible reasons include pregnancy hormones, compression of the legs’ blood vessels, and calcium or magnesium deficiency.

What can you do about it:

  • regular physical activity might help prevent leg cramps; stretch your calf muscles before bedtime,
  • stay hydrated,
  • choose comfortable footwear with good support,
  • a hot shower, warm bath, ice or muscle massage can all help,
  • eat magnesium-rich foods, such as whole grains, beans, dried fruits, nuts and seeds.

Discuss with your doctor whether it’s OK for you to take a magnesium or calcium supplement.

7) Restless leg syndrome (RLS)

2nd trimester restless legIf you are among the 20% of pregnant women who suffer from this condition, you may have felt an itchy, pulling, burning or creepy-crawly sensation which causes an overwhelming urge to move your legs.

RLS usually strikes at night, when you are lying down or sitting for prolonged time periods; it may also affect the arms. Once you move your legs or arms, the feeling subsides; the problem is that, by then, the movement has already woken you up, making you feel tired and cranky during the day…

The cause of RLS is unknown, but in some women it may be triggered by a deficiency of iron or folic acid.

What can you do about it:

Be patient! RLS goes away right after birth… If your RLS is not that severe, simple lifestyle changes may help:

  • avoid drinking beverages with caffeine (coffee, soda, etc), particularly during the afternoon or evening,
  • don’t exercise close to bedtime (exercising can wind you up),
  • establish a sleep routine: go to bed and wake up at the same time every day,
  • relax before bedtime: take a warm bath, read a book…

When you wake up with RLS:

  • massage your  legs,
  • apply warm or cold compresses to your leg muscles,
  • get up and walk or stretch your legs,
  • a vibrating pad placed under the legs (Relaxis) seems to help some women.

The treatment of severe RLS is challenging during pregnancy, as medications used for its treatment are possibly dangerous for the baby.

  • You may ask your doctor to check your iron levels, if they are low you can take an iron supplement.
  • If RLS makes you feel miserable, discuss with your doctor the possibility of a medical treatment (opioids); this would be the last resort as opioids can cause withdrawal symptoms in the baby.

8) Round ligament pain 

2nd trimester round ligament painAs the womb grows, the ligaments that support it start stretching, making them more likely to become strained.

Round ligament pain is one of the most common complaints during pregnancy. Sudden movements can cause the ligaments to tighten quickly, which provokes a quick jabbing feeling, often felt in the lower belly or groin area on one or both sides, most commonly on the right side. Generally the pain is triggered by exercise, sneezing, coughing, laughing, rolling over in bed or standing up too quickly, and lasts only a few seconds or minutes.

What can you do about it:

  • avoid sudden movements,
  • flex your hips before you cough, sneeze, or laugh,
  • mild exercise will help you strengthen your abdominal muscles,
  • stretching exercises and yoga can be helpful,
  • a heating pad or a warm bath may ease pain,
  • you may take a painkiller such as acetaminophen.

Round ligament pain usually doesn’t last long. If you have severe pain that lasts more that a few minutes, or if it is accompanied by fever, burning with urination, or difficulty walking you should call your doctor right away.

9) Skin changes

2nd trimester skin changes woman with hatPregnancy hormones and your growing uterus are responsible for numerous skin changes that you will start noticing from now on. Here are the most common:

Pregnancy glow: pregnant women often look as though they are “glowing” because hormones increase the skin oil production and vascularisation, thus your face may appear flushed and shiny.

Mask of pregnancy: also called chloasma;  an increase in the pigment melanin leads to brown marks on the face.

Linea nigra: related as well to increased melanin, it’s a dark line down the middle of the abdomen.

These skin changes should fade after the baby is born. In the meantime, you can use makeup to conceal them.

Keep in mind that your skin is more sensitive to the sun right now, so make sure to wear a high-protection sunscreen;  limit also your time in the sun, especially between 10 am and 4 pm; a hat and sunglasses will provide extra protection.

Itchy skin: as your skin stretches due to your growing belly -and weight gain- it may feel itchy and dry, especially around your womb and breasts2nd trimester skin changes.

To relieve it, moisturize often with mild skin care products; do not take hot showers and baths, which will dry out even more your skin. Also, avoid synthetic clothing which may irritate your skin.

Inform your doctor if your itching is unbearable, she/he can recommend you a medication adequate for pregnancy, and eventually rule out certain rare conditions which may be dangerous for you or your baby (though they usually appear during the third trimester).

Stretch marks: as with itching, stretch marks are the result of your skin expanding. Starting now, you may notice red or purple lines on your abdomen, breasts or thighs.

Watch your weight gain! The more weight you gain, the more likely to get stretch marks. Many creams and lotions are available to prevent them, although their efficacy is not backed up by much scientific evidence… In any case, most stretch marks will fade on their own after delivery.

10) Sleep problems

2nd trimester sleep problemsWhile everybody tells you to rest now to get prepared for the sleepless nights ahead once the baby is born, sleeping in pregnancy is not easy! A recent study showed that 3 out of 4 women! experience poor sleep quality: from all women included in the study, all of them reported frequent awakening, mostly due to frequent urination and difficulty finding a comfortable sleep position; insomnia, breathing problems (snoring and sleep apnea) and restless leg syndrome (see above) were also common complaints.

And let’s not forget heartburn, leg cramps, stuffy nose, eventually vivid dreams or nightmares…

What can you do about it:

  • avoid caffeine in the afternoon or evening,
  • stay away from sugar at night,
  • don’t drink too much right before bedtime to avoid frequent visits to the toilet,
  • work out, but only until early evening, as exercise can be energizing,
  • have a light snack before bedtime to prevent “hunger attacks” at night,
  • a glass of warm milk before sleeping may help,
  • take a warm bath just before bed,
  • keep your room cool; research has shown that is useful for better sleep,
  • a massage before sleeping can soothe you, as well as relaxation exercises, deep breathing, meditation, yoga, etc,
  • making love can also help!

You should mention any sleep problems to your doctor, who might be able to suggest more tips or eventually prescribe you medications that are safe during pregnancy.

11) Spider and varicose veins 

2nd trimester spider and varicose veinsYour blood circulation increases to send more blood to your baby; this can cause tiny red veins known as spider veins. Pressure on your legs from the growing uterus can result in swelling of your legs’ veins, which become blue or purple; these are called varicose veins.

What can you do about it:

Spider veins usually fade once your baby is born.

Varicose veins should improve within three months after you deliver. In the meantime, you may prevent them from getting worse:

  • avoid standing up for long periods of time,
  • get up often, move throughout the day,
  • keep your legs elevated (prop them on a stool) whenever you have to sit for a long time,
  • wear support hose.

12) Swelling of the ankles and feet

2nd trimester swollen legsA very common symptom, is experienced by about three in four pregnant women, starting at about week 22 of pregnancy and lasting until delivery.

What can you do about it:

  • try to keep active,
  • avoid long periods of standing or sitting,
  • if you can’t avoid sitting or standing for a long time, move regularly your feet, or
  • keep your legs elevated while sitting,
  • support hose can help.

What else to expect

Quickening”, baby movements

At about 20 weeks you will probably start feeling the first flutters of movement in your belly, which is often called quickening. Quickening may be first felt as early as week 15, but usually around weeks 18 to 22. A multipara (that is, a woman who has been pregnant before) usually feels the baby earlier. Some women won’t experience quickening until week 26, so don’t worry!

Keep in mind that babies, like the rest of us, are all different: while some are very active, others are more calm; activity also varies among different days and within the same day.

Weight gain

2nd trimester what elseYour appetite should be back during the second trimester, once nausea and vomits have diminished or gone away. Since now you will feel hungrier, be aware of how much you’re eating! You only need about an extra 300 to 500 calories a day during the second trimester, and you should be gaining about 1,4 -1,8 kilograms a month until delivery. However, if you were overweight before pregnancy, your doctor may recommend gaining less weight.

Discuss with your health care provider what’s best in your case in order to manage your weight throughout pregnancy.

Braxton Hicks contractions

During the second trimester, your uterus may start contracting. These contractions, called Braxton Hicks, should be weak and come and go unpredictably.

If contractions become painful or regular, they could be a sign of preterm labor, so you should inform your doctor.

When to worry

2nd trimester warningAny of these symptoms could be a sign that something is wrong with your pregnancy. Call your doctor right away if you experience:

  • Severe abdominal pain or cramping
  • Bleeding
  • Severe dizziness or fainting
  • Rapid weight gain or intense swelling
  • Fever (unrelated to a cold)
  • Watery vaginal discharge
  • Abundant green, yellow, foul-smelling discharge.

 

References

  • NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
  • HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

Photo credits

Intro: Getty images, businessinsider.com; 1) simplebackpain.com; 2) pinterest.com; 3) kentuckianamommies.com; 4) drdina.ca; 5) hemorrhoidexpert.org; 6) newkidscenter.com; 7) babygaga.com; 8) viphealthandfitness.com; 9) woolworthsbabyandtoddlerclub.com.au, beautysouthafrica.com; 10) thebabychecklist.com; 11) pinterest.com; 12) pinterest.com; What else: popsugar.com; When to worry: earlypregnancy.net.

PREGNANCY SYMPTOMS: WHAT TO EXPECT THE FIRST TRIMESTER

Pregnancy usually comes with a lot of joy… but sometimes it can be pretty overwhelming! Especially the first trimester, when your body starts changing. These changes are not the same for all women, though: while some women feel great and full of energy, others feel completely miserable…

Food cravings, nausea, mood swings… You have most likely heard about these pregnancy symptoms, but… what is normal? What to do about them? When to call your doctor?

In this article you will find a list of 16 common symptoms you may experience during the first trimester of pregnancy (weeks 0 to 13), you will learn why they happen, what you can do about them, and when to call your doctor -or midwife.

1) Abdominal cramping and backache

Pregnancy symptoms back painWhy it happens: one of the earliest pregnancy symptoms, this slight cramping confuses many women who believe they’re about to have their period. Abdominal and back pain are caused by normal, mild uterine contractions related to the increasing pregnancy hormones.

What can you do about it: nothing, unless pain gets intense or comes with vaginal bleeding.

When to call your doctor: if you experience strong pain, or if you have pain and bleeding, in order to rule out certain pregnancy complications (see vaginal bleeding) or other conditions unrelated to pregnancy.

2) Acne

Pregnancy symptoms acneWhy it happens: this is a very common symptom -pimples appear in about 50% of women- and sometimes can be quite intense. The β-HCG hormone (beta – human chorionic gonadotrophin), which raises from the beginning of pregnancy has androgenic effect (mimics male hormones), leading to increased skin oil production and the appearance of acne.

What can you do about it: most of medications used to treat acne are not allowed throughout pregnancy -isotretinoin, one of the most effective acne medications is also one of the most dangerous during pregnancy. Be patient! pregnancy acne will resolve after childbirth.

In the meantime, just get some good medication-free skin care:

  • wash your face and body with a gentle cleanser, alcohol and oil-free,
  • avoid over-cleansing as it may have the opposite effect,
  • shampoo regularly and avoid oily hair mousse,
  • do not pop your pimples, since it may cause permanent scarring.

When to call your doctor: If your acne is severe, you may consult a dermatologist to get the most adequate care for your skin type.

3) Bloating and constipation

Pregnancy symptoms constipationWhy it happens: during pregnancy a hormone called progesterone relaxes the bowels wall and slows down their activity in order to allow the absorption of more nutrients to feed your growing baby. The downside: you may feel bloated, gassy and get frequently constipated.

What can you do about it: 

  • increase your fiber intake,
  • avoid foods that cause bloating (beans, cauliflower, etc),
  • drink plenty of fluids,
  • engage in physical activity.

When to call your doctor: if constipation really bothers you, ask your doctor for a laxative or stool softener that is safe for pregnancy.

4) Breast swelling and tenderness

Pregnancy symptoms breast pain 2Why it happens: your breasts, under the influence of the high hormones, start getting ready for breastfeeding, thus they engorge and receive more blood supply; this will cause tenderness and swelling.

What can you do about it:

  • wear a support bra (you may need to get a bigger size),
  • avoid lacy or wired bras.

When to call your doctor: if you get severe breast pain or redness, or if you palpate any lump.

5) Dizziness and fainting 

Pregnancy symptoms dizzinessWhy it happens: your blood vessels dilate to increase blood supply to the womb and to your baby, leading to a drop in blood pressure, which can make you feel dizzy, lightheaded, or even faint. Dizziness can also be due to low blood sugar, especially if you are not eating adequately.

What can you do about it:

  • avoid prolonged standing,
  • rise slowly when you get up from sitting or lying down,
  • be especially careful if you drive or execute activities that require special concentration,
  • eat healthy, frequent meals (every two to three hours),
  • drink plenty of fluids to raise your blood pressure.

When to call your doctor: if your experience intense dizziness, especially if you have bleeding or intense abdominal pain, to rule out a miscarriage or an ectopic pregnancy (see vaginal bleeding).

6) Fatigue and sleepiness

Pregnancy symptoms fatigueWhy it happens: from early pregnancy, your body has some extra work to do! Your metabolism increases and you start preparing the placenta; these changes together with the high progesterone levels are responsible for this constant feeling of drowsiness and intense fatigue. Your body reminds you that you should get some rest, so you will be stronger to carry your baby!

What can you do about it:

  • take naps and rest when possible,
  • eat healthy,
  • drink plenty of fluids,
  • avoid standing up for long periods of time.

When to call your doctor: if you feel that your drowsiness affects your daily activities, inform your doctor who can rule out other possible causes of fatigue such as anemia. If you have intense sleepiness together with negative feelings, hopelessness or sadness, inform your doctor to rule out depression.

7) Food cravings, food aversions

Pregnancy symptoms cravingWhy it happens: the sudden hormonal increase changes your food tastes; therefore, you may get food cravings -a sudden and intense urge to eat something in particular, which may eventually be quite unusual- or food aversion -repulsion for certain foods, even with the thought of them.

It is believed that during pregnancy our body asks for what it needs -hence cravings- and makes us reject things we don’t need or may be harmful, such as aversion to cigarette in smokers (unfortunately, this is not always the case).

What can you do about it:

Cravings:

  • Go ahead and indulge yourself with what you crave, provided that you generally follow a balanced and healthy diet,
  • when you crave for unhealthy foods, try to avoid excess: eat one scoop of ice cream, not the whole 1-kilo carton!
  • if cravings are too frequent, try to do activities to distract yourself so that you don’t think about food all the time: go for a walk, talk to a friend, read a book, go to the movies…

Aversions:

  • Most food aversions will go away after the first trimester, so most likely you will be able to eat meat or drink milk again thereafter,
  • if you keep having aversion to certain foods, try to find healthy substitutes for what you can’t tolerate, e.g., have calcium-fortified cereals if you can’t drink milk.

When to call your doctor: If you crave for clay, ashes or dirt -a condition called pica– as this can be really dangerous for you and your baby; if your food aversions are too intense and followed by frequent vomiting (see Nausea and vomiting).

8) Frequent urination

Pregnancy symptoms frequent urinationWhy it happens: you may notice from very early in pregnancy that you need to pee more often. As your body blood flow increases with pregnancy, more blood goes to the kidneys in order to flush more waste products out of your body; this leads to increased urine production. Urination is more frequent during the night because the fluid you had retained in your legs during the day will get reabsorbed when you lie down. In addition, as the uterus grows it starts putting pressure on the bladder.

What can you do about it:

  • don’t hold you urine, as this can predispose you to urinary infections,
  • avoid too much caffeine (coffee, tea, cola drinks) since they have diuretic effect,
  • don’t drink too much before going to bed.

When to call your doctor: If, besides frequent urination, you feel burning or pain when you pee, or you see blood when wiping: these can be signs of a urinary tract infection.

9) Headaches

Pregnancy symptoms headacheWhy it happens: headaches occur frequently early in pregnancy mostly due to the increased hormone levels; but low blood pressure, low sugar, anemia or dehydration can all worsen headaches. Women who had migraines before getting pregnant may experience worsening in the first trimester, but usually improvement as the pregnancy progresses.

What can you do about it:

  • drink plenty of fluids,
  • eat frequent meals,
  • get some rest when possible.

When to call your doctor: If headaches persist, check with your doctor whether you can take acetaminophen (Tylenol), which is usually allowed throughout pregnancy. Contact you doctor if your headaches are too intense, do not subside with Tylenol or are accompanied by visual disturbances or other symptoms.

10) Heartburn, heavy stomach

Pregnancy symptoms heartburn 2Why it happens: Again, progesterone is responsible for relaxing the sphincter (ring of muscle) that separates the stomach from the esophagus; this leads to acid reflux.

What can you do about it:

  • eat small, frequent meals, don’t eat too much before going to bed,
  • avoid too spicy, greasy, acidic or sweet foods,
  • don’t lie flat, sleep with two or more pillows to have your head at a higher level than your body.

When to call your doctor: if you can’t cope with heartburn, ask your doctor to prescribe you an antiacid medication that is safe for pregnancy.

11) Mood swings

Pregnancy symptoms mood swingsWhy it happens: mostly because of your hormones, but eventually increased by your dizziness, nausea or other pregnancy symptoms, you may feel at times irritated or depressed, anxious or out of energy, overjoyed or panicked! Is not only hormones,  though. Pregnancy will bring major changes to your life, so it’s natural to worry about many things: whether your will make it through labor and delivery, if you baby will be fine, whether you will be a good mother, if the relationship with your partner will be affected, etc, etc… Most women will also become more forgetful; while this is normal, it may be quite frustrating…

What can you do about it:

  • talk about it, find someone who can listen to you: your partner, a family member, a friend, or other mums-to-be,
  • ask for understanding and support, not only psychological but also physical: if you can’t do certain activities at work or a home, let someone help you,
  • get some rest: you may feel worse if you are tired or sleep-deprived,
  • engage in activities that calm you down and relax you; mild exercise can also help.

When to call your doctor: if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life; in these situations you may need professional help.

12) Nausea and vomits

Pregnancy symptoms nauseaWhy it happens: nausea is one of the commonest pregnancy symptoms (occurs in about 85% of pregnancies). It is not fully understood why it happens, but it seems to be related to β-HCG levels: the higher levels, the more nauseous you may feel (e.g., women carrying twins).

Nausea and vomits usually start around the 6th week of pregnancy and persist until week 13, although they may last up to the 16th – 20th week, or more rarely beyond 20 weeks. They can be of variable intensity, for some women very mild, for others very severe, leading to continuous vomiting. Nausea may be more intense during the morning -that’s why it’s called morning sickness– although this is not always the case.

What can you do about it:

  • nausea gets worse when you have empty stomach, therefore, have frequent and small meals,
  • foods with high starch content may relieve nausea (crackers, potatoes, rice, pasta), but each woman find which foods can tolerate and which not,
  • avoid food with strong smell or taste,
  • ginger can help (either raw ginger, ginger ale or ginger pills),
  • accupressure, motion sickness wristbands and vitamin B6 can also be effective,
  • stress and tiredness can worsen nausea, therefore try to get plenty of rest,
  • keep drinking to avoid dehydration, but drink small amounts of fluids at a time, since large amounts can make nausea worse.

When to call your doctor: if nausea doesn’t allow you to eat or drink anything, or if you can’t stop vomiting, your doctor can prescribe you certain medications that may be helpful. Sometimes intense vomiting may lead to dehydration, a condition called hyperemesis gravidarum, which requires admission to a hospital for rehydration and intravenous treatment.

13) Nosebleed, stuffy nose, gum bleeding

Pregnancy symptoms stuffy noseWhy it happens: blood flow increases in pregnancy, and your gums and nasal lining are very fragile and bleed easily. Gums may bleed when you brush your teeth. Nosebleeds may appear when you blow your nose; you may also notice that your nose gets more easily congested, also as a result of the increased blow flow to the nose’s mucous membranes.

What can you do about it:

  • keep seeing regularly your dentist to rule out certain gums problems, which are common in pregnancy and may increase bleeding,
  • switch to a softer toothbrush,
  • to stop nose bleeding pinching your nose for a few minutes should help,
  • for your nose congestion you may use a humidifier, or try a saline nasal spray,
  • don’t use nose spays or other decongestants without checking with your doctor.

When to call your doctor: if your gum or nose bleeding are heavy or too frequent. If your nose congestion gets too intense and you can’t breathe.

14) Smell intolerance, increased sense of smell

Pregnancy symptoms smellsWhy it happens: many women won’t stand certain strong smells, either from food, cosmetics or others sources, triggering nausea or vomits. This sensitivity to smells is hormone-related; it is said that nature prepares you to “sense” dangerous threats in order to protect your baby.

What can you do about it:

  • avoid foods with intense smell,
  • you may need to stop cooking for a while -if possible,
  • don’t use scented cosmetics if the smell bothers you; this is also true for laundry soap, softeners, air fresheners, etc.

When to call your doctor: in case your smell intolerance leads you to intense vomiting (see Nausea and vomits).

15) Vaginal bleeding

Pregnancy symptoms vaginal bleeding 2Why it happens: Bleeding during the first trimester is extremely common (it happens in about 25% of pregnancies) and is usually of no concern. A slight bleeding may be due to the implantation of the embryo in the uterus; sometimes a small detachment of the sac from the uterine cavity -or subchorionic bleeding- may be the reason; an inflammation of the cervix may occasionally cause slight bleeding (mainly with intercourse). Sometimes though, bleeding can be worrisome, i.e., when related to threatened miscarriage or ectopic pregnancy (a pregnancy outside the uterus).

What can you do about it:

  • keep track of the amount and characteristics of the blood,
  • don’t have intercourse, don’t use tampons,
  • according to the cause of the bleeding, you may be asked to get some bedrest, and refrain from heavy work or heavy lifting.

When to call your doctor: If you see blood, you should inform your doctor, even if you have light bleeding, as it may not be always easy to understand when bleeding is to worry about. But you should call your doctor right away (or go to the emergency room) if you have heavy bleeding, cramps (like intense period pain), or sharp pain in your abdomen, as these can be signs of miscarriage or ectopic pregnancy.

16) Vaginal discharge

Pregnancy symptoms vaginal discarge 2Why it happens: Your high hormones are responsible for an increase in vaginal discharge, that should be white or clear, and thin.

What can you do about it:

  • you can wear panty liners, but you should not wear tampons,
  • prefer cotton underwear,
  • avoid string or thong underwear that may cause intense rubbing, which together with the increased discharge can favor yeast or other infections.

When to call your doctor: if you have discharge that is yellow, green or foul-smelling, or if you have intense itching or burning.

 

Stay tuned! More posts with symptoms to expect during the second and third trimester of pregnancy will follow…

 

References

  • NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
  • HAS: Comment mieux informer les femmes enceintes? Avril 2005, France
  • American College of Obstetrician and Gynecologists: Nausea and vomits, Vaginal bleeding

Photo credits

Cover: Getty images; 1) dornascostasnuncamais.com.br; 2) babycenter.com; 3) adriseaplanes.eu; 4) thealphaparent.com; 5) pregnancymagazine.com; 6) womenshealthcaretopics.com; 7) motherandbaby.co.uk; 8) ladycarehealth.com; 9) momjunction.com; 10) ladycarehealth.com; 11) fitbottomedmamas.com; 12) not-equal.eu; 13) womenshealthcaretopics.com; 14) health-and-parenting.com; 15) zliving.com; 16) privatepregnancy.co.uk

MY NATURAL HOSPITAL BIRTH STORY

Wonderful. Empowering. Overwhelming. It is difficult to find a word to describe the experience of a vaginal birth. As a mother -who went through this experience-  and obstetrician, even after having delivered thousands of babies, I can’t help but admire every single time the beauty of a vaginal birth, it always feels to me like a perfectly designed choreography…

But the fact that something is natural doesn’t mean that is devoid of risks or complications. Thus, a hospital natural birth allows a woman to deliver with minimum intervention, while assuring peace of mind in case something goes wrong. And believe me, sometimes things DO go wrong, and then we may have just a few minutes to save the mother or the baby… 
True, hospitals can sometimes interfere with the process of a natural birth: measures such as fetal monitoring or the IV line are usually non-negotiable requirements for a hospital birth, but they can be invaluable, even life-saving in case an emergency ensues.
A natural, unmedicated hospital birth IS possible, it’s just a matter of having a motivated mom and a supportive team…
Here, KM shares her experience of a natural birth at a hospital and provides some tips to overcome the obstacles that may present in the process…

Natural Birth KM 2 resized

My Natural Hospital Birth: Overcoming obstacles to get to the birth I had

“I gave birth without pain relief and I consider my fifteen hours of labour as some of my best. My husband turned ace birth partner – a nice surprise, and a lucky one considering we opted not to hire a midwife or doula. We swayed to Don Carlos’s Rivers of Babylon and Simon and Garfunkel’s I am a Rock, among other soothing tunes in our Labour Chill Mix; moo-ed like cows; and got tennis balls rolling on my back. The first ten hours at home and en route to the hospital felt like a date: laughter, teamwork, watermelon juice (it was August, we live in Greece)… and some manageable pain thrown in to rally against together.

Natural Birth KM 1 resizedWhat I found least pleasant about my birth experience wasn’t the pain. It was the hospital admittance process keeping my husband and me apart and waiting. The hospitals I know prioritise hospital practicalities and legal self-protection over emotional wellbeing. Routine procedures like the IV are designed to allow quick and easy access to medical intervention, not for soothing pregnant women to “open up and let the baby out”. We didn’t expect the hospital setting to encourage natural birth, so we worked with my obstetrician ahead of time to overcome the obstacles we could predict.

Having read Birthing from Within and Ina May’s Guide to Childbirth (one of these suggests moo-ing like a cow to relax and open the cervix), attended birthing classes at Eutokia and Babycenter’s online birthing course, we were convinced that the less unnecessary medical intervention the better for both mom and baby. Avoiding unnecessary intervention seems like common sense, but as my obstetrician reminded us: common sense is not so common. We prepared for birth in the country with the highest rate (at 70%) of caesarean births in the world, a Human Rights in Childbirth case study.

Here is what was at stake at the hospital and how we managed each concern:

A. My rights over my body – My obstetrician kept me informed of my choices throughout. Her track record in vaginal births, willingness to explain our options, welcoming attitude to our attempts to be informed all set the stage for mutual respect. When she suggested interventions, we agreed. I had a membrane sweep a day before my due date and had my waters broken when I was about 8cm dilated.

B. My responsibility towards my baby – Protecting my birth experience felt like a first success at parenting. The memory still provides a deep well of confidence that we draw from in the endurance sport of parenting.

C. Recovery time – I was able to walk to the toilet by myself after the birth, and to walk to the nurse’s desk to ask for my baby back.

D. Breastfeeding success – I chose to room in with my baby and I enforced this choice by asking for my baby back. Even though we were “rooming-in”, our baby spent a lot of time out of our sight. My obstetrician informed the hospital staff that I was interested in exclusive breastfeeding and asked that they not to offer formula or water. Leaving the hospital after 24 hours ensured that any accidental feeds during the baby’s long absences from rooming in didn’t sabotage my breastfeeding goals.

E. The opportunity to bond with baby – My obstetrician did her best to remove unnecessary separations between us and our new baby. She arranged some alone time for the three of us before the hospital’s priorities took over again after the birth. She also signed off on our “early” release at 24 hours.

Natural Birth KM 5 resizedEight tips to having a natural birth in hospital: 

  1. Learn about what you can expect. We had read about the “I don’t think I can do this” moment getting through the last couple of centimetres. Knowing about this ahead of time kept us calm and later we laughed in recognition of the predictability of it. Just because childbirth (and breastfeeding, for that matter) is natural, it doesn’t mean that it comes easily or without need for knowledge.
  2. Be vigilant about what you want and get your birthing team on the same page. My husband and I wrote our birth wishes down (see below) and talked them over with each other, our obstetrician and the hospital staff until we reached a version that was more realistic. The process of writing this one pager was invaluable – it helped us become more informed and helped us mentally prepare for what success could look like.
  3. Arrive at the hospital late. On our obstetrician’s advice, we didn’t leave our home until after my contractions were about three minutes apart, ten hours into labour. I credit my obstetrician with sharing this advice, but I imagine that the advice she is able to give varies based on how informed a couple is.
  4. Make yourself at home in the hospital. We dimmed the lights, brought music and admittedly a small suitcase full of other personal touches we didn’t end up using. It turned out that I was focused inward much of the time in the later stages of labour at the hospital and my husband and music were all I needed to feel relaxed. I still claim that having the little suitcase of other supplies was comforting.
  5. Have at least one champion who will be vocal about what you want. There came a time when I was in another zone and talking was difficult. I was lucky to have both my husband and obstetrician fend off well-meaning nurses offering an epidural too late into my labour,  when it was tempting but would have been counter productive. I later roomed with a mom who was given such a late epidural, essentially sabotaging her natural birth efforts after having done most of the hard work.
  6. Rooming in – ask for your baby back! In my experience “rooming in” babies seem to spend a surprising amount of time in some auditorium that parents aren’t allowed even to look into. They are not returned after their individual checks are done but when they are all done, unless you ask.Natural Birth KM 4 resized
  7. Ask for the advice you need to care for your baby yourself – how to change a nappy, how to hold the baby to wash away poop, how to help baby latch onto nipple, how to breastfeed lying down. Many of these are much easier to learn with guided practice rather than through books. I noticed that hospital staff are used to parents who are content to let them handle the baby, but who miss out on learning while in the hospital.
  8. Get out as soon as possible, unless you find the hospital setting a rest from home (my obstetrician suggested I keep an open mind about this since the hospital can be a nice break when there are other children waiting at home). I gave birth at the only Greek hospital at the time that allowed exit after 24 hours, assuming all is well. We fought for our exit and the two couples we roomed with decided to do the same. We were much more relaxed at home and I could stop demanding for my baby back.

The husband adds:

Natural Birth KM 3 resizedPreparation was key to having an excellent birth experience. To support my wife, it was important to be involved, not just by being present for the labour but at an early stage. Reading the books Katerina mentions, Birthing from Within and Ina May’s Guide to Childbirth, were critical to understanding exactly what was going on – and what to expect — at all of the stages of labour, and how panic can cause the process to go into reverse. Doing my homework beforehand allowed me to remain calm and focused. Being involved also created a sense of shared endeavour with Katerina, an important bond necessary for fostering the feelings of trust and safety between us during the labour.

One more thing: if you’re a birth partner, and you have any feelings of self-consciousness about not behaving “seriously” during the labour, get over them. The books were full of useful tips about what to do in specific situations to help Katerina overcome fears and relieve tensions that commonly crop up. If she was going to open up her whole body to let a human out, mooing like a cow was a small ask for me.

 

BIRTH WISHES

KM & MB

Due date: Sunday, 11 August 2013

Baby details: Our first, a girl, we intend to name her CLLB

Obstetrician: Dr. Liliana Colombero

 

We are open to any intervention that Dr. Colombero judges is necessary for the safety of mom and baby. We ask that, outside of an emergency, we are informed before any procedures and be allowed to ask questions about the pros and cons. We are aware that things can change suddenly. Below is our best case scenario, as we imagine it today, 9 August 2013. Thank you for taking the time to read our birth wishes. 

HOSPITAL ADMISSION & PROCEDURES 

Once I’m admitted, I’d like to: 

Prep

  • Opt out of being shaved, assuming I’ve shaved myself already.
  • Opt out of the enema, assuming my system has emptied out ahead of time on its own.
  • Have a heparin lock instead of routine IV, assuming I’m not going for an epidural or c-section.

Environment

  • Listen to music and limit outside noise.
  • Dim the lights when visibility isn’t important.
  • Drink water, or other clear fluids.

LABORING AND BIRTH

As long as the baby and I are doing fine, I’d like to:

  • Avoid a cesarean.
  • Avoid being induced with pitocin.
  • Try a membrane sweep before induction by pitocin.
  • Progress in labor without time limits.
  • Not be offered an epidural, unless I request it.

When it’s time to push, I’d like to:

  • Try different positions.
  • Try perineal massage or compress.
  • Push instinctively when I have the urge.
  • Get guidance about how to push during crowning to reduce the chances of perineal tearing.
  • Avoid an episiotomy, unless Dr. Colombero feels that tearing will be very extensive.

After birth, I’d like to: 

  • Have the baby placed on my stomach immediately for skin-to-skin contact.
  • Hold off on the cutting of the umbilical cord until it stops throbbing.
  • Try to nurse immediately.
  • Wait for the placenta to be delivered in its own time, as much as possible.
  • Hold off on procedures (labelling, shots, tests) for an hour to allow for nursing and bonding.
  • Stay together during recovery with my husband and baby as long as possible.

IF CESAREAN IS REQUIRED

  • I would like to be conscious and have skin-to-skin contact with the baby as soon as possible.
  • Please use double-layer sutures to raise my chances of a VBAC in future.
  • I would like to stay together with my baby during recovery, and to breastfeed as soon as possible.

POSTPARTUM 

While recovering, I’d like to: 

  • Choose 24-hour rooming-in with our baby.
  • Have procedures on our baby done in our presence, as much as possible.
  • Breastfeed exclusively.
  • Speak to a lactation consultant as soon as possible.
  • Avoid baby formula, sugar water, or a pacifier being offered to my baby without my consent.
  • Go home as soon as possible, if all is well.”

 

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