Animated explanation of how pregnancy and conception happen!

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CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY

Changes in the body during pregnancy are most obvious in the organs of the reproductive system.

a. Uterus.

(1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:

(a) In length from 6.5 to 32 cm.

(b) In depth from 2.5 to 22 cm.

(c) In width from 4 to 24 cm.

(d) In weight from 50 to 1000 grams.

(e) In thickness of the walls from 1 to 0.5 cm.

(2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal membranes.

(3) The abdominal contents are displaced to the sides as the uterus grows in size, which allows for ample space for the uterus within the abdominal cavity.

(a) Growth of the uterus occurs at a steady, predictable pace.

(b) Measurement of the fundal height during pregnancy is an important factor that is noted and recorded.

(c) Growth that occurs too fast or too slow could be an indication of problems.

(d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as “lightening.” This is more noticeable in a primigravida than a multigravida.

Appproximate height of the fundus at various weeks of pregnancy

NOTE: Remember a primigravida is a woman pregnant for the first time. A multigravida is a woman who has been pregnant more than once.

b. Cervix.

(1) The cervix undergoes a marked softening which is referred to as the Goodell’s sign.”

(2) A mucus plug, which is known as “operculum” is formed in the cervical canal. This is the result of enlarged and active mucus glands of the cervix. It serves to seal the uterus and to protect the fetus and fetal membranes from infection. The mucus plug is expelled at the end of the pregnancy. This may occur at the onset of labor or precede labor by a few days. When the mucus is blood-tinged, it is referred to as a “bloody show.”

(3) Additional changes and softening of the cervix occur prior to the beginning of labor.

c. Vagina. Increased circulation to the vagina early in pregnancy changes the color from normal light pink to a purple hue which is known as the “Chadwick’s sign.”

d. Ovaries.

(1) The follicle-stimulating hormone (FSH) ceases its activity due to the increased levels of estrogen and progesterone secreted by the ovaries and corpus luteum. The FSH prevents ovulation and menstruation.

(2) The corpus luteum enlarges during early pregnancy and may even form a cyst on the ovary. The corpus luteum produces progesterone to help maintain the lining of the endometrium in early pregnancy. It functions until about the 10th to 12th week of pregnancy when the placenta is capable of producing adequate amounts of progesterone and estrogen. It slowly decreases in size and function after the 10th to 12th week.

CHANGES OF THE SKIN DURING PREGNANCY

Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system. The following changes occur during pregnancy:

a. Linea Nigra. This is a dark line that runs from the umbilicus to the symphysis pubis and may extend as high as the sternum. It is a hormone- induced pigmentation. After delivery, the line begins to fade, though it may not ever completely disappear.

b. Mask of Pregnancy (Chloasma). This is the brownish hyper pigmentation of the skin over the face and forehead. It gives a bronze look, especially in dark-complexioned women. It begins about the 16th week of pregnancy and gradually increases, then it usually fades after delivery.

c. Striae Gravidarum (Stretch Marks). This may be due to the action of the adrenocorticosteroids. It reflects a separation within underlying connective tissue of the skin. This occurs over areas of maximal stretch–the abdomen, thighs, and breasts. It will usually fade after delivery although they never completely disappear.

d. Sweat Glands. Activity of the sweat glands throughout the body usually increases which causes the woman to perspire more profusely during pregnancy.

CHANGES OF THE BREASTS

a. In early pregnancy, the breast may feel full or tingle, and increase in size as pregnancy progresses. The areola of the nipples darken and the diameter increases. The Montgomery’s glands (the sebaceous glands of the areola) enlarge and tend to protrude. The surface vessels of the breast may become visible due to increased circulation and turns to a bluish tint to the breasts.

b. By the 16th week (2nd trimester) the breasts begin to produce colostrum. This is the precursor of breast milk. It is a thin, watery, yellowish secretion that thickens as pregnancy progresses. It is extremely high in protein.

c. Nursing implication: Inform the pregnant patient to wear a good, supporting bra.

CHANGES OF THE CIRCULATORY SYSTEM DURING PREGNANCY

a. Blood Volume.

(1) Blood volume increases gradually by 30 to 50 percent (1500 ml to 3 units). This results in decrease concentration of red blood cells and hemoglobin. This explains why the need for iron is so important during pregnancy.

(2) By the time pregnancy reaches term, the body has usually compensated for the decrease resulting in an essentially normal blood count.

(3) Blood count is interpreted as anemia by the physician if the hemoglobin falls below 10.5 grams per 100 ml and the hematocrit drops below 30 percent.

(4) Increased blood volume compensates for hypertrophied vascular system of enlarged uterus. It improves the placental performance. Blood lost during delivery, less than 500 cc is normal (300 to 400 cc is average).

b. Cardiac Output.

(1) Cardiac output increases about 30 percent during the first and second trimester to accommodate for hypervolemia. This is not a problem for patients with a normal heart. A patient with a diseased heart is especially at risk for cardiac decompensation 28 to 35 weeks of pregnancy when the blood volume and cardiac load are at their peak; also, during labor and immediately after delivery when rapid hemodynamic changes occur.

(2) Change in output is reflected in the heart rate. It usually increases by 10 beats per minute.

(3) Nursing implication. Patients with a diseased heart need to be advised to get plenty of rest and to report any shortness of breath or unusual symptoms to their physician.

c. Blood Pressure.

(1) Normally, the patient’s blood pressure will not rise.

(2) Nursing implications.

(a) The patient’s blood pressure should be checked carefully and often since a significant increase is one of the indicators of toxemia of pregnancy.

(b) When monitoring the blood pressure, be sure it is done under the same circumstances (that is, patient sitting and left arm).

d. Venous Return.

(1) The lower extremities are often hampered in the last months of pregnancy due to the expanding uterus restricting physical movement and interfering with the return of blood flow. This results in swelling of the feet and legs.

(2) Nursing implications.

(a) Advise the patient to rest frequently. This will improve venous return and decrease edema.

(b) Have the patient to elevate her feet and legs while sitting.

(c) Remind the patient not to lie in a supine position since this inhibits return blood flood flow as the heavy uterus presses on the vessels. This leads to the vena cava syndrome or supine hypotension. The patient may complain of feeling dizzy, nauseated, or weak.

Vena cava syndrome

CHANGES OF THE RESPIRATORY SYSTEM DURIN PREGNANCY

a. The respiratory rate rises to 18 to 20 to compensate for increased maternal oxygen consumption, which is needed for demands of the uterus, the placenta, and the fetus.

b. Women may feel out of breath and may need to sit a moment to catch their breath.

CHANGES OF BODY TEMPERATURE DURING PREGNANCY

a. A slight increase in body temperature in early pregnancy is noted. The temperature returns to normal at about the 16th week of gestation.

b. The patient may feel warmer or experience “hot flashes” caused by increased hormonal level and basal metabolic rate.

CHANGES OF THE URINARY SYSTEM DURING PREGNANCY

a. The kidneys must work extra hard excreting the mother’s own waste products plus those of the fetus. There is an increase in urinary output and a decrease in the specific gravity.

b. The patient may develop urine stasis and pyelonephritis in the right kidney. This is due to pressure on the right ureter resulting from displacement of the uterus slightly to the right by the sigmoid colon.

c. Frequent urination is a complaint during the first through third trimester. As the uterus rises out of the pelvic cavity in early pregnancy, pressure on the bladder decreases and frequency diminishes. When lightening occurs during the final weeks of pregnancy, pressure on the bladder returns to cause frequency.

CHANGES OF THE SKELETAL SYSTEM DURING PREGNANCY

a. There is a realignment of the spinal curvatures during pregnancy to maintain balance. It is due to the increase in size of the uterus and pressure on the abdominal wall. The patient walks with head and shoulders thrust backward and chest protruding outward to compensate. This gives the patient a “waddling” gait.

b. There is a slight relaxation and increased mobility of the pelvic joints, which allows stretching at the time of delivery of the infant.

Postural changes during pregnancy

CHANGES OF THE GASTROINTESTINAL SYSTEM DURING PREGNANCY

a. As mentioned, as the pregnancy progresses, the uterus enlarges. It rises up and out of the pelvic cavity. This action displaces the stomach, intestines, and other adjacent organs.

b. Peristalsis is slowed because of the production of the hormone progesterone, which decreases tone and mobility of smooth muscles. This slowing enhances the absorption of nutrients and slows the rate of secretion of hydrochloric acid and pepsin. Flare-up of peptic ulcers is uncommon in pregnancy. Slow emptying may increase nausea and heartburn (pyrosis). Relaxation of the cardiac sphincter may increase regurgitation and chance for heartburn. Movement through the large intestines is also slowed due to an increase in water consumption from this area. This increases the chance for constipation.

c. Nursing implications.

(1) If the mother has difficulty with nausea and/or heartburn, advise her to eat small, frequent meals.

(2) The patient should eat a well- balanced diet high in protein, iron, and calcium for fetal growth; high fiber and fluids to prevent constipation.

(3) The mother should not lie flat for 1 to 2 hours after eating because this may cause heartburn and/or regurgitation.

CHANGES OF SELECTED GLANDS OF THE ENDOCRINE SYSTEM DURING PREGNANCY

a. Parathyroid Gland. This gland increases in size slightly. It meets the increased requirements for calcium needed for fetal growth.

b. Posterior Pituitary. Near the end of term, the posterior pituitary will begin to secrete oxytocin that was produced in the hypothalamus and stored there. It will serve to initiate labor.

c. Anterior Pituitary. At birth, the anterior pituitary will begin to secrete prolactin. This stimulates the production of breast milk.

d. Placenta. The placenta acts as a temporary endocrine gland during pregnancy. It produces large amounts of estrogen and progesterone by 10 to 12 weeks of pregnancy. It serves to maintain the growth of the uterus, helps to control uterine activity, and is responsible for many of the maternal changes in the body.

CHANGES IN BODY WEIGHT DURING PREGNANCY

a. Normal weight gain is about 24 to 30 pounds during pregnancy.

b. Weight gain in pregnancy.

(1) There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting.

(2) She then gains 2 to 4 pounds by the end of the first trimester.

(3) A gain of a pound per week is expected during the second and third trimesters.

(4) Monitoring of weight gain should be done in conjunction with close monitoring of blood pressure.

(5) A lack of significant weight gain may be an indication of intrauterine growth retardation (IUGR) of the infant.

(6) Patients with multiple fetuses will require a higher caloric diet and expect a higher weight gain than a patient with only one fetus.

c. Adequate protein intake should be emphasized to the patient for development of the healthy fetus and proper diet reviewed at each prenatal visit.

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Treatment in pregnancy

Topical treatments that can be used in pregnancy include:
* Benzoyl peroxide
* Azelaic acid

Benzoyl peroxide

Benzoyl peroxide is a commonly used topical treatment for mild acne. It is safe for adults and children, and can be used in pregnancy.

Benzoyl peroxide has the following properties:

* Antiseptic i.e. it reduces the number of skin surface bacteria (but it does not cause bacterial resistance and in fact can reduce bacterial resistance if this has arisen from antibiotic therapy). It also reduces the  number of yeasts on the skin surface.
* Oxidizing agent – this makes it keratolytic and comedolytic i.e. it reduces the number of comedones.
* Anti-inflammatory action.

Benzoyl peroxide is available as cream, gel, lotion and wash at concentrations of 2.5 %, 5 % and 10 %. It may
be combined with other topical or oral therapy. It is especially valuable in combination with topical or oral antibiotics as it may reduce the growth of antibiotic-resistant bacteria.

In New Zealand, products containing benzoyl peroxide are available without prescription. They include:

* Benoxyl™ 5%, 10% Lotion
* Benzac™ AC2.5%, 5%, 10% Gel; Wash 5%
* Brevoxyl™ 4% Cream
* Oxy™ 5 5% lotion, Oxy™ 10 10% Lotion
* PanOxyl™ 2.5%, 5%, 10% Gel, PanOxyl™ AQ 2.5%, 5%, 10% Gel

How to use benzoyl peroxide products

* Make sure the skin is clean and dry before applying
* Apply a thin smear to areas of skin affected by acne, initially every second night, then build up to  once or twice daily as tolerated
* It can be used on the face as well as the trunk
* Be patient: acne responds very slowly to treatment. It may take several months to notice improvement

Problems with benzoyl peroxide products

* Dryness of the treated area can be expected and is usually mild. If the skin is visibly scaly, apply a light non-oily moisturizer.
* Skin irritation is rarely severe. Occasionally, irritation means that product must be discontinued.

Consider applying it less frequently.
* Contact dermatitis (red, dry, itchy skin) can be due to irritation or allergy. It can be treated with a topical steroid such as hydrocortisone cream (available at a NZ pharmacy without prescription).
* Bleaching of clothing. Make sure the benzoyl peroxide has completely dried before the treated skin touches clothes or bedding.

Azelaic acid

Azelaic acid is a natural material produced by a yeast that lives on normal skin, Malassezia furfur (also known as Pityrosporum ovale). In New Zealand, azelaic acid is available at a concentration of 20% as Skinoren™ Cream and Acne-Derm™  Medicated Lotion.

Azelaic acid is used as a topical treatment for mild to moderate acne, and may be combined with oral antibiotics or hormonal therapy. It is useful for both comedonal acne and inflammatory acne.

Azelaic acid is:

* Antibacterial – it reduces the growth of bacteria in the follicle (Proprionibacterium acnes and Staphylococcus epidermidis)
* Keratolytic & comedolytic – it returns to normal the disordered growth of the skin cells lining the  follicle
* A scavenger of free radicals – i.e. it reduces inflammation.

Azelaic acid also helps reduce pigmentation, so it’s particularly useful for darker skinned patients whose  acne spots leave persistent brown marks or who have melasma.

The cream should be applied to the area affected by acne initially daily, then if tolerated building up to a generous twice-daily application after thoroughly cleansing the skin.

Acne responds slowly to treatment. Some improvement should be seen after one month of using azelaic acid cream. Further improvement should occur with maximum results after six months’ continuous use. Treatment may be continued safely for months or years if the acne remains active.

Azelaic acid is nontoxic and is well tolerated by most subjects. However, those with very sensitive skin or who suffer from eczema, may find it irritating to apply, resulting in a mild irritant dermatitis.

Discontinue applying the cream and seek medical advice if you develop severe:

* Redness
* Scaling
* Itching
* Burning

Azelaic acid does not result in:

* Bacterial resistance to antibiotics
* Reduction in sebum production
* Photosensitivity (easy sunburn)
* Staining of skin or clothing
* Bleaching of normal skin or clothing

Although not registered in New Zealand for other skin disorders, azelaic acid cream may also be useful in the treatment of:

* Postinflammatory pigmentation
* Melasma
* Rosacea
* Lentigo maligna, a type of early melanoma. Azelaic acid is not recommended for most cases of this pre-cancerous lesion; where possible, surgery should be performed.

On the whole, it is preferable to avoid oral medicines in pregnancy in case they have an effect on the fetus.
However, oral erythromycin may be prescribed safely for severe acne.

The following medications must be avoided in pregnancy or if pregnancy is being contemplated:

* Tetracycline
* Oral isotretinoin
* Topical retinoids (tretinoin, isotretinoin and adapalene)
* Salicylic acid preparations

See also: Acne is Not Just for Teenagers

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weight loss program should not be started in the first three months after the birth of the baby. The weight gained by the pregnant women in nine months cannot be lost in a short period time.it probably takes still nine months to get their original weight. one should not expect fast and instant results.
First you should allow your body to recover after the child birth. You should take a low fat diet with some moderate exercise. Breast feeding alone is a good exercise. It is very interesting that breast feeding helps in the weight loss.during the process of breast feeding ,some hormones are released.

These hormones helps the uterus to regain its original shape and size. you should take valuable nutrients.your diet should at least contain 2000 calories a day. It is very necessary to take high nutritious food to keep your baby healthy. Junk foods should be avoided totally.

Exercise plays a major role in the weight program. A good exercise brings out from depression, improves your confidence.should not do heavy exercise because it may result in fatigue.

Eat healthy diet should contain a range of vegetables and fruits. Diet should be low fat but not no fat. Diet should be rich in vitamins and high fiber content. Should not take high fat containing foods ,which may result in adverse affects. So proper diet in which low fat content an high vitamin content.
A number of medical experts advice how to lose their weight after the child birth. It is very necessary to follow their advice. You should not neglect your baby’s health in reducing your weight. One cannot lose their weight at a time, needs some time.
While doing exercise take help of your relatives or friends.this will give you the emotional help and support while doing the exercise. These exercises will boost your energy levels and helps to remain fit.
Then after some days you look elegant, totally devoid of the fat during pregnancy time.

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2. Pregnancy Weight Gain
3. Healthy Dieting While Pregnant

Caloric Intake For Dieting While Pregnant

The old adage that a pregnant woman is eating for two is not quite correct. The nutritional requirements for the unborn child are not for a lot of calories but are for highly nutritious foods. Most women only need to increase their caloric intake by about 300 calories for the growth and development of the baby. There are some high risk pregnancies that will require different nutritional amounts such as extremely obese women, teen mothers, underweight women and women with medical conditions such as diabetes. These women will need to be closely monitored by their physician and may even want to see a registered dietician for nutritional counseling and advice on dieting while pregnant.

Nutritious Dieting While Pregnant

For good nutrition a pregnant woman will want to be sure to include certain foods in her diet and will, also, want to avoid certain foods. The woman will need to increase her protein intake significantly. To do this she can eat one or two extra servings daily of lean read meat, poultry, lamb or pork, eggs, or a combination of beans and rice. She will also need to make sure and eat enough fruits and vegetables. One way to do this is to use these foods as snacks during the day. Raw carrots and other vegetables are great to munch on and provide key vitamins for the growth and development of the child. Of course, a woman also needs to increase her milk intake and make sure and eat enough whole grain foods. A woman should avoid eating foods that are high in calorie but have little nutritional value. Dieting while pregnant must be focused on eating foods that are high in nutritional value. This focus will enable to child to develop normally and will improve the mother’s health while she is pregnant and leading up to the birth and breastfeeding of the infant.

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The minute you notice an early sign of pregnancy – like lower back pain, breast tenderness or bouts of nausea, you rush to buy a testing kit – and when pregnancy is confirmed, you feel unmatched joy. However, in truth, joy is not the only feeling you experience. You are most likely to feel a wide range of emotions, from elation to apprehension, to anxiety and so on. Coping with some of the early symptoms of pregnancy can be extremely difficult, yet the more understanding you have about your body, the easier it will be for you to accept and deal with the changes. Here’s what to do and how to cope with your early pregnancy symptoms.

Your changing body

• Back pain

Early pregnancy symptoms can be a real pain in the back! Typically lower back pain is caused by several factors including weight gain, realignment of the posture and torso, the loosening of pelvic joints and ligaments and also lack of sleep. All of these changes added together can cause the early pregnancy symptoms of lower back pain.

- What to do? The best thing you can do is to stretch daily and attend antenatal yoga classes in order to relax any areas of body tension and strain. You can also ask your partner to give you a gentle massage or better yet, treat yourself to one by a professional.

• Breast tenderness

Swollen, itchy or tender breasts may begin as early as 1-2 weeks after conception due to the presence of pregnancy hormones. Your breasts will probably also feel fuller and heavier.

- What to do? Wearing a more supportive bra may help. For itchy breasts you can also try applying a nipple cream that helps alleviate dryness.

• Nausea

Many women have queasiness, nausea or vomiting in early pregnancy, probably due to normal hormonal changes. Nausea tends to be worse in the morning, but it can last all day.

- What to do? Eating small, frequent meals throughout the day will help relieve this pregnancy symptom as it is important to keep your sugar levels balanced. Substitute processed sugars and white flour with whole grain foods and protein, as they are less likely to cause nausea. You can also try sucking on hard candy or drink ginger ale or ginger tea. Avoid foods or smells that make your nausea worse, and don’t forget to drink plenty of water to ensure that dehydration doesn’t become a problem.

• Unusual fatigue

You may feel tired as your body produces more blood and prepares to support the pregnancy. Your heart will need to pump faster and harder and your pulse will also quicken, which may take a toll on your energy level.

- What to do? Make sure you’re getting enough iron and protein in your diet. Include physical activity in your daily routine, such as a brisk walk and get as much rest as you can, taking naps of 15 minutes to a half-hour whenever possible. Explain to your family, friends and co-workers that you need this rest and ask for their help in making this possible for you.

• Dizziness

Normal circulatory changes in early pregnancy may leave you feeling a little dizzy. Stress, fatigue and hunger also may play a role.

- What to do? To prevent mild, occasional dizziness, avoid prolonged standing. Rise slowly after lying or sitting down. Keep blood sugar from falling with occasional snacks, such as dried fruit or low-fat yogurt. If you start to feel dizzy while you’re driving, pull over. If you’re standing when dizziness hits, sit or lie down.

• Food Cravings and Aversions

While you may not have a strong desire to eat pickles and ice cream, many women will feel cravings for certain foods when they are pregnant. Another related early symptom of pregnancy is a heightened sensitivity to aromas. Even a favourite aroma, such as the smell of a food or perfume, can make you feel sick. This can last throughout your entire pregnancy and is thought to be yet another side effect of the oestrogen that is flooding your body.

- What to do? Taking a good pre-natal vitamin supplement and a pure fish oil capsule may ease some cravings and help prevent extra weight gain, and of course it is doctor recommended for the health of your baby.

• Heartburn and/or Constipation

This pregnancy symptom is caused by the uterus starting to swell and pushing against the stomach and other organs as it grows. Also, increasing levels of hormones may slow down digestion and bowel functions to allow the body to absorb as much vitamins, minerals and nutrients as possible from foods. The slower emptying of the stomach may also cause the release of increased stomach acid to aid digestion, leading to a feeling of heartburn.

- What to do? Antacids that are certified as safe to use during pregnancy and sparkling water can help with the heartburn, and smaller, more frequent meals are easier to digest. Drink plenty of water and eat fruits, vegetables and perhaps some raisin and bran cereal to help regularity. Some daily vitamin formulas also contain digestive enzymes (from pineapple and papaya fruits), which can help with digestion.

• Frequent Urination

You may need to urinate more often as your uterus presses on your bladder during the first few months of pregnancy. The same pressure may cause you to leak urine when sneezing, coughing or laughing.

- What to do? To help prevent urinary tract infections, urinate whenever you feel the need to. If you’re losing sleep due to middle-of-the-night bathroom trips, drink less fluid in the evening. If you’re worried about leaking urine, panty liners may help you feel more secure.

Your changing emotions

With all of these physical symptoms of pregnancy to deal with, along with raging hormones, it is perfectly natural to have mixed emotions and ‘mood swings’. Where one moment you may be perfectly happy and laughing; the next you can be screaming and rolling out those tears. To cope with these emotions, remind yourself that what you’re feeling is normal. Take good care of yourself, and look to your partner and family for understanding and encouragement. If the mood changes become severe or intense, consult with your doctor or see a psychologist for additional support.

Here are a few tips on coping with your emotions and maintaining a general good mood:

• Share Your Joys And Anxieties

Don’t confine yourself after noticing the signs of pregnancy. Rather, even if you are an introvert, try to discuss them with your partner, family members, and friends. Even when your pregnancy is confirmed, share your joy with all the people who are close to you. Speak about the coming days to them and discuss the likely changes and precautions to be taken. This will definitely ease your mind.

• Try Meditation

Meditating is a wonderful stress buster. You are likely to need something like meditation because of the raging hormones inside you. Apart from other bodily changes, they also bring on mood swings and irritability. Therefore, try meditation during the very early days, when you first notice the early signs of pregnancy. If you are able to do it even for a limited time, go ahead and make it a routine throughout your pregnancy. It will most likely make those nine months extremely smooth for you. Get a good book on meditation for guidance or browse the net for more information.

• Get Mild Exercise

Go for a walk every day. It would help you get some fresh air and cope with indigestion, heartburn, constipation, and stress. You can also give yoga a try during pregnancy. It can help you stay fit during your entire pregnancy as well as have an easy labour.

• Nurture your relationship

Encourage your partner to identify his doubts and worries and be honest about what he’s feeling – both the good and the bad. Do the same yourself. Discussing your feelings honestly and openly will strengthen your relationship and help you begin preparing a home for your baby.

In Conclusion

While some women are lucky and feel fine during their first trimester, many others suffer from one or many of the early pregnancy symptoms. By knowing how to recognise these for what they are, you can take action to better manage and help alleviate some of your discomfort, which will also improve on your emotional wellbeing. The good news is that by the second trimester things seem to get easier. But in the meanwhile – just try to get plenty of sleep, eat right, take your prenatal vitamins and remember that what you are experiencing is perfectly normal.

Rapid Info (Pty) Ltd

Hayley Alexander

Journalist

February 2008

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In 1990 the Food and Drug Administration (FDA) issued the following warning (FDA Warning, 1990) about aspirin use during pregnancy: “It is especially important not to use aspirin during the last three months of pregnancy, unless specifically directed to do so by a physician because it may cause problems in the unborn child or complications during delivery.”

Aspirin is listed on the California Environmental Protection Agency (CAL/EPA) Proposition 65 list of developmental toxins (CAL/EPA Proposition 65 List). A developmental toxin is a substance that an expert group of scientists found sufficient evidence of possible harm to unborn children. The FDA warning is included in the CAL/EPA listing.

Aspirin and Breast Feeding

Aspirin is transferred to breast milk and it is estimated that a nursing baby receives about 4-8% of the mother’s dose (WHO 1988). Continued exposure to small doses of aspirin may be harmful to babies because aspirin tends to build up in their bodies (Findlay et al. 1981). In some countries, nursing woman are advised against aspirin use because of the possible development of Reye’s Syndrome in their babies (WHO 1988). Reye’s Syndrome is a rare condition that affects the brain and liver and is most often observed in children given aspirin during a viral illness (NOAH, Erie County Department of Health). Because sufficient information is not available to accurately determine the extent of aspirin accumulation in babies and the resulting health outcomes, the World Health Organization (WHO) Working Group on Human Lactation considers aspirin intake by nursing mothers as unsafe (WHO 1988).

References

Findlay JWA, DeAngelis RL, Kearney MF, Welch RM, Findlay JM: Analgesic drugs breast milk and plasma. Clin Pharmacol Ther 29:625-33, 1981.

The WHO Working Group, Bennet PN (ed): Drugs and Human Lactation. Elsevier, Amsterdam, New York, Oxford, 1988. pp. 325-6.

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Acne plagued Julie Harper throughout high school and college. She depended on makeup and wore her hair down over the side of her face. She gave up chocolate and french fries, only to find that neither made a difference. And she went through medicine after medicine, from over-the-counter creams to oral antibiotics.

These were not occasional pimples that vanish after a couple of days. This acne covered her face and left scars on her neck. “I had tried everything and felt frustrated all the time,” says Harper, now a physician and assistant professor of dermatology at the University of Alabama-Birmingham–a career she chose due in large part to her struggle with acne.

Harper finally found a successful treatment nine years ago at the age of 22. She took a drug called isotretinoin (trade name Accutane) and watched her skin improve in just a couple of months. By the third month, her acne had disappeared. She says with clearer skin came more self-confidence and higher self-esteem.

Considered the biggest breakthrough in acne drug treatment over the last 20 years, Accutane is the only drug that has the potential to clear severe acne permanently after one course of treatment. (See “Why Acne Forms, and How Accutane Knocks It Out.”) One course, which is typically five months, results in prolonged remission of acne in up to 85 percent of patients. A member of a class of drugs known as retinoids, Accutane is highly effective. But it doesn’t work for everyone, and some patients need more than one course of treatment. Dr. Harper took a second course of Accutane one year after the first and has been free of severe acne ever since, now only occasionally using a topical medication.

No other acne medicine works as well for severe acne. Patients generally have to keep using other medications because they only suppress acne temporarily. But as powerful as Accutane can be in improving patients’ lives, its adverse effects can be just as powerful. The drug is known to cause miscarriage and severe birth defects. Patients taking Accutane may develop potentially serious problems affecting a number of organs, including the liver, intestines, eyes, ears, and skeletal system. And some patients taking Accutane have developed serious psychiatric problems, including depression. More rarely, patients have developed suicidal behavior and killed themselves.

Because it is a high-risk drug, Accutane should be reserved for cases of “severe recalcitrant nodular acne,” according to the product’s labeling. This type of acne is resistant to standard acne treatment, including oral antibiotics, and is characterized by many nodules or cysts–inflammatory lesions filled with pus and lodged deep within the skin. These lesions can cause pain, permanent scarring, and negative psychological effects.

“Sometimes people tend to dismiss the impact of acne because it’s not life-threatening, says Kathy O’Connell, MD, PhD, a medical reviewer for Accutane in FDA’s division of dermatologic and dental drug products, Center for Drug Evaluation and Research (CDER). “But patients with severe acne know all too well the very real suffering caused by this disfiguring disease.”

FDA approved Accutane in 1982, and since then, about 5 million people in the United States and 12 million worldwide have been treated with it, according to its manufacturer, Hoffmann-La Roche of Nutley, N.J. The number of patients taking the drug has increased, and half are females, most of whom are in their childbearing years (age 15-44). Because of concern about the drug’s risks, FDA continues to evaluate Accutane and work with the manufacturer to maximize safe use of the drug.

When FDA approved Accutane, the drug was known to be teratogenic–able to cause birth defects. It was designated as Category X, meaning that it must be avoided under all circumstances during pregnancy. Nursing mothers also should not use Accutane.

Though not every fetus exposed to Accutane becomes deformed, the risk of birth defects among pregnant women is extremely high. These defects include hydrocephaly (enlargement of the fluid-filled spaces of the brain) and microcephaly (small head), heart defects, facial deformities such as cleft lip and missing ears, and mental retardation.

Reports in the literature suggest that about 25 to 35 percent of babies will suffer a malformation after exposure, and that doesn’t account for other defects, such as learning disabilities, that aren’t detectable at birth. Miscarriages and premature births have also been reported.

Though FDA approved labeling in 1982 that warned Accutane should not be used in pregnant women, reports of severe birth defects associated with the drug began to arrive in June 1983. Over the following years, a series of labeling changes and letters to pharmacists and prescribers of the drug stressed pregnancy warnings and sought to increase awareness about reported malformations.

Then, after an FDA review of pregnancy exposures to Accutane, Roche launched the Pregnancy Prevention Program (PPP) in late 1988 to further educate women using Accutane and their physicians about the dangers. The goal was to ensure that prescriptions would only be given to women with severe recalcitrant nodular acne who could comply with contraceptive requirements.

Roche sent PPP kits to physicians and encouraged them to review pregnancy prevention materials with patients before starting the drug. Materials included a contraceptive booklet, checklists to help assess whether patients could adhere to the drug’s requirements, and consent forms that patients sign to acknowledge their understanding of the risk of birth defects. Roche also set up a toll-free line, made contraceptive information available in 13 languages, and offered to pay for contraceptive counseling and pregnancy testing by a specialist.

To further reinforce pregnancy prevention, Roche began packaging Accutane in blister packs that include red and black warnings, along with a drawing of a malformed baby and the “Avoid Pregnancy” symbol.

Even though Accutane’s labeling recommended use of two reliable forms of contraception, there have been reports of pregnancies occurring in patients who used hormonal contraception, including pills, injectables, and implantables, while taking Accutane. Accutane’s labeling was updated in the summer of 2000. One change emphasized the need for two reliable forms of contraception for at least one month before taking Accutane, during treatment, and for one month after discontinuing Accutane, even when one of the forms of contraception is hormonal.

Yolonda Lawrence of Santa Monica, Calif., says there was no way she could miss the point about pregnancy prevention before she used Accutane for severe adult-onset acne in 1998. “I got a pamphlet, I signed papers, the doctor told me over and over, and the pictures of what can happen were very clear–babies with no ears” and other deformities, she says.

But reports of Accutane-exposed pregnancies continue, and that’s enough to make FDA concerned, says Peter Honig, MD, director of FDA’s office of postmarketing drug risk assessment (OPDRA) in CDER.

Shortly after the Pregnancy Prevention Program began, Roche sponsored a survey of women taking Accutane to assess compliance with the program, and the company encouraged doctors to enroll patients. Run by the Slone Epidemiology Unit at Boston University’s School of Public Health, the survey set out to track pregnancy rates and outcomes, patients’ awareness of risks, and patient and physician behavior.

Of the 500,000 women enrolled in the Slone survey from 1989 to 1998, there have been 958 pregnancies, 834 of which were terminations (either elective, spontaneous or due to ectopic pregnancies), 110 that resulted in live births, and 14 patients that had unknown outcomes. Of the 60 infants with available medical records, eight had congenital abnormalities. Since Accutane’s approval, Roche has received close to 2,000 reports of Accutane-exposed pregnancies, 70 percent of which occurred after the PPP began.

According to FDA, exactly how well the PPP has worked is unclear. Experts say the PPP is a significant program that has prevented many pregnancies and is the first of its kind initiated by a pharmaceutical company. Roche has made extraordinary efforts to educate patients that they must not become pregnant while taking Accutane, says a Roche spokesperson.

At a September 2000 meeting of FDA’s Dermatologic and Ophthalmic Drugs Advisory Committee, a Roche representative reported that from the company’s perspective, pregnancy rates have declined. Amarilys Vega, MD, an FDA medical officer, agreed. However, because use of the product has increased over the years, the actual number of pregnancies occurring while taking Accutane has not declined. One limitation is that the survey is voluntary and only captures about 30 to 40 percent of all patients on Accutane. So there’s no way to know exactly how many pregnancy exposures there have been, according to FDA experts. Of serious concern is that women who enroll in the survey may be more likely to comply with the contraceptive requirements than those who don’t enroll in the survey. This leaves open critical questions about how representative the PPP group is and about unreported pregnancies among women who don’t enroll in the PPP.

Most patients in the Slone survey have reported that they understood Accutane may cause birth defects. And according to Roche, the percentage of female patients who reported they were pregnant when they began Accutane dropped from 30 percent of pregnancies reported in 1989 to 11 percent of pregnancies reported for the period of 1991 to 1997. But substantial noncompliance with the PPP continues to be reported.

For example, a 1997 report on the survey shows that 25 percent of women in the program did not report having a pregnancy test before starting Accutane, and 33 percent did not report postponing the start of Accutane until a pregnancy test result was known. It is estimated that 40 percent of women taking Accutane are sexually active.

The only patients exempt from Accutane’s contraceptive requirements are men, and women who have had a hysterectomy or who say they will abstain from sex during treatment. But the challenge is that going from sexually inactive to active can happen overnight.
Many patients say they feel better about themselves after receiving successful treatment for acne. Evelyn Germanakos, of Los Angeles, Calif., struggled with acne as an adult, and says she felt like her old self after Accutane cleared up lumpy blemishes in 1997. “I had gotten to the point where I didn’t even want to go outside or be with people, let alone look in the mirror,” she says. But while Accutane may help lift psychosocial distress such as embarrassment, evidence suggests that it may actually cause serious psychiatric disorders in some people.

Though the drug’s label previously listed depression as a possible reaction, FDA strengthened the label warning in 1998 after reviewing cases with serious outcomes reported in the years after the drug was approved. The new labeling states that Accutane may cause depression and psychosis, and that in rare cases it may cause suicidal ideation (thoughts of suicide), suicide attempts, and suicide.

The label also advises providers that simply discontinuing the drug may not remedy any psychiatric problems and that further evaluation may be necessary. “In some cases, stopping Accutane alone may not be enough to relieve the mood changes,” says Jonathan Wilkin, MD, director of CDER’s division of dermatologic and dental drug products. “Psychiatric treatment may also be needed.”

The relationship between Accutane and depression remains unproven, but some patients have reported that their depression subsided when they stopped the medication and came back when they resumed taking it. And some who have reported problems with depression while taking Accutane had no previous psychiatric history. FDA considers the number of reports of serious depression associated with Accutane high compared to other drugs in its database.

From 1982 to May 2000, FDA received reports of 37 U.S. Accutane patients who committed suicide, 24 while on the drug and 13 after stopping the drug. In addition to suicides, FDA received reports of 110 U.S. Accutane users hospitalized for depression, suicidal ideation, and suicide attempt during the same time period. As of May 2000, FDA had received reports of 284 Accutane users with non-hospitalized depression.

Several factors make it hard to definitively link depression with Accutane. Depression is a common problem, and some patients may be suffering from it before starting Accutane therapy. Additionally, some patients who reported depression with Accutane had previous courses of the drug without depression. Even so, it is recommended that doctors act as if Accutane could have psychiatric effects until there is more information, says FDA’s Wilkin.

Roche does not want to have any Accutane-exposed pregnancies, a company spokesperson says, and plans to continue educational efforts. This year Roche launched a targeted Pregnancy Prevention Program that focuses on women who are at highest risk of becoming pregnant while taking Accutane.

Experts agree that pregnancy prevention education should remain a key part of risk management for Accutane use. But more labeling changes and letters are not likely to make a significant difference, according to FDA’s Honig. “During all the time the drug has been on the market and after all of those labeling changes, there are still pregnancies,” he says. “It is not expected that another labeling change or ‘Dear Doctor’ letter will change behavior at this point.” Psychiatric adverse events have also continued after labeling changes.

FDA’s Dermatologic and Ophthalmic Drugs Advisory Committee met in September 2000 to discuss options for Accutane, and to evaluate whether a framework for safer use of the drug can be developed. One change since then is that all Accutane prescriptions now come with a new Medication Guide that contains warnings about pregnancy and psychiatric issues, plus other important warnings and precautions regarding potentially serious or life-threatening effects.

FDA has also proposed a mandatory registration of patients taking Accutane, prescribers, and pharmacists. “The main reason is to ensure that pregnancy testing is done before the drug is prescribed,” says Julie Beitz, MD, of FDA’s office of postmarketing drug risk assessment. The goal would be to have doctors document negative pregnancy tests and to have pharmacies dispense the drug only to women who have had negative pregnancy tests. The program to track Accutane patients is expected to be in place by summer 2001.

The registry for prescribers may involve a continuing education course that doctors would have to take to be able to prescribe Accutane. According to Hoffmann-La Roche, about 85 percent of Accutane prescriptions come from dermatologists and 15 percent come from primary care physicians. The course would be open to all medical doctors. And all Accutane patients would have to sign a mandatory consent form that would address both pregnancy and psychiatric issues, Beitz says.

The American Academy of Dermatology and the Dermatologic Nurses Association were among those who testified at the September 2000 committee meeting in opposition to a mandatory registration, saying that it would be a disservice to patients, making it harder for them to obtain the drug. Others, including the March of Dimes and the Public Citizen’s Health Research Group, testified that they want to see stricter measures for Accutane.

FDA’s experts say it’s a balancing act. The value of Accutane is clear, but when it comes to even one report of death–whether it’s suicide, miscarriage, or some other cause–FDA must make choices that will best protect the public’s health.

Michelle Meadows
U.S. Food and Drug Administration
FDA Consumer magazine
March-April 2001

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Many women are taking the drug fluoxetine (prozac) either when they fall pregnant or while they are trying for pregnancy. There is some research into the outcomes of pregnancies in women who are using this common anti-depressant. There are two concerns with regard to pregnancy and Prozac – firstly whether its use in the first trimester is associated with any risk to the developing fetus – is there an increased risk of congenital abnormalities? Secondly, does it affect the outcome of the pregnancy or the subsequent development of the fetus.

First Trimester Use of Prozac and Congenital Abnormalities

There is no evidence that first trimester use of fluoxetine leads to higher rates of pregnancy loss or increased risk of fetal abnormality [ref's 1-4]. There is consistency among the animal and human studies and significant numbers have now been accrued (about 1000 first trimester exposures in all).

Ongoing Use of Prozac During Pregnancy

In 1996, a study was published that suggested worse outcomes for the babies of women who continued fluoxetine usage during the last trimester of pregnancy [3]. They included 73 exposed infants and found higher rates of early delivery, smaller babies, increased risk of breathing problems and feeding difficulties, and more admissions to the neonatal intensive care unit.

Criticisms of the interpretation of the results of this paper followed [5,6] with particular reference to the fact that the women who continued with fluoxetine probably included those who had more severe depressive illness, and there is already evidence that this alone is a risk factor for worse perinatal outcome. In addition, one of the letters included data on 123 women who continued to use fluoxetine throughout pregnancy, and their outcome was no different to the controls (those who didn’t use prozac) of the original study.

There is further reassurance from two other studies which find no increase in problems when fluoxetine is continued into the third trimester. One paper contained 115 exposed infants and looked at differences in early neonatal problems [7], and the other contained 55 exposed infants and examined developmental differences in terms of IQ and language development up to age 7 [8].

Obviously it is important to try and limit the exposure of the developing fetus to drugs, but depressive illness is likely to return if treatment is stopped and uncontrolled depression has its own problems. When fluoxetine is being used for anything more than mild depression, one must weigh up the pros and cons of discontinuing treatment during pregnancy.

Breastfeeding

With regard to breastfeeding and the use of Prozac, there is very little in the published literature to guide. Fluoxetine has a long half-life and it may accumulate in the infant. There is no evidence to reassure that breastfeeding is safe and as one paper puts it, it should be a case-specific, risk-benefit decision. There are other antidepressants, such as the tricyclics (eg. amitriptyline), which do not accumulate in the infant, and with which there is more published experience.

References

1. Pastuszak A, Schick-Boschetto B, Zuber C, et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 1993;269:2246-8
2. Rosa F. Medicaid antidepressant pregnancy exposure outcomes. Reprod Toxicol 1994;8:444
3. Chambers CD, Johnson KA, Dick LM, Felix RJ et al. Birth Outcomes in Pregnant Women Taking Fluoxetine. N Engl J Med 1996;335:1010-5
4. Goldstein DJ; Corbin LA; Sundell KL. Effects of first-trimester fluoxetine exposure on the newborn. Obstet Gynecol 1997 May;89(5 Pt 1):713-8
5. Cohen LS, Rosenbaum JF. Birth Outcomes in Pregnant Women Taking Fluoxetine. N Engl J Med 1996; 336: 872-3 (Letters)
6. Goldstein DJ, Sundell KL, Corbin LA. Birth Outcomes in Pregnant Women Taking Fluoxetine. N Engl J Med 1996; 336: 872-3 (Letters)
7. Goldstein DJ. Effects of third trimester fluoxetine exposure on the newborn. Journal of Clinical Psychopharmacology. 1995; 15: 417-20
8. Nulman I, Rovet J, Stewart DE et al. Neurodevelopment of Children Exposed in Utero to Antidepressant Drugs. N Engl J Med 1997;336:258-62

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First Trimester Worries

Am I doing the right things to ensure my baby will be healthy?

In today’s world there are so many resources out there at our fingertips that it is easy to get overwhelmed with all the do’s and don’ts of pregnancy. If you go overboard and freak out anytime you’re not sure that you should be eating something or doing something, you are going to end up having a very stressful pregnancy. The best rule of thumb to follow to make sure that you are doing all the right things for you baby is to ask your doctor; they will most likely tell you to eat healthy making sure that you include all the important baby building foods like green leafy veggies, red meat, whole grain foods, and foods rich in calcium. They might also tell you to exercise, don’t go run a marathon, but make sure that you stay active; gaining too much weight during pregnancy can cause complications for your baby during and after delivery. Avoid the obvious dangers like chemicals, cigarettes, alcohol, and illicit drugs. And last but not least, keep up with your prenatal appointments, the only way to make that the precious life growing inside of you is doing well is to get regular checkups. Follow the same basic principals you would follow to keep yourself healthy, its better then wondering if the fumes from the nail salon you walked by were too strong, the outcome will be less stressful on you and your baby.

I don’t feel any real bond with my baby yet, I’m worried that this will continue after the baby is born.

Bonding with your baby while it is still in the womb is something that will happen over time for most women, it’s hard bond with anyone when you’ve got morning sickness morning, noon, and night. For most women it’s hard to overcome the fact that their body is all of a sudden a baby making factory and they can no longer indulge in some of the things they used to and because of that there can be a bit of resentment, even if it was a planned pregnancy. Not to worry though, once the morning sickness passes and you get to see your baby’s first picture on the ultrasound monitor or you feel those first noticeable movements; those feelings of unattachment or disappointment will disappear and be replaced with joy and reassurance, once that happens you will start to feel a bond grown between you and your little one. If you continue to feel unattached or unsure about your pregnancy talk to your doctor, this could be a sign of a serious problem. No matter what feelings you may start out with at the beginning of your pregnancy, forming a bond with your baby is something that will grow with time, there are a lot of things for you to think about and as long as you get to know your child, the bond between you two will grow.

I’m afraid that I will fall or something will happen causing me to miscarriage

This is a common concern for every pregnant woman, whether or not you have experienced a miscarriage before; the fear of loosing that precious life growing inside is a major concern. The odds of having a miscarriage are about 1 in 5, most of which happen due to chromosomal problems, in which the miscarriage occurs before you even know you are pregnant. Short of putting yourself in a bubble, your chances of preventing a miscarriage are the same as if you intentionally tried to cause one, which are slim. Experts say that the average vehicle accident or fall will not cause you to miscarriage; they also say that once you have been deemed officially pregnant you have an 80% chance of carrying the baby until term and by the time your baby is 10 weeks and doctors are able to detect a heartbeat that chance jumps to 98% to 99%.

Second Trimester Worries

I’m thinking about doing the triple screen test, but I am worried that the results will come back showing there is a problem.

The screening tests offered by your doctor can either ease your thinking that there might be something wrong with your baby, or they can bring in new worries for you to dwell on. Just because a test came back positive, it does not meant that your baby actually does have problem, the screening tests are not a definite answer, the chances of your baby actually having a disorder is about 1 in 100. If the test does come back positive there are other tests, like an Ultrasound, Amniocentesis, or a Chorionic Villus sample (CVS), which can be done in order to get a concrete diagnosis of a disorder. Many women think that if they do decided to go on with the further testing and the results come back showing that there is definitely a problem, that the only course of action is to terminate the pregnancy, which can be a very difficult decision due to the fact that you’ve already started forming a bond with your growing baby, but this is not always the case. The advanced testing only confirms that there is a problem; it does not determine the severity of the disorder. There are support groups out there that women can get connected with to help them deal with the diagnosis of the disorder and help get them prepared for what to expect when caring for a child with the certain disorder. Even if the first screening test comes back positive, there is a 97% chance that your baby will be born without any type of defect.

I’m worried, is my baby is developing properly, is my stress level affecting my baby, what if something goes wrong.

No matter if this is your first or fourth baby, every woman wonders if their child is growing properly, if all their organs are functioning right, are they getting the right nutrients for their little bodies. As a woman, you’re body was made to protect that precious life inside of you and whether you notice it or not, those maternal instincts that you seem to be missing, are already at work. Nature will take it’s course to ensure that your baby comes out healthy, but you need to do your part also to ensure that your body stays healthy, the only way you can do that is to make sure you follow your doctors instructions and avoid the bad things, like drugs, alcohol, and cigarettes, if you do that then the odds are on your side that your pregnancy will turn out great! Don’t misunderstand, having some concerns is a good thing, it means that you will be a great parent, but having too many worries can create a lot of stress not only for you but for your baby as well. Being so worried about what could go wrong can often lead you to miss out of the little miracles that are happening everyday with your little one growing inside of you.

I feel so overwhelmed with trying to get things in order for the baby, I’m not even registered for a baby shower, and I’m not sure how I will ever get all the stuff I need to have by the time my baby gets here

Every pregnant woman goes through the need to make sure that everything is in order for their new baby, you want to make sure that the nursery is set up perfectly, that you have all the clothes you will need, plenty of diapers, and those baby checklists don’t always help ease your mind, sometimes they will have so many differences in the things that you need that it gets scary trying to think of where you will get all these things, one says 6 onesies another says 8, one suggests you get the new super duper diaper disposal while another one says that a regular trash can will serve just fine as a diaper disposal; it’s hard to determine which list you should follow, if you should even follow a list at all. Experts say not to let it get to you, because just when you think that you’ve achieved perfection, there is always something else that needs to be done before your baby arrives, just take one thing at a time and only do what you can when you can. If you want to ensure that you have what your baby need, stick to the basics, you’ll need a rear facing car seat that reclines, a safe and secure place for the baby to sleep, one or two layette sets, diapers, and of course feeding supplies (especially if you decided to formula feed rather than breastfeed); handy items like a baby tub, changing table, and diaper disposal are not crucial items to have right off the bat, you can get those later. There are other items that you don’t need right away like a high chair, a jogging stroller, and other items that can wait until your baby is older. Keep your mind at ease, you will get everything done in time, if all else fails, don’t be afraid to ask for help.

I’m worried that having a new baby in the family is going to have a bad affect on my firstborn

Moms who are pregnant with their second child all worry about how their firstborn is going to react to the new baby. Introducing a new baby can be a rough thing for a younger child to go through, especially since they have been the sole focus of mom and dad’s attention, but not to worry, they will adjust, it might take a couple of months and they may experience some regression or jealousy, but if you reinforce the fact that they are going to be a big brother or sister before the new baby arrives and continue to reinforce that once the new baby gets here, they will feel more confidante in themselves and with their new position in the family. Don’t dwell on the negative factors that you think you are putting your first born through, think about the positive things that your child will experience, if they are not in school yet, they will be ahead of the game when it comes to building relationships with the other kids and they will have the pride in knowing that they are a older sibling.

Third Trimester Worries

I’m worried that once my baby gets here I won’t know what to and that I will be a bad mom.

Sure the idea of having a baby cry at all hours, feeding every 2 hours, changing diapers over and over again seems like an overwhelming task, but soon it will come so naturally to you, you’ll be able to do it with your eyes closed, well not literally, but close enough. Many new moms have this fear because they haven’t had any experience dealing with a newborn that they couldn’t “give back”, the third trimester is the perfect time to start honing your parenting skills and learning those techniques that will make you a super mom. One key thing to remember is don’t strive for perfection, it won’t happen, every child and mother is different, what works for one may not work for another, so don’t give up hope if the tried and true method that worked for your mother and grandmother doesn’t work for you. You want to make sure that you know the signs for when your baby is hungry or is not getting enough milk, what health issues are important to watch for in infants, and that the car seat you have is installed right, these are the important things to know to ensure that you are giving the best care you can to your baby.

I’m worried that I won’t get everything done at work, that no one will be able to do my job while I am gone, and that I won’t be able to plan my maternity leave

Moms who work have a lot on their minds already, besides the need to get everything done before their baby arrives. The thing you need to remember when getting ready to take maternity leave is to take care of yourself and your baby first and foremost, next you need to make sure that when you do take your maternity leave that everything is left in order for those who will take over your duties while you are gone, leave notes on how procedures are done, what the priorities are, what tools will be needed to complete a project, and that your co-workers and boss has a list of all there things; lastly you need to make sure that you have everything in order for when you return to work. When you start to plan your maternity leave, check with your company to see what their policy is; ask what is covered in the Family Medical Leave Act and your company’s medical coverage. Also don’t forget to have your spouse ask about his benefits and from his company, a lot of companies now days are allowing paternity leave. Make sure that before you take your leave that you and your boss have a clear understanding of how long you are going to be gone and what your availability status is. Don’t let your work make you feel guilty about wanting to spend time with your infant, this is a once in a lifetime chance you get at spending time with your child as an infant, don’t let anyone or anything get in the way of that.

I’m planning on returning to work, I’m worried that I won’t be able to find childcare for my baby

Child care can be a tricky thing; you want to make sure that the people you put in charge of the care of your infant are capable and knowledgeable. Before choosing a day care take the time to spend getting to know the caregiver(s), observe their daily operations, get your child into the day care before you have to go back to work, that way you know how you’re child will react and it gives them a chance to get into the flow of things at the caregivers; getting them into daycare before you make the transition back to work will also put your mind at ease, so you don’t spend your days worrying about how your baby is doing rather then concentrating on your work. While you and your baby are getting used to the daycare situation, don’t dive head first into it, start slow, try a couple of hours at first, maybe enough time for you to do some grocery shopping, then expand from there if they do well, next time add another 1 or 2 hours to the time they spend in daycare, and slowly work you way up to a full work day in daycare. Starting slowly will help your child ease into a new routine and help set your mind at ease knowing that your child will do fine in the care of someone else.

I want my child to be here so bad, but I am worried of what will happen during labor, what if I do something embarrassing?

Going into labor can be a nerve racking thing, we’ve all heard the horror stories of women having extreme pain, and it’s no lie that giving birth does hurt; but when you stop to think about it, it’s just one day out of your life that last for a short time, and ends with great joy. If you can’t handle the pain don’t be afraid to ask for pain medication, no one is going to look down on you because you didn’t have a totally natural childbirth. The fear of doing something embarrassing is something you shouldn’t fret about, it may be embarrassing to you, but while you are in the throes of labor your focus is on pushing your baby out you’re not even going to notice if you had a bowel movement, and the nurses are trained to quickly and discreetly deal with situations like that, and they are not going to tell anyone. If you’re worried that you won’t have the dream delivery you’ve always thought of don’t be, not all deliveries are the same as long as you and your doctor have an understanding of what you hope your delivery to be like you are in good shape, don’t forget to create a birth plan, it will help you and your doctor remember what kind of experience you want it to be, just remember to be flexible, not everything can always go according to plan, so make sure that you keep an open mind for changed should anything serious arise during your delivery. Lastly, remember that giving birth is a joy; it’s not a horror story, if it were people would not do it more than once.

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