pregnancy guide → FAQ
In the first four months of your pregnancy the baby is surrounded by a little amount of amniotic fluid. After four months the amount increases quickly to about a litre of fluid. The average amount of fluid is 800 ml. More or less is perfectly normal. The amount is adjusted to how much the baby pees or drinks in the uterus. In the last two months of pregnancy the amount of fluid is more constant and from 38 week onwards it is slowly decreasing.
The most important function of liquor/fluid is protecting the child against all sorts of dangers from outside and it plays an important role in the development of the baby’s lungs.
- When you bump your tummy the fluid is there to protect your baby and often doesn’t give any concern.
- The liquor keeps the baby at a constant temperature. Overheating or cooling is not possible.
- The fluid also protects your baby against any infections that can arise from the vagina.
- The fluid allows your baby to move freely around inside the uterus which helps the baby grow and develop.
In the first half of the pregnancy fluid is being produced by the placenta and by the cord and comes from big blood vessels. You can compare this process with sweating. When the fluid is lost from these vessels important nutrients like minerals and glucose come along with the fluid. Halfway through the pregnancy the kidneys of the baby will start to function. The baby will pee regularly and in the last months of pregnancy the fluid will consist mostly of the amount that baby is peeing.
The fluid around the baby is constantly being refreshed. This refreshing is necessary as the baby both drinks and pees in the fluid and waste products need to be get rid of (W.Braam & A. Leemhuis,(2002).
Caffeine: Is it OK to drink coffee, tea and coke during pregnancy?
Different researches have shown that the element caffeine in coffee can cause congenital abnormalities in the newborn. It is said that drinking 4 cups of coffee or more is damaging. Also it showed that there is an increased risk for cot death later on. The same increased risks count for coke and tea. When you drink normal quantities (4 cups a day), there is no reason for concern.
Other reasons to reduce caffeine intake are physical problems resulting from drinking too much, such as heart palpitations, stomach problems and difficulty sleeping. The excretion of caffeine in the body is slowed down during pregnancy. Your pregnant body takes two to three times longer to excrete caffeine than when not pregnant.
(W.Braam & A. Leemhuis, 2002).
‘Comadrona’ means ‘midwife’ in Spanish. Another Spanish word for midwife is ‘partera’
Fertility: How soon after giving birth is it possible to get pregnant again?
After childbirth, it takes 4-5 weeks for an ovulation to occur. So, from a month onwards after delivery it is possible to get pregnant again when sexually active.
When breastfeeding, the maturing process of an egg in the ovary is delayed by the hormone Prolactin. Because of this it takes at least 10 weeks until the first ovulation occurs when fully breastfeeding. So, when you start introducing artificial formula earlier you have to take into account that you possibly could get pregnant, when not using contraceptives.
Fertility: Is it true that you can’t get pregnant when you are fully breastfeeding?
NO. It is true that the chance of getting pregnant is small, but 1 in 20 women do get pregnant in this period. Advice: when another pregnancy is not desirable and you are sexually active it is best to start contraceptives from 6 weeks onwards.
Flying: Is it OK to fly during pregnancy?
Flying is not damaging for your pregnancy. Though in the last month of your pregnancy it is not recommended to fly as it can stimulate the onset of the first labour contractions. The development of those early contractions is caused by a change in pressure inside the plane. (W.Braam & A. Leemhuis, 2002).
Most airlines have implemented policies. Generally, it is not recommended that you fly domestically after 36 weeks gestation and after 34 weeks for international flights. Please check with your airline regarding their policies.
During pregnancy the metabolism in your body is much higher. Your thyroid will work quicker than normal and your heart activity is increased. The blood flow in the skin and other organs is increased too. This all leads to more release of warmth in your body. You will notice warmer hands and you might feel you can resist the cold better. (W.Braam & A. Leemhuis, 2002).
Heartburn: Is heartburn normal during pregnancy?
It is estimated that between 50 and 70 % of women get some heartburn when pregnant so you could say that this is quite normal during pregnancy. Most of the time this problems starts from the 5th month onwards. Although you are not an exception if heartburn starts earlier in pregnancy. In the last three months of the pregnancy heartburn is most of the time its worst.
It has always been thought that the cause of heartburn relies on the growing uterus which is pushing other organs in the body aside or upwards. This is partly true. The real reason for the cause of heartburn is that the sphincter, that normally closes the stomach opening to the oesophagus/gullet, weakens under the influence of hormones. In normal circumstances this sphincters function is to make sure that only food passes through the gullet into the stomach. When this function is a little bit weakened under the influence of pregnancy hormones , it is possible that present stomach acid can flow into the gullet, for example when you are laying down or bending over. This stomach acid causes a burning pain in the gullet behind the chest bone. This pain can be felt severe and even in your throat. Also it is possible that you feel nausea due to this (W.Braam & A. Leemhuis,2002).
To relieve yourself from heartburn there are different things you can do:
- Food intake: There are some foods that stimulate the production of stomach acid such as greasy foods like chips, chocolate, butter, juice and sauces, coffee, tea, coke, orange juice, tomato juice, peppermints and alcohol.
- Instead of having three big meals a day it might be better to cut the meals into smaller portions. When this is spread out more during the day then the stomach can work on it without having high peaks of formation of acid.
- Quit or cut down your smoking.
- A teaspoon of the juice of a rasped potato neutralises the stomach acid. dry biscuits may have a similar effect. Drinking milk can relieve the pain.
- Rise the head end of your bed 15 to 20 cm. You can do this by putting a couple of books or bricks under the head of the bed.
- Avoid wearing tight clothing.
- If heartburn persists despite all these measures then talk to your midwife to see what the pharmacological options available.
HIV is a virus that affects the body’s ability to fight infection. It can lead to AIDS (acquired immunodeficiency syndrome) if left undetected and untreated.
The number of people in New Zealand with HIV is low. However the number is increasing and all pregnant women are now being offered an HIV test as part of their antenatal care. The HIV test can be done at the same time as other routine antenatal blood tests.
A woman with HIV can pass the virus on to others, including her baby during pregnancy, birth or through breast milk.
Most pregnant women with HIV do not know they have the infection. The test is the only way to tell. A woman who finds she has HIV is able to get early treatment and support for herself, her partner and family and help reduce the risk of passing the virus to her baby.
The majority of pregnant women will be found not to have HIV.
Treatment to prevent HIV being passed on to the baby is very effective. Without treatment there is a 25% chance the baby will be born with HIV. With treatment, the chance of the baby being born with HIV is less than 1%.
If you have concerns or want to know more about the HIV test please ask your midwife.
Haemorrhoids / Piles
Haemmorrhoids often cause discomfort in the second half of pregnancy. Piles or haemorrhoids are swollen blood vessels on the outside or inside of the rectum. Haemmorrhoids on the outside of the rectum can be seen by eye as a red blue swelling. They often cause discomforts such as itchiness or pain (severe with a bowel movement). Piles are caused by the pregnancy hormone progesterone. Progesterone weakens the blood vessels as well as the intestines. This causes loss of strength in the mechanism of both the blood vessels and intestines which leads to problems in passing a bowel motion and causes congestions of blood inside the blood vessels. Factors that increase the risk of constipation and piles are a lack of physical movements, wrong eating habits and the use of sleeping tablets.
You can prevent the severity of piles by changing some lifestyle habits. It is very important to prevent constipation in the first place. You can do this by eating healthy (kiwifruit and good hydration) and by having enough physical exercise (eg, go for a 30 min walk every day). When you feel you need to go to the toilet don’t delay (W.Braam & A. Leemhuis,2002).
‘Hebamme (die)’ means ‘midwife’ in German. Another German word for midwife is ‘geburtshelferin’
Infections: What infections are dangerous in pregnancy?
Rubella: Despite the fact that it is possible to be immunised against Rubella, 5% to 10 % of pregnant women remain non- immune. Your rubella status will be checked with your first antenatal screen.
Toxoplasmosis: Outside the pregnancy this infection is completely harmless. Most pregnant women have had the illness, often without even knowing it, They are generally immune for the rest of their lives. An infection during pregnancy can cause harm to the baby. Toxoplasmosis is caused by exposure to cat faeces. Avoid this while pregnant and use gloves if gardening.
Listeriosis and Cytomegalovirus (CMV): These infectious diseases don’t have many symptoms in the pregnant woman. But for the unborn baby it can cause miscarriage. The symptoms of Listeriosis will most likely be a raised temperature. With CMV the symptoms can be a high temperature with liver and lymph glands inflammation. Both infectious diseases are very rare.
Influenza: Pregnant women are at greater risk from pandemic influenza H1N1 (swine flu)
Pregnant women who get sick with pandemic influenza H1N1 2009 (swine flu) are more likely to suffer serious complications than others. Some pregnant women with pandemic influenza H1N1 2009 have had early labour, severe pneumonia and it has proved fatal in a small number of cases.
If you are pregnant and have a pre-existing medical condition such as asthma or diabetes, you have a higher chance of developing severe health complications as a result of influenza. This is because pregnancy on top of such conditions can intensify the effects of influenza in your body.
The vaccine is free for pregnant women. The seasonal influenza vaccine is free for pregnant women in 2010.
This year’s seasonal influenza vaccine will protect you against pandemic influenza H1N1 2009 (swine flu) as well as two other strains that are expected to be the dominant strains circulating in the community this year.
The vaccine is strongly recommended for women who will be pregnant during the influenza season as pregnancy places a woman at greater risk of complications from influenza illness. The vaccine is available from early March until the end of June and may be given to pregnant women after this period if need be.
The vaccine protects baby too. Influenza immunisation for pregnant women has clear benefits for both mother and baby. Mothers who receive influenza vaccine while pregnant can pass protection on to their baby. The vaccine offers protection to infants who would normally be too young (under six months) to receive immunisation individually (MOH, 2009)
Lightheaded / dizziness
Feeling light headed or dizzy is a common complaint during pregnancy, especially in the last months. This is often caused by a change in blood vessels as they dilatate under the influence of progesterone hormones during pregnancy. In particular when you stand up after having laid down or sitting down there is a shortage of blood with oxygen in the brain. The blood will flow down and your blood pressure can be low. You can see stars in front of your eyes. The trick is not to move up too quickly but rather slowly. Another reason for this feeling can be when you are low in iron. For this reason your midwife checks your blood iron levels a couple of times during pregnancy and might prescribe you a supplement (W.Braam & A. Leemhuis, (2002).
Nipples: Is it normal to produce breastmilk during pregnancy?
This is very normal during pregnancy. For many women this happens from the second half during pregnancy. Sometimes you don’t even notice it. Other times you accidently notice that there is some moist excretion from your nipple by seeing a stain in your bra. The colour most of the time is light yellow or clear transparent and comes from lacteal glands inside the nipple. Because of the fact that these glands are suddenly developing so quickly under the influence of hormones it is possible that they start producing some colostrum (foremilk)(.Braam & A. Leemhuis, 2002).
Placenta: What is it?
The placenta is an important organ for the growth and the development of the baby. At the birth the placenta presents itself as a round flat organ with a diameter of 15 to 25 centimetres. The placenta at term is around 2 to 3 centimetres thick and the weight is 500 to 600 grams on average. The placenta has two sides. One side has been sitting against the wall of the uterus and has a dark red colour. The other side of the placenta is where the baby has been growing and is covered by membranes in which the baby and the amniotic fluid have been enclosed. The baby’s umbilical cord attaches here as well.
The blood vessels of the cord, that are coming from the baby, branch to all sides of the placenta. The beginning of this is often clearly seen. What you can’t see is that small blood vessels are ending in large numbers of little holes right in the middle of the placenta. These tiny holes are the place where the blood flow is coming from the mother. This blood is constantly being refreshed by blood vessels of the uterus. Between the blood vessels coming from the cord of the baby and the tiny holes with the blood flow from the mother there is a very thin membranous wall. Through this wall the baby’s blood flow is receiving oxygen and nutrients from mother’s blood flow and in return waste products from the baby’s blood flow are passed back to mother’s blood flow. You could say that this thin wall is works like a filter.
The baby is completely dependent on the placenta for its growth and development. The placenta is the only source of nutrients and oxygen for the baby and the only organ to which the baby can discard waste products. The placenta keeps the pregnancy intact by producing hormones such as oestrogen and progesterone. These hormones are important in preparing the body for labour and birth. Another important task of the placenta is its barrier function between the mother and baby. It prevents that the pregnancy being rejected by the mother. This might seem odd, but the baby inside the mothers body can be seen as a strange object which doesn’t belong there. The babys genes are completely different to the genes of the mother. Without that barrier function of the placenta the pregnancy could be rejected just like what could happen with a transplant. The placenta also protects the baby against harm causing matters/substances. Most of these substances that come from the mother can’t reach the baby eg: bacteria and viruses. Unfortunately the placenta can’t resist all substances. Alcohol, nicotine, cigarette toxins, hepatitis and some medications are substances that can cross the placenta to the baby (W.Braam & A. Leemhuis, 2002).
The most common painkillers that are used without needing a prescription are Paracetamol (Panadol) and Aspirin. Sometimes these two are combined in one tablet and sometimes other products like caffeine are added to it. Most of the times these combinations are not recommended during pregnancy. Generally you are best of with the normal Paracetamol. Take only as directed as exceeding the recommended dose can cause liver damage. Talk to your LMC if you are experiencing pain that is not well controlled with the use of paracetamol or if the pain is chronic or on-going. Aspirin is not recommended in pregnancy unless on Specialist instructions. Anti-inflammatories like diclofenac and ibuprofen should be avoided in the first 12 weeks and in the last trimester of (W.Braam & A. Leemhuis, 2002).
Stretch marks: What are they and how can I prevent them?
These are scars that can be seen on places like the abdomen (growth of the uterus and baby), the breasts (growth of the milk ducts) or the hips (storage of fat). It is caused by the rupture of elastic fibres below the skin that goes with the stretching of the abdomen during pregnancy, often after the 24th week of pregnancy. Because of the fact that the skin has become a little bit thinner on those places, the normal blood flow is easier seen and that explains the stripes that are red-blue in colour.
The reason that some women don’t have stretch marks and others do is not completely known. It is possible that hereditary factors play a role, but also pregnancy hormones that weaken the structures of certain parts of the skin. The chance of getting stretch marks is greater in the first pregnancy than in subsequent pregnancies.
When stretch marks are hereditary there is not much you can do to prevent these. This doesn’t mean that there is nothing you can do to reduce the amount and severity however. Wearing good supportive clothes for your growing abdomen and breasts may help. Massaging moisturiser or oils into your skin once or twice a day may reduce the amount and severity as well. You have to start this early on in pregnancy. The idea behind the use of oil is that the massage of the skin will make the skin more supple and allow it to give more easily with growth.
Like all scars, stretch marks don’t disappear after the baby is born. However over time they do become less apparent (W.Braam & A. Leemhuis, 2002).
Sleeping: Is it OK to sleep on your stomach?
If you find this comfortable then there is no reason to stop doing this, especially in the first 5 to 6 months. There is no reason to believe that there will be too much pressure on your baby or uterus. However later in pregnancy it will not be so comfortable and you may need to change to a different position. (W.Braam & A. Leemhuis, 2002).
In a sauna your body gets exposed to high temperatures. A healthy person normally can cope with this, even with a cold bath afterwards. The changes in blood pressure that result from this are not a danger to the human body.
During pregnancy there is a natural change in blood pressure. Your heart will have a higher workload. When you use a sauna it can lead to a low blood pressure and can make you feel faint. Despite this not being a significant danger, it is probably wiser to avoid if possible. If your blood pressure has been low during your pregnancy or if you have a high blood pressure it is advisable to avoid saunas. In all cases it is also advisable to avoid using a sauna in the first three months in pregnancy, as research has shown that the high temperature can lead to congenital abnormalities in the baby. The risk of this is very small though. (W.Braam & A. Leemhuis, 2002).
It is not advisable to sit in a spa for a long time in the first months of your pregnancy. This is because research has shown that a high body temperature can lead to congenital abnormalities. Whilst this risk is very minimal it is best to avoid. Don’t stay longer than about ten minutes in a hot spa pool or bath. A normal bath is fine during pregnancy and can be very relaxing, but make sure you don’t get too hot (W.Braam & A. Leemhuis, 2002).
Sexual Transmitted Infections
Chlamydia is one of the most common sexually transmitted diseases in the world. Men and women can both be affected by Chlamydia, but symptoms of the infection are not always present. In fact, up to 75% of women and 50% of men experience no symptoms of Chlamydia. Because Chlamydia can easily be passed to your newborn, causing illness and possible tissue damage, it is important to get tested if you are experiencing any Chlamydia symptoms or are pregnant.
Chlamydia has been linked with premature delivery resulting from the infection stimulating the rupture of your uterine membranes. Additionally, Chlamydia can cause your baby to have a low birth weight. The infection can also be easily passed to your child during birth.
As your baby passes through the birth canal, she will come into contact with your blood and vaginal fluids. The bacteria that cause Chlamydia, Chlamydia trachomatis, are passed through contact with these fluids. In fact, between 20% and 50% of babies born to infected mothers will contract the infection. If your baby contracts Chlamydia from you during pregnancy, it is possible that he will develop infections in the genitals, lungs, ears, and eyes. Babies infected with Chlamydia are at a particular risk for developing neonatal conjunctivitis (pink eye) and pneumonia.
Even though your baby’s symptoms can vary, from very mild to severe, it is necessary to seek treatment as soon as possible. Conjunctivitis can be very damaging to your newborn’s eyes and can cause scarring and even permanent blindness.
Chlamydia infections in newborns can also lead to Infant Pneumonia. Symptoms of this infection develop between three and six weeks after birth. Your baby will exhibit a dry, irritating cough, which will gradually become more congested. Symptoms will become worse and can include rapid or laboured breathing. 50% of newborns with Chlamydia pneumonia will also develop Chlamydial conjunctivitis.
Pregnant women who are infected will be treated with antibiotics. If your baby is born with signs of Chlamydia he can also be successfully treated with antibiotics. However, by getting tested when you first find out you are pregnant, you can prevent your baby from contracting the disease and suffering any physical damage as a result.
‘Sage Femme’ means ‘midwife’ in French.
weight: Why do most babies initially lose weight?
Often a baby doesn’t drink enough in the first days to compensate the loss of fluid via the skin (transpiration), lungs (air that is exhaled), kidneys (urine) and intestines (stool). This loss of fluid is often the main cause of some weight loss during the first week of life.
It is completely normal for a baby to lose some weight in the first week. On an average the amount of weight that is lost is about 5 to 8 percent of the birth weight, or 150 to 250 grams. After the first week the baby will gain weight again and around the 9th or 10th day of life the baby reaches its initial birth weight. Sometimes, this can take a little longer. (W.Braam & A. Leemhuis, 2002).