Pregnancy guide before and after childbirth
Many women think that a missed period, morning sickness, and fatigue are necessary signs of early pregnancy. However, even these classic symptoms may not always be present. Their presence does not always indicate pregnancy. There are other reasons for missing menstrual periods. These includes emotional stress, excessive weight loss, intensive exercise schedule, illness, thyroid disease, and the recent use of birth control pills. Stopping of birth control pills requires several months before your body readjusts and resume regular menstruation. However, many women who are pregnant have a light “menstrual period” during the first month or two of pregnancy.
Nausea or inability to tolerate certain foods or tobacco smoke is common during early pregnancy. Often the nausea can be relieved by eating a few crackers in the morning before getting out of bed. Sometimes, however, vomiting is such a problem that medication is required to control it.
Breast tenderness is a reliable sign of pregnancy. The feeling of soreness usually starts about the time of the missed menstrual period or a week or two later. But because the feeling also occurs before-menstruate, it is possible to be fooled by this sign. Some women begin producing excessive saliva; others experience fatigue. Some are constipated; others have diarrhea. Still others experience a large increase in appetite.Every person is slightly different. You may experience all of these symptoms or you may experience none of them.
There are several different tests which can tell you whether or not you are pregnant. In recent years home pregnancy tests provide reliable results, but only if instructions are followed very carefully. All pregnancy tests are based on the detection in the blood or urine of the hormone called human chorionic gonadotropin (HCG). The levels of secretion of HCG double every two days in the first trimester.
Tests have been developed in which antibodies are used to detect HCG in the woman’s blood or urine. The blood test, called radiology-muneassay or RIA, can detect HCG as early as 7 days after ovulation and fertilization, or one week before a missed period.
The urine test has been improved to the point where it is almost as sensitive as the blood test. However, it cannot be relied on to detect pregnancy until almost two weeks following conception, or a few days before the missed period. While these tests are highly accurate, a lower than normal amount of HCG in the blood or urine may produce a false negative result. It is suggested to test repeatedly after a week if a pregnancy is suspected.
An ectopic pregnancy, or an impending miscarriage, may result in lower than normal HCG values. (Higher than normal HCC levels are produced by a multiple pregnancy or some other anomaly that should be investigated further.) Pregnancy tests are offered free of charge or at low cost by some family planning clinics. Your local health department or the county medical society can supply information of this kind.
They are quite similar to the urine pregnancy tests performed professionally in clinics and in doctors’ offices. The test kits are available in most drugstores and can be bought without a doctor’s prescription. If you are planning to use a home test, make sure that the test uses monoclonal antibodies rather than hem-agglutination. Hem-agglutination process considered less reliable than the antibody technique. Instructions on how to take the test and how to read the results must be followed with extreme care.
If the results of the home test are positive, the results should be sent to the doctor for confirmation of the pregnancy. If the results are negative, you may still be pregnant. The test should be repeated in about 10 days if your period still has not begun. If the result is negative second time around, pregnancy has probably not occurred but a doctor should be consulted to find out why menstruation has been interrupted.
Babies are delivered every day by obstetrician-gynecologists, family practitioners, nurse-midwives, and lay midwives. Whichever type of professional you select, the most important thing is to find someone with whom you are comfortable and in whom you have confidence. If you have a special problem such as heart disease, hypertension, hyperthyroidism, etc., you should be cared for by an appropriate specialist as well.
Obstetricians vary in their attitudes toward childbirth as well as such specifics as medications during labor, breast feeding, role of the father,episiotomy, rooming-in, and length of hospital stay. If any of these things are important to you, discuss them with your obstetrician early in pregnancy.
Many babies are delivered by family practitioners, particularly in rural areas or small towns where such a doctor may be the only one available. Women enjoy having the family doctor, who takes care of the entire family for all medical problems, care for them during pregnancy, labor, and delivery. Many family practitioners have had some advanced training in obstetrics. A family doctor trained in obstetrics can handle a normal pregnancy and childbirth, but he or she may refer you to an obstetrician or other specialist if you have serious complications at any time during pregnancy.
Certified nurse-midwives deliver approximately 2.3 percent of the babies born in the United States. These midwives are registered nurses (RNs) who have had an additional one or two years of training in obstetrics. According to the American College of Nurse-Midwives, the nurse-midwife’s management of labor and delivery may differ from that of some physicians. Nurse-midwives are less likely to use fetal monitors or use forceps. They often prefer deliveries in a bed instead of on a delivery table. An episiotomy, an incision to enlarge the vaginal opening prior to delivery, is often not done by nurse-midwives.
Many offer family planning and postpartum checkups. Typically, they try to encourage breast feeding and rooming-in. (Of course, many physicians are willing to deliver your baby and care for you in this manner.)Because nurse-midwives generally have fewer patients than either obstetricians or family practitioners, they may have more time to spend with each patient during prenatal visits or during labor. Nurse-midwives handle uncomplicated pregnancies quite satisfactorily. However, if complications arise, the patient may have to be transferred to the care of a physician.Most midwives today practice with obstetricians or use obstetricians as consultants.
Lay midwives are people without nursing degrees who are trained to deliver babies. As a group lay midwives are the most willing to perform home deliveries. Many states recognize only nurse-midwives and do not allow lay midwives to practice. Some states that permit lay midwives to practice have little or no regulation. Because of this wide variation in regulation by states, the level of training required of a lay midwife also varies enormously. Before you select a lay midwife, you should inquire thoroughly into the level of his or her training.
The decision as to where to have your baby should only be made after you have carefully considered the alternatives.
The birth of a baby is a normal physiological process and is usually uncomplicated.. However, when complications do occur, they often happen very quickly and with little or no warning. Labor may be progressing well when vaginal bleeding begins and the baby’s heartbeat starts to slow. Even a healthy mother with an uncomplicated pregnancy and a normal labor and delivery may have a baby that has difficulty breathing and needs to be given oxygen and receive immediate pediatric care. Hospital delivery will have the assurance that any necessary treatment is immediately available if any complications do occur.
Some women choose to have their babies at home. They object to the cold and sometimes impersonal environment of the hospital and prefer to share the intimate joyous experience of birth with their families and friends rather than with doctors and nurses in masks and gowns. Labor and delivery are normal processes, not diseases. If you are considering home delivery, discuss it thoroughly with the person who is overseeing your prenatal care and delivery (your clinician, whether it be physician, nurse-midwife, or lay midwife).
During the course of your prenatal care the clinician can tell you if any condition indicates a likelihood of complication. In such a case you may be advised that hospital delivery would be much safer. Even if it is assumed that delivery will be normal, arrangements must be made for emergency transportation and additional medical aid in case of unexpected difficulty. Even if arrangements have been made, there is still a risk that complications may develop too quickly to be treated adequately. In many European countries home delivery is safer than in the United States because of an extensive system of back-up ambulances and emergency teams that can be dispatched at a moment’s notice.
A third and increasingly popular option for women who find hospital delivery too impersonal and expensive, and home delivery too informal is an independent licensed childbearing center staffed by certified nurse-midwives. These centers are usually located in a suitably con- vented private dwelling where the mother-to-be goes for prenatal care and delivery after she has been evaluated by a physician who rules out the likelihood of complications.
On the average, with all services included, delivery in a childbearing center costs about half of a hospital delivery. Typical services include a preparation-for-parenthood program consisting of 10 to 14 weekly sessions of two hours each; prenatal care provided by a licensed nurse-midwife who also attends the mother during labor and birth; the services as necessary of a backup team of obstetricians, pediatricians, and nurse assistants; facilities for a 12-hour stay by the family after the baby is born; a complete examination of the baby by a pediatrician; home visits by public health nurses within 24 hours as well as on the third and fifth days. If you are interested in having your baby at such a center, be sure to investigate the arrangements for transfer to a hospital in case of an emergency.