IN THIS CHAPTER
Knowing what symptoms to look for
Getting the answer to that all-important question: Are you pregnant?
Knowing what to expect as your pregnancy progresses
Scheduling doctor appointments and routine tests
So you think you may be pregnant! Or maybe you’re hoping to become pregnant soon. Either way, it’s important to know what to look for so that you can find out whether you’re pregnant as early as possible. This chapter takes a look at some of the most common signals that your body sends you in the first weeks of pregnancy and offers advice for confirming your pregnancy and getting it off to a great start.
Seeing Signs — of Pregnancy, That Is
So assume it has happened: A budding embryo has nestled itself into your womb’s soft lining. How and when do you find out that you’re pregnant? Quite often, the first sign is a missed period. But your body sends many other signals — sometimes even sooner than that first missed period — that typically become more noticeable with each passing week.
· Honey, I’m late! You may suspect that you’re pregnant if your period hasn’t arrived as expected. By the time you notice you’re late, a pregnancy test will probably yield a positive result (see the next section for more on pregnancy tests). Sometimes, though, you may experience one or two days of light bleeding, which is known as implantation bleeding, because the embryo is attaching itself to your uterus’s lining.
· You notice new food cravings and aversions. What you’ve heard about a pregnant woman’s appetite is true. You may become ravenous for pickles, pasta, and other particular foods yet turn up your nose at foods you normally love to eat. No one knows for sure why these changes in appetite occur, but experts suspect that these changes are, at least partly, nature’s way of ensuring that you get the proper nutrients. You may find that you crave bread, potatoes, and other starchy foods, and perhaps eating those foods in the early days is actually helping you store energy for later in pregnancy, when the baby does most of its growing. As with any other time in life, though, be careful not to overeat. You may also be very thirsty early in pregnancy, and the extra water you drink is useful for increasing your body’s supply of blood and other fluids.
· Your breasts become tender and bigger. Don’t be surprised if you notice that your breasts become larger during the first portion of your pregnancy. In fact, large and tender breasts are often the first symptom of pregnancy that you feel because very early in pregnancy, levels of estrogen and progesterone rise, causing immediate changes in your breasts.
Determining Whether You’re Pregnant
Well, are you or aren’t you? These days, you don’t need to wait to get to your practitioner’s office to find out whether you’re pregnant. You can opt instead for self-testing. Home tests are urine tests that give simply a positive result (often showing two lines) or negative result (showing only one line); some use little plus (positive) and minus (negative) signs. These tests are very accurate for most people. Your practitioner, on the other hand, may perform either a urine test similar to the one you took at home or a blood test to confirm that you’re pregnant.
Getting an answer at home
Suppose you notice some bloating or food cravings, or you miss your period by a day or two. You want to know whether you’re pregnant, but you aren’t ready to go to a doctor yet. The easiest, fastest way to find out is to go to the drugstore and pick up a home pregnancy test. These tests are basically simplified chemistry sets, designed to check for the presence of human chorionic gonadotropin (hCG, the hormone produced by the developing placenta) in your urine. Although these kits aren’t as precise as laboratory tests that look for hCG in blood, in many cases, they can provide positive results very quickly — by the day you miss your period, or about two weeks after conception.
The results of home pregnancy tests aren’t a sure thing. If your test comes out negative but you still think you’re pregnant, retest in another week or make an appointment with your doctor. A urine test is positive at a level of about 20–50 IU/L, while a blood test is positive at a level of 5–10 IU/L, depending on the test. So a blood test will be positive a little earlier than a urine test. An ultrasensitive blood test can even detect an hCG level of about 1–2 IU/L.
Going to your practitioner for answers
Even if you had a positive home pregnancy test, most practitioners want to confirm this test in their office before beginning your prenatal care. Your practitioner may decide to simply repeat a urine pregnancy test or to use a blood pregnancy test instead.
A blood pregnancy test checks for hCG in your blood. This test can be either qualitative (a simple positive or negative result) or quantitative (an actual measurement of the amount of hCG in your blood). The test your practitioner chooses depends on your history and your current symptoms and on her own individual preference. Blood tests can be positive even when urine tests are negative.
REACTING WHEN YOUR PARTNER BREAKS THE NEWS
When your partner tells you the big news, try to mirror her reaction, at least outwardly. If her reaction is “Oh … heck,” you can go along in that vein also, at least for a minute or two. Remember, though, that she’s gauging your reaction to the news, and if you act like having a baby is a huge imposition in your life, she’ll be really upset, even if it is going to be a huge imposition and even if she just said the same thing five minutes before. Try to throw in a few encouraging statements about how you wanted kids eventually, how having a baby will be fun in the winter when there’s nothing else to do, or whatever encouraging babble you can come up with at a stressful time.
Some women get very creative with their announcements, from filling the living room with balloons to baking a cake with a pair of booties inside. Just try not to choke on one, literally or figuratively. If she’s gone all out to break the news, you can safely bet that she’s really excited, so make sure to be as supportive as possible.
Even if you’ve been trying to conceive forever, an initial reaction of fear isn’t uncommon. Remember that your partner may also be feeling some sudden doubts and fears, and allow her to express them. Under no circumstances is “We spent $20,000 for fertility treatments and now you’re not sure this is the right time?!” the right response to her concerns.
Calculating your due date
Only 1 in 20 women actually delivers on her due date — most women deliver anywhere from three weeks early to two weeks late. Nonetheless, it’s important to pinpoint the due date as precisely as possible to ensure that the tests you need along the way are performed at the right times. Knowing how far along you are also makes it easier for your doctor to see that the baby is growing properly.
The average pregnancy lasts 280 days — 40 weeks — counting from the first day of the last menstrual period. This day is used to calculate your due date.
If your cycles are 28 days long, you can use a shortcut to determine your due date. Simply subtract three months from your last menstrual period and add seven days. If your last period started on June 3, for example, your due date would be March (subtract three months) 10 (add seven days). If your periods don’t follow 28-day cycles, don’t worry. You can establish your due date in other ways. If you’ve been tracking ovulation and can pinpoint the approximate date of conception, add 266 days to that date (the average time between the first day of your last menstrual period and ovulation is about 14 days, or 2 weeks).
If you’re unsure of the date of conception or the date your last period started, an ultrasound exam during the first three months can give you a good idea of your due date. A first-trimester ultrasound predicts your due date more accurately than an ultrasound done in the second or third trimester.
You can also use a pregnancy wheel to calculate how far along you are. To use this handy tool, line up the arrow with the date of your last menstrual period and then look for today’s date. Just below the date, you see the number of weeks and days that have gone by. (If you know the date of conception rather than your last period, there’s a line on the wheel corresponding to this, too.) You can find online wheels as well as apps that you can download to calculate your due date.
A Week-by-Week Overview of Pregnancy
As indicated throughout this book, pregnancy is usually referred to as a 40-week enterprise, which is a tad misleading. The pregnancy starts at conception, which — with a normal 28-day cycle — is two weeks after the first day of your last menstrual period. So if you start at conception, pregnancy is only 38 weeks, but obstetricians use 40 weeks because most women don’t know when they conceive but do remember when their last period was.
Here are a few things to remember as you read this week-by-week guide:
· Many of the things discussed in a particular week may still be important at other times throughout the pregnancy. So just because the ultrasound is mentioned at 20 weeks doesn’t mean it can’t be done at any other time.
· Some things included in this chapter are optional and may not be necessary for everyone.
· The week/weeks assigned to prenatal tests or pregnancy events are an approximation. Don’t be overly alarmed if, in your pregnancy, they are off by a week or so.
OVERCOMING YOUR FEARS OF BEING A FATHER
You have a lot of time to get used to the idea of being a dad, so don’t worry if you have a lot of fears at first. Even if you aren’t sure you’re ready to become a father, you’ll be surprised how quickly you come around to the idea. Besides, the baby will be here before you know it, ready or not.
It’s important, however, to use this time to confront your fears about parenting. Spend time with the male role models from your past (and present) and use them as learning tools. Ask them what they did right, what they would change, and what advice they have for you when raising your own child. You may feel like you’re the first father ever, but you don’t need to reinvent the wheel when it comes to parenting. If you admire other people’s skills, monitor and mimic their behaviors.
Working on overcoming your fatherhood fears is doubly important if the father in your life wasn’t the best role model for the type of dad you want to be to your son or daughter. To attempt to come to terms with any wrongdoings your father may have committed, talk with a counselor or therapist, or even a trusted friend, about your relationship with your father and try to identify the mistakes you don’t want to repeat. Talking about your experience with your own father can also help heal some of the emotional wounds. Being a father is hard work, and you don’t want to wait until after the baby arrives to start overcoming your fears or past traumas.
Weeks 0 to 4
If you suspect that you’re pregnant, you’re probably both excited and anxious to find out if you truly are. The first four weeks are important because the pregnancy is getting established as the implantation process is underway.
During these initial weeks, do the following:
· Record your last menstrual period. Doing so helps your provider better estimate your due date (40 weeks from your last period). Be sure to tell him if your cycles are irregular.
· Begin taking a daily prenatal vitamin if you haven’t already. Check to see that the vitamin has at least 400 micrograms of folic acid to make sure your baby is as healthy as possible.
· Check for ovulation. Some women know when they ovulate by a sensation known as mittelschmerz (German for “middle pain,” due to the mild pain that may be felt when the egg is released from the ovary, typically 14 days after your last period). Others know they’ve ovulated due to a change in the cervical mucus or a positive reading from an ovulation prediction kit.
Fertilization usually occurs within the fallopian tube. The embryo starts as one cell. During the 1st week, that cell divides many times as it moves down the fallopian tube toward the uterine cavity.
· Take your first pregnancy test. As stated earlier, pregnancy tests check for a hormone called human chorionic gonadotropin (hCG), which is produced by the placenta as the embryo implants into the wall of the uterus — usually five to seven days after conception. By the time you miss a period, around ten days after conception, your pregnancy test will most likely be positive.
Don’t be too concerned if you have a little spotting around the time when you would expect your period. This is most likely due to the embryo implanting in the womb (implantation bleeding).
At the end of the 4th week, your baby measures 0.2 inches (5 mm) in length.
Weeks 5 to 8
By this time, the pregnancy is well established, and you’re feeling the typical signs and symptoms of pregnancy, such as nausea and fatigue. During weeks 5 to 8, most of the baby’s organ systems are beginning to form. The first organ to start working is the heart. It’s amazing to realize it starts beating at just 5 weeks, although you can’t see it beating on ultrasound until 6 weeks. The baby’s arms and legs are beginning to develop at this stage. The head is the biggest part of the embryo because the brain is the fastest-growing organ at this time. (Check out Chapter 1 in Book 2 for more on what happens during the first trimester.) The placenta is rapidly growing and is now the way nutrients and oxygen get to your developing baby.
This is an important time to make any necessary lifestyle changes, if you haven’t already done so (like stopping smoking or speaking with your doctor about adjusting medications — Book 1, Chapter 2 explains the effects of certain medications, alcohol, and drugs on the developing fetus). Also during this time, begin making these necessary medical appointments:
· Call your doctor to make an appointment for your first prenatal visit. Most doctors want to see their patients before 8 to 10 weeks. Head to Book 1, Chapter 2 for advice on selecting a practitioner and what to expect during your prenatal visits.
· Talk to your healthcare provider about scheduling an ultrasound or obtaining a heartbeat by Doppler to confirm a healthy pregnancy. An ultrasound during this period is very accurate at establishing your due date (it is sometimes called a “dating scan”) and can also tell you whether you’re having one, two, or even more babies! Your due date is most accurate when it is established by an ultrasound between 8 and 12 weeks.
· If you’re taking any medications, call or see your doctor earlier than the 8 to 10 weeks mentioned. You want to make sure that these meds aren’t a problem for your developing baby. You should also discuss any over-the-counter or herbal medications you’re taking to make sure they aren’t a problem, either.
At the end of the 8th week, your baby measures 1.2 inches (3.0 cm) in length. Your uterus is about the size of a medium orange.
Weeks 9 to 12
Although you won’t be feeling it this early, this is the time when your baby starts to move around. If you’re having an ultrasound at this time, you may actually see these movements on the screen. Before 10 weeks, male and female embryos look the same. After 10 weeks, their external genitalia start to develop differently, although your practitioner may not be able to see this difference on ultrasound until after 16 to 20 weeks, depending on the position of the baby, the amount of abdominal tissue the sound waves have to pass through, the kinds of equipment used, and the experience of the person performing the ultrasound. By the end of the 10th week, all the organ systems have formed. The brain is unique in that it continues to develop throughout pregnancy and even into adulthood.
You want to consider the following counseling and testing at this time:
· Schedule an appointment for genetic counseling if you have a family history of genetic problems. Your doctor may also recommend it, depending on varying circumstances.
· Make sure you schedule your first-trimester screen for Down syndrome. Remember, the best time to screen for Down syndrome is at 11 to 12 weeks (see Book 2, Chapter 1 for detailed information about the first trimester and Down syndrome screening). This screen combines a measurement of the fluid-filled region behind the fetal neck (called a nuchal translucency), your age, and blood tests (hCG and PAPP-A) to give you a specific risk for Down syndrome as well as for Trisomy 13 and 18 (other chromosomal disorders).
Talk to your provider to see whether he thinks you’re a candidate for a newer type of screening for Down syndrome that extracts fetal genetic material from your blood. This blood sample can be drawn as early as 9 weeks.
· If you’re considering having a chorionic villus sampling (CVS), weeks 10 to 12 are the best time to do this. This test can reveal chromosomal conditions as well as other genetic conditions, such as cystic fibrosis. See Book 2, Chapter 1 for more information on this test.
At the end of week 12, your baby is 2.13 inches (5.4 cm) long and weighs less than half an ounce (around 14 g). Your uterus is the size of a large orange.
Weeks 13 to 16
Congratulations! You and your baby made it through the first trimester. You’re starting to feel more like yourself — you have more energy and less nausea. After week 14, the majority of the amniotic fluid surrounding your baby is made up of the baby’s urine. By week 15, an experienced sonographer can tell by ultrasound whether you’re having a boy or a girl. By week 16, your baby starts to grow fine, soft hair (called lanugo) and fingernails.
The following considerations apply during this time period:
· Between weeks 15 and 18, have your blood drawn to check the alpha-fetoprotein (AFP) level. This blood test helps to identify fetal abnormalities such as spina bifida. This is also the time to have the second part of your Down syndrome screening (the quad screen).
· If you’re planning on having an amniocentesis, schedule it between weeks 16 and 18. See Book 2, Chapter 2 for the reasons to consider an amniocentesis.
· Consider shopping at a maternity store. Many women start to show at this time. If you aren’t showing, don’t worry, because some body types hide pregnancy better than others.
At the end of week 16, your baby is 4.6 inches (11.6 cm) long and weighs about 3.5 ounces (100 g). Your uterus is the size of a large grapefruit.
Weeks 17 to 20
During weeks 17 to 20, your baby begins to put on some fat and looks more like a real baby. The baby’s skeleton, which starts out mostly as cartilage, is now transforming into bone. You may notice a little fluttering sensation in your abdomen. This could be gas, but more likely it’s early fetal movement. By 20 weeks, the top of the uterus (called the fundus) is at the level of your belly button. Twenty weeks is the halfway mark, so you should congratulate yourself. The second half usually flies by faster than the first.
You want to keep the following in mind:
· Schedule your anatomy ultrasound. This is the ultrasound where the doctor is able to check the baby’s anatomy and make sure he is growing properly and is surrounded by normal amniotic fluid.
· Pay attention to the baby’s movements. This period is when many women start to feel the baby move, which is called quickening. First-time moms, though, don’t always feel quickening this early, so don’t be alarmed if you haven’t.
Your baby now weighs about 10 ounces (300 g) and is about 10 inches (25 cm) long.
Weeks 21 to 24
During this time, your baby’s lungs are going through a very important phase of development. The lining of the lungs is beginning to thin out enough to allow for oxygen exchange. You may be experiencing discomfort on either side of your lower abdomen (in the groin area). This discomfort is known as round ligament pain. The round ligaments are actual ligaments that attach from the top of the uterus to the labia. Many women feel an uncomfortable pulling sensation, which tends to worsen upon standing and improve upon sitting or lying down. The good news is that after 24 weeks, round ligament pain usually goes away.
At this time, your baby is regularly swallowing large amounts of amniotic fluid and excreting urine back into the amniotic cavity. The baby’s fingernails are almost fully formed, and he has started to grow eyelashes and eyebrows. The lanugo is turning from a pale color to a darker hue.
By 24 weeks, your baby is considered viable. This means survival on the outside is possible, although the baby would need a great deal of medical attention. The top of your uterus is usually at or above the level of your belly button.
There aren’t any actual tasks that you have to schedule with your provider during this time, other than your routine prenatal visits (which should be about every four weeks during this period).
At the end of this period, your baby weighs about 1 pound, 5 ounces (600 g) and measures about 12 inches (30 cm) long.
Weeks 25 to 28
Your baby’s bones are continuing to harden, and his fingernails, toes, eyebrows, and eyelashes are fully present. Meanwhile, your baby’s skin is still fairly see-through, although it is changing from transparent to a more opaque look. You should still be seeing your provider about every four weeks during this period of pregnancy.
The following considerations are typically addressed during this time:
· Get your glucose screen. This is the blood test to screen for gestational diabetes. You’re instructed to drink a 50-gram glucose drink (it tastes like flat soda), and your blood is drawn one hour later. If the glucose level is above a certain value, a definitive test called a GTT (glucose tolerance test) is needed. You’re instructed to fast the night before this test so that your fasting glucose level can be determined with the initial blood draw. You then drink a 100-gram glucose drink and have your blood drawn every hour for the next three hours. Two abnormal values are needed for a diagnosis of gestational diabetes. During the glucose screening process, your doctor may draw some additional blood to check for conditions like anemia.
· If your blood type is Rh negative (see Book 6, Chapter 2), you need to get a shot of Rh immune globulin. This shot can prevent any effects of incompatibility between you and your baby.
The top of your uterus is a couple of inches above your belly button. By 28 weeks, your baby weighs about 2 pounds, 4 ounces (1 kg). He is about 14.8 inches (38 cm) long.
Weeks 29 to 32
Your baby’s eyes can now open. His permanent teeth have developed, and the lungs and digestive tract are nearly mature. To keep a closer eye on you and your baby, your practitioner will start to schedule your prenatal visits every two weeks.
The following steps are recommended during this time:
· If you haven’t started childbirth classes, begin them now. Many alternatives are available, so check with your doctor or the hospital where you’ll deliver. Book 1, Chapter 5 discusses several options. If you’ll have help taking care of your newborn, remember that it’s a good idea for all caregivers (including you and your partner) to take an infant CPR class to be as prepared as possible for your newborn.
· Pay closer attention to your baby’s movements. Although fetuses still spend most of their time sleeping, they start to develop clear sleep and wake cycles. A good general rule is that feeling about six movements in an hour is a sign of fetal well-being. You don’t have to feel these movements every hour, but if you’re ever concerned that you’re not feeling your normal fetal movement, lie down and count the movements. If you can feel six movements in an hour, you can rest assured that this is normal.
The nature of the fetal movements may also change. Instead of the big punches and kicks you were feeling earlier, the movements during this time may be gentler, rolling type of movements.
· Undergo a follow-up ultrasound if your practitioner orders one. This ultrasound can confirm that the baby is growing normally and has a good amount of amniotic fluid. Most practitioners also follow growth by measuring your uterine height every time you visit.
The top of your uterus is midway between your navel and your sternum. By 32 weeks, your baby weighs from about 3 pounds, 11 ounces to 4 pounds (1.8 kg) and is 16 to 17 inches (43 cm) long.
Weeks 33 to 36
During this time, you may be feeling lots of rhythmic fetal movements, which are really the baby hiccupping — a normal occurrence. These hiccups can continue even after the baby is born. If you’re having twins, you should be well prepared for their arrival now, because on average, twins deliver at about 35 to 36 weeks.
The following considerations come into play now:
· Get a culture taken for GBS (group B strep). Your doctor tests for these common bacteria that can be found in the vagina or rectum. If your GBS culture is positive, your doctor will place you on antibiotics during labor to prevent the baby from contracting the infection. There isn’t any point in treating it earlier, because it can just come back again.
· Continue to pay attention to the baby’s movements. Even though you’re used to feeling kicks and punches, it’s normal for the intensity of these movements to decrease during these last weeks of pregnancy. It’s the number that is important, though, rather than the intensity. See Book 2, Chapter 3 for more about fetal movements in the third trimester.
The top of your uterus is a couple of inches below your sternum. At or just after 36 weeks, your doctor will see you at least once a week until you deliver. Your baby weighs about 5 pounds, 2 ounces (2.3 kg) and is almost 18 inches (46 cm) long.
Weeks 37 to 40
Congratulations — you are now considered term. Even though you may not yet be at your due date, any delivery that occurs at or after 37 weeks is considered a full-term delivery. You may notice irregular contractions that come and go in spurts. The big event can happen at any time during this period, so be prepared — day or night.
Do the following to ensure that you’re ready for the big day to arrive:
· Make sure that your bags are packed and you have the phone numbers of your practitioners handy! If you have other children at home, make sure you have all the arrangements set for their care, in case you go into labor.
· Watch for signs. Loss of your mucous plug, bloody show, or loose stools may happen during the days before labor to indicate that labor is coming. Unfortunately, they don’t determine when labor will happen with any certainty.
The average baby at full-term weighs about 7.5 pounds (close to 3.5 kg), but there is a wide degree of variation in what’s considered normal. At this point in pregnancy, your baby will put on about a quarter of a pound per week until delivery. The top of your uterus should be at or just below your sternum or breastbone. Babies at 40 weeks average about 20 to 21 inches (51 to 53 cm) long.
Weeks 40 to 42
Don’t worry — the end really is in sight. If you haven’t gone into labor on your own, your doctor will likely schedule you for either induction or cesarean section by 41 to 42 weeks. If you’re older than 35, and especially if you’re older than 40, your doctor may want to deliver you sooner. Because the risks to continuing the pregnancy really increase after 41 to 42 weeks, your baby should be delivered by then. Your doctor makes sure your baby remains healthy during this time:
· Your doctor monitors you with non-stress tests to check on fetal well-being. This is a noninvasive way to make sure the baby is tolerating the in-utero environment. (See Book 2, Chapter 3 for more information.)
· Your doctor checks the amount of amniotic fluid present to make sure it’s still adequate. The amniotic fluid volume usually tends to decrease after 36 weeks, so it isn’t uncommon for it to be low at this time. Low amniotic fluid volume is a common reason for labor induction during this period.
Although the baby continues to grow after 40 weeks, the rate of growth slows a little, and he may not put on the quarter pound per week that he did in the few weeks before 40 weeks.
Common Tests during Pregnancy
Table 1-1 lists common tests that may be recommended during your pregnancy. Some of these tests may not be recommended for every pregnancy but are included for the sake of those who need them.
Table 1-1 Common Tests during Pregnancy
|
Test |
Gestational Age (Weeks) |
Purpose of Test |
|
Dating ultrasound |
7–12 |
Confirms viability of pregnancy, establishes due date, rules out multiple gestations |
|
Harmony, MaterniT21, Panorama, or Verifi |
9–20 |
Screens for genetic defects in the fetus |
|
Nuchal translucency test (ultrasound) |
11–12 |
Part of the first-trimester screen for Down syndrome |
|
Chorionic villus sampling (CVS) |
10–12 |
Samples the placental tissue for genetic abnormalities; recommended for some women but should be offered to all women |
|
AFP/quad screen |
15–18 |
Screens for defects such as spina bifida and completes the second-trimester screen for Down syndrome |
|
Amniocentesis |
16–18 |
Samples the amniotic fluid for genetic abnormalities; recommended for some women but, again, should be offered to all women |
|
Anatomy ultrasound |
18–22 |
Looks at the baby from head to toe to make sure he is developing normally (to rule out many birth defects) |
|
Glucose screen |
24–28 |
Tests for gestational diabetes |
|
Group B strep (GBS) swab |
35–37 |
Sees if the birth canal is colonized with group B strep bacteria (if so, Mom will be given antibiotics during a vaginal delivery to protect the baby) |
|
Non-stress test (NST) |
40–42 |
Tests the baby’s heart rate patterns to determine fetal well-being, despite going past his due date; often done earlier in pregnancy for other complications like high blood pressure and diabetes |
|
Biophysical profile (BPP) |
40–42 |
Determines fetal well-being; often done earlier in pregnancy for other complications; includes an assessment of amniotic fluid volume |