Pregnancy and Childbirth

Childbirth is one of nature’s greatest wonders. We live in an age where we expect a perfect outcome but throughout history until just a couple of generations ago, childbirth was a most precarious event. Mercifully mortality has been reduced to just 2% compared to a century ago and we can now concentrate more on the outcome for the baby.

We are increasingly turning to the internet for information. Questions about health are amongst the more common reasons for Web searches.

Patients rightly wish to be involved in decisions about their care. There are often options relating to investigations and management. The purpose of this Web site is to present the background for decision making and to explore areas of current debate.

For those without medical training, all medical terms in the text have a link to the explanation. ‘Obstetric Health .com’ is for discerning people who wish to appreciate the background to pregnancy related treatment options. Health professionals, including nurses, medical students, junior doctors and general practitioners looking for a text that provides a balanced discussion of the issues, rather than a basic review of the essential clinical facts, may find this book helpful not only for obstetrics and midwifery but as a framework for the caring aspects in the art of medicine.Those studying for postgraduatequalifications, may find the presentation, with links to clinically relevant medical abstracts, to be of assistance.

Links to the abstracts of selected medical papers are provided to allow a more in depth understanding. This area of the Web site will be an ongoing project. The ethos of this e-book is to explain the advantages and disadvantages of the various options whilst leaving it to each individual to come to their preference according to their particular circumstance.

During pregnancy one (or more) offspring, known as an embryo (early pregnancy) or fetus (from about 8 weeks into the pregnancy), develop inside the uterus of a woman. Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as “fertilization”, or more commonly as “conception”. The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination and in vitro fertilization (IVF) has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility). In the majority of human pregnancies, only one baby develops (singleton pregnancy) but there can be more (multiple pregnancy) as in the case of twins or triplets. Some infertility treatments, particularly IVF, are prone to result in multiple pregnancy. The outer layers of the embryo grow and form a placenta, for the purpose of receiving oxygen and essential nutrients and removing carbon dioxide and waste products. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of foetal development.

Obstetrics and the Pregnant Woman

Obstetrics is the medical field that studies and treats pregnant women and the doctors who specialise in obstetric medicine are known as obstetricians.

Childbirth usually occurs about 38 weeks from fertilization, i.e., approximately 40 weeks from the start of the last menstruation.

A commonly used scientific term for the state of being pregnant is gravid, and a pregnant woman  is sometimes referred to as a gravida.  Similarly, the term “parity” (abbreviated as “para”) is used for the number of previous deliveries occurring after 24 weeks. Women who have never been pregnant before are referred to as “nulliparous” and during a first pregnancy as a “primigravida” (“gravida 1, para 0”) and in subsequent pregnancies as “multigravida” or “multiparous”. Hence during a second pregnancy a woman would be described as “gravida 2, para 1”.

Pregnancy is divided into three trimester periods. The first trimester of pregnancy concludes at 16 weeks and carries the highest risk of miscarriage. In some cases the fertilized egg might implant itself in a fallopian tube, causing an ectopic pregnancy. The second trimester of pregnancy tends to be less prone to complications. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as “quickening”, can be felt. This typically happens by the fourth month. The placenta is now fully functioning The third trimester of pregnancy commences at 28 weeks and approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.  The use of modern medical intensive care technology has greatly increased the probability of premature babies living, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance.0801 Theseadvances in the quality of neonatal care have resulted in survival of many babies delivered at 24 weeks and even earlier. An unfortunate complication of extreme prematurity is morbidity.

Calculating Dates In Pregnancy

Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. Though pregnancy begins at implantation, it is more convenient to date from the first day of a woman’s last menstrual period (LMP). Starting from one of these dates, the expected date of delivery (EDD) can be calculated. Counting from the LMP, pregnancy usually lasts between 37 and 42 weeks, with the EDD at 40 weeks, or 38 weeks following conception. 40 weeks is nine months and six days, which forms the basis of Naegele’s rule for estimating date of delivery. Less than 10% of births occur spontaneously on the EDD; 50% of births are within a week of the due date, and almost 90% within two weeks. Dating a pregnancy is only a rough estimate, and the process of accurately dating a pregnancy using the LMP method is complicated by the fact that not all women have 28 day menstrual cycles, nor ovulate on the 14th day following their last menstrual period. Unless a woman’s recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown.

Pregnancy is considered ‘at term’ when gestation attains 37 complete weeks but is less than 42. Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered to be post-term. When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly. This is one indication for obstetricians to recommend induction of labour, generally between 41 and 42 weeks.(Induction of Labour)Obstetricians have tended to refer increasingly topre-term and post-term rather thanpremature andpost-mature.

Accurate dating of pregnancy is important for several reasons. It is used in determining the significance of results of various prenatal tests such as the triple test – a screening test for Down syndrome. Assessment of the appropriateness of the fetal size depends on an accurate knowledge of the gestational age. Interventions may be indicated if the fetus is small or large for dates. A decision may be made to delay delivery if labour begins prematurely and to administer steroids to reduce complications or to induce labour (Induction of Labour) if a fetus is believed to be overdue.

A number of symptoms and signs are associated with pregnancy

 

Symptoms and signs of pregnancy:-

Missed Period If you have normal regular cycles then a missed period is more than likely can indicate a pregnancy. On occasion  or it may be related to an illness or stress. It is considered one of the major possible symptoms of pregnancy.
Unusual or abnormal period A period or menstrual cycle that is different in some way. The period may be last longer or shorter. It may be a difference in the amount of flow. Any of these variances may indicate that you are pregnant.
Just “feeling” pregnant Many women just know when they are pregnant.
Nausea and Vomiting If you were to ask women to name a single pregnancy symptom, morning sickness would be at the top of everyone’s list.
Increased urinary voiding The urgent need to empty the bladder, even small amounts, throughout the day and night is caused by pressure of the enlarging uterus on the bladder. It is helpful not to drink too much just before going to bed. No treatment is needed for urinary Frequency alone but if micturition becomes painful, urinary infection should be excluded.
Food aversions or cravings  When you’re pregnant, you might find yourself turning up your nose at certain foods, such as coffee or fried foods. Food cravings are common, too. Like most other symptoms of pregnancy, these food preferences can be chalked up to hormonal changes ? especially in the first trimester, when hormone changes are the most dramatic.
Heartburn and Constipation The smooth muscle of the stomach and bowel relax more in pregnancy in response to progesterone, the pregnancy hormone. You may require antacids for the heartburn. Ensure adequate fluid intake to reduce constipation. Mild laxatives may occasionally be required.
Positive Pregnancy Test Modern pregnancy tests are extremely accurate, often being positive even before a missed period.
Ultrasound Ultrasound may be able to show the pregnancy from about 5 weeks.
Fetal Heart Tones With modern sonicaid monitors, the baby’s heart beat can be heard from about 14 weeks.
Tender Breasts Early in the first trimester you may notice that your breasts are sore or tender. For some women this is also a sign of an impending period, so it may go unnoticed. You may have a slight tenderness when you touch your breasts or you can have the severe pain whenever you wear a bra. Both variants are normal and are usually most intense in the first trimester. This is one of the reasons that sex in the first trimester is often avoided by some women. Sex in pregnancy is safe, you may just want to avoid having anyone touch your nipples.
Enlargement of the Breasts Towards the end of the first trimester or the beginning of the second trimester you may notice that your breasts begin to grow. This is again the tissues inside the breast preparing for nursing. Towards the end of pregnancy you will want to be fitted for a nursing bra to help accommodate the larger breasts.
Nipple Colour Changes Your nipples and the area around the nipples (areola) get darker and broader.
Montgomery’s Tubercules These are small goose bump like raised areas on the areola of your breast.
Colostrum from the breasts Colostrum is a pre-milk substance that is high in antibodies and works to get the meconium out of your baby’s system after birth. It can appear at any point during pregnancy, but is not seen in all women.
Changes in libido You and your partner may find your desire for sex increased because you do not have to think about birth control. The vagina is more lubricated and the clitoris and vagina are more engorged. Many women will become orgasmic or multi-orgasmic for the first time during pregnancy because of this added engorgement.
Strange Cravings Some studies show that up to 68% of women will have a craving at some point during pregnancy.
Fatigue This is nature’s way of making you take some extra rest which is probably healthy in pregnancy.
Skin Changes Striae gravidarum, or stretch marks, are probably the most discussed of the skin changes during pregnancy. They appear in 50 – 90 of all pregnant women, usually showing up in the later half of pregnancy. While the majority will be on the lower abdomen they can also be found on the thighs, hips, buttocks, breasts and arms of women. They reflect the separation of collagen of the skin. While not painful the stretching of the skin may cause a tingling or itchy sensation. These are most commonly seen as small depressions in the skin. They tend to be pinkish in light skinned women, and in dark skinned women they will be lighter than the surrounding skin.While many people will swear by certain creams or lotions, the truth is there’s there is no evidence that any of them are effective. Striae gravidarum are exacerbated if you gain weight excessively and so you may help yourself by taking care of your diet.

 

Quickening (Fetal Movement) This is the time that you feel your baby move for the first time. Fetal movement begins around eighteen weeks into the pregnancy.
Enlarged abdomen As the baby grows the pregnancy begins to ‘show’.
Braxton Hicks Contractions The uterus is a muscular organ and contractions occur throughout pregnancy. As term approaches, they become stronger. This is normal.
Fetus palpable From about 28 weeks you may be able to feel the parts of the baby particularly the head.
X rays With the advent of ultrasound, x-rays are rarely used nowadays in pregnancy.
Emotional Changes Most women experience emotional mood swings. It’s natural to feel doubt, anxiety, and fear about pregnancy and childbirth, as well as happiness, excitement, and anticipation.
Weight gain The average weight gain is 25lb with about 1 pound per week in later weeks.
Fainting This is more common in late pregnancy, particularly if the pregnant woman lies flat on her back and the pressure of the pregnant uterus reduces the blood flow in the big vessels returning blood to the heart. Fainting may occur in early pregnancy and is usually related to sudden change of position, such as when sitting up from recumbency, or standing up from the sitting position. If you feel faint, lie down with your feet elevated and your head flat. Avoid standing for long periods and don’t rush around. Be particularly careful getting up.

Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missed menstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period, increased basal body temperature sustained for over two weeks after ovulation, Chadwick’s sign (darkening of the cervix, vagina, and vulva), Goodell’s sign (softening of the vaginal portion of the cervix), Hegar’s sign (softening of the Vaginal fornix), and Linea nigra, (darkening of the skin in a vertical line on the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy).

The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta (afterbirth). Clinical blood and urine tests can detect pregnancy within a few days of implantation, which is as early as 6-8 days after fertilization.

Following the development of the blastocyst (early embryo) a hormone named human chorionic gonadotropin (HCG) is produced and this stimulates the corpus luteum in the woman’s ovary to produce progesterone (hormone in favour of pregnancy). This maintains the lining of the uterus so that the embryo will continue to be nourished.

An early ultrasound examination can accurately determine gestational age. This method is slightly more accurate than methods based on LMP.9901

Symptoms and Signs of Pregnancy Morning Sickness Nutrition for the Pregnant Woman Calculating Dates in Pregnancy Weight Gain In Pregnancy Sexuality In Pregnancy Pregnancy Week By Week Pregnancy Complications

 

Morning Sickness – Introduction

During the first three months of pregnancy, feeling sick or nauseated is quite common, as is vomiting. Morning sickness can occur in about seventy percent of all pregnant women and typically improves after the first trimester. Most miscarriages occur during this period. The problem varies from woman to woman. Some just feel a little sick in the morning and throw up once, whilst others suffer from constant nausea and frequent vomiting throughout the day. About 75% of women are troubled and the incidence has not changed over 20 years.0301, 0601
For the majority, the nausea stops after the first three months of pregnancy. A few, however, continue to have problems even after four or five months.

Causation

The actual causes of nausea and vomiting are still unknown. It is probably brought about by the hormonal changes. Physiological, psychological, genetic, and cultural components have been quoted as contributing factors0101 although evidence that underlying depression is a risk factor is lacking.0602
It is not increased in association with malformed babies. Younger women are more troubled by it. It is increased when there have been a number of miscarriages. Twin pregnancies are more affected.0601 It is not increased in association with malformed babies. It is increased when there have been a number of miscarriages.0601

There is a some good news. Morning sickness is associated with pregnancies that are less likely to result in miscarriage, preterm delivery, or intrauterine growth retardation.0101 There is no evidence that morning sickness, even if severe, causes any harm to your baby. It has been suggested that morning sickness is promoted by secretion of human chorionic gonadotrophin (hCG), largely on the basis of the coincidence between the onset of NVP and hCG secretion and the peaks of both at around 12 to 14 weeks’ gestation and also the increase in symptoms associated with twins. Furthermore, when there is a hydatidiform mole, hCG and morning sickness are both increased.

Risks of Morning Sickness

If you are vomiting heavily and often, you may lose so much liquid that it causes dehydration. When morning sickness is this severe it is called hyperemesis gravidarum and requires medical attention. This usually requires hospital admission and being given fluids through an intravenous drip.
Reducing Morning Sickness Problems

Treatment generally begins with non-pharmacologic interventions; if symptoms do not improve, drug therapy is added.

In the mornings:-.

  • Do not rush about.
  • Take your time getting out of bed.
  • If you tend to feel really sick in the morning, eat a little as soon as you wake up and before getting out of bed.
  • Ask your partner to bring the food to you, or prepare a snack the night before and leave it beside your bed.

Throughout the day:-

  • Eat little and often, every two or three hours – even if you’re not hungry.
  • Open windows or turn on exhaust fans when cooking and after meals.
  • Cooking in the microwave usually produces less odours.
  • Drink a lot of liquid, preferably 10 to 12 glasses of water, fruit juice or herbal tea each day.
  • Avoid food containing a lot of fat or spices.
  • Avoid alcohol and caffeine.
  • Eat dry crackers, toasted bread or rusks.
  • Ginger tea or ginger tablets can help reduce nausea.0501, 0502
  • Rest several times a day. Lie down with a pillow under your head and legs.
  • Move slowly and avoid sudden movements.
  • After eating, sit down so that gravity helps to keep the food in your stomach.
  • Avoid smells that make you feel sick or throw up.
  • Get some fresh air and exercise by going for a little walk every day.
  • Avoid smoking. Not only is it harmful for you and your child, it also diminishes your appetite.

At night:-

  • Before going to bed, it may help to eat a snack such as a yoghurt, bread, milk, cereal or a sandwich.
  • If you wake up during the night, eating a small snack may stop you feeling sick in the morning.
  • Sleep with the windows open to get some fresh air, if possible.
  • Visit your doctor
  • If none of the remedies mentioned above seem to work.
  • If you vomit more than three or four times a day.
  • If you lose weight.
  • If your vomit contains blood or looks like ground coffee.
  • If you lose more liquid than you can keep down.
  • If you are worried about your condition, or believe that something serious is the matter.
  • Your doctor may examine you for signs of dehydration. A simple urine test (ketones) is often helpful in deciding the degree of dehydration.
  • Anti-sickness tablets, notably antihistamines and pyridoxene (vitamin B6) can be prescribed. There is evidence for their effectiveness and safety of these medications.0301
  • Your doctor will be careful to ensure you are prescribed medication that does not harm your baby.
  • Acupressure was found to be effective in reducing symptoms of nausea but not Frequency of vomiting in pregnant women 9401 but a more recent study0701 found that acupressure therapy is no more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy.

Prenatal medical care is of recognized value throughout the developed world. Periconceptional Folic acid supplementation is the only type of supplementation of proven efficacy.

 

Symptoms and Signs of Pregnancy Morning Sickness Nutrition for the Pregnant Woman Calculating Dates in Pregnancy Weight Gain In Pregnancy Sexuality In Pregnancy Pregnancy Week By Week Pregnancy Complications

Nutrition in pregnancy

A balanced, nutritious diet is essential for a healthy pregnancy. Balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables usually ensure good nutrition. Those whose diets are affected by health issues, religious requirements, or ethical beliefs may choose to consult a health professional for specific advice.

adequate periconceptional folic acid intake has been proven to limit fetal neural tube defects including spina bifida.  Folates (folia, leaf) are abundant in spinach (fresh, frozen or canned), and are also found in green vegetables, salads, melon, eggs and hummus. In Canada and the United States, most wheat products are fortified with folic acid.

There is some evidence that omega-3 (n-3) fatty acids have a beneficial effect on the developing fetus, but further research is required.0701 At this time, supplementing the diet with foods rich in these fatty acids is not recommended, although it seems to be safe.0702 Potenteially dangerous bacteria or parasites may contaminate foods, particularly listeria (soft cheeses may contain listeria, if milk is raw) and toxoplasma. Cat faeces pose a particular risk of toxoplasmosis. Practicing good hygiene in the kitchen can reduce these risks.

Weight Gain In Pregnancy Caloric intake must be increased, to allow for the development of the fetus. The amount of weight gained during pregnancy varies. The recommendation is that overall weight gain during the 9 month period for women who start pregnancy with normal weight be 10 to 12 kilograms. Excessive weight gain can pose risks to the woman and the fetus. Women who are prone to being overweight may choose to plan a healthy diet and exercise plan to help moderate the amount of weight gained.

Sexuality during pregnancy

Most pregnant women can enjoy sexual intercourse throughout pregnancy. Most research suggests that, during pregnancy, both sexual desire and Frequency of sexual relations decrease.0201 In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease. However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies.

Until the mid 20th century, it was considered a socio-moral “taboo” action for pregnant women to engage in sexual activities. This is far from universal however, for example the Talmud recommends it for the health of the mother and child. Sex during pregnancy is a low-risk behaviour except when the physician advises that sexual intercourse be avoided, which may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high-risk for premature labour or bleeding if the placenta is planted low in the uterus (placenta praevia).

 

  How is your due date calculated?

We calculate your due date by simply adding 280 days to the day when you started your monthly cycle. The human gestation period is actually 266 days, so by adding 14 days, which is the average ovulation period to the first day of your cycle, we come to the 280 day figure. Of course, if you have been monitoring your cycle and know when you ovulated, it does make it easier to calculate your conception and due dates.

 

Symptoms and Signs of Pregnancy Morning Sickness Nutrition for the Pregnant Woman Calculating Dates in Pregnancy Weight Gain In Pregnancy Sexuality In Pregnancy Pregnancy Week By Week Pregnancy Complications

 

Week by week pregnancy calendar – Your guide to pregnancy events for you and your baby.

The First Trimester – Up to week 16

 

Within this trimester the most rapid rate of growth and development take place. All the organs have developed. Of course the majority of early pregnancies fare well but complications including miscarriage and ectopic pregnancy can occur. Pregnancy symptoms, such as morning sickness, and pregnancy signs such as an enlarging uterus, occur. By the end of the 1st trimester, your son or daughter will have grown to 3.4 inches (8.7 cm) long and weigh about 1.5 ounces (43 grams).

The majority of babies are healthy but abnormalities such as Down’s Syndrome can occur and you will need to consider your options with regard to antenatal screening.

Pregnancy Week by Week – Weeks 1 – 4

  • Ovulation occurs 14 days before your next period is due.
  • The gender of your baby is determined at the time of fertilization. A spermatozoon carries either an “X” (girl) chromosome or a “Y” (boy) chromosome.
  • Implantation occurs a few days after conception.
  • The neural tube forms – it will develop into the nervous system – brain and spinal cord.
  • The heart and primitive circulatory system rapidly form.

Picture – Four cell embryo

Four week embryo

 

Pregnancy Week by Week – Week 5

  • The first heartbeats begin – If you have an early ultrasound you may not be able to recognize this tiny being as a baby, but there is no mistaking what it feels like seeing your baby’s heartbeat on that screen.
  • The umbilical cord develops – this is your baby’s lifeline in utero. It carries in oxygen, and takes away waste, and supplyies the necessary nutrients for the remainder of your pregnancy.
  • Blood is now pumping – All four heart chambers are now functioning, insuring your baby’s body will receive all it needs over not only the remainder of your pregnancy but throughout life.
  • Most other organs begin to develop – the lungs start to appear, along the brain.
  • Arm and leg buds appear.

 

 

Pregnancy Week by Week – Week 6

Picture of a mother and her baby

  • The arms and legs continue to develop.
  • The brain is growing well – over the course of the remaining months that your baby’s brain will develop over 100 billion neurons?
  • The lenses of the eyes appear.
  • The nostrils are formed. Soon, the nerves running from the nose to the brain develop.
  • The intestines grow – initially these are actually located outside the baby’s body.
  • The length of the baby is measured from the crown to the rump (bottom) as the legs are flexed.

 

 

Pregnancy Week by Week – Week 7

  • The elbows form.
  • The fingers start to develop.
  • Feet start to appear with tiny notches for the toes.
  • The ears, eyes and nose start to appear.
  • Teeth begin to develop under the gums.

 

 

Pregnancy Week by Week – Week 8

  • Cartilage and bones begin to form.
  • The basic structure of the eye is underway.
  • The tongue begins to develop
  • The intestines start to move into the abdomen.
  • The fingers and toes have appeared but are webbed and short.
  • Baby’s length (crown to rump) is 0.61 inch (1.6cm) and weight is 0.04 ounce (1gm)

 

 

Pregnancy Week by Week – Week 9

  • Baby has begun movement.
  • Most joints are formed.
  • Fingerprints are already evident in the skin

 

 

Photograph of a happy couple

Pregnancy Week by Week – Week 10

  • The baby is now called a fetus in “medical terms”.
  • The most critical part of your infant’s development is complete. Now you are headed into a period of rapid growth.
  • While a bit strange to envision, your baby’s head is now about half its length.
  • Eyelids fuse shut and irises begin to develop – eye colour is also determined by this point.

 

 

Pregnancy Week by Week – Week 11

  • Nearly all structures and organs are formed and beginning to function.
  • Fingers and toes have separated.
  • Hair and nails begin to grow
  • The genitals begin to take on the proper gender characteristics.
  • Amniotic fluid begins to accumulate as the kidneys begin to function – this fluid, consisting primarily of water, helps provide a cushion for your baby whilest nestled within your womb.
  • The muscles in the intestinal walls begin contractions that will eventually allow digestion of food.

 

 

Pregnancy Week by Week – Week 12

  • The vocal cords begin to form.
  • The eyes begin to move closer together.
  • The ears shift to their normal place on the side of the head
  • The liver begins to function. It has responsibilities for cleansing the blood, storing nutrients, and providing needed chemicals.
  • The pancreas begins to produce insulin
  • Your baby’s average size is now at a whopping length: 2.13 inches (5.4cm) and weight: 0.49 ounce (14gm)

 

 

Pregnancy Week by Week – Week 13

  • Baby begins to practice inhaling and exhaling movements.
  • Baby’s neck is getting longer, and the chin no longer is resting on his chest
  • The hands are becoming more functional.
  • On your next doctor visit you may be able to hear heartbeat with a Doppler by now.

 

 

Picture of a mother with her twin babies

Pregnancy Week by Week – Week 14

  • The thyroid gland begins to produce hormones that will be used throughout life to adjust the speed of the body’s chemistry.
  • In boys, the prostate gland develops
  • In girls, the ovaries move from the abdomen to the pelvis
  • Your baby’s skin is very transparent still.
  • Lanugo (very fine hair) covers the baby’s body and will continue to grow until 26 weeks gestational age – Generally this will be shed prior to birth. Its purpose is to help protect baby’s skin while in all that water!

 

 

Pregnancy Week by Week – Week 15

  • Occasionally mothers report that they begin to feel some fluttering movements as baby kicks, flails, twists and turns.
  • Your baby’s legs have grown longer than the arms and the body is now longer than the head.
  • The three tiny bones in his middle ear have begun to harden. The auditory centres in your baby’s brain haven’t developed yet,.
  • Eyebrows are beginning to grow and scalp hair begins to show. It will probably change colour and texture after birth.

Pregnancy Week by Week – Week 16

  • Fat begins to form underneath skin, providing your baby with insulation for the coming months.
  • Baby and placenta are now about the same size?
  • The genitalia are developed sufficiently that an experienced ultrasonographer might be able to determine if your baby is a boy or a girl.
  • The heart is pumping as much as 6 gallons of blood a day and beats at a rate about double your heart rate.
  • Your baby has learned to breathe.

 

The Second Trimester – Weeks 16-28

For many women, the second trimester is an enjoyable time — morning sickness has receded and the aches and pain of advanced pregnancy are far in the future. Your body is finally expanding enough for people to realize you’re pregnant and not just gaining a few pounds.

By the end of this trimester your baby is between 11 and 14 inches long and weighs about 2 to 2? pounds and swallowing and hearing have developed. You will notice periods of activity. Check below to see what’s happening with your baby week by week!

Photograph of a pregnant woman in an antenatal clinic

Pregnancy Week by Week – Week 17

  • He or she has a much more normal “human” appearance now.
  • Pads are forming on his tiny fingertips and toes. Soon those individual swirls and whorls will be apparent.
  • Meconium (composed of products of cell loss, digestive secretion and swallowed amniotic fluid), is accumulating in the bowel. This black gooey substance will become your baby’s first motion.
  • The skeleton is transforming from cartilage to bone. The head bones remain flexible to make the journey through the birth canal easier.

Pregnancy Week by Week – Week 18

  • Vernix, a white protective material, forms on baby’s skin, and together with the lanugo, serve to protect your baby’s skin during the months in water.
  • Tiny air sacs called alveoli begin to form in lungs.
  • Features of your baby’s heart, including ventricles and chambers, should be visible during an ultrasound.

Pregnancy Week by Week – Week 19

  • Throughout baby’s body, nerves are being coated with a fatty substance called myelin, which insulates the nerves so that impulses can flow smoothly.
  • Scalp hair becomes apparent this week.
  • The milk teeth buds have already developed and over the next few days the buds for the permanent teeth will begin to form behind the milk teeth.
  • If baby is female the uterus starts to develop. If you’re having a girl, the vagina, uterus, and fallopian tubes are in place.
  • If it’s a boy, the genitals are distinct and recognizable.
  • Your baby is swallowing amniotic fluid and his or her kidneys are making urine.

Pregnancy Week by Week – Week 20

  • The rapid growth stage is about over.
  • The legs are reaching their relative size. With the increase muscle develop occurring as well, you will start feeling much more than tiny flutter kicks soon!
  • Antibodies are being transferred from you to your baby now. They will protect your child.
  • The nerve cells for taste, smell, hearing, seeing, and touch are now developing in specialized areas of the brain. Production slows down as existing nerve cells grow larger and make more complex connections.
  • Your baby may startle in reaction to loud sounds.
  • Baby is about 6.46 inches (16.4cm) and weighs around 10.58 ounces (300g).

Pregnancy Week by Week – Week 21

  • Leukocytes, the white blood cells, are under production. The form our body’s defence systems, helping to fight infections and diseases.
  • Your little one’s skin becomes more opaque.
  • The tongue is fully formed.
  • Unlike males, females have a limited supply of gametes in their lifetime. At this point your daughter will have 6 million eggs. This amount decreases to approximately one million by birth.
  • Baby swallows more this week. After your baby takes in amniotic fluid, his body absorbs the water in the liquid and moves the rest into the large bowel. This is good practice for the digestive system.
  • Wake and sleep periods become more consistent.
  • Length is now measured crown to heel.

Pregnancy Week by Week – Week 22

  • Eyelids and eyebrows are fully formed.
  • Fingernails have grown to the end of the fingers.
  • If your baby is male his testes begin their descent to the scrotum.
  • Primitive sperm have formed and he is producing testosterone.

Pregnancy Week by Week – Week 23

  • The proportions of the body are now quite similar to a newborn although thinner since he hasn’t begun to form body fat.
  • The bones of the middle ear harden.
  • The eyes are formed, though the iris still lacks pigmentation.
  • The pancreas, essential in the production of hormones, is developing steadily with production of insulin, important for the breakdown of sugars.
  • If born now, your baby has a 15% chance of survival, his odds going up with each passing day.

Pregnancy Week by Week – Week 24

  • Taste buds begin to form.
  • Little creases have appeared on the palms.
  • Over the next seven days the sweat glands will be forming in the skin.
  • Cells start developing in the lungs that will produce surfactant, a substance that helps the air sacs inflate easily. Without surfactant the fetal lungs would stick together and couldn’t expand after the baby is born.
  • This week your baby is officially considered viable.
  • Baby weighs 1.3 pound (600gm) and is 11.8 inches (30cm) long — almost the length of a ruler!

Pregnancy Week by Week – Week 25

  • Your baby’s nostrils begin to open.
  • The nerves around the mouth and lip area show more sensitivity. When baby is rooting for food later on, these will be valuable.
  • Swallowing reflexes are developing.

Pregnancy Week by Week – Week 26

  • To support the fetus’s growing body, the spine is getting stronger and more supple.
  • Although they’ve been sealed shut for the last few months, your baby’s eyes are opening and beginning to blink this week. Depending on ethnicity, some babies will be born with blue or gray-blue eyes, which may change colour in the first 6 months of life and some will be born with brown or dark eyes.
  • Retinas begin to form.

Pregnancy Week by Week – Week 27

  • Response to sound grows more consistent toward the end of the seventh month, when the network of nerves to the ear is complete.
  • Lungs continue to grow and prepare for functioning outside of the womb. Each day in the womb greatly increases survival rates.
  • Eyelids are now open more.
  • Retinas have formed.

Pregnancy Week by Week – Week 28

  • Eyebrows and eyelashes are now very noticeable.
  • Hair on baby’s head is growing longer.
  • Eyes are completely formed now.
  • Your baby’s body is getting plump and rounded. Most of that increase is muscle tissue and bone. Fat will be added during the third trimester.
  • Lungs are capable of breathing now but baby would still struggle and require medical attention if born now.
  • Your baby weighs in now at 2.2 pounds (1005gm) and is 14.8 inches (37.6cm).

 

The Third Trimester – Weeks 28 to delivery.

 

You’re in the homestretch now. This is the time for childbirth classes. As the anticipation rises though, so may those feelings of anxiety and even a bit of fear. Don’t worry, as all these emotions are perfectly normal.

This pregnancy is suddenly very real. That due date that was once so far away is looming ever closer. Your baby is making his or her presence known with karate kicks, twists and turns until there simply is no more room.

The third trimester as the one where the finishing touches are added. The majority of pregnancies run smoothly but complications such as premature labour, gestational diabetes, and pre-eclampsia can occur.

Pregnancy Week by Week – Week 29

  • Your baby’s head is in proportion with body now.
  • Fat continues to accumulate under the skin..
  • Your baby’s brain can control primitive breathing and body temperatures.

Pregnancy Week by Week – Week 30

  • A pint and a half of amniotic fluid surrounds him. As he grows and fills your uterus, the amount of amniotic fluid will decrease.
  • Early lanugo is beginning to disappear that served to protect your baby’s skin from the water in the womb. Your little one’s own hair may begin to appear.
  • Toenails are entering their final growth stage.
  • Bone marrow is now in charge of red blood cell production.
  • Your baby has the capability now to produce tears.

Pregnancy Week by Week – Week 31

  • The rate of physical growth slows down just a bit, but even though she doesn’t get much longer.
  • Fat continues accumulating. This layer of fat turns the skin from red to the rosy pink of a newborn.
  • The brain enters another period of rapid growth, producing hundreds of billions of new nerve cells.
  • The lungs are the only major organ left to complete development.

Pregnancy Week by Week – Week 32

  • All five senses are working. Your little one is fascinated and practicing testing these out as much as possible!
  • Toenails are completely formed.
  • Brain scans have shown that babies have periods of dream sleep (REM) starting around the eight month.
  • Your baby is up to 3.75 pounds (1702gm) now and is 16.7 inches (42.4cm) long.

Pregnancy Week by Week – Week 33

  • Amniotic fluid is at its highest level during your pregnancy.
  • Neurons and synapses are developing in huge numbers — forming connections in your baby’s brain will provide the skills needed to thrive as a newborn. This week coordination of sucking and swallowing with breathing become better developed.
  • While most bones are hardening, the skull is relatively pliable and not completely joined. The bones will be able to move slightly to make birthing easier.

Pregnancy Week by Week – Week 34

  • Antibodies from your blood continue being transferred from you. These immunities continue to build until birth. Then breast milk will add even more protection against disease.
  • Your baby may have already turned to a head-down position in preparation for birth. If he is your first baby, he may be settling into the pelvis with his head pressing against your cervix.
  • Fingernails have reached the end of the fingertips now.

Pregnancy Week by Week – Week 35

  • Most babies born now will survive and without many long-term problems.
  • Fat accumulations plumps up the arms and legs this week. These layers of fat will help regulate body temperature. They also provide those cute little dimples on elbows and knees.
  • Hearing is fully developed.
  • The testes have completed their descent in males.

Pregnancy Week by Week – Week 36

  • If he hasn’t already, this week your baby may drop into the birth canal (engagement). While breathing for mum becomes easier, walking may be the exact opposite! If he’s not your first baby, this “lightening” may not occur until right before labour.
  • Skin is becoming smoother, “baby” soft.
  • Your child’s average size is now 18.66 inches (47.4cm) and 5.78 pounds (2622 g).
  • Pregnancy Week by Week – Week 37
  • The baby is now officially full term.

 

Pregnancy Week by Week – Week 38

  • Your child’s intestines are accumulating lots of meconium.
  • Circumference of head and abdomen are about the same size for your baby.

 

Pregnancy Week by Week – Week 39

  • The lanugo has mostly disappeared, but you’ll probably find a bit on her shoulders, arms and legs and in those protected little bodily creases.
  • The lungs are maturing and surfactant production is increasing and fully prepared.
  • His body continues laying on the fat stores that will help regulate his body temperature after birth. In addition to normal fat, a special “brown” fat is accumulating in the nape of his neck, between the shoulders and around organs. Brown fat cells are important for thermogenesis (generating heat) during the first weeks.

 

Pregnancy Week by Week – Week 40

  • Much of the vernix has vanished but you will notice traces on the body.
  • 15% of your child’s body is fat. Approximately 65 percent is water!
  • Small breast buds are present on both sexes.
  • Any day you will be cradling your son or daughter!

 

Pregnancy Week by Week – Week 41

 

Complications in pregnancy

Complications in pregnancy include:

Miscarriage

Ectopic Pregnancy

Urinary Tract Infection (UTI – Cystitis)

Intrauterine Growth Restriction

Depression

Gestational Diabetes

Obstetric Cholestasis

Preterm Delivery

Pre-eclampsia

Multiple Pregnancy

Breech Presentation

Postterm

Thrombo-embolism

Careful management is required for pre-existing risk factors including:

Teen Pregnancy

Obesity

Smoking

About this time, your obstetrician is likely to recommend that labour be induced as there is a risk that the function of the placenta will become inadequate.