Archive for March 2011
The second trimester spans from 12-24 weeks and is often considered the most pleasant time of pregnancy. Generally nausea, vomiting and fatigue have subsided and although the mother’s uterus has grown substantially, she is still able to comfortably enjoy many of her normal activities.
During this trimester, many exciting events take place. Sometime between the 15th and 20th week, the mother may begin to feel the baby moving. This may not be as evident to new mothers, who may dismiss these first kicks as gas. This event is called quickening and can be easily overlooked.
During this trimester, the baby is continually developing, expanding and gaining weight. The baby’s organs are still developing. The stomach begins to aid in digestion and the distribution of nutrients and oxygen through the baby’s body. The baby is still considered extremely immature during this trimester. Should the baby be born at this time, the odds of survival are very unlikely. Many of the baby’s organs are still too immature to withstand the demands placed outside of the womb.
The second trimester can also be an exciting time because between the fourth and sixth month many parents get their first opportunity to see their baby via ultrasound. This scheduled appointment with the ultrasound technician can provide valuable information about the baby’s overall growth and development thus far. The technician may be able to identify any growth abnormalities and may also be able to identify the gender of the baby for curious parents. Often being able to see the baby moving and the heart beating gives parents a visual connection and answers many questions they may have had during those early formative weeks.
The normal length of a full term pregnancy is 40 weeks. This length of time includes the two weeks between your last period and approximately when the egg was fertilized. This 40 week span of time is divided into three parts that are commonly called trimesters. Each trimester lasts approximately three months. During each trimester the baby and mother go through changes that are specific and unique to that period of time. In the next three blogs we will be looking at the stages of pregnancy to familiarize ultrasound technicians with what can be expected.
The first trimester encompasses many of the early signs of pregnancy. Some women may experience nausea, vomiting, breast tenderness or swelling, a feeling of fullness in the abdomen and often unexplainable fatigue or exhaustion. These early signs of pregnancy are not guaranteed to affect every woman and are only general signs that are common during this phase. Often women, who do suffer with nausea, vomiting or breast tenderness, experience relief from these symptoms during the second trimester.
The first trimester is considered the most unstable time in a woman’s pregnancy. The risk for miscarriage of a developing fetus is extremely high during this trimester. The tissues and organs form during this time. If the mother is exposed to certain chemicals, drugs, radiation or other harmful agents the potential for damaging the delicate developing tissues of the fetus are high. Depending on the severity of the birth defects that are formed at this time, the fetus may miscarry. Many women are likely to experience this type of spontaneous abortion before they are even aware that they are pregnant. Approximately 20% of all confirmed pregnancies will result in miscarriage. Repeated miscarriages are usually caused from a problem with the uterus, however, two-thirds of all miscarriages are caused from the abnormal development of the growing fetus.
As soon as the egg has been fertilized and has implanted into the soft lining of the uterus, the placenta and amniotic sac forms around the egg. Within a few weeks the developing embryo will develop internal organs that will differentiate it from the embryos of many other animals. The arms, legs, hands and feet begin to form. By the end of this trimester the baby’s heart beat can be heard with Doppler ultrasound.
Some women have a more difficult time conceiving. There are many reasons why this may occur. If you are having a difficult time becoming pregnant, you should speak with your physician. He or she should be able to perform certain tests that can help uncover any imbalances or conditions that may be causing your infertility. Your physician can also discuss ways that you may be able to increase your chances for conception.
There are several medical conditions that can affect a woman’s fertility. A hormonal imbalance that can cause ovarian cysts is called polycystic ovary syndrome. This syndrome is a common problem related to female infertility. Endometriosis is another condition that occurs when cells from the lining of the uterus spread to other areas and cause scarring and blockages that can affect fertility. Hormonal imbalances can also affect ovulation. Low levels of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can also make conception difficult. This is because these hormones are responsible for triggering the release of an egg from the ovary. Another possible problem may be due to low levels of progesterone which may be too low to sustain a fertilized egg. Some women may have an abnormally shaped uterus that makes fertilization difficult, or perhaps the uterus has been scarred making the implementation of an egg extremely difficult. It is also possible that some women have a low egg supply.
There are several procedures that are available to help women with fertility problems to conceive. In Vitro fertilization (IVF) is the most widely used treatment. This procedure is a seven-step process that can be used for most fertility problems. Artificial insemination is another form of treatment that can be performed with donor eggs or the women’s own eggs. This procedure is more complicated than artificial insemination.
An ultrasound examination is commonly performed during the first trimester of pregnancy. There are two types of ultrasound examinations that can be preformed. The nuchal translucency scan can be performed between 11-14 weeks in most health care facilities. The dating ultrasound can be preformed before the first trimester genetic screening. As a nurse midwife it will be important to know the difference between the two different ultrasounds.
The dating ultrasound is primarily used to determine the distance from the top of the baby’s head to its bottom. This measurement is called the crown-rump measurement. The diameter of the head is also measured. This measurement is called the biparietal diameter and is the distance between the parietal bones on either side of the head.
The nuchal translucency scan uses ultrasound to measure the fluid behind the baby’s neck. A general thickness of fluid from 2-3 mm or less is considered a normal amount of fluid. This test is preformed in the first trimester because it has been determined that the size of fluid collection at the back of the fetal neck can correspond to the risk of Down syndrome. Although there is a correlation between fluid levels and Down syndrome, this test is only 80 percent accurate. There is a blood test that is often done in conjunction with the scan. When these two tests are done the accuracy increases to between 85-90 percent. If the nasal bone is measured as well, the accuracy rises to 95 percent.
Your physician or midwife should explain the reliability of these screening tests and will be able to answer any questions or concerns you may have.
Prenatal care can mean many different things to many people. The type of prenatal care available can vary across the US. Before you commit to one type of prenatal care you may want to look into the number of options available to you in your area. In many cases, your medical insurer may limit the types of prenatal care your plan will cover. So, you should consult with your health insurance company to see what types of options are covered by your plan. Most insurance plans give people the option to choose care from a physician, like a family practice doctor or obstetrician, or a midwife. Certified midwives or certified nurse-midwives are another option outside of a traditional physician. Both the nurse-midwife and midwife must graduate from a formal midwifery program and pass a national board exam.
In some instances, women who choose a midwife or family practice physician for prenatal care may still have to follow the care of a specialist. This commonly occurs if a women experiences complications during pregnancy. A specialist may be necessary to monitor her condition and will usually give a plan of care to the midwife or family practice doctor who is responsible for the mother’s prenatal care. In many instances, when this type of situation occurs, the mother will have alternating visits with her specialist and her prenatal doctor or midwife. This type of care that is managed between two parties is called collaborative care and is designed to ensure that the mother and baby receive the best care when complications arise.
A certified midwife or nurse-midwife that is licensed by the state can legally provide care to women during their reproductive years. These healthcare professionals work with women and families and are available to for consultation, collaborative management, or referral in many states.
The first trimester of pregnancy is unique for each woman. Although there are many similar experiences each pregnancy has its own challenges. Here are a few common aches and pains that you may be experiencing. Before you make yourself crazy with worry, here are answers to some very common questions.
Pelvic pain in early pregnancy can be very alarming for mothers. This pain is associated with the soft area between the two pubic bones. Often during pregnancy the soft area swells or separates causing a lot of pain and discomfort. This is believed to be caused by pregnancy hormones and can occur in early or late pregnancy. Often the most pain is experienced when walking or climbing stairs. To help lessen the pain, wear comfortable shoes, use pillows to support the hips and legs in bed and get enough rest. A pain killer like acetaminophen can be taken to help relieve the pain. Serious cases are often referred to a physical therapist who often advises patients to wear a support belt. Severe cases may need to use crutches. Most of these cases resolve after the baby is born.
Headaches are common during the early stages of pregnancy. They are thought to be caused by the change in hormones. Dehydration, low blood sugar, fatigue and lack of sleep can also cause headaches. Women who suffer from regular headaches should increase their water intake to at least eight glasses a day, eat at least three regular meals a day to maintain their blood sugar and get adequate rest.
At some point in your pregnancy you may be asked by your doctor to under go a diagnostic test. Diagnostic tests are commonly requested for mothers who may have an increased chance of having a baby with an abnormality such as Down syndrome. Before most diagnostic tests are preformed a screening test is often done. Your doctor may ask you to take a screening test if you are 35 or over, of if you have a family history that increases your risk of having a baby with an abnormality. Before you undergo any diagnostic test your doctor will inform you of the potential risks involved. There is small risk of miscarriage with every diagnostic test. You can decide whether or not to undergo the test.
Chorionic villus sampling (CVS)- This diagnostic test involves taking a sample of tissue from the placenta. The tissue is used to identify whether your baby has Down syndrome or another type of genetic abnormality. A sample of placenta is extracted because it contains the same genetic information as the baby. This test is usually done when the mother is between 10 and 13 weeks of pregnancy. This test is helpful in determining early in the pregnancy any abnormalities.
Amniocentesis- This diagnostic test is used primarily to determine a chromosomal abnormality. It is commonly used to identify Down syndrome. To do this a sample of amniotic fluid is extracted from the uterus. Amniotic fluid contains cells from the baby’s system and can be used to determine the baby’s chromosomal nature. This test can be offered at around 15 to 19 weeks of pregnancy.
Cordocentiesis- This diagnostic test is also called ‘blood sampling” or percutaneous umbilical sampling” (PUBS). A sample of blood is taken from the baby’s unbilical cord and is used to identify chromosomal defects if earlier diagnostic tests indicate a possible problem.
A spoon is a very simple tool that can be used to feed a baby when breastfeeding is interrupted, when complementary feeding is not sufficient or when colostrum is hand expressed or pumped to complement early feeding and to prevent hypoglycemia. A spoon is also helpful at priming a baby for breast feeding.
There are many advantages to using a spoon over an artificial nipple. A spoon is inexpensive and usually easily available compared to an artificial nipple. It can also be used a s a temporary aid to initiate milk intake if a baby has not latched on yet. A baby who has not latched on may also be more eager to try breastfeeding if their sucking needs have not been met.
There are also disadvantages associated with spoon feedings. These include that spoons must be continually refilled. Unlike bottles that can hold a specific quantity of breast milk, a spoon only holds a small amount of liquid. Also a spoon does not teach the baby how to suck at the breast and can not correct any improper sucking patterns.
Spoon feeding is useful as a short term means for feeding baby. To spoon feed successfully position the baby in a semi-upright position and place the spoon inside the infant’s lips over the tongue. Do not pour the milk into the baby’s mouth. Allow the infant to sip or lap at the milk. Only spoon feed an infant if he or she is alert with a good swallow reflex.
