How it all begins
Now that a couple has decided to go ahead and have a baby, let us see how it all happens – I mean how a new human being starts developing within the mother.
What is conception? To understand the phenomenon you need to have some idea of the process of ovulation. In simple words, it means shedding of ripe eggs (ova) from the ovary, the female egg-producing organ. The ovum enters a tube that joins the uterus. One of the would-be-father’s innumerable sperms may meet it and fertilise the woman’s ripe egg to form a zygote. After fertilisation, the zygote shortly divides into equal new cells.
What is quite fascinating is that each of the two new cells has a fundamental structure of the original combined cell. In simple words, it contains half of the chromosomes (bodies carrying inherited characters from parents to child) from the father and half from the mother. It is, therefore, at this very early stage that the child’s inheritance is decided.
The cluster of cells resulting from the sperm-and-ovum meeting in a few days passes from the tube down into the uterus. It is here in the lining of the uterus that the cluster buries itself firmly for further growth. Thus fertilisation and implantation together constitute what is called conception. It marks the cessation of menstruation. If, on the other hand, the thick warm lining fails to receive a fertilised ovum, it gets shed in the form of menstrual flow – a process which is repeated as menstrual period every month in every normal woman until she reaches menopause.
Most experienced mothers seldom find much difficulty in recognising a pregnancy. This may not be true in the case of young women who are becoming mothers for the first time.
Stopping of the menstrual period is usually the earliest sign of pregnancy. It should, however, be remembered that a woman may miss her period just out of anxiety rather than as a result of conception. Secondly, the menstrual period may be missed by some women with irregular and scanty periods. In any case, as and when a suspicion about occurrence of pregnancy arises, it is advisable to consult your doctor who knows how to confirm it.
Morning sickness usually accompanies early stages of pregnancy. The woman wakes up with nausea and may vomit. In subsequent weeks it slowly subsides.
By the end of the first month changes occurring in the breasts in preparation for producing milk for the baby, cause their fullness and tenderness.
By the third month a pregnant woman becomes aware of a mass in the lower abdomen which by then starts protruding.
The so-called “quickening” refers to the movements of the foetus (baby in the womb) felt on palpation of the abdomen of the mother. The sign occurs as the pregnancy advances.
As soon as it becomes clear that pregnancy has resulted, arrangements should be made to attend an antenatal clinic at a hospital, health centre or dispensary. It is advisable to have good medical care right at the outset rather than when pregnancy is fairly advanced.
How long will the pregnancy last?
A well-founded query in the mind of every pregnant mother, particularly if it is going to be her firstborn is how long will the pregnancy last?
As a convention it is held that an average pregnancy lasts 280 days (40 weeks) from the first day of the last menstrual period the woman had. Since it is very difficult to be sure of the actual date of conception, the conventional method comes in handy as a convenient way to calculate the expected date of delivery (EDD). For an approximate EDD, add seven days to the first day of last period and go three months behind or nine months ahead.
Three trimesters of pregnancy
The first three months are the most crucial as the baby’s organs such as heart, brain, kidneys, eyes, etc., are formed during this trimester of pregnancy. Infections, such as German measles, during this period can do grave harm to the foetus.
How does the baby grow inside the womb?
The small bundle of cells implanted in the wall of the womb are differentiated in the first three weeks into two major groups. The first group forms in due course, arms and legs, and heart and lungs. The second group forms part of the umbilical cord that joins the foetus to the placenta, popularly known as the afterbirths. The latter is a saucer-shaped mass of blood vessels and soft tissue. It is through this that the foetus obtains its nutrition from the mother. It also provides certain hormones for the maintenance of the pregnancy.
As the foetus approaches fourth week, a head, a trunk and arms and legs have already developed. It remains encased in a waterproof membrane. The water in the case keeps the baby protected from outside shock and also keeps it warm.
The sixth week shows development of remarkable features. The embryo measures about an inch in length and weighs 1/30th of an ounce. It has taken the shape of a human face with eyes, nose, ears, lips and tongue and buds of milk teeth buried in the minute gums. Muscles, skin and a soft skeleton as also a tiny brain and heart with minute blood vessels are there. The stomach has begun to produce the digestive juices, so are the liver and kidneys making a beginning of their future task.
At the end of the eighth week, external sex organs show up. However, it is nearly impossible to make out the baby’s sex from the appearance of these ambiguous organs.
Between 16 and 24 weeks the baby’s heartbeat can be heard by a doctor.
By the end of 24th week, the foetus is around 12 inches in length. Its weight is about 1.5 pounds. In a healthy woman, it should increase its weight nearly five times in the last trimester of pregnancy. It is during this period that the mother may become increasingly conscious of the baby “kicking” inside the womb. Many authorities believe that the greater the kicking and thumping – to the extent of exhausting the mother – the higher the chances of the baby growing into an active adult who will always be on the move. Professor W.E. Clark has in his anthology, On Infancy to Adulthood, quoted Freud as saying, “a baby who lies quietly in mother’s tummy is a candidate for becoming an easygoing individual.” It is during these last 12 weeks that the baby attempts sucking his fingers. He may attempt to cry as well, without producing a sound.
Antenatal check-up and booking
As soon as a woman becomes aware of the pregnancy (or even suspects it), she should have an antenatal check-up and then follow it regularly throughout the pregnancy. A woman who fails to take care of herself during pregnancy is less likely to give birth to a healthy baby.
At the first antenatal check-up, the doctor would like to have the pregnant woman’s medical history, make a physical examination and do a few tests. He may ask about the present and past state of your health, as also about your earlier pregnancies (if any), the family history, your diet and the like. Sitting over some information that may have a bearing on the course or outcome of pregnancy may well prove dangerous. The doctor needs your full cooperation.
A thorough physical examination includes examination of the birth passage (the pre-vaginal examination) and checking the blood pressure (BP). It is also important to make a record of the weight and height. The doctor may also like to have certain measurements of the pelvis, the bony cage through which the baby will ultimately pass during delivery.
The laboratory tests which the doctor would like to carry out include (i) blood examination for level of haemoglobin to ascertain if anaemia is present and for blood grouping (particularly if Rh is positive or negative), (ii) urine examination for pus cells and albumin (a protein), and (iii) stool examination for eggs of intestinal parasites such as roundworm, hookworm, giardia and amoeba.
If your obstetrician suspects foetal abnormalities, he may like to do such sophisticated investigations such as –
- Alpha-fetoprotein (AFP)
- Chorionic villus sampling (CVS)
Abdominal ultrasound You should attend the antenatal clinic (or perhaps your obstetrician can do it at your own place) once a month until the seventh month. After the seventh month such a check-up should be once in a fortnight. During the ninth month, it should be every week until delivery. At the time of antenatal check-ups, the would-be mother should discuss with the doctor any emotional problems or apprehensions (about the pregnancy) she may have, which may be causing undue tension. It is not just your physical health that is important, you should be healthy emotionally too. Most pregnancies with good antenatal care would end up happily. Yet the pregnant woman should remain vigilant and alert. Report to your doctor if the morning sickness is severe and adamantly persistent, or there is any vaginal bleeding, swelling of feet and ankles, blurring of vision, persistent headache/giddiness, leakage of water from womb or cessation of foetal movements.
Care of the mother-to-be
The pregnant woman needs a well-balanced diet. It will be advisable to include fresh vegetables, fruits, milk, cheese, eggs, meat and fish in the daily food.
There is no truth in the saying that the pregnant woman should eat enough for two. Too much of eating may cause extra weight gain, putting excessive load on the already overburdened liver and kidneys. Excess weight is also likely to increase her discomfort when the abdomen becomes enlarged. There is also a risk of permanent marking on her skin and impairment of her figure after childbirth.
That a pregnant woman should eat very little to safeguard against difficult delivery is again a myth.
What, then, is the precise recommendation? Well, you should eat a well-balanced diet and little extra of everything that you normally take when you are pregnant. This will amount to some 300 additional calories every day.
A well-balanced diet does not mean expensive foods but foods that provide energy and foods rich in proteins, vitamins and minerals. Energy-giving foods include rice, wheat, maize, potatoes, sugar, jaggery, fats and oils. Protein-rich foods include pulses, peas, beans, nuts, milk, meat, fish and eggs. Fruits (orange, banana, mango) and vegetables (carrot, spinach, methi, mustard leaves, mint) are rich in vitamins and minerals.
Alcohol and smoking should decidedly be given up by the pregnant woman. There is now convincing evidence that smoking, especially in the last trimester, may cause growth retardation of the baby that is in the womb. Not only that, his brain may also be affected.
Coffee and tea in moderation are permissible. Fig. 2.1: Nutrition tips for pregnant woman
Ordinary dress will do for the first four months. After the fifth month, the pregnant woman should make it a point to wear loose clothing. The garment should not constrict the waist. Instead it should hang from the shoulders, hardly putting any pressure on the abdomen. You may get tailored or ready-made maternity dresses – attractive, loose and comfortable. These should have fairly good allowance for further expansion.
It is necessary to wear a well-fitting brassiere to prevent excessive stretching of the skin under the weight of the large breasts.
Exercise and rest
The pregnant woman needs at least eight hours sleep during night. An afternoon nap is desirable. Every now and then, during daily routine work, she should sit down for a few minutes and relax.
An evening walk done in moderation does a lot of good but should be diminished slowly as the pregnancy advances. As the delivery date is round the corner, short strolls within or around the house are good enough.
Exercise, in one or the other form, is strongly recommended. Any exercise or a sport in which risks of falls or blows are considerable is best avoided. The same can be said about long and tiresome journeys.
She should not feel fatigue as it is the enemy of the pregnant woman.
The time-honoured advice that “pregnant woman should think of beautiful things to ensure a happy baby” continues to hold good even today. A woman who learns to relax and enjoy her pregnancy (never mind even if you have to talk over your worries and problems to experts or other family members to come to terms with your anxiety) will come to the labour room with a relaxed body and a calm, peaceful mind. She is most likely going to have a relatively easier labour. Such a labour leaves the mother happy, cheerful and relaxed. She, in turn, transmits her feelings to her baby, making him relaxed and contended and easy to establish a happy feeding schedule. That is exactly what you need!
Well-nourished mothers who are also free from diseases are known to bear strains of pregnancy better. They give birth to newborns with greater birthweight and higher vitality for growth and development.
Fig. 2.2: Recommended exercises during pregnancy
A pregnant woman should take precaution not to contract German measles (rubella) during early months of pregnancy. Else, the baby may be born with variable physical defects.
Certain medicines may have adverse effects on the foetus. You should, therefore, avoid taking any drug – yes, this includes even the indigenous herbal medicines – without doctor’s advice, especially in the early half of pregnancy. Your doctor may, however, prescribe for you iron, calcium or vitamin pills in case you are anaemic and/or nutritionally lacking in vitamins and calcium. What is important is that you should leave medication to him, even for such commonly-used ones as tranquillisers, paracetamol or aspirin.
Avoid smoking and drinking like the plague.
During the first two trimesters, sexual intercourse is very much permitted, provided that there is no history of past abortion or vaginal bleeding. In the latter situation, it is advisable to go by the advice of your obstetrician.
Fig. 2.3: Precautions during pregnancy
Preparing for breastfeeding
Every pregnant mother must appreciate that the ideal and the most natural method of feeding the baby, at least during the first few months, is breastfeeding. It protects the baby from quite a few infections and diseases and assists in establishing a healthy mother-child relationship. The figure-conscious woman would find an additional gain from breastfeeding. It helps her to shed the fat collected during pregnancy and contributes a great deal towards her attempt to slim down.
Proper care of breasts, in preparation for feeding the baby should begin during pregnancy per se. A well-fitting brassiere and a protective pad are helpful. It should also be seen that the nipples are kept clean and made softer and longer by massage, etc.
Shopping for the baby
Now that the baby is expected in another month or so, the mother should get ready with his material requirements. These are:
- Baby cot with sides to protect against rolling over. No pillow is needed but a foam rubber mattress will be ideal. Sheets for mattresses as also plastic or rubber sheets to protect mattresses from soiling are needed.
- Baby bathtub (plastic).
- Nappies or diapers made of gauze or cotton towel material together with a pad of cotton for wiping the soiled buttocks of the baby, some safety pins and nappy bucket.
- Clothing : napkins, vests, shirts without buttons or zips, caps, sweaters, socks, blankets, etc.
- Feeding equipment: What is strongly and without reservations recommended is that the mother must breastfeed the infant unless there is a solid case for giving artificial feeding. In the latter case, there should properly-designed feeding bottles and nipples, brushes to clean them, milk powder and a container if cow’s milk is not regularly available and a kettle for sterilising the bottles.
- Pram will prove handy for carrying the baby once he is more than three to four months of age.
- Baby soap, powder, cream and oil.