Articles about Planning Your Pregnancy
Until recently we have not paid too much importance to our gut. But there is now research coming out with a new paper being published every 6 hours around the world with how important the gut and the microbes are to particularly our long term health.
What is the gut to a baby – milk goes in at the top and poo comes out at the bottom. The gut is now known to be the most important part of our immune system. We are full of microbes. In fact we have approximately 1,5kg of microbes in our body. We are full of microbes – there are trillions in our intestines, different ones on our skin, in our mouth, nose etc. Each area of our body has a unique pattern of microbes. There are thousands of different species of bacteria. If we took a swab from say our computer keyboard and cultured it we would have a unique “fingerprint” of microbes. Each individual is unique. People in the same family would have similarities.
Medical conditions associated with specific patterns of gut microbes include diseases such as – asthma, allergies, cancer, autism, dental caries, depression and anxiety, diabetes, ischaemic heart disease, necrotising enterocolitis, obesity, rheumatoid arthritis, sepsis, stroke….. In fact we have 10 times as many bacterial cells as human cells. We carry 150 times as many bacterial genes as human genes. So how does a new baby acquire these essential cells and genes for a healthy being?
Through the birthing process, the new baby is colonised with first colonisers from its first environment. This means different things for different babies. A baby that is born vaginally is exposed to its mom’s vaginal microbes during labour as it is passing through the vagina. The vaginal secretions coat the baby as it is born and these good vaginal microbes enter its mouth, cover its body and are on its fingers. As it is born it passes very close to the mom’s anus where often during labour she has passed a small bit of poo. Baby comes into contact with her intestinal microbes this way. As baby is put on the mom’s chest skin to skin – baby explores his new environment of the mom using the most sensitive part of it – its mouth – licking the mom’s chest, licking the nipple and picking up the microbes from moms skin. Baby then latches on to the nipple and suckles breast milk which has microbes of its own that joins the other first colonisers lining this baby’s gut – in this case giving the baby a healthy microbiome and setting it on a healthy path for life.
For other babies – those born via caesarean – they will have different first colonisers – baby comes through a sterile environment, touched first by latex gloves, placed in a hospital towel. So this baby would be colonised by hospital organisms leading to an unhealthy microbiome at birth and setting the baby up for susceptibility to chronic diseases at birth, purely because of what baby is initially exposed to at birth!
Babies have different microbiota and totally different gut microbes because of the way they are fed – either breast milk or formula. To the extent that babies are 26% more likely to be obese if they were born by caesarean than vaginally.
So is there anything we can do about a baby that is born via caesarean – how can we maximise their exposure to a healthy microbiome? A swab can be placed into the mom’s vagina before the caesar so vaginal secretions can be placed on the baby at birth. A mom can wear a towel from home before the caesar and the good microbes from mom’s skin will coat the towel and ask for the baby to be put on this towel instead of a hospital one first. Baby can be given a good probiotic immediately at birth. These steps will certainly help create a healthier microbiome, but they won’t be as good as a baby that is born vaginally and then exclusively breastfed. Place baby skin to skin as soon as possible in theatre during the caesar.
It is not just a matter of names for a baby and colour schemes for the nursery, now is the time to get to grips with some serious planning about your home, your finances and her job…
Should we move?
This is one of the first questions parents-to-be ask themselves and it is a difficult decision to make. If you do decide to move, don’t assume you have to do it before your baby is born – you may not need more space until your baby is walking or crawling around. If you decide to move during the pregnancy, do it early on in the pregnancy when she has more energy, don’t wait till the last minute and then baby may decide to arrive at the time of the move. Plus she needs to get her nesting in order, to be ready for labour knowing her baby has a place to be well cared in.
Should she change her job or working hours?
Whether she decides to return to work full-time, part-time or not at all depends on your finances, her employer and her attitude to her job. Some people find part-time work brings them the best of both worlds. Some people find going out on their own or consulting gives them real flexibility to manage their time. So whatever she decides now, it is a good idea to leave her some options to change her mind later on. It is worthwhile investing both your time and energy into your baby rather than just in finances to live it up especially initially, give your baby the best start to life by letting mom be there for him, she can return to work later once your little one is old enough to attend a play group
How much having a baby will it all cost?
Remember in this calculation, the older your baby gets the more expensive they become. Don’t just think it is the initial cost of equipment for them and that is it for a while!
How can I protect my family financially?
Having a child is when many people think about “growing up” and take concerns like life assurance and educational policies seriously
Do I need to change our car?
Lifestyles inevitable change when you start a family and this impacts on what you need from a car. Practicality takes precedence.
- Is it big enough? A young family means a lot of stuff – prams, toys, shopping and children take up a lot of space
- Is it too big – try manoeuvring and parking in a confined space to make sure you are comfortable with the car’s handling and size
- Is it easy to fit and remove baby car seats – some cars have larger door openings and a higher seating position, which makes fitting or removing car seats easier and less strenuous
- What is it like in the back with small children, it is often best to keep them company in the back of the car. Make sure you are comfortable with the ride and space in the back seats
The greatest fear as you go off to attend your first official class – is that you will be the only guy there and how horribly embarrassing that would be! Never fear – most guys attend classes with their partner.
Having a baby is such a new and different experience and childbirth education classes will help you grasp this reality. Classes should be a whole lot of fun to attend – you will definitely learn an enormous amount that will help you cope with pregnancy and birth as well as life in general. It is a tremendous help to chat to other guys in the same situation as yourself – and to know the changes that have taken place in your partner are quite normal (what a relief! – she is not going to remain totally crazy for the rest of her life)
Reasons to attend classes
- You learn facts about her body that you never knew
- You get a rare opportunity to safely commiserate with other guys about the joys of having a pregnant partner
- You have an excuse to get out of the house, which doesn’t often happen at this stage of pregnancy
- You don’t have to read all her pregnancy books as long as you pay attention in the class
- You see eye-opening dvds about childbirth
- You will replace your fears with facts, and ignorance with information
- You will learn specific techniques to help you help her, through labour and birth
- You will build a strong relationship with your partner
- You can bond with other expectant parents facing the same challenges, and you will benefit from their support
- You will get a weekly opportunity to quiz an expert with your childbirth questions
- You build up your support system with other dads who are experiencing pregnancy, labour and parenting at the same time as you – they really understand you and your pregnancy situation
- You learn to be her spokesperson when in labour
- You learn to have a new found respect for your pregnant partner with what she has to experience and cope with
The true purpose to attending these classes is for you to both understand the birthing process and hence what normal labour and childbirth are like and how best to cope. Learning how to help and support your partner through this awesome experience that has taken over your entire life. These sessions stimulate discussion en route back home so you can both voice your expectations about your labour and birthing experience. It should definitely bring you closer together as you share your thoughts and dreams together in the most memorable experience of a life time.
By Anchen Verster – Registered nurse, midwife, SA Certified Perinatal Educator – SACPE, wife, mother to 4 children including a set of twins
As the Gynae moved the probe over my 12-week abdomen my husband opened his mouth to say something but the doctor, needing a few seconds to confirm his findings, silenced him. “Well,” he said, “You’re my second couple today expecting twins”. Elation and disbelief filled me. Two hours of giggling commenced (50% nerves, 50% excitement!).
At that doctor visit I was told that I was most likely to deliver the two babies prematurely given a shortened cervix. And so began 26 weeks of anxious days and fretful nights as I anticipated the premature delivery. Along with this ‘prophecy’, a fellow twin mom (her twins were 18 months and she was expecting her 3rd baby) proclaimed that it is impossible to manage twins without two fulltime housekeepers or nannies. Given the fact that our budget didn’t even accommodate one fulltime helper I fell further into the pit of “how will we all survive”. So here’s my list of survival tips if you’re a twin mom or soon to be twin mom…. Incidentally we’ve done more than just survive, I actually enjoyed the twins and feel quite sad that they’re turning 5!
- Make a plan. It was helpful to sit with my husband and verbalize my greatest fears about coping with 2 babies. We worked out a plan to tackle some of the anticipated challenges. For example my husband promised to be home between 5 and 7pm most nights so that he could help with supper, bath and bedtime. If he needed to work late he would start again after 7pm. The idea of that plan before the babies were born was comforting (I actually slept better at night after we decided that) and he stuck to his promise! Your plan could include asking a granny to come at a fixed time each week, using online shopping or doing your weekly shopping on Saturday or Sunday while your partner is at home, freezing some meals before the births…
- Pace yourself. Don’t conquer the world before the babies are born. Most of us feel that we have limited time left when expecting a baby and especially multiples. We think life will end after the babies are born so we renovate or attempt new business goals or generally just wear ourselves out. The burden of sustaining two or three babies is greater on your body and thus the risk of premature delivery increases too. Don’t try and conquer the world during your pregnancy. If you have a closed office or private space at work put your feet up or lie on a mattress on the floor during breaks so that your body can benefit from some down time. If you’re home with a toddler use his nap time to lie flat and rest or catch up on admin while lying down.
- Ignore the doom and gloom or at least try and be realistic about it. I lost count of how many people pitied me after the girls were born – both strangers and friends. Comments like “Rather you than me”, “Double trouble”, “How do you cope, I would die”. Set your own ‘new normal’ parameters. Of course life’s going to change and intensity of the work is more than with one baby but it’s do-able. I remember replying to one comment, “if I could pick out of a list of life challenges (assuming every person on earth has some or other challenge in life) I’d pick twins any day over a challenges like an incurable illness…”
- A bigger perspective. In the span of your 80 years of life, 6-18 months of intensity is actually very little. I know it doesn’t help to think of this in the middle of sleepless nights (believe me I know!) but when you’re planning your parenting style and you are persevering through breastfeeding hiccups it’ll help to think of how little this time is in relation to your life-span. Persevere, knowing that the intensity will ease in a few months and it’ll be worth it to look back at your twin rearing achievements when you’re 80!
- Make use of Multiple Births Resources in South Africa such as SAMBA. They have helpful talks and get-togethers that many multiple parents have found invaluable. However, don’t confuse this resource with childbirth education classes/prenatal classes. They are not interchangeable and provide different kinds of education and support. It’s also very beneficial to get help and support from other ‘multiple moms’! Always be aware that this advice is usually not medical or backed by research so be careful what you follow.
- It is possible to exclusively breastfeed Many moms assume that it’s not possible to provide enough breast milk for two babies and they are often encouraged by their health care providers (believe it or not!) to start supplemental formula feeds very soon after the birth. It’s much easier to ‘outsource’ some of the job of feeding if you formula feed. As I look back, breastfeeding forced me to slow down with my babies and really ‘be’ with them. As I look back those first few months were such a blur of mothering tasks, I am so thankful for the ‘forced’ hours and hours stuck on the bed or couch breastfeeding them. If you’re determined to breastfeed your twins can I encourage you in the following?
- Set your breastfeeding goal prior to the birth. Don’t decide to “see how it goes” because it will be tough at times. These goals may include how long you would like to breastfeed for. For example one year, two years or until your babies self wean? Do you want to only give breastmilk until your babies start solid food? If you are unsure of what you’d like your goal to be then do plenty of breastfeeding research before you decide. During the 3rd night after my twins were born they wouldn’t settle and wanted to drink every hour. I was emotional and tired and the nursing sister on duty tried to persuade me to give some formula. I waddled to the nursery still struggling with post-caesarian pain and a large ‘unpregnant’ belly and pleaded with the staff (in tears) not to give formula. We made it through that night with lots of regular feeding and then next day was better again but how easy it would have been to give that first bottle in hospital if I didn’t know exactly where I was headed with my breastfeeding goal.
- Keep a list of names of Lactation Consultants or book an appointment prior to your hospital admission. Unfortunately unless there is a specialized staff member in the hospital you may be exposed to lots of varied advice and prodding and poking. If you book an appointment in advance you can always cancel it if things are going well.
- Feed your babies regularly. Don’t stick to the hospitals 4-hourly rule if your babies seem to want to feed more regularly. Trust your instinct and follow their cues. The first two weeks of regular feeding can really set you up for better supply later on.
- A breast pump is not always a necessity, but with multiples it can come in very handy. Pumping is a great way to increase your milk supply and it may help when your babies are 8 weeks or so and you want to give them some expressed milk or let dad do an evening feed while you get an early night. Breast pump hire is also an option and may be very beneficial in the first few weeks while you establish what your future pumping needs are going to be. For regular pumping with multiples it is ideal to use a pump that will do the best job in the least amount of time.
- Don’t be pressured into feeding both babies at the same time! If you’ve breastfed before it’ll be easier to latch two babies, but if this is your first time breastfeeding concentrate on getting a good latch with each feed before you get into the rhythm of feeding both at the same time. If they’re ‘easy latchers’ then it’ll be more do-able during the first few days but otherwise wait until the latching is a bit easier. On my second day after the birth a staff member walked into the room and asked me why I wasn’t feeding both babies at the same time. I was highly annoyed, knowing she’d never tried it before!
- Feeding on demand is ideal but this is a bit more complicated with multiples. Follow the cue of the baby who wakes first-let’s say baby A. Either wake baby B and feed them at the same time or finish feeding Baby A before waking Baby B. This is still, in essence, feeding on demand, but by demand of the first waking baby which will not always be the same baby. Alternatively give Baby A ‘main course’, wake baby B for main course then offer them both ‘dessert’ either together or apart. I found I used different techniques depending on how tired I was. If I was too tired I didn’t manage feeding both at the same time. In the first weeks each feeding session (feed, burp, change) took 90mins and they fed every 3hours so I’d have 90 minutes before the next feed began (yes during the night too!). This sounds ridiculous, but the feeding duration gets shorter within a few weeks.
- Use your help wisely. If granny is visiting pass the first fed baby to be burped and changed to her while you feed the next baby. (Then leave both babies with granny while you catch a nap!) The workload with multiples is a bit like a sausage machine and getting tasks done quickly and effectively (using available help) can make a difference to coping. I had a housekeeper three days a week to help with the chores, but I would plan a quick admin or shopping trip while she was there and the twins were sleeping. I also met two University honours students who I paid occasionally to come and help for an afternoon. This was a great help. It also gave the students some exposure at looking after newborns and they developed a special bond with my girls which continues today.
- Get used to some crying. I often chat to parents who never conceptualized the fact that their baby will cry or scream at times. It is abnormal and concerning to have a baby that never cries. I’m not talking about a baby that cries some and then is easily consoled. I mean a baby who doesn’t make use of their communication tool to let you know: “I’m tired”/ “I’m over stimulated”/ “I’m hungry”/ “I want to be held”. With two or three babies in the house your ‘crying threshold’ needs to be a bit higher than a singleton mom’s or dad’s. That doesn’t mean letting your babies ‘cry it out’ but it’s just not physically possible to respond immediately if you are one adult looking after 2 babies. I remember shouting from the shower to two screaming babies (on numerous occasions) “I’m coming my girls, mommy can hear you, I’ll be there soon”. Even calling to them when you can’t lift them immediately lets them know that you hear them. It’s also unrealistic to expect to meet all your regular “activities of daily living” while your babies are asleep or calm. For the sake of your own sanity there will be times you’ll have to put a fussy baby in a safe place (like a baby chair within your vision) while you finish getting dressed. That’s okay! On a few occasions our ‘colicky’ babies would scream late into the night, my husband would be at a work function and our two-year-old would be woken by a thunder storm. My husband would come home to me rocking on a chair in the dark, two crying babies on each shoulder and one crying toddler on my lap and of course the tears were streaming down my face. Thankfully those nights were the exception!
- Keep a box of “extra’s” in the car. It becomes quite bulky carrying around extra clothing and nappies for multiples. Other than the usual nappy bag “stash” I kept an extra plastic box (just bigger than a shoe box) with extra nappies, wipes and clothing in the boot of my car. This meant I always had extras if our day out was unexpectedly long. If your babies are big on bringing up milk you can even keep an extra T-shirt or top for yourself in the box.
- Lower your standards. Part of getting used to the complexity of 2 or 3 babies might mean a messier house, fewer ‘braais’ on weekends or social outings. If you’re a tick box person or fanatical about a spotless house it’ll ease some of the stress to lower your standards a little. Leaving the dishes till the morning might translate into 40 minutes with your partner, which is way more important. You don’t have to bath your babies every night (it’s actually better for their skin and normal flora maintenance). This might mean an extra hour of sleep for you!
- Potty in a pram. Once we started with potty training I kept a potty in the car/ under the pram everywhere we went. It was inside a plastic bag so no-one could see but it made potty training so much easier if the potty was always available. Even if we used a public toilet it was still easier to use our own potty.
- Enjoy your twins or triplets! It’s so easy to work the months and years away with caring for them that you don’t ever take time to enjoy them. Sit and read to them (even from a few weeks old), play with them, giggle with them. Work hard at laying down special memories (for you and them) of your double or triple blessing!
PS my twins were born at almost 38 weeks so the anxiety was wasted!
A new life begins
A woman’s egg is fertilized by a man’s sperm in the fallopian tube. During the next few days, the fused egg and sperm move through the fallopian tube to the lining of the uterus. There it implants and starts to grow. The cluster of cells that reaches your uterus will become the foetus and the placenta. The placenta functions as a life-support system during pregnancy. It delivers oxygen, nutrients, and hormones from mother to foetus.
Pregnancy is a time of major change. From the very start, your growing baby alters your body and the way you live. For your entire pregnancy, the baby depends on you for all the things it needs to grow and thrive. Although each pregnancy is unique, the growth and development of a foetus take place in a fairly standard pattern.
0 – 4 weeks of pregnancy
Common signs of pregnancy
- missed menstrual period
- sore or tender breasts
- frequent urination
The most common sign of pregnancy is when you do not start menstruating at the normally expected time. There are a number of home pregnancy tests on the market or alternatively you can have a BHCG blood test done at the nearest laboratory. As most of these tests are quite accurate you do not need to visit a doctor or midwife until you are 8 weeks pregnant. Miscarriages occur in 1/5 of pregnancies (1 in 20).
Seven days after the egg is fertilised, about the time of implantation in the lining of your uterus, the egg begins to produce a hormone called HCG. It now develops into an embryo and begins to form a placenta – the vital link between mom and baby. The heart develops and begins to beat. At 4 weeks the embryo is about 4mm long and weighs less than 1g.
Boy or girl
The father’s sperm determines whether your baby will be a boy or girl. The egg carries 2 X chromosomes, but the sperm carries an X or Y chromosome. If a Y chromosome sperm fertilises the egg it will be a boy, if it is a X sperm it will be a girl. There is a 50% chance of either sex.
5 – 8 weeks of pregnancy
During these weeks, the placenta is starting to grow and secrete its own hormones. You may start to experience nausea especially in the mornings, breast tenderness and an urge to empty your bladder more frequently. Ensure that your diet contains adequate amounts of iron, folic acid and calcium. If you are not nauseous you can start taking vitamin supplements recommended for pregnant women.
During pregnancy an ideal weight gain is 12,5kg. In order to best prepare your body for this weight gain use an oil to rub in frequently to your skin in susceptible areas for stretch marks like the abdomen, breasts and thighs. Moisturised and well hydrated skin will be better able to accommodate the stretch it will have to endure.
- Average baby – 3,4kg
- Placenta – 0,6kg
- Amniotic fluid – 0,8kg
- Uterus increase – 0,9kg
- Breast increase – 0,4kg
- Blood volume – 1,5kg
- Fat – 3,5kg
- Extracellular fluid – 1,4kg
By 8 weeks of pregnancy you can now have a blood test to determine whether you are expecting a boy or girl! The advantage of this test is that it is available a lot sooner and generally a more accurate test than ultrasound which depends on the position of the baby. It detects the sex of the baby by characterising minute quantities of foetal cellular material which is released into the maternal bloodstream as part of normal foetal development.
Issues to decide
- The birth place
- Your caregiver – midwife, GP or obstetrician
- Routine tests
Signs of premature labour
- Low dull backache
- Vaginal bleeding
- Lower abdominal cramps
Dramatic changes occur during this stage. The nervous system is starting to develop with the growing of the notochord and the neural folds. Formation of the heart and the gut is also in progress. An embryo during this period will normally have a crown to rump length of 2,5cm. The following are present – a primitive brain, a heart, arm and leg buds and beginnings of eyes and ears.
9 – 12 weeks of pregnancy
Your body is starting to change. Breasts may still be tender and you may need to empty your bladder frequently. You may still feel nauseous.
By twelve weeks the foetus’s limbs and internal organs are fully formed and is now about 8,5cm long. The heartbeat can be heard using a doptone. It beats much faster than yours – about 140 beats per minute. For the rest of the pregnancy the foetus only grows and matures – the organs are all now perfectly formed. The placenta is mature and provides all the nutritional needs of the foetus. The external sex organs are sufficiently developed to enable the sex determination on a scan. Skin becomes downy as hair starts to grow.
13 – 16 weeks of pregnancy
Your uterus is now easily palpable above the pubic bone. Your breasts are enlarging and the areola (the dark area around the nipple) may become darker. You may notice a line on your abdomen – the linea nigra – which will disappear after pregnancy. Some women may experience some pigmentation on their face as well. Pressure on your bladder may now be less as the uterus has moved higher up into the abdomen, out of the pelvis.
At 12 weeks the placenta is fully formed – it is the baby’s main link with its mother during pregnancy. It controls body functions and provides vital food and oxygen.
At 16 weeks the foetus is about 14cm long. The legs are starting to grow longer than the arms. Fine hair (lanugo), and vernix caseosa (white greasy substance) is starting to cover your baby’s skin. Some of it is still present at birth, and it protects the baby’s skin, which is very thin.
17 – 20 weeks of pregnancy
At 20 weeks your uterus is just below the umbilicus. Sometimes it may be noticed that the umbilicus gradually flattens as your uterus grows. You may start to feel movement (quickening). First time mothers usually become aware of the movement at a later stage. It sometimes feels like “fluttering butterflies in your stomach”
It is important to talk things over together with your partner about your feelings and not to get trapped in your separate worlds. You are both becoming parents, and the transition is easier if there is understanding between you.
At 20 weeks your baby’s head is about 1/3 of the size of the body. The baby weighs about 225-500g and is about 20-30cm long. Eyebrows and eyelashes are starting to grow. Breathing movements can be seen on ultrasound. As the baby matures, breathing becomes more regular, although he can’t breathe in air. This is like a rehearsal for the moments after birth. The foetus is also swallowing amniotic fluid and passing urine. The skin is starting to form fingerprints.
Each baby tends to have its own characteristic rhythm of activity and moves most energetically at a particular time of the day. You won’t feel all the movements your baby makes – sucking, the fluttering of hands and breathing movements are all too slight to notice. A baby might be inactive for several hours at a time when he is probably sleeping.
21 – 24 weeks of pregnancy
By 24 weeks the top of your uterus has grown to just above your belly button. You are probably gaining between 240g and 480g a week. Now that your physical and emotional adjustments of early pregnancy are over, you may be feeling good about yourself and starting to really enjoy your pregnancy.
Lovemaking can take on a new aspect of enhanced enjoyment – you no longer have to be anxious about falling pregnant. When you make love, it is more comfortable to experiment with different positions where your partner’s weight is not bearing down on your growing abdomen.
The baby now has sleeping and waking cycles. The bones are starting to harden. By 24 weeks the baby is about 36cm long and weighs 680g. By 24 weeks the baby’s organs of balance inside the ear have developed. The baby has delicate eyebrows and eyelashes now. The baby can suck and sometimes sucks its thumb.
25 – 28 weeks of pregnancy
You may start to experience some backache because of the softening influence of pregnancy hormones on your ligaments – exercise will help to strengthen these muscles. Braxton-Hicks contractions may be noticed – these are irregular hardenings of your uterus. They are usually not painful, and become more frequent closer to the end of the pregnancy. These Braxton Hicks are the practice contractions preparing for labour. Heartburn may become a real problem now – so eat smaller meals more often and try to avoid fluid with your meals.
Common fears for mom
- Will I be a good mother?
- Will my baby be normal?
- Will I survive the pain of labour?
- Will I love my new baby as much as my toddler?
After 28 weeks your baby is able to survive should it be born prematurely. Fat is being deposited under your baby’s skin. The eyelids can open and your baby can distinguish your voice from others. The uterus is a noisy environment – mom’s heartbeat, blood flowing through the placenta, mom’s tummy rumbling.
Decisions to make
- Choose your childbirth educator
- Draw up a birth plan
29 – 32 weeks of pregnancy
This is the beginning of the third trimester. Your belly is now growing and you may become breathless even with little exertion. It is important to be aware of your baby’s movements – this is your only way of knowing that your baby is fit and healthy. Each baby has its own movement pattern – if this decreases drastically – consult your caregiver or hospital immediately.
Try to sleep on your side. If you lie on your back, ensure that you sleep on at least 2-3 pillows otherwise the weight of your pregnant uterus and your baby presses down on your main blood vessels which slows down the blood flow to your baby.
- Severe headaches
- Abdominal pain
- Draining of fluid from the vagina
- Blurred vision
- Vaginal bleeding
- Baby not moving nicely
Baby measures about 28cm from crown to rump. He weighs about 2kg
33 – 36 weeks of pregnancy
The uterus now pushes right under the lungs causing you to experience shortness of breath and to become easily tired. Your baby’s movements can become fewer but bigger movements. If you are having a home birth, the necessary steps for preparation of equipment should now be taken.
The head and body are now in the same proportions as at birth. Lanugo, the very fine downy hair covering your baby may start to disappear. The baby is moving, blinking, passing urine, swallowing the amniotic fluid and hiccuping. Her muscles are strong as you can feel from the vigorous kicking and thrusting of her arms and legs.
Issues to see to
- Pack your bags for hospital
- Book your bed at the hospital
- Ensure your medical aid knows about your pending baby
- Decide on a birth partner
37 – 42 weeks of pregnancy
These last few weeks usually feel the longest. The baby’s room is ready and you are getting anxious. It is important to keep your mind occupied during this period. Plan a couple of interesting things to do. If you are expecting your first child, go out and enjoy a candle light dinner – remember this is the last few weeks of not having extra responsibilities
Signs of labour
- a gush of water from the vagina as your membranes rupture
- continuous slow leaking of fluid from the vagina
- regular tight contractions of your abdomen – these contractions need to become regular, stronger and last a longer time span.
When to go the hospital
- when your contractions are about
- 5 minutes apart
- lasting 45 seconds long
- good strong regular contractions
- when your waters have ruptured
At 39 weeks your baby is now a term baby and ready to be born at any stage. The baby may still be covered with vernix and is putting on weight every day. The intestines contain the first bowel movement called merconium a black greenish stool.
Your baby should be lying in a normal position – head down. If baby is lying breech – bottom first, you may consider having your baby turned. This is known as ECV (external cephalic version). Not all practitioners are skilled to do this procedure and you may ask your caregiver to refer you for this procedure to someone else if he is not willing to offer you the service.
Creating a baby together is nothing short of a miracle – and will be one of the most important decisions of your life. Your baby is created from two cells – and with much cell division and growth they develop into a miniature person. In order to give your baby the best opportunity in life, make sure your body is in optimal condition before you fall pregnant.
It’s never too early to start planning a pregnancy.
Ideally, you should plan your pregnancy at least 3-6 months in advance. This will allow you to prepare for a healthy conception and pregnancy. A general check-up by your doctor and a routine PAP smear is advisable. The healthier you are, the better chance of having a healthy baby, and your body provides the healthiest environment in which to grow your baby.
Nutrition and weight
Your nutrition needs should be high on your list of priorities for good preparation for pregnancy. Your body will be providing all the essential nutrients for your growing developing baby. If your body is nutrient deficient – your baby develops in a less than optimal environment. Vitamins do not take the place of a healthy diet. It is best to eat a well-balanced diet containing a variety of nutritious foods. Whole grains, fresh fruits and vegetables, dairy products and foods high in protein are part of a healthy diet. Avoid skipping meals or relying on fast foods and junk foods; these are high in fats and chemical additives and lower in nutrition.
Being underweight or overweight can make your pregnancy more difficult. If you are very thin or exercise excessively, conception may be more difficult and you risk having a low birth weight infant. If you are overweight, you will have higher chances of developing fatigue, back pain, high blood pressure and diabetes during your pregnancy. You may have a larger baby and a higher chance of needing a caesarean section. Try to achieve an appropriate weight before becoming pregnant – develop a diet and exercise strategy with the help of a dietician.
Being active and having a regular exercise program will help you to cope with the physical demands of pregnancy. If you don’t already exercise, find activities that you can do regularly like walking, hiking, biking or swimming. Or join a gym and try aerobic activities or floor exercises. Overheating in the first weeks of pregnancy may be harmful, so sauna and hot tub use is discouraged. You should exercise in moderation; excessive exercise can diminish fertility. If you are not already exercising, start a program that you can continue throughout your pregnancy.
See you dentist and oral hygienist.
The health of your teeth and gums, can affect the growth and development of your foetus. Studies show that gum disease and oral infections can increase your risk for premature birth and low birthweight babies from either preterm labour or premature rupture of the membranes. Schedule any dental work that is needed to be done before you fall pregnant.
Home and Work Hazards
Make a list of chemicals you may be exposed to in your home or work environment. These may include lead (found in old paint and water from old pipes), pesticides and insecticides (for the garden or in animal flea collars), chemicals from factory work or other industries. If you work in a hospital, think about exposure to x-rays or chemotherapies. If you are a childcare worker, contagious and infectious diseases are more of a concern.
Have a good chat to your partner and share with each other your priorities, expectations and fears about pregnancy, birth and parenting. You can then start on the same page for your pregnancy.
- Healthy eating – ensure you are eating a well balanced nutritious diet. Your diet should be rich in folic acid
- Start a maternity supplement containing 400mcg folic acid to decrease the risk of your baby having any neural tube defects like spina bifida. This is of utmost importance as your baby’s brain and spinal cord have formed significantly before you even know that you are pregnant
- Try to reach your goal weight. Becoming pregnant is one of life’s greatest motivators for making healthy lifestyle changes. Try to maximize your own health and fitness.
- Start or continue on a good regular exercise program
- Cut back on your caffeine intake as even two cups of coffee a day can make it harder to conceive.
- Avoid medication – even over the counter medications. If you are on chronic medication, discuss the medication with your doctor to ensure it is the best medication you are on for during pregnancy
- Avoid alcohol. Heavy alcohol use during pregnancy has been associated with mental retardation and facial deformities in babies. There are no studies that have determined a safe minimum level for alcohol use in pregnancy, so it is safest to avoid alcohol altogether.
- Stop smoking – both you and your partner. Smoking can make it harder for you to conceive and it can adversely affect the sperm count. Smoking is dangerous for a developing foetus! Smoking has been shown to cause underweight babies and restrict their growth as well as causing premature birth.
- Check all your vaccinations are up to date. The most important of these is rubella. Make sure you are rubella-immune and have received a vaccination as a teenager. If you catch rubella in the first four months of pregnancy it can cause serious sight and hearing defects in your baby.
- Know your HIV status
- Do you need to go for genetic counselling? Read up on genetic counselling in one of our other articles called Genetic Counselling.
If you are using contraceptives such as the injection, IUCD or the pill, you should change to the diaphragm or condom during these 3-6 months until you have experienced a normal cycle. Once the initial 3-6 month period is over you can attempt to conceive. Remember not all women fall pregnant immediately. About 80% of women usually will fall pregnant within one year of trying. Make a habit of writing down the 1st day of your menstrual period. This day is used to work out the estimated date of delivery.
By Hettie Grove – Registered nurse, advanced midwife, internationally certified childbirth educator, SACLC – SA certified lactation consultant and course developer, IBCLC
Looking at birth announcements, one of the most featured pieces of clothing these days has become the beannie…oh what a gorgeous baby in that blanket with a cute hat covering his head! It just appears that a newborn needs to have a hat to be fashionable!
In most hospitals, swaddled babies and beanies will be the baby’s uniform. In the not so distant past we wanted hats on all babies. Fortunately these days some only offer it to low birthweight and premature babies. If a baby is born by a c-section or if the baby is separated from the mother, to use a beannie is not a bad idea. Lets say if the baby can’t be with the mother a beanie is a must.
What has changed that we don’t need those hats anymore
We would advocate that most moms and babies who have a normal birth don’t need to use hats.
- It covers up the newborn smell
A newborn’s smell is one of the most amazing smells that anyone can experience. In terms of recent findings this smell is very important and babies are biologically primed to recognise the scent of their mothers and vice versa, so please don’t use perfume on your baby’s birth-day. A hat will cover this smell from the mom and dad and we are trying to avoid that.
This smell of the newborn creates a pleasurable response in the mother’s brain. This is such an important tool in this very important part of the bonding process, but not only for bonding. When the mother enters the third stage of labour, that is after pushing the baby out before the placenta or afterbirth is birthed, the mother takes a deep sniff. If the baby has a hat on mommy smells fabric softener instead of her baby’s scent. When the baby doesn’t wear a hat, she would smell her own baby’s pleasurable scent which will trigger a rush of oxytocin, which then will cause the uterus to contract and helps the placenta to be expelled. How intricate is the wonders of birthing a baby if not disturbed. This is also one of the important reasons for skin to skin for as long as possible after birth.
- Your baby doesn’t need a hat
Your body temperature will regulate your baby’s body temperature, another reason for skin-to-skin. By simply doing skin-to-skin, smelling your baby, your body has the ability to raise its temperature when the baby is cold in order to heat the baby, and if the baby is hot your body’s temperature lowers to cool the baby down again. Interesting if it is twins, your body can heat the one side and cool the other side depending on the various babies temperatures.
We really need to be careful that babies don’t overheat indoors as research has shown that overheating a baby may increase the risk for cot death. This also applies to hospitals as hospitals are often warmer than houses.
Studies have shown that skin-to-skin provides thermo-regulation faster than any other means.
What You should do instead
A 2010 study found that skin-to-skin contact after birth leads to better thermo-regulation, a faster third stage of labour, and also improved rates for exclusive breastfeeding at the time of hospital discharge.
Of course, it’s not possible in all cases to experience skin-to-skin. If you are separated from your baby, have a sick or premature baby or perhaps he is having a few troubles after the birth, putting clothes and a hat on, or using a warmer, would be the best option. Uninterrupted, skin-to-skin time is for well mothers and babies.
So if all is well and you are offered a hat in the hospital, explain instead that you would rather hold your baby skin-to-skin, and let your body help regulate your baby’s temperature. Your baby should be placed directly on your chest, skin-to-skin, with a warm blanket placed over the two of you to help you maintain body heat. Now, lie back, relax, and enjoy that gorgeous new baby smell whilst nature takes care of the rest.
Some birth professionals have adopted the saying: “No hatting, patting, or chatting!” immediately after the birth. This was coined by a passionate women’s and baby’s advocate, Carla Hartley. Any patting or chatting should only be done by the mother, with the father right there too. The precious moments right after birth are very important, and should be as undisturbed as possible. It’s the beginning of an attachment, a momentous and important moment that you will never, ever get back. Make it count.
By Anchen Verster – Registered nurse, midwife, SA Certified Perinatal Educator – SACPE, wife, mother to 4 children including a set of twins
As a childbirth educator I’m often asked by expectant moms how they will know if their doctor is recommending a caesarean that is not necessary. Short answer is that you won’t necessarily know but here are some tips to help you self-assess your ‘risk’ for an unnecessary caesarean.
Step 1: Know what you’re looking for. What kind of service are you purchasing? Like buying any item, you choose to shop where you’re most likely to find that item at the price you want it for. Choosing medical care in the private sector in South Africa is much the same. Don’t go looking for natural birth at a hospital with a very high caesarean rate.
Attending childbirth education classes with a childbirth educator who is well qualified and certified should help you make a decision based on current evidence. Most women and their partners have a rough idea what they want (ie vaginal birth or caesarean section) when they go for their first antenatal visit, but this can be ‘fine-tuned’ as you learn more about the birth and baby journey and the research that should govern good practice. If you want a vaginal birth, your best chance is with your first birth. It’s much more difficult to have a vaginal birth after a previous caesarean section so shop in the right place the first time round so that you have the best chance possible!
Step 2: Look for common courtesy. I have been amazed at how many couples have told me that their caregiver makes no effort to greet or interact with the dad/partner during consultations. A small amount of courtesy goes a long way and basic etiquette can give you some insight into the personality and perhaps even the ethics of the person you’re seeking medical advice from. Most moms feel more comfortable with a discussional-style where they are given information and then have an opportunity to discuss the information and share in the decision-making. Some research shows that doctors who have a good relationship with their clients and take time to answer their questions have a lower incidence of litigation. You shouldn’t feel like you are on a sausage machine when you’re going for your antenatal visits.
Step 3: Ask questions. There is significant variability in caesarean section rates across private and state hospitals in South Africa. In general the state hospitals win out with lower caesarean section rates but vary significantly from between 19-50% whereas some private hospitals ‘boast’ a 60-90% C-section rate. When you go on your labour ward visit, ask what the hospital’s C-section rate is and ask your obstetrician what his/her C-section rate is. Be concerned if they don’t want to tell you. An expectant mom recently told me that she was shocked on the hospital tour to hear the hospital had a 95% caesarean section rate. If she was looking for her best chance at a normal birth, that hospital would not be the place to ‘purchase’ it.
The World Health Organization recommends a rate around 10-15%. When the rate hovers around these percentages it has a positive effect on mother and baby outcomes. That means it’s the right amount of intervention to save lives but not too much intervention that it exposes women to unnecessary risk. As soon as it rises above these ‘markers’ there is either no improvement in outcome or an increase in maternal and neonatal morbidity (health condition or complication) and mortality (death).
Other questions to ask your Obstetrician / midwife:
“Will you be happy to deliver the baby if I am squatting or on ‘all fours’? In other words a position other than semi-recumbent?”
A friend recently asked her gynaecologist this and he told her there was no chance he was going to crawl around on all fours on the floor after her. Needless to say she went elsewhere for her care, but ‘hats off’ to him for being honest!
“How far over 40 weeks do you usually allow moms to go before performing an induction?”
Keep in mind in most countries a baby not born by 42 weeks is considered ‘post date’ whereas in South Africa many inductions are done before 40 weeks
“Do you allow a mom to go into labour first and see how the labour progresses before deciding that the baby is too large?”
“If I have a medical indication for a caesarean, would you be happy for me to go into labour first before the caesarean is performed?”
Step 4: Get a 2nd opinion. Don’t be scared to get another opinion. If you are unsure of the planned intervention or feel uncomfortable, ask another doctor for another opinion. I once told a doctor I wanted another opinion prior to major back surgery. His response to me was that I was making a “dumb decision”, that he could do the surgery and he didn’t need my money. That was an absolute confirmation to me that I not only needed another opinion, I needed another doctor! One of the negatives of another opinion is that you have to pay for another consultation, however it might save the cost of a C-section.
Step 5: Don’t rush to hospital as soon as you go into labour. While ensuring that your caregiver is happy for you to labour a few hours at home, this will decrease the chance of unnecessary intervention and being diagnosed incorrectly with a labour that’s ‘not going fast enough’. The International Childbirth Education Association recommends staying at home until you reach the 5-1-1 mark. This means your contractions are 5 minutes apart, lasting for at least 1 minute, for a period of 1 hour.
The 4 walls of a labour room can be very boring. Home is much more relaxing and offers more variety in distraction. Your hormones may also be able to do their job better because you’re more relaxed at home thus enabling your labour to progress better.
Step 6: ‘Test the waters’. Nosipho really wanted a vaginal delivery but her doctor wanted to do an induction at 39 weeks because the baby wasn’t growing. She was concerned that the induction might end in a caesarean. She asked her doctor if he would be happy for her to come back in 2 days for a check-up. He said he didn’t think it would be safe to wait longer and that the induction needed to be started that night. She ended up delivering her baby normally after an induction. She tried to delay the delivery but felt sure her doctor was genuinely concerned about her baby’s well-being.
Mareli was told she needed an induction because the amniotic fluid levels were too low. She also wanted to try and avoid the induction and asked her doctor if she could come back the next day for a check-up. He said he was happy to check day-by-day. The next day the baby’s heart rate was perfect and the fluid volumes hadn’t changed. Three days later the fluid levels were normal and she went into labour spontaneously and delivered her baby naturally. Both moms ‘tested the waters’ to see if there was an alternative to the suggested intervention and to see if their doctor thought the situation was serious enough for immediate intervention. The answer was different for each but both trusted their doctor’s judgment and also had their birth of choice.
I’ve noticed some trends that should trigger warning bells…
- Your caregiver does not want to talk about your desired type of birth or birth plan or is putting off the discussion for subsequent antenatal visits.
(I do that with my children when they ask for something I don’t want to say yes to. Instead of disappointing them immediately I say “we’ll see” or “let’s talk about it later”. What I actually mean is “no”.)
- At your last few antenatal visits your caregiver alludes to the size of the baby’s head as being “very big”. You immediately assume that the size of your baby’s head is bigger than average and you start to lose confidence in your body’s ability to facilitate the passage of the “unusually large head”. Did you know that an ultrasound scan to determine the size of the baby in the 3rd trimester is much less accurate than in the 1st trimester! Ask Tina who was talked into a caesarean section because her baby was “very big” and the doctor told her she would never forgive herself if the baby got stuck during a vaginal delivery! Her baby was born at a healthy average weight of 3 500grams. Yes that’s a true story!
The average size of a baby is between 2 500 grams and 3 500grams.
- Your caregiver wants to do an induction prior to 40 weeks for no other reason than it’s close to your due-date (or he’s going on holiday next week). The greater proportion of first time labours’ start after 40 weeks. Inductions fail or end in caesarean sections in at least 50% of cases.
- Your small frame, ‘narrow pelvis’ or shoe size are alluded to as reasons for planning a caesarean.
- Your doctor is going on leave/holiday around your due date. (In which case, by the way, many mothers opt for an induction or a caesarean so that their doctor can still deliver the baby and not a locum doctor they don’t know). Ask about holiday plans early on in your antenatal visits.
- Too little amniotic fluid. Although this may be a reason to start labour earlier (not a reason for a caesarean unless there are other indications), it is worth having the fluid volumes (pockets) measured again in a day or two as the measurement may not always be 100% accurate.
Suggested Labour Bag
A labour bag should be a bag packed with items that you and your partner might want in labour. Plan to pack things that are of comfort both physically and emotionally.
- Birth plan
- Childbirth education class notes
- Loose fitting large T-shirt – for comfortable labouring
- Socks non-skid ones – your feet might get cold in labour
- Hair brush and elastics – to keep your hair out of your face
- Dressing gown and slippers – easy to get on and off
- Your own favourite pillow – for personal comfort (use bright coloured pillow case so it doesn’t get mixed up with hospital linen
- 2 Face cloths – keep face cool and refreshed
- support of the perineum
- Refreshing face wipes
- Lip-ice, gloss – to prevent dry cracked lips
- Fan or firm paper plate – to keep face cool
- Water spray bottle – to cool you down
- CD & player / MP3 player / smart phone with iTunes – for relaxing music to create your own environment for your labour and birth
- Candles and lighter
- Oil or powder – for massage – odourless or slight smell – not highly perfumed
- 2 Tennis balls in a sock – for a back massage / to lean back against while sitting
- Manual massagers to roll, stroke, press or vibrate on back, shoulders, hands and feet
- Hot packs to place over your lower back, shoulders or abdomen during labour
- Cold can of soft drink – to roll over your lower back (keep several cans cold in a bowl of crushed ice)
- Focal point / picture / baby toy – for inspiration and visualisation
- A birth ball
- Bendy straw – to be able to drink easily
- Fruit juice or high energy drinks for labour
- High energy snacks – raisins, bananas, cereals, breads
- Camera – extra batteries / memory cards / video camera
- Toothbrush and paste – freshen your mouth
- Towel, toiletries, tissues
- Clean T-shirt for after labour
- Cell phone + list of relatives and friends to call
- Cell phone charger / battery power pack
- Cord stem cell pack
- iPad / tablet to help pass the time in early labour
- Vaginal swab for good microbiome formation (see article on page )
Anything else that might personalise your labour room and make you feel more comfortable in labour
Labour Bag for Dad
- Cash & credit cards
- Medical aid card
- Paperwork for the hospital
- Watch for timing contractions
- Copy of birth plan
- Light reading material
- Favourite snacks
- Change for the vending machine
- A change of clothes
- Comfortable shoes as you may be pacing up and down the corridors with your partner
- Cell phone
- Cell phone charger
- List of names to call
Your hospital case
Leave this in the car until you have been transferred to the ward
- 3 T-shirts / sleep shirts – front opening to start breastfeeding with
- Bath towel – large thick one for added comfort as hospital’s one might not be quite so luxurious
- Disposable pants
- Maternity sanitary pads
- Linen savers
- Feme pad – perineal ice pack to relive discomfort of stitches
- Feeding bra
- Breast pads
- Breast soother – gel pad for the breast – cold or hot
- Plastic bag for dirty washing
- Healthy snacks and fruit juice
- Ear plugs – in case your ward is noisy
- Slippers or comfortable shoes
- Contact number of lactation consultant
- Loose maternity outfit
- 2 disposable nappies
- Vest, babygro, booties
- Receiving blanket
- Car seat
How to use the listings of Childbirth Educators on the following pages
- The childbirth educators listings are divided into provinces
- They are highlighted under which area they teach – areas appear in alphabetical order
- Check her qualifications – has she a medical qualification? Is she a midwife and so has integral knowledge of the birthing process as well as having delivered babies? Has she specialised in Childbirth Education? Specialised childbirth educator qualifications are highlighted in red. ICCE – Internationally certified childbirth educator through ICEA in the USA. SACPE – South African Certified Perinatal Educator.
- Check her star rating (*) for attending the CBEPF – (Childbirth Educators Professional Forum) Roadshows. These are free professional updates provided for the childbirth educators in private practice. They are held 3 times a year in Johannesburg, Cape Town, Durban and Port Elizabeth. The star rating shows how many roadshows she has attended in the past 3 years. Maximum rating is 8*
- Has she her own Practice Number (PR No.) and hence is registered with the medical aids?
Take your time choosing your childbirth educator as she can make a difference to your birthing and parenting experiences. Phone the educators in your areas and chat to them all before deciding which one to choose.
This list of childbirth educators is for the sole purpose of helping pregnant moms and dads find an educator. It is not to be used for company and promotional purposes – please respect this fact!