AIRPLANE FLIGHTS (see FLYING DURING PREGNANCY below)
BRAXTON-HICKS
(See FALSE LABOR and UTERINE CONTRACTIONS)
BABY NAMES (see NAMES below)
BREASTFEEDING
AND ATOPIC DERMATITIS
Although there are many benefits of breastfeeding, the claim that breastfed children are at lower risk of atopic dermatitis (allergic skin reactions) doesn’t appear to be one of them. In fact, breastfed children appear to have a higher risk of atopic dermatitis, according to a British study. The study looked at every infant born in the county of Avon from April of 1991 to December of 1992, 14,585 babies in all. It was possible to track 7,753 of these children a minimum of 42 months and to obtain complete information about whether and how long they had been breast-fed. The figures showed that the longer a child was breast-fed the greater was the chance of their developing atopic dermatitis. But the risks were still small, only a 60% increased risk for infants breast-fed for 6 months or more. [Ob.Gyn.News December 1, 2001 page 14]
AND OBESITY
Whether breastfed children are at lower risk of becoming obese remains in question. In one study of older children age 9-14, one study found slight protection against obesity among those who had been breast-fed as infants. [JAMA 2001; 285(19):2461-2467] But another study of mostly younger children showed no effect [JAMA 2001; 285(19):2453-2460]. So there might or might not be a benefit but, if there is, it is probably fairly small.
CERVIX
The cervix is the part of the uterus that is visible at the top of the vagina. In obstetrics it is important because it is the part of the uterus that “holds in” a developing pregnancy and also that dilates and shortens during LABOR to allow the baby to deliver through the vagina.
CESAREAN DELIVERY
When a vaginal delivery is not safe either for mother or baby, the preferred means of delivery is by Cesarean. This is an operation in which an incision is made into the mother’s abdomen and then into the uterus to remove the baby. Then the uterus and the other layers are sutured (sewn) together again.
Many women, when they think of pregnancy, think first of avoiding a Cesarean. We obstetricians also would prefer that our patients deliver vaginally. But the most important consideration is getting a healthy baby. If a Cesarean delivery is the best way to get a healthy baby, then a Cesarean is much to be preferred than a vaginal birth that may impose unnecessary risks on a baby or on the mother.
It is not true that Julius Caesar was born by Cesarean, especially since his mother lived into her son’s adulthood and no woman was known to survive a Cesarean until the 16th Century. It is thought that the procedure is called “Cesarean” because it was the law of Caesar (and of many other nations and cultures of ancient times) that a dying or dead pregnant woman be delivered of her child in this way in the hope that the child might be saved.
There is interesting historical material about Cesarean delivery at this site: http://www.nlm.nih.gov/exhibition/cesarean/cesarean_2.html
DUE DATE
The due date is an estimate of the date by which a baby will be born. But only about 5% of babies will be born right on the due date.
It is considered full-term for a woman to deliver plus or minus two weeks from the due date and an additional week is allowed before that if a woman labors on her own. So up to three weeks before the due date and up to two weeks after the due date is considered full-term. Before that, of course, a birth considered “preterm” or, especially when a preterm baby has problems, “premature.” More than two weeks after the due date is considered “post-term” and babies can develop problems from this as well. It is no better to go well past the due date than to deliver prematurely!
The due date is much easier to be confident of when prenatal care begins earlier. This is because, even with ultrasound (sonograms), the size of the baby becomes a progressively worse guide to how far along a pregnancy is. This is just common-sense because while all early embryos and very early fetuses are about the same size, healthy full-term babies can be 6 pounds or they can be 9 pounds or more.
The way to calculate the due date is to add 40 weeks from the first day of the last menstrual period (LMP). Or, what amounts to much the same thing, subtract three months from the first day of the last period and add one week. Thus, if the LMP was May 11, the due date would be February 18th.
But now you may be saying: "Hey! 40 weeks is ten months and pregnancy is only supposed to last 9 months!" Yet the two systems, weeks and months, are the same when you realize two things: 1) the month system counts from conception, approximately two weeks after the last period, while the week system counts from the first day of the last period, and 2) a month is not four weeks. In fact, the "month" of pregnancy is the lunar month, the time from one new moon to the next (something most people pay no attention to these days) which is 29 1/2 days.
So, doing the math:
40 weeks - 2 weeks = 38 weeks
38 weeks x 7 days/week = 266 days
266 days / 29 1/2 days/lunar month = 9.0169, or 9 months !!
FALSE LABOR
False labor, also known as Braxton-Hicks contractions, are contractions of the uterus that do not dilate and efface (thin) the cervix. They can nevertheless be quite painful. They are usually relived by a change in activity, either walking about or rest. Relaxing in a tub of warm water, the use of heating pads or hot water bottles or Tylenol® (or generic acetaminophen) can also help. In some cases medications used to treat PREMATURE LABOR may also be appropriate. Also see UTERINE CONTRACTIONS.
FETAL MOVEMENT
Fetal movement can be first felt by a pregnant woman at around 15-16 weeks. But many women do not feel any movement for a month or more after this.
Many factors affect when and how much a pregnant woman will feel fetal movement. Since fetal movement is detected by the touch nerves in the skin of the abdomen, a woman with a thin abdominal wall will feel fetal movement more easily than a woman with a thick abdominal wall. Likewise, if a baby kicks against the back wall of the uterus, that will be less likely to be felt than if it kicks against the front wall of the uterus. An increased amount of amniotic fluid or a PLACENTA that’s attached to the front wall of the uterus can also reduce a woman’s sensation of fetal movement.
But other things being equal, fetal movement is considered to reflect fetal health. A baby that is felt to move frequently is likely to be a baby that is doing OK in the womb. On the other hand, a noticeable reduction in fetal movement may reflect a baby that is having a problem of some kind. A pregnant woman of more than about 28 weeks (about 6 months) who thinks her baby is not moving or has noticed a reduction in movement should see her doctor or go to the hospital for monitoring.
FLYING DURING PREGNANCY
The main risk to pregnant women traveling by air has to be that of blood clots due to long periods of sitting in a confined space. While it is safe to travel during most of pregnancy, therefore, whether traveling by car or flying, it is advisable to get up and move around frequently.
An interesting article in Obstetrics and Gynecology [2004;103:1326-30] also considered the risk of radiation exposure during airplane flights. How's that you ask? Well, the earth is being constantly bombarded by cosmic rays, a variety of forms of radiation that come both from the sun and sources beyond the solar system. The atmosphere protects us from much of these but living at high elevations or being at the high elevations typically achieved by commercial air flight increases the exposure to cosmic radiation.
Calculations made by the authors of the article showed that for casual travelers this exposure is trivial. But pregnant women who travel by air frequently, or who work as flight attendants and pilots, could exceed the recommended limits to. The authors recommended that these individuals should check their exposure by using information and software available from the FAA (Federal Aviation Administration) at http://www.cami.jccbi.gov/AAM-600/Radiation/trainingquestions.htm. In addition, such individuals should consider postponing their flight schedules at times when a solar flare, which occur unpredictably and for usually short times. Recent and current solar radiation measurements are also available online at the Space Environment Center of the National Oceanic And Atmospheric Administration.
HOME BIRTH
Some people claim that having babies at home is better than going to the hospital. Unless “better” is a subjective psychological benefit for some people, there is no evidence of this. In fact, the evidence shows that home births involve a risk of the baby dying during labor that is about 2-3 times higher than in the hospital. [BMJ 1998;317:384-8; In this Australian study, of 7002 home births there were 50 deaths of babies: 31 before birth and 19 after. This was compared with 1.5 million births in the hospital and found to be 3 times higher.] This is a particularly striking finding. A very similar study that looked at births in Washington state from 1989-1996 [Obstetrics & Gynecology 2002 Aug;100(2):253-9] found similar results: that babies were twice as likely to die. This study also found that women having their first baby were about twice as likely to have prolonged labor and increased bleeding if they planned to deliver at home.
Perhaps the best way to think of home births is to consider its similarity to a sport with some risk of injury and death such as downhill skiing. Most people engage in this sport at resort locations where there is a ski patrol and medical services available. But some take helicopters to remote locations where there are no such support services. Now ask: if you have to ski with a baby strapped to your back, where is the more reasonable place to ski? Obviously, it is the ski resort where the slopes are groomed and cared for and the ski patrol is available. Likewise, in the 21st Century it is simply not appropriate to deliberately plan a birth outside of the hospital.
Fortunately, most people seem to agree with this way of looking at it. In fact, so many people became outraged over mothers being discharged from the hospital very soon after delivery that the Texas legislature passed a law in 2000 that prohibited such “drive-through deliveries.” (Of course, these and other laws that require health insurers to pay for more things also drive the costs of medical insurance up ... )
LABOR
True labor is UTERINE CONTRACTIONS that cause progressive dilation and effacement (thinning) of the CERVIX. FALSE LABOR is UTERINE CONTRACTIONS that do not cause such changes in the cervix.
LABOR PAINS
(see UTERINE CONTRACTIONS)
LENGTH OF PREGNANCY
“Everyone knows” that a baby is born after nine months of pregnancy. But in medicine we generally count by weeks from the last menstrual period rather than by months from conception. There are several reasons for this:
Most women know when their last period started. But most pregnant women don’t know when they conceived. Even if they only had sex once on a certain date it doesn’t mean that that’s when conception happened because sperm can live in a woman’s reproductive tract for several days at least.
A month is a long time and doesn’t lend itself well to keeping track of what’s going on when during pregnancy. If doctors used the month system they’d have to use fractions a lot, which is inconvenient.
A month is not the number of days in a calendar month, which, of course, vary. And a month isn’t four weeks as is often used as an estimate. The “month” in the “nine months” of pregnancy is the lunar month, the orbital period of the moon from one new moon to the next, which is 29 ½ days.
The week system works out the same as the month system if these facts are remembered:
40 weeks – 2 weeks] x 7 days/week = 266 days
and
266 days ÷ 29 ½ days/month = 9 months
(see also DUE DATE)
MEDICATIONS DURING PREGNANCY
As a general rule, it’s better not to take any medications during pregnancy if they can be avoided. This is because, almost regardless of the drug, it’s impossible to conduct good scientific studies on whether one or another medication may cause birth defects or other pregnancy complications.
There are some particular medications about which there are concerns, although it depends very much when during pregnancy they are taken. These can be divided – more or less – into three groups: (the medications shown are examples only and should not be considered complete listings)
| Minor/Theoretical Concerns | Some definite risk of harm | Serious risk of harm |
|
Discontinue or don’t take if |
Use in pregnancy only if truly necessary | Not to be taken during pregnancy for any reason |
|
aspirin (salicylates)* birth control pills† Motrin®, Advil®, Medipren® (ibuprofen) Orudis® (ketoprofen) Anaprox®, Aleve® (naproxen) caffeine |
anti-cancer drugs
anti-coagulants anti-epilepsy drugs anti-thyroid drugs ephedrine immune suppressants lithium steroids |
Accutane® (isotretinoin)
Clomiphene Estrogen tetracyclines thalidomide |
* Read the package label! Many things contain aspirin including Alka-Seltzer®, Doan’s Pills®, and Pepto-Bismol®.
† if taken unintentionally early in pregnancy
It goes without saying that alcohol, tobacco, marijuana, cocaine, and other recreational drugs should not be used at any time during pregnancy. Even though pregnant women do use these substances to some degree and not all of them suffer complications, some do and there is therefore no justification for taking unnecessary risks. Why depend on good luck when good judgment can be used?
On the other hand, there are many medications that have been around for a long time, or with which there is some experience, that are believed to be safe during pregnancy. Also, there are a few things that are certainly safe to take in pregnancy:
|
No evidence of harm in pregnancy,
so probably safe |
Safe to take during pregnancy
|
|
Use if necessary
|
Use if necessary or desired
|
|
Benadryl® (diphenhydramine)1 Gynelotrimin® or Mycelex® penicillins and some other antibiotics Robitussin® cough syrups Sudafed® (pseudoephedrine)3 Tylenol® (acetaminophen)4 Zantac® |
calcium supplements including Tums®5
iron supplements prenatal vitamins Nutrasweet® (aspartame) Kaopectate® (original formulation)6 Equalactin®6 |
1An antihistamine: for allergy symptoms; also a good night-time cough suppressant.
2Can be used for any vaginal discharge or irritation during pregnancy.
3For nasal congestion.
4Extra-strength and generic brands are also OK.
5Each Tums® contains 300 milligrams of calcium, so 5 of these a day are a good source of calcium, especially for women who don’t drink milk.
6These are over-the-counter remedies for diarrhea.
There is simply not enough information available about most herbal products and other “nutritional/dietary supplements,” even though they are usually advertised as “all natural” and therefore “safe.” Some are definitely dangerous, such as chaparral and pennyroyal. With others, even though they may have been used safely in the past on a sporadic, short-term basis as folk remedies, their regular use in pills, capsules, creams, and teas has simply not been studied. With these products, the unfortunate fact of the matter is that you are being your own guinea pig. In pregnancy it is best to avoid them.
NAMES
One of the most important things we do for our children is to give them names.
People have all kinds of different strategies for naming their children. Some people whose last names are short and/or common, for example, like to give their children something other than short and/or common first names. Others like to draw on names of relatives. Still others just prefer names that sound pleasing or appealing.
Among all these considerations is that of what other people name their children. Few parents are happy when their child enters school and finds that half a dozen other children have the same name, for example.
Here’s a helpful resource for finding out how popular are the names you’re considering for your children: http://www.ssa.gov/OACT/babynames/ Yes, that’s the US Social Security Administration which, of course, gets a whole lot of applications for social security numbers (our national ID) for babies every year. The URL given lets you put in the name you’re thinking about and see how popular that name has been in the years since 1990.
UTERINE CONTRACTIONS
Contractions of the UTERUS are common in pregnancy, especially during the last three months. The UTERUS is a muscle, after all, and that’s what muscles do: they contract. When the UTERUS contracts enough to cause a cramping or pressure sensation, a pregnant woman becomes aware of these contractions. And when the DUE DATE is more than three weeks off, these kinds of symptoms can be a sign of PREMATURE LABOR. But in other cases, uterine contractions are often irregular and do not dilate the CERVIX, even though they can be quite painful. These are often called FALSE LABOR or BRAXTON-HICKS contractions because they do not change the cervix. It is thought, though, that these uterine contractions may cause or may be a sign of changes in the UTERUS that prepare it for true LABOR.
True LABOR is often difficult to distinguish from FALSE LABOR. But FALSE LABOR is usually irregular. That is, unlike true LABOR, the contractions don’t come regularly every 2, 3, or 4 minutes with gradually increasing intensity. FALSE LABOR pains are usually also weaker than the kind of contractions that happen during true LABOR, and they tend to be felt more in the front than in the back. Also, FALSE LABOR tends to ease with a change of activity, either walking or rest, or with relaxing in a tub of warm water.
The best thing for any pregnant woman to do if she suspects that she is really in LABOR, or if she is experiencing bleeding, constant severe pain, thinks the BAG OF WATERS may have broken or is leaking, or if she has felt no FETAL MOVEMENT, is to go the hospital. Although there may be some physicians who still prefer that their patients call first, there just isn’t much that can be done over the telephone. And the staff on the labor and delivery unit or in the emergency room at the hospital are in most cases able to find the physician faster anyway if that is needed.
PREMATURE LABOR
Premature LABOR is when labor occurs prior to full term, which in practice means labor that occurs more than 3-4 weeks before the due date. Premature labor, also known as preterm labor, is a serious problem because it often results in premature or preterm DELIVERY. And prematurity is the leading cause of infant mortality in the United States. In fact, infant mortality is higher in the United States than in some other countries because of a higher rate of prematurity. (This is contributed to by the practice in the U.S. of classifying some early pregnancy losses as premature births that in other countries would be considered miscarriages. In addition, a major risk factor for prematurity is mutliples such as twins or triplets, which happen more often in the U.S. when women, especially older women, undergo advanced infertility treatments such as in vitro fertilization – embryo transfer.)
Premature labor is often treated with medications such as terbutaline (Brethine®) or (rarely) ritodrine (Yutopar®). Sometimes magnesium sulfate (yes – the same as Epson Salts!) given by injection is used. Bedrest is also a mainstay of the treatment of premature labor as well as hydration and keeping the bladder empty. Sometimes hydration and bedrest are all that are needed to treat preterm labor.
UTERUS
The uterus is the muscular organ in which pre-embryos implant and become embryos, fetuses, and, eventually, babies. Halfway through a pregnancy, at 20 weeks, the top of the uterus is about at the level of the umbilicus (the “belly button”) when a woman is lying down on her back.
See also the LINKS section!