Pregnancy
During pregnancy a baby develops inside a woman’s womb. Most pregnancies are singleton, ie with one baby developing in the womb. A multiple pregnancy involves more than one baby developing in the womb (twins, triplets) – this occurs naturally in about 1-2:100 pregnancies, but is more common after fertility treatment. Pregnancy occurs naturally, after sexual intercourse, or with assisted reproductive techniques such as IVF (test tube babies). It usually lasts around 40 weeks from the last menstrual period (38 weeks after conception). Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting.
To test if you are pregnant you can do a pregnancy test at home, which measures a hormone level only released during pregnancy. This is called human chorionic gonadotrophin (hCG) and is tested for in the urine. This can be done on the day of your first missed period and the test can be bought from a pharmacy or supermarket. The same kind of test is also carried out at your local medical centre or family planning clinic.
Pregnancy is divided into three parts, each of which is called a trimester. The first trimester is from week 1 to 12, the second trimester is from week 13-28 and the third trimester is from week 29 to 40. The first trimester carries the highest risk of miscarriage. Around the middle of the second trimester movement of the baby may be felt. Babies born before 37 weeks are classed as preterm or premature. They are more likely to develop health problems, and these risks increase the more preterm a baby is. Babies born under 23 weeks are unlikely to survive, and if they do survive, many have long-term disabilities such as cerebral palsy. Babies born prematurely need to be looked after in a hospital with specialist medical care.
A baby is ‘term,’ or ready to be born, from 37 weeks. After 41 weeks, your midwife will start to discuss medical ways of bringing on or inducing labour. In most countries, pregnancies are not advised to go beyond 42 weeks because the risk of stillbirth increases.
It is important for pregnant women to look after themselves and have good support at home from their family and partner. This includes taking folic acid (which significantly reduces the risk of spina bifida), avoiding smoking, drugs and alcohol, taking regular exercise, eating a healthy diet and attending all the antenatal care, tests and scans that are available to you. Some women find that their partner is not supportive during pregnancy, and unfortunately domestic violence can start, or worsen if it was happening previously. Domestic violence is unacceptable and it is not your fault. You can get help, including finding somewhere else to live, from your midwife or GP.
The aim of antenatal care is to ensure that you stay as healthy as possible during pregnancy. The midwife or health worker will check your blood pressure and urine regularly and take blood two or three times to check for anaemia (low iron levels) and your blood group. Ultrasound scans are carried out two or three times to check that the baby is developing normally, and that the placenta (the organ that ‘feeds’ the baby) is growing in the right place, away from the cervix (neck of the womb). If the midwife or health worker has any concerns about you or the way the baby is developing, you will be referred to the hospital to see a women’s health specialist (obstetrician).
During pregnancy a woman may have a number of symptoms that are not dangerous but may need some attention. These include muscle cramps, passing urine frequently, urinary incontinence, heartburn and indigestion, varicose veins, backache, constipation, haemorrhoids and thrush. These symptoms are mostly mild and will get better once the baby is born. If they are causing a lot of problems, discuss them with your midwife or see your GP – simple medication can help alleviate most of them.
More serious problems in pregnancy are uncommon, and regular attendance at antenatal check-ups aims to pick these problems up at an early, treatable stage. These include high blood pressure, pre-eclampsia (high blood pressure with protein in the urine), gestational diabetes (pregnancy diabetes), iron deficiency, and severe itching in pregnancy (obstetric cholestasis). These conditions require some extra monitoring of you and the baby and more visits to see women’s health specialists. In some cases, it may be advised that you be admitted to hospital to be monitored even more closely, or that labour is induced early.
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