Pregnancy is an important part of a woman’s life and health. It presents unique health risks and needs. It can be a joyful time, but also a huge transition that can cause issues with both physical and mental health. From the various physical changes and symptoms to complications of delivery, and even postpartum depression, there are many aspects of pregnancy health that all women need to consider and learn about before entering into this exciting stage of life.
What Happens During Pregnancy?
Pregnancy is a time period during which a fertilized egg develops into a fetus in a woman’s uterus. The gestation period, the time from fertilization to birth, is approximately 40 weeks, although some women may give birth earlier or later. Pregnancy is divided into three trimesters. During the first trimester, the period stops as the fertilized egg implants in the uterus and begins to divide.
Women often experience a lot of uncomfortable symptoms during the first trimester, and many find that the second trimester is much easier. It is during this period that the body really starts to change, the pregnancy becomes more noticeable, and the baby begins to move. During third trimester, the fetus continues to grow and a woman may start to feel uncomfortably big. Contractions will begin at some point during this last stage, although they may be false alarms initially.
Signs of Pregnancy
Women who are actively trying to get pregnant will watch out for signs of pregnancy, but will also use pregnancy tests to determine if a fertilized egg has implanted. The most obvious sign of pregnancy, although it does not always indicate a pregnancy, is missed periods. Other signs include morning sickness (feeling nauseated and vomiting at any time of day), swollen breasts, mood swings, fatigue, and headaches. Some women experience other signs and some few or none at all. Seeing your doctor for an exam is the best way to know for sure if you are pregnant.
Prenatal care is the health care women receive or engage in while pregnant and before birth. It is essential to have healthy habits, avoid certain habits, and to get the right nutrients during this critical time period. Poor health in the mother has an impact on the developing fetus and may even cause birth defects or contribute to later health and behavioral problems.
The first thing to do for prenatal care is to see an obstetrician. This is a doctor that specializes in caring for pregnant women and delivering babies. A woman may also choose to work with a midwife or a doula, a birth coach, leading up to delivery. Regular visits to an obstetrician and a woman’s regular care doctor are important for monitoring the health of the mother and the course of the pregnancy. These regular checkups may uncover potential complications that need to be addressed.
The recommended schedule of prenatal doctor’s visits are once a month through the first 28 weeks, twice a month through 36 weeks, and then once a week until the baby is born. These visits will allow the doctor to monitor your weight and blood pressure, the baby’s heartbeat, to test for anemia and gestational diabetes, to check for infections that can harm the baby, and to check for any birth defects in the baby.
Women during pregnancy should avoid alcohol, smoking, and certain drugs, should limit caffeine, and should get adequate nutrition. Especially important is folic acid, a nutrient that helps prevent birth defects of the central nervous system. Women should also maintain a generally healthy lifestyle with a good diet, regular exercise, and a healthy weight. Doctors recommend that women who are underweight gain 25 to 40 pounds, those that are overweight to gain just 15 to 25 pounds and those that are at a healthy weight gain only 25 to 35 pounds.
Doctors consider a pregnancy to be high-risk if the mother is very young or over the age of 35, if she has had a complicated pregnancy in the past, if she is overweight or underweight, if she has certain health issues, like diabetes, or if she is going to have multiples, like twins or triplets. These high-risk pregnancies are not always problematic, but they come with a greater risk for complications and may require more monitoring.
During the first trimester, which lasts from conception to about 12 weeks, the baby goes from a fertilized egg to a growing fetus in the womb. A first visit to the doctor and to check for pregnancy is important and will likely include a general discussion of health and wellness as well as tests for blood type, infections, and other health issues. Also during the first trimester, a woman may have a blood test that determines the risk of the baby being born with Down syndrome and other chromosomal abnormalities.
There are some common symptoms that many women experience during the first trimester, although everyone is different and may have all or none of these: fatigue, swollen breasts, a frequent need to urinate, weight gain, heartburn, headaches, mood swings, food cravings, morning sickness, and constipation.
The second trimester lasts approximately between 13 and 28 weeks and this is the time during which an ultrasound can be used to image the fetus and determine the gender. Around week 20, a woman may start to feel the baby moving. By 24 weeks most babies become more active, wake up, and kick. The end of the second trimester, at week 28 is the earliest time at which a baby may be born and have a good chance of survival. Second trimester doctor visits will include more screening tests for the mother’s health and possibly an amniocentesis, which draws fluid from around the baby for testing.
During this time period many women find relief from a lot of the symptoms of the first trimester. In the second trimester there may be darkening of the mother’s skin, pain in the back and abdomen, stretch marks, itchy skin, and swelling in the face, fingers, and ankles. Swelling is normal, but sudden and extreme swelling could indicate a dangerous condition called preeclampsia.
The third trimester usually starts around week 29 and lasts until the baby is delivered. Women may need to have checkups every week at this point. The later during the trimester that the baby is born, the better chance it has of being healthy. During the third trimester a woman may experience difficulty breathing, heartburn, more swelling, tender breasts, difficulty sleeping, hemorrhoids, and false contractions that precede the real contractions that signify the beginning of labor.
Labor and Delivery
Labor starts when real contractions begin. The first stage of labor is defined as the start of contractions to a dilation of the cervix to ten centimeters. In the active stage, the new mother begins to push as contractions continue until the child is born. In the final, placental stage, the afterbirth and placenta are delivered following the baby’s delivery. Signs of the first stage of labor are not always obvious, but may include a clear discharge, lower back pain and abdominal cramps, and a feeling of lightness as the fetus shifts position.
Most babies are born through a vaginal birth, but about one-third are delivered via a Cesarean section. This is a procedure in which the doctor delivers the baby through an incision in the mother’s abdomen. A doctor may choose to perform a Cesarean section if there are multiple babies, if the baby is abnormally large, if it is in breech position, if there are placental or other complications, or if the mother has an infection that could affect the child through vaginal birth.
All pregnancies are susceptible to complications, although many women give birth with no difficulties. Some women may be more vulnerable because of risk factors, but any woman may suffer complications with no warning. This is why it is so important for women to have regular checkups to be screened and evaluated for complications. Not addressing them can be life-threatening.
Gestational diabetes is a complication that occurs when a pregnant woman has high blood sugar levels. This can be controlled with diet and exercise, but some women may also need to use insulin. Not controlling it can lead to other complications, like preeclampsia, early delivery, and a large baby.
High blood pressure is another potentially serious complication. Even women who normally have lower blood pressure can develop this during gestation. Measures can be taken to control and lower blood pressure, but if it is not controlled it may lead to preeclampsia. This is chronic high blood pressure that can lead to edema, protein in the urine, and serious risks to the health of the mother and fetus.
Depression is a major concern for pregnant women and one that is not always talked about. Postpartum depression can be very serious and damaging, but women may also experience extreme feelings of sadness and hopelessness during pregnancy. This needs to be treated by professionals and if it is severe, may warrant the use of antidepressants in spite of the risks to the fetus.
Some less common complications of pregnancy include urinary tract infections and other types of infections, anemia, a deficiency of iron, and hyperemesis gravidarum, a severe type of morning sickness. Obesity in a pregnant woman is also considered a complication because it increases the risks of other complications like preeclampsia and gestational diabetes.
Dangerous Drugs for Pregnancy
Women who are pregnant or could become pregnant need to be aware of the fact that prescription drugs are not always safe for developing fetuses. Too many people make the mistake of thinking that if a medication is prescribed by a doctor that it must be safe. The U.S. Food and Drug Administration (FDA) categorized drugs by risk level to a pregnant woman and her fetus:
- Category A drugs have not shown any risks for women or fetuses in studies.
- Category B drugs proved to elevate risk in animal studies, but not in human studies.
- Category C drugs showed elevated risks in animal studies and were not tested in humans.
- Category D drugs showed some harm can be caused to fetuses, but the benefits of the drugs may outweigh the risks.
- Category X drugs should never be used by pregnant women and have shown to harm fetuses.
The FDA recently changed this categorization because it does not give women enough information about the risks versus benefits of certain drugs. The labels on medications will be changed to include more of a narrative description as well as information about labor, delivery, and nursing while using a medication.
Some drugs are well known for potentially causing birth defects in developing fetuses. Accutane, for instance, a drug used for acne was pulled from the market after being added to Category X by the FDA. Antidepressants like Prozac and Zoloft are in Category C and may be used if the benefits are likely to outweigh the risks. Paxil, another antidepressant belongs to Category D and is best avoided by pregnant women. These antidepressants may cause persistent pulmonary hypertension of the newborn, heart defects, a cleft palate, and may even contribute to autism.
Topamax, a drug used to treat seizures and migraine headaches is in Category D and should be avoided except for extreme cases. It has been shown to cause birth defects. Another anti-seizure drug, Depakote, is also in Category D and it can cause polycystic ovarian syndrome, which may prevent pregnancy. Testosterone is a drug women should never take, but if a pregnant woman accidentally comes into contact with it, it may cause abnormal development in the fetus. Crestor, a drug for lowering cholesterol is in Category X and may cause serious birth defects.
Pregnancy health is so important because it affects two people. Both the mother and her developing fetus can be harmed by health problems, and a baby may even die during pregnancy because of complications. Regular health checkups, healthy lifestyle habits, and mental health awareness with treatments for any complications that arise can keep both mom and her baby safe and healthy.