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The birth of a baby is magical. It never ceases to amaze me. At the first delivery I ever witnessed as a medical student, I was so intensely moved that I cried longer and harder than the mother who had just given birth. Each person evolves following the fertilization of an egg, so minute that it can't be seen without the help of a microscope, by an even smaller sperm. When they join together, they become an embryo, which is like a small orb that encapsules all the necessary information with which to create an autonomous human being. It contains all it needs in order to determine the different organs that must be made, the place they must occupy within the body and their function, information about the color of the eyes and hair, as well as the fact that, at nine months, the development within the mother will cease, only to be continued independently after birth. Birth is the glorious moment when this little being becomes a new individual who breathes, feels, eats, cries, smiles, and begins to relate with the environment.
Ideally, you hope your pregnancy and delivery will be perfect, especially considering all the technology presently available. But there are no guarantees. There are certain things that can be done, though, that may help prevent problems or detect them at an early stage. The mother's health and her gynecological and medical background, as well as her family's, play an important role.
IF YOU ARE THINKING ABOUT GETTING PREGNANT
Your pregnancy should be a very special experience that, ideally, you will remember with love. If you take care of yourself and are prepared before becoming pregnant, your chances of having that kind of experience are excellent. Your physical health and your nutrition help determine whether your pregnancy is easy or more difficult. Though you may feel well, have your doctor examine you before you become pregnant. If you have any condition such as diabetes, hypertension, hypothyroidism, asthma, etc., see your doctor and make sure that it's under control and that you are taking the proper medication. This will increase your chances of becoming pregnant and of helping your baby develop and grow under the best circumstances.
IF YOU THINK YOU ARE PREGNANT
As soon as you realize, or imagine, or think you may be pregnant, it is important to see your doctor. Even though there are several possible reasons for missing your period-including nervous tension, overwork, weight change, or excessive exercising-it is important to know whether you are pregnant. I have patients who say, "Well, I've already had one (or four) children without any problems. I know I have to take my prenatal vitamins and eat well and not gain too much weight.... Why should I see the doctor now? I'll wait." My answer is, don't wait. Each pregnancy is different and requires medical supervision in order to detect whether there is any problem that may not have been present earlier. Seeing your doctor early increases the chances that this pregnancy will be an uncomplicated one.
SYMPTOMS THAT MIGHT SUGGEST PREGNANCY
* Absence of a menstrual period * A very light menstrual period * A change in the size of your breasts, increased sensitivity, or slight discomfort. It is possible that you may feel discomfort, such as the kind some women experience a few days prior to menstruation, which then disappears when menstruation begins. If you are pregnant, the discomfort may continue for several weeks and be accompanied by a tingling sensation in the nipples and visible increase in their size. This is due to the mammary glands, which are preparing to produce the milk that will feed your baby. * Nausea due to increased hormonal production * An increase in the frequency of urination. The uterus is growing and presses on the bladder. This symptom disappears in the third month and reappears in the last trimester of the pregnancy, when the baby's weight increases dramatically. * Cravings and food preferences. Were you among those who believed cravings were "tall tales" told by pregnant women? You may notice it happening to you. In any case, eating a little more of the foods you crave will not harm you, as long as you maintain a balanced diet. * Fatigue
* Slight increase in vaginal secretions. This can be a normal symptom during pregnancy, due to the increase of hormones. A laboratory exam by your doctor will rule out an infection. * Increased saliva production in the initial months
TESTS TO CONFIRM YOUR PREGNANCY
All pregnancy tests are based on the presence of the hormone known as human chorionic gonadotropin (HCG). The placenta produces this hormone, and it may be detected in female urine or blood.
Pharmacies sell test kits over the counter that require only a urine sample. Among them are "First Response," "EPT," "Clearblue Easy Digital," "Fact Plus Select," and "Answer One-Step." Some include instructions in Spanish. They are excellent for women who don't have the patience to see a doctor in order to find out if they are pregnant. The cost varies between $10 and $23. They do not require a prescription. Though they are not infallible, they are more precise when used correctly. They are considered quick and practical initial home tests. The final diagnosis should be determined by a medical examination.
All home tests are more precise when the instructions are followed carefully and when the menstrual period is at least two weeks late. If the result is negative, repeat the test a week later. If the second result also proves negative, the chances of a pregnancy are doubtful. However, even though the result from a home pregnancy test is negative, you should see your doctor immediately after missing a second menstrual period. It could be the sign of some other problem.
There are circumstances when the results are positive although there is no pregnancy, and vice versa.
Some of the causes of a false positive result (in other words, the woman is not pregnant, but the test results are positive) are:
* The woman has recently used marijuana, methadone, or certain medications, such as methyldopa (known as Aldomet), which is prescribed in the treatment of hypertension. * The woman has a type of cancer known as hydatidiform mole.
Some of the causes of a false negative result (in other words, the woman is pregnant, but the test results are negative) are:
* The urine is very diluted. * The test is not performed within a relatively short time after the urine sample is taken. * The container holding the sample is contaminated or dirty. * The test is carried out too early in the pregnancy.
As I indicated earlier, lab tests are based on the presence of human chorionic gonadotropin in the urine or blood that your doctor sends to a laboratory.
Besides confirming the pregnancy with a urine or blood sample, your doctor may detect certain changes-such as an increase in the size of the womb-from a pelvic examination. A pelvic examination diagnosis is more accurate after eight weeks of pregnancy. Naturally, this examination does not affect the baby.
The blood test may be qualitative, meaning it tells whether there is a pregnancy, or it may be quantitative. Quantitative means that it provides your doctor with a number. Along with the date of your last period, this number may help the doctor determine the date of delivery. The quantity of human chorionic gonadotropin hormone increases as the pregnancy advances. Its quantity may be used to evaluate growth and the normal progress of the pregnancy.
In the event of an ectopic pregnancy (in other words, a pregnancy where the baby is not growing inside the womb), the result of the pregnancy test will be positive. But, usually, these pregnancies do not reach term and they may endanger the mother's life. For this reason, even if you feel well, if your home test result is positive, you must see your doctor as soon as possible.
If you were to have a baby, you would probably not take him to just any pediatrician, right? Well, the same applies to choosing the doctor who will monitor your pregnancy. The fact is, the obstetrician will be your baby's doctor ... until it is born.
* He or she must be a professional with a degree in medicine and must have specialized in obstetrics and gynecology. * Ideally your doctor should be someone who is recommended by a relative or friend who has been her patient, or who is recommended by another doctor you trust. * You must trust the doctor enough to share all of your concerns regarding your pregnancy, and he or she must be comfortable speaking your own language. * It is also important to ask who would deliver the baby in the event your doctor were not on call that day. * Ideally, your doctor will be associated with the hospital where you wish to deliver your baby.
VISITING THE DOCTOR
There will always be those who will tell you that you visit the doctor too often and that it is not necessary because you are a healthy woman. They will give you an example of a mother who had healthy children with no medical assistance at all. You should simply reply that, thanks to pregnancy supervision, complications have been greatly reduced, both for mothers and their babies. Your chances of having a healthy baby and of minimizing maternity risks are directly linked to early medical prenatal care.
Your first visit to the doctor
Ideally, this should happen as soon as you suspect you might be pregnant. It is useful to make a note of the date when your last menstrual period began. Avoid douches before your visit, as this could eliminate certain significant secretions important to your gynecological examination. The answers you give your doctor should be as precise as possible. Feel free to ask any and all questions that will clear up any doubts you may have.
What you should expect from your first visit:
* Confirmation that you are pregnant, if you are * Approximate date of delivery, calculated by using the date of your last period * Understand the frequency of your future medical examinations * Be aware of the signs or symptoms that may alert you to call your doctor or to go to an emergency room or to the hospital * Learn recommendations on diet, exercise, and vitamins
What type of medical attention you will receive on this first visit:
You will be asked general questions about your health, the health of the baby's father, and the health of your parents and the father's parents.
What makes up your medical history:
Your doctor will take your medical history. The information needed concerns your health, the health of your family, and whether you have had previous pregnancies. It is important that you answer honestly and offer as much information as possible. This information is confidential. You should mention whether you are taking any medication (even those that do not require prescriptions, e.g., aspirin), whether you are suffering from a medical problem (such as diabetes, high blood pressure, or asthma), if you have allergies, if you have received any blood transfusions, whether you've had any surgery or previous infections (such as hepatitis), if you have had German measles or have been vaccinated against it, or if you smoke, drink alcoholic beverages, or have used drugs.
Family history is important in order to determine whether there is any possibility of a hereditary disease. Sometimes, if you have had a child with a medical problem, certain tests are recommended in subsequent pregnancies. A consultation with a genetics specialist (someone who deals with hereditary diseases) may be in order.
What makes up your gynecological-obstetrical history:
The information on your gynecological and obstetrical history is as important to your doctor as any information resulting from each of your visits concerning the evolution of your pregnancy.
It is important that your doctor be well informed about any problem or previous condition because, though these circumstances may bear no immediate relation to this pregnancy, they will help your doctor know more about your body and how it has functioned and responded in the past.
Before your visit, make a list of the health problems you have had so you don't forget any of them. Include everything, for example, abortions (miscarriage or induced), previous pregnancies, surgeries, sexually transmitted diseases, etc.
Do not censor your information for moral reasons based on what the doctor may think of previous pregnancies, previous infections, etc. Your doctor needs this information in order to make a thorough evaluation and therefore prevent problems. He or she is not there to pass judgment on you or on your past.
If you have had other pregnancies, it will be important to mention the baby's (or babies') weight at birth, how long labor lasted, whether delivery was vaginal or by cesarean section, whether anesthesia was administered and whether there were any complications, for example, premature delivery (before the nine-month term), high blood pressure or diabetes during pregnancy or delivery, infections, bleeding, or any complications concerning breast-feeding.
What the physical examination will evaluate:
* Your height and weight * Your blood pressure * Your overall health from head to toe, listening to your heart and lungs, and a breast, abdominal, and pelvic examination
With the woman lying on her back with her legs bent, the obstetrician inserts two fingers in the vagina and places his or her hand on the patient's abdomen to palpate the womb and the ovaries.
What the blood and urine tests and ultrasound look for:
You will be given a battery of tests. Among them are the following:
* A test to determine your blood type and Rh factor * A test to determine the level of hemoglobin in your blood, to rule out anemia * A test to detect the presence of antibodies against German measles (if you have not been vaccinated, have not had the disease, or you don't know whether you have) * A test for syphilis and other sexually transmitted diseases * A test for hepatitis antibodies * A Pap smear, if you have not had one in the last year (to rule out the presence of cancer cells in the neck of the womb or cervix) * A test for the HIV/AIDS virus * A urine sample to test for sugar and protein; this may suggest diabetes, kidney trouble, or infections * If you are over thirty-five, or there is a family history or possible susceptibility to certain diseases, your doctor might recommend certain special examinations (genetic) and, later on, an examination of the fluid that surrounds the fetus in the womb (amniotic fluid), known as amniocentesis. * An ultrasound to determine if the pregnancy is inside the uterus, whether the fetus has heartbeats already, and whether the size coincides with the dates of pregnancy (see Chapter 3)
Several of these tests will be repeated during the course of the pregnancy.
The frequency of the medical examinations varies from woman to woman, but generally you should expect the following:
If you do not have other medical problems and you feel well, your doctor will see you every four to six weeks during the first seven months of the pregnancy. Starting with the eighth month (or thirty-two weeks), you will be seen every two weeks. In the final month, your visits will be on a weekly basis. Make sure you discuss any symptoms you have and ask any questions regarding doubts you may have. If necessary, write them down and take them with you.
At each visit, your doctor will check your weight and blood pressure, examine the size of your womb, and, as the pregnancy advances, check the size and position of the baby as well as his heartbeat. A urine sample will also be taken to test for the presence of sugar and protein.
At sixteen weeks, a blood test known as alpha-fetoprotein will be routinely performed to determine any abnormalities in the development of the baby's nervous system. At thirty weeks, a test will check the level of sugar in the blood to rule out gestational diabetes (see Chapter 2) and a blood cell count will rule out anemia (lowering of red blood cell count).
Do not assume that, because you are feeling well, you can monitor your pregnancy on your own. Not going to the doctor, though you feel healthy over several months, endangers your health and your baby's health.
Excerpted from HEALTHY MOTHER, HEALTHY BABY by Aliza A. Lifshitz Copyright © 2007 by Aliza A. Lifshitz. Excerpted by permission.
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