Stages Pregnancy

Objectives

• To evaluate the importance of good prenatal care • To summarize the signs, symptoms and trimesters of pregnancy • To identify the stages of fetal growth and development • To examine the birth process, stages of labor and delivery and possible complications 2

Signs and Symptoms Of Pregnancy

Sign After Conception Darkening of areola 1-14 weeks (first sign) Tender or swollen 1-2 weeks breasts Feelings of 1-6 weeks exhaustion Nausea and 2-8 weeks vomiting Missed period 2-4 weeks

1 Signs and Symptoms Of Pregnancy Sign After Conception Frequent urination 6-8 weeks

Fetal heart beat 10 weeks

Fetal movement 16-22 weeks

Backaches During entire pregnancy Frequent headaches Sometimes entire pregnancy Food cravings During entire pregnancy 4

Good Prenatal Care

;Exercise, good food and responsible prenatal care are the keys ;Get early prenatal care from doctor, even before you are pregnant ;Eat a well-balanced diet, including a vitamin supplement that contains folic acid ;avoid alcohol, cigarettes, illegal drugs ;limit caffeine ;Exercise regularly with your doctor’s permission ;Avoid x-rays, hot tubs, saunas and infections

Before You Become Pregnant

ÎMake sure you are immune to rubella (German measles) ÎKnow your blood type ÎStop smoking ÎMake sure your diet is healthy ÎGet any illnesses you might have under control

2 Health Professional

See your healthcare professional once pregnancy is confirmed

• Obstetrician • Family practitioner • Nurse-practitioner •Nurse midwife

Medical Exams

The doctor will 9Measure growth of the uterus 9Listen to baby’s heartbeat 9Take mother’s blood pressure and weight 9Check her urine for evidence of protein or sugar 9Ask the mother questions and concerns 9blurred vision 9leg cramps 9abdominal cramps 9unusual headaches 9Sometimes perform ultrasound and genetic tests 8

Nutrition During Pregnancy

Pregnancy takes about 300 extra calories a day to maintain Recommended weight gain is 25-35 pounds Balanced diet of protein, fruits, vegetables, whole grains and a minimum of sweets/fats 6-11 servings of breads, other whole grains 3-5 servings of vegetables 2-4 servings of fruit 4-6 servings of milk and dairy 3-4 servings of meat and protein 6-8 glasses of water, not more than one soft drink or cup

9 of coffee per day

3 Nutrition During Pregnancy

Some nutrients have been found to provide specific benefit to mother and child 9 Folic acid —reduces the risk of birth defects of the brain and spinal cord, referred to as the “neural tube” 9 Calcium —helps prevent a new mother from losing her own bone density as the fetus uses the mineral for bone growth 9 Iron —helps both the mother and baby’s blood carry oxygen 9 Vitamin supplement —needed by most women to maintain adequate levels of these minerals 10

Nutrition During Pregnancy

2500 babies are born with neural tube defects each year • Most common of these is spina bifida (spine is not closed) – The exposed nerves are damaged, leaving the child with varying degrees of paralysis, incontinence and sometimes mental retardation

Neural tube defects develop in the first 28 days after conception When is the time to start eating right for pregnancy? 11

Nutrition During Pregnancy

US Public Health Service recommends that all women of childbearing age get 400 micrograms of folic acid each day

FDA now requires that all flour products, such as breads, buns and bagels be fortified with extra folic acid Sources of folic acid: green leafy vegetables nuts citrus fruits beans fortified cereals and vitamin supplements 12

4 Nutrition During Pregnancy

Avoid :Smoking • Higher risk of preterm birth, low birth weight and stillbirth • Babies are more likely to have poor lung development, asthma, respiratory infections and die of sudden infant death syndrome (SIDS) • Second-hand smoke is also dangerous :Alcohol • Can damage a developing fetus • Travels rapidly through bloodstream, baby drinks also • Causes mental retardation and facial abnormalities, called fetal alcohol syndrome (FAS)

Nutrition During Pregnancy

:Alcohol (cont.) • Estimated 12,000 children are born with FAS in the US each year :X-rays • Exposes the fetus to radiation and can potentially cause birth defects :Hot tubs and saunas • Raises core temperature of a pregnant woman’s body and potentially harm the fetus :Medications • No medications should be taken (even over the counter) unless approved by doctor

Nutrition During Pregnancy

Exercise ;According to medical evidence, even a rigorous workout is healthy during pregnancy ;Check with doctor before beginning a new exercise routine ;Drink plenty of water ;Staying in shape helps to maintain stamina during labor

5 Testing for Birth Defects

If doctor feels it is necessary Ultrasound—uses high-frequency sound waves to form pictures of the fetus on a computer screen can verify due date determine causes of bleeding check for overall health, development, sex and position of the baby measure the amniotic fluid check condition of the placenta

Testing for Birth Defects

Alpha-fetoprotein Screening (AFP)— measures the levels of alpha-fetoprotein in the mother’s blood abnormal levels can indicate a brain or spinal cord defect, presence of twins, a miscalculated due date or an increased risk of Down syndrome Chorionic Villi Sampling (CVS)—inserts a catheter or needle into the womb and extracts some of the chorionic villi (cells from the tissue that will become the placenta) can detect same abnormalities as amniocentesis 17

Testing for Birth Defects

Amniocentesis—examines the cells shed by the fetus into the surrounding amniotic fluid performed about 16 weeks into pregnancy involves inserting a long, thin needle through the mother’s abdomen to extract fluid from the womb indicates chromosomal abnormalities such as Down syndrome, Tay-Sach disease and others can also assess the maturity of the baby’s lungs in the last trimester

6 When Will Baby Be Born?

Pregnancy lasts about 280 days, 9 months or 40 weeks To figure due date: 1. Find the day the mother’s last period started 2. Count backwards 3 months 3. Add 7 days

The baby will be born on or around that due date, give or take two weeks before or after 19

Weight Gain

Plan to gain 25-35 pounds Baby 7 ½ lbs. Placenta 1 ½ lbs. Uterus 2 lbs. Amniotic fluid 2 lbs. Breasts 1 lb. Extra blood 3 lbs. Tissue and fluid 3 lbs. Mother’s reserves 5 lbs. TOTAL 25 pounds 20

Quiz 1 1. Name three symptoms of pregnancy.

2. What might a health care professional do in a pregnancy checkup?

3. What are 2 components of good prenatal care?

4. List 4 things that should be avoided during pregnancy.

5. The recommended amount of weight gain is ___

21 to ___ pounds.

7 Conception

Ovulation—woman’s The egg is drawn into the ovary usually releases Fallopian tube which leads just one fertile egg to the uterus

If sperm are present in the Once fertilization occurs it tube, the egg will be takes about 3-4 days to reach fertilized (conception) and the uterus continue its journey to the uterus Once inside the egg cell, the sperm will release the genetic The newly fertilized egg cell material it has been carrying will divide many times before reaching the uterus

Conception

Sperm’s genetic material (23 chromosomes) will combine with the eggs genetic material (23 chromosomes) Newly formed cell now has 46 chromosomes and is called a zygote The process of cell division Is called mitosis After many divisions, there will be a mass of cells, each cell Implantation of the fertilized containing the identical genetic egg cell in the wall of material present in the first the uterus--complete by fertilized egg cell about the 10th day after 23 conception

Fertilization Facts

Only about 50 sperm will ever reach the egg and compete to be the one single sperm to break through the egg’s protective layer Sperm can live about 48 hours inside the uterus Did you know? Almost half of the sperm will die shortly after release and more will die while searching for the fertile egg The male deposits approximately 2-3 million sperm, which have been developing for about

24 30 days

8 First Trimester 1 through 12 weeks Zygote— first two weeks Embryo— two weeks to eight weeks Fetus— eight weeks to birth

3rd week— after implantation, a row of cells begins to form inside the cell mass this begins the embryo Placenta keeps baby’s blood separate from the mother’s, but allows smaller particles to pass 4th week— the embryo is about 1/8 inch long Internal organs form without an abdominal cavity surrounding Heart starts beating on the 18th day 25

First Trimester

4th week (cont.)—arm and leg buds soon appear Head and brain area still compose about 1/3 of the embryo’s mass The still small embryo is attached to the placenta by the umbilical cord Placenta firmly attached to the mother’s uterine wall Placenta—allows small particles in mother’s blood to pass through to embryo’s blood, waste is also passed through placenta to the mother’s blood 5 weeks—embryo is about 1/3 inch long Other facial features begin to develop 6 weeks—spinal column is clearly visible 26

First Trimester

6 ½ weeks—umbilical cord contains 2 arteries (from embryo to placenta) and 1 vein (back from placenta to embryo)—mother and embryo blood does not mingle 7 ½ weeks—embryo (1 inch) attached to placenta via umbilical cord 8 weeks—embryo is now called a fetus 10 weeks—fetus is about 2 inches and growing quickly Fetus has eyes, eye lids, nose, lips, fingers, among other human features 12 weeks—3 inches long, systems of body are well developed, organs more or less complete Heart pumps about fifty pints of blood through the circulatory system each day 27

9 Second Trimester 13 through 27 weeks

16 weeks—4th month, baby grows more rapidly, and reaches a length of 8 inches Blood vessels are visible through thin, loose skin 18 weeks—fetal “quickening” felt as baby moves and kicks 20 weeks—white, cheese-like substance, vernix, forms to protect baby’s skin from chapping in amniotic fluid 6th month—fetus develops layer of fat beneath skin and lanugo, fine hair, covers head and body 24 weeks—baby stands slight chance of survival if born now—said to be “viable” 28

Third Trimester

28th week to birth

During last two months, fetus increases in weight by almost 1 ounce a day Baby settles into a curled position, usually head down Last month—”lightening” occurs, baby drops into lower pelvis

Signs that labor is about to begin 9Loss of mucous plug 9Loss of weight 9Nesting instinct 9Increase in appetite 29

Quiz 2 1. When and where does conception take place?

2. The fertilized egg is called a ______in the first two weeks.

3. The baby from the 2nd week to the 8th week is called a(n) ______.

4. From the 8th week to birth, baby is called a _____.

305. By the _____ week, all major organs are present.

10 Labor

Labor Series of continuous, progressive contractions of the uterus which help the cervix to open (dilate) and to thin (efface), allowing the fetus to move through the birth canal

Usually starts two weeks before or after the due date, What triggers the onset of labor is still a mystery

Signs of Labor

9 Bloody show—small amounts of mucous, slightly mixed with blood; expelled from vagina 9 Uterine contractions—uterine muscle spasms occurring at intervals of less than 10 minutes, usually indicate that labor has begun; contractions become more frequent and severe 9 Rupture of amniotic membranes—(water breaks) labor sometimes begins with amniotic fluid gushing or leaking from vagina; most women go into labor within 24 hours of rupture

Stages of Labor

First Stage (dilation of cervix) Contractions are more frequent (usually 5 to 20 minutes apart) Dilation of the cervix is necessary for the fetus to move through the birth canal Contractions become more frequent and intense, occur every 2 to 4 minutes and last between 45 and 60 seconds Cervix is completely dilated to 10 centimeters at the end of this stage Epidural block may be given during first stage; local anesthetic delivered to block pain from waist to feet 33

11 Stages of Labor

Second Stage (expulsion of fetus) Begins with cervix completely opened and ends with delivery of baby Also called “pushing” stage “Crowning” occurs when baby’s head is visible at opening of vagina Doctor may perform an episiotomy—a small incision in the skin below the vagina, prevents tearing of the vaginal tissues as the baby emerges Usually most painful stage May last 10 minutes to 2 hours

Stages of Labor

Third Stage (expulsion of the placenta) Lasts from a few minutes to 30 minutes Mild contractions Placenta (organ that has nourished the baby inside of the uterus) is expelled

Average labor and delivery time is 12 to 14 hours, but any length of time up to 24 hours is considered normal

Types of Birth

Vaginal—baby delivered through the birth canal

Caesarean—fetus is delivered through an incision in the mother’s abdomen

12 Caesarean Delivery

Conditions under which Caesarean delivery may be recommended 1. Breech presentation (fetus is feet or buttocks first) 2. Unfavorable shape of pelvis 3. Large fetus (over 8 lbs.) 4. Premature rupture of amniotic sac 5. Active genital herpes 6. Fetal distress (significant increase or decrease in fetal heart rate 7. Prolonged pregnancy (more than 42 weeks) 37

Diagnosing the Infant

Apgar scale—a simple and effective method of diagnosing potential problems in full-term and preterm newborns Baby is examined for five vital signs 1. Heart rate 2. Respiration 3. Skin color 4.Muscle tone 5. Reflex response 38

Diagnosing the Infant

Apgar scale 3 or lower indicates that scores emergency medical attention Performed at is needed 1 minute and 5 minutes after birth 7-10 indicates 4-6 indicates child is in that good assistance condition is needed

13 Becoming Parents

Becoming parents affects your relationship Reality of caring for the baby can be overwhelming Lack of sleep is a factor in the early months of baby’s life Less energy and lack of sleep turn errands and housework into difficult chores, not able to concentrate, irritable Feelings of jealousy Pregnancy temporarily robs mom of former body Less interested in intimacy Overwhelming company and advice from friends and family May have different approaches to parenting

Becoming Parents

New parents checklist 9Communication is the best tool to diminish anger and prevent arguments 9Find time to be together as a couple 9Be aware of one another’s emotions and needs 9Enjoy the time with your new baby 41

Quiz 3 1. Define labor.

2. List the three signs of labor.

3. List and explain the three stages of labor.

4. What is caesarean birth?

5. What is the name of the test performed on infants after birth?

14 Quiz 3 (cont.)

6. How does becoming a parent affect your relationship?

7. What is one of the first signs of pregnancy?

8. What should women avoid during their pregnancy?

9. Define amniocentesis.

10. Pregnancy is divided into ______.

Acknowledgements

KidsHealth. 2002. www.kidshealth.org Babyonline.com. 2002. www.babyonline.com Williams, Rebecca D. Food and Drug Administration. “Healthy Pregnancy, Healthy Baby.” 2002. vm.cfsan.fda.gov/~dms/fdbaby2.html Childbirth.org. 2002. www.childbirth.org

Production Coordinators Treena Aston Alliso n Mango ld Production Manager Geoff Scott Executive Producer G.W. Davis