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Even before she knows she’s pregnant, she’ll notice breast changes. Her breasts become tender. Her nipples become tender. Her breasts enlarge ever so slightly and increase during the entire pregnancy. Some other changes are generalized gas production, so constipation as well as gas bloating of the belly occurs. These are some of the changes that people come into the office complaining of when they don’t even know they’re pregnant.
Other early changes occur in the skin. There are some ever-so-slight pigment changes in the face or all over the body. Some women can get increased oil production and acne as well in early pregnancy.
Some of the tip-offs that you’re pregnant could include generalized bloating or difficulty in digestion. That’s a big one. Many women begin to feel like they have to urinate very often. Few others are nausea, vomiting, drowsiness and wanting to sleep for long hours.
The causes of morning sickness are not always clear. There is some thought that hormone changes increases in progesterone and estrogen cause morning sickness. Usually about 70 to 80 percent of women suffer from morning sickness during early pregnancy; some even begin noticing nausea as early as four to eight weeks.
Morning sickness occurs not just in the morning but actually all through the day. It usually ends at about 14 to 16 weeks. One thing that triggers morning sickness is an empty stomach. One way to battle that would be to actually keep food in the belly every two to three hours. There have also been reports showing that vitamin B-6 and calcium can help as well. You can alleviate the symptoms by consuming small, frequent meals, low fat/non oily foods and drinking plenty of fluids.
Morning sickness is a signal that the progesterone hormones are actually increasing normally. When a woman has quite a bit of morning sickness, that’s actually a very good thing. That usually shows that the progesterone hormones are increasing normally and her pregnancy is most likely very protected. However, absence of morning sickness in a pregnant woman does not necessarily indicate problems during pregnancy.
The uterus is made of muscle cells. Throughout pregnancy, many changes occur in the uterus. First, these muscle cells start increasing in size and number. They increase in size all the way through to the delivery.
During pregnancy, the uterus grows from about the size of my fist and even smaller in some people, to the size of a large orange or grapefruit, then to the size of a cantaloupe, and then, of course, to the size of a small watermelon at the end.
Around nine to 12 weeks the uterus actually goes from being a pelvic organ to being an abdominal organ. We can feel it in the abdominal exam after about 12 weeks or a little bit earlier.
As the uterus grows, the top half of the uterus expands. As it expands or stretches, it actually pushes all the organs that used to occupy that space higher and higher into your upper abdomen. That’s why your digestive system, your small and large intestines, are pretty cramped. That’s why you have a lot of the indigestion, the heartburn, the feeling of fullness immediately. It’s a lot of pressure.
During pregnancy, the blood volume increases dramatically, probably by about 40 to 50 percent. That’s a large blood volume for a woman, but amazingly, the body compensates very, very well.During early through middle pregnancy, a woman running up a flight of stairs will notice that her heart’s pumping away and she’ll get a little lightheaded. Her cardiovascular system is taking some time to compensate. As the pregnancy progresses, she will have to be aware of these changes and actually slow down so that the symptoms have some time to settle down a little bit. The increased blood volume is a pretty big load on the heart and lungs. But women are made to actually compensate for that.
About 10 to 15 different hormones cause the actual increase of the blood volume and control the compensation mechanisms that the organs, including those of the cardiovascular system, use to accommodate those changes.
The lungs also go through many changes. The diaphragm actually rises. The diameter of your chest increases outwardly. Despite those adjustments, though, you often feel out of breath and you may feel that you can’t take a deep breath or that you feel a little bit more out of breath. The hormones again have a big role to play in that and cause those changes and the compensating mechanisms as well.
It used to be thought that the actual lung volume or capacity was lower or less efficient during pregnancy. But in reality studies have shown that there’s actually an increase in the volume of the lungs. The efficiency is definitely greater, although a pregnant woman is actually more prone to getting lung infections that stay a little bit longer.
Even prior to pregnancy and during the very early stages of pregnancy, it’s very important to have a balanced nutritional plate. The caloric requirements of the body increase to about 300 calories a day all throughout pregnancy. And breast-feeding requires an additional 500-calorie increase on top of that.
In early pregnancy, nutrition has a big impact on fetal development. Amazingly, the body compensates and takes the fats, carbohydrates and proteins from whatever you give it, but if you have a healthier, balanced diet there are fewer problems in development. There’s an increased need of folic acid this has been in the media for quite a while. Studies have shown that folic acid actually decreases spinal problems and genetic problems.Since nutrition is so critical, especially during the early stages of pregnancy, women need to actually start on prenatal vitamins even before conception, and to continue that all the way through pregnancy. But it’s very vital in the very early stages of pregnancy, during the first four to eight weeks of early fetal development.
Tobacco is extremely dangerous to both mother and fetus. It affects their respiratory systems greatly. It puts the mother at greater risk of getting infections and pneumonia, it worsens asthma, and depending on the time of year, these can be greatly increased.
Smoking can affect the mother’s cardiovascular system as well, including how efficiently the heart is pumping. It can also affect skin changes and general well- being or mood. Smoke affects the weight of the fetus as well, causing a lot of low- birth-weight babies. Even though some women may think, “OK, I don’t want to gain a lot of weight during pregnancy” and keep smoking, it actually affects the fetus, not just the mother’s weight.
Alcohol has been well studied. Even small amounts and regular doses can cause fetal alcohol syndrome, which is a horrible outcome for the baby. These are two drugs that are so dangerous to moms and babies.
Normal weight gain is calculated using your body mass index (BMI) before pregnancy. If you are underweight before you become pregnant (have a BMI of les than 19.8) your recommended weight gain is between 12.5kg and 18kg (28 to 40lb). If you have an average BMI (19.8 to 26) before pregnancy you should gain between 11.5kg and 16kg (25 to 35lb). If you are overweight before getting pregnant (have a BMI above 26) you should gain between 7kg and
11.5kg (15 to 25lb).
Some foods carry a greater risk of harbouring bacteria and should be avoided during pregnancy. These include unpasteurized milk, blue and mould ripened cheeses, raw fish, uncooked shellfish, anything-containing raw eggs (including homemade ice cream and mousse), and any cooked food chilled for reheating.
Some household products contain very strong chemicals and although they have not been proven to be harmful to your child they are best avoided during pregnancy. Avoid anything with strong fumes such as oven cleaner and let someone else do any painting as some paints include lead and mercury. Also avoid insecticides or choose environmentally friendly products instead.
Sex while pregnant is normally safe though you may have to adjust your position to allow for that bump. Women who have a history of miscarriage may be advised to avoid having intercourse during the first trimester and those with a history of early births should avoid it in the final trimester. Speak to your doctor if you have any concerns. You may want to consult your doctor if you notice bleeding in the early months.
You should check with your doctor before taking any medication while pregnant. This includes over-the-counter medications such as aspirin and homeopathic medicines.
Although most airlines will allow you to fly until week 36 you need to check with each one and with your doctor before booking any tickets. Most airlines require a letter from your doctor to state that you are fit to fly. Make sure to stretch your legs and walk around during the flight and drink plenty of water. It’s also a good idea to ask for an aisle seat so you don’t disturb your neighbour when making those frequent trips to the loo.
The seat belt will not hurt you or your baby even if you are involved in an accident; there is a greater risk of injury if you do not wear your seat belt. Wear the seatbelt normally across the shoulder and under, rather than over, your belly.
Regular exercise during pregnancy has been linked to less overall weight gain and fat deposits that may help prevent gestational diabetes. Regular aerobic activity prior to or early in pregnancy has also been linked to a reduction in the risk of preeclampsia. A complete exercise program helps to prevent deconditioning, promotes retention of muscle, bone and connective tissue; relieves stress; prepares a mother for labor; helps to maintain posture, increase or maintain range of motion; and may relieve some discomforts induced by pregnancy.
In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women”
If you begin an exercise program in the first or second trimester, you should do your best to continue it through the rest of your pregnancy, being sure to modify your activities and intensities as your body changes. Barring any complications in your pregnancy, continuing exercise through third trimester will reduce the chance of your baby gaining excessive weight in the last few months. Continuing exercise through the third trimester may also reduce your chances of excessive weight gain.
Some exercises such as the pelvic tilt have been shown to safely decrease the intensity of back pain in pregnant women. Depending on the cause of the pain, prescribed exercise and stretching can be useful in decreasing or eliminating back pain caused by the shift in center of gravity associated with pregnancy. This is one reason that supervised exercise sessions during pregnancy are suggested.
Regular moderate exercise during pregnancy has been linked to less overall weight gain and subcutaneous fat deposition (fat under the skin). It helps maintain muscle mass and increases your metabolism, which probably reduces the risk of gestational diabetes. Adequate weight gain is important for a healthy pregnancy, but exercise can help play a role in preventing excessive weight gain and the associated complications. Starting a moderate weight-bearing exercise routine early in pregnancy and continuing it throughout can help in maintaining a healthy pregnancy weight.
Dietary protein plays an important role in the growth and development of the baby, meeting the mother’s daily needs, as well as in producing the extra blood necessary for carrying nutrients during the pregnancy. It is recommended an extra 10 grams of protein per day (for single baby being carried) than normal. This approximately comes up to a total of 60 grams per day. Women who are more active may call for slightly higher amounts of protein, which can be decided between you and your practitioner.
Adequate protein may also play a role in preventing pregnancy induced hypertension (PIH) or preeclampsia.
Water is important in supporting the production of extra blood volume and plasma necessary for pregnancy. This increase in blood volume is essential for nutrient transport, placental function, and temperature regulation. Hydration is especially important before and during exercise to aid cooling and preventing cramping or Braxton Hicks contractions.Pregnant women should have 0.1-0.2 liters of water before exercise and 0.05-0.1 liters every 20-30 minutes during activity. Pregnant women should consume 2 quarts of water through the day and even more if the woman is more active. If a woman experiences Braxton Hicks during exercise, she should cease activity, drink 4 glasses of water, void her bladder, and rest on her side. If the contractions do not cease, she should contact her healthcare provider.
Regular moderate exercise during pregnancy may prepare the body for labor by increasing or maintaining her endurance for the process. Exercise participation may also increase beta-endorphin levels that can lower a woman’s pain perception during labor.
Some studies have found evidence of shorter labor, improved long-term condition of the mother, lower rates of c-section, and reduced length of hospital stay for the mother.
Good nutrition before you’re pregnant will mean a healthier you and baby. If you’re already eating a well-balanced, nutritious diet now few, if any, changes will be necessary during pregnancy. The American College of Obstetrics and Gynecology, also referred to as the ACOG, recommends that pregnant women increase their pre- pregnancy servings of the four basic food groups to include the following:
- At least four servings of fruits and vegetables. This is important for making sure you consume enough vitamins and minerals
through food, in addition to any prenatal vitamins your doctor has suggested during your pregnancy.
- At least four servings of whole-grain or enriched bread and cereal to ensure you have enough energy during your pregnancy.
- At least four or more serving of milk and dairy products (not including butter, ghee or margarine) for the calcium you need during pregnancy.
- You’ll also need to consume at least three servings of meat, fish, chicken, eggs, nuts, dried beans, legumes or peas to ensure an adequate level of protein in your diet.
- A well-balanced diet during pregnant helps ensure that both you and your baby are healthy.
- The only necessary recommended daily allowance or RDA that is difficult to achieve through diet is iron. In most cases, your physician will prescribe an iron supplement during pregnancy. Also, be sure to follow any additional diet or vitamin supplementations recommendations that your personal physician recommends during your pregnancy.
You do not need a special diet just because you are pregnant but you should eat healthily as your body has to work especially hard during pregnancy. It is now known that what you eat can have a far-reaching effect on your baby’s health. You should therefore make sure that you have a well-balanced, varied diet and that you eat regularly and often. In the last three months of your pregnancy, aim to increase your daily calorie intake by about 200 calories – the equivalent of a banana and a glass of milk.
It is a good idea to be realistic in your dietary aims and eat what you actually enjoy, because it is likely that if you restrict yourself to an artificial (and possibly unappealing) diet, you will be more tempted to go on an eating binge and put on unwanted pounds. Just make sure that you are getting the basic nutrients in your core diet.
Try to cut out very fatty foods such as fried foods, and
cream sauces. These are likely to make you feel nauseous in the first three months as well as contribute to weight gain. Look out for the fat in convenience foods like biscuits, pastries, puffs and cakes. Avoid certain foods that carry the risk of infection and damage to your baby.
As your blood volume increases, you need to increase your fluid intake. Drink water rather than high-calorie fizzy drinks, which are full of sugar and can make nausea and heartburn worse. Even if you have fluid retention, do not cut your fluid intake; try to drink up to six glasses of water each day. Drinking fluid can also prevent constipation, a common problem in pregnancy.
Snacking in itself is not a bad thing but if you can, you should try to snack on healthy foods. Fresh fruit, nuts, raisins, and raw vegetables are all much better for you than junk foods like chocolate, chips, and fried snacks etc.; these are high in calories, fats and sugars, and salt, and although they may produce a fast energy high, they do not contain many nutrients that will help your baby to grow and develop. They may also contain artificial colouring and additives. Of course, the occasional snack now and then will not do you any harm, but snacks shouldn’t play a large part in your diet. This would also cause you to gain excessive weight.
Although not as bad for you as junk foods, fast foods can still be high in fat and carbohydrates and, if they are kept heated for long periods of time, many of the vitamins and minerals in the food are destroyed. However, restaurant meals such as freshly made pizza can be nutritious for you, as long as you make sure that you maintain your basic core diet.
Your weight is not important during pregnancy unless you are very underweight or seriously overweight. What is more important is the growth-rate of the baby; this does not depend on your weight or how much you eat but rather on the efficiency of the placenta and the quality of the food, which supplies the appropriate nutrients. However, you will feel happier if you gain the weight steadily and don’t put on large amounts.
No, it is not a good idea at all, because this is a time when you should be eating a balanced and nutritious diet so that your baby can get all the nutrients he or she needs for healthy development. You will also need plenty of energy to cope with the extra physical demands of pregnancy and labour. Even though you might not want to put on any weight, you will and you should if your pregnancy is going well, and this is quite natural and essential. If you were seriously over-weight before you became pregnant, you may need to watch your diet. Your doctor or midwife will give you more information on this.
As the uterus grows and the abdomen distends, the actual muscles of the abdominal wall increase in size. Since it’s over a long period of time, the body compensates very nicely.
Women who have had more than one or two pregnancies will sometimes get a separation of the muscles that run up and down the mother’s abdomen and the rectal muscles. It usually doesn’t happen in first-time pregnancies, but it can.
In general, though, these muscle tissues as well as the facia, which is a strong tissue underneath the skin and fat, are made to stretch very, very slowly and can accommodate the very large uterus.
Many hormones are responsible for the accommodation of the skin. The collagens, collagenase, even the increased progesterone has some effect on the increased elasticity of the skin during pregnancy.
Some of the most noticeable skin changes during pregnancy involve pigmentation. The “mask of pregnancy” is one that is often written about. It’s a darkening of the skin usually around the sides of the face and the forehead.
There can also be a change of the line down the abdomen. It’s usually called a linea alba, which is a white line. During pregnancy it can become a dark line, called the linea nigra. This change sometimes occurs as early as the beginning of the second trimester, and increases and then disappears probably three to four months after delivery.
Some other common changes include little spider veins that pop up in the legs and sometimes on the arms and the abdomen. The reasons why these happen are not quite clear. We know that in many women, these spider veins disappear after delivery.
The pigment changes are probably due to the increase in the melanocyte- stimulating hormone during early pregnancy, as early as the first month, which then usually drops off after delivery. We don’t know what levels are associated with women who get a lot of pigmentation.
Another common skin change during pregnancy is definitely acne. You’ll notice outbreaks mostly on the face, but sometimes the shoulders and the backs of the arms. Again, there aren’t any specific hormones that cause these, but increases in both estrogen and progesterone are known to cause acne throughout life.
During early pregnancy, a lot of women actually experience a change in their vision, and have to get their prescriptions changed if they wear glasses. So we usually ask women to go ahead and get their eyes checked. Most of the time their hearing stays in check, but there can be changes. The reasons are again very unclear. It’s most likely due to the change in the multitude of hormones. Their vision will sometimes return to normal, but most of the time, vision changes remain that way.
As pregnancy progresses, many women will come into the office complaining that their hands or feet are numb or that they’re swelling. Again, with increases of hormones, particularly progesterone, in pregnancy, the vascular system becomes very leaky and increased tissue fluid is particularly noted in the hands, feet and legs.
Carpel tunnel syndrome is also very common in pregnancy because of that swelling. Sometimes women have to get wrist braces and elevate their legs or undergo hydrostatic pressure, like getting in a swimming pool or a bathtub, to feel better. Those conditions alone are not dangerous, but they are something that we do see in mid- to later-pregnancy.
After about 20 weeks of pregnancy, we encourage pregnant women not to lie on their back anymore. At this point, the uterus is quite a bit heavier and it actually lays on the blood vessels that run up your back, the inferior vena cava and the aorta. The vena cava is the big vessel that carries the blood to the heart, and the aorta’s the big vessel that carries blood away from the heart. They both become compressed, and some people will lose consciousness when pressure’s applied to these vessels. Numbness and tingling can occur in the upper and lower extremities. After about five months, we encourage women to sleep on their sides instead.
Braxton Hicks contractions are irregular contractions that happen even in very early pregnancy. As early as four to eight weeks, the uterus is noticed to exhibit very low- pressure, irregular contractions maybe five to 20 a day. Most of the time they’re not detected. When most women reach maybe 24 to 28 weeks, they will actually feel these contractions. Again, they’re not painful; they’re
very low in pressure. Women typically notice a tightening that quickly passes.
The cause is not well known. We know that they’re there and no cervical change occurs with them, so it’s not preterm labor. Braxton Hicks contractions actually increase in frequency during late pregnancy. So at around 36 to 40 weeks, most women will notice they’re much more frequent, but without any specific pattern and without pain.
One of the early signs of labor would be regular contractions. We usually have women time their contractions, and tell them to call us if they’re coming more than four to six times an hour and lasting at least 30 to 60 seconds. These are also stronger than Braxton Hicks contractions. They’ll sometimes start with some mild cramping, then increase to about four to six times an hour.
If you notice that one hour goes by and you have six contractions, and then the next hour goes by and you have 10 contractions, and you’re noticing that there is actually a pattern every 10 minutes or every five minutes that’s when we have you call the doctor just to let them know what’s going on.Some other things that you can look for are mucus changes. You might notice bloody mucus or the mucus plug, which is a large amount of mucus that actually passes out some time between two weeks and a few days before actual labor starts. Sometimes the water breaks before contractions begin, either as a small trickle of fluid or a large gush. Usually when that happens, women are aware and they call us right away.
A contraction is the uterus muscles tensing at the same time. The uterine muscles are smooth muscles. They’re involuntary muscles, which means that we don’t have control of them. The parasympathetic system or the involuntary system of the body actually causes the uterus to contract.
The water that the baby is enveloped in the amniotic fluid is actually fetal urine that’s swallowed and then passed through the fetus’s renal system and excreted again during pregnancy. It’s sterile urine. The amniotic fluid also bathes the baby’s lungs when the baby “inhales” it, which helps the lungs to mature properly.
The first stage of labor begins when the initial strong contractions start and continues until the cervix is dilated fully. The second stage of labor begins with the mother pushing and ends with the expulsion of the baby. Stage three begins at the delivery of the baby and ends at expulsion of the placenta.
Many changes happen to the cervix during pregnancy. Early on, the cells on the outside of the cervix become hypertrophied or more prominent. During the first exam, very early in pregnancy, sometimes you can actually see a blue cervix, due to increased blood vessel changes.
Sometimes a little bit of bleeding can occur after normal activity or sex. Usually this is not dangerous, but it’s very alarming to a newly pregnant woman. Another change that can happen due to hormonal changes is that the cervical opening can become a
little more relaxed. As labor approaches, the pelvic opening actually widens a little bit. The pelvic bones separate ever so slightly, which can cause a lot of discomfort. In late pregnancy, there can be much pressure and pulling and tugging in the pelvic region, which we call round ligament pain, and that’s usually in the groin area.
During the last four weeks of pregnancy, beginning at around 36 weeks and sometimes even a little bit earlier, many doctors will start checking the mother’s cervix. During this time, the cervix will shorten or efface and it will start dilating, or opening. These things progress slowly until actual labor hits.
The rhythmic, powerful uterine contractions cause the cervical changes. Cervical change doesn’t usually happen without uterine contractions.
The contractions are a physical tightening of the entire uterus. All those uterine smooth muscles work together in concert to squeeze the infant out as well as when the mother pushes. Of course the mother has to push to actually get the baby out, but the uterus itself is expelling the baby with the uterine contractions.
Labor pains are due to the uterus muscle squeezing and contracting. When muscles contract, it’s very painful. Menstrual cramps are actually uterine contractions on a very smaller scale. There are also chemicals produced in the body, the prostaglandins, that actually cause pain, and these are released during labor.
Some of the factors that cause or contribute to a C- section would be slow progression of labor or no
progression of labor. There’s a certain speed to labor that is normal. We usually try to adhere to that to keep it safe for the mom and the baby.
What happens in many cases is that the pelvic bones are just not large enough to allow the passage of a certain size baby. If that’s the case, the cervix may open to a certain number, say, to 4 to 5 centimeters, and just stop and stay at that number for two hours.
Usually a first-time mom who is experiencing good, strong labor contractions with no progress for several hours would be a candidate for a C-section. Another case would be if the cervix dilated to 10 centimeters and the mom was pushing for a certain amount of time without the baby appearing, we’d assume that the baby’s just not going to be able to come out through the pelvic outlet. We allow a shorter amount of time for somebody without an epidural.
But there are two big reasons that C-sections happen. One big one would be where the fetal heartbeat would drop suddenly and stay down rather than recovering after a contraction. That would be an emergency and we would have to get the baby out.
The other situation would be if the fetal heart tracing just does not look normal regardless of the resuscitation that we’re doing oxygen and position change or putting some fluid back up inside the uterus. If things are just not looking healthy or safe for the baby or the mother, that would necessitate a C-section.
Few other factors include: Failure to progress with good labour pains; cervix does not dilate; disproportionate size of the pelvis and the baby; big baby and foetal distress.
Symptoms of Pregnancy
- missed period
- breast tenderness
- nausea, vomiting or morning sickness
Whether using hair dye products during pregnancy is safe is a common question on the mind of pregnant women in countries where hair coloring is common among women. Do hair dye products affect the health of your developing baby?
The answer to whether it is safe to dye hair during pregnancy is not clear. The probability is that only a small amount of hair dye is absorbed into your body. This makes it unlikely that the modest amount of chemicals absorbed by your system would reach your baby. No changes to developing babies were noted in the few animal and human studies that are complete. If you are unsure about whether you should dye your hair during pregnancy, you should share your concerns with your doctor.
An estimated 10 to 45 percent of pregnant women in the first trimester, unaware of their condition, reach for the most common OTC drug, aspirin. Aspirin and other drugs containing salicylate are not recommended throughout pregnancy, especially during the last three months, except under a doctor’s supervision. Acetylsalicylate, a common ingredient in many OTC painkillers, may prolong pregnancy and cause excessive bleeding before and after delivery
Overall, most other OTC drugs can be used during pregnancy with the supervision of a physician. Although scientists do not know the effects on the fetus of all OTC and prescriptions drugs, some are known to cause birth defects and should be avoided.
Since 1984, all OTC drug products have carried the following warning: “As with any other drug, if you are pregnant or nursing, seek the advice of a health professional before using this product.”
One drug that can cause severe birth defects is Accutane, or isotretinoin. Accutane, a derivative of vitamin A, is a powerful prescription drug that can clear severe cystic acne, but can cause birth defects (such as heart defects, small jaw, cleft palate, and skull and facial disfigurements) in about 1 out of every 4 exposed fetuses. Accutane can also cause miscarriages.
Avoid any self-medication and in case of emergency, you can use paracetemol for pains or fever.