Prenatal Testing

  When I meet with pregnant women as a volunteer counselor at our crisis pregnancy center, many women have no idea about prenatal tests they will encounter in upcoming weeks.  Let alone, the nature of these tests and their right to decline or allow these prenatal tests.  It seems that since the 80's prenatal testing has expanded greatly.  During my pregnancies, women who had children in the early 80's or before seemed surprised at the litany of common prenatal tests.  This expansion of technology in obstetrics may have benefited the already medically high risk, but it also introduces unnecessary testing to those with no indication of high risk.  Therefore, viewing all patients with the potential for complications and their pregnancies as a disease process.
  As previously stated, all testing should be thoroughly explained.  Women should understand the value of the test, along with  it's risks and benefits.  Practitioners should maintain an air of courtesy  in explaining the testing to the woman and remain respectful of her decision if she should decline.
   Testing to be expected initially:

• Medical confirmation of pregnancy- When you go to the ob, doctors will administer a pregnancy test (not unlike the 5 you previously took at home) to detect hCG. hCG stands for human chorionic gonadotropin  and is a hormone present in both blood and urine after fertilization.  It is produced by the cells that form the placenta.  hCG levels peak in the first 8-11 weeks of pregnancy and later level off.
• Blood tests to test for HIV, your immunity to various childhood diseases such as chickpox, your iron level, and your blood type.  All of these blood tests are essential and give your practitioner a picture to your overall health.
• Blood pressure
• Current weight
• A pap smear (if you're due for one)

Subsequent Routine Visits:

• Weight Checks: To see if your gaining too much or too little  The growth of the baby will also be monitored to judge that according to the EDC (due date) your baby is growing appropriately.
• Fetal Heart Tones: Fetal Heart tones can be heard at around 10 weeks gestational age with a doppler device.
• Urine tests: to monitor the presence of sugar spilling into the urine.

Other Tests:

• Alpha-fetoprotein (AFP or triple screen test): A screening test is blood test done at 15-20 weeks of gestation that looks at multiple markers of proteins or hormones in the blood that can suggest a potential problem with the developing fetus.  This is only a screening and can only suggest that the abnormally high or low levels of various proteins indicate the possibility of a problem such as a neural tube disorder such as spina bifida or a genetic anomaly such as Down's Syndrome.  It has a high rate of false positives that are often discovered with further testing.  Of course until those other tests are performed, you don't know that.  This is a test that the pregnant woman has the right to decline.  Some women chose not to have the test because even if they were to have a child with a genetic disorder or neural tube defect, it would not affect their decision in parenting a child born this way.
• Ultrasound : Routinely performed at 18-20 weeks to detail the growth and development of the baby as well as monitoring the levels of amniotic fluid.  Sometimes performed earlier in pregnancy to determine due date or detect proper implantation when accompanied with other symptoms. Misread ultrasounds can lead to unnecessary intervention.
• Glucose Screening Test: At 24-28 weeks, a glucose tolerance test is performed to screen for gestational diabetes.  Gestational diabetes when unchecked, can lead to large baby at the time of delivery and other concerns such as frequent bladder infections.
• Group Strep B: At around 35 weeks, a vaginal swab will check for the presence of Group Strep B. About 20% of women will have this in their system and will have to receive IV antibiotics prior to delivery to avoid the transmitting to the baby at the time of delivery.  The baby is greater risk of developing a serious infection such as meningitis.

  You have the right to decide which of these tests you are fine with having administered. With the proper information, you can feel good about your choice.  Some women are fine with knowing less about their pregnancy. They choose to avoid the  anxiety sometimes accompanied with testing. While others find it is important to know everything possible.  And knowing would help them feel prepared in the event of a health concern regarding the health of their baby or pregnancy.  Either way, the choice remains yours and that will ultimately bring you peace and enjoyment during your pregnancy.

Common Symptoms of the First Trimester: Bigger Boobs, Longer Naps, and Feeling Seasick

      A friend of mine shared wonderful news that she and her husband were expecting another baby.  The pregnancy took her somewhat by surprise, and the symptoms of tiredness and nausea she had mistook as maybe a bug she was coming down with. "Boy, are you ever," I remarked.
     Most commonly, women experience subtle changes in their breasts.  The breasts are slightly sore, with increased dark pigmentation in the nipple, and fullness.  Some freakishly large blue veins in your chest may be seen.  These are all hallmarks of changes in hormone levels, and these changes in the appearance of breast tissue is nature's way of preparing our bodies to nurse our young.
    Other common changes is the fatigue of early pregnancy.  With all three of my children I felt like a Mac truck slammed straight into me and I only woke for periods racked my nausea.  Yes, nausea is another common symptom and probably the most infamous of early pregnancy symptoms.  It is mostly commonly referred to as morning sickness, but it does not wear a watch and can occur at anytime of day.  Researchers report that nearly two-thirds of pregnant women will experience some nausea in the early weeks of pregnancy.  Since waves of nausea are often triggered by the smell or sight of eggs, meats, alcohol, cigarette smoke, this may be the body's way of shielding the developing embryo from dangerous foods that could threaten development in addition to hormonal shifts.  For the vast majority of women fatigue along with nausea will subside as the pregnancy progresses into the 2nd trimester.  This gives way to increased energy levels and the real joys of pregnancy, feeling all those little kicks and somersaults of a growing healthy baby.

   So if you're not feeling so blessed, try these tips.

• Eat smaller, more easily digestible foods. Often this means carbohydrates, i.e. the saltines on your bedside.  It is often helpful to eat something before getting up in the morning if nausea is a problem in the morning.
• Avoid foods that commonly trigger your nausea when possible.  Maybe your partner shares in meal preparation if possible.
• Avoid overheating.
• Citrus smells can quell nausea symptoms.
• Pressure points on the wrists can sometimes help ease nausea.  OTC products such as "Sea Bands" designed to help those with seasickness may be beneficial.
• Suck on Peppermints.

   Remember this too shall pass.  Take some comfort that these symptoms indicate a healthy pregnancy.  

 

Embracing the Ordinary

    After a week of respite, the kids are all back.  Even though it was a welcome break from the hectic.  I missed them.  The week even seemed longer than usual.  Our summer routine of opening Popsicles, settling the occasional sibling argument, and drying wet swimsuits came to a halt.  For them it was a week of bonding between grandparent and grandchildren.  Fond memories of fishing, hiking, and swinging on the back porch until dark, will go with them for the rest of their life.  But I was so glad to see them running up the drive, arms open wide.

  Love these guys.  Holding onto everyday cause it's going by way too fast!

Enjoy the Meanwhile

     My two year old has recently began a nap strike. I don't understand why she would forego one of the greatest pleasures of my life.  I love sleep. My inability to sleep past 8:00 a.m. is one aspect of parenting that is most frustrating.  
Daily, I plead with her, "Quinn, do you want to take a nap?" 
She grins, not even looking up from her flutter of activity, "no." 
Fifteen to twenty minutes later, "Quinn, it's time to take a nap."
Now I have insulted her.  "NO!!" Her brow is furrowed and she storms off murmuring something in her native toddler speak. 
     So, I wait.  She has found a bag of clothes she and her sister have outgrown.  She puts the over-sized shirts on and wears the pants on her head.  I feign terror, "Oh no, it's the silly monster!" She finds it hilarious, pulling off her disguise revealing herself. We sing. She tells me to shush.  She is the star of this show.  Finally, I see her begin tire. She is fussy.  She grabs a paci and blanket and wants to be held. So we rock.  And rock. Until finally she surrenders.  Outside it is raining softly and the wind chimes play a beautiful tune.  I would probably be this successful more often if I wouldn't push.  Another metaphor for so many things.  Don't push, just surrender, and enjoy the meanwhile.

Thoughts between Loads of Laundry

   Let's face it motherhood is a thankless job.  If you were to work a similar job outside the home under the same conditions how long would you tolerate it?  A day? A week?  Some days your employees (your children) are insubordinate.  They willfully disobey you and then try to pass the blame to a fellow employee, manipulate you by appealing to your sympathies, or have the audacity to challenge your authority.  To an outsider, it would appear they are trying to undermine you.  You work so hard at your tasks, and then they sabotage your efforts by their careless actions.  A mopped floor shows the tracks of muddy shoes minutes after it dries.  A load of laundry is ruined due to a rogue crayon in the pockets.   Cleaned window panes display sticky fingers.  What a hostile work environment!  And as the manager you have no firing power.  Talk about a good union.
    If my twenty-one year old self  were to look at her thirty-five year old self, as Scrooge was able to look at what lay ahead in his lifetime, she may be pleading to the Ghost of Christmas future, "I'm sorry! What must I do to make amends!"  But thank goodness every minute of motherhood is not punishing.  For one thing my children are full of pleasant surprises.  My two year old is very into grooming.  She loves combing her hair, brushing her teeth, putting on deodorant (on her belly), and as I discovered his morning washing her hands in the bathtub.  My son is infinitely considerate.  Yesterday after receiving a belated birthday present from his grandmother, he offered to give it to his slightly older sister who was feeling a little left out.  Then my oldest is ever obedient.  She is always helpful and rarely complains when asked to pitch in.
     Those times when our children are difficult, I wonder how often I try my heavenly father's patience.  He poured out just enough grace to me so that even though I was a sinner, he loved me and made me one of his own (Rom 5:8, Eph. 1:5).  As a Christian, I know how I should behave, but like a stubborn child, at times I  want my will for my way rather than my loving father's will (Eze. 36:26; Jere. 29:11).  The only way to understand the plans He has in store for us is to talk to him. I am continually amazed at God's willingness to reveal himself to me. Despite my circumstances, in good and bad, the Lord is with me (Psalm 139).  But we have to seek Him and constantly work to better the lines of communication with God and deepen our relationship with Him.

                                         

Epidurals...Making an Informed Decision

  Earlier in the week, between planning our church's annual bible school, picking up spilled Cheerios, and wondering where my sanity went, I had the opportunity to view a video segment re: one person's uninformed opinion about epidurals.  I am referring to actress-comedienne, Ali Wentworth's reaction to Victoria's Secret model, Miranda Kerr's decision not to have an epidural because she did not want her baby "drugged up." Ms. Wentworth responded that her babies were not drugged and how dare she! As a childbirth educator I cringe at public personalities further disseminating misinformation.  

   There is some debate on whether drugs used in epidural anesthesia crosses the placenta .  This is largely due to the type of anesthesia administered.  But many women are uniformed or misinformed by their health care professionals when making a decision about receiving an epidural.  To flippantly say, "an epidural won't affect your baby," is WRONG.

      Studies show that epidurals can have the following implications:

• Increased need to augment birth with Pitocin;

• Increased maternal risk of low blood pressure while using epidural;

• Decreased spontaneous birth;

• Increased risk your baby will be evaluated for infection and receive antibiotics;

• Increase risk your baby will be jaundiced.

• fetal malpresentation (meaning baby is not in a good position);

• breathing problems in the baby immediately after birth;

• babies scoring lower on the Neonatal Behavioral Assessment Scale (NBAS)

      For some women, the risks of these complications are risks they can live with.  And often the fear of losing control, and enter the unknown are too much to bear.  Too often by failing to educate and inform we fail to empower birthing women. There is nothing more powerful to a woman who will give birth in their life, than the realization that she can learn to dance with the power of her contractions and discover the depth of her strength.

                                      

Baby Squash

 This morning when watering my deck top garden I noticed this...

       Yay!  A baby squash is about ready to be born.  My deck top garden got off to a late start this year, and I have been so anxious to begin harvesting our own veggies.  It is also a metaphor for pregnancy, isn't it?  We care for our babies by nurturing them (via ourselves) and day by day we anxiously await their arrival.  If you've had a summer baby (all 3 of mine were), the heat and the discomfort of late pregnancy may tempt you to take matters into your own hands, and choose your baby's birthday for him.

      But babies, like my little squash friend, need time to grow and mature. Less than 10 percent of babies actually arrive on the date they are due.  That means most babies are born anywhere from three weeks before to two weeks following their expected due date.  Their brains are continuing to grow and lungs are maturing. Babies born too soon are more likely to have trouble breathing on their own and have difficulty adjusting to life outside the womb.  Sneaky preemies, or near term infants, can have trouble breastfeeding because of their weak suck. Which requires more assistance from lactation professionals. As I once overheard an OB tell a very pregnant women at her appointment, "Your discomfort is not a medically necessary reason to induce labor."  I know she hated to hear it, but I wanted to cheer.

      If you find yourself overdue, remember very soon your little one will be here. Take these last days to bond with your baby.  When the baby is born he will be everybody's baby in a sense.  This is your time with your baby. Don't rob yourself of that!