9789188099433 by Smakprov Media AB

HAVING A

contemplation, excitement and joy. It is an experience that adds a new dimension to life! It is also a time of uncertainty, when there is much to be learned. This book will help to answer many of your questions about pregnancy and childbirth.

H AV I N G A B A B Y

H A V I N G A B A B Y is a time of expectation,

baby A book about pregnancy and giving birth

It covers many aspects, including:

. The physical and mental changes of pregnancy

. The week by week development of the baby . The phases of labour and pain relief Having a baby was written by obstetrician Ulla Björklund and midwives Hanne Fjellvang and Susanne Åhlund.

ISBN 978-91-8809-943-3

789188 099433

H AV I N G A

baby A book about pregnancy and giving birth English translation: Gruffydd and Lisa Jones

© 2016 The authors and Gothia Fortbildning AB ISBN 978-91-8809-943-3 Copying is illegal! The reproduction of the contents of this book, in whole or in part, is forbidden under copyright law without the express p ermission of the publisher, Gothia Fortbildning AB, Stockholm. This exclusion applies to the text and illustrations and applies to all forms of reproduction. Vänta barn was first published in 1980. The text was originally written by consultant gynaecologist Kajsa Sundström and commissioned by the then Bureau of Health Commissions of the Swedish National Board of Health and Welfare. The book was also later published by the Swedish National Institute of Public Health. The authors of the current edition are consultant obstetrician Ulla Björklund and midwife Hanne Fjellvang of the Dept. of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, and midwife Susanne Åhlund of BB Stockholm antenatal clinics. This edition is an abridged version of the original edition and was first published in 2008. Gruffydd and Lisa Jones and Space 360 Susanne Bardell Carlbring C O V E R D E S I G N A N D G R A P H I C S : Anna Hild O R I G I N A L : ord & form, Karlstad C O V E R I M A G E : iStock.com/gornostaj I L L U S T R AT I O N S : Maria Källström P H O T O G R A P H Y: Karin Alfredsson

T R A N S L AT I O N :

EDITOR:

The photographs were taken at the Department of Obstetrics and Gynaecology at Södersjukhuset. Third edition, second impression P R I N T E D B Y:

Baltoprint, Litauen 2016 Gothia Fortbildning Box 22543, SE 104 22 Stockholm Customer service +46 (0)8 462 26 70 www.gothiafortbildning.se

CONTENTS Foreword

Having a baby

You are going to be a family

Mother-baby-child Health and the environment

Food and nutrition Physical activity and exercise Sex during pregnancy Can sex hurt the baby? Dental care Work Medication Tobacco Alcohol Allergies Pregnancy can affect you in many different ways

Tender breasts Tiredness and nausea Mood swings Fear and anxiety Stretch marks Heartburn Constipation

Increased blood volume, faster pulse Swelling and fluid retention Varicose veins Contractions Stitches and cramps Discomfort in the back and pelvis

Reduced fetal movement

8 18 18 18 18 19 19 20 20 21 21 22 23 23 23 24 25 25 25 26 26 26 26 27 27 28 29

Maternity care and antenatal care centres are there for you

What happens when I see the midwife?

Illness in pregnancy

Miscarriage

32 Premature birth 32 High blood pressure and pre-eclampsia 33 Diabetes in pregnancy 33 Vaginal bleeding 34 Intrauterine growth retardation 35 Thyroid problems 35 Infectious diseases that can affect pregnancy 36 Pregnancy itch/cholestasis 39 Mental difficulties 39 Depression 39 Sickness/parental/pregnancy benefits 40 Childbirth

Preparation

41 42 43 46 48 55 58 59

Caesarean section

61 62

Support during labour Going into labour What happens on the labour ward? Pain in childbirth The different stages of labour A child is born After the birth

Problems that can occur What about the next time?

Ventouse

Breastfeeding

FOREWORD Having a Baby is a book for all parents-to-be. It describes the physical changes that take place during pregnancy and childbirth, as well as the emotional journey through pregnancy and childbirth. The aim of the book is to provide a useful resource for all parents-tobe, whatever the family background. We have therefore described parents as mother and father or partner. We hope that the book will prove to be a valuable source of information during pregnancy. It is based on our own knowledge, skills and experience. Our information and inspiration have come from published literature and from expert colleagues. We have also learned a lot from sharing the experiences of parents. Having a baby is a time of expectation, contemplation, excitement and joy. It is an experience that adds a whole new dimension to life! The authors

HAVING A BABY Pregnancy is a time of great change. A new life is developing inside you! As a mother-to-be you may feel proud and amazed that you can carry a child inside your own body. You become aware of your body in a completely new way, feeling how it changes and develops. These changes are immense and exciting! You may become more open and receptive, but also more sensitive to criticism and to the attitude and behaviour of those around you. You may swing between self-confidence and insecurity, and between happiness and sadness. These mood swings are often caused by hormonal changes. The months leading up to childbirth and parenthood are a time of physical and mental preparation. The physical changes are obvious as the hormones flow and your belly gets bigger, and especially when you feel your baby kicking for the first time. For many women, the mental adjustments start with the positive pregnancy test. What’s it like to give birth? How will I react to the pain, and will I be able to cope with it? What sort of relationship do I have with my own parents? What were they like as parents, and will I be like them? These are questions that often run through the mind of a pregnant woman. Your body and soul will go through nine months of preparation for the coming event, and you need time to think things through and get ready. By the end of pregnancy most women are mentally prepared and motivated to give birth to their baby. You may not sleep very well and feel heavy and a bit tired but, most of all, you will be curious and eager to see the baby you have been carrying inside you. Most women therefore welcome the onset of labour. For the expectant father/partner, pregnancy can be just as much of a bewildering experience as it is for the expectant mother. You, too, should prepare yourself for becoming a parent, and this can generate strong feelings of both joy and worry. It is thrilling to follow the baby’s development as every month the approaching birth comes closer. It is important to feel part of your partner’s pregnancy, but don’t forget to share your own thoughts and feelings with her. There are also lots of practical things you can do to help ease her symptoms and problems.

Perhaps you are putting off some of your own thoughts about what it will be like to be a parent, but pregnancy is a time for you to prepare yourself as well. You may well start thinking about your relationship with your own parents and use this to form the basis of your own identity as a parent. Try to work out how you as a father/partner can give your child the best start in life.

You are going to be a family The modern family has changed, and its relationships are much more diverse these days. Many parents live together, whether married or not, while others choose to be single parents. Today, there is no standard Âfamily. But there is one thing that all parents have in common, no matter what type of family structure you have â&#x20AC;&#x201C; you and your child are going to become a family. For many, friends become even more important, and many parents-tobe think afresh about their social network. Do you have good contact with your own extended family? Have you left the area where you grew up or even the country of your birth? Now that you are going to have your own family, your social network will become increasingly important. How will this affect your relationship with your original family? What will you want to take with you from your own upbringing, and how will this fit in with your new family? For many, pregnancy is a time for working out how to be a good Âparent. But it is only after your child is born that this lifelong journey starts in earnest. Remember that you are creating something of your own and that it is the choices you make that will shape your new family.

MOTHER–BABY–CHILD The following pages describe the changes that take place in your body and how these may feel. They also describe how the fetus/baby grows and develops. 5–10 DAYS A F TER C O NC E PT IO N

The fertilised egg moves down to the womb. Cell division begins during this passage down the fallopian tubes. The first divisions are simple divisions into two, i.e. 1 into 2, 2 into 4 and so on until there are 16 cells. The first small clump of cells looks under the microscope like a little mulberry and is therefore called a morula (Latin for a little mulberry). After this the cells begin to divide into cells of different form and function. By the time the fertilised egg reaches the womb, about 5 days later, the cells have begun to differentiate according to function. They now form what is known as a blastocyst, because it has a little space in the middle. The blastocyst is about 0.2 mm in size, roughly the same as the full stop at the end of this sentence. On the sixth day after fertilisation, when the blastocyst lies against the wall of the womb, the outer layer bursts. This is usually referred to as hatching. Now the fertilised egg can implant itself in the membrane lining the womb, as the outer layer of cells (called the trophoblast) starts to grow into the membrane and its rich blood supply. Implantation is complete by day 8 or 9 after conception. THE P LACEN TA I S TH E LI N K B ET W E E N M OT H E R A ND C H IL D

The placenta begins to develop along with the fetus after the fertilised egg is implanted into the lining of the womb. The umbilical cord is the link between mother and child. The baby’s heart pumps blood through the umbilical cord to the placenta and back again. Various substances are exchanged between the bloodstream of mother and baby at the junction between the womb and placenta, but the blood of mother and baby do not actually mix. The baby obtains oxygen and gets rid of carbon dioxide via the mother, who you could say breathes for both of them. The placenta also produces hormones, e.g. oestrogen, progesterone and HCG. These hormones are absorbed into the mother’s bloodstream and influence her body in a variety of ways. They play a vital part in the development of 8

pregnancy, regulating the changes that take place in her body during pregnancy. The placenta also transfers fluid and nutrients to the baby and extracts waste products. The baby also obtains antibodies from the mother via the placenta. Drugs, too, can pass through the placenta, but usually in much smaller amounts. But the unborn baby doesn’t just get beneficial nutrients from the mother – it can also be exposed to harmful substances such as alcohol and nicotine (see page 21). The inside of the placenta is lined by the amniotic membrane which forms a fluid-filled sac in which the baby lies. The placenta usually grows at the same pace as the baby, weighing about 600 grams at full term. 4 W EEK S

14 days have passed since fertilisation. You may now begin to feel that you could be pregnant. Your menstrual period may be late. The unborn baby is still less than 0.5 mm long but already has three different types of cell layer called the germ layers: ectoderm – which will form the skin, hair, teeth and brain, mesoderm – which will form e.g. the skeleton and muscles, and endoderm – which will form the different internal organs such as the liver, heart and intestines.

Length 0.4 mm

5–6 W EEKS

A pregnancy test may show positive at this stage, but you could still be pregnant even if the test is negative. You may begin to have pregnancy symptoms like swollen breasts, some nausea or the need to empty your bladder more often than usual. Many feel bloated. At this early stage of pregnancy this is mainly the result of the intestines becoming distended and sluggish. Dizziness is also common, usually the result of a drop in blood pressure as the blood vessels dilate. By now, your body temperature is about 0.5 °C higher than before you became pregnant. These early signs are mainly due to the hormonal changes that are taking place. 9

Grows from 1 mm to 3.5 mm

The tiny fetus now grows from 1 mm to 3 mm. It is now entering a period of intensive development during which it obtains oxygen and nutrients via the placenta and umbilical cord. The skin is thin and translucent, and the brain is beginning to form, along with the spinal cord (which starts to develop in an uncovered groove). The heart, blood vessels and blood also start to develop, and there is already a heartbeat. Disturbances of this early period up to week 8–9 can result in malformations. 6–7 WEEKS

The early symptoms of pregnancy are usually still present. These may make you instinctively avoid the things that could harm your baby. Many women now meet their midwife for the first time. Initially the fetus looks like a little fish, but now the long tail folds inwards, which means that the length of the fetus is now measured from the top of the head (crown) to the bottom of the spine (rump). An ultrasound examination at this point may show the heartGrows from 3.5 mm to beat and allow the length to be measured from crown 7 mm, weight about to rump. It is this measurement that gives the most 1 gram accurate estimate of the duration of pregnancy. The head and torso can be distinguished, and small buds appear at the sites of the arms and legs. The formation and development of many internal organs progresses. The heart develops from a single chamber into four chambers. The lungs, intestines, kidneys and pancreas start to develop. 7–9 WEEKS

Grows from 7 mm to 11 mm and weight increases from 1 to 2 grams.

Now you can probably feel that something is growing inside you. It is not unusual to feel slight period pains, and small bleeds are not that uncommon even when the pregnancy is progressing normally. The pregnancy affects you emotionally as well as physically. You may become particularly sensitive in early pregnancy. This receptiveness helps you to accept this new little life and to look after yourself in the best possible way. 10

Now the baby’s arms and legs begin to appear. It starts to move and stretch out its body. The head is relatively large and the brain undergoes intensive development. The first signs of brain activity can now be detected. The eyelids begin to form. The membrane covering the anus disappears as well as the membrane between the fingers. The baby is very vulnerable at this stage, and it is important that you avoid the things that can cause harm, e.g. alcohol and nicotine. 10 W EEKS

Length about 30 mm, weight about 15 grams

Your belly may feel “big and bloated” even though the baby and womb have not yet grown that much. This is because the stomach and intestines work in a different way and food passes through them more slowly. All the structures of the human body have now been formed, but they will continue to grow and develop. The head is relatively large, making up nearly half the baby’s weight. The external genitals are developing but it is still hard to tell male from female. Now the baby can open and close its mouth, and the tip of the nose becomes visible. The thyroid gland starts to produce thyroid hormone but the baby is still dependent on mother’s thyroid hormone. 12 W EEK S

The first symptoms of pregnancy, nausea and tiredness, usually start to improve and you can feel more confident that the pregnancy is progressing normally. Try to make sure that you have some time to relax and daydream about the arrival of the baby. You will now notice that the womb is enlarging and taking up more room, although it may still be difficult to feel it through the abdominal wall. You may just about feel the top of the womb immediately above the pubic bones. 11

Length about 55 mm, weight about 30 grams