Posts Tagged ‘organs’

General Points of View
In this section we describe a number of points of view which serve as a guideline for the way we view, and relate to, young children.
The child’s development and care, sleeping and waking, play and toys, safety and feeding are subjects which will be tackled in this section in terms of content. A practical approach to these subjects can be found under the advice for every stage (see Chapters 3-6).
The child’s development
From the moment the child is born, the parents have the important task of monitoring his or her development. This gives rise to many questions. How can we best prepare for the child’s future? Should we, or should we not, familiarize the child with elements of adult life at an early stage, so that she will be prepared for this later on? The answers to these questions will depend on your view of the child’s developmental stages.
We proceed on the assumption that the more successfully a child is able to fully develop at a particular stage, the more harmonious the development will be. This also applies for future development.
Fora baby and young child, this means that we must create the conditions in which a baby can most successfully be a baby, and a young child can most successfully be a young child.
The first developmental stage after birth is strongly centred on the child’s physical and motor development. Growth is quite exceptional during the first year of life, and is still rather like the growth of the embryo. The development and growth, which takes place outside the womb in humans, takes place completely inside the womb in other mammals. When the child is one year old, the development has reached a level comparable to the birth level of other mammals.
For the baby’s development, it is good if the conditions after birth are still quite similar to the situation in the womb. This particularly concerns the protective cocoon around the child. Warmth, a sense of security and some protection against environmental influences promote the baby’s health. It is extremely important for the baby’s physical development for her to have physical contact — rocking, cuddling or simply holding the baby in your arms. Children who lack this physical contact do not develop well, even if they have ‘the best feeding.’ These babies immediately start to grow again when attention and care is devoted to physical contact. Satisfying the need for physical contact gives the child a basis for the rest of his or her life.
Nevertheless, in humans, a good environment alone does not guarantee development. Every person has his own rate of development and his own way of developing. For example, there are babies who develop motor skills very quickly, sit up at an early stage, roll over, stand and walk. On the other hand, other children appear to ’stand still’ in their development fora long time, then seem to miss out a few stages and can suddenly walk, even though they never crawled. Some children start to develop speech very early, while others remain unintelligible for a long time.
It is important to be aware of a child’s own way of developing. There may be a tendency to a certain one-sidedness. This sort of one-sidedness — for example, the slow development of speech — can be regarded as the child’s own way of developing. It is only when this one-sidedness is particularly strong that it may be seen as a developmental disorder.
Thus, the first year of the child’s development can be seen as a continuation of the embryonic stage.
During this first year of life, the body matures to the extent that the child becomes able to control it for herself. A one-year-old child can stand and go where she likes and move about freely in space. It is as though she is taking charge of her own physical body. This stage of development depends on healthy physical growth and development. Illness and malnutrition will immediately delay the process. Development at this stage is mainly influenced by the physical organism and the care of this organism.
The basis for the later development of speech is laid during the first year of life. Talk to, and with, the baby, and play with her. She sees the gestures which accompany words, and hears the songs. All this contributes to the child becoming increasingly familiar with human language. The clearest sign of this is contented baby talk by the end of the first year of life.
After the first year, the child depends on being able to imitate what she has heard. She will start to copy the words herself, first words of one syllable and then words of several syllables. She then begins to combine words, and finally produces short sentences. In this way, the child enters a second area in which she can move about freely — the field of language. By mastering speech and language, the child takes part in social life in her own way, and becomes able to express herself through the spoken word.

The next stage of development is the time at which the child starts to say ‘U Prior to that stage the child called herself by her own name. This can be seen as an expression of the fact that the child was not yet deeply connected with her own body; thus in a sense the child saw herself from outside, as other people see her.
When she becomes more closely connected with her own body, the first, still primitive, sense of self-consciousness emerges and the child experiences a sense of self; she starts to say ‘F and experiences herself as a centre. As a result of this process, the child may also feel cut off from the world around her.
By the age of three or four, the child has gone through a sort of first cycle of development. By learning to stand and walk, she has achieved a certain degree of freedom in space. By learning to speak and understand, she can develop socially and communicate with others. With the deeper connection of the self and the body, self-consciousness emerges for the first time, and this is expressed when the child uses the word ‘I’ to talk about herself.
Learning to use language independently is an important psychological development, as is developing a sense of individuality. However, healthy physical development is always a prerequisite for this. Motor development is particularly important for the development of psychological functions later on. Playing
THE CHILD’S DEVELOPMENT    21
with bricks, simple ball games, finger games, circle games — in short, everything we do with the physical organism of the child as the point of contact — will have a positive influence on development.
The behaviour of the people in the child’s direct environment is very important for development. A small child learns and develops by imitating what she sees, hears, feels and so on. In this way the child learns to walk, speak and think, and during this first learning process carefully assimilates all the details — particularly during the first three years. This once again underlines the importance of being conscious of our own behaviour as well as the material environment of the child (see also Impressions, p.25).
Admittedly, the aspects of child development described here are very general, but they can still provide a direction for the way in which we behave with the child. The care for the physical processes of growth and development are of central importance. We can measure and weigh growth, while we can assess development from the development of the motor system, the mastery of language, and the birth of the ’self’ when the child starts to say ‘F.
Sleeping and waking
During the course of life a person’s need for sleep undergoes great changes. A newborn baby often sleeps for between eighteen and twenty hours out of every twenty-four. A one-year-old can sleep for fourteen hours, while an adult needs between six and eight hours of sleep. Therefore, in the first year of life, the child should spend a great deal of the time asleep.
We have seen that there are two important things in this first year — growth (a baby’s weight triples in the first year) and development. Growth takes place particularly during sleep, while development is stimulated during the waking hours. The various organs ‘learn’ to operate in a sense, with the use of the body during, the daytime (by eating, moving, etc.). What the organs ‘learn’ during the day continues to have an effect while the baby sleeps, and is assimilated in the body’s growth activity.
A one-sided predominance of growth and excessive stimulation to develop both have a negative effect. There should be a healthy balance between the two processes; an alternation between waking and sleeping which is suitable for each stage. When the child is about one year old, this balance will have become established in the operation of the organs, in a particular day/night rhythm — the biological clock.
For good health and for the child to be able to make use of his physical capabilities properly, it is essential for this day/night rhythm to become well established. Therefore, it is literally of vital importance for a small child to establish a steady pattern during the day with regard to sleeping, eating and waking.

A steady pattern of set times in the life of a child promotes growth and development and helps to establish a healthy rhythm of sleeping and waking. Too much stimulation during the day may prevent the child from falling asleep; however, a completely unstimulating environment, without healthy challenges for the child, can also lead to problems with sleep because the child is not sufficiently tired. A healthy routine in the day, alternating challenges and periods of quiet, being together and being alone, can help to correct sleeping problems. Rituals for going to sleep can also be helpful — rocking, singing lullabies, the use of musical boxes or a prayer for the child are methods used by many families.
Sleeping well means that the child must be able to surrender and ‘let go.’ This is not as easy for some children as for others. It is helpful to give the child a sense of security, for example, in the enclosed space of the cradle (possibly with a hood) or lying against the mother. Warmth promotes a sense of comfort and relaxation; a bonnet, a sleeping bag, some drops of lavender water on the pillow, or a hot water bottle can sometimes help babies who find it difficult to fall asleep. Hot water bottles should always be removed before the baby is placed in the warm cradle. A light silk bonnet is appropriate for indoor use, but be aware of the risk of overheating. Wrapping the child up firmly pro-
SLEEPING AND WAKING    23
vides a sense of security as well as a feeling of warmth.
However, there are babies who assimilate everything that happens around them so greedily that they actively seem to suppress their feelings of tiredness and the need for sleep. The more stimulation they are given, the hungrier they seen to be. They are unable to set their own boundaries. Increasingly, we see babies who spend many hours of the day — and sometimes the night —awake, constantly asking for attention from the environment. For these children, the parents must learn to see when they show signs of being sleepy. The fact that this is quite an art is clear from the many stories told about this problem. If you miss the right moment, the child appears to go past his sleepiness and will keep going for many hours. Signs of sleepiness are restlessness or agitation, looking away, rubbing the eyes and face, warm hands and red ears, grizzling and crying. By responding to these signs of sleep immediately and consistently, by placing the baby in his cot, it is possible to create a healthy need for sleep. By not responding straightaway every time the baby cries, he will learn to resolve minor discomfort for himself. It is important to realize that any attention wakes the baby up. All the extra attention and special behaviour associated with going to sleep often achieve quite the opposite of what the parents hope to achieve.

Testings During Pregnancy. FAQ

Testing, testing
investigations in pregnancy
What is the difference between diagnostic and screening tests?
Screening tests identify your baby’s ”risk factor” for a particular condition, but do not confirm that your baby definitely has a condition. For example, a screening test for Down’s syndrome may give your baby a risk factor of 1:200 This means that your baby has a 1 in 200 chance of being affected by Down’s syndrome. Another way to view this result could be that the baby is most likely to be healthy. If your baby has a high risk factor, you may then decide to have a diagnostic test, such as amniocentesis or chorionic villus sampling (see pp 122-123), which gives a definite yes or no as to whether or not a condition is present. These tests are more invasive, as they require a sample of amniotic fluid or blood from the fetus or placenta, and they carry a slight risk of miscarriage.
Certain screening tests, such as first- or second-trimester screening for Down’s syndrome, are offered routinely to all women regardless of any factor other than they are pregnant. These tests, in the form of scans or blood tests, identify who would benefit from further diagnostic tests. This avoids subjecting all pregnant women to diagnostic tests, which carry some risks (see p. 125). Any benefit from a test should outweigh the potential risk.
What do these tests look for?
Screening and diagnostic tests aim to identify abnormalities in the unborn baby, which may be congenital, genetic, or chromosomal. Congenital abnormalities are often detected in the 18-22 week scan (see p.121) and these include conditions such as heart abnormalities or extra digits These abnormalities can sometimes be treated after, or sometimes even before, the birth and are not inherited. Some conditions, such as spina bifida, are thought to be due to a combination of genetic and
environmental factors; a dietary deficiency of folic acid may also contribute to this condition. Other congenital abnormalities may be caused by infections caught in pregnancy.
Diagnostic tests are usually carried out to identify genetic or chromosomal abnormalities, such as Down’s syndrome, cystic fibrosis, sickle-cell anaemia, and muscular dystrophy. (Cystic fibrosis and muscular dystrophy are screened for if there is a family history) These conditions occur either because there is a problem with the inherited genetic material, for example a gene has mutated, or because there is a chromosomal problem, for example there may be an incorrect number of chromosomes, as in Down’s.
Down’s syndrome, or ”trisomy 21”, is a chromosomal abnormality in which there is an extra copy of the chromosome 21. It is the most common ”trisomy” disorder. Babies born with this condition have physical anomalies, such as slanting eyes and
a protruding tongue, and there is a high incidence of heart, intestinal, hearing, and sight problems. Down’s is the biggest single cause of learning difficulties. The majority of Down’s syndrome conceptions are lost through spontaneous miscarriage early on in pregnancy, although over 600 babies are born with Down’s syndrome in the UK each year.
I’m 38 - will I have more tests because I’m older?
Although the risk of Down’s syndrome increases as you get older (see p 118) currently many women regardless of age are offered one of two types of screening test for Down’s. This is either a first trimester screening that involves a blood test and a scan to measure nuchal translucency (see p.118), or second trimester screening which is a blood test only, called the triple, or Bart’s. test (see below) Both tests give the result as a risk or a percentage risk. If the test indicates there is a high risk of Down’s, then all women are offered a diagnostic test such as amniocentesis (see p.123). However, if you are over 35. amniocentesis is offered routinely in the UK.
Your midwife should discuss with you in detail all the tests that are available and give you written information about them. Ideally, you should have this information several weeks before you are asked to decide if you wish to go ahead with any screening or diagnostic tests so that you have plenty of time to consider the possible outcomes and whether these tests are something -you wish to undergo
Depending on your past medical history and other factors, such as your blood pressure during your pregnancy or problems you had in previous pregnancies, you may be offered additional scans to check your baby’s growth after 26-28 weeks.
We don’t want invasive tests as we will love the baby whatever. Can we refuse diagnostic tests?
Whether or not you have a diagnostic test is your choice and you can refuse at any time to have any test offered As well as the question of whether you are prepared to have a Down’s baby, there is also the risk of miscarriage to consider (see p.125) On the other hand, you might decide you want a definite diagnosis to be able to prepare for your child.
What blood tests will I be having, and when?
There are various blood tests offered during pregnancy As well as routine blood tests taken during antenatal checks to assess your health, there are also blood tests to screen for problems with the baby. Within the first 12 weeks you will be given a routine blood test to check your levels of haemoglobin, the oxygen-carrying part of blood. Although these fall slightly in pregnancy as the blood becomes more diluted, a significantly low haemoglobin level indicates iron-deficiency anaemia (see p 8 1). You will also have tests to identify your blood group, Rhesus factor, and rubella immunity (see p 15). and to screen for infectious diseases including syphilis, HIV, and hepatitis B. You may also be tested for sickle cell and thalassaemia, inherited blood conditions more commonly found in people of African, Caribbean, Indian, or southern Mediterranean origin.
Other blood tests may be offered to screen for congenital abnormalities in the baby Between 10 and 14 weeks, a blood test that measures the levels of the substance known as pregnancy associated plasma protein (PAPP-A) may be offered that is combined with the nuchal translucency scan (see opposite) to calculate a risk of Down’s syndrome.
If first trimester Down’s syndrome screening isn’t available, then second trimester blood screening tests are offered, which also include screening for neural tube defects, such as spina bifida These tests, carried out between 16 and 18 weeks, include the triple, or Bart’s, test, which measures the levels of the hormones AFR hCG, and oestriol; and the quadruple test, which, in addition to the other three hormones, measures inhibin A and PAPP-A.
Will I have a test for HIV?
Ali screening and diagnostic tests recommended in pregnancy are optional, so it is up to you and your partner to decide whether to have them. One of these is a blood test to check if you have the human immuno-deficiency virus, or HIV, and, indeed, some women only find out about their HIV status in pregnancy It is worthwhile to test for HIV in pregnancy as, if the result is positive, anti-retroviral medication, careful monitoring of maternal blood levels, and careful, safe delivery of the baby can reduce the chance of transferring the infection to the baby from 40 per cent to 2 per cent.
For pregnant women with HrV, a blood test is taken around the time of delivery to measure the levels of the virus. Depending on the results of the blood test, the obstetrician will either recommend a planned Caesarean section or decide that the levels are low enough to have a normal delivery.
After the delivery, HIV-positive mothers are advised to bottlefeed, again to reduce the risk of transferring the virus to the baby
How do ultrasound scans work?
Ultrasound scans use high-frequency sound waves — so high we can’t hear them — that bounce off solid objects and create a picture, visible on a
computer screen, of your baby, the placenta, and your organs in the surrounding area.
How many scans will I have and when?
All women should routinely be offered two scans, a dating scan between 10 and 14 weeks and an anomaly scan between 18 and 22 weeks. Some units routinely offer a screening scan for Down’s syndrome between 11 and 14 weeks, known as the nuchal scan (see opposite), although this isn’t available nationwide. You can also arrange to have private scans that may be 3D/4D (see p, 124) and which you have to pay for
I’m quite scared about my first scan. What happens during the scan and what does it feel like?
Although not painful, early scans can cause discomfort as you need a full bladder (see p, 124). Ultrasound scans can be carried out by a doctor,
a midwife, or a sonographer. You will lie on a couch and need to wear something that makes it easy to expose your tummy. The person doing the scan puts cold gel on the lower part of your tummy, which improves contact with the skin, making it easier to view the baby. You will feel a little pressure as a transducer is pressed against your skin and moved around to look at the baby from different angles and to take measurements The image produced by the scan is viewed on a screen similar to a computer monitor. The person carrying out the scan may spend some time first studying the image and taking measurements before talking to you about what they can see Although this can be unnerving, it does not mean that anything is wrong
Some units offer a transvaginal scan in early pregnancy, which can give an improved image at this stage. This internal scan is done using a probe that is covered by a condom and gently inserted into your vagina. The image is viewed on the screen in the same way as an abdominal scan. This may be offered before 10 weeks if there is bleeding or pain.
Many units offer to print an image from the scan for you to take home Although ultrasound scans
Should I have a scan? is ultrasound safe ill pregnancy’?
Ultrasound scans in pregnancy, first introduced 40 years ago, have become a routine part of antenatal care.
* Most research indicates that they are a safe way to view the baby even when extra scans are needed for medical reasons * Suggested links between additional scans and growth problems and dyslexia are tentative as babies scanned more often are more likely to have problems linked to other factors.
* Recommendations are that scans are carried out only for clinical reasons and the number done is kept to a minimum.
How long do scans last?
The length of time an ultrasound scan takes varies depending on the reason for the scan and the experience of the ultrasonographer.
During the dating scan, performed at around 10-14 weeks, the sonographer takes some basic measurements. This includes the measurement from the top of the head to the end of the bottom, known as the ”crown-rump” measurement, used to calculate how many weeks old your baby is and
therefore your due date. This scan can take around 20-30 minutes. The nuchal fold scan (see p 118), during which the sonographer measures the fluid at the back of the baby’s neck, takes around 20 minutes. Anomaly scans, performed between 18 and 22 weeks, are detailed scans that take approximately 40 minutes (see opposite) At this scan, the sonographer measures the baby and looks at physical and structural development. The size and position of the placenta are examined and the amniotic fluid around the baby is measured
If, during your pregnancy, your midwife has any concerns about your baby’s growth or wellbeing, she may refer you to an obstetrician who may recommend another scan. As this will be to identify a specific problem, such as whether there is a concern about your baby’s growth, it may take a bit longer. This may be in the form of a Doppler scan, which measures the blood flow in the uterus, placenta, and umbilical cord and can help to identify growth problems in the baby This procedure usually takes around 30 minutes.
Do I have to have scans in pregnancy?
Official guidelines are that all women should be offered two routine scans during their pregnancy, but the choice to have one is yours. As scans are screening tests to look for anything out of the ordinary some women choose not to have any as they prefer not to know about any problems until the baby is born, or are confident that they will continue with the pregnancy regardless. You need to decide whether you fall into this category
Can my partner come along for the scans?
There is no reason why your partner should be excluded from attending these appointments if you want him to be there and, indeed, it’s very common for partners to attend ultrasound scans For many couples, the scan is a special moment as it’s the first time they get to see their baby and begin to think of themselves as parents.
primarily area clinical screening tool to determine if your baby is growing and developing as expected, they are also an opportunity to see your baby for the first time and often see your baby moving even before you feel the first flutters inside your uterus.
So scans become part of the developing relationship between you and your partner and the baby. In recognition of this, most units offer the facility of providing photos of the scan for a small charge to cover printing costs. Ask your community midwife whether the maternity unit where you are having your scan has this facility.
Do you have to drink pints of water before a scan? I’m scared I’ll have an accident.
For the 10-14 week dating scan it’s important to have a full bladder to make it possible to view the baby. This is because until 12 weeks the uterus stays in the pelvis and the bowel obscures the view. a full bladder raises the uterus and pushes the bowel out of the way. You may need a full bladder for a nuchal scan, between 11 and 14 weeks, depending on when it is done. Some units do transvaginal. scans (a small ultrasound probe placed inside your vagina) before 10 weeks if the image from an abdominal scan is poor In this case, you won’t need a full bladder and research indicates that transvaginal scans are more comfortable in early pregnancy compared to abdominal scans. You don’t need a full bladder for the 18-20-week scan, as the position of the uterus has changed
I’m pregnant through IVE Will I have more scans than normal?
It’s usual to have one extra scan in an IVF pregnancy usually carried out by the centre where you had the
3D and 4D ultrasounds
Many companies now offer special scans that reveal your baby in three dimensions or moving on film or video. These 26-32 week scans can be quite expensive and are carried out for curiosity value and not for medical reasons The quality of the pictures is usually amazing and parents are sometimes able to spot genetic similarities between themselves and
procedure This scan is usually done around two weeks after the embryo has been transferred to confirm the pregnancy and make sure that the pregnancy is within the uterus rather than in a Fallopian tube (see ectopic pregnancy, p.25) Although the main purpose is to reassure you that all is well, the centre also has to inform the Human Fertilisation and Embryology Authority (HYEA) of the outcome of the IVF treatment. Once your pregnancy is confirmed, you will continue with routine antenatal care like any other pregnancy
Can they really tell the sex
of the baby early on? I’m 18
weeks and not sure if I want to know.
It is possible to identify the sex of a baby on routine ultrasound scans from around 20 weeks, but this is dependent on a number of factors, including the expertise of the person performing the ultrasound, the quality of the equipment being used, the position the baby is lying in, and the position of his or her legs. Even if all of these factors are favourable and the genitalia can be seen, there is an error factor, so
their baby However, the scan is often lengthy which means the baby is exposed to ultrasound for longer than is normal Also, if the baby is in the wrong position, it may be difficult to get a clear picture The position of the placenta, the amount of amniotic fluid, and the size of the mother can also affect the quality of the pictures obtained  the information given about gender from a scan is never seen as 100 per cent accurate Some research has been carried out to try and determine gender at an earlier stage, but this was even less accurate. Sometimes when you are watching the scan you may be able to see the genitalia yourself and may decide you know the sex of your baby without being told. But remember you may be wrong. If you have an amniocentesis the sex of the baby can be definitely identified during the procedure.
Most units have a written policy only to reveal the baby’s sex if this information is requested Some units have a policy of not telling anyone the sex of the baby from scans alone, partly because they cannot be 100 per cent accurate and also because, in a small number of cases, the information about gender may lead to a request for termination. If you want to know the policy in your area, ask your community midwife.
I’ve seen lots of companies advertising scans and videos of scans - are these safe?
Many companies offer 3D scans (still pictures) and 4D scans (moving pictures copied onto video or DVD) (see opposite), and the detail in these can be very good. If you have a private scan, you should check the expertise of the person carrying out the scan, and check if the company has a referral policy to an appropriate consultant obstetrician if anything untoward is discovered, as not all companies employ the services of obstetricians or midwives.
There are twins in our family. When will they be able to check whether I’m having twins?
Most women find out that they are having twins
at their ultrasound dating scan between 10 and 14 weeks Very occasionally, one twin is hidden on the first scan and is seen at the second ultrasound scan, but nowadays this is less likely due to advances in scanning Family history also gives a clue to the possibility of twins, but only if they are fraternal, or non-identical (see p.129).
Is everyone offered amniocentesis?
Amniocentesis is a diagnostic test (see p 123) that is routinely offered if you are over 35 and so have a higher risk of having a baby with Down’s syndrome Alternatively, you may be offered the test if your family history suggests there may be a risk of your baby having muscular dystrophy, haemophilia, cystic fibrosis, or another genetic disorder. Also, if you have had a screening test that suggests your baby has a high risk for a congenital condition, you will be offered a diagnostic test to confirm or rule it out For example, if the nuchal scan (see p.118) showed a high risk of Down’s, amniocentesis may be offered.
I’ve heard that amniocentesis carries a risk. Is this true?
Amniocentesis does carry a small risk of miscarriage. It is thought that the risk of miscarriage is increased above the normal risk by 1 per cent immediately following an amniocentesis, but after two days the risk returns to normal. You need to balance the risk against the value of the test to you and also be aware that a normal test result is not a guarantee that there will not be any other problems, but is nonetheless reassuring
Can chorionic villus sampling cause miscarriage?
Chorionic villus sampling (CVS) is another diagnostic test used to establish whether a baby has Down’s syndrome (see p.122). Unfortunately, as with other invasive tests, this carries a risk of miscarriage, of around 1.5-2 per cent, with the risk reducing each day, Larger hospitals carrying out more than 100 CVS tests a year may have lower miscarriage rates due to the opportunity for the doctors to fine tune their ability to carry out the procedure.
When is cordocentesis used?
Cordocentesis is a diagnostic test used to diagnose Down’s syndrome and other problems
in a baby It can also detect infection from diseases such as toxoplasmosis (see p.45). Additionally,
cordocentesis is used to detect rubella infection (see p.15), as well as to perform a blood count on a baby that is suspected of having anaemia From 18 weeks, the baby’s blood is examined using a sample of
blood carefully extracted from the umbilical cord The test is carried out in a similar way to that of amniocentesis, though results are available within 72 hours. The risk of miscarriage is 1-2 per cent.
Will I get weighed at my antenatal appointments?
In 1941, routine weighing of all pregnant women at each antenatal appointment began Although it was thought that there was a connection between a mother’s weight gain and a baby’s birth weight,
it was decided more recently that this is not a good indicator of when a baby is not growing, and so over the last 10 years routine weighing at each appointment has been abandoned. Furthermore, weight gain can vary from woman to woman in normal healthy pregnancies as widely as 3-18 kg (7-401b).
Nowadays, all women are weighed once at the beginning of pregnancy and then, together with a height measurement, their BMI (body mass index) is calculated (see p.18), which helps to predict certain risk factors, for example in women who have a very high or very low BMI The only time that you might be weighed on successive visits is if there is a medical reason to do so, for example if you had significant weight gain in a short space of time that could indicate excessive fluid retention (oedema), a sign of pre-eclampsia (see p 89).
My friend is 27 and has had a Down’s baby - is that unusual?
Although the risk or chance of having a baby with Down’s syndrome increases with age, particularly over 35, the majority of Down’s babies are born to younger mothers. This is probably due to the fact that more women have their babies younger, and also because women over 35 are likely to have more tests The risk of having a baby with Down’s at the age of 20 years is 1 in 1,700. This risk increases to 1 in 1,400 by the age of 25 and by the time the mother reaches 35, the risk has increased to about 1 in 400
My partner wants to hire a Doppler so we can listen to the baby’s heartbeat. Is this a good idea?
During pregnancy your midwife listens to the baby , s heartbeat with an instrument called a Doppler sonicaid or pinard (ear trumpet). Most midwives use a sonicaid so the parents can hear the heartbeat too This passes sound waves through the abdomen. which pick up movement and bounce it back to the machine, where it is converted into sound.
Being able to hear your baby’s heartbeat during pregnancy is reassuring, especially when the earlier symptoms wear off but the baby’s movements have yet to be felt. However, your baby’s heart beats at a rate approximately double the rate of your heart. If the closest moving thing to the ”beam” is your blood pulsating through your aorta, the sonicaid will pick this up, and if you pick up your heart rate, this might cause you anxiety Also, depending on your gestation and the position of your baby the heartbeat will be found in different areas on the abdomen. If you can’t pick up a heartbeat, you may be unduly worried.
Midwives undergo specialist training to find the heartbeat and many won’t try to find the heartbeat until the baby is around 16 weeks, and even then may have difficulty Occasionally, due to the baby’s position, they may need to call another midwife or doctor to help them locate the heartbeat
It is up to you and your partner if you decide to hire a sonicaid, but it would be wise to be aware of the anxieties that may accompany this decision.

 
The 18-22 week anomaly scan
Your baby’s physical examination
Also known as the fetal anomaly or anatomy scan, this detailed scan is offered to all women between the 18th and 22nd week of pregnancy. At this stage of gestation, your baby has well-developed limbs and facial features and all its major organs and
body systems are in place and can be checked.
How is it done? The scan involves transmitting high-frequency sound waves through the uterus that bounce off the baby and the returning sounds are converted into an image (see p.119), The biggest echoes are from hard tissues, such as bones, which appear white in the image on the screen, while soft tissues are grey-flecked. Fluid-filled spaces, such as the stomach, bladder, blood vessels, and amniotic fluid surrounding the baby, do not return sound waves so appear black. It is
the difference between echoes and colours that enables the ultrasonographer to interpret images
What will be checked? The ultrasonographer starts by checking the fetal heartbeat and then counts the babies - rarely, twins are not revealed until 20 weeks! She will measure the head circumference and diameter (biparietal diameter), and the abdominal circumference and the femur (thigh bone) to date the pregnancy and ensure your baby is growing well She will check for abnormalities in the brain, face and lips, spine, abdomen, heart, stomach, kidneys, bladder, and hands and feet. Lastly, the placenta, umbilical cord, and amniotic fluid are examined You may be able to find out the sex of your baby, although you can ask not to be given this information (see p.124).

Diagnostic tests
Identifying fetal abnormalities
Diagnostic tests give a definitive answer as to whether or not your baby has an abnormality such as Down’s syndrome These tests are not carried out routinely and you will be offered one only if a screening test indicated that your baby had a higher risk for Down’s syndrome, if you are over 35, or you have a family history that puts you at a higher risk of having a baby with an abnormality, All diagnostic tests also carry a small risk of miscarriage and you will need to weigh up the pros and cons before deciding to go ahead with one
Chorionic villus sampling (CVS) This is a
diagnostic test that involves taking a tissue sample from the placenta to identify for certain whether your baby has Down’s syndrome or a genetic
Chorionic villus sampling
needle and
syringe  ultrasound transducer
abnormality This can be done as the placenta contains the same genetic information as the baby The test is carried out between 11 and 13 weeks, The advantage of this test is that it can be performed earlier in pregnancy than amniocentesis, so if an abnormality is found and you decide to terminate, it is early enough to have a suction termination.
How is it done? There are two procedures for CVS: one method extracts a sample of the placenta via the abdomen, and the other method carries out the procedure vaginally With the abdominal method, a fine needle is inserted through your abdomen and, using an ultrasound scan for guidance, the doctor removes a very small sample of tissue from the placenta You have to wait about
ultrasound transducer
catheter 10 days for the results, which means that if your baby has an abnormality and you want to terminate your pregnancy, you can do so well before you start to feel your baby kicking.
To carry out CVS vaginally the doctor inserts a small tube through your vagina and the cervix, which then passes through the uterine wall. As with the abdominal method, the doctor then takes a small sample of tissue from the placenta, using ultrasound for guidance. The sample is sent to a laboratory where it is grown in a culture for around seven days. The sample is then studied under a microscope to check for chromosomal abnormalities or other defects.
Amniocentesis Amniocentesis is a diagnostic test used mainly to identify a chromosomal abnormality and it is the most commonly used test for identifying Down’s syndrome. During the test, a sample of amniotic fluid containing cells from the baby’s system is taken from the uterus. It is a relatively quick and painless
Amniocentesis test
ultrasound — needle and
transducer syringe
placenta uterus — amniotic  
fluid
cervix
procedure and may be offered at around 16-19 weeks of pregnancy It is offered later than CVS because there may be insufficient fetal cells in the amniotic fluid before this stage of pregnancy The results from this procedure are usually very accurate and, although there is a slight risk of miscarriage, this is lower than the risk of miscarriage with CVS, especially in units where a large number of the tests are carried out and the doctors are particularly practised at conducting the test Apart from the slight risk of miscarriage, the main disadvantage of amniocentesis is that it has to be carried out later in pregnancy, so if the result comes back as positive, then you will be half way or even further into your pregnancy should you decide to terminate and would need to be induced to undergo a vaginal delivery
How is it done? Using an ultrasound scan to guide the procedure, a long, thin needle is inserted through the mother’s abdomen into the amniotic sac and a small sample of amniotic fluid is extracted. This contains fetal cells, which are then grown in a culture in a laboratory to be analysed. As there is a small risk of miscarriage, you may be advised to rest for a day or two afterwards to minimize this risk. Depending on the maternity unit and the laboratories used, there may be a chance that the result could be back before the end of one week, but the majority of units still have to wait two or even three weeks. It usually takes 2-3 weeks for the fetal cells to grow, Very occasionally this does not happen and you may need to have another amniocentesis test
Cordocentesis This diagnostic test is also known as ”fetal blood sampling” or “umbilical vein sampling”. In this test, blood is taken from the baby’s umbilical cord to diagnose Down’s syndrome when earlier screening tests have shown a possible problem. Since this is an extremely specialized procedure, it can only be carried out at a regional specialist fetal medicine centre in certain parts of the country.

 
Nuchal fold and dating scans
Ultrasound examinations
A dating scan at 10-14 weeks measures fetal growth so that a gestational age can be given The nuchal fold scan, or nuchal translucency scan, is offered between weeks 11 and 14 and assesses the risk of Down’s syndrome. Only some hospitals offer this scan at the moment The risk of Down’s syndrome rises with age. At 20 the risk is 1:1527; at 25 it is 1:1352; at 30 it is 1:1895; at 35 it is 1: 356; and at 40 it is 1,97,
What does the dating scan look for? The distance is measured from the top of the baby’s head to its bottom (crown-rump measurement), and the diameter of the head is recorded, known as the biparietal diameter - the distance between the parietal bones either side of the head
How is the nuchal fold scan done? The sonographer will measure the width of the fold of
skin behind your baby’s neck to see if any excess fluid has collected there This measurement is calculated into a risk ratio based on your age The ratio is considered high if it is above 1:300. You will be given the results of the scan immediately If your baby has a high risk, you will be offered further tests and, depending on the results and after counselling, the choice of continuing your pregnancy with support or having a termination.
Is it reliable? The nuchal fold scan is considered to be 80 per cent accurate, which means there is a 20 per cent (1:5) chance of it being inaccurate If your hospital offers you a blood test (PAPP-A, see p.119) with the scan, it becomes 85 to 90 per cent accurate. When the nasal bone is also measured, the accuracy rises to 95 per cent. Your local maternity unit should be able to provide you with information as to how accurate their scans are.

What’s happening to my body?
how your body changes
I’m feeling like a beached whale and I’m only 16 weeks, what can I do?
Weight gain during pregnancy is not only due
to the baby, placenta, and amniotic fluid, but to a number of factors. Changes in your metabolism, the development of certain organs such as the uterus and breasts, and an increase in your blood supply causing more fluid retention and swelling,
all contribute to your weight. In addition, extra stores of fat are laid down as pregnancy requires more energy for the work involved in developing the fetus and coping with the demands of labour. Although most of this fat is stored in the first 30 weeks, weight gain is usually slower at the beginning of pregnancy and suddenly increases in the second half.
The average weight gain is 12 5kg (271b), 4.5kg (101b) of which is gained in the first 20 weeks, and the remainder thereafter. If you feel you have put on more than this, my advice is to eat healthy, smaller, more regular meals and take some gentle exercise.
People keep telling me I’m too small, but the midwife says everything is fine. Can you explain?
Tell them to mind their own business! If your midwife says she is not worried, then I would feel reassured -some women just hide a pregnancy very well! Your midwife starts to measure your tummy at around 26-28 weeks, as by then the major organs are more or less developed and your baby is concerned with growing and laying down fat supplies. Most units use personalized growth charts that are designed to take into account your individual traits such as your race and height, which influence how big your baby is likely to be By taking these factors into account, your midwife can predict more accurately the expected weight and measurements of your baby.
I’m 17 weeks and my breasts have changed - they’re painful and look different. Is that normal?
It’s perfectly normal and very common to
experience breast changes in pregnancy. These are caused by both an increased blood supply and a rise in pregnancy hormones, particularly in the
first 12 weeks. Before your pregnancy was confirmed you may have felt tingling sensations (especially in the nipple area) as the blood supply increased. As early as 6-8 weeks, breasts can get larger and more tender and may begin to look different on the surface, with threadlike veins starting to appear. At around 8-12 weeks, the nipples darken and can become more erect, and as early as 16 weeks, colostrum, the first milk, may be expressed.
Why am I getting more vaginal discharge since becoming pregnant?
In pregnancy, the layer of muscle in the vagina thickens and this, combined with an increase in the pregnancy hormone oestrogen, causes the cells in the vagina to multiply in preparation for childbirth. As a side effect, the extra cells mean that there is an increase in vaginal discharge, known as leucorrhoea.
If you feel sore or itchy and the discharge is anything other than cream or white, or smells, see your midwife or doctor so that a swab can be taken to rule out infection Some infections: such as thrush, cause an abnormal discharge They are common in pregnancy and are easily treated.
Dark patches have appeared on my face. What could they be?
The dark patches on your face are called “chloasma’ or `pregnancy mask” and these patches affect around half of pregnant women. Nearly all pregnant women notice some changes in skin colouring, with skin usually darkening from 12 weeks. This is due to an increase in the hormones that stimulate skin pigmentation, with darker-skinned women affected more. This darkening may be more apparent on certain areas, such as the nipples, perineum (skin between the vagina and anus), and naval, or areas that experience ”friction rubbing”, such as the inner thighs and armpits. You can reduce or prevent dark patches on your face by minimizing your exposure to the sun and using high-factor sun creams.
I’m a model and I’m worried I’ll get stretch marks. Is there anything I can do to avoid them?
I appreciate your concern, especially as looking good affects your work. Stretch marks, also called striae gravidarum, are thought to be connected to the collagen and elastin content of your skin rather than to how much your stomach expands They occur as the collagen layer of the skin stretches over areas of fat deposits on the breasts, abdomen, and thighs. Unfortunately, there are no pills, creams, or magic lotions that can influence whether or not you will get stretch marks or, if you do, how badly you will get them, although taking regular exercise can help you to maintain an ideal weight during pregnancy and so minimize your chances of developing stretch marks.
Take comfort from the fact that although the marks may be red and livid in pregnancy, in the months following the delivery they lose their colour, usually becoming silvery-white and less obvious.
My tummy is really itchy. Is it safe to use moisturizers on my skin in pregnancy?
As your abdomen grows it can become itchy as the skin stretches You can use moisturizers on your body in pregnancy, and these may relieve the discomfort. Choose non-perfumed lotions oils, or creams to avoid further irritation Rubbing almond oil, vitamin E, or wheatgerm oil over the abdomen may also help.
Eating a healthy diet with fruit and vegetables and drinking plenty of clear fluids to keep you well hydrated will also help the condition of your skin.
I can’t look in the mirror as I’m feeling so depressed about my size. Will things get better?
You are not alone in battling with your self-image in pregnancy For many women, their changing body shape can create very negative feelings Eating a healthy diet and taking some exercise helps to keep weight gain to a minimum, and exercise will help to lift your spirits and improve your sense of wellbeing. There is no set emotional response to pregnancy, but as well as coming to terms with a momentous life and body change, you are also under the influence of fluctuating hormones, all of which affect your moods and add to feelings of negativity.
Mild depression in pregnancy is often helped by reassurance and support from your partner, family, or friends. Talking over your fears and concerns with your partner, or with other pregnant women at antenatal classes, may help to relieve your anxieties -you will probably find that other pregnant women are experiencing the same feelings.
If your depression is very severe and you
feel desperate, consult your midwife or doctor as antenatal depression is now recognized as having an effect on pregnancy and birth outcomes, with studies showing a possible link between medication given to treat depression in pregnancy and a lower birth weight and increased risk of premature birth. Your doctor or midwife may refer you for counselling, and some areas hold group classes for pregnant women suffering from antenatal depression.
Why do people talk about the second trimester as the time when pregnant women “bloom”?
For many women, the second trimester is the most enjoyable part of pregnancy. As women find themselves released from the draining symptoms of early pregnancy, this can lead to an upsurge of energy and many find it easier to eat, sleep, and work. Many women also notice that their skin is glowing and their hair is glossier than usual. It is also around this time when you first feel your baby move and, as your baby grows, you start to notice a definite bump and begin to look pregnant - changes that can help you feel more positive and excited
However, not all women feel this way A sizeable minority of women don’t feel any better as the second trimester progresses, with nausea, tiredness, and other symptoms continuing unabated Some may find it hard to come to terms with physical changes such as weight gain, or skin and hair changes. If this is the case, it’s important to remind yourself that almost all of pregnancy’s downsides clear up as soon as the baby is born. If you’re feeling particularly down or low on energy it may be a sign of other problems, such as anaemia (see p 81) Speak to your midwife or doctor for further advice.
I’m worried that my husband doesn’t find me attractive any more. Am I being paranoid?
Self-image can be a big problem with pregnant women and many worry that they are unattractive to their partners in the latter stages of pregnancy This worry is usually unfounded and more to do with their own feelings about their increased size. Keeping anxieties bottled up can make them seem bigger than they actually are, so talk to your husband about your worries and explain how you are feeling. He may be completely unaware of what you are thinking
As your husband isn’t carrying the baby he cannot truly understand the physical demands of pregnancy. Informing him about the changes your body is going through can help him to understand the process of pregnancy and be better equipped to
provide support when you need it most Some men actually find their partners more attractive during pregnancy but you won’t know this unless you talk to each other about your changing shape.
If you are worried about gaining too much weight in pregnancy, focus on eating a healthy, balanced diet (see p 50) and take some light, daily exercise. Even if this is only a short walk or swim, it will help to keep you toned and supple, which will help your confidence as well as prepare you for childbirth
Can I wear high heels?
Although lots of pregnant women continue to wear the same footwear during pregnancy, it is advisable to avoid heels and opt for a flatter shoe, particularly as your pregnancy progresses.
Later in pregnancy, your posture and centre of balance changes, as your increased weight is now mainly at the front of your body. In addition to this, increased levels of hormones secreted during
pregnancy, such as relaxin, make the joints and muscles of the body more lax So wearing high heels can increase the strain on the lower back and pelvic
Looking good
Making the most of the pregiiar..cy “bloom”
Whether you are ecstatic about your body shape, or feeling like a beached whale, spending time pampering yourself will help you enjoy the new you. *Your hair may feel thicker and glossier o:- become more unmanageable. TYeat yourself to a new haircut to make the most of your pregnancy hair.
* Book yourself in for a massage to relax and chill out. Find a masseur experienced in dealing with pregnant women.
* If you’re feeling low about your size, splash out on some new maternity clothes, nowadays available in fabulous styles.
joints, oints, giving rise to aches and pains in those areas However, it’s alright once in a while to wear high heels, for example at a party, but it might be wise to take flat shoes to change into for walking home.
What shall I do about my pierced belly button?
If you are pregnant and your navel is pierced, your midwife will probably recommend that you remove any metal jewellery from your navel for the duration of your pregnancy Some women are happy with this advice, but a lot of women do not want to risk letting their piercing heal up, and then having to have it re-pierced after their baby is born, so they try to wear jewellery in their navel through their pregnancy
You can use something called a”pregnancy retainer” Due to the popularity of body piercing, these have been manufactured to help pregnant women maintain their piercing as their body shape changes. They are made up of a soft, flexible substance called PTFE (polytetrafluoroethylene) in the shape of a ”banana” bar that has two acrylic screw-on end balls. There is a wide range of sizes and styles for women to choose from. As a general rule, you should choose a retainer that is at least 4mm longer than the size of the jewellery you are currently wearing, although, as you can imagine, every tummy is different and will obviously change in size as your pregnancy progresses The important factor is that your pregnancy retainer should not pinch into your skin at any time - if you feel your retainer is causing you discomfort, then buy a larger size.
I don’t have much to spend on maternity clothes, any ideas?
Lots of women are faced with this predicament when they become pregnant, but you don’t need to spend a lot of money Most women’s clothes shops now stock selections of maternity wear at very reasonable prices. Invest in a couple of pairs of trousers or skirts that you will be able to adapt as your pregnancy progresses and then mix and match colours and styles with a few tops. The tops don’t have to be maternity wear - you could just buy ones a couple of sizes up from your normal size.
You could look in charity shops too, or loan maternity clothes from friends and family, as women wear maternity clothing for such a short period that it is often in good condition. Ebay is a good place to pick up a bargain, and local NCT (National Childbirth Trust) sales have plenty of items in excellent condition. Lastly, don’t forget your partner’s tops and jeans, which may be the perfect fit!
I’m 20 weeks’ pregnant and have noticed that I get short of breath very easily. Is this normal?
When you’re pregnant, your lungs have to work much harder to meet your body’s increased oxygen needs. To help you take in more air, your ribs flare out and your lung capacity increases dramatically This can make you feel breathless, particularly from mid-pregnancy onwards. In the last three months, most women find they get breathless even during mild exertion, which happens as the expanding uterus pushes up against the lungs. However, being breathless can also be a sign of anaemia, which may need to be treated (see below). Your breathing may start to get easier when your baby engages - moves down into your pelvis ready to be born.
My midwife has told me I’m anaemic. Can I improve my iron levels through my diet?
All pregnant women should be offered screening for anaemia, which is done early in pregnancy (at the first appointment), and again at 28 weeks. Generally,an iron-rich diet is advised in pregnancy and this
is enough to prevent or improve anaemia. Eat plenty of lean red meat, beans, dried fruits, dark green vegetables, fortified cereals, and bread Try including a vitamin C-enriched food or drink in your diet, as vitamin C helps the body to absorb iron more efficiently. Vegetarians need to eat plenty of eggs, pulses, beans and nuts to boost iron supplies. Iron tablets may be recommended depending on how low your iron levels have become.
I have developed a dark vertical line down the middle of my tummy. What is this?
A brown line down the centre of your stomach is known as the linea nigra This occurs due to changes in skin pigmentation, which are extremely common in pregnancy, affecting 90 per cent of all women in some way or another, and is often more noticeable if you are darker sl6nned. As well as the line on your tummy, you may also notice a darkening of the skin around your nipples and a darkening of freckles, moles, or birthmarks. A few women may also experience brown patches on their face called chloasma or ”pregnancy mask” (see p.105), These changes are caused by the extra amounts of the hormone oestrogen in pregnancy, which affects the melanin-producing cells of the skin - the cells that produce the pigment that darkens the skin. These colour changes are normal and will usually fade once the baby is born
I’m 32 weeks and my pelvis
is really aching now - what are the reasons for this?
Mild pelvic discomfort is a common symptom in pregnancy as your ligaments loosen due to the increased levels of the hormones relaxin and progesterone in pregnancy These changes in your pelvis prepare your body for the birth. This feeling is quite normal and happens to most pregnant women. If your pelvis continues to give you discomfort, you can try to adapt your day-to-day living to relieve the symptoms Keep your legs together and swing them
round when getting in and out of a car or bed. Think about your activities for the day and plan your movements ahead so as not to exacerbate any discomfort you have Avoid wearing high-heeled shoes and take a rest whenever the discomfort becomes more noticeable
If your pelvis is more than just uncomfortable, seek medical advice More extreme discomfort that causes chronic pain is a sign that there’s a dysfunction in the pelvic area, which may require treatment and support as pregnancy progresses The most common form of pelvic dysfunction is symphysis pubis dysfunction (SPD), which is caused by the pubic joint not working as it should (see p.82)
I’ve never looked better -why is that?
Hormone levels in early pregnancy can make for a miserable time for many women as they battle against morning sickness, tiredness, and sore breasts. However, at around 12-16 weeks, when pregnancy hormones begin to settle and these symptoms start to subside, many women feel that their skin and hair are in great condition and their energy levels are at a high. This is sometimes called ”blooming” (see p 108) and you may be lucky and find that this continues throughout your pregnancy.
If you are feeling particularly well, you may feel tempted to do too much, but you should exercise some caution as there will still be times when your body needs additional rest and you need to store up energy in preparation for labour and birth.
GETTING COMFORTABLE:
I’m 36 weeks and have noticed that I’m more comfortable and breathing more easily. Why is this?
It sounds like your baby has moved down into the pelvis. The baby’s head is ”engaged” when the widest part of the head has passed down into the pelvis. This means that when the midwife feels your abdomen, less than half of the head can be felt abdominally. Engagement is normally recorded in your antenatal notes in fifths, ranging from 1/5 to 5/5, so if the midwife has written ” 1/5 palpable” your baby’s head is deeply engaged in the pelvis, as this means that 4/5 of your baby is down within the pelvis The timing and significance of engagement depends on several factors. Women expecting their first baby tend to have firmer abdominal muscles, which gently ease the baby down into the pelvis during the last four weeks of pregnancy. This appears to be what your baby has done, and that is why you suddenly feel you can breathe a little easier as your lungs and rib cage are not so squashed A second or third baby may not become engaged until labour starts, as the abdominal muscles tend to be more lax.
What is perineal massage?
Perineal massage is the practice of massaging the perineum, the stretch of skin between the vagina and anus, to make it more flexible in preparation for childbirth. The intention is to prevent tearing of the perineum during birth, and the need for an episiotomy or an assisted (forceps or vacuum extraction) delivery, as the skin in this area may become more stretchy as a result of massage. Clinical trials indicate that perineal and vaginal massage can reduce the seriousness of tears and so some consider it beneficial.
Use a lubricant such as KY jelly cocoa butter, olive oil vitamin E oil, or pure vegetable oil on your thumbs and massage around the perineum Place your thumbs about 3-4cm (1-1%zin) inside your vagina and press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation. With your thumbs, hold the pressure steady for about two minutes, or until the area becomes a little numb and you don’t feel the tingling as much. As you keep pressing with your thumbs,slowly and gently massage back and forth over the lower half of your vagina, avoiding the urinary opening, and along your perineum, working the lubricant into the tissues for three to four minutes. This helps stretch the skin in much the same way that the baby’s head will stretch it during birth. Do this massage once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility
I’m 35 weeks and feeling as tired as I did in the first trimester. Is that normal?
Tiredness can cause real problems for women in the first and last trimesters and is often worse for women who are overweight or who have a multiple pregnancy In the early stages, you may feel tired
and lethargic due to hormonal changes, while later in pregnancy tiredness is caused by the extra demands on your body Rest is the best cure, though this may be difficult if you’re working or looking after children.
Boost your energy levels with regular, balanced meals. Late pregnancy is also the time to get your
partner, family, and friends to help out with things like shopping. chores around the house, and cooking
Severe tiredness in the last trimester may indicate that your iron levels are low, so it may be worth getting your iron levels checked
I’ve gone from an A cup to a size D - my husband hopes this will last forever, but it won’t will it?
Many women notice an increase in the size of their breasts in the second trimester and some maintain a bigger size after the birth, especially if they breastfeed. This is due to the effects of oestrogen, which causes fat to be deposited in the breasts. As your breasts enlarge, the veins become noticeable under the skin, the nipples and area around the nipples (areolae) become darker and larger, and bumps may appear on the areolae. Some women get stretch marks on their breasts, but these fade in time After the birth, your breasts may get even bigger when the milk comes in! They do reduce in size once you finish breastfeeding, although the majority of women report a permanent increase of some degree.

Maternity bras
Breast changes are one of the first signs of pregnancy, as from around 3-4 weeks’ gestation there is an increased blood flow, which increases tenderness. Some women notice a change in breast size early in pregnancy. while others may not notice any change until they breastfeed Nevertheless, it’s a good idea to get advice from a shop that stocks maternity bras with staff trained to measure and advise on what size you need. If your current bra fits well, wait until later in pregnancy to get measured when changes in cup size are more likely In the early days of feeding, you may experience some engorgement of your breasts, but don’t panic and send your partner out for a bigger size as this settles in a few days.

 
Weight gain in pregnancy
Monitoring your weight
The recommended weight gain in pregnancy depends on your pre-pregnancy weight. If your BMI was less than 19.8 you should aim for a gain of between 12.5-18kg (28-401b): between 19.8 and 26 you should aim for 11 5-16kg (25-351b); above 26 you should aim for 7-1 lkg (15-251b).
What if I gain too much or too little? There is a link between not putting on enough weight in pregnancy and low birth weight babies. If you gain too much weight, you are more likely to suffer from pre-eclampsia, high blood pressure, diabetes, backache, varicose veins, tiredness, shortness of breath, and to have a large baby
How do I maintain a healthy weight?
Take moderate exercise, eat healthily (see p.50), and follow a weight-reducing diet only under supervision. You need only 200-300 calories more per day so ”eating for two” is not a healthy option.