Posts Tagged ‘third trimester’

Twins and multiple births

We are expecting twins following IVF treatment. How will we cope?
Although finding out that you will be the parent of two babies rather than one can be a shock, the initial surprise will settle and you will soon start to get used to the idea There are many associations that offer information and support to parents of twins, as well as companies that make products for parents of two or more children (see p.310) Your midwife and obstetrician will offer information and support and may put you in touch with local multiple birth support groups You will also be invited for more regular antenatal appointments and scans than if you were having just one baby to keep an eye on the growth of your babies.
As with all multiple births, there are no additional financial benefits if you are having twins, although you may receive more of certain benefits that are dependent on income (see below).
We’re having triplets. Help! My wife is over the moon, but I feel numb. Where can we get advice?
As having triplets is relatively rare - only 149 sets
of triplets were born in the UK in 2006 - the majority of information and support for couples does relate to having twins. However, more and more research is being carried out into how to help and support parents having more than two children
Your midwife and obstetrician will be great sources of information and will be able to put -you in touch with other parents of multiple-birth children. There are also several organizations that offer support and information for parents having a multiple birth (see p.310). As you and your wife learn more about having triplets, your anxiety will hopefully start to ease
Will we receive any additional financial or practical support
as we’re having more than one baby?
Unfortunately, there are no financial benefits available to all parents having twins or multiple births. However, there are some benefits that are dependent on your income, some of which you may be able to claim per baby One of these is the Child Tax Credit, made up of three elements: a family element: an amount payable per child dependent on your joint income; and a baby element of £545 if you have cne or more children under a year old This credit is the focus of the Twins and Multiple Birth Association’s current campaign, as they feel strongly that the baby element should be paid per baby, so that a family with newborn triplets would be entitled to £1635. The Sure Start Maternity Grant, a payment of £500, is payable per baby so if you are entitled you would be able to claim £ 1500 for triplets. This must be claimed within three months of the birth so it is important to apply as soon as possible For practical support, it is worth finding out about Home Start schemes in your area. Home Start is a charity that provides trained volunteers to lend support at home. Each scheme is locally based, managed, and run by individual communities, supporting families in that community.
IDENTICAL TWINS: NON-IDENTICAL TWINS:
Does taking folic acid increase the incidence of twins?
There has been some debate and conflicting studies about whether taking folic acid pre-conceptually could increase the chance of having twins. A study in Sweden in the 1990s found a higher incidence of multiple births among women taking folic acid. However, this could be attributed to other factors, such as a greater number of women undergoing fertility treatment, which carries an increased probability of twins. Also, subsequent studies have refuted these findings; in 2003, the medical journal The Lancet reported on a large-scale study in China that found there was no significant difference in the number of women who had taken folic acid carrying twins.
Are all same-sex twins identical?
No. Whether or not twins are identical depends on how they were conceived, not on what sex they are (see above). While identical twins are obviously the same sex, non-identical same-sex twins are as similar or different as any other non-twin siblings.
How likely is it that our twins will be identical?
One in 80 pregnant women carries twins and one-third of twins are identical Although there are factors that make you more likely to have non-identical twins, such as a family history of twins or being over 35, having identical twins is not an inherited trait and there are no other factors that make this more likely.
Will I know before the birth if they are identical?
The term “zygosity determination” means finding out whether twins, triplets, or more are identical (monozygotic) or non-identical (dizygotic or fraternal). It is natural for parents to want to learn all about their babies, and with twins this includes their zygosity As well as for reasons of natural curiosity, knowing whether twins are identical can help parents to determine the chance of having a multiple pregnancy again, and also has implications on care during pregnancy, as identical twins, especially if they share a placenta, are higher risk, and so the pregnancy may be more closely monitored.
In two-thirds of cases, the placenta provides the answer as to whether twins are identical. If the babies have a single amniotic sac surrounded by one outer protective membrane, known as the chorion, they are monozygotic However, one-third of identical twins whose egg split early, before the placenta started to form, have two chorions with either a fused placenta, where two placentas grow together, or two separate placentas. These placentas are hard to distinguish from those of dizygotic twins
We don’t know if our twins are identical. Will it be obvious after the birth?
In a third of cases, twins are different sexes and therefore obviously non-identical In same-sex twins by the time the children are around two
years old their’ zygosity” is usually quite clear from their physical features Before this, there are many indications as to whether twins are identical such as the colour of their hair and eyes, the shape of their ears, the eruption and formation of teeth, the shape of the hands and feet, and the pattern of growth
If there is doubt as to whether twins are identical, the most accurate way to determine zygosity is by the DNA probe method when tiny amounts of DNA are collected with a swab from inside each twin’s mouth. A laboratory examines specific markers present in the DNA and 12 diagnostic targets are compared. Although non-identical twins may share five marker patterns by chance, monozygotic or identical, twins will have the same pattern for all 12 markers
Will I love one twin more than the other?
Although this can be a concern, it is more likely to be the case that rather than favour one child over the other, a parent gives more love and attention to the baby who needs it most at that particular time
It is also possible that the strain of having two new babies in the house may increase the likelihood of delayed bonding, although this can also happen_ the birth has been traumatic if the mother or indeed the father is exhausted: or if one baby has taken time to establish feeding, or is more fractious than the other This does not mean that bonding will not take
Am I likely to have a normal birth?
Although many women having twins have normal deliveries, the rate of Caesareans is increased with twin births With one baby the Caesarean rate is around 25 per cent in the UK; with twins, the rate is closer to 50-60 per cent which also means that 40-50 per cent of twins are delivered vaginally. Triplets and above are generally delivered by Caesarean in the UK and Europe Whether or riot twins are born vaginally depends on their position in the womb ~ whether one or both twins is head down (see p 133).
There may be an indication as to the type of birth in pregnancy as women with twins are usually scanned to check the position of the babies near to term, at around 27-34 weeks.
place over time, but if this is worrying you, you should mention it to your midwife or health visitor, as they may well be able to offer some helpful advice
In every family, there are bound to be ebbs and flows of love between parents and children, which is normal and not a cause for concern When a parent has two children born at different times, that parent may love one child differently to the other, but this does not mean that the love a parent has for one child is to the detriment of the other.
Will the side effects of pregnancy be much worse with a multiple pregnancy?
Although in some cases the side effects of pregnancy may be the same when you are expecting two or more babies, the likelihood is that many pregnancy symptoms will be exaggerated Symptoms such as morning sickness, fatigue or exhaustion, disturbed sleep and swollen hands and feet are often worse with a multiple pregnancy Unfortunately, women with multiple pregnancies also tend to suffer more from varicose veins (see p.86) In addition to these increased side effects, weight gain is greater and more rapid for mothers carrying more than one baby and the uterus measurement is often increased for the gestational age This extra weight and size caused by carrying two or more babies may also cause more constipation haemorrhoids (piles), urinary tract infections, and vaginal thrush infections.
Although there may be more exaggerated symptoms with a multiple pregnancy the majority of these problems can be monitored by your midwife or doctor, and they may be able to offer advice and treatment to ease these symptoms.
Will my weight gain be much greater than for someone who is having just one baby?
Mothers of twins or triplet pregnancies are likely to gain more weight than women having one baby. Indeed, in the first trimester, rapid weight gain may be an indicator of a multiple pregnancy The increased blood volume and size of the uterus, as
well as each baby’s weight, possibly two placentas, and the amniotic fluid for each baby, will continue this pattern of greater weight gain during pregnancy
Although on average a woman having a multiple pregnancy is likely to put on around I Okg (221b) or more than a woman having one baby, this is not double the weight gain If you are having twins, you should raise your calorie intake by only 500 calories per day in the last trimester, compared to 200 calories more for a single pregnancy
I’m only 24 weeks, expecting twins, and already I’ve got high blood pressure. What can I do?
Unfortunately high blood pressure is more likely to start, or worsen if you already have the condition, in a twin pregnancy as the rates of pregnancy-induced hypertension (PIH) and pre-eclampsia (see p 89) are increased in multiple pregnancies
There is little that can be done to prevent PIH General lifestyle changes, such as reducing your salt intake, avoiding alcohol and tobacco, taking gentle, regular exercise, and getting enough rest, are thought to help. You should also ensure that you attend all your antenatal appointments and contact your midwife or doctor if you experience headaches or visual disturbances such as flashing lights or there is reduced movement from your baby
What can go wrong if I have a vaginal delivery?
If both twins are head down, a vaginal birth is usually possible. Sometimes, the first twin may be head down and born vaginally, but the second twin may be breech Sometimes, the second twin will turn and be head down after the birth of the first twin, and you are then more likely to deliver both twins vaginally Studies suggest that there has been a significant increase in combined vaginal-Caesarean births of twins and a decrease in vaginal only births, which may be due to the fact that there is a greater willingness nowadays to allow women carrying twins to try for a vaginal delivery, which also increases the likelihood of this scenario. If you have a vaginal delivery, there is a greater chance of one or both twins having an assisted delivery by vacuum extraction or forceps (see p.202), either because one or both twins is positioned in a tricky -way, for example facing the mother’s back, or because the labour may be longer and weaker because of the amount of work involved in pushing two babies out, which means that the mother is therefore likely to be more tired and needing help at the end of labour.
Why might the doctors decide to deliver my twins by Caesarean section?
An elective Caesarean (see p.206) might be recommended for a twin delivery for several reasons, but ultimately it is your decision The optimum time for delivering any baby is at term (37-40 weeks’ gestation) and this remains the case for delivering twins as they may well be smaller than a singleton baby, having had to share your supply of nutrients However, if one or both of the babies are compromised, possibly due to twin-totwin transfusion syndrome (see p 134) or raised
blood pressure in pregnancy there may be a need to deliver the babies preterm.
Many units recommend a Caesarean for a breech baby where the baby is bottom down inside the womb, because there are more risks associated with a breech vaginal delivery In a twin pregnancy if the first baby is breech, this puts the second twin at risk too Also. if the first twin is breech and the second is head first (cephalic), a Caesarean is recommended due to the rare complication of ”locked” twins, when the babies’ chins get locked together
If both babies are head down and appear to be thriving, many maternity units will encourage a normal delivery Your doctor and midwife will discuss this with you nearer the delivery time.
Will my triplets need to be delivered before 40 weeks?
Yes, it is very likely that your triplets will be delivered before 40 weeks. Although most twins are born at around 37 weeks, which is considered to be a term pregnancy it is rare for triplets to reach term, and most are delivered at around 32-36 weeks’ gestation
As a woman’s body is designed to carry one infant at a time, carrying more than one increases the risks for both mother and babies, and the decision to deliver your triplets will be taken when one or more of the babies is not coping well. To improve the chances of a good outcome, get plenty of rest and eat a healthy diet (see p.50) Although premature deliveries do carry a risk to the infant, if the baby’s wellbeing is compromised an early delivery is necessary. If you go into premature labour, you may be given medication (see p.162) to try to stop labour for long enough to administer steroids, which will help to mature the babies’ lungs before delivery -as long as this does not put the babies at risk
How likely is it that my twins will have a lower than average birth weight?
Over 40 per cent of twins are born with a lower than average birth weight, which is mainly due to the fact that they are born earlier than singleton babies.
Do twins run out of room to turn in the womb?
It does tend to be the case that, in the third trimester, twins find a position and settle there at an earlier stage of pregnancy than if there was just one baby. Generally, with twin pregnancies there seems to be a lot less movement in presentation from about 32-34 weeks. However, how your twins are likely to be delivered depends largely on the direction that the twin who is lowest in the pelvis is facing. If this twin is head down, then a vaginal delivery should be possible and the second twin may be able to be gently coaxed into a favourable position, or may need to have an assisted delivery (see p 202)
I’ve been told that one baby isn’t developing as well as the other.What will the doctors do?
Although it is common for twins to grow at a different rate in the womb, if there is a significant difference in size, it may be that one baby is getting a greater proportion of the nutrients than the other. It is important to check that your babies are developing in line with their gestational age. It is not unusual for some babies to grow slowly and then accelerate later on, which is not a concern if it’s within the accepted range of growth for their gestational age. However, if your midwife or doctor is concerned about the development of one baby, they will probably refer you to a fetal medicine specialist: an obstetrician with additional training in caring for the unborn baby He or she may do blood tests and perform an ultrasound to assess the growth of each baby and investigate why there is a difference.
You may continue to have additional scans, known as growth scans, which will help the doctor to assess if one baby is small or growing slowly These usually start around 26-28 weeks and continue every 2-4
weeks until your babies are due to be delivered They look at a number of areas including the head, abdomen, and thigh bone measurements; the amount of amniotic fluid around the babies; the babies’ levels of activity; the blood flow in the umbilical cord; and the position of the placentas. Your doctor should
explain the findings of the scans and if there is a concern you will be closely monitored.
What is twin-to-twin transfusion syndrome?
This is a rare but serious condition that occurs only in identical twins who share a placenta. It is caused when there is an abnormal blood supply and a blood vessel directly connects the twins. One twin pumps blood around his own body and that of his twin and, as a result, he does not grow properly An early delivery is usually needed to save the smaller twin.
Am I likely to lose one or more of my babies?
There are increased risks for both mother and babies associated with multiple pregnancies and sadly there are occasions when one or more of the babies dies in the womb This occurs in around 2 5-5 per cent of twin pregnancies. In some circumstances, for example if there is a fetal abnormality in one twin such as a heart defect, the doctor may suggest that one or more of the babies is terminated in the very early weeks to allow the normal healthy development of the other baby or babies. However, many doctors believe that this is unnecessary as the procedure itself carries the risk of losing all the babies.
Although incredibly hard, this is ultimately your decision so you should spend time discussing the options with your doctor.
Unfortunately the death of a baby in a twin pregnancy can sometimes cause problems for the surviving twin, although the degree and type of problem depends on whether the twins were identical or non-identical. If the twins were identical, the doctors will want to assess whether it was a monochorionic pregnancy (in which the twins share the same placenta) or a dichorionic pregnancy (in which they have a different placenta). This is because, when the placenta is shared, there is a 30 per cent risk of death or a neurological problem to the surviving twin if the other dies, whereas if there are two placentas, there is a lower risk of 5-10 per cent, of death or disability occurring in the surviving twin.

The position of twins
Twins can lie in a variety of positions in the uterus and these positions can determine how your baby will be born One baby will always be lower than the other one, and this baby will be known as the first baby - it is closer to the birth canal and will
generally be born first.
What are the possible positions? Babies can be in the head down position (cephalic) or buttocks or feet first (breech). Occasionally a baby may be lying across you diagonally or horizontally (transverse) Twins can lie in any combination including: cephalic-cephalic, cephalic-breech, breech-breech, breech-cephalic These positions can change throughout the pregnancy, As with a singleton pregnancy (one baby), once the presenting baby nearer to the cervix goes down into the pelvis, it will stay in that position ready for birth.
Can I have a vaginal birth? When both babies are in a cephalic position you may be offered the chance to try for a normal labour and vaginal birth Sometimes, the first baby is cephalic and the second twin is in a breech position. If this is the case, your obstetrician may suggest that you have a Caesarean from the outset, or may suggest that you have a vaginal birth with the doctor assisting the birth of the second twin with forceps or ventouse (see p 202) if necessary You can certainly be party to these discussions and it’s important to share your feelings about the birth and birth choices. If the first baby is breech and the second baby is cephalic, then it is highly likely that your doctor will recommend that you have a Caesarean delivery. If both your babies are in the breech position you will almost certainly need a Caesarean, as is the case if both babies are lying across you in the transverse position

How are twins conceived?
Identical ”monozygotic” twins are produced when a single egg is fertilized by a single sperm, and the egg then splits into two. The babies may share the membranous, or amniotic, sac that surrounds them in the uterus Depending on when the egg splits, they may also share a placenta. Identical twins, therefore, are the same sex and look almost completely alike as they share the same genetic makeup. Non-identical, or ”dizygotic”, twins result when two eggs are fertilized by separate sperm at the same time and each therefore has its own individual genetic makeup Each fetus also has its own amniotic sac and placenta.

What’s happening to my baby?
fetal development
Is it true that much of the really important brain development happens in the first trimester?
Your baby’s brain starts to develop soon after conception when brain cells begin to form at the tip of the embryo After about three weeks, a structure called the ”neural tube” begins to change in order to form the spinal cord, and the brain and brain cells (neurons) start to develop and send messages to each other In the early weeks, brain cells multiply at a rate of about 250,000 per minute.
After about 20 weeks of pregnancy, the rate at which brain cells multiply begins to slow down and the brain starts to organize itself into over 40 systems to direct vision, language, movement, hearing, and other functions By the time you are half way through your pregnancy, almost all the brain cells your baby needs for life are present
During the third trimester, the connections between the brain cells start to mature and the baby’s nervous system becomes more developed. Brain development is not totally complete by the time the baby is born and many important brain connections that help your baby develop skills and personality are made after the birth.
So, although fetal brain development occurs throughout pregnancy, and after, crucial foundations are certainly laid during the first three months
Is there anything I can do to help the development of my baby’s brain?
You can ensure that your diet includes good sources of omega-3 fatty acids, as these are thought to play an important part in the development of the brain They can be found in oily fish such as mackerel and salmon (limit to one or two portions a week) ; omega-3 supplements designed to take in pregnancy are available.
When will my baby’s face be formed?
The development of the face starts as early as the sixth week of pregnancy, when grooves that
will form the structures of the face and neck start to grow. A week later, the eye starts to develop and a primitive mouth and nose are evident. By the end of the first trimester the face is well formed and has a definite human appearance, although the skin is still transparent By the 24th week of pregnancy, the eye is fully developed, the eyebrows and lashes have formed, and the skin becomes less transparent, but the eye remains fused shut and does not open until around the 28th week of pregnancy
During the last trimester, your baby’s hair begins to grow on the head and fatty deposits give your baby rounded cheeks
I would like to communicate and bond with my baby before the birth. Is there anything I can do?
As your pregnancy progresses, there are many ways to focus on your baby and communicate with him, and these occasions area chance for you to relax and take time out, too.
* Relax in a warm bath and concentrate on feeling your baby’s movements, imagining what he is doing inside you.
* Talk to your baby. Your baby can detect sounds from outside the womb by the second trimester and is especially likely to tune in to your voice. You can give a running commentary on your activities, or even read to your baby Get your partner to chat too! * Rub or massage your bump. You may find that your baby responds by kicking; it’s almost like having a conversation!
* Spend some time making plans for your baby’s arrival, for example, choosing colours for the nursery
or even just buying a few sleepsuits
* Sign up for birth preparation classes for you and your partner This will give you both a chance to think about labour, birth, and your baby
* Start reading through a book of baby names and make a list of those you and your partner like * Some couples enjoy taking regular photographs of their growing bump
I’ve got a full-on career and have hardly thought about the baby. Will this stop us bonding?
Even if you work full time during pregnancy, this doesn’t have to have a negative effect on your relationship with your baby. As your baby grows, you will probably find that you start to develop a relationship with your ”bump” as you anticipate your baby’s movements and perhaps talk to your baby Make sure you plan enough maternity leave before your due date as this gives you time for practical and emotional preparations, as well as time to rest There is some evidence to suggest that too much stress in a mother can affect her unborn baby’s brain development although this is not conclusive. However, it does highlight the importance of regular opportunities to relax during pregnancy
I’m trying to get my partner involved; I keep letting him feel the baby move, what else can I do?
This is a common concern Feeling the baby move inside you is a great way for your partner to begin to connect with the baby as a separate person and seeing the baby on an ultrasound scan can help too, as can hearing the heartbeat.
It is often difficult for partners to feel involved with a pregnancy since it is not physically happening to them and can feel quite an unreal experience Try to spend time together finding out about pregnancy labour, and birth as this will help your partner to feel as informed as you and discover ways to help -you during the labour and birth and care for the baby after the birth. Some of the suggestions in the box above may also help.
My husband didn’t talk about the baby before the scan. Now he is over-protective. Is this normal?
Many fathers-to-be find it difficult to come to terms with the fact that their partner is carrying their baby, and that the baby will eventually be born and bring all the joys, trials and responsibilities of parenthood. This is all even harder to envisage when they are not physically experiencing the changes that pregnancy brings - not feeling the symptoms or feeling the movements. The ultrasound scan is often a pivotal point for partners - suddenly they are ”face to face” with their baby, and it becomes more real Perhaps your partner is now realizing his responsibilities and affection for the baby and is showing these feelings by taking care of you. If you are finding that his cosseting of you is a little too much, you might want to discuss other ways he can feel involved with the pregnancy and prepare for the baby (see box, above)! Try to embrace his involvement and enthusiasm for the pregnancy - it is a great way for you to strengthen your relationship as a couple and prepare to face parenthood together.
When can a baby first suck its thumb?
Ultrasound scans have shown unborn babies sucking their thumbs from as early as 12 to 14 weeks of pregnancy However, this is likely to be a reflex at this stage as the brain does not have any conscious control over movement until the fetus is much more developed later on in pregnancy,
Some research has suggested that if an unborn baby shows a preference for sucking, for example its right thumb, then it will prefer to lie with its head turned to the right after the birth The same research also suggested that this preference in the womb could be used to predict right or left handedness in the baby as it grew older
When will the midwife be able to hear my baby’s heartbeat?
Your midwife should be able to hear your baby’s heartbeat by the time you are around 12 weeks pregnant using a hand-held device called a sonicaid”. The heartbeat sounds rather like a galloping horse, and the rate is usually somewhere between 120 and 140 beats per minute — around double the rate of your own pulse.
There are factors that can influence whether or not the baby’s heartbeat can be picked up. For example, if you are overweight, or the baby is in an awkward position, it may be harder to hear the heart. If your midwife is unable to locate the baby’s heartbeat at 12 weeks, try not to worry, At this stage, the baby is only about 5cm (2in) long, so it’s still very tiny’ Your midwife will try again in a few weeks. Certainly by 16 weeks it should be easier to pick up and listen to the heartbeat.
When will I first feel my baby move?
Although ultrasound scans have shown that babies may start to move slightly from around 6 weeks, it is not usually until the second trimester (13-26 weeks) that the fetus will make active movements. The sensation known as ”quickening” is described as a fluttering type of feeling usually felt by mums between 16 and 20 weeks, although exactly when a movement is felt can vary from woman to woman and may be affected by various factors. If it is your first baby, you may not notice any movement until later as you won’t know what to expect. Also, if you are an active person, these slight flutters may be missed. Women with an anterior placenta (lying at the front of the womb) may feel movements later, as may larger women, as there is more flesh for the movement to be felt through.
It is not until around 28 weeks that it becomes more important to monitor the pattern of movements. From this stage, the amount your baby moves, as well as the type of movement and the time it happens, are relevant as these indicate that the placenta is sustaining the pregnancy and your baby’s muscles are developing. If you are concerned about lack of movement, contact your midwife or hospital.
What sounds can my baby hear in the uterus?
The baby’s outer ear is visible at around eight weeks and the first reaction to loud noises has been recorded at nine weeks. This has been measured in studies by playing a range of sounds through the mother’s abdomen and recording any responses, such as movement, through ultrasound scans. It is thought that babies start off hearing low tones and then higher tones are heard later on as the hearing system continues to develop.
Studies also suggest that a fetus can determine
its mother’s voice and the voices of close friends and family significantly during pregnancy One study revealed that not only did the fetus hear its mother’s voice, but its heart rate decreased, indicating that her voice had a calming effect. By 16-20 weeks, hearing is considerably developed. Premature babies born at this time react to sounds, so they are living proof that babies inside the womb at that gestation can hear Research also suggests that babies respond to stories read to them or music played during pregnancy after the birth
I’m 25 weeks’ pregnant, and my baby seems to “jump” when it hears loud noises - is this likely?
Babies born prematurely react to sounds, and loud sounds will produce a ‘’startle reflex’, so this provides strong evidence that babies inside the womb at that gestation will hear and react to loud sounds too, possibly with sudden movements
As mentioned above, studies have shown that a baby can react to sounds in the womb from as early as nine weeks’ gestation. As the fetus grows, the hearing develops, with babies responding to a greater range of sounds.
My tummy measurement has been the same for three weeks. Why isn’t my baby growing?
In pregnancy, your abdomen is measured to establish the height of the top of the womb, which indicates how the baby is growing It is important
to know whether the same person is measuring you, as there is an element of subjectivity depending on techniques. In early pregnancy, it is not necessary to measure you as this doesn’t give an indication of fetal growth, but from 26-28 weeks, growth can be assessed this way. However, even with your own personalized growth chart and with the same person measuring you at the correct time, on their own these are not an accurate means of estimating your baby’s growth. If there are any concerns, you will probably be referred to a consultant to decide whether you need further investigations, for example ultrasound scans. If you are at the end of your
pregnancy, one possible explanation may be that your baby’s head is engaging into the pelvis, so although your baby is still growing, some of his head has not been measured due to its position If you are worried, talk to your midwife and, if necessary, she can refer you for a ”growth scan”,
Do babies have hiccups in the womb? I’m sure I can feel them.
Babies hiccup from early in the third trimester. This is a normal phenomenon that is usually short-lived but often recurs at similar times each day It feels like a quick, spasmodic sensation in your abdomen. Hiccups are not harmful to the baby and in fact are a sign that your baby is healthy, in the same way that your baby’s movements are a positive sign.
It is thought that the hiccups may be caused when, occasionally, babies take a deep breath in and ingest the amniotic fluid that surrounds them. The sudden change in chest cavity pressure when they take in fluid can cause the hiccups, just as when we drink something fast. These deep breaths help to exercise breathing muscles and stimulate their lungs to produce “surfactant”, which is essential for the lungs to function. The baby cannot drown, as it receives its oxygen supply from the placenta.
When will my baby grow fingernails?
Babies begin growing fingernails from the end of the first trimester and the nails reach the fingertips between 34 and 36 weeks of pregnancy It is possible for babies to scratch themselves inside.
After birth, cutting a baby’s nails can be a cause of concern for parents. Newborn nails grow rapidly and the best time to shorten them is after a bath, when they are at their softest and the baby is more relaxed. There is some controversy over whether to use scissors, clippers, or simply bite them off. Scissors and clippers may easily cut the skin, but biting carries a higher risk of infection if the skin is broken. Pressing the nail helps to distinguish nail from skin. Using emery boards or simply peeling them off can be slightly safer options, or put your baby in scratch mittens.
At what stage could my baby survive outside of the womb?
Until relatively recently, babies born under 28 weeks’ gestation often did not survive Today, with medical advances in special care baby units, babies of 22 weeks’ gestation have survived outside the womb, although this is still very rare. The guidelines for most hospitals is that 24 weeks is the earliest point at which they will resuscitate a baby, unless the baby shows signs of life at birth.
Extremely premature babies have an increased risk of disability, even with the best medical care, and often the delivery itself can put an enormous strain on the baby.
Very experienced doctors, midwives, and nurses will be involved in the care of extremely premature births If possible, the delivery should take place in a hospital with a dedicated special care baby unit (SCBU) If this is not possible, babies are often transferred to a specialist centre when they are stable enough to be moved.
As each day and week is a milestone for your baby, the nearer to your due date you deliver, the better the chances for your baby.
I like to rub my tummy and talk to my baby as even now I feel like my baby is here - is this daft?
No, this is perfectly normal and may be soothing for him as babies can determine their mother’s voice in the womb and sometimes their heart rate decreases in response. However, I wouldn’t recommend that
you rub your tummy too vigorously or too often as, in some cases, this can cause contractions and may trigger a premature labour if you are around 37 weeks’ gestation.
Many women feel that the mother-child bond
is there before the baby is born. It is good that you are having these positive thoughts during your pregnancy, as this is an excellent foundation for your future relationship with your baby
Can my baby see bright lights? I’m 32 weeks’ pregnant.
A baby’s eye structures begin to develop from as early as 4-5 weeks, with the eyelids forming at around 8 weeks and closing between 9 and 12 weeks. By 24 weeks, all of the eye structures are fully developed and at around 28 weeks, the eyelids start to open and shut Although we tend to presume the uterus is dark, this is not so Between 30 and 32 weeks, the baby experiences light and dark environments, depending on where the mother is and the time of day. It has even been reported in studies that not only do babies react to light, but have been seen on ultrasound scans trying to grasp at the light source. When a baby is born, he reacts to lights by frowning or blinking and can see to a distance of around 15-20cm (6-8m) (the same distance to mum’s face from the breast!).
Is it normal for babies to stop moving around so much towards the end of pregnancy?
Towards the end of pregnancy, your baby’s range of movements may change as there is less room for him to extend his limbs and trunk However, you should still be aware of a regular pattern of movement. Over the last 30 years, women have been actively encouraged to count how much their babies kick However, in 2003, the National Institute for Clinical Excellence (NICE) recommended that this practice of counting movements stopped, as counting how many kicks a baby makes is not an accurate indication of whether the baby is well and each baby makes a different number of kicks Nowadays, women are encouraged instead to tune in to their babies’ pattern of activity, including the type of movement they make and the periods when they are most active. Studies have shown that over 50 per
cent of women who had a stillbirth noticed a change in the pattern of movement. The general advice is, if -you are worried about your baby’s movement pattern you should speak to your midwife or hospital.
When will my baby’s head engage?
Engagement, when your baby’s head moves from higher in your abdomen down into your pelvis in preparation for the birth, can happen at any time from 36 weeks until the onset of labour (see p 148). The head tends to engage earlier in a first pregnancy
Can my baby’s position in the womb affect when his head engages?
A baby’s position can affect how it engages into the pelvis. For example, if the baby is lying in a ”back-to-back” position, with his back lying along the mother’s back; this can make it more difficult for the baby’s head to move through the pelvis. Similarly, if the baby is in a breech, feet first, position or a transverse position (see p. 145), then engagement will not be possible unless the baby moves and a Caesarean delivery may be necessary.
It is thought that the mother’s level of activity and the positions she adopts can influence the position of the baby in the womb. Nowadays, it is more common for babies to lie in a back-to-back position and it is thought that this may be due to people leading a more sedentary lifestyle. In the past, when women were possiby more active, perhaps performing tasks such as scrubbing the floor on their hands and knees, there was less incidence of this position
Will my baby develop much in the last month of pregnancy?
During the final month of pregnancy, your baby is busy preparing for birth. He will be practising breathing movements and sucking, and will start to turn towards light. You may notice that there are fewer vigorous movements now — this is natural as there is less space within the uterus. However, you should still be noticing plenty of nudges and wriggles.The downy hair that covered your baby’s body starts to disappear and the hair on the head and your baby’s nails continue to grow Meconium, the waste product that will be your baby’s first poo, starts to form in the bowels at this time. During this last month, most of your baby’s organs are fully mature and the lungs will continue to develop. ”Full term’ is considered to be from 37 weeks.
I feel very emotional at times and am scared that I won’t love my baby - is this normal?
The feelings you have are not uncommon An increase in hormones during pregnancy can cause some extreme and deep feelings, some of which are irrational Pregnancy is a major life event and, as well as the physical changes that are going on in your body, the emotional pressures are vast. There may be a range of pressures that are adding to how you are feeling, such as relationship problems, financial pressures, caring for other children, lack of space in your house, or returning to work after the birth. It is fine if these are occasional feelings, but if you find
that you are constantly snapping or crying, tired, having difficulty sleeping and eating, or sleeping and eating too much, are unable to concentrate, feel reluctant to leave the house, feel sad and anxious most of the time, or have developed obsessive compulsive disorder (OCD), then you need to speak to your midwife or doctor for help and advice as these are all symptoms of depression.
I’ve recently lost a parent and am very traumatized. Can stress affect my baby’s development?
This is a major life-changing event and with the additional fluctuation in hormone levels and the physical changes that are occurring in pregnancy you are obviously under a great deal of stress However, it may be helpful to bear in mind that your body is designed to deal with episodes of stress
There are studies that have suggested that women experiencing long-term stress may have an increased risk of pre-eclampsia (see p.89) and premature birth, although how reliable this evidence is has been questioned It has also been suggested that there may be a link between extreme stress in pregnancy and children becoming hyperactive, but again this is inconclusive The most important thing to do, now that you have recognized you may be at risk of long-term stress, is to speak to your doctor or midwife, particularly as there has been a recent increase in levels of support and treatment offered
to pregnant and new mothers in your situation, which may help to limit any adverse effects of stress.
YOUR BABY’S MOVEMENTS
First kick
The moment when you feel your baby’s first movements is a truly emotional experience, as you start to become completely aware of, and connect with, the baby growing inside
you. Usually, the first movements are felt as a fluttering sensation, or a ”quickening”, as your baby starts to stretch and turn. This can be felt from around 18 weeks, although for some women it is much later; if you have had a baby before you are likely to be aware of these movements earlier, but for a first baby, awareness of the baby’s movements is usually later, around 22 weeks It is not until about 24 weeks that you will really start to feel regular, more definite movements and you will soon become accustomed to your baby’s activities.