Pregnancy

Pregnancy is counted from the first day of your last menstrual period and lasts on average about 40 weeks. Of course, this is assuming you have a 28 day menstrual cycle! "Term", or "Full Term" is considered to be anywhere from 37 weeks to 42 weeks of gestation.

Prenatal Care

Mothering begins during pregnancy, not after your baby is born. By taking good care of yourself during your pregnancy you are taking good care of your baby. This care is the foundation for all care during pregnancy, labor, birth, and the postpartum and newborn period. Prenatal care includes both the care provided by your midwife or physician, and most importantly, the care you give yourself.

The prenatal care that you give to yourself includes several things:

• Eating a healthy, nutritious diet designed to provide both you and your growing baby with everything needed for optimum health. Your diet is probably the most important factor in having a healthy pregnancy and growing a healthy baby

• Adequate and common-sense exercise

• Avoiding tobacco, alcohol, recreational drugs, unnecessary medications, and toxins or chemicals that may be hazardous to your developing baby

Prenatal Care Schedule

The normal schedule of visits for routine prenatal care is as follows:

• Every 4 weeks until the 28th week of pregnancy

• Every 2 weeks from the 28th week - the 36th week

• Every week from the 36th week until birth

Nausea and Vomiting Of Pregnancy (NVP)

Tips and Suggestions For Coping

NVP, or "morning sickness", can be just plain miserable. Since one of the causes is hypoglycemia, or low blood sugar, there are some specific measures you can try to alleviate the symptoms.

• Eat small amounts very frequently. The more nauseous, the more frequently you should eat.

• Take extra B vitamins, specifically B6

• Ginger in any form has been helpful. You can try ginger in capsules, candied ginger root, ginger tea, etc.

This is a VERY short list out of many ideas. You can view, download, or print this brochure which has a comprehensive list of specific suggestions to try. Most women will be able to find something to help! In addition, don't forget to try and get some fresh air and mild exercise, which can also help stabilize blood sugar and in general help you to feel better.

Nausea and Vomiting of Pregnancy

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Ultrasound

There have been several trials of routine ultrasound examinations during pregnancy. The largest, a prospective, randomized one of routine vs indicated ultrasound examinations, was the RADIUS study. [Ewigman BG, Crane JP, Frigoletto FD, LeFevre ML, Bain RP, McNellis D, The RADIUS Study Group. Effect of prenatal ultrasound screening on perinatal outcome. N Engl J Med. 1993; 329:821-827] This study included 15,530 pregnant women. One group underwent routine ultrasound at 15-22 weeks and again at 31-35 weeks. The other group underwent ultrasound only if a specific indication arose, such as uncertain dating or positive triple screen. The primary outcome measure was adverse perinatal outcome (fetal or neonatal death or moderate or severe neonatal morbidity). The secondary outcomes were multiple gestations, birth weight, and incidence of preterm delivery. This trial found no difference in perinatal outcome between the groups. There was, however, a 3-fold increase in the detection of fetal anomalies, which did not have an effect on perinatal outcome, the investigators' primary outcome variable. Therefore, they concluded that, "The adoption of routine ultrasound screening in the United States would add considerably to the cost of care in pregnancy, with no improvement in perinatal outcome."

From:

Field Notes in Obstetrics and Maternal-Fetal Medicine
Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (Yet Profitable) Screening Modalities
by Martin Donohoe, MD, FACP

posted April 30, 2007 [on Medscape]

..."Other monitoring tests may be misused. One example of this is fetal ultrasonography. Although it is helpful in estimating gestational age, identifying twin pregnancies, and detecting genetic anomalies, the American College of Obstetrics and Gynecology (ACOG) position is that routine ultrasonographic screening during pregnancy is not mandatory. They deem routine use reasonable when requested by a patient.[11] Most women in the United States undergo at least 1 or 2 ultrasounds during pregnancy; this level of exposure has never been associated with significant risk and use may provide significant benefits. However, some expectant couples have followed the lead of actors Tom Cruise and Katie Holmes and purchased (for costs ranging between $15,000 and $200,000) their own ultrasound machines, which they use daily.[12]

There are some data (mostly from other vertebrates) suggesting that prolonged and frequent use of fetal ultrasound can cause abnormalities in fetal brain development, behavior, and body weight.[13] Even though such findings have not been substantiated in humans,[13] the US Food and Drug Administration (FDA) considers promotion, selling or leasing of ultrasound equipment for the purpose of making "keepsake fetal videos" an unapproved use of a medical device.[14] Such use may also violate state laws and regulations."
 

Ultrasound, used appropriately, is wonderful technology. It is not necessarily risk-free though, so the benefits should outweigh any potential risks. What are the potential risks? Most women have no idea there are any! However, several studies have shown that ultrasound heats cells, especially brain cells, which increases intracranial temperature, and may cause brain damage. No one really knows for sure what the possible consequences are, although it is known that male babies who have undergone ultrasound while in the womb have a higher incidence of left-handedness. A study published in August 2006 found that prenatal ultrasound exposure to ultrasound waves has a definite impact on neuronal migration in the brains of mice. The implications to the human fetus are still unclear. You can read the entire study:  Prenatal ultrasound exposure to ultrasound waves impacts neuronal migration in mice. Some researchers believe that ultrasound may be the culprit in the unexplained dramatic increase in the numbers of autistic children, although this is mainly speculation at this point. The fetus also "hears" the ultrasound waves through vibration. This is similar to you 'hearing' your finger being lightly tapped near your ear. No one near you would hear it - you are actually hearing the vibration of the tapping. Dr. Mustapha Fatemi, a medical engineer at the Mayo Foundation's Ultrasound Research Laboratory in Rochester, Minnesota, concluded from his studies that ultrasound vibrations sound like the high tones of a piano, at about the same volume as an approaching subway train. Could this cause hearing problems? Again, no one really knows.

• The FDA prohibits unapproved, non-medical uses of the ultrasound.  The FDA policy states that "keepsake" fetal videos are an unapproved use of a medical device.

• The American Medical Association officially adopted the current Food and Drug Administration policy on the use of non-diagnostic fetal ultrasound in July of 2005.

• The American College of Obstetricians, in their guidelines on routine ultrasound in low-risk pregnancy, concludes "In a population of women with low-risk pregnancies, neither a reduction in perinatal morbidity [harm to babies around the time of birth] and mortality nor a lower rate of unnecessary interventions can be expected from routine diagnostic ultrasound. Thus ultrasound should be performed for specific indications in low-risk pregnancy" (ACOG 1997).

In spite of all of these recommendations routine ultrasound during pregnancy is the norm, with many women being scanned multiple times during their pregnancy. In addition to ultrasound scanning, the use of the hand-held doppler to listen to the fetal heart beat during pregnancy is also routine, which is also ultrasound. With so many unknowns regarding ultrasound, and benefits dubious, it seems prudent to at the very least limit exposure to ultrasound to the medically indicated reasons.

Medical indications for diagnostic ultrasound (with the understanding that ultrasound may not be conclusive) may include: suspected ectopic pregnancy, pregnancy dating when usual methods are not adequate, suspected fetal anomalies, to confirm or rule out multiple gestation, placenta previa or abruption, mal-presentation, abnormal amniotic fluid levels.

Sonograms Safe If Done Properly 

A press release from the Society of Diagnostic Medical Sonography Aug. 8, 2006
 

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