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"Mom, I'm pregnant"

These are not the words a mom with a teenage daughter wants to hear.

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29 January 2008
Monitoring your bump

 
Some prenatal appointments are more meaningful, others are more important. We look at what's in store for you.

 
Many of my friends, cousins and colleagues, who range in age from their late twenties to their early forties, are pregnant or have recently given birth.

Most have passed the anxious stage of early pregnancy and many have graduated on to the sleep deprived stage that comes with being a new parent. All are in awe of the baby-making process.

To give you an idea of what lies ahead, we asked them which doctor's visits or foetal assessments stood out for them.

Ooh-aah ultrasound
Freelance journalist, Lisa Lazarus, has yet to give birth to her baby boy. At 25 weeks she comments: "The scans at the foetal-assessment clinic at 12 and 22 weeks are exciting and nervewracking.

"They assess your baby incredibly closely. The 12-week scan is the scariest, as they look at your chance of having a baby with Down's syndrome, and if all the fingers, toes and so on are there.

"At this stage it is difficult to believe your baby is real; you don't even have a visible bump yet."

Marketing manager Adri van der Merwe, who gave birth in April, advises: "It is good to have hubby there for the 'biggies' – the first 12-week scan, the separate nuchal translucency scan (if you decide to go for it) and the heart-abnormalities scan at around 20 weeks."

Loryn Caulfield, a 29-year-old radiotherapist, decided to go for a nuchal scan as her partner's family has a history of Down's syndrome.

She remembers making the decision: "It was a hard call to make, but I felt that I would rather know in advance so we could prepare.

"As it turned out, everything was fine, the baby was perfect and seeing the heart beating for the first time was a feeling that compares to nothing we’ve ever felt before."

Even celebrity moms appear overjoyed by that first encounter. Jools Oliver, mother of Poppy and Daisy with Naked Chef, Jamie Oliver, writes in her book, Minus Nine to One (Penguin):

"There was so much anticipation and excitement that we were going to see our baby properly for the first time. I just can't describe how I was feeling."

This is the general reaction to the amazing ultrasound scan, which shows your baby and its movements on screen. The first one is usually offered at between 10 and 16 weeks. But why is an ultrasound so important?

Obstetrician/gynaecologist Dr Linda Rogers explains: "The importance of ultrasound is definitely to exclude any foetal abnormalities, rather than simply as a way of telling the baby's gender. Antenatal visits are predominantly there to monitor the health of the mother and the foetus."

Question time
On your first visit, your doctor will ask you a number of questions to compile your medical history. Here's what to expect, and why:

  • What was the date of your last period?
    This is used to estimate the date of delivery.

  • Did you have any difficulty falling pregnant?
    Fertility treatment may mean you are carrying multiples.

  • Have you had any problems up to this point such as bleeding, pain or discharge?
    Do you suffer from a chronic illness? These problems may require special care.

  • Have you had treatment for a psychiatric illness in the past?
    Postnatal depression can then be pre-empted.

  • Have you previously had abdominal or pelvic surgery?
    To help decide whether a Caesarean or vaginal delivery is best for you.

    Your honesty in answering these questions will go a long way towards ensuring that you receive the best possible care.

    A wee drop
    You will be asked to produce a urine sample at your first booking – and most subsequent ones – to monitor for high levels of sugar or protein, the possible result of increased blood flow in pregnancy, which puts pressure on your kidneys.

    An excess of sugar in your urine may indicate gestational diabetes, a serious condition that affects between one and three percent of pregnant women. It can often be managed by diet alone, but 10% of patients need additional insulin treatment.

    Proteinuria, a condition marked by too much protein in the urine, can have several causes. An infection of the urinary tract or kidneys is the most common cause, for which antibiotics will be administered.

    Preeclampsia may also be indicated, for which the only cure is early delivery of your baby. In most cases, though, a urine test is just a minor inconvenience and should not put you off check-ups.

    As Lisa says: "That first scan was the one in which we bonded with our son. We found out we were having a boy, so it all became very real.

    "He looked so beautifully formed and like a real little baby that it was extremely exhilarating. It was so exciting that I forgot, at least briefly, about my morning sickness."

    What is it?
    The test: Chorionic Villus Sampling (CVS) detects chromosomal and genetic disorders such as Down's syndrome and sickle-cell anaemia.

    A tube is inserted into the uterus at eight to 12 weeks and cells are taken from the placental tissue.

    Pros and cons: Very accurate. There is a miscarriage risk of about two in 100. Results take only two days and will either put your mind at rest or, if an abnormality is found, will help you to make future plans. Some conditions can be treated in the womb.

    The test: Nuchal translucency scan
    Non-invasive ultrasound carried out at between 11 and 13 weeks to detect chromosomal disorders. "Nuchal" means neck: the scan checks for abnormal thickness in the fold at the back of the baby's neck.

    Pros and cons: When combined with a blood test, this is 80 to 90 percent accurate in predicting Down's syndrome. It is non-invasive and carries no risk of miscarriage. Only consider taking the test if you are going to take action over it.

    the test: Amniocentesis
    A sample of amniotic fluid is taken, under local anaesthetic, through the abdominal wall at 16 to 18 weeks. Cells are tested for various disorders, including Down's.

    Pros and cons: Test is about 90 percent accurate. It reveals baby's gender, which is important for some disorders. There is a risk of miscarriage (about one in 100).

    Side effects range from discomfort to bleeding and possible infection afterwards. The results take up to three weeks.

    Financial findings
    It's a good idea to meet your financial advisor at around the time you tell family and friends you are pregnant to find out exactly what your medical aid and/or hospital plan covers and resolve any other financial queries.

    For example, on Discovery Health you will be reimbursed for two ultrasound scans (2D or 3D) per pregnancy at 100% of their approved rate.

    Some retirement-annuity policies, like Liberty Life's Excelsior 1 000, allow you to suspend your premiums for up to six months while on maternity leave. Investigate similar benefits – including discounts on antenatal classes – with your advisor.

    12 weeks on
    In the second trimester, a special blood test will detect any neurological problems in the foetus, such as spina bifida (for which folic acid is preventative) or hydrocephalus.

    Your 20-week ultrasound will then check that your baby is well formed. As this is more detailed than the previous scan, it is usually performed by an experienced sonographer.

    The baby's physique, the position of the placenta and blood flow to the womb are all checked.

    Infernal internals
    After your initial vaginal and pelvic examination at the first antenatal visit, you will probably not have to have another during your pregnancy unless you've complained of discharge or bleeding, or had a previous Caesarean because your pelvic arch was too narrow.

    Increased risk?
    Women over 35 are generally offered an amniocentesis due to a higher risk of abnormalities in the babies of older moms.

    Some women are absolutely determined to have their baby, regardless of problems, and refuse to take the test. Others, however, struggle with the idea of a child with a diminished quality of life and may decide to terminate, says Dr Laura Goetzl in Conception and Pregnancy over 35.

    If you're faced with this dilemma, counselling may help you reach a decision.

    Third trimester niggles
    You can expect to be seen by your caregiver with increasing frequency towards your due date so that he or she can pick up problems that may slow down your baby's growth.

    If you are Rhesus negative, for example, you will need an injection of anti-D at both 28 and 34 weeks to prevent you from developing antibodies that might harm your baby. But most women have just minor niggles – indigestion, back pain and itching skin – that need attention.

    As many medications are contraindicated in pregnancy, check with your doctor or pharmacist before taking anything.

    "As these 'minor niggles' are hugely unpleasant for pregnant women and have a significant impact on their quality of life, sorting them out as effectively as possible is a great relief," adds Dr Rogers.

    Lastly, it is important to relax and focus on the positive during this special time. Your emotional and mental state can have a very real effect on your body.

    Try and take time out of every day for some meditation, visualisation and positive thinking in case labour starts early and you feel unprepared.

  • Previously published in Fit Pregnancy, Subscribe now and save

     
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    Comment
    I'm 29 weeks pregnant with my second child. My son is going to be 6 in July. I had a healthy, energetic problem-free pregnancy with him. this time around though, I'm enjoying in a different way. I've learned to pace myself and I'm so in tuned with every movement my little girl makes. My son loves feeling her kick and has conversations with her as if she has been born. My husband is wonderful and this makes the pregnancy so enjoyable. It is essential to have a good support structure especially in the form of a partner. Althought I did a lot of reading-up with my first pregancy, one is not as prepared though. You cannot wait for the baby to make it's appearance.This time around, I'm so relaxed and positively glowing!
    Desiree on 31.05.2007 at 12:52

     

    i`m pregnant again after i had an ectopic pregnancy earlier this year. i am very scared i wonder was gona happen and what to expect. i was very not ready for my first baby i just got married and all i wanted was to enjoy married life now i am prepared but for what i dont know. Pray its a healthy girl growing in my tummy. i will be very disappointed should it turn out otherwise
    Keke on 06.06.2007 at 16:14

     

    My 1st child is 16yrs and now I'm expecting another baby at age 45 after my gynae told me the chances are 0 for another baby. I'm so excited, I can't wait to hold my bundle of joy. I believe that my baby will be born health without any down syndrome as they told me what to expect.
    Vuyelwa on 14.06.2007 at 10:00

     

    My doctor performed a CVS a week ago. I a not sure from where you received your information regarding the fact that the results are available within two days, as I was assured that the results will only be available within 2-3 weeks, same as an amniocentesis. I still don't have my results. Maybe you should check the accuracy of that piece of information.
    Annalize on 04.07.2007 at 11:11

     

    what are the complications if you are having your peroids in the first trimester for 5 days very painful.
    zozo on 04.07.2007 at 11:57

     

    As with Annalize, my CVS results only came back after two weeks. I would most definitely edit that information as the wait, of course, is stressful and worrying, and it doesn't help for anxious moms-to-be to be misinformed.
    Amanda on 21.07.2007 at 17:39

     

    My eldest son is 16 and the younger one 12. It was quite a surprize to find out shortly after my 40th birthday that I am expecting no 3. The first Giney appointment was amazing. She did a ultrasound scan and I can hardly explain the feeling seeing this tiny little human - complete with arms, legs, moving around. I did not expect to be that far pregnant and listening to the heart beat brought tears to my eyes. I am anxious about the amnio test and the doctor decided that she will first do the tripple blood test. I am still very emotional.
    Leana on 27.09.2007 at 08:59

     

    I'm 10 weeks and 3 days pregnant and i still can't believe it. I had an ultrasound done in my 9th week but the pe;vic and vaginal examinations were not conducted. Am I seeing the wrong doctor, or will i be examined in my next check up? Please help me I don't know much about pregnancy as it is my first time. I'm 22yrs old and have been married since July 2007.
    zodwa on 02.10.2007 at 16:06

     

    i am 8 weeks pregnant i need to know weather it is fine to have sex with my spouse couze i sometimes crave for it but i afraid of hurting my babe ? or is too early
    motswaki on 07.02.2008 at 07:51

     

    i am 13 weeks pregnant and my face is filled with rashes/pimples? is it normal? is there any drug or precaution i can take?thank you.
    abiodun on 13.02.2008 at 11:24

     


     
    Article: Vanessa Walker from Fit Pregnancy
    Image: Ablestock
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