What to expect when you're expecting (20 page)

Get help—all the help you can get. This will make getting that rest you need possible (or, at least, somewhat possible). Start with your spouse, who should be shouldering what he can in terms of child and house care, but don’t stop there. If you haven’t already, teach your older children to be more self-sufficient and assign them age-appropriate chores. Any nonessential chores you can’t pass off to someone else, skip for now.

Feed yourself. Moms with many mouths to feed often neglect to feed their own. Not only does meal skipping or junk-food-grabbing shortchange you these days (leaving you with even less energy than you already have), but it shortchanges the baby you have on board. So take the time to eat well. Making healthy snacking a habit can help a lot (and finishing off PB&J scraps and half-eaten chicken fingers doesn’t necessarily count).

Watch your weight. It’s not uncommon for women who’ve had several pregnancies to put on a few extra pounds with each baby. If that’s been the case with you, be particularly careful to eat efficiently and keep your gain on target (a target that should be determined by your practitioner). On the flip side, make sure you’re not so busy you don’t eat enough to gain adequate weight.

“I’ve had two abortions. Will they affect this pregnancy?”

Multiple first-trimester abortions aren’t likely to have an effect on future pregnancies. So if your abortions were performed before the 14th week, chances are there’s no cause for concern. Multiple second-trimester abortions (performed between 1. and 27 weeks), however, may slightly increase the risk of premature delivery. In either case, be sure your practitioner knows about the abortions. The more familiar he or she is with your complete obstetrical and gynecological history, the better care you will receive.

Do Tell

Whatever gynecological or obstetrical history is in your past, now’s not the time to try to put it behind you. Telling your practitioner everything about your history is more important (and relevant) than you might think. Previous pregnancies, miscarriages, abortions, surgeries, or infections may or may not have an impact on what happens in this pregnancy, but any information you have about them—or any aspect of your obstetrical and gynecological history—should be passed on to your practitioner (all will be handled with confidentiality). The more he or she knows about you, the better care you’ll get.

“I had a preterm delivery in my first pregnancy. I’ve eliminated all my risk factors, but I’m still worried about having a repeat preterm labor.”

Congratulations on doing everything you can to make sure your pregnancy is as healthy as possible this time around—and to give your baby the very best chances of staying on board until term. That’s a great first step. Together with your practitioner, there are probably even more steps you can take to minimize the chances for a repeat preterm labor.

First, ask your practitioner about the latest research into preventing preterm labor. Researchers have found that the hormone progesterone—given as shots or a gel during weeks 16 through 36—reduces the risk for preterm birth in women with a prior history of one. If you’ve had a previous preterm birth, ask your practitioner if you’re a good candidate for progesterone.

Second, ask your practitioner if one of the two screening tests available for predicting whether you’re at risk for preterm birth would be right for you. Usually, these tests are only recommended for high-risk women since positive test results aren’t an accurate predictor of early delivery, but negative results can help avoid unnecessary interventions—and needless anxiety. The fetal fibronectin (fFN) screening test detects a protein in the vagina only present if there has been a separation of
the amniotic sac from the uterine wall (an early indicator of labor). If you have a negative fFN test, it’s unlikely you’ll go into preterm labor within the next few weeks after the test (so you can breathe easy). If it’s positive, your risk of going into preterm labor is significantly higher, and your practitioner may take steps to prolong your pregnancy and prepare your baby’s lungs for an early delivery.

The second screening test is for cervical length. The length of your cervix is measured via ultrasound, and if there are any signs that the cervix is shortening or opening, your practitioner may take some steps to reduce your risk of early delivery, such as putting you on bed rest or perhaps stitching your cervix closed (if you’re before 22 weeks).

Knowledge is always power—but in this case, knowledge can also help prevent your second baby from being born too soon. And that’s a very good thing.

“I had a miscarriage in the fifth month of my first pregnancy. The doctor said it was caused by an incompetent cervix. I just had a positive home pregnancy test, and I’m worried that I’ll have the same problem again.”

The good news (and there
is
good news here) is that it doesn’t have to happen again. Now that your incompetent cervix has been diagnosed as the cause of your first pregnancy loss, your obstetrician should be able to take steps to prevent it from causing another loss. With proper treatment and careful watching, the odds of your having a healthy pregnancy and a safe delivery this time around are greatly in your favor. (If you have a different practitioner now, make sure you share your history of incompetent cervix so you can receive the best care possible.)

An incompetent cervix, one that opens prematurely under the pressure of the growing uterus and fetus, is estimated to occur in 1 or 2 of every 100 pregnancies; it is believed responsible for 10 to 20 percent of all second- trimester miscarriages. It can be the result of genetic weakness of the cervix, extreme stretching of or severe lacerations to the cervix during one or more previous deliveries, an extensive “cone” biopsy done for precancerous cervical cells, or cervical surgery or laser therapy. Carrying more than one fetus can also lead to incompetent cervix, but if it does, the problem will not usually recur in subsequent single-fetus pregnancies.

Incompetent cervix is usually diagnosed when a woman miscarries in the second trimester after experiencing progressive painless effacement (shortening and thinning) and dilation of the cervix without apparent uterine contractions or vaginal bleeding.

To help protect this pregnancy, your ob may perform cerclage (a procedure during which the opening of the cervix is stitched closed) when you’re in your second trimester (anywhere from 12 to 22 weeks). Although recent research has seriously questioned the effectiveness of cerclage (more study needs to be done), many practitioners still perform it routinely. More often, however, doctors will only do cerclage when an ultrasound or a vaginal exam shows that the cervix is shortening or opening. The simple procedure is performed through the vagina under local anesthesia. Twelve hours after surgery, you’ll be able to resume normal activities, though sexual intercourse may be prohibited for the rest of your pregnancy, and you may need frequent medical exams. When the sutures will be removed depends partly on the doctor’s preference and partly on the situation. Usually they’re removed a few weeks before your estimated due date.
In some cases, they may not be removed until labor begins, unless there is infection, bleeding, or premature rupture of the membranes.

Your Pregnancy Profile and Preterm Birth

Here’s the good news: It’s far more likely your baby will be arriving late (as in overdue) than early. Just about 12 percent of labors and births are considered premature, or preterm—that is, occurring before the 37th week of pregnancy. And around half of these occur in women who are known to be at high risk for premature delivery, including the ever-multiplying percentage of moms-to-be of multiples.

Is there anything you can do to help prevent preterm birth if your pregnancy profile puts you at higher risk for it? In some cases, there isn’t—even when a risk factor is identified (and it won’t always be), it can’t necessarily be controlled. But in other cases, the risk factor or factors that might lead to an early birth can be controlled or at least minimized. Eliminate any that apply to you, and you may up the chances that your baby will stay put contentedly until term. Here are some known risk factors for premature labor that can be controlled:

Too little or too much weight gain.
Gaining too little weight can increase the chances your baby will be born early, but so can packing on too many pounds. Gaining just the right number of pounds for your pregnancy profile can give your baby a healthier uterine environment and, ideally, a better chance of staying there until term.

Inadequate nutrition.
Giving your baby the healthiest start in life isn’t just about gaining the right number of pounds—it’s about gaining them on the right types of foods. A diet that lacks necessary nutrients (especially folate) increases your risk for premature delivery. a diet that’s nutrition packed decreases that risk. In fact, some evidence indicates that eating well regularly can lower the risk of early delivery.

Lots of standing or heavy physical labor.
Check with your practitioner to see if you should cut back on the time you spend on your feet, especially later on in pregnancy. Long periods of being on your feet—especially when it involves
heavy
physical labor and lifting—has been linked to preterm labor in some studies.

Extreme emotional stress.
Some studies have shown a link between extreme emotional stress (not your everyday “I’ve got too much to do and not enough time to do it” stress) and premature labor. Sometimes the cause of such excessive stress can be eliminated or minimized (by quitting or cutting back at an unhealthily high-pressure job, for example); sometimes it’s unavoidable (as when you lose your job or there’s been illness or death in the family). Still, many kinds of stress can be reduced with relaxation techniques, good nutrition, a balance of exercise and rest, and by talking the problem out with your spouse or friends, your practitioner, or a therapist.

Alcohol and drug use.
Expectant moms who use alcohol and illegal drugs boost their risk of having a premature delivery.

Smoking.
Smoking during pregnancy may be linked to an increased risk of premature delivery. Quitting before conception or as early as possible in pregnancy is best, but quitting at any time in pregnancy is definitely better than not quitting at all.

Gum infection.
Some studies show that gum disease is associated with preterm delivery. Some researchers suspect that the bacteria that cause inflammation in the gums can actually get into the bloodstream, reach the fetus, and initiate early delivery. Other researchers propose
another possibility: The bacteria that cause inflammation in the gums can also trigger the immune system to produce inflammation in the cervix and uterus, triggering early labor. Practicing good oral hygiene and getting regular dental care can prevent the bacterial infection and possibly lower your risk for an early labor. Treatment for existing infections prior to pregnancy—though not necessarily during pregnancy—may also help lower the risk for a variety of complications, including preterm labor.