What to expect when you're expecting (118 page)

Don’t Hold It In

Making a habit of not urinating when you feel the need increases the risk that your inflamed bladder may irritate the uterus and set off contractions. Not going when you’ve got the urge could also lead to a UTI, another cause of preterm contractions. So don’t hold it in. When you gotta go, go … promptly.

Lifesaving Screenings for Newborns

Most babies are born healthy and stay that way. But a very small percentage of infants are born apparently healthy and then suddenly sicken. Luckily, there are ways to screen for such metabolic disorders. Most babies born in the U.S. live in states that require screening for at least 21 life-threatening disorders—and there is an effort under way to push all 50 states to screen for 29 universally recommended diseases. These include phenylketonuria (PKU), congenital hypothyroidism, congenital adrenal hyperplasia, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, and sickle cell anemia.

If your state doesn’t offer at least the core group of these tests, you can request that a private lab arrange testing. The lab will use blood that’s collected in the hospital during your baby’s routine heel stick (when drops of blood are drawn from baby’s heel after a quick stick with a needle).

In the very unlikely event your baby screens positive for any of the disorders, your baby’s pediatrician and a genetic specialist can verify the results and begin treatment, if necessary (there is a high rate of false positives, so any positive result should be followed up by retesting). Early diagnosis and intervention can make a tremendous difference in the prognosis. For more information on private lab screening and newborn screening in general, contact Baylor University Medical Center: (800) 4BAYLOR (422-9567);
baylorhealth.com/medicalspecialties/
metabolic/newbornscreening.htm
; or Pediatrix Screening: (954) 384-0175;
pediatrixscreening.com
.

To find out if your state screens for the 29 conditions that the March of Dimes recommends, go to
genes-r-us.uthscsa.edu/
.

Bottom line: Birth plans, though by no means necessary (you can definitely decide to go with the flow when it comes to childbirth, and you’ll give birth with or without one), are a great option, one that more and more expectant parents are taking advantage of. To find out more, and to figure out whether a birth plan is right for you, talk it over with your practitioner at your next visit.

Doulas: Best Medicine for Labor?

Think three’s a crowd? For many couples, not when it comes to labor and delivery. More and more are opting to share their birth experience with a doula, a woman trained as a labor companion. And for good reason. Studies have shown that women supported by doulas are much less likely to require cesarean deliveries, induction, and pain relief. Births attended by doulas may also be shorter, with a lower rate of complications.

Doula is a term that comes from ancient Greece, where it was used to describe the most important female servant in the household, the one who probably helped mom out the most during childbirth. What exactly can a doula do for you and your birth experience? That depends on the doula you choose, at what point in your pregnancy you hire her, and what your preferences are. Some doulas become involved well before that first contraction strikes, helping with the design of a birth plan and easing prelabor jitters. Many, on request, come to the house to help a couple through early labor. Once at the hospital or birthing center, the doula takes on a variety of responsibilities, again depending on your needs and wishes. Typically, her primary role is as a continuous source of comfort, encouragement, and support (both emotional and physical) during labor. She’ll serve as a soothing voice of experience (especially valuable if you’re first-timers), help with relaxation techniques and breathing exercises, offer advice on labor positions, and do her share of massage, hand holding, pillow plumping, and bed adjusting. A doula can also act as a mediator and an advocate, ready to speak for you as needed, to translate medical terms and explain procedures, and to generally run interference with hospital personnel. She won’t take the place of your coach (and a good doula won’t make him feel like she’s taking his place, either) or the nurse on duty; instead, she will augment their support and services (especially important if the nurse assigned to you has several other patients in labor at the same time or if labor is long and nurses come and go as shifts change). She will also likely be the only person (besides the coach)
who will stay by your side throughout labor and delivery—a friendly and familiar face from start to finish. And many doulas don’t stop there. They can also offer support and advice postpartum on everything from breastfeeding to baby care.

Though an expectant father may fear that hiring a doula will relegate him to third-wheel status, this isn’t the case. A good doula is also there to help your coach relax so he can help you relax. She’ll be there to answer questions he might not feel comfortable broaching with a doctor or nurse. She’ll be there to provide an extra set of hands when you need your legs and back massaged at the same time, or when you need both a refill on ice chips and help breathing through a contraction. She’ll be an obliging and cooperative member of your labor team—ready to pitch in, but not to push dad aside and take over.

How do you locate a doula? Many birthing centers and hospitals keep lists of doulas, and so do some practitioners. Ask friends who’ve recently used a doula for recommendations, or check online for local doulas. Once you’ve tracked down a candidate, arrange a consultation before you hire her to make sure both of you are comfortable with her. Ask her about her experience, her training, what she will do and what she won’t do, what her philosophies are about childbirth (if you’re planning on asking for an epidural, for instance, you won’t want to hire a doula who discourages the use of pain relief), whether she will be on call at all times and who covers for her if she isn’t, whether she provides pregnancy and/or postpartum services, and what her fees are (some doulas command hefty fees, especially those in big cities). For more information or to locate a doula in your area, contact Doulas of North America: (888) 788-DONA (788-3662);
dona.com
.

An alternative to a doula, which could also be beneficial, is a female friend or relative who has gone through pregnancy and delivery herself and with whom you feel totally comfortable. The plus: Her services will be free. The drawback: She probably won’t be quite as knowledgeable. One way to remedy that is having a “lay doula,” a female friend who goes through four hours of training in doula techniques (ask if your hospital has such a training course). Researchers have found that a “lay doula” can provide the same benefits as a professional one.

Don’t feel too picked on. Almost all practitioners screen for gestational diabetes in almost all patients at about 24 to 28 weeks (though those at higher risk for gestational diabetes, including older or obese mothers or those with a family history of diabetes, are screened earlier in their pregnancies and more
often). So chances are the test your practitioner ordered is just routine.

“My practitioner says I need to take a glucose screening test to check for gestational diabetes. Why would I need it, and what does the test involve?”

And it’s simple, too, especially if you have a sweet tooth. You’ll be asked to drink a very sweet glucose drink, which usually tastes like flat orange soda, one hour before having some blood drawn; you don’t have to be fasting when you do this. Most women chugalug the stuff with no problem and no side effects; a few, especially those who don’t have a taste for sweet liquids, feel a little queasy afterward.

If the blood work comes back with elevated numbers, which suggests the possibility that you might not be producing enough insulin to process the extra glucose in your system, the next level of test—the glucose tolerance test—is ordered. This fasting three-hour test, which involves a higher-concentration glucose drink, is used to diagnose gestational diabetes.

Gestational diabetes occurs in about 4 to 7 percent of expectant mothers, which makes it one of the most common pregnancy complications. Fortunately, it’s also one of the most easily managed. When blood sugar is closely controlled through diet, exercise, and, if necessary, medication, women with gestational diabetes are likely to have perfectly normal pregnancies and healthy babies. See
page 546
for more.

“I’ve been reading a lot about the high incidence of low-birthweight babies. Is there anything I can do to be sure I won’t have one?”

Some cases of low birthweight are preventable, so you can do a lot—and, inasmuch as you’re reading this book, chances are good you already are. Nationally, 8 of every 100 newborns are categorized as low birthweight (under 5 pounds 8 ounces, or 2,500 grams), and slightly more than 1 in 100 babies as very low birthweight (3 pounds 5 ounces, or 1,500 grams, or less). But that rate is much lower among women who are conscientious about both medical care and self-care (and are lucky enough to be able to afford the first and informed enough to do a good job on the second). Most of the common causes of low birthweight—use of tobacco, alcohol, or drugs (particularly
cocaine), poor nutrition, extreme emotional stress (but not normal stress levels), and inadequate prenatal care, for example—are preventable. Many others, such as chronic maternal illnesses, can be controlled by a good working partnership between the mother and her practitioner. A major cause—premature labor—can sometimes be prevented.

Signs of Preterm Labor

Though the chances of your baby arriving early are pretty low, it’s a good idea for every expectant mom to be familiar with the signs of premature labor, since early detection can have a tremendous impact on outcome. Think of the following as information you’ll probably never use but should know, just to be on the safe side. Read this list over, and if you experience any of these symptoms before 37 weeks, call your practitioner immediately:

Persistent cramps that are menstrual-like, with or without diarrhea, nausea, or indigestion

Regular painful contractions coming every 10 minutes (or sooner) that do not subside when you change positions (not to be confused with the Braxton Hicks contractions you might be already feeling, which don’t indicate early labor; see
page 311
)

Constant lower back pain or pressure or a change in the nature of lower backache