Pregnancy Week by Week | Pregnancy Stages

Let’s face it: Labor hurts to the mother as she is going through and the father who is with her and seeing the pain.  Your uterus will have to rhythmically squeeze your baby down toward the birth canal, and then your baby’s head will have to push its way through your cervix and out your vagina. Plenty of gain you get a baby when you’re done, but also, plenty of pain.  Whether you opt for an unmediated childbirth experience or choose one of the many pain relief options available, as a pregnant woman in the 21^st century, you can take some of the labor out of childbirth.

How to Handle Labor during Pregnancy?

A number of women undergo fairly clear signs of labor, while others do not experience it. Nothing can be said with certainty as to what causes labor or when it will commence, but quite a few hormonal and physical modifications may signify the commencement of labor. These modifications consist of lightening, passing of the mucus plug, contractions, breaking of the bag of water, effacement and dilation of the cervix. The procedure of the baby settling or dropping into the pelvis is referred to as lightening. Lightening can take place some weeks or a few hours prior to labor. Since the uterus lies on the bladder to a somewhat greater extent subsequent to lightening, one may undergo the necessity to urinate more often.

The mucus plug builds up at the cervix all through pregnancy. While the cervix starts to open wider, the mucus is released into the vagina and may well be clear, pink or somewhat bloody. Labor may commence almost immediately after the mucus plug is released or one to two weeks afterwards. All through contractions, the abdomen happens to be stiff. Between contractions, the uterus slackens and the abdomen tends to be supple. The feeling of contraction may vary from woman to woman may be dissimilar from one pregnancy to the subsequent one. But, labor contractions generally give rise to a sense of uneasiness or a dull pain in one’s back and lower abdomen, together with pressure in the pelvis.

Contractions progress in a wave-like action from the top of the uterus to the bottom. A number of women equate contractions with intense menstrual spasms. Different from false labor contractions or Braxton Hicks contractions, labor contractions do not end when an individual alters her position or rests. Prior to the commencement of “true” labor, one may undergo “false” labor pains, also referred to as Braxton Hicks contractions. These erratic uterine contractions are completely common and may begin to take place in the second trimester, although it is more common in the third trimester of pregnancy.

They are the body’s method of preparing for the crucial moment. Braxton Hicks contractions can be explained as contraction in the abdomen that occurs and leaves. These contractions do not augment with walking, do not intensify in how long they continue, do not get closer together and do not feel stronger over spells which is the case when an individual is in true labor.

False and true labor

·     It is important to note that there are distinct dissimilarities between false labor and true labor.

·     During false labor contractions are frequently erratic and do not get close together while during true labor contractions take place at frequent gaps and continue for thirty to seventy seconds and in time they get closer together.

·     During false labor contraction ceases when an individual walks or relaxes and may disappear even if an individual alters her position.

·     However during true labor contractions persist in spite of movement or alteration of positions.

·     In false labor contractions are generally felt in the front of the abdomen or in the pelvic area.

In true labor contractions generally commence in the lower back and generally progress to the front of the abdomen.

Postpartum Blues: 

Mood swings, anxiety, unexplained crying and irritability are all caused by the hormonal changes taking place, as well as the lack of sleep. 

This usually happens between the second and tenth day after birth.  These feelings are normal and pass quickly. 

Try to get as much rest as possible

Go ahead and cry- don’t try to keep your feelings in.  Talk to someone about your feelings your partner, friend or nurse. Be realistic. Don’t try too much. 

You and your baby come first.  Housework and entertaining can wait.  

 Recognizing Signs of Post Partum Depression

If you don’t feel better about life by two weeks after delivery, call your doctor, midwife or public health unit for help.  Approximately 10 - 20% of all mothers develop postpartum depression.  This is quite different from the “baby blues”. 

Signs and symptoms of postpartum depression include: 

·         Strong feeling of sadness or guilt

·         Difficulty sleeping even when tried

·         Crying all the time

·         Sleeping all of the time, even when the baby is awake

·         Unable to eat, even when hungry

·         Not able to eat because of poor appetite or feeling unwell

·         Worrying about the baby too much

·         Panic attacks

·         Feelings of anger toward the baby

·         Thoughts about harming the baby or yourself 

If you have any of these signs, get help right away.

Many parents find that adjusting to their new roles involves changes in their sexual relationship.  Therefore, it is important that you and your partner talk about the way parenting is affecting your life, your sexual response to each other, and your feelings and needs.

Many new parents initially experience a decreased desire for sexual relations because they are too tired from the night feeding s and the constant care the baby requires.  Other parents are concerned about interruptions in their in their lovemaking by a crying baby, infection or fear of another pregnancy. 

Intercourse may be safely resumed when your bleeding has stopped and the stitches have healed.  Some new parents prefer to wait until after the six-week check-up with their doctor/midwife.  To assess for vaginal tenderness, you or your partner can insert one or two fingers in the vagina and gently check for any painful areas.

There are a number of physical changes after pregnancy that may make changes in your lovemaking style.  You may experience: 

• Decreased lubrication
• Longer arousal time
• Shorter and weaker orgasmic spasms
• Slackness of the vaginal muscles 

These changes last about 2 to 3 months after which sexual responses gradually return to normal.  The decreased lubrication will last longer in women who are breastfeeding. 

You may find the following suggestions helpful for dealing with the temporary changes described above 

·     Try using more kissing, cuddling and fondling to get each other interested in lovemaking Use a lubricating jelly or a spermicidal cream/foam to help lessen the discomfort resulting from decreased lubrication.  Vaseline is not recommended. 

·     If the scar tissue at the vaginal opening is tender and tight, place pillow under your hips to tilt your body at an angle to decrease the pressure on your bottom

·     Initial penetration should be gentle and slow to allow for the vagina to relax and stretch.  If penetration is uncomfortable, try using different positions that lessen the pressure of the shaft of the penis on the episiotomy area.  A side-lying position or a position or a position where you are on top of your partner may be more comfortable.

·     Conscious and active relaxation of the pelvic floor muscle will increase your comfort level and the elasticity of the tissues.  Daily repetition of the pelvic floor exercise will promote a more rapid return of the elasticity and tone on the vaginal muscles.

Some breastfeeding women find their breasts are tender when they are full and may experience milk letdown reflex with orgasm.  Breastfeeding before you make love will help with these concerns and will decrease the chance of being interrupted by a crying baby.  You should also explain to your partner about the chance of milk letdown from you breasts with sexual excitement and/or orgasm. 

Since fear of another pregnancy can also interfere with your enjoyment of sexual activity, discuss which method of birth control you will use with your partner.  If you need to consult your doctor about your choices, be sure to use a condom and foam for the love making until you talk with your doctor.  Almost all mothers who are totally breastfeeding their babies (i.e. No bottles and no soothers) do not resume their periods for the first six months.  You can however, still become pregnant. 

It is very important that you take good care of yourself over the next few weeks.  Rest is very important after you give birth and caring for your baby places extra demands on you emotionally and physically.  If you have had a caesarean birth, we have included an additional section to help you understand your care over the next few days.  

After the birth of your baby* 

Your nurse will check your blood pressure, the position of your uterus and your vaginal blood loss (lochia) frequently during the first hour and regularly throughout your hospital stay.  If you have chosen to breastfeed she will also help you to give your baby his/her first feed during this time.  As soon as you feel able and medication (eg. Epidural anesthesia) has worn off your nurse will assist you up to the bathroom.  Please do not get out of bed for the first time on your own as you may feel somewhat dizzy or weak. 

* The above procedures are definitely performed in Canada and some developed countries but may differ from country to country. 

Vaginal Bleeding (Lochia) 

 After the birth of your baby you will have vaginal bleeding which may continue for 3 to 6 weeks.  Initially, the bleeding, called lochia, will be bright red like a heavy period.  Your bleeding will then decrease in amount, from moderate to spotting and will change in coloure from bright red, to pink to brown.  If you are breastfeeding it is normal to experience an increase in flow of brighter red blood during or following a feeding.  This will decrease over time.  

Please let your nurse/midwife knows if: 

• your bleeding increases
• you pass any clots (show these to your nurse/midwife)
• your bleeding has a bad smell  

Do not use tampons until after your post partun chech up with your doctor/midwife.  The time of your post partum visit will vary according to your caregiver ( usually around 6 weeks after the birth of your baby.)  Until the bleeding stops, do peri-care (as discussed below) each time you use the bathroom.    

Peri-Care/ Going to the Bathroom 

Often it is difficult to empty your bladder completely due to bruising and discomfort.  Medication for pain is available every three to four hours.  Be sure to take it as often as necessary.  The medication ordered for you is safe for the baby if you are breastfeeding. 

Using ice packs helps to relieve swelling and bruising for the first 24 hours.  After that, heat in the form of a warm bath or spray from the showerhead can soothing. 

Episiotomy or Perineal Tear 

The stitches that were used to repair your episiotomy or tear will dissolve on their own, usually within 2 weeks. Occasionally the stitches may be seen on your sanitary napkin or toilet tissue when they have dissolved and the end piece drops off.  If you have any discomfort you may take pain medication that has been ordered by your doctor or midwife.  It is also safe to take a daily bath, but avoid oils or bubble bath in your bath water. 

Call your doctor/midwife if you have vaginal discharge with a bad smell or if the area becomes hot, swollen, reddened, if you develop increased pain or if you have a fever. 

Abdominal Cramping (After Pains)

If this is your second baby, or more, you may feel cramping or pains in your uterus as your baby nurses.  Occasionally, first-time mothers experience this as well.  These are called after pains and are stimulated by the release of oxytocin, when your baby nurses.  This is how breastfeeding helps to promote shrinking of your uterus back to its pre-pregnant size.  You may find that deep breathing and relaxation techniques, or taking pain medication ½ hour prior to feeding helps you to cope with cramping.  Remember that the cramping is only temporary. 

 Bowel Movements  

Normal bowel movements should occur within 3 days of the birth.  The best way to avoid constipation is to eat foods high in fiber such as bran, whole wheat, vegetables and fruit and to drink plenty of fluids, especially water.  Try to minimize the use of pain relievers with codeine as it has a constipating effect.  However, ensure that you have adequate pain relief so that you can maintain activity, as this is just as important to preventing constipation.  

 Hemorrhoids 

Hemorrhoids are swollen veins around the rectum.  Ice packs are often soothing.  Apply hemorrhoid cream to your hemorrhoids as your doctor/midwife has prescribed.  You can also apply compresses called “Tucks” to the rectal area.  These can be obtained at your local drugstore.  

Avoid sitting or stranding for long periods.   Keep bowel movements soft by eating a high fiber diet and drinking plenty of fluids (6-8 glasses per day).  Also consider taking the stool softener and take as directed.  

Hemorrhoids usually reduce in size or disappear within six weeks after delivery. 

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  Your Baby’s Progress 

Once it has implanted, the embryo secretes chemicals that have two functions.  First, they signal to your body that the embryo has arrived, and this triggers a number of changes in your body: Your ovulation cycle stops, the mucus in your cervix thickens, your uterine wall softens, and your breasts begin to grow.  Second, your immune system is suppressed so that the embryo is not treated as foreign and rejected, but is allowed to grow. 

In addition, an outer layer of the blastocyst develops into a protective cocoon around the embryo.  This cocoon will create the rudiments of the placenta and the support system in which the embryo will grow- the amniotic sac  (the watery balloon in which it will float), the chorion (a safety cushion around the amniotic sac), and the yolk sac (which will manufacture blood cells until the liver takes over).  The chorion then grows finer like projections, the chorionic villi, which the cocoon burrows firmly into your uterine lining.   

The Cells specialize 

Throughout these early weeks, the embryo’s cells become more specialized.  There are now three layers of them, each destined to create different organs of the body.  The innermost layer forms a primitive tube that will later develop into the lungs liver, thyroid gland, pancreas, urinary tract, and bladder.  The middle layer will become the skeleton, muscles (including the heart muscle), testes or ovaries, kidneys, spleen, blood vessels, blood cells, and the deepest layer of skin, the dermis.  The outer layer will provide the skin, sweat glands, nipples (and breasts, if it is a girl), hair, nails, tooth enamel, and the lenses of the eyes.  These three cell layers differentiate to create an entire human body.  

The Embryo’s Support System 

The villi of the growing placenta intermingle with the maternal blood vessels of the uterine wall in such a way that they eventually become surrounded by lakes of blood.  Maternal blood flows in and around these spaces, and because it is divided by only a cell or two from fetal blood, exchange of nutrients and waste between fetus and mother can occur in this blood space.  The placenta is a hormone factory pumping out hormones, such as human chorionic gonadotropin (hCG), that are designed to support a healthy pregnancy.   

Until the sixth week, the embryo’s blood cells are supplied by the yolk sac; after the end of the third week, blood circulation is pumped by the baby’s own heart. 

The second trimester starts at the 14^th week of pregnancy.  Your baby is steadily growing, and if you have a scan at this time it is possible to discern the baby’s sex.  If it is felt necessary, around this time you will be offered various tests to rule out abnormalities.  The length of the femur will be measured, as well as the diameter of the head; this latter measurement will be used to confirm the EDD.  

Your Baby’s Progress  

She is looking more human, with legs longer than arms and the parts of her legs in proportion.  The skeleton continues to produce bone and those parts with sufficient calcium can be seen on X-ray. 

The fetus now contains the same number of nerve cells as an adult.  The nerves from the brain begin to be coated in a layer of protective fat (myelin).  This is an important step in their maturation because it facilitates the passage of messages to and from the brain.  Connections between nerves and muscles are established so that your baby’s well-formed limbs can move at the joints when muscles are stimulated to contract and relax. Now that her arms are long enough, her hands can grasp each other if they touch accidentally, and she can form fists. 

However, movements are not yet under the control of the brain.  Nor do they register with you at first because the fetus is not big enough to activate nerve endings on the uterine wall.   Second-time mother tend to feel fetal activity sooner. The fetus’s external genital organs acquire a more distinctive appearance.  A girl’s vaginal plate, the precursor to her vagina, is clearly developing, and a boy’s testes are at the deep inguinal ring and well on their way to descending into the scrotum. 

Her Support System 

The placenta is producing the increasing amount of chorionic gonadotropin, estrogen, and progesterone that are needed throughout pregnancy.  It also produces an assortment of other hormones that maintain the health of the uterus and play an essential part in the growth and development of the mother’s breasts in preparation for lactation. 

The placenta forms a barier against infection, although not against viruses such as rubella (German measles) and AIDS or poisons such as alcohol and nicotine.  By the end of the 16^th week, the placenta has grown to about half an inch (1cm) in thickness and three and a half inches (7-8 cm) across. 

Growth will continue until at term it reaches a weight of 11 pounds (500gm), a thickness of an inch and a half (3cm), and a diameter of 8 to 10 inches (20-25cm).  It is firmly attached to the uterine wall (usually the upper part).

Your baby has sufficiently increased in size at this time to have developed a nervous system and muscles capable of allowing him to move.  Because he is still so small, he can swim up and down and be in any position at any time. 

Your Baby’s Progress 

Starting now, form 19 weeks after your LMP, your baby’s rapid growth rate (but not weight gain) starts to slow down, and he matures in other ways.  He begins to build up his defence systems.   A sheath begins to form around the nerves in his spinal cord to protect them from possible damage.  He also has his own primitive immune system, with which he can partially defend himself against some infections. 

To produce body heat and maintain his temperature, your baby needs specialized fatty tissue.  This is provided by a substance known as brown fat, which started to form during the fourth month.  Now, deposits of brown fat begin to build up in areas of his body such as his neck, chest, and crotch.  This will continue until term.  One of the reasons that premature babies are so vulnerable is that they have insufficient amounts of brow fat and so are unable to keep themselves warm. 

His skin will continue to grow, although it will be red and wrinkled because there is so little fat underneath it.  From this month on, he becomes increasingly plumper.  The baby’s sebaceous glands become increasingly plumper.  The baby’s sebaceous glands become active and produce a waxy, greasy substance known as the vernix caseosa, which provides his skin with a protective coating during its long immersion in the amniotic fluid. 

Your baby’s body is also covered with fine hair called lanugo.  As yet, no one is quite sure of its purpose, but it may help to regulate his body temperature or it may be there to hold the protective vernix caseosa in place.

His Movements 

As his nerve fibers become connected and his muscle development and strength increase, his movements are more purposeful and coordinated.  He embarks on his own athletic program- stretching, grasping, turning - which builds up his muscles, improves his motor ability, and strengthens his bones.  These movements can make your abdomen sore. 

Sex Organs 

A boy’s scrotum is solid at this stage.  A girl’s vagina starts to become hollow, and her ovaries contain about 7 million ova, which will decline to approximately two million by the time she is born.  By the time she reaches puberty, 200, 000 to 500, 000 ova will be left, and she will release only 400 to 500 of these during her adult life - approximately one per month.

Your baby is growing taller and stronger, while her movements are becoming more complex.  She is also showing signs of sensitivity, awareness, and intelligence.  A baby is legally viable if born after 24 weeks of pregnancy and may survive with specialized neonatal intensive care. 

Your Baby’s Progress 

She is still red and skinny, but she will soon start to put on weight.   Any extensive wrinkling of the skin is caused by a lack of subcutaneous fat and a relative abundance of skin. Her body is growing faster than her head, and by the end of this month her proportions are approximately those of a newborn.  Her arms and legs have their normal amount of muscle, her legs and body are in proportion, and the center of her bones is beginning to harden. 

The lines start to appear on the palms of her hands.  The brain cells she will use for conscious thought now start to mature, and she begins to be able to remember and learn (in one experiment, babies in the uterus were trained to kick in response to a specific vibration). The genitals are now completely differentiated; if the baby is a boy, testosterone-producing cells in the testes increase in number. 

Hearing 

Your baby can hear sound frequencies that are beyond your range; she moves more in response to high frequencies than to low ones and moves her body in rhythm with your speech.  Starting this month, she will respond to drum beats by jumping up and down.  Some mothers report having to leave concerts because their unborn babies would not settle down. 

If she hears a piece of music frequencies she may discover that when she is grown up it is familiar to her- even if she can’t remember ever hearing it.  Some musicians have said that they “knew” unseen pieces of music and later discovered that their mother played them during pregnancy. She can also learn to recognize her father’s voice from this month onward. 

A baby whose father talks to her while she is in the uterus can distinguish father’s voice in a roomful of people immediately after she is born and will respond to it emotionally for example, if she is upset, she may stop crying and calm down. 

Breathing

Inside her lungs, air sacs are forming in ever-increasing numbers.  They will continue to increase until eight years after birth.  Around them, the blood vessels that will help her absorb oxygen and expel carbon dioxide are multiplying. 

In addition, her nostrils have now opened, and she is beginning to make breathing motions with her muscles, so her system will have plenty of breathing practice before she is born.

Your baby is now so big that when your doctor or midwife gives you an abdominal examination, his position can be assessed.  This is the last month he can turn a somersault. 

Your Baby’s Progress 

Great changes take place in the nervous system this month.  The brain grows larger (to fit inside the skull, it has to fold over and wrinkle up until it looks like a walnut), and the brain cells and nerve circuits are all fully linked and active.  In addition, a protective fatty sheath begins to form around the nerve fibers, just as a similar sheath formed earlier around the spinal cord, and this fatty myelin will continue to develop until early adulthood.  As a result, nerve impulses can travel faster and your baby becomes capable of increasingly complex learning and movement. Your baby starts preparing himself for birth.  (If he were to be born at this stage, he would have an excellent chance of survival. 

Even though such a baby may have some breathing problems and difficulty in keeping himself warm, modern special-care facilities should help him thrive.) Some fat is beginning to appear underneath his skin, which smoothes out, loses its wrinkles, and becomes more rounded.  His coat of hairy lanugo may diminish to a patch on his back and shoulders.  The membranes that sealed and protected his eyes during their growth will, by the beginning of this month, have fulfilled their function, as his eyes are now fully formed and allowed his eyes to open.  He will also continue to develop his swallowing and sucking skills. 

Breathing 

He has now fully developed his mature breathing rhythm, and the air sacs in his lungs start to prepare for the first breath he will take in the world outside the uterus.  They line themselves with a coating of special cells and a fluid (surfactant) the will prevent them from collapsing.   

Movements  

Over the course of this month, he will find he has less room to move around and will gradually give up moving so much.  He will wriggle uncomfortably if you are in a position that doesn’t suit him. 

Orientation 

During his weeks of “gymnastics practice,” he has done more than increase his muscle tone- he has developed the ability to orient himself in space.  He will probably continue to lie in your uterus with his head upward during this month.  However, if he is maturing very fast, he may turn upside down and settle into place for delivery, or engage, somewhat earlier than usual. 

This is more common in first-born babies.