KEEP COOL THIS SUMMER

Coping with the heat of summer can be a real trial when you’re heavily pregnant. Here are ideas from other mums about keeping yourself cool on those humid days. • Wear loose, thin cotton clothing • Fill a spray bottle with water and squirt yourself • Find a hand fan and flap yourself cool • Rest. The heat can tire you out. Find a cool place for a snooze with the windows open to let in a breeze or the fan going. Better still, nap under a shady tree with the sound of the sea in the background • Take to the water. The weightlessness of being immersed will feel blissful and the coolness of the water will perk you up. Or jump under a cool shower, the garden sprinkler or join the kids and wallow in the paddling pool. • Try a footbath of tepid water with a handful of sea salt. Get your partner or a friend to give you a deep leg and foot massage with an oil or lotion. • One mum told us, “I’d go for a swim as often as possible, then wrap a sarong around my wet togs and keep them on until they dried.”

THE BABY GAP

Is it easier to give birth if you have a shorter gap between babies? That is, do things ‘stretch’ more easily? SAMCL midwife Anne Whyte and obstetrician Alec Ekeroma answers our question.

Answer

No. How much you “stretch”, and how quickly you recover, depends on your genetic make-up, what happened during the last birth, or earlier births, and other factors like healing of tissue and your physical and mental fitness prior to the birth. And your relaxing levels, which increase during pregnancy and make you “stretchy”, are usually back to normal within six weeks. As a general rule (which is often broken!) second babies are shorter in labor than first babies, and third babies will take longer than second babies, but not as long as the first. The reason subsequent labors are often shorter than the first is that the uterus contracts more effectively (it has been schooled as they say) and the vaginal tissue resistance is less. However, it has been observed that labors tend to be long again in women who have had a gap of more than 10 years between children, and older women tend to have longer labors than younger women. Other factors may also lengthen a labor – such as the baby settling into a pelvic position that limits your muscle co-ordination.

Keep cool this summer

Coping with the heat of summer can be a real trial when you’re heavily pregnant. Here are ideas from other mums about keeping yourself cool on those humid days. • Wear loose, thin cotton clothing • Fill a spray bottle with water and squirt yourself • Find a hand fan and flap yourself cool • Rest. The heat can tire you out. Find a cool place for a snooze with the windows open to let in a breeze or the fan going. Better still, nap under a shady tree with the sound of the sea in the background • Take to the water. The weightlessness of being immersed will feel blissful and the coolness of the water will perk you up. Or jump under a cool shower, the garden sprinkler or join the kids and wallow in the paddling pool. • Try a footbath of tepid water with a handful of sea salt. Get your partner or a friend to give you a deep leg and foot massage with an oil or lotion. • One mum told us, “I’d go for a swim as often as possible, then wrap a sarong around my wet togs and keep them on until they dried.”

DIET DURING PREGNANCY

Eating for two

A good diet gives you and your baby the best chance of staying healthy The mere thought of food in the first trimester of pregnancy can provoke the ‘gag reflex’ in many women as morning sickness hits. But, while it’s natural to have aversions to some foods, it’s vital to eat enough to sustain you and your growing baby now and right through your pregnancy. A balanced diet is the key. What you put in your mouth impacts on both of you. Your body is working hard, especially in the first trimester. You're making the placenta, the baby's life-support system; your hormone levels and metabolism are changing; and your blood sugar and blood pressure tend to be lower, which can make you feel tired. Don’t make the mistake of grabbing energy-dense food like pies and pastries when you’re hungry. Instead, choose good-quality protein – lean meat, fish, chicken, eggs, nuts or legumes – and a good mix of fruit, vegetables and good-quality carbohydrates. That way, you’ll have the fuel needed to help cope with tiredness, and you’re delivering top-class nosh to the baby growing inside you. An empty stomach can increase nausea, so eat frequent small meals if you have morning sickness. Try eating small amounts of bland food throughout the day. Good choices include plain dry biscuits, yoghurt or bananas. Water and fiber are also essential and help prevent constipation. Keep hydrated; aim for eight glasses of water a day.

Folic Acid and Iron

If you began taking folic acid before you got pregnant, continue to do so for the first three months. Even if you didn’t, start taking it once you find out you are pregnant. Folic acid has been shown to reduce the risk of neural tube deficiencies (such as spinal bifida) in babies. A recommended dose is 800mcg (.8mg) of folic acid a day for this time. You can buy it over the counter at the chemist, or have it prescribed. Although folic acid is in vegetables, tomatoes, dried beans and peas, diet alone cannot provide enough folic acid for pregnancy. Some women also require extra iron. A blood test will check your iron levels and, if necessary, your doctor will prescribe extra iron for the duration of your pregnancy. It’s also a time when your body needs more calcium, for bone growth in the baby and to protect your own bones. Calcium intake should go up from around 900mg a day to 1300 mg at this time. You don’t need to swallow a tablet to do this – check the amount of calcium in yoghurt, milk and cheese and try to eat more of these.

Fruit and Veggies

Experts recommend you have five servings of fruits and vegetables each day - preferably three servings of yellow fruit and vegetables and green leafy vegetables, and two servings of other fruits and vegetables. This is definitely not the time to be trying to lose weight. Babies of a low birth weight – due to the mother’s poor nutrition during pregnancy - are more at risk of developing health complications. By eating a balanced diet, you are doing the best you can for yourself and your baby.

PREGNANCY EXERCISE

How to get going

You shouldn’t over-do exercise when you’re pregnant, but being active is definitely good for you. There are some types of exercise that pregnant women shouldn’t do, such as contact sports and extreme sports. But that doesn’t mean you have to confine yourself to the couch for 40 weeks. In fact, a few hours of light to moderate exercise each week can help combat stress and leave you feeling strong, healthy and energized throughout pregnancy. Some forms of exercise – walking, Pilates, antenatal aquarobics and swimming – can be continued right up until the birth. Get advice from your health professional about other kinds of exercise, and always follow the golden rules: Rule 1 - Listen to your body. Do not to push yourself to a level of discomfort. Rule 2 - If you’re red in the face or too breathless to talk you’re over-exerting and overheating. Rule 3 - Do not compress the baby or diaphragm. Avoid abdominal crunches and some forward stretches. Rule 4 - Go gently to avoid overstretching as the pregnancy hormone relaxing acts on all connective tissue. Rule 5 - Eat well and take plenty of fluids.

Walking

Walking is a safe form of exercise for pregnant women. Start with one or two laps around the block and increase the distance as you get fitter. If you’re new to the walking, aim to does a brisk 20-30 minute walk three times a week? The more fit mums-to-be should aim for 30-40 minutes.

Pilates

It’s great for improving your balance, posture, co-ordination, and breathing, and you can start after you’ve fallen pregnant. However, some exercises and positions are not suitable or are uncomfortable for pregnant women, such as ones where you’re lying on your back or stomach. Your instructor can tailor some of them to suit.

Antenatal aquarobics and swimming

Water provides a welcome sense of weightlessness and feels very soothing as it caresses your body. Antenatal aquarobics and swimming are very safe because there’s no impact, and you can start at any stage during pregnancy, even in the final few weeks. If doing antenatal aquarobics, you may need to wear a supportive bra, and keep your heels down to avoid shin splints. Don’t do side movements in the latter stages of your pregnancy. With swimming, if you suffer from pubic pain avoid doing breast-stroke. The opening and closing of your legs can aggravate your pubic joint. To avoid overheating or over-exertion, swim at a sedate pace. As a general rule, keep your heart beat below 140 beats per minute and avoid pools that are too hot, such as thermal pools.

Gym and running

If you don’t already run or work out at a gym, don’t start after you’ve fallen pregnant. And stop – even if you have been a regular runner or gym-gore – if you have conceived through IVF, have had previous miscarriages or entopic pregnancies, if this is your first pregnancy or there is a history of miscarriage or complications in your family. Otherwise, ask staff to tailor your fitness programmed as your pregnancy progresses. Don’t do abdominal work lying on your back, after your first trimester. Take low-impact options, such as marching on the spot instead of running. Some squats and lunges are unsuitable. In weight training, maintain good posture to avoid injury and consult an experienced trainer about what’s safe for you to lift. Runners: Listen to your body, and know when it’s time to slow down and stop; for example, if you begin feeling pressure on your lower abdomen and undercarriage.

Cycling

In the first few months of pregnancy, cycling can be an ideal sport with the baby tucked away low in the pelvis. However, at all times, an accident could cause damage. For safety reasons, try an exercise. You won’t crash and you can monitor your heart rate and control your pedaling rate.

Yoga

Yoga during pregnancy focuses on stabilizing your physical structure and creating space for the baby. Poses are tailored to strengthen your spine, maintain the alignment of your pelvis, and improve your breathing. It can also develop a calm, confident attitude towards giving birth. Continue with the poses you’ve always done up to eight weeks; from week 10-12 do no physical activity; from week 14 until the birth, pregnancy-oriented yoga is beneficial. Don’t do abdominal work lying on your back, jumping, or twisting where your leg crushes the baby. Don’t do aggressive back bending. The spine helps hold the baby in place; aggressive backbends have the reverse affect.

COPING WITH THE FEAR OF MISCARRIAGE

Women are often surprised by how deeply sad they feel following a miscarriage. One day there’s a baby on the horizon, the next day it’s over. Couples who miscarry are often surprised at the depth of grief and disappointment they feel. Even if you’re only a few weeks pregnant, it’s natural to dream about the baby you’ll have, and plan for your future together. It’s a miserable experience to be left with nothing, often not knowing why you lost your baby or whether you’ll be able to conceive another.

How common is miscarriage?

Professor Peter Stone, head of department at the University of Auckland’s department of obstetrics and gynecology, estimates that 15 per cent of “identified” pregnancies miscarry, and around 40 per cent of all conceptions do not lead on to a live baby – women lose the baby so early they don’t even realize they had conceived. “The further on in the pregnancy you get, the less common it is, although five per cent still occur after 13 weeks. We call it a miscarriage up to 20 weeks and following that it is known as a prenatal loss,” says Professor Stone.

How will I know if I’m having a miscarriage?

The most obvious signs are period-like pains and heavy bleeding, which may include blood clots. The good news is that not all bleeding heralds a miscarriage. “Early pregnancy bleeding is very common and the majority of people who bleed will not miscarry,” says Professor Stone, describing what is known medically as a “threatened miscarriage”. You need to see your LMC if you experience any bleeding.

What happens during a miscarriage?

An “inevitable miscarriage” occurs when the cervix opens and the placenta breaks free from the uterine wall, usually causing heavy bleeding (including pieces of the placenta resembling clots) and cramping period like pains. Once an inevitable miscarriage has begun there is nothing you can do to stop it: how it is dealt with depends on whether the placenta is passed completely or some of it remains inside the uterus. While most women miscarry at home, some require hospitalization. “The further on in the pregnancy, the less likely it is for the miscarriage to be complete. Most miscarriages of up to eight weeks will miscarry completely at the time and over the next few days, but the further on you go after that it’s more likely the miscarriage will be incomplete and you will require a D&C [dilation and curettage].” A D&C is an operation to open the cervix and empty the uterus, usually performed under a general anesthetic.

What can I do to avoid miscarrying?

Often there is no explanation for a miscarriage. “Isolated miscarriage causes are generally unknown, it is most likely to be genetic or chromosomal problems in that particular pregnancy and they are not likely to be recurrent in another pregnancy.” Professor Stone says all you can do prevent a miscarriage is avoid cigarettes, excessive alcohol and extremely strenuous exercise.

If I’ve had one miscarriage, am I at risk of having another?

Professor Stone admits that women who have had one miscarriage are slightly more likely to have another one, and those who have had two are more likely to have a third, but he also says it is important to remember that in each pregnancy “you are still more likely to have a healthy pregnancy” than to miscarry. However much it feels like the odds are stacked against you, they are not.