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??Pregnancy FACT SHEETThe enormous hormonal changes taking place during pregnancy trigger a variety of symptoms. Some women will experience all of the symptoms of early pregnancy, while others may have only a few. Most symptoms – such as amenorrhoea (missed period), morning sickness or fatigue – can also be caused by stress, illness or other events, so a suspected pregnancy needs to be confirmed with urine or blood tests. These tests check for the hormone human chorionic gonadotropin (hCG). Absolute and irrefutable proof of pregnancy is hearing the baby’s heart beat (which can be heard through a special listening device sometime between weeks 10 and 12) or viewing the baby with an ultrasound scan. If you suspect you may be pregnant, see your doctor or family planning professional for confirmation.SymptomsThe symptoms of early pregnancy can include: Missed period (amenorrhoea) Morning sickness Breast changes Fatigue Frequent urination Mood changes Food cravings.Missed periodThe absence of the menstrual period (amenorrhoea) is often the first sign of possible pregnancy. However, some women experience light bleeding around the time of expected menstruation. Apart from pregnancy, amenorrhoea can be caused by other factors including: Excessive exercise Low body weight Stress Hormonal imbalances Breastfeeding.Morning sicknessAround eight out of 10 pregnant women experience some degree of ‘morning sickness’, especially in the first few months. The symptoms include nausea and vomiting. Most women don’t just get symptoms in the morning, but throughout the whole day. For most women, morning sickness begins around the fourth week of pregnancy and resolves by week 12. Apart from pregnancy, nausea and vomiting can be caused by other factors including: Food poisoning Gastrointestinal disorders Some types of infection.Breast changesDuring pregnancy, the breasts become fuller, swollen and tender. Many women report that the sensations are similar to those experienced in the few days prior to menstruation. Other breast changes related to early pregnancy include a darkening of the skin around the nipple (areola) and more prominent veins across both breasts. Apart from pregnancy, breast changes can be caused by other factors including: The effects of hormones during the lead-up to menstruation Oral contraceptive pills Hormonal imbalances.FatigueMany newly pregnant women report feelings of overwhelming tiredness. This is thought to be caused by the massive increase in the sex hormone progesterone. In most cases, energy levels rise by about the fourth month of pregnancy when the placenta is working properly. Apart from pregnancy, fatigue can be caused by other factors including: Stress Hectic lifestyle Insufficient sleep and rest Poor diet Anaemia Chronic illness Lack of exercise.Frequent urinationPregnancy prompts increased levels of body fluids and greater kidney efficiency. The swelling uterus also presses against the bladder. Most women start experiencing more frequent urination within the first few weeks of conception. Apart from pregnancy, frequent urination can be caused by other factors including: Urinary tract infections Diabetes Diuretic medications.Mood changesSome newly pregnant women experience mood changes that are similar to those typically felt in the days leading up to menstruation, such as irritability or weepiness. Other pregnant women experience feelings of elation. It is thought that the pregnancy hormones influence the brain chemicals and cause the mood changes. Apart from pregnancy, mood changes can be caused by other factors including: Impending menstruation Stress Life events.Food cravingsAround eight out of 10 pregnant women experience cravings for at least one particular food. Between 50 and 80 per cent also experience aversions to particular foods they previously enjoyed. According to some theories, a craving indicates a deficiency in the diet. Most nutritionists recommend that cravings be accommodated, as long as they don’t dominate and replace more important foods. Apart from pregnancy, food cravings can be caused by other factors including: Poor diet Stress Hormonal changes in the lead-up to menstruation.Testing for pregnancyThere are pregnancy home test kits available from pharmacists that offer reliable and accurate readings if performed strictly to the manufacturer’s instructions. Typically, a kit includes special paper that is sensitive to the presence of the pregnancy hormone hCG in your urine. False-negative results can occur if the test is taken before the levels of hCG have built to detectible levels in the urine, or if you have had a lot to drink and the urine is diluted. Blood tests are also used to detect your hCG levels and can be accurate within one week or so of conception. The ultimate test of pregnancy is hearing the baby’s heart beat or seeing the baby via ultrasound scan. Be guided by your doctor or family planning professional. Where to get help Your doctor Your local pharmacist Family planning clinic Family Planning Victoria Tel. (03) 9257 0100Things to remember Common symptoms of early pregnancy include amenorrhoea (missed period), morning sickness and breast changes. A suspected pregnancy needs to be confirmed by your doctor, since most symptoms can be caused by other factors such as stress or illness. Irrefutable proof of pregnancy includes hearing the baby’s heart beat or seeing the baby via ultrasound scan.Stages of labourLabour is divided into three stages - the dilation of the cervix, the delivery of the baby, and the delivery of the placenta. For first-time mothers, labour takes around 12 to 24 hours. Women who have undergone childbirth before can expect about seven hours of labour. Recognising the start of labourBraxton-Hicks contractions are sometimes mistaken for labour. These ‘false’ contractions usually start halfway through the pregnancy and continue for the duration. You may find these contractions visibly harden and lift your pregnant belly. It is not known what triggers the onset of labour, but it is thought to be influenced by the hormone oxytocin, which is responsible for causing uterine contractions. Some of the signs and symptoms of going into labour may include: Period-like cramps Backache Diarrhoea A small bloodstained discharge as your cervix thins and the mucus plug drops out A gush or trickle of water as the membranes break Contractions.The first stage of labourThe first stage of labour is concerned with the thinning of the cervix and its dilation to around 10cm. The different phases include: The latent phase - generally, this stage is the longest and the least painful part of labour. The cervix can thin out over weeks, days or hours and be accompanied by mild contractions. The contractions may be regularly or irregularly spaced, or else you might not even notice them at all. The active phase - the next phase is marked by strong, painful contractions that tend to occur around three or four minutes apart and last up to a minute or so. The cervix dilates to around 7cm. The transition phase - the contractions become more intense, painful and frequent. It may feel like the contractions are no longer separate but running into each other. The cervix may take around an hour or so to dilate the final 3cm. It is not unusual to feel a strong urge to go to the toilet as the baby’s head pushes against the rectum. The second stage of labourOnce the cervix is dilated to around 10cm, the second stage of labour can begin. The contractions should now be regular and spaced apart, so that you can relax between them (as best as you can). As each contraction builds to a peak, you may feel the urge to bear down and push. The sensation of the baby moving through the vagina is described as a stretching or burning, particularly as the baby’s head crowns (appears at the vaginal entrance). Once the head has emerged, the delivery staff will turn the body to deliver the shoulders. The rest of the baby will then slip out. The second stage of labour typically lasts around 15 minutes to one hour.The third stage of labourThe placenta is then delivered, usually five to 30 minutes later. Your uterus gently contracts to loosen and push out the placenta, although you may not be able to feel these contractions.Suggestions for the early stages of labourBe guided by your doctor or midwife, but general suggestions for a woman approaching labour include: Once you go into early labour, take the opportunity to rest and relax at home. There is no need to be in hospital until the contractions are regular and painful. Once the contractions are around seven to 10 minutes apart, you might like to start timing them. You do this by noting how many minutes elapse between the start of one contraction and the start of the next. If you are unsure whether to stay home or head to the hospital, ring and speak to one of the midwives. They will ask you a number of questions and help you decide what to do. Once your contractions are five minutes apart, or if you no longer feel comfortable being at home, go to the hospital. If your waters break or if you start bleeding from the vagina, go immediately to hospital. Once in hospitalSuggestions include: Resist any urge to push until your cervix is fully dilated. The pressure of your baby’s head helps to widen your cervix, so use gravity and walk around, stand or sit upright. Don’t feel embarrassed or inhibited by your appearance or behaviour - the medical team have seen it all before. If you want to grunt, yell or swear - go ahead. Remember that passing a bowel motion during labour is normal and nothing to be concerned about.Week by WeekThe unborn baby spends around 38 weeks in the womb, but the average length of pregnancy (gestation) is counted as 40 weeks. This is because pregnancy is counted from the first day of the woman’s last period, not the date of conception, which generally occurs two weeks later. Pregnancy is divided into three trimesters: First trimester – conception to 12 weeks Second trimester – 12 to 24 weeks Third trimester – 24 to 40 weeks.ConceptionThe moment of conception is when the woman’s ovum (egg) is fertilised by the man’s sperm. The gender and inherited characteristics are decided in that instant. Week 1 This first week is actually your menstrual period. Because your expected delivery date (EDD) is calculated from the first day of your last period, this week counts as part of your 40-week pregnancy even though your baby hasn’t been conceived yet.Week 2Fertilisation of your egg by the sperm will take place near the end of this week.Week 3 Thirty hours after conception, the cell splits into two. Three days later, the cell (zygote) has divided into 16 cells. After two more days, the zygote has migrated from the fallopian tube to the uterus (womb). Seven days after conception, the zygote burrows itself into the plump uterine lining (endometrium). The zygote is now known as a blastocyst.Week 4 The developing baby is tinier than a grain of rice. The rapidly dividing cells are in the process of forming the various body systems, including the digestive system. Week 5 The evolving neural tube will eventually become the central nervous system (brain and spinal cord).Week 6 The baby is now known as an embryo. It is around 3mm in length. By this stage, it is secreting special hormones that prevent the mother from having a menstrual period.Week 7 The heart is beating. The embryo has developed its placenta and amniotic sac. The placenta is burrowing into the uterine wall to access oxygen and nutrients from the mother’s bloodstream.Week 8 The embryo is now around 1.3cm in length. The rapidly growing spinal cord looks like a tail. The head is disproportionately large.Week 9 The eyes, mouth and tongue are forming. The tiny muscles allow the embryo to start moving about. Blood cells are being made by the embryo’s liver.Week 10 The embryo is now known as a foetus and is about 2.5cm in length. All of the bodily organs are formed. The hands and feet, which previously looked like nubs or paddles, are now evolving fingers and toes. The brain is active and has brain waves.Week 11 Teeth are budding inside the gums. The tiny heart is developing further.Week 12 The fingers and toes are recognisable, but still stuck together with webs of skin. The ‘combined test’ (maternal blood test + ultrasound of baby) can be done around this time. This test is an indicator of possible Down syndrome or other major disabilities in the baby.Week 13 The foetus can swim about quite vigorously. It is now more than 7cm in length.Week 14 The eyelids are fused over the fully developed eyes. The baby can now mutely cry, since it has vocal cords. It may even start sucking its thumb. The fingers and toes are growing nails.Week 16The foetus is around 14cm in length. Eyelashes and eyebrows have appeared, and the tongue has tastebuds. Routine ‘maternal serum screening’ is offered at this time to help determine the risk of having a baby with a birth defect. An ultrasound is also commonly performed (usually week 18) to check for abnormalities, position of placenta and multiple pregnancies. Interestingly, hiccoughs in the foetus can often be observed. Week 20The foetus is around 21cm in length. The ears are fully functioning and can hear muffled sounds from the outside world. The fingertips have prints. The genitals can now be distinguished with an ultrasound scan.Week 24The foetus is around 33cm in length. The fused eyelids now separate into upper and lower lids, enabling the baby to open and shut its eyes. The skin is covered in fine hair (lanugo) and protected by a layer of waxy secretion (vernix). The baby ‘breathes’ amniotic fluid in and out of its lungs. Week 28Your baby now weighs about 2lb 2oz (two pounds, two ounces) or 1,000g and measures about 10 inches (25cm) from crown to rump. The crown to toe length is around 37cm. The growing body has caught up with the large head and the baby now seems more in proportion.Week 32The baby spends most of its time asleep. Its movements are strong and coordinated. It has probably assumed the ‘head down’ position by now, in preparation for birth.Week 36The baby is around 46cm in length. It has probably nestled its head into its mother’s pelvis, ready for birth. If it is born now, its chances for survival are excellent. Development of the lungs is rapid over the next few weeks.Week 40The baby is around 51cm in length and ready to be born. It is thought that the baby secretes hormones that trigger the onset of labour.Where to get help Your doctor Obstetrician MidwifeThings to remember Pregnancy is counted as 40 weeks, starting from the first day of the mother’s last menstrual period. The gender and inherited characteristics of the baby are decided at the moment of conception. ................
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