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Women everywhere understand how you feel. I have some ideas for you. They are simple, and they come from the experts, women like you who have been waiting, waiting, waiting: Visit a new or elegant restaurant; Catch up on the latest movies, or enjoy old classics; Swim; Make a couple of stews or casseroles, and freeze them for after the baby is born; Have lunch with a friend; Treat yourself to a massage; Make a list of numbers to call when the baby is born; Spend a romantic night or weekend in a hotel with your partner; Take a bubble bath; Shop for yourself, not the baby; Buy some fresh flowers; Bake cookies or bread; Visit a local museum; Read a good book that’s not about birth or babies; Write a letter to someone you don’t see often enough; Go to a concert; Go dancing with your partner; Play with your pet, as it may sense that change is coming; Ask your mate for a foot rub; Go to the beach; Spend an evening cuddling in front of a fire with your sweetie; Have your partner take some sexy and silly photos of your pregnant body; Look at your baby pictures and your partner’s; Savor being two before you become three!
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Cesarean sections are performed differently today from when your mother had her babies. The surgery requires two incisions, one through the mother’s skin and the other in the mother’s uterus. When your mom had her cesareans, her uterine incision was probably vertical, or classical. Today, cesareans are performed with horizontal uterine and skin incisions. A horizontal uterine incision is called low transverse. As several studies confirmed in the early 1990s, this type of incision makes it safe to attempt a vaginal birth after cesarean (VBAC) with a second pregnancy. More recent studies have found a small risk—1 chance in 200 to 400—of the uterus’s tearing during VBAC with a horizontal incision. (The risk is much greater after multiple cesareans.) Because of these latter findings, the trend toward repeat cesarean sections has increased in recent years. Yet many women still choose VBAC, and 70 percent of those who do elect this type of delivery succeed in delivering vaginally.
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I’ve heard that only a small percentage of women actually have their “bag of waters” break prior to labor. With my first child, my amniotic sac ruptured at 29 weeks and I delivered at 31 weeks.
There was no known cause, such as infection, for the premature rupture. Now I am 32 weeks along in my second pregnancy, and preterm labor began in my 26th week. I am doing very well, taking terbutaline tablets, and staying on bed rest. Could my water bag break before this baby’s birth, too?
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Your question concerns two topics: the rupture of the water bag (amniotic sac) before labor begins, and premature labor. Let’s address these two separately. In the movies, labor always seems to begin with the breaking of the water bag. But labor actually begins this way for only 10 to 15 percent of women. When it does, it usually happens at full term, between 37 and 41 weeks. Labor seldom begins before 37 weeks. But when it does, it often begins with rupture of the membranes. Sometimes, there has been a mild infection in the uterus and amniotic sac. This condition, called chorioamnionitis, can be difficult to diagnose and treat. In other cases, undiagnosed cervical dilation has caused the amniotic sac to break. In still others, the amniotic membrane was weak for some reason.
The fact that your water bag ruptured prematurely in your first pregnancy does not necessarily mean it will this time. Although both the premature birth of your first baby and the premature labor you have experienced in this pregnancy increase the likelihood that you’ll deliver prematurely again, the terbutaline and bed rest appear to be working well for you. Hang in there for just a few more weeks!
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A trained labor assistant, or doula (from a Greek word for “woman’s helper”) provides continuous physical, emotional, and informational support to mothers and their partners during labor and birth. Studies have shown that continuous labor support decreases the use of pain medication, epidural anesthesia, episiotomies, and cesarean sections and provides greater feelings of control and satisfaction for women in labor.
A doula would play a unique role on your birth team. She would not replace your own loving support for your partner. Instead, she could help both of you by offering suggestions about comfort measures—such as relaxation, visualization, breathing, massage, aromatherapy, use of a birthing ball, and spending time in the tub or shower—and assistance in carrying out these measures. She would not influence any medical decisions that you and your partner may need to make, but she could help you figure out what questions to ask of your practitioner and your nurse to help you in making these decisions. Each person on the birth team has different responsibilities, and everyone working together makes the amazing dance of labor a very positive experience for the mother and her partner.
The cost of using a doula can vary a great deal. The community hospital in my neighborhood provides free doula services to women who have no partner, friend, or relative to accompany them in labor. Doulas usually charge for their work, however, and I have seen fees ranging from $350 to more than $1,000. Fortunately, some insurance companies are reimbursing couples for a portion of a doula’s fee. You may want to check with your insurance provider.
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My partner, who is about nine weeks pregnant, does research in environmental chemistry in a laboratory at her university. I am concerned about the chemicals she is in contact with every day. What chemicals might be harmful to our baby, and what precautions should she take if she is working with these chemicals?
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Your partner’s employer should have a list of all the chemicals that are used in the workplace. Those that are dangerous to pregnant or lactating women should be posted, and she should not have contact with them. If you have any questions about this, you can contact the Occupational Safety and Health Administration (OSHA), 200 Constitution Avenue NW, Washington, DC 20210. The OSHA website, http://www.osha.gov, is also an excellent source of information.
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Many physicians now have ultrasound scanners in their offices. With these machines, it is usually possible to see the baby’s heart beating at 6 to 8 weeks. Most ultrasound scanners have amplifiers, so you can hear as well as see the heartbeat by this early date. If your doctor or midwife doesn’t have an ultrasound scanner, he or she will listen with a Doppler, a small, ultrasonic device that amplifies the sound of the baby’s heartbeat. With a Doppler, it’s sometimes possible to hear the baby’s heartbeat at 6 to 8 weeks, but it’s much easier to do so at 11 or 12 weeks.
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You may be having symptoms of carpal tunnel syndrome. Although this condition occurs most commonly in women between 40 and 60 years old, often as a result of repetitive movements of the wrists and hands, it also occurs in as many as 25 percent of pregnant women. In pregnancy, hormonal effects, swelling, and weight gain can compress the nerve inside the carpal tunnel, which is a sheath of tissue surrounding the median nerve. This nerve supplies the thumb, the first two fingers, and half of the ring finger. The symptoms of carpal tunnel syndrome are numbness, tingling, pain, and often a burning sensation in these areas, on one or both hands. Treatment includes wearing a wrist splint at night and during activities that make the symptoms worse, such as driving a car or holding a book. You may also be able to relieve the discomfort by rubbing or shaking your hands. Although the symptoms of carpal tunnel syndrome can be disturbing, they almost always disappear after the baby is born.
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PUPPP stands for pruritic urticarial papules and plaques of pregnancy (say that ten times quickly!). Among the many skin rashes that can develop during pregnancy, this one most commonly occurs in abdominal stretch marks but can also occur on the buttocks, thighs, and arms. As you know, PUPPP is itchy, itchy, and itchier. Its cause is unknown, but PUPPP is not a serious condition; it poses no danger to you or your baby. It lasts about six weeks, on average, and disappears within two weeks after birth. It generally doesn’t recur, even in subsequent pregnancies.
To lessen the itching, you can try taking oatmeal baths or use an over-the-counter anti-itch cream containing 1 percent hydrocortisone. If this doesn’t help, your doctor or midwife may suggest an antihistamine or, if the itching is very severe, a corticosteroid.
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Although I tried to lose weight before conceiving, I started pregnancy nearly 40 pounds overweight. My doctor has told me that I do not need to gain any weight and that I should just try not to lose any. He has given me suggestions about sensible eating, and I am committed to following them. Besides eating well, I am walking a great deal. I know that much of the weight gained in pregnancy goes to the placenta, baby, extra blood flow, and fluid. How, then, is it possible for overweight women not to gain?
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It is wonderful that you have a sensible approach to weight and nutrition and that you are doing everything possible to keep yourself and your baby healthy.
Obesity in pregnancy is associated with a higher incidence of hypertension (high blood pressure), preeclampsia, gestational diabetes, and macrosomic babies (heavier than 91⁄2 pounds). Poor eating habits can cause obese women to gain even more weight in pregnancy. But overweight women who eat sensibly often discover that they gain very little during pregnancy. With proper diet and exercise, the body redistributes some of the weight. Some of the existing fat stores are used for the baby, the placenta, and breast tissue. This can happen without extreme dieting. It’s important, in fact, not to strictly limit calories during pregnancy nd while you are breastfeeding.
If you need help in managing your weight, ask your doctor about visiting with a dietitian or nutritionist. He or she can help you develop a healthy approach to eating and nutritious meal plans.
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Help! My mother was recently exposed to fifth disease. I’m seven months pregnant, and I have been advised to stay away from my mother. I had never heard of fifth disease before; it’s not even mentioned in the books I’ve looked at. What are the symptoms, how dangerous could it be to my baby, and what should I do now?
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Fifth disease, caused by a parvovirus, is so called because it is the fifth in a group of six childhood diseases that cause rash and fever. The symptoms of rash and fever are generally mild and frequently go unnoticed. It is uncommon to develop fifth disease during pregnancy. Most women are in fact immune, having been infected as children without being aware of the infection.
Very rarely, infection with fifth disease during pregnancy increases the risk of an early miscarriage or a rare form of fetal anemia. It is best to follow your practitioner’s advice in your situation, but you and your baby are likely to be completely unaffected.
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About Tori Kropp
Known as "the Dear Abby of pregnancy," Tori has been interviewed on national television and radio and in national print publications, including CNN, The Wall Street Journal, New York Post, Washington Times, Atlanta Journal Constitution and Chicago Sun-Times.
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Aarrgg! I am 38 weeks along and losing my mind! Do you have any tips for how I can get through this waiting? I am so excited I can’t stand it!