Health care in pregnancy

It’s true that vitamins and minerals are essential for a baby’s health and well-being, but doctors say that most of them are present in quite sufficient amounts in an ordinary mixed diet. As long as you eat a protein meal containing a good portion of meat or fish once a day, you’ll be getting adequate supplies, but take care not to increase your carbohydrate intake. This won’t be of any benefit and will just add extra unwanted calories. Above all, don’t be tempted into ‘eating for two’!

The only two substances which most pregnant women need supplements of are iron, and folic acid, the vitamin required for growth. However, in many countries these two supplements are usually prescribed for pregnant women and there’s little risk of a deficiency occurring. So, unless a pregnant woman is short of a particular vitamin or mineral for some reason, there’s no point taking supplements of any substances other than those mentioned.

Although you don’t normally need synthetic calcium supplements, you do need to increase your calcium intake slighdy to ensure that your diet contains sufficient to keep your teeth and bones strong and healthy, and help the baby’s bones to grow. Even though bones appear to be fairly static, they are in fact continually dissolving and being renewed. Normally these counter activities are carefully balanced out so that your bones and teeth remain strong, but certain hormone changes in pregnancy tend to increase the dissolving action and slow up the laying down process. This alteration allows the baby to take what it needs but it may leave the mother a little deficient. The calcium imbalance could make your bones slighdy britde and can cause leg cramps at night. However, you can help overcome both problems by making sure that your daily diet contains some milk and cheese — both are rich sources of calcium.

It’s also particularly important to eat plenty of roughage. You can get this from high-fibre foods like whole-grain cereals, wholemeal bread, fruit and vegetables. And if you’re not particularly fond of cabbage, spinach, and other high-fibre vegetables, then bran is a very useful alternative, either the coarse health-food variety or the more refined manufactured breakfast cereal type. If you drink enough fluid (minimum of 2 pints a day) and eat sufficient fibre you’ll minimize the risk of suffering from constipation.

Smoking is harmful at all times, but it can have a particularly detrimental effect on the foetus.

The nicotine and carbon monoxide in cigarette smoke are the substances which do the damage. Nicotine may cause the blood vessels of the placenta to narrow bringing about a reduction of placental blood supply, and therefore of oxygen and nutrients, from mother to child. Carbon monoxide can enter the baby’s circulation, and, because the baby’s blood pigment has a strong affinity lor carbon monoxide, the poison becomes even more concentrated. These and other harmful chemicals absorbed from the smoke, combined with the reduction of placental blood supply and the generally poorer appetite of mothers who smoke, affect the nutrition and growth of the developing baby.

It’s a fact that the child born to a cigarette-smoking mother will be born lighter and less mature than one to a non-smoker. There is a further risk in that if the woman should develop toxaemia (when blood pressure rises, protein leaks into the urine and the limbs become swollen and puffy) it tends to be very much more severe than in a non-smoker, and is more likely to cause the death of the unborn child. As well as these hazards, it seems that the baby born to the smoking mother shows a marked retardation of reading ability and educational capacity later.

You can see from this how important it is for a pregnant woman to cut out smoking for the sake of her unborn child, even if she is prepared to take a risk with her own health.

Why is sleeping often a problem late in pregnancy? Discomfort in bed and trouble staying asleep are usually due to the increase in size of the uterus. It may be hard to find a comfortable position to sleep in, especially if you normally sleep on your back or your tummy. In addition, the sheer size of your stomach tends to interfere as you turn over. We all turn many times during a night’s sleep so when you’re pregnant it can mean that you wake up in order to turn over. This soon becomes very irritating and can build up into a habit of waking in the night If this proves really difficult to cope with, consult your doctor and he may prescribe some treatment to help.

What causes stretch marks and what can be done to prevent them? The basic cause of stretch marks is the pulling of skin above its own limit of elasticity. A certain amount of elastic fibres are present in your skin and when they’re stretched fairly suddenly, as in pregnancy, and tighten above their elastic limit, die fibres in the deeper layers start to tear and red irregular marks show on the skin’s surface.

The reason that stretch marks are worse in some women than others is simply due to the fact that elasticity of the skin varies from person to person. Although there’s not much you can do to increase your skin’s elasticity, some women find it helpful to massage their skin daily as this seems to postpone the appearance of stretch marks.

There’s no evidence that the specially formu-lated creams which claim to prevent stretch marks are of any use in themselves, and doctors say that if there is any benefit from these it’s most likely due to the massaging action of the fingers during application, rather than the properties of the cream.

Wherever possible it’s best not to take medicines and drugs while you’re pregnant. However, itfs a fact that very few meaicines actually produce abnormalities in human beings, and any that can are only available on prescription. All doctors know about them and would not willingly prescribe them forawoman is pregnant. If you have to consult a doctor for illness, and you think you might be pregnant, it’s vital to tell him.

If you’re used to doing a certain amount of physical exercise or sport such as tennis, cycling, swimming or walking there’s no reason why von shouldn’t continue, providing pregnancy pro-gresses normally. However, you must take care not to overtire or overstrain yourself: always stop when you become tired and never allow yourself to become exhausted. Doctors believe that the two best and safest exercises to keep you fit while pregnant are walking and swimming (provided deep underwater diving is avoided).

It’s not a good idea to take on any form of exercise and sport and, if you’re not used to it, avoid vigorous exercise. Pregnancy itself imposes quite a lot of extra work on your body, both physical and metabolic, and anything extra that you’re not accustomed to will cause unnecessary strain. Indeed, for most women who have a home to look after, or a job to do, or odicr children to take care of, the duties involved will provide quite enough exercise during preg-nancy.

In fact, adequate rest is much more important than physical exertion when you’re pregnant. Obviously the amount of rest you need varies enormously from one woman to another, but ideally it’s wise, in the second half of pregnancy ai least, to rest on the bed for two hours every afternoon. If you can’t manage this try to make sure that you get as much rest as possible at night: avoid late nights and do lie-in.

When you think of the extra weight you carrying around it’s not really surprising that you need lots of rest. If your total weight gain is say, 25lbs, then towards the end of pregnancy it’s much the same as carrying a 25lb suitcase all day. If this were so you’d certainly need to put it down occasionally!

So, however slight the possibility. That way there’s no danger of him prescribing drugs which could damage the baby.

For instance, a certain type of commonly used antibiotic, harmless in normal circumstances, may seriously affect the growing foetus. Potentially damaging drugs are especially harmful in the first three months of pregnancy. It’s during this time that abnormalities are produced and that you should be particularly careful about taking any new medicine. It’s especially important not to go to the bathroom cabinet and take some medicine prescribed for another person at this or any time during pregnancy.

Most of the common overthe-counter pain killers, containing aspirin and codeine, are safe as long as taken in reasonable doses. For example, a couple of aspirins for the occasional headache won’t do you any harm, but the same dose taken regularly every four to six hours for two or three days is not recommended. It’s also perfecdy all right to Lake heartburn and indigestion preparations in reasonable doses. On the whole, it’s safe to take sleeping tablets during pregnancy, and if you’re having great difficulty getting a good night’s rest your doctor may prescribe them. However, it’s obviously much better if you can manage without them.

Despite some controversy over anti-nausea pills, the latest scientific evidence has shown those available to be safe. Indeed, in cases of severe morning sickness doctors say their use is necessary and fully justified. Not only do they help relieve the intense discomfort but they may prevent damage to the baby- due to metabolic alterations in the short term, or, if the vomiting goes on for more than three months, to deficiencies in the mother’s diet.

Over all, the decision to take a specific drug during pregnancy involves your doctor balancing out its benefits against the disadvantages of any possible side effects. For example if a woman is being treated for a long standing condition that started well before pregnancy, it’s likely that the advantages of continuing the treatment will outweigh any disadvantages.

For most couples there is no reason why a normal sex life should not be continued throughout pregnancy, since sexual intercourse does not disturb a normally implanted growing baby. However, if a woman has any bleeding from the vagina, in early pregnancy, indicating a threat to miscarry, intercourse should be stopped until her doctor advises that it’s all right to start again. Towards the end of pregnancy, the size of the baby may make intercourse mechanically more difficult but this can usually be overcome by a change of position. In the last few days, some people believe that intercourse actually promotes the onset of labour. There’s little evidence to prove this, but there is no reason why intercourse should be stopped. It does not increase the risk of infection in delivery, so ifs entirely up to the couple whether or not they want to make love.

Backache is very common throughout pregnancy It’s mainly due to the fact that most women change their posture and it throws extra strain on die bottom part of the spinal column and surrounding muscles. Trying to compensate for the weight of the uterus as it grows upwards and forwards, you tend to lean backwards as you walk, pushing out your stomach and arching your back. As pregnancy advances this stance becomes even more exaggerated. If you’re a bit overtired or especially if the balance of muscles in the pelvis is upset, backache is the inevitable result.

Correct posture is essential to help relieve or better still, prevent this kind of backache since, by redistributing the weight, it puts less unnatural strain on the muscles and ligaments of the back. You should aim to stand with your back straight and your shoulders loose and relaxed rather than braced and flung back, holding your tummy and bottom ‘in’, so that your centre of gravity is immediately over your feet. Practise this by pressing the whole length of your spine against a flat wall and trying to maintain that posture. Towards the end of pregnancy you may well find that it’s almost impossible not to arch your back a little, and that the only points touching the wall are your shoulders and bottom! The strain on the surrounding structures can cause backache and discomfort. And if there is any tendency to weakness here, it will be made worse in early pregnancy.

The only cure for backache of this sort is extra rest If you’re already taking rest make sure that you take more, particularly lying down, and clon’t let yourself get overtired. Local heat either in the form of a hot water bottle or linament may help a litde, and if the discomfort is severe it may be necessary to take pain relievers.