Hygiene and Health During Pregnancy

Hygiene and Health During Pregnancy

During pregnancy it is important for a woman to pay considerable attention to her general health. This is not only beneficial for herself and for minimizing potential complications during the eventual delivery, but also provides the unborn child with the optimum conditions for its development. In this way the child has a favourable start when it begins life on its own. To ensure good general health, it is necessary for the mother-to-be to have information on a wide variety of subjects, such as the diet that is most suitable, what drugs should be avoided, and what hygienic measures should be undertaken.

Diet during pregnancy

The old adage that you should eat for two during pregnancy has very little truth in it: the quality of the food is far more important than the quantity. Controlling weight gain is also very important. The average gain is 12kg, but if the woman is underweight at the start of her pregnancy she may benefit from putting on slightly more weight than this. Conversely, if she weighs more than she should for someone of her height and build, whereas a restrictive diet aimed at losing weight is not recommended, she may be advised not to put on as much weight as a slimmer woman. Whatever the case, the woman’s doctor will be able to give advice appropriate to individual needs. The recommended energy requirement for a pregnant woman is about 2,400 Calories* (kilocalories) a day. This is only about 200 Calories above the recommended amount for a non-pregnant woman because, in pregnancy, it is usual to economize on the energy needed for everyday activities. However, if a sensible mixed diet is followed it should not be necessary to resort to counting calories.

A pregnant woman needs plenty of protein during pregnancy for the healthy growth of the baby, placenta and uterus, and she should make a positive effort to increase the amount in her diet. Foods rich in protein are meat, fish, pulses (such as peas, beans and lentils), nuts, eggs, milk and cheese. Potatoes cooked in their skins (jacket potatoes) and wholemeal bread are also good sources of protein.

In order to control weight gain, it may be wise for the woman to reduce the amount of fat in her diet. Consequently, she should try to eat only lean meat, grill rather than fry foods, and avoid rich dishes that include ingredients such as cream and butter. Fatty fish such as mackerel and herring, on the other hand, are a good source of vitamin D – essential for the formation of healthy bones.

Carbohydrates, which are found in foods containing sugar and flour, provide the body with energy. Excess intake of carbohydrates, however, will turn to fat so care should be taken not to eat too many cakes, pasta (except wholemeal pasta), rice (except brown rice), pastries or sweets and chocolates. Good sources of carbohydrates, which also supply protein, fibre and vitamins, are jacket potatoes and wholemeal bread. A woman’s need for calcium increases considerably in pregnancy because it is used in the formation of the baby’s bones and teeth. A pint of milk a day is a good source, as are cheese, fish, nuts and green leafy vegetables. A good supply of calcium is particularly important in the second half of pregnancy and while breast-feeding.

Increased blood circulation and the demands of the baby mean that extra iron is needed in pregnancy if the woman is not to become anaemic. Iron is an important constituent of haemoglobin, the oxygen-carrying component of the blood, and if the expectant mother does not have enough she will become easily tired and the baby will not get enough oxygen via the placenta. A pregnant woman’s haemoglobin levels will be regularly tested using blood samples taken during her check-ups at the antenatal clinic, and if necessary she will be prescribed iron supplements. Many clinics give these as a matter of routine. Anaemia can be avoided by eating iron-rich foods such as lean red meats – especially liver and kidney – green leafy vegetables such as spinach, broccoli and watercress, and eggs, nuts and pulses. Anaemia during pregnancy can also result from a deficiency of folic acid, a B-group vitamin, and this is often given in a combined pill with the iron supplement.

Care should also be taken to eat plenty of fresh fruit to meet the body’s vitamin C requirements.

Although in most circumstances salt is not harmful during pregnancy, it is unwise to deliberately increase the amount of salt in the diet. A craving for salty foods should therefore be suppressed. Towards the end of pregnancy many women may have to reduce even normal salt intake because of too rapid a weight gain or because of high blood pressure. If this is the case, adding some extra spices to a dish will enliven a diet that might otherwise be a little bland.

Drugs and pregnancy

Nicotine and alcohol are not commonly thought of as drugs but they are in fact among the most toxic substances to which an unborn baby can be exposed. Nicotine and carbon monoxide inhaled when smoking cigarettes reduce the amount of oxygen and nutrients that reach the baby. Mothers who smoke are more likely to have small babies and to give birth prematurely; the risks of congenital malformations, stillbirth and perinatal death of the baby are also increased.

A doctor will be able to give advice on ways of giving up smoking, and if the woman’s partner also smokes, she may find it easier to cut down if they both make the effort. Many women ‘go off cigarettes in early pregnancy and if this happens it may provide a first step in the direction of giving up completely.

It makes sense to limit the intake of alcohol during pregnancy. Excessive drinking during pregnancy increases the risk of giving birth to a baby with congenital abnormalities or even foetal alcohol syndrome, characterized by mental retardation and physical deformities. The occasional glass of wine or beer is unlikely to do any harm, however.

The effect of certain drugs on the developing foetus is in some cases unknown so care should be exercised when taking anything during pregnancy, particularly in the first weeks after conception. This advice also applies if the woman is trying to conceive. In general it is unwise to take any drugs or medicines that have not been either prescribed or recommended by a doctor. Also, a woman should make sure if she has to see a different doctor or dentist that they know she is pregnant. If a woman is already taking drugs for the long-term treatment of a disorder such as asthma, diabetes or epilepsy, she would be wise to consult a doctor before becoming pregnant.

Intercourse

It is perfectly safe for a woman and her partner to make love during pregnancy. The only circumstances in which intercourse is not advisable are when there has been previous miscarriage, or if the woman experiences any vaginal bleeding or other signs of

miscarriage in this pregnancy. A doctor will be able to advise on when it is safe to resume love-making in both these cases.

The size of the woman’s abdomen and the tenderness of her breasts may mean that she and her partner will have to experiment with different techniques and positions for love-making during pregnancy. The woman may feel uterine contractions for a while after orgasm but these are not harmful and will not cause her to go into labour.

Clothes

Loose, comfortable clothes are ideal in pregnancy, although a woman will probably not notice any increase in the size of her abdomen until about 12 to 14 weeks. Tight jeans and boots, garters, and underwear which constricts the tops of the legs may make varicose veins and haemorrhoids more likely. Shoes should be well-fitting with broad-based and low, although not necessarily flat, heels.

If it is a woman’s first pregnancy and she does not normally wear a pantie-girdle, she is unlikely to need to start wearing one now. However, if the woman is overweight or has previously had twins or polyhydramnios*, and the abdomen tends to sag in late pregnancy, some kind of abdominal support will be necessary. The breasts should be supported by a well-fitting bra that does not press on the nipples.

Hygiene

There is no reason why a woman should not take baths or showers during pregnancy just as she would normally do, although the bath should not be too hot. In the last few weeks it may be easier for the woman to kneel in the bath. Careful hygiene will help prevent pruritus vulvae, irritation of the vulva, which is quite common in pregnancy because there is an increase in vaginal discharge.

The teeth and gums are more susceptible to decay and infection during pregnancy and bleeding from the gums may occur. Regular brushing of the teeth after meals and at night will help to minimize these problems but a woman should still visit her dentist during early pregnancy.

Travelling

Travel during pregnancy is as safe as it is normally, although it may be more tiring or uncomfortable, especially in late pregnancy. At that stage the jolting of a train or car can cause labour to begin. Where possible, long periods sitting in the same position should be avoided. If a woman finds that she needs to empty her bladder more frequently than usual, this should be borne in mind when planning a journey. Travel by air is safe provided the woman has not had a threatened miscarriage earlier on in pregnancy because, if this is the case, the change in air pressure can bring on premature labour. Most airlines will not accept pregnant women for travel if they are more than 35 weeks pregnant, and from 25 weeks a letter from a doctor confirming fitness to travel may be required.

There is no reason why a woman should not continue to drive right up to the onset of labour, making sure that the seatbelt is not too tight.

Activity and rest

Exercise and fresh air should be taken each day to help the circulation and muscle tone. If a woman already takes exercise in the form of an activity such as cycling, dancing or swimming, there is no reason why she should not continue, provided she does not tire herself. Sitting indoors all day with the feet up is certainly not advisable for the woman who feels fit and ready for activity; besides losing physical condition, she may become bored and listless and lose out on her social life.

It is not advisable, however, to take up a strenuous sport for the first time during pregnancy. Sports with an inherent degree of danger such as horse riding, skiing, water-skiing and skin diving should be avoided. Gentle swimming, on the other hand, is excellent exercise. Cycling may be dangerous in the second half of pregnancy because of the risk of losing balance and falling off.

Adequate rest is essential throughout pregnancy, with a sufficient number of hours in bed resting, even if not sleeping. Sleep is often disturbed in late pregnancy and it may be difficult to get comfortable. Relaxation exercises often help to obtain rest.

Posture

Although it may be an effort to maintain a good

posture all the time, a woman will feel better and reduce the chances of getting severe backache if she takes care over how she sits and stands. When standing, a woman should relax her shoulders, keep her tummy in and her back straight, slightly pushing the small of the back out behind, so that the abdomen feels girdled by the hips. When sitting, a woman should make sure that her back is well supported and try not to slump in her chair, or sit with the legs crossed.

Finally, many women say they have ‘never felt better’ during the middle months of pregnancy. Having a baby is a natural process, and despite the problems and irritations it can be a time to be enjoyed. If a woman has a positive attitude throughout, pregnancy is an opportunity for her to become more aware of her body, how it works, and how to look after it.

Self-image

Many women embrace pregnancy as a time when they have never felt more feminine, more `alive’; they feel, even if they would not consciously admit it, that they are fulfilling their role as a woman. As a result they are comfortable in their new appearance and do not regret the disappearance of their previously slim figure. Indeed, some women identify being pregnant as the period when they have thought of themselves as being at their most attractive.

It might be pointed out by a cynic that these women rarely suffer from the more disfiguring effects of pregnancy, such as fluid retention, or experienced prolonged morning sickness. There are, however, women who despite having a largely unproblematic pregnancy still regard their condition with a certain amount of distaste. Even if the child they are carrying is an anxiously awaited one, they feel out of touch with what is happening to their body and physically unattractive. In such cases, the normal side-effects of pregnancy, stretch marks, for example, constitute an unwelcome reminder for the woman concerned that, as she thinks, she is losing her formally attractive appearance.

The self-image of a woman during pregnancy can also be influenced by new patterns of behaviour over which she perceives she has no control. Crazes for particular types of food, or a compulsive routine that is followed when doing domestic chores, for instance, are frequently reported by pregnant women. These ‘fads’ may even be frightening for a woman who is used to being in control of every aspect of her life: she may feel that she is somehow being ‘taken over’.

As in most things, ignorance adds to any distress that is being experienced.

The woman who is most informed and aware of what is happening to her and her body is the one who is least likely to see pregnancy as an unwelcome intrusion. Indeed, the purpose of these articles is to allay precisely those sort of anxieties.