Family doctor

Overview:

• A normal pregnancy lasts for 280 days (40 weeks)
• Good health and ideal body weight are keys to pre-pregnancy planning
• Folic acid should be taken for one month before conception
• Limit alcohol and tobacco and try to avoid them completely
• Any current medication should be reviewed
• Two percent of newborns have birth defects
• Common pregnancy complaints include nausea, tiredness, aches, and heartburn

Pregnancy planning

Optimal health is always the key to successful pre-pregnancy planning. One should attempt to be of optimal weight.

The consumption of alcohol, tobacco products and recreational drugs should be curtailed or ideally stopped completely.

Any medication should be reviewed and the optimal "safe" medicine used.

Any chronic diseases such as hypertension, diabetes, heart disease, or thyroid disease should be optimally controlled.

A state of physical fitness should be aspired to.

For any couple considering a pregnancy there are risks, fetal and maternal, to be considered. Two percent of newborns have one or more major malformations. One percent have a genetic single gene disorder and nearly one percent will be mentally handicapped. In addition, at least 15 percent of all conceptions abort spontaneously in the first trimester, two percent abort in the second trimester and about one percent is lost in the perinatal period as stillbirths or early neonatal deaths.

All possible steps should be taken to minimise these tragedies. Folic acid taken at a dose of 400 micrograms per day one month prior to pregnancy and for the first three months of pregnancy will prevent two thirds of neural tube defects, such as spina bifida, from occurring.

Genetic counselling where appropriate will help identify 50 percent of those at risk.

Normal pregnancy

A normal pregnancy lasts for 40 weeks or 280 days after the last menstrual period, assuming that conception occurred two weeks after the last period began.

Naegele's formula can be used to estimate gestational age: add seven days to the last menstrual period, subtract three from the month and add one to the year. For example, if the last menstrual period was 14.8.98, add 7 days = 21.8.98, subtract three from the month = 21.5.98, add one year = 21.5.99.

Pregnancy is divided into three trimesters, roughly at three-month intervals. A number of physiological and anatomical changes occur. These are divided into three:

Hormonal changes

Placenta and other hormones maintain the lining of the uterus, initiate growth of the uterine muscle, increase the blood supply to the entire genital tract and increase the tissue in the breast.

Changes due to uterine enlargement

The increased blood flow through the uterus causes great changes in the maternal circulation, and the enlarged uterus alters the general posture and affects the mechanism of respiration.

Metabolic changes

Major changes occur to enable the fetus to receive oxygen and food as well as to enable the uterus to grow and the breasts to lactate.

Pregnancy is a normal physiological process. The body adapts and changes in order to nurture and grow this parasite, the fetus. It is a time of physiological well being.

During pregnancy common sense should prevail. Women should listen carefully to their bodies for example, if the body says "rest" then rest.

Common irritants in pregnancy:

• Nausea
• Tiredness, overwhelming and not relieved by sleep. It is the higher metabolic rate that is required to feed her and her baby's development that usually creates exhaustion.
• Constipation. A combination of hormones, poor diet and pressure on the large bowel.
• Aches and pains. Anywhere, anytime, often related to growth of bone and joint laxity.
• Haemorrhoids and varicose veins.
• Heartburn. Pure pressure events where there are changes in intra-abdominal pressure causing gastric reflux and heart burn.
• Carpal Tunnel. Pins and needles in the hands due to swelling around the area of the wrist.
• Swelling of the ankles and hands - without toxaemia can be quite normal.

The first trimester is often an unpleasant time because of tiredness, nausea frequency, and a general feeling of ill health.

The second trimester is the honeymoon time. It is a time of well being.

The third trimester is the uncomfortable time, due to the enlarging fetus.

For the majority of women, pregnancy is a wonderful, normal and natural state to be enjoyed. It is an experience like no other.