Kitabı oku: «Blooming Birth: How to get the pregnancy and birth you want», sayfa 3

Air travel tip:

Obstetrician Lucy Chappell says, ‘As a general rule, simply think about the health care system of the country you are going to and whether you would like to be in it, should any complications arise. Avoid islands – where you can’t easily get to a hospital – and developing countries where possible.’

VACCINATIONS | This is a legitimate worry. Some ‘live’ vaccines, like those against chickenpox are unwise to have when pregnant; others such as Hepatitis B, Hepatitis A, and tetanus are OK for pregnant women who are at risk of getting these diseases. Talk to your doctor about vaccinations if you’ve had them before you knew you were pregnant, or if you are thinking of having them before travelling.

AIR POLLUTION | Thousands of healthy babies are born each year in inner London, one of Europe’s most polluted areas. Books will warn you about lead in traffic fumes, but really, if you live in an urban area, there’s not much you can do about this short of ceasing to breathe or wearing a Michael Jackson mask. City life is not going to harm your unborn baby. If it did, half the babies in Hammersmith would have birth defects.

PESTICIDES IN FOOD | You will probably hear, at some point, that you should eat only organic food when pregnant or you will poison your unborn child with pesticides. Some women have the money to do this. Most of us, however, don’t. The vast majority of us eat normal supermarket food when up the duff and our babies emerge just fine. According to the UK Government’s 2002 Committee on Toxicity, pregnant or breastfeeding women are unlikely to be any more vulnerable to the ‘cocktail’ effect of low-level pesticides in food than anyone else. You should, however, wash fruit and vegetables thoroughly. If you peel fruit, by the way, you will reduce the vitamin and fibre content.

BENDING AND LIFTING | Your midwife or health visitor will be able to give you tips on how to avoid back strain, what you should and should not lift, and how to cope when you have to carry bigger children or toddlers. It’s handy to pretend that you can’t lift anything at all, so that your partner has to do all the supermarket shopping etc., but it is fine for a pregnant woman to lift moderate weights (i.e. a shopping bag or two) from the car to the house. The main problem is back strain, so bend from the knee rather than your back when lifting. Having said that, most mothers of more than one child have, at some point, been forced to wrestle a howling, kicking, 30lb toddler out of the toyshop/supermarket/playground while heavily pregnant with no bad consequences (other than to our mental health). The basic rule is: if it’s heavy, try to avoid lifting it, and if you have to lift it, try to lift it with a good posture and try not to lift it above waist level. A physiotherapist-run class at your hospital will give you tips for bending and lifting. You can also divide your shopping into smaller, lighter bags: more trips, in general, are better than heavier bags.

HOT BATHS | The baby inside you does not have a temperature regulation of its own so if you get overheated your baby can’t do anything about it. For this reason, hot tubs, saunas and Jacuzzis are not a good idea in pregnancy as they can raise your temperature too high for too long (above 39C/102F) which may affect your baby’s heart rate. Normal baths (unless you go mad with the hot tap and sit there sweltering for hours) will do you and the baby no harm (and probably some good, as you’ll relax).

Bath tip:

Keep a limb out of the water during your bath and lift your body out for a bit if you feel too hot or sweaty.

SEX | Unless you have a contra-indicating medical condition (for example, you have a low lying placenta, your waters have broken early or you have been warned by your doctor to abstain for any other reason) normal sexual intercourse will not harm your baby. Many women, particularly in mid-pregnancy, feel seriously sexy. Since most of us have a low sex drive after pregnancy (for up to a couple of years!) make the most of any rampant phases you may have. Many men, paradoxically, can’t look this gift horse in the mouth: the most common fear among male partners is that their penis’s head will ‘bump the baby’. Luckily no man – no matter how impressively large he is down there – is that well-endowed. He’d have to get through the vagina, mucus plug and cervix, into the uterus then through the amniotic sac before he could do any damage to your baby. This is simply not going to happen. It is, however, best to avoid really forceful or deep penetration – this can be uncomfortable, for a start. Nor will the weight of your partner squeeze the baby out (if only it did medical induction would be distinctly less common). The best tip is to experiment with positions: side-lying, your partner behind you, you on top of him – any angle really, once the missionary position gets tricky. Your orgasm will not make you miscarry (unless you are at risk of premature labour, in which case talk to your midwife). A vibrator is fine, too. There are no studies to show a vibrator cannot be used during pregnancy. But – brace yourself here if you’re squeamish – introducing germs into the vagina during pregnancy is not a good idea, so clean your vibrator well and don’t mix orifices.

Sex tips:

Don’t insert foreign objects, air or water in your vagina during pregnancy. If you bleed at any time after intercourse, contact your doctor/midwife straight away.

If, after orgasms, you experience a lot of uterine contractions, check with your doctor/midwife. Oxytocin, the ‘love hormone’ associated with orgasm, can also cause mild, clenching, harmless contractions in your womb after orgasms. (During labour oxytocin is actually the hormone that makes your womb contract to get the baby out.)

If you know you are at risk of premature labour, or if you have any other concerns, talk to your doctor/midwife about whether or not it’s ok to have sex.

Sex can be genuinely beneficial (it tones the pelvic floor muscles, gets the circulation going, relieves tension) but it may feel a bit weird for you in your pregnant state. You have a greater blood supply to your vagina which can affect sensation (it may feel ‘fuller’ down there) and your clitoris may be extra sensitive. You may also feel either less or more lubricated (lubricants like KY Jelly can be helpful if sex becomes uncomfortable). You’ll hear women boast about how rapacious they were throughout pregnancy but if your libido is paltry (or very variable) for nine months try not to feel cheated. You’re swimming in hormones. You may be faintly distracted by the sight of your own body, even if your partner appears to be passionate about it. You may feel like your body has been ‘taken over’ by the baby, and you don’t want to be assailed by anyone else. You may feel constantly sick, swell up like a balloon or have loony mood swings. You may simply be knackered. These things will not make you hot stuff in bed. And that’s OK. Dr Petra Boynton, a psychologist specializing in sex and relationships at University College London says, ‘What tends to disappear is not just the sex, but the communication, comfort, petting. If you’re not feeling sexy you should at least be having rampant hand holding every night.’ We talk more about sex in pregnancy in Chapter 8: Blokes, Birth and Babies.

Dr Petra’s sex tip:

‘There is a bizarre idea that pregnant women are not supposed to be sexual. This is part Victorian hangover and part fear that sex is bad for the baby (it isn’t). Sex toys can actually be a great bonus for pregnant women – they can be soothing as well as sexy. Go for vibrating toys designed for clitoral stimulation rather than penetration. I have had women tell me they used one of these in early labour to cope with low level pain. A colleague of mine, what’s more, discovered that her silicon vibrator on a low, soothing, setting, wrapped in a towel and placed along her baby’s back was a fantastic remedy for her baby’s colic.’

Where to go for help:

You may have dropped this book in horror by now, but if you’re still reading, or have always enjoyed this sort of thing anyway www.nicesextoys.co.uk might be worth a go (your guffaws will be fun for your baby anyway).

HAIR DYE | Except at your scalp, hair is dead tissue that cannot transmit toxins to your body. The hazard from hair dyes is therefore related to the amount of dye that can actually penetrate your scalp and enter your bloodstream while you’re dying your hair, and from residues after you’ve finished. Some recent studies suggested a link between permanent hair dye and an increased risk of bladder cancer (yours, not your baby’s), but no studies have found that dyeing your hair when pregnant will harm your baby. Most midwives will tell you that while the safest colour, when pregnant, is your natural one, dyes that involve minimal scalp touching, such as highlights, are extremely unlikely to damage your baby.

LOTIONS | No studies have found that lotions or make up cause birth defects or otherwise harm a fetus. If they did, there would be few healthy babies knocking around. However, many environmental groups have concerns about ingredients in cosmetics and lotions. This is an area of huge debate and there’s no conclusive evidence either way. For more information try the Women’s Environmental Network (WEN): 4 Pinchin Street, London E1. 020 7481 9004 www.wen.org.uk.

TOXIC SUBSTANCES | Watch out for things known to affect a fetus: cigarette smoke, drugs, large quantities of alcohol, lead (in water and paint – see below), carbon monoxide inhaled in excess, mercury, solvents, benzene and formaldehyde.

PAINT | Best get your partner to paint the nursery because certain types of paint and paint thinners may contain chemicals that aren’t great for the developing fetus. I had a ludicrously strong ‘nesting’ urge towards the end of each of my pregnancies, and found myself uncontrollably painting wardrobes, cots, walls – indeed, anything I could get my hands on. My babies are fine but if I’d known about toxins in paint I might have taken up macramé instead.

Weight gain
Getting it into perspective

It’s the infernally emotive topic: how fat will I get? Some admirable women simply don’t care. They eat healthily and avoid the whole unnecessary issue. They are the minority. At the extreme end are those who quake over the scales, restrict their food intake and panic if they’ve gained an ounce more than the ‘recommendations’. The rest of us, meanwhile, scoff cream cakes with gay abandon then whinge about how fat we are after the baby is born. Your weight in pregnancy should not be your prime concern. What matters is that you produce a healthy, well nourished baby. If you crash or fad diet during pregnancy you can severely damage your baby (inadequate nutrition can lead to low birth weight or premature babies who are at higher risk of complications and death⁵). So chuck out Atkins, the Zone, or whatever mad fad you’re addicted to and feed yourself healthily for once (without beating yourself up, or getting paranoid). If your eating is genuinely out of control, or otherwise worrying you, it is essential that you find help and support so you can grow a healthy baby.

Where to go for help:

Your doctor/midwife is a good first base. You can also contact:

National Centre for Eating Disorders They can refer you to specialist help in your area. 01372 469493 www.eating-disorders.org.uk

Eating Disorders Association 01603 619090 Helpline 0845 634 1414 www.edauk.com

Weight charts and what to do with them

In the US, where I had Sam, my second baby, they stuck me on the scales at every antenatal appointment. At one point, I found myself apologizing to the nurse for my excessive bout of chocolate muffin-induced poundage. In Britain, doctors and midwives have realized that being constantly weighed has little medical benefit and causes many women undue anxiety and guilt. As obstetrician Lucy Chappell puts it: ‘You don’t weigh an oven to see if the cake is done.’ Your midwife usually asks your pre-pregnancy weight at your booking in appointment but is unlikely to weigh you after this unless there’s a medical reason to do so. As a rough guide don’t weigh yourself more than once a week.

How much weight you ‘should’ gain over the next nine months will depend on how fat or thin you are in your unimpregnated state. As a rough guide, if your pre-pregnancy Body Mass Index,⁶ is in the ‘ideal’ range, you might gain about 25–35lb over the pregnancy. Very roughly this means a gain of about 3–6lb in first trimester, about 1lb a week in second and third. Loads of women gain far more than this, and lose it (albeit annoyingly slowly) afterwards. Do not succumb to the tyranny of weight charts: gain what is right for you. If you are already overweight doctors say you should gain slightly less than the average. If you are underweight, they say you should gain more. If you’re worried about your rate of weight gain either way, talk to your doctor/midwife. For example, a really rapid weight gain (more than about 2lbs a week) could be an early sign of pre-eclampsia (pregnancy-related high blood pressure) if it is caused by fluid retention.

An experienced mother’s weight tip:

‘When I was pregnant first time around I weighed myself every morning. I avoided chocolate and anything fattening. I weighed out portions of food according to my pregnancy book’s instructions. I panicked if I had put on more than I “should”. I felt like I was on a radical diet. Once she was born, I lost the 6lb of ‘baby fat’ within a month. But I was exhausted all the time. With the other two I didn’t care (too busy to care). I ate what I wanted, when I wanted – tried to make it healthy but didn’t obsess. It was SO much more relaxing just to throw out all that weight worry for nine months. I was a stone heavier for a few months after the other two births, but it came off. And I had more energy with the second two babies. All my babies were healthy – and similar sizes – at birth. Looking back on it, that first time weight obsession was a ridiculous waste of time and energy.’ Jules (40), mother of Chloe (7), Madeleine (4) and Daniel (1)

Fat fascism

Zoe, 33, was about three stone overweight at the start of her first pregnancy. ‘Because I am fat, my GP treated me like a pariah. I was barely through the door on my first visit and he was talking about caesareans.’ In the end, Zoe gave birth to her 8lb daughter in water after a healthy pregnancy and eight hours of drug-free labour.

If you are overweight you may, like Zoe, experience confidence-sapping comments. The best advice is listen to the health professionals but get facts not opinions or knee jerk prejudices (ask, if necessary, for references so you can look yourself). Do not allow anyone to force you into believing that because you are overweight, you will necessarily have a complicated pregnancy and birth. Here are the basic things you should know about obesity and pregnancy.

Being clinically obese (two to three stone overweight, BMI over 35), rather than just a bit chubby has the following documented risks:

1 It can be harder for midwives and doctors to assess the pregnancy and labour as it is harder to feel the baby and your womb. (Some health professionals, by the way, can be offensive. ‘I can’t see baby, because of too much mummy,’ snapped one sonographer to a friend of mine, who, while plump and curvaceous is certainly not vastly overweight.)

2 You will be, statistically, more prone to pregnancy complications like hypertension, pre-eclampsia and oedema – where your body swells more because of fluid retention.

3 You have a slightly higher risk of developing gestational diabetes and consequently of having a larger than average baby.

4 You have a slightly higher chance of having a caesarean section (because of the baby’s size, or your blood pressure).

5 If you are obese and have a caesarean you have a slightly higher risk of some operative complications.

Ask your doctor to refer you to a dietician for dietary advice and support during pregnancy if you are obese, and if any of the above worry you, discuss them in detail. Most overweight women have perfectly healthy babies.

Eating: the basics

Pregnancy eaters divide roughly into two extremes: neurotic self-abnegators, who take the books literally, cut out anything fun and start weighing out grams of fat and protein. And self-indulgers, who think ‘Wey hey! Eating for two!’ and start deep frying their Mars Bars. Ideally, you want to be somewhere in between the two. ‘Before you close your mouth on a forkful of food,’ says the pregnancy book that tyrannized me the most in my first pregnancy, ‘consider “is this the best bite I can give my baby?”…if it’ll only benefit your sweet tooth or appease your appetite, put your fork down.’ Now, forgive my selfishness here, but satisfying my appetite, and even – gasp – my sweet tooth are, I believe, not an insignificant part of my overall well-being. This kind of nutritional fascism should really be outlawed by publishers of pregnancy books. You are pregnant. You are not on a diet. You are not sick. You are not going to harm your baby if you have the occasional bag of maltesers. However if you start eating in earnest for two, three or four, polishing off an entire tub of Haagen Dazs on the sofa, and generally throwing caution to the wind you will put on extra weight (just as you would if you weren’t pregnant) and you might produce a slightly bigger baby. Being really too heavy will not help you feel good later in pregnancy, and of course it’ll be harder to shift afterwards. Perhaps most important of all, you may not be giving yourself and your baby adequate nutrients if you’re eating a lot of junk.

Most pregnancy books tell you that you only need to eat about an extra 300 calories per day when you are pregnant. This in itself is shocking news if you were expecting to be wolfing down the cream buns for the next nine months. Brace yourself now because many experts say the reality is even harsher than this. The most recent Department of Health guidelines conclude that (partly because of our reduced levels of activity, and partly because our metabolism alters) pregnant women don’t strictly need any extra calories whatsoever in the first two trimesters of pregnancy. In the final trimester – hooray – we need about an extra 200 calories a day (a couple of large bananas).

Most of us, of course, eat loads more than this – because it’s socially acceptable to do so when pregnant – and so we get a bit fat. This does us, and the baby, no harm. Most of us lose it afterwards if we eat sensibly and are reasonably active. (I put on 45lb with Sam largely as a result of moving to ‘supersizing’ America. My weight gain was technically 10lb or so ‘too much’. I felt lardy afterwards, but the weight slowly came off and I was back to roughly my normal weight after maybe nine months.)

Verboten foods: what’s the truth?

It’s all horribly confusing. Can you eat that kind of cheese, or not? Can you drink that glass of wine, or not? One recent survey of British women by a baby formula manufacturer⁷ found that most of us don’t fully understand which foods to avoid when pregnant. Indeed, we often cut out foods that are beneficial, in the mistaken belief that they are somehow dangerous. Cottage cheese, for instance, is a good, low fat source of calcium. But many women avoid it in pregnancy thinking it’s a ‘soft’ cheese, therefore verboten.

Our paranoia is understandable. For a start, the goalposts keep changing. When I was pregnant for the first time I stuffed myself with tuna, which I’d been told was an excellent source of fatty acids, protein and vitamins. Five years later, pregnant with number three, I was only allowed a couple of medium-sized cans a week. In the interim, studies had found that tuna may contain too much mercury and so harm a baby’s developing nervous system if you eat too much of it in pregnancy (see guidelines). Swordfish, marlin and shark are now officially out, for the same reasons. And some reports have recently suggested that farmed salmon may contain unacceptable levels of toxins, though the Food Standards Agency says the benefits of eating salmon outweigh any potential harm as salmon is a fantastic source of protein, vitamin D and good fats that can help your baby grow. (If you’re really worried you could try buying organic or wild salmon instead of cutting it out.)

There is, among all this confusion, some sensible evidence that certain foods should indeed be avoided during pregnancy. Mostly they are the ones that carry a very small risk of food poisoning such as listeria or salmonella, which studies have found may damage your fetus or cause miscarriage. Apart from this relatively short list of foods (see Pregnancy Eating Crib Sheet below), most doctors say you should eat basically as normal during pregnancy.