COLUMN: Birthing with Bridget - The First Trimester (0-13 weeks)

COLUMN: Birthing with Bridget - The First Trimester (0-13 weeks)

Hello everyone, I hope this finds you well.

Covid-19 has made us all look at the way we do things and has forced us to adapt.

Nothing can replace face-to-face antenatal classes, where friends are made, questions answered, and worries eased.

Hopefully, these articles will help in some way.

Most women are delighted to find out they are pregnant; some are shocked, and a lot are anxious. Pregnancy tests are getting more and more sensitive. So, women are finding out earlier that they are pregnant.

Often, very soon after a missed period. Pregnancy is divided into thirds; these are called trimesters.

The 1st trimester spans from 0-13 weeks. The HCG hormone is a pregnancy hormone that, when present, gives a positive pregnancy test.

We talk often about the HCG hormone, it is blamed for a lot of the unpleasant side effects of early pregnancy including morning sickness, or as I often call it “allday sickness”.

Shortly after a positive pregnancy test a trip, or in the current climate, a phone call to your GP is advised.

Usually the GP will confirm the pregnancy via a urine sample and lifestyle, diet and the importance of folic acid will be discussed.

Folic acid, also called folate is a B group vitamin. Like most vitamins it can’t be made in the body, so it must be taken either in dietary form or by means of a supplement.

Folic acid helps support the development of your baby’s spine and brain. It also helps prevent conditions known as neural tube defects (NTD’s) such as spina bifida and hydrocephalus.

Folic acid can help reduce the risk of having a baby with spina bifida by up to 70%. Ideally, taking folic acid preconception is strongly advised, for 12 weeks pre pregnancy.

Some experts recommend that all sexually active women should supplement with folic acid as 25% of all pregnancies in Ireland are unplanned.

The recommended dose of folic acid is 400micrograms (mcg). Some women will require a higher dose. These include women who had a previous baby with an NTD.

If you or your partner have a family history of NTD. If you have a raised BMI or have type 1 or type 2 diabetes.

Women should discuss their required dose of folic acid with their GP either preconception, or at the consultation that confirms pregnancy.

Depending on the policy within your local GP practice, most women will return to see their GP or midwife between 6-8weeks.

At this consultation documentation that the hospital require will be completed. The schedule care will be outlined.

Lifestyle/ dietary advice will be discussed and Mums to be will have a check-up including blood pressure and urine check.

The schedule of care in the Republic of Ireland and Northern Ireland is similar.

Up to 28wks gestation the recommendation is that pregnant women have check-ups with their GP/midwife ever 4 weeks.

From 28-36weeks these check-ups increase to every 2 weeks and from 36 weeks until the birth of your baby the check-up will occur every week.

Combined care is the name given to shared care between your local maternity unit and your GP. Some women choose to go privately to a pregnancy consultant called an obstetrician.

With combined care, most checkups will occur with your GP/midwife, however, there are specific appointments such as your scans that will happen in LUH.

In a healthy, well pregnancy the first scan occurs between week 10-13, this is often referred to as the dating scan.

The next scan happens between 18-22weeks, called the anomaly scan or “big” scan.

For women that have a history of miscarriage/ectopic or molar pregnancies, they may be referred for an earlier scan pre their dating scan.

An earlier scan may also be needed if there is bleeding/pain or both in this pregnancy.

There is a wealth of information to be found out there about what pregnant women should eat. However, what not to eat in pregnancy is important.

Raw, smoked or undercooked meat should be avoided. Including, soft-mould ripened cheese such as camembert. This is because they can cause listeria. There is no risk with hard cheese such as cheddar. Avoid pate.

Shark, swordfish, marlin and raw shellfish should be eliminated. Avoid eating raw eggs or foods that contain raw or partially cooked eggs. This is to reduce the risk of salmonella, which can cause a type of food poisoning.

In pregnancy, always wear gloves when gardening or emptying cat litter, and wash your hands as soon as you remove the gloves.

This is to avoid toxoplasmosis, an infection caused by a parasite found in meat, cat faeces and soil. This infection can be harmful to unborn babies.

Always remember to wash your fresh fruit and vegetables before cooking or eating.

Lambing is a particular risk for pregnant women. Handwashing is so important for so many reasons.

We cannot discuss the 1st trimester without talking about morning sickness, or all day sickness for some. Most women feel nauseated or vomit in early pregnancy.

It is estimated that nausea and vomiting affect up to 80% of pregnant women and that 35% of these women have significant problems with it.

The HCG hormone is blamed for this sickness along with other hormones, such as oestrogen and progesterone. HCG protects the baby in the first 12weeks, until the placenta (afterbirth) is formed. Research often tells women that the sickness will ease at 12weeks.

In my experience, the sickness lessens at 12 weeks, but it is often not completely gone until 16 weeks. However, between 12-16 weeks, every week should be a little better.

The more HCG present, the sicker the woman can be. Often, excessive sickness, especially compared to a previous pregnancy, can be a sign of a twin or multiple pregnancy and should be mentioned to your GP or midwife.

There are numerous tips and old wife’s tales about the relief of nausea or vomiting in pregnancy.

It must be remembered that not one thing in isolation will help everyone. As long as they are safe, women can experiment with different tips and see what works best for them.

These are some of the things that I have seen working well.

1. Not allowing yourself to get too hungry. Small, frequent meals and snacks throughout the day. Especially, biscuits left on your bedside locker and taken, dry, first thing in the morning before getting up. Having snacks in your bag.

2. Eating your fluids. This may sound silly, but we can live without food but not without water. Eating jelly, not low fat. Freezing 7up or Lucozade as ice cubes and sucking on these, are all ways of getting calories and sugar in without too much difficulty.

3. Eating and drinking separately.

4. Bowls of dry breakfast cereal, no milk, left around the kitchen and nibbling on these as you pass by.

5. Avoid foods high in fat, spicy food or citrus fruit.

6. Carbonated or sparkling water is often tolerated better than plain water. Hydration is so important. Water mixed with diluting juice or sparkling water is much better than not being able to drink.

7. Some women find ginger or herbal teas especially peppermint tea helpful. Remember different things will work for different women and if it is safe, nothing is right or wrong. Try your best to see what works for you.

Morning sickness is common and unpleasant. However, if it becomes excessive and it is destructive or destroying your quality of life, then this is not normal.

Hyperemesis gravidarum is prolonged, severe nausea and vomiting. If affects 1% of all pregnancies. Women can not keep fluids down and if often causes dehydration. If you think you are suffering from this then you will need to speak to your GP/midwife. They will chat to you about what food/fluids you are able to tolerate.

They will also check a urine sample for ketones, a sign of dehydration. If hyperemesis is suspected, then you will need to go to your local hospital.

Often to the gynae ward, when you are under 16weeks gestation. They will treat you with drip (IV) fluids, rest and sometimes anti sickness medication.

Up until now I have not painted the 1st trimester in a good light. Some women experience no problems and often forget they are pregnant. Unfortunately, miscarriages are most common in the 1st trimester.

They often present with pain/bleeding or both. Up to 25% of all pregnancies, that is 1:4 end up in miscarriage.

Women must know that they are not to blame for this, and I often say, you could wrap yourself up in cotton wool and a miscarriage would still happen.

Miscarriages are extremely sad, as it is not just the actually loss i.e. the baby at 8 weeks gestation that the parents grieve. It is also the loss of what could have been.

If anyone out there is struggling to cope during or after a miscarriage, no matter when it occurred, please reach out to your GP/midwife or have a look online at The Miscarriage Association of Ireland @www.miscarriage.ie.

Loss is loss no matter how many weeks pregnant you are and never be afraid to ask for help.

We have talked about the Mum during the 1st trimester but what about the other little part of you, your growing baby.

The 1st trimester is when massive growth and development occurs within the baby. You will be able to see your baby’s heartbeat on scan at the at the end of your 6th week.

Your baby will start to develop eyes, ears, teeth buds, fingers, toes, vital organs and even urine. By the end of your 1st trimester your baby will weigh about 15grams and measure about 8-9cms from the head to the bump.

Medically, this is called the crownrump length and will be used to date the size of your baby at your dating scan.

Even thought the baby is moving, you will not be able to feel these movements yet. I really hope that you found this article helpful. Remember if you are concerned about anything please speak to your GP/midwife, as this information is a guide.

Its amazing what is going on in your body, all the while, you physically look no different. Hopefully chat to you all soon, as we look at another aspect of your pregnancy journey.

Bye for now, take care and stay safe. Bridget the Midwife

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