Smoking During Pregnancy

If this article were like most I've found, I would be saying "You should quit smoking. THE END." However we all know that in some cases that isn't going to happen. So first let's discuss what will happen to baby when mom smokes according to the Surgeon General:

• Smoking causes blood vessels to constrict. This includes blood vessels in the umbilical cord, which provides oxygen and nutrients to the baby. The result is usually an underweight newborn. This is bad because babies born with less fat have a more difficult time regulating their temperature. Maintaining adequate body heat is essential to the health of a baby. Low birth weight is a leading cause of death for babies born in the United States.
• Decreased oxygen and nutrients to baby during development could result in devastating birth defects or possibly learning disabilities later in life.
  
• Babies of moms who smoke during pregnancy are more likely to die of SIDS.
• Babies of moms who smoke during pregnancy are more likely to be born prematurely.
• Babies of moms who smoke are more likely to have decreased lung function. Decreased lung function would lead to less oxygen getting to babies brain and other organs.
• Daughters of mothers who smoke during pregnancy are more likely to begin smoking later in life, even if mom quits.

Now then. In my experience as a nursery nurse, I can also give you first hand information about newborns born to smoking mothers. The baby is born addicted to nicotine. After baby is born, he/she will go through withdrawal just as any smoker would. Usually mom hasn't had a cigarette for a while by the time baby is delivered, so even as the baby is born, he/she is already in the throes of withdrawal. Baby will shake uncontrollably, cry more often and be inconsolable. Withdrawal will interfere with breastfeeding, and possibly even bottle feeding. This is important as dehydration in an infant can happen very fast, and have devastating effects. Withdrawal from nicotine will also interfere with mother infant bonding. In my experience mothers of withdrawing infants send their babies to the nursery more often and for longer periods of time. Baby cannot be comforted by anyone.

Now then. I can hear you sitting there saying "Well So-and-So smoked during her pregnancy and her baby was fine." That very well may be true. Maybe that baby was lucky. However are there learning difficulties? Behavior problems? Was baby sick a lot? If so, those problems could be due to mom's cigarette use during pregnancy.

However, even after having all this information, you simply feel that you cannot quit smoking. Ok. Let's deal with that.

• Decrease your smoking by at least half. If you have a hard time with this try chewing nicotine gum at times. Nicotine isn't good for baby, but it's better than all the other poisons baby's getting from the cigarette. (never wear a nicotine patch and smoke, this will cause heart problems)
  
• Start smoking outside. This decreases the amount of smoke in your home in preparation for when baby comes home, and probably will automatically decrease the amount you smoke.
• Even if you smoke outside, consider wearing an over shirt while smoking to decrease the amount of smoke in your clothing.
  
• If you are breastfeeding, the baby will get nicotine and other poisons through the breast milk. HOWEVER. The benefits to breastfeeding outweigh the risks here. Don't smoke an hour before feeding the baby or pumping, this will decrease the amount of contaminants in the breast milk.
• Be aware that quitting smoking at any point during pregnancy will decrease risks for your baby.
  

Answers To The Questions You Don't Want To Ask

1. What do people mean when they say I'll lose all modesty when I have a baby?

Well, they're probably overstating. You'll get the modesty back. However, when you have a baby you need to realize that your va-jay-jay, as it were, is going to be the girl of the hour. It will seem as though EVERYONE is 'down there' at one point or another. Nurses and Doctors will need to do vaginal exams with their gloved fingers to determine how much your cervix is dilating (often called "checking the cervix"). Some women want to be checked often to gage their progress, some women want left alone. However embarrassing, this will need to be done while you are in labor.

When you are fully dilated, often the nurses will place your legs in stirrups, and shine a bright light RIGHT THERE. While you are pushing the staff can monitor how well you are pushing, as well as progress made not only by vaginal checks, but also watching the perineum for crowning (when the pressure baby's head causes the perineum to bulge out, and the labia to separate, revealing the first peek at baby's head!).

Even after delivery, if you are breastfeeding, the staff will need to watch your breastfeeding attempts. This is the only way to help the process if need be, and report to the physician and pediatrician how well baby is nursing. Staff may even need to touch your breast in order to help baby latch on correctly.

So, while there is usually every effort made to maintain your privacy, when you have a baby, there will be a certain amount of exposure going on.

2. Am I going to poo on the delivery table?

Um, maybe. This doesn't happen often, but it does happen. While pushing you are using the same muscles you do when having a bowel movement. It feels like you are having a bowel movement even if you aren't.
However. If a mom does poo, it's always just a small amount, and the caregiver will just quickly wipe it away, and no one really gives it a second thought. Mom usually isn't even aware of it, nor is anyone else.

3. Are my breasts supposed to be leaking while I'm pregnant?

Yes, they are. This is just the body getting ready for baby breastfeeding. It normally begins around 5 months, and generally is only in very small amounts of clear, yellow, or white fluid.

4. Am I going to get aroused while breastfeeding?

Maybe at first. And if you do, it's NORMAL. Breastfeeding should be a pleasurable experience, our bodies are made that way. It doesn't mean anything subconscious is going on, and soon your body will be able to distinguish that pleasurable feeling associated with the closeness and nurturing of your baby from the times of intimacy.

Have more questions? Ask away in the comments, I'll do my best to give you answers to any "embarassing" questions you might have!

What Should You Bring To The Hospital?

While this list can vary greatly from person to person, there are some basic items and ideas which will make your stay more comfortable. Make up your bag a couple of weeks before you're due, even if you are having a planned C-section (babies don't always like to follow our plans!). This way you won't have to worry about the details when the big moment arrives. Be sure your support person knows where this bag is as well!

• Insurance information
• Lotion or oil for massage during labor
• Toothbrush, mouthwash
• Hairbrush
• Other toiletry items for mom(shampoo, deodorant, etc.)
  
• Warm socks
• Relaxing music (check to see if your facility has a CD player, or bring your own)
• Bathrobe
• PJ's
• Bras (consider nursing bras if you are breastfeeding)
• Topical pain relieving spray such as Dermoplast for after vaginal delivery
• Change of clothes for your support person
• Clothing to wear home (something you wore in your 5th or 6th month of pregnancy)
• Camera
• From home snacks or change for the vending machine
• If you are breastfeeding, consider a Boppy style nursing pillow
• Deck of cards, books, movies (check if your facility has VCR or DVD players)
• Overnight maxi pads (hospital may supply these, but your own brand may be more comfortable)
• Several pair of underware you won't mind throwing out (post delivery flow can be quite heavy, you might ask your facility if they provide disposable underware)
• Body Pillow
• Two outfits for baby
• blankets
• Baby Book (ask the nursing staff to put in baby's footprints! Most nurses would be happy to do it . . . don't count on good hand prints though . . . those are tough to get!)
  
• Baby Mittens or socks to prevent baby from scratching face
• Baby nail clippers (hospital staff generally are not allowed to clip baby's nails, and NEVER use adult clippers)
• List of phone numbers of people you will want to call
• Cell phone, you won't be able to call long distance from most hospitals
• Car seat-be sure to try it out in your car first to be sure it fits properly!

Most hospitals will provide diapers, baby wash, baby lotion, etc. If there is a specific brand you would like to use however, be sure to bring your own.

Postpartum Depression

Depression occurring during pregnancy or even up to a year after delivery is called postpartum or perinatal depression. Researchers believe that depression is one of the most common complications during and after pregnancy. Postpartum depression is especially not recognized die to other normal pregnancy changes causing similar symptoms, such as tiredness, insomnia, increased emotional reactions, and of course changes in weight.

Severity of symptoms range from "baby blues" to postpartum psychosis.

The baby blues generally happen in the days after childbirth and go away in a few days. Symptoms include sudden mood swings, sadness, sleeping problems, irritability, restlessness, anxiety, and loneliness. These symptoms aren't severe, and don't require professional treatment. During this time, the new mom should nap often, when the baby does. Ask for help from friends and family, and get support from other moms.

Postpartum depression can occur anytime within the first year after childbirth. Some symptoms are the same as having baby blues, only on a larger scale. In addition, postpartum depression includes the feelings of guilt and worthlessness. This depression affects mom's well-being and prevents her from functioning well for a longer period of time. As this type of depression will not go away on it's own, the new mother will need treatment by a doctor. If left untreated, this depression can last for years.

Postpartum psychosis occurs in 1 or 2 out of every 1000 births, and usually begins in the first 6 weeks after birth. Usually women who have bipolar disorder or other psychiatric problems are at higher risk for developing postpartum psychosis. Symptoms may include delusions, hallucinations, sever sleep disturbances, and obsessive thoughts about the baby. She may have rapid mood swings, and thoughts of hurting herself or her baby. Postpartum psychosis obviously needs to be treated by professionals.

Women who experience any level of depression often don't' tell anyone about their symptoms. They may feel they are unfit mothers, and are ashamed, guilty or embarrassed by their symptoms. However perinatal depression can happen to any woman, those affected can still be fantastic mothers with help and support.

Speak to your doctor or midwife if you are having symptoms of depression while you are pregnant or after you deliver your baby. Your doctor or midwife can give you a questionnaire to test for depression and can also refer you to a mental health professional who specializes in treating depression.

Here are some other helpful tips:

* Try to get as much rest as you can. Try to nap when the baby naps.
* Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest!
* Ask for help with household chores and nighttime feedings. Ask your husband or partner to bring the baby to you so you can breastfeed. If you can, have a friend, family member, or professional support person help you in the home for part of the day.
* Talk to your husband, partner, family, and friends about how you are feeling.
* Do not spend a lot of time alone. Get dressed and leave the house. Run an errand or take a short walk.
* Spend time alone with your husband or partner.
* Talk with other mothers, so you can learn from their experiences.
* Join a support group for women with depression. Call a local hotline or look in your telephone book for information and services.
* Don’t make any major life changes during pregnancy. Major changes can cause unneeded stress. Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

Seat Belt Safety While Pregnant

Protecting yourself in the car means protecting your baby as well. Did you know the biggest danger to an unborn baby in a car crash is injury to the mother? However if you are in a wreck, even a fender bender, be check out at your nearest emergency room. It is possible for baby to become injured while you are ok.

A lap shoulder belt is necessary to provide the maxium protection. Both lap and shoulder belts should be snug.

1. Wear the diagonal strap between your breasts, moving the strap around the side of your bump.



2. Make sure the lap strap sits comfortably under your bump. If it is over your belly button then it is too high. It should go from hip bone to hip bone, as low as possible. Check frequently while driving to be sure both belts remain in place.
   

Sit back as far from the steering wheel as possible, and tilt the wheel toward your chest. A crash or even sudden stop could cause you to hit the wheel and cause injury to your baby.

Let others do the driving as much as possible during the third trimester!

Should You Have An Epidural?

When it comes down to it, there is no right or wrong answer. There are a number of factors to consider, and your choice should reflect those that you feel are most important to you.

Epidural Pros:
*Compared to other pain relieving drugs given during labor, such as Demerol or Stadol, an epidural will have the least effect on your baby. The medication given through the epidural does not reach baby, as IV medications do. IV medications can cause temporary respiratory depression and/or a lethargic newborn. These symptoms will persevere until the narcotic clears baby's system. Severe reactions of this type would require additional drugs to reverse the narcotic effects.

*Having an epidural can greatly reduce stress and fear for a laboring mother. It enables mom to concentrate entirely on the work to be done (pushing etc.) when the time comes, rather than the pain.

*Reducing pain while allowing mom to remain alert. An epidural should only work from mid-abdomen down, it will not cause sleepiness or sluggishness as narcotics will.

*Greatly assists in allowing the laboring mother to get the rest she needs prior to the exhaustive process of birth.

Epidural Con's:
*Invasive procedure, can lead to additional medical problems such as infection, severe headache if the spinal fluid is accidentally reached, allergic reaction to epidural medications, back problems.

*Placing the epidural requires mom to curl forward as much as possible, and stay as immobile as possible for several minutes. This can be fairly uncomfortable for a pregnant woman, much less one in labor.

*Many women will not be able to feel or move their legs while the medication is working. Not only somewhat disconcerting, but this temporary "paralysis" can impede mom's ability to push during delivery. Many doctors will turn off epidural pumps at the completion of dilatation for this reason.

*An extremely rare complication consists of the epidural medication migrating up above the diaphragm/lungs, essentially precluding the laboring mom's ability to breathe on her own. This complication is easily dealt with by medical personnel, by manually ventilating or "bagging" the mother until the medication wears off-but of course this is very frightening for the patient.

*Some women feel their need for any pain medication, epidural or IV, makes their birth experience a "failure". This is especially true for those who have planned a natural childbirth.

Like any decision in pregnancy, labor, delivery, and later raising your child, the decision to have an epidural is a personal one. Be prepared to be flexible when the time comes. In my experience some women who were sure they would need an epidural sailed through labor and delivery without one. Other times I have seen laboring mom's who were determined to have no drugs at all requesting an epidural fairly early on in labor. No matter what your choice, I wish you a happy, healthy delivery!