How to prepare for pregnancy: from planning to birth
Preparing for any big business makes life a lot easier. - and pregnancy is no exception. Carrying a child is inevitably stressful, but planning helps minimize it. However, not all women who think about a child have someone to equal themselves with, and the first visit to a doctor may even frighten someone. Last week we raised the question of whether it is possible to play sports during pregnancy. This time we asked obstetrician-gynecologist Natalya Ivanova, as well as the founders of the MedOK clinic network, Elya Logina and Lisa Maslova, about how in principle to approach such an important and difficult life stage as pregnancy and childbirth: why do you need planning, what should be prepared and what prejudices should not be believed.
Why plan a pregnancy and how to do it
Unplanned pregnancy naturally becomes a cause for stress, because the parents do not necessarily lead a lifestyle focused on the health of the unborn child. However, this can be avoided - it is precisely for this that pregnancy planning exists: it helps to conceive and bear a healthy child. Preliminary analyzes and treatment will take not so much time and will not cost so much compared to correcting various complications later, when the child is already conceived. Psychological determination is also important so that future parents or parents are prepared. Overseas planning has been around for a long time, but our doctors in recent decades have openly supported and promoted such an approach.
The most important thing is the prevention of health. Roughly speaking, it is necessary to prepare for pregnancy all adult life. This is not as scary as it sounds, you just need to undergo a minimal examination by a gynecologist at least once a year, donate blood for hormones in order to be confident in the processes occurring in the body, and to cure diseases in a timely manner. Preparation for a specific pregnancy should begin no less than three months before the intended conception - both from a psychological and physiological point of view. All those who will take part in the life of the future child should be aware of their responsibility. It is not necessary to postpone the trip to the psychotherapist if there are doubts: the birth of a child is associated with a large psychological burden, and consultations with a specialist before pregnancy will help make an informed decision.
Pregnancy is a difficult condition for the body, and before it you need to gain strength, gradually improving your lifestyle. You should not sit in a confined space and wait until the pregnancy comes. This is a good chance, in principle, to start living healthier: sleep, walk in the fresh air, get regular exercise, eat a balanced diet and give up bad habits, including alcohol and, of course, smoking. Most likely, you will need to take vitamins, but all appointments should be made by a doctor, since hypervitaminosis is no less dangerous than a lack of vitamins - the same is true for minerals. If you need help to quit smoking, you can always contact a psychologist.
Already at the planning stage, you need to choose a clinic and a gynecologist who will lead you as a patient and send you to a full general examination by other specialists: Laura, an optometrist, a dentist, a neuropathologist. If you have been under observation at a specialized doctor for a long time, you also need to discuss your future pregnancy with him. It is important to pay attention to dentistry, because dental caries and dental diseases mean the presence of a chronic infection that can affect the health of the child.
Can diseases be contraindications for pregnancy?
Various diseases and conditions can affect pregnancy. For example, some medications are strictly prohibited for pregnant women, so when planning a child, a woman must tell about all the drugs she has been taking or has taken recently. There are many contraindications precisely in the early stages, when the fetus is especially vulnerable. The easiest way to reduce the risk is to carefully read the annotations and not take medications marked “Prescribed by a physician,” even if at first glance they are safe herbal preparations.
Drugs prescribed to women with depression or other psychological disorders may not be combined with pregnancy. Their reception should be discussed in advance with your doctor and if necessary, change the medicine, an obstetrician-gynecologist should also be aware of them. In the case of an unexpected pregnancy, you can not cancel the drugs yourself and you need to immediately consult a doctor.
HIV-positive women can conceive and give birth to a perfectly healthy child. There are a lot of discordant couples, when one of the parents is infected, and the second is not. Such patients receive prophylactic treatment and successfully give birth under the supervision of doctors. At birth, they come with special preparations. If a woman has cervical cancer, then she gives birth with a cesarean. HIV-infected women are also required by law to operate: it is believed that a cesarean section reduces the risk of infecting a child. However, she can write a failure and give birth in a natural way - the same applies to breastfeeding.
How to choose a doctor and clinic
When choosing a clinic, you need to understand that the relationship between the patient and the doctor must be a partnership, and nothing else. In no case should the patient feel like a begging party, and the doctor should show indulgence, the woman should have confidence in the woman on a subconscious level. A doctor should always explain everything with a simple language, explaining in detail why examinations, medications and procedures are prescribed and why, and not just put before the fact.
When choosing a doctor, you can focus on your psycho. To those who are used to strictly conduct business, a cheerful doctor may seem unprofessional, and vice versa. For nine months, the patient will need to feel free to openly discuss everything with her doctor, sometimes call up with him at night and ask questions - it is therefore important that both of them be psychologically comfortable with each other. Ideally, you should first choose a clinic, and then, according to the psycho type, select a doctor for yourself. This is also possible in an ordinary women's clinic: to do this, you need to write a statement addressed to the manager asking you to transfer you to another doctor.
What needs to be tested
According to the standard scheme, it is necessary to pass all general tests: normal and biochemical blood tests, urinalysis. Be sure to check for sexually transmitted diseases and ToRCH infections. If the test results require treatment, it should be done before pregnancy. In no case should you conceal information about the STDs that have been transferred: there is nothing to be embarrassed - the doctor must be aware of all the details.
ToRCH is an abbreviation for the names of infections: toxoplasmosis, rubella, cytomegalovirus and herpes. Pregnancy reduces immunity, which in turn can lead to activation of processes that are already running, but occur in a sluggish form. ToRCH infections have the most detrimental effect on the establishment of an unborn child's systems. So, if an unexpected pregnancy reveals a rubella in the acute course, then, unfortunately, it is recommended to terminate the pregnancy. Toxoplasmosis caused by cats is also dangerous. In order not to get infected with them during pregnancy, it is better to entrust someone else to clean up after pets.
Cervical cancer and breast cancer occupy the fourth and first place, respectively, in the prevalence of cancer among women, so it is important to undergo regular examinations. Before pregnancy, Schiller or more sensitive tests must be carried out to see if there is a change in the cervix; You also need to find out if your relatives had cancer of any location. It is worth checking for the human papillomavirus: it is not known for certain whether HPV causes cancer, but studies show that it was detected in all women with cervical cancer. Modern methods, including genetic tests, allow us to say with certainty whether a woman has a predisposition to cancer.
When planning a child, not only the expectant mother, but also the father should pay attention to their health. Men must test for STDs, ToRCH infections, and be examined by a general practitioner and urologist. Male infertility is a common phenomenon, partly due to the fact that inflammatory diseases in men are not so acute, they can simply be overlooked or under-treated.
If there is such an opportunity, it would be good to do genetic tests on the eve of pregnancy in order to eliminate the danger of the most frequent hereditary diseases. Some people need to do this without fail. For example, women after 35 years, those who have frequent miscarriages, and those who have children with chromosomal abnormalities in the family, should be tested for the elimination of chromosomal diseases. If a pregnancy has already been interrupted, then this must also be told to the doctor.
How does a woman's age affect pregnancy
The popular opinion that after 30 years a woman is considered to be "old-aged" has long been outdated. Now women, in principle, tend to give birth later. This is due to a variety of factors, including the level of medicine. The achievements of modern science allow a woman of reproductive age to worry less that she will not have time to give birth to children, if she does not start at any particular moment. If a woman is healthy, fully examined, she has material and psychological readiness, then there is no reason not to conceive a child.
It is necessary to understand that during the life we pick up various infections and carry diseases of varying severity; some diseases become chronic. The age of 35 years, by which doctors determine women with a higher risk of complications in pregnancy, is approximately chosen, nothing concretely occurs between 34 and 36. However, it is statistically established that the majority of chromosomal abnormalities in the fetus and cases of miscarriage fall to women over 35 years old.
What can cause infertility
Infertility is the inability to conceive a child during the first year of regular attempts. You should not worry about a year, especially if sex life is not very frequent. After a year of unsuccessful attempts, one has to start testing: first of all for men, because they are easier to examine - the female reproductive system is much more complicated. A man must be tested for infections and semen.
Then begins the study of women's health. It includes everything spoken above: breast analysis, ultrasound, flora, HPV, chlamydia, ureaplasmosis, leukoplasmosis, genital herpes - all of which can affect the possibility of conception. Examination of the cervix is done with a microscope, because changes are not always visible to the naked eye. A common cause of female infertility is a previous inflammatory disease. Obstruction of the fallopian tubes or inflammation of the cervix caused by HPV infection also affect the ability to conceive.
In our body, everything is regulated by hormones, so the cause of infertility can be hormonal diseases, which do not allow the egg to mature. In this case, you can stimulate ovulation - cause superovulation. It happens that a woman cannot become pregnant for psychological reasons, since a high level of stress also affects hormonal processes. For the same reason, women often become pregnant after adoption — a psychological block is being removed, which has been exposed to constant unsuccessful attempts.
What can and can not be during pregnancy
Pregnancy is not a disease. Do not believe the prejudices that during pregnancy it is best to lie unmoved for all nine months. Nothing of the kind - go in for sports and live life to the fullest. If the pregnancy was planned, everything proceeds without pathologies and the woman feels good, then there is no need to change her usual way of life. If you are involved in sports, then go on, the main thing is not to go to extremes. Ride a bike, eat your favorite food, have sex; Many and feel great at the wheel until the last weeks.
From the first days of pregnancy, you can not soar legs, put mustard plasters and banks, go to the bath - a temperature increase can adversely affect the fetus. Running in the first and second trimester may even facilitate the course of pregnancy, but strength exercises can increase the tone of the abdominal muscles, so just in case physical exertion must be spoken with a doctor. Swimming is usually recommended, as the negative load on muscles and joints is significantly reduced in water. If there is no threat of termination of pregnancy and placental abruption, then you can fly on an airplane for the entire duration. Another question is that airlines will not let you on board after 7 months by their own rules.
A popular recommendation to carefully dye hair and do a perm was not accidental: for most of these procedures, one has to breathe the acrid smell of ammonia. If the procedure is gentle enough, and the room is well ventilated, you can also dye your hair.
The body during pregnancy will certainly change. The standard weight gain is 10 kilograms, but everything is very individual, and the smaller the initial body weight, the greater will be the set. Weight changes are not limited to: there is drowsiness, shortness of breath, frequent urination, swelling, pigment spots, which usually themselves pass after pregnancy; in the first months, the perception of habitual tastes changes, and in the last months - insomnia arises. Of a good woman, it is often noted how strong their hair and nails have become and how fast their hair grows, many have a better skin condition, but acne can appear. However, different women have hormonal changes in different ways.
Doctors should not bully patients with all the possible complications in the world. Most likely, none of them will happen to the pregnant woman, while the psychological state will be compromised - the woman will be afraid all the time. The risk of absolutely all complications cannot be excluded. However, the doctor must necessarily explain the most likely risks, depending on the history and characteristics of each particular pregnancy. If anything is to be feared, it is depressed during and after childbirth. This is a very real problem that cannot be dismissed and with which you can help. You need to monitor your mood, listen to yourself and do not write off your experiences on hormones alone.
What to do in each trimester
The first trimester is mostly tests, the second is highly specialized doctors, and the third is constant communication with the gynecologist. The frequency of visits to the gynecologist is determined by the course of the pregnancy itself, but according to the standard it is 12 visits. The higher the gestational age, the more often the meetings become.
First, pregnancy should be properly diagnosed: check the growth of the hormone hCG, and also make sure that the pregnancy is uterine. In the eighth week, fetal heartbeat should be monitored. After that, it is necessary to go through all the tests once again: pregnancy affects all body systems. Up to 12 weeks, Prisca is being studied for chromosomal abnormalities, at which point the probability of abnormalities in fetal development can be established. In the first weeks, the health of the unborn child is laid and it is especially sensitive to adverse effects.
After 12 weeks, in the second trimester, highly specialized physicians should identify possible problems that may affect the course of pregnancy. It is convenient to do this at this time, since the fetus is not so vulnerable. After 20 weeks, an exchange card is issued - the main document of a pregnant woman. You should always carry it with you so that when you are unexpectedly hospitalized, the doctor will know about all the analyzes and features of the course of pregnancy. If it is not present at birth, then the woman will be placed in the observational department for untested women and women with pathologies.
In the third trimester to the gynecologist want most often. CTG is done - a study of the fetal heartbeat - and dopplerometry, showing how the fetus is supplied with oxygen. Now you can easily buy a gadget that allows you to listen to the child's heartbeat at home through headphones. This, of course, is not a professional examination, but for your own comfort, it is quite suitable.
Pregnancy and childbirth are like two different specialties: it rarely happens that one specialist does this. Most likely, the leading pregnancy doctor will recommend his colleague, whom he trusts. Many enter into contracts for childbirth with a particular doctor or hospital, but this is guaranteed only service. Any doctor is interested in that the birth was successful and from a legal point of view, and simply from the point of view of professional ethics - by contract or without. Childbirth is the collaboration of two people: a woman and a doctor. As with the management of pregnancy, it is important to establish contact - it also affects the success of childbirth.
Should we be afraid of epidural anesthesia and cesarean section?
Многие женщины боятся эпидуральной анестезии, но, когда понимают, как без нее больно, вводить препарат уже слишком поздно. Бояться анестезии не нужно. Никто не заинтересован в роддоме в том, чтобы навредить ребенку или женщине. Now there are schemes for the selection of anesthesia drugs in certain doses so that they do not cause any harm. The prejudices that in light childbirth the child will not be purposeful, and do not withstand any criticism.
Now all over the world a very large percentage of cesarean sections. Young doctors are afraid of legal consequences, and because of this fear, they make a choice in favor of a caesarean section, because obstetrics is the most "complication" branch of medicine. For some doctors, it is easier to stand for half an hour at the operating table than for a day of childbirth. Obstetrics is the art of predicting childbirth and catching a delicate moment when giving birth through the birth canal is fraught with complications, and only then resort to caesarean.
The hard indications for cesarean are, firstly, a longitudinal scar on the uterus, that is, if a woman had a cesarean section before. In this case, it is simply impossible to deliver the baby through the birth canal: uterine rupture can occur at any time, and it is almost impossible to determine if there is a rupture - and not all maternity hospitals are provided with quick help in case of bleeding. Secondly, caesarean can be planned: for placenta previa, for HIV-positive mothers, for women who have had cervical cancer, for a particularly narrow pelvis or large fetus, and so on. Emergency caesarean is prescribed, in particular, if the contractions have begun, but labor activity does not progress for a long time.
Childbirth through the birth canal, if there are no contraindications to it, is of course preferable to both the mother and the fetus. Firstly, a woman does not remain with a scar on the uterus and she will not have a risk of much more severe postoperative and post-anesthetic complications. This is also good for a child, as he is gradually being prepared for life outside the mother's body, passing through the birth canal. There is also a danger that a child with an Caesarean will have an excess of anesthesia. Somehow it is impossible to be safe here - you can only rely on the competence and professionalism of the doctor.
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