Pregnancy can be one of the happiest times of your life but with it can also come an overwhelming array of questions and concerns about what to expect. When it comes to parenting advice, let’s face it, there’s a ton of information available, but often it’s hard to discern what information is accurate or not. South Shore Hospital’s new Healthy Pregnancy and Parenting blog has been created by a trusted community of expert colleagues from our maternity team as well as other experts throughout our system of care. The main goal of the blog is to disseminate accurate, useful information focused on healthy pregnancy and parenting to the community at large.
The interactive platform of the blog allows readers to engage with our team of experts as well as other readers on a variety of pregnancy and parenting-related topics.
In the past, healthcare providers defined “term” to be the period of time from 37 to 42 weeks of pregnancy. This 5 week range was believed to be the healthiest time for a baby’s birth as most organs were thought to be adequately developed and functional; however, numerous studies over the last several years support a more narrowly demarcated range for “term” due to evidence that babies can experience different outcomes within that 5 week period.
As a result, the American College of Obstetricians and Gynecologists redefined “term” and created these 4 separate categories:
Early Term: Between 37 weeks 0 days and 38 weeks 6 days
Full Term: Between 39 weeks 0 days and 40 weeks 6 days
Late Term: Between 41 weeks 0 days and 41 weeks 6 days
Post-term: Between 42 weeks 0 days and beyond
Did you know that at 35 weeks, a baby’s brain weighs only two-thirds of what it will weigh at 39 – 40 weeks? Every week counts in fetal development. Unless there is a medical condition that necessitates an earlier delivery, babies are better off if they are born at full term. Babies born in early term can be at risk for jaundice, low birth weight, respiratory distress, and other conditions that are typically associated with premature babies and require medical intervention. For these reasons, organizations such as the March of Dimes and the Association of Women’s Health Obstetric and Neonatal Nursing developed campaigns to educate women and providers on the benefits of avoiding elective inductions and Cesareans; “elective” meaning these interventions are not medically necessary but performed due to the woman’s or provider’s choice.
For a low-risk pregnancy, this two week period is considered the optimal time for a baby to be born. All organs are fully developed and the placenta is typically healthy and functioning at full capacity. Babies born at full term have a lesser chance of experiencing negative outcomes; however, birthing a baby at full term is only half the picture. The method of delivery is an additional factor. Currently, one out of three women will deliver by Cesarean section in the United States. Cesarean involves the same risks as any surgical intervention (including risk of infection, bleeding, blood clots) and should be avoided unless medically necessary. The American College of Obstetricians and Gynecologists promotes Safe Prevention of the Primary Cesarean Delivery, or preventing cesareans for first time pregnancies in which there is one baby in a head down position at term. To avoid unnecessary cesareans, ACOG recommends redefining stalled labor, utilizing improved and standardized definitions for fetal heart rate assessment, and integrating non-medical interventions such as continuous labor support, among other suggestions.
Before defining a pregnancy as late term, your provider should confirm that the estimated due date is accurate. Because of an increased risk of stillbirth from 41 weeks on, ACOG states that special tests, known as antepartum fetal surveillance, “may be warranted” to assess the baby’s well-being. ACOG also notes that induction of labor between 41 weeks 0 days and 41 weeks 6 days “can be considered”.
During post term, there is evidence that risks for both baby and mother increase. In addition to the increased likelihood of stillbirth, there is also increased risk of forceps or vacuum delivery, cesarean delivery, shoulder dystocia, meconium aspiration, neonatal seizures, and low Apgar scores. Per ACOG, induction of labor after 42 weeks and 0 days and by 42 weeks and 6 days of gestation “is recommended”, due to this elevated risk.
As you can see, there’s a Goldilocks component to birth – best not to deliver too early or too late and full term is “just right”. You may begin to feel tired of being pregnant when you’re in the latter part of your third trimester. It may make sense on an emotional level that you want to meet your baby sooner rather than later but be aware of the potential consequences and let nature take its course. Early delivery is justified when there is a medical complication but, for low-risk pregnancies, remember what the March of Dimes promotes: “healthy babies are worth the wait”.
Recent history has shown an overall rise in induction and Cesarean rates, while, at the same time, attendance in childbirth classes has declined. Could there be some relation between these two trends? We don’t have a definite answer but one could surmise that patients who are inclined to choose elective induction or Cesarean might think twice after taking a childbirth class and discussing the risks and benefits of these options.
The value of on-site prenatal classes has been questioned ever since high quality, web-based and digital information came on the scene. You might ask, “Why waste the time on on-site classes when I can get similar content online and have the freedom to review it at my own pace?” While it’s true there are plenty of websites and apps that can answer your questions and help you gain knowledge about birthing and parenting, there’s still a lot to be gained from an on-site class. Benefits include the opportunity to bond with your birth partner, a chance to meet other couples going through the same life-altering experience, and the ability to interact face-to-face with the instructor and ask questions.
Here are 4 more major reasons you should sign up for prenatal education:
1. Reduce Fear & Increase Confidence
In prenatal class evaluations and postpartum surveys, birthing mothers and their partners routinely comment on how classes reduced their fear of labor; made them feel more confident about birth, breastfeeding and parenting; and helped the partners become more involved in the pregnancy. In a childbirth class, for example, you will learn about the connection between fear, tension and pain in labor and ways to maintain a relaxed and confident state to reduce the symptoms of anxiety and tension.
2. Gain Knowledge of Evidence-Based Guidelines
Prenatal education classes of the highest quality are routinely updated with current research and relevant resources for class participants. Recommendations are constantly changing and organizations such as the American College of Obstetricians & Gynecologists, the American College of Nurse-Midwives and the American Academy of Pediatrics regularly revise their guidelines and policy statements. For this reason, even second- and third-time moms will benefit from re-taking prenatal education classes. As an example, in just the last couple of years, new CDC guidelines have been instituted which recommend that every pregnant woman receives a pertussis booster during each pregnancy to protect the baby from whooping cough. Chances are several new recommendations are in place since the delivery of your last baby.
3. Develop Awareness of Your Options
In childbirth education classes, participants learn about pharmacologic pain relief for labor, natural comfort measures and risks and benefits of different types of medical interventions. These classes also cover effective ways to relay your birth preferences and communicate with your provider when you have questions or concerns. Breastfeeding classes teach a variety of breastfeeding holds and, for special situations, alternate ways to feed breast milk to your baby. Newborn care classes offer an assortment of comfort techniques to soothe your baby.
4. Practice Hands-On Techniques
In birthing, breastfeeding and newborn care classes, participants practice breathing, labor positions, relaxation exercises, effective breastfeeding holds, infant massage, dressing the baby, diapering and many other techniques. You will also learn some of these skills at your birth site after you have the baby; however, the first couple of postpartum days are not the best time for retaining information due to lack of sleep, visitor interruptions and being overwhelmed by your new beginning. Taking a prenatal education class gives you time to absorb the information you need to know so postpartum practice at your birth site can reinforce what you learned before.
The best prenatal education is research-based, objective and presents various options in care. Birthing and parenting information can be delivered in an on-site class, online or as part of group prenatal care such as Centering Pregnancy. Make sure your class is completed by one-month before your due date (earlier for twins) just in case you go into labor on the early side. Becoming a parent is an amazing life-changing event that should involve the preparation and attention it deserves. Get off to the right start and take time to learn, practice and ask questions while you can.
All South Shore Hospital prenatal classes are taught by experienced nurses and lactation consultants. To register for childbirth, newborn care or breastfeeding classes at South Shore Hospital click here.
Are you newly pregnant and full of questions you can’t wait to get answered? Are you wondering which fish are safe to eat and which are not? Whether or not you can still dye your hair? Or which medications are OK to take while pregnant? If so, then this FREE Early Pregnancy Education class is for you.
Taught by South Shore Hospital nurse-midwife, Nannette Landry, and nurse-practitioner, Jaimie Kullack, this class will give you the opportunity to ask all the questions you’ve had ever since the test showed you were positively pregnant.
The class includes the following topics:
Your options for prenatal care
Genetic screening choices
Ways to manage common discomforts of pregnancy
Safe prenatal exercise
Healthy weight gain
Get off to a great start by educating yourself in early pregnancy. You may be reading lots of information on the internet but how do you know which pieces are based on valid, evidence-based material? In this class you will hear the real deal directly from the experts.
FREE Early Pregnancy Education Class Registration Details: Who: Any woman in early pregnancy and one support person When: Tuesday, January 20, 2015 at 6:30 – 7:30 pm Where: Crown OB, Quincy, MA
When: Tuesday, January 27, 2015 at 6:30 – 7:30 pm Where: Crown OB, Pembroke, MA
To register or learn about future dates for this class: Call 617-479-6636
Join us and meet other women that are experiencing pregnancy just like you!
Couvade Syndrome or “sympathetic pregnancy” is a condition in which a partner experiences some of the same symptoms as his or her pregnant companion, such as bloating, morning sickness, weight gain, and food cravings. As real as these symptoms may be for the afflicted, this syndrome is not officially recognized as a medical condition and much remains unclear about the details surrounding it. The rate of incidence is a bit murky due to inconsistencies in reporting - some partners may be hesitant to admit having pregnancy symptoms. Also, researchers are not yet sure what provokes the syndrome. Is it a psychosomatic condition, i.e. a physical condition caused by mental factors? Or is this phenomenon more biological in nature and due to hormonal changes in the partners of expecting mothers?
These questions involve a bit of a “chicken and the egg” conundrum and are not fully answerable at this time; however, the role of hormonal changes in the male partners of pregnant women has been studied in more depth over the last decade. For some time, researchers have known that new dads have lower testosterone levels than single men and also experience a rise in prolactin and oxytocin, hormones that promote love, nurturing, fidelity, and bonding between a man and his partner and baby.
Findings from a more recent study out of the University of Michigan suggest that a drop in testosterone may even start occurring during the pregnancy and not just after the birth. While testosterone can play an important role in a man’s desire and ability to conceive a baby, lower levels after conception can set the groundwork for a healthier and more successful parent-child experience and relationship; that is, this biological change could promote a gentler approach to fatherhood.
Couvade Syndrome (from the French word couver, meaning “to hatch) may seem strange to some at first; however, there is comfort in knowing that the partners of pregnant women are also becoming biologically prepared to parent. While it may take a village to raise a child, having two prepared parents, rather than just one, is not a bad start.