The Down and Dirty of Pregnancy Education

Pregnancy has been romanticized and villainized by pop culture for decades and, let’s face it, that one high school sex education class didn’t really cover a whole lot other than how people get pregnant. Unless a close friend or family member has given birth when you were both old enough to remember and interested enough to care, pregnancy is likely a mystery for you.

When my husband and I decided to start our family, I started doing research. I thought I learned so much, but the absolutely amazing doula and childbirth educator that taught my natural childbirth class proved me wrong. There is just so much you don’t know until you experience it and that can be scary. So here is the pregnancy education class you never got, down and dirty.

The rate of miscarriage is 20% in all pregnancies and may be as high as 70% in first pregnancies.

This is not exactly something that is covered in detail in your high school sex ed class, but unfortunately many women find this one out the hard way. 20-25% off all known pregnancies end in miscarriage, likely due to chromosomal error or another unavoidable mishap. As many as 50-70% of first pregnancies likely end in miscarriage, but many women do not realize they are pregnant right away and assume they had a late period. The good news is, the rate of miscarriage drops after a heartbeat is detected at 6-8 weeks and then to less than 2% by the time you reach 14 weeks.

Your doctor doesn’t care until you’re eight  weeks along

It depends on your doctor and your practice, but most doctors won’t see you until you are suspected to be eight weeks pregnant. Why? Well there isn’t a whole lot to do until then. At eight weeks the baby and its heartbeat should be detectable by transvaginal ultrasound. Before then, the rate of miscarriage is much higher as well, so as crass as it sounds, it may be a waste of both of your time. Now, if you have a history of pregnancy complications, including recurrent miscarriage, they may see you sooner to mitigate those issues.

Morning sickness comes at all times and in all forms, but it is a good thing!

Some women never experience morning sickness, others (like me) experience nausea without vomiting, and others are running to the toilet multiple times a day. All are completely normal.  Most of the time morning sickness correlates to times of the day your stomach may be extra empty (right when you wake up), but that doesn’t necessarily mean you’ll feel it in the morning.  I always felt ill in the late afternoon. Generally, if you’re going to get morning sickness, it will start between four and nine weeks and peak between seven and 12 weeks. Most women experience relief around the start of their second trimester (14 weeks), but some continue to have it throughout pregnancy.

Did I mention morning sickness is a good sign? Morning sickness has been found to have a positive correlation with a viable pregnancy. So if you find yourself hanging out around the porcelain throne all day when you’re expecting, try to remind yourself you likely have a lesser chance of miscarriage.

Every stereotype about pregnancy has an equally true and normal counterpart

Beautiful skin and hair, heartburn, morning sickness, cravings, aversions, the list goes on of all the stereotypes about pregnancy we not only see on television, but hear from friends and family.  Every one of those items could definitely be true, but for every woman that experiences one of those, another experiences the exact opposite in pregnancy and it is totally normal. Not feeling extra randy in the second trimester, but actually turned off? Normal. Hair falling out instead of growing lusciously? Normal. Not having any cravings at all? Normal. Once you start reading books on pregnancy, you’ll find out most reactions are normal and the ones that aren’t you’ll likely have a gut feeling to talk to your doctor or midwife about (headaches that won’t go away, excessive swelling, etc.)

You don’t really get to eat more, but what you eat matters

If you are only carrying one baby, and start at a healthy weight, your doctor will only ask you to gain 25-35 pounds throughout pregnancy.  You’ll also only get an extra 300-500 extra calories to eat each day, and only in the last two-thirds of pregnancy. To put that in perspective, 300 calories is a serving of almonds and yogurt. However, the types of food you’re eating really matter once the placenta is formed, because then the baby gets all its nutrients from your body.  When you’re feeling sick in the first trimester, don’t worry too much about not being able to stand the sight of vegetables, because the baby is still getting most of its nutrients from a yolk sack.

Diet changes

Speaking of diet, there are lots of things you need to cut back on or cut out while pregnant. Of course there is cutting out alcohol and recreational drugs altogether, but there is so much more.  Caffeine should be limited to the equivalent of two cups of coffee a day or less. Fish and lunch meat should be eaten in moderation. Fish can be high in mercury (bad for baby) and lunch meat poses a higher risk of foodborne illness. Those over easy eggs should be cooked until they’re medium and your steak should too. Just when you thought it couldn’t get any worse, you’ll have to cut out that cookie dough too. Here is a list of things to avoid or consume in moderation.

Kiss ibuprofen goodbye

Once you see that second line, you get to kiss a lot of medications goodbye. While there are medications that are safe during pregnancy (and your doctor will help weigh risk versus benefit) you will likely be instructed to avoid medication as much as possible. Many medications have been linked to adverse effects on a developing baby and for other medication the risk is unknown.

No more wild rides

You may be aware that a pregnant woman shouldn’t ride a roller coaster, because you’ve seen the warning labels at amusement parks. Did you know about horseback riding, underwater swimming, trampoline jumping, and more? Most doctors will both restrict the activity of pregnant women and the amount of weight they lift (usually 35 pounds or less) to minimize the risk of injury, strain, and miscarriage. Plus, once your belly is out to the wall, you’re just downright clumsy. There is a silver lining though, you aren’t allowed to shovel or mow the lawn either.

Pregnancy sleep

Pregnancy is different for everyone, but sleep disruptions are fairly universal. The first trimester women often feel like they are constantly recovering from the flu due to their bodies working overtime, morning sickness, and hormonal changes. Sleep comes almost too easily then, but it never seems like enough. Many women find relief in their second trimester, but by the time the third trimester hits between leg cramps, restless leg syndrome, nasal congestion, and a larger body, it may be very hard to get comfortable and stay asleep. Not to mention that many women experience very vivid, sometime frightening dreams that will wake them up.

Your first pregnancy will likely go to 41 weeks

That’s right, your first viable pregnancy will likely go all the way to 41 weeks and one day according to the statistics. So forget counting down to that 40 week due date and buckle up a bit longer. Be sure you like your doctor too, because some get antsy after 40 weeks and want to induce labor, but unless you or the baby or showing signs of distress there isn’t really a reason to do it. Even the American College of Obstetricians and Gynecologists recognizes this and makes a distinction between late term and postterm pregnancies. According to them, your baby isn’t technically “late” until you pass 42 weeks. Sorry, mama.

You should labor at home as long as you can

Labor is generally broken into three stages, but we really only see stage two on television. The first stage usually lasts 12-19 hours. That sounds incredibly frightening, but labor doesn’t happen the way it does on TV. At first you may not even be sure you’re in labor. Contractions slowly intensify, become longer in duration, and closer together. During the first stage of labor most women are comfortable sleeping, eating, walking and socializing. Laboring at home will then not only be more comfortable (no wires, interruptions, you can eat whatever you’d like), but it may also make the experience go by faster. Plus, hospitals don’t like women to be there very long (they won’t even admit you until you’re 4 cm dilated) so the longer you are there the more likely you are to have unnecessary interventions.

Even if you want drugs, you won’t get them right away

You can request medication as soon as you get to the hospital and they confirm you’re in labor, but that doesn’t mean they will scoot along and get them to you right away.  Many doctors want to wait until you are at least 5 cm dilated before giving medication like an epidural.  Since epidurals block signals your body is sending to reduce pain, they are also known to prolong the process of labor and therefore encourage further interventions. If you want to use painkillers, I do not blame you.  You may want to learn some other coping techniques though so you can put off the pain meds for a while so labor isn’t slowed down.

Rate of Caesarian Section in the U.S. is crazy high

A Caesarian Section (c-section) is a lifesaving procedure for both mother and baby and the number of people who have been able to live because of it are almost innumerable. With that said, they happen way more in the United States than most other western countries. It’s about one in every three births which is twice as high as the World Health Organization recommends. Why?  There are many factors that may be playing into it. The U..S medical system has long put time limits on how long a woman can be in labor, so if you’re taking longer than they think you should you may be at risk for more interventions and therefore at higher risk or requiring or getting a c-section. Many Western European countries have nurse midwives, who are specifically trained in natural childbirth, attend births where in the U.S. we have trained surgeons doing the job. You can’t really blame people for doing what they know. The documentary, The Business of Being Born, though very bias to natural, at home birth, gives a good explanation of why this happens.

There are still hundreds of more things to know about pregnancy and birth and there is no way any one person could ever know them all completely. If you’re planning a family or are pregnant, the best places to seek knowledge and advice are your doctor or midwife, childbirth educator or doula, and the American Congress of Obstetricians and Gynecologists. They will be able to give you the best, most up to date information to help you make informed decisions

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