Pregnancy is a unique experience and one that you will want to enjoy while doing what’s best for your baby. Until recently, however, pregnancy did not always result in a healthy infant and mother. But today great progress has been made – not only in understanding the risks to a baby’s natural development, but also in knowing what a mother needs to do to successfully meet the challenges of pregnancy and delivery.

Normally, the development of a baby takes 38 weeks (8.5 – 9 months) from conception. It is during this time that a lot of hormonal and metabolic changes occur inside a mother’s body.

Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time. Lets have a look at all the three trimesters of pregnancy and how a mother can keep herself healthy and her baby safe by avoiding various complications.

The first three months of pregnancy will be exciting for you. It is unlikely for you to put on much weight during this stage as it is during the third week after conception that your pregnancy is confirmed. Contact your doctor or gynecologist and arrange for your first visit to an antenatal clinic between weeks 8 and 12. You will be aware of the speeding up of your metabolism.

You will start noticing the feelings of fatigue and nausea. You may also notice that your hands and feet feel warmer, due to the increase in blood volume. You may also find yourself feeling thirstier than usual, as your body signals that it needs extra fluid. Although you won’t look different, your baby is starting to develop and his/her brain and spinal cord are beginning to form.

By week nine you should be thinking about antenatal tests.

Nutrition for Mother and Baby
The first three months of pregnancy are in many ways the most crucial for your baby’s healthy development. A poor diet may affect the formation of organs and the full development of body systems, as well as leading to a reduced birth weight. Certain vitamins and minerals are particularly important which are mentioned below.

KEY NUTRIENTS: Of the key food types, protein is needed in large amounts by the mother for building and repairing cells, muscles, organs, tissues and hair and for enzyme production. At least half the calories should come from carbohydrates, mainly in the form of starch. Of the key nutrients needed at this time, folate and iron are vitally important. Folate is a B vitamin used for cell division, red blood cell formation, and development of the baby’s nervous system. Iron is needed to transport oxygen and carbon dioxide to make enzymes and to generate energy.

Action Plan
During these first few weeks, you will be coming to terms not only with the physical changes to your body but also with the impact the new baby is going to have on your life. The advice on the next page may be helpful.

Take Time to Adjust
You will experience emotional highs and lows, and you may feel more exhausted than ever before. Do not rush decisions: take time to adjust and make plans.

Improve Your Diet
Folic acid supplements are advised at least 6 months pre-conception, to decrease the risk of a condition in the baby known as ‘Spina bifida’. The chances are that you lack the full complement of nutrients needed while your baby’s organs are forming. Try to eat fresh organic food, take a good multivitamin and a folic acid supplement, and avoid tea, coffee and highly processed foods.

Get Enough Sleep
A good night’s sleep is the best foundation on which to start each day.

Exercise Sensibly
Do not force yourself to exercise at this stage of pregnancy if you do not feel like it. Undertake gentle form of exercise such as walking and stretching.

Prepare Mentally
Take time out each day to be quiet and calm and to reflect upon what is happening to you.

Common Problems in the First Trimester

The following are some of the minor ailments that are common in early pregnancy:

Morning Sickness:
About half of pregnant women experience morning sickness. It is most likely to affect those with nutritional deficiencies. Vomiting is the body’s way of eliminating toxins that result from the development of placenta and associated hormones.

SYMPTOMS: Nausea and vomiting, excessive salivation, disinclination to eat and resulting fatigue.

DIET & NUTRITION: Your need for vitamin B6 and B12, folic acid, iron and zinc increases in pregnancy. Nausea is linked with B6 and zinc deficiencies in particular. Brown rice, soup, mashed potatoes, pickles, lemonade, apples, bread, noodles, cakes, juices, mint and crackers are some of the foods that help relieve nausea.

KEY TIPS:

Avoid empty stomach.

Eat small/frequent meals.

Avoid smell and taste of foods that upset you.

Drink plenty of water to avoid dehydration.

Hyperemesis
Severe vomiting during pregnancy affects one in 100 women.

SYMPTOMS: Inability to keep food down and severe repeated vomiting, dehydration which may lead to depression and a feeling of isolation.

DIET & NUTRITION: Pregnant women need extra zinc and vegetarians often already lack zinc. Zinc-rich foods include ginger, poultry and almonds etc. Magnesium is lost through vomiting so have plenty of nuts and dried apricots. Potassium-rich foods such as bananas, melons and fruit juice are essential after sickness.

KEY TIPS:

Get up slowly and avoid sudden movements. Have a bed time snack to prevent blood sugar levels dropping at night.

Mouth Problems
Hormonal changes during pregnancy also cause gums to thicken and soften, which may lead to tooth and gum problems.

SYMPTOMS: Inflamed gums are common and can lead to bleeding gums, blisters on the lips, loose or itching teeth and unusual taste sensations.

DIET & NUTRITION: Eat plenty of foods rich in Vitamin C. Also avoid eating large amounts of sugar and starch.

KEY TIPS:

For cold scores, cut fresh lemon balm leaves and apply to the affected area of the lips.

For toothaches, put 1-2 drops of clove oil diluted in almond oil on cotton wool and dab on to the affected tooth.

Have regular dental check-ups.

Threatened Miscarriage
It is thought that one in three pregnancies miscarries. The causes of miscarriage include nutritional deficiencies, hormonal imbalance, infection and auto-immune or chromosomal foetal disorder.

SYMPTOMS: Backache, abdominal cramping pains and spots of blood and bleeding.

DIET & NUTRITION: Take multivitamins every day. Also take Vitamin E supplement such as sweet potatoes and green leafy vegetables.

KEY TIPS:

Avoid tea, cold drinks, caffeine and smoking.

Take plenty of rest.

Avoid hot baths.

Second Trimester
(14-17 weeks)

During this stage of your pregnancy you may well be ‘blooming’, with shining hair and glowing skin. You should by now know the results of most antenatal tests and generally be feeling more confident and comfortable about your pregnancy. Sickness and exhaustion should have lessened, while appetite and energy should have returned.

Nutrition for Mother and Baby
By the second trimester, the nausea and extreme exhaustion of early pregnancy should be easing off. You will find that your energy levels increase and your appetite improves. Diet continues to be of great importance and certain nutrients are essentially valuable at this stage of the baby’s development.

KEY NUTRIENTS: Calcium is needed to form strong bones and teeth, to support muscle growth and to control nerve and muscle function in your baby. Magnesium is also important for the baby’s development.

Action Plan
Bear in mind the following points:

Eat For Two
It is not more food that you need but more vitamins and minerals as your baby takes what it needs.

Stay Fit
As your energy returns, you may feel like exercising again. But avoid jerky exercise movements or too much bending and lifting. Gentle stretching is preferred to strenuous aerobic exercise.

Common Problems in the Second Trimester
Even though you are feeling better and you may be comfortable about your pregnancy now you may still be affected by the common problems that tend to occur during this trimester.

Heartburn
Up to 80 percent of pregnant women suffer from heartburn, a burning feeling in the chest and throat.

SYMPTOMS: Sensation of burning acid in the throat, nausea and unpleasant taste in the mouth.

DIET & NUTRITION: Heartburn is aggravated by eating large meals and by certain combinations of foods. Acidic food should never be a part of the same meals as Alkaline foods (carbohydrates).

KEY TIPS:

Sleep with several pillows to keep your upper body straight.

Avoid bending over suddenly.

Limit fluid intake during the meals.

Anemia
Many pregnant women particularly those expecting for the second time are anaemic. This occurs if the level of oxygen-carrying haemoglobin in red blood cells falls below normal.

SYMPTOMS: Dizziness, palpitations, pale skin, lethargy, general malaise and constipation.

DIET & NUTRITION: There are three main causes of anaemia: deficiency in iron, folate or vitamin B. Iron deficiency is the most common in pregnancy as a result of the demand from the baby. To prevent iron deficiency, eat plenty of green leafy vegetables, cherries, fish and poultry. To remedy vitamin B deficiency, eat eggs, milk and cheese. Eat steamed green leafy vegetables.

KEY TIPS:

Eat vitamin C-rich foods such as oranges.

Avoid too many calcium-rich foods.

Backache, Pubic Pain and Sciatica
Backache in pregnancy often occurs as a result of ligaments and joints being softened by hormonal actions. In the pelvis, this leads to pubic pain which makes it difficult to sleep or do the chores. Sciatica may be caused by the pressure exerted on the nerves by the baby.

SYMPTOMS: Pain along the spine or in the pelvis, pain in the legs or thighs and walking hampered by pain in the feet or legs.

MASSAGE: Backache can benefit from massage. Ask someone to massage your back along either side of the spine, using almond oil.

KEY TIPS:

Rest and take the weight off the pelvis whenever possible.

Avoid doing things that cause discomfort.

Constipation and Varicose veins
Constipation is common in pregnancy. Pressure on the circulatory system, due to increased weight and blood volume, may enlarge and may distort veins, especially in legs.

SYMPTOMS: Constipation and large raised veins in the legs.

DIET & NUTRITION: Eat parsley, onions, garlic, cabbage, peas and papaya.

KEY TIPS:
For Constipation:

High fiber diet such as fruits, raw vegetables, chapatti and Isphagul husk.

Increase fluid in-take.

Walk.

Eat raw papaya.

For Varicose veins

Avoid long sittings/long standings.

Elevate legs on foot stool while sitting.

Wear stockings, if very painful.

Third Trimester
(28 weeks to birth)

The final three months of pregnancy are an important time of preparation, when you need to gear yourself up nutritionally, emotionally and physically for the birth of your baby. Plenty of rest can help to alleviate some of the ailments that occur in the third trimester as well as fortifying you for the birth. Good nutrition and appropriate exercise also help.

Nutrition for Mother and Baby
In the third trimester, as is in the last two, there are windows of nutritional opportunity.

Action Plan
At this stage your body is changing to cope with the growing baby and in preparation for labor and breast feeding.

Boost Energy
Your metabolism becomes more efficient during this stage to provide extra nutrients to the baby and to prepare your body for labor. Drink a lot of water, too little will diminish your energy.

Gear Up Mentally
Prepare yourself mentally not just for the birth of your baby but also for the life afterwards as a parent.

Common Problems in the Third Trimester

Sleeplessness/Insomnia
Sleeping difficulties during pregnancy is very common and lead to fatigue during the day.

SYMPTOMS: Difficulty in falling asleep, restlessness and irritation all day long.

DIET & NUTRITION: Vitamin B deficiency can cause insomnia (sleeplessness). If blood sugar levels fall during the night, you may feel hungry or nauseatic. Drink warm milk before going to bed. Leafy green vegetables (vitamin B) have a tranquilizing effect.

KEY TIPS:

Avoid afternoon naps.

Eat sustainable lunch and a light supper.

Relax before bed and avoid mental stimulation.

Raised Blood Pressure
Raised blood pressure affects 5-10 % of women.

SYMPTOMS: Headaches, nausea, vomiting, visual disturbances and raised blood pressure.

DIET & NUTRITION: Eat plenty of raw fruits and vegetables which are rich in Vitamin C and potassium.

KEY TIPS:

Eat light food.

Get plenty of rest.

Undertake regular gentle exercises.

Refer to the doctor immediately if a problem occurs.

About the Author: Ms. Rabya Aqeel has previously worked as the Editorial Content Manager with Catco Kids, Inc. She has also worked with the Dawn Group of Newspapers in addition to teaching at the Lahore Grammar School.

References:
Zita West ‘Natural Pregnancy’ – Complementary Therapies for Preconception, Pregnancy & Postnatal Care

“Your Pregnancy Bible” – Consulting Editor, Dr. Anne Deans

“Antenatal Class 1: Minor disorders of pregnancy” prepared by Ms. Mehrunissa Kabani & Ms. Mumtaz Budhwani – Aga Khan University

www.healthlink.uhseast.com

www.netdoctor.co.uk

Sharma, Rekha: Pregnancy and Nutrition. Obstetric and Gynaecology Today. September 1996. 1(3).p.195-199.

Labor & Later

Nutrition during Labor
Building up energy ready for labor will help to prevent tiredness, dehydration, weakness and demoralization, all of which increase the likelihood of medical intervention in the birth.

Postnatal Depression

Postnatal depression (PND) is a depression oriented illness that occurs after having a baby. It is common for women following childbirth to experience a period of 'low' mood. This can range in severity from a mild and normal period of mood disturbance ('baby blues'), through to PND and the most severe and rarest problem (postnatal psychosis).

PND is very common. Up to 85% of the women suffer from ‘Postnatal depression’ and it is considered to be normal in many of the cases. Usually there is unexplained tearfulness. Exhaustion, lethargy, constant desire to sleep, lack of concentration forgetfulness and difficulty sleeping are some of the common symptoms. PND usually develops within the first month following childbirth.

Symptoms of Postnatal Depression

Although there are differences between PND and 'ordinary' depression, there are many similarities:

Feeling 'low', 'miserable' and tearful for no apparent reason.

Being unable to enjoy yourself. This may be particularly prominent in new mothers who feel that they are not enjoying having a new baby in the way they expected to.

Irritability is common. This may be with other children, the new baby and particularly with the partner.

Sleep disturbance is part of looking after a new baby. However in PND there may be additional problems of finding it hard to go to sleep even though you are tired.

Appetite is sometimes affected, with mothers not being interested in food. This can be a particular problem since new mothers need all the energy they can get to look after their babies.

Anxiety frequently occurs in PND. This may take many forms. It may be feeling tense and 'on edge' all the time. In addition mothers may experience 'panic attacks' which are episodes lasting several minutes when they feel as if something catastrophic is about to happen - such as collapsing, having a heart attack or stroke. These are extremely frightening but they get better on their own.

Depression is often accompanied by feelings of being 'worthless' and 'hopeless'. These feelings are common in PND.

5 ways to help yourself overcome Postnatal Depression

Because the symptoms are very similar to those seen in 'ordinary' depression PND is treated in much the same way as ordinary depression.

Try not to feel guilty or inadequate. There is no such thing as a perfect parent – or a perfect child.

Eat healthy and avoid chocolates, sugar and alcohol.

Try meditations and other relaxation techniques.

Get out and about – take the baby for a walk.

Communication is very important between you and your partner during the immediate postnatal period. He will most be able to support you during this time.