Unsolicited advice is usually both unwanted and inaccurate.
Everyone has a certain amount of knowledge about pregnancy but it is not until a woman has had a baby that she can talk with any conviction or authority about the signs, symptoms or the finer details of what happens to a pregnant woman. It necessarily follows, therefore, that the majority of girls obtain, or are given, information about pregnancy which is really just a reflection of their mother’s experiences of pregnancy. These may have been easy or difficult, good or bad, happy or unhappy, but however they are interpreted they will be transmitted to her children. Pregnancy is no exception to the general principle that a child’s ideas are gradually moulded and modified by the things that are read or learned during childhood and adolescence. By the time she is ready to start her first baby, a girl will have a fairly definite idea of what it is all about. She may wish to have more information but the basic ground work has nevertheless been systematically laid down over the preceding years and the careful or thoughtless way in which she has been consciously or unconsciously influenced will show in her approach to her own pregnancy.
The Public Media
Over the past ten years or so the public media have responded to the general public’s demand for more information about medical science with a number of extremely good programmes on radio and television and a mass of articles in journals and magazines. Radio and television, however, have yet to treat pregnancy as an educational subject. The accent has been more on delivery than on the importance of antenatal care and general basic advice, and written articles can only cover small aspects of pregnancy at any one time.
Unfortunately, it is only the relatively small proportion of the population who is either pregnant or who has someone in their immediate family circle who is pregnant that is really interested in a fundamental knowledge of pregnancy.
It is because there are so many gaps in the average woman’s knowledge concerning pregnancy that she is so vulnerable to unsolicited advice and if such advice worries her there is no comprehensive work to which she can turn to relieve her anxiety. This particular book is a genuine attempt to provide information in an unbiased manner although there will always be differences of opinion upon certain matters and undoubtedly in some places this book is either imperfect or will subsequently be shown to need modification. It is nevertheless intended to be fair and impartial; written in the hope that it may provide some guidance to those who require it and some helpful support to those who may be unduly anxious, particularly those who have heard hair-raising stories of difficulties and problems in pregnancy or delivery.
There are many authoritative books on pregnancy or different aspects of childbirth that give very sound advice and useful information. Antenatal classes, relaxation classes, natural childbirth (National Childbirth Trust) and psychoprophylaxis classes all provide an immense amount of invaluable advice and information. Do not listen to unsolicited and often potentially harmful advice.
How much rest should you have when you are pregnant? It is impossible to say because it varies with so many personal factors. The ideal is 8 hours in bed at night and 2 hours in bed in the afternoon. This, however, is almost impossible to arrange especially in early pregnancy, because those who are pregnant for the first time are frequently going out to work and those who are pregnant on subsequent occasions have to look after their children. Bearing in mind then that the ideal is 10 hours’ rest in every 24 hours, you should get as much rest as you can. Remember that in the early part of pregnancy you may feel unduly tired or lethargic and there is simply no point in trying to fight it. You can either give in to it and rest, in which case you will feel much better, or try to resist it with the inevitable result that you become bad-tempered and even more tired. If you have previously arranged to do things and feel too tired, you should have no hesitation in cancelling your arrangements. This can, however, be very difficult unless your husband appreciates the problem, so it is up to you to see that he knows about the needs of his newly pregnant wife.
After the end of the 14th week of pregnancy you will feel much better, much less tired and much more energetic. You should still, however, have an adequate amount of rest.
In the last three months of pregnancy you will need more rest and during the last 6 weeks especially you should rest as frequently as possible with your feet up. When you are pregnant you should always avoid sitting with your knees bent and never with one knee crossed over the other. So long as you are fit and well there is no reason why you should not take a reasonable and normal amount of exercise but remember that you do not have to take exercise in order to become a healthy mother or to have a healthy baby. If you want to go for a walk, go for a walk. If you don’t want to, then don’t.
Tiredness is one of the natural phenomena of pregnancy. This usually commences shortly after the first missed period and is characterized by a definite lassitude and tiredness during the day as well as at night. Ten hours’ rest is usually advised throughout the whole of pregnancy. The majority of pregnant women will not be able to sleep for 10 hours, but the important factor is rest rather than sleep. The natural tiredness normally occurring in early pregnancy will usually ensure an adequate amount of sleep and it is frequently more severe in subsequent pregnancies than in the first. It usually begins about the 6th week and continues until about the 14th week during a first pregnancy, but may last until the 20th week during subsequent pregnancies.
A woman can be told how long she should spend in bed or resting during the day but no one can predict, or demand, a certain number of hours of sleep. As pregnancy advances sleep usually becomes lighter. The pregnant woman finds it more difficult to get to sleep and then she tends to wake more easily and, therefore, to sleep for shorter periods. There are various reasons for this. The enlarged abdomen produces generalized discomfort. Foetal movements may disturb her just as she is falling asleep. The increased weight of the advanced pregnancy on the abdomen makes it difficult to find a comfortable position. The irritable bladder may wake her during the night. Congestion in the nose is one of the more annoying side effects of pregnancy which may also disturb sleep.
It does not matter what time you go to bed as long as you are going to stay there for 8 hours. Resting during the afternoon is almost as important as sleep at night and, ideally, the rest should be in bed, but if this is not possible then it should be taken on a couch. It is surprising how much refreshment can be gained from even the shortest sleep.
The secret of sleeping during the afternoon and also at night is that of relaxation. On the principle that physical relaxation results from mental relaxation, conscious relaxation will gradually induce somnolence and then sleep. The cultivation of both physical and mental relaxation is an enormous asset. The majority of people who cannot sleep during the afternoon, or have difficulty in sleeping at night, are mentally overactive, worried or concerned, and of course finally they become worried because they cannot sleep.
If for some reason sleep is difficult discuss this with your doctor. Most doctors agree that sleeping pills should be avoided if possible, but it is better to have a good night’s sleep with a mild and safe sleeping pill than to fail to sleep altogether and be a neurotic wreck the next day. Doctors will avoid the administration of sleeping pills in early pregnancy, but many pregnant women have great difficulty in sleeping towards the end of their pregnancy and then sleeping pills are occasionally indicated. These must be prescribed by your doctor and taken according to his instructions. Many sleeping tablets are available which are completely harmless during pregnancy if taken in the prescribed dose, but there are others which should not be taken during pregnancy. Never, therefore, take sleeping pills without first consulting your doctor.
Dreams in Pregnancy
Most women dream more when they are pregnant than they are accustomed to. The reason for this is not known but it is probably associated with a change in sleeping pattern which results in lighter sleep and ‘waking dreams’. Certainly in the second half of pregnancy sleep may be disturbed not only by foetal movements but also by the difficulty in maintaining a comfortable position in bed or by increased frequency of micturition. All these factors may contribute towards an increased frequency of dreams. There are many old wives’ tales suggesting that frightening or disturbing dreams may affect a baby either physically or mentally. This is not true.
No importance should be attached to this phenomenon and such dreams certainly have no profound meaning or significance.
Exercise in Pregnancy
Most people understand exercise as meaning physical activity over and above their normal daily duties. This is not strictly true. Most women have a home to look after and either a job to do or other children to take care of, and these duties in themselves require a considerable amount of work and exercise. It is difficult to imagine a more vigorous exercise than scrubbing a floor or even polishing a table. There is no reason why a woman progressing through a normal pregnancy should not continue with her normal household duties. If, however, complications arise, then her activities may be restricted by her doctor.
For a pregnant woman who goes out to work, the kind of work must be considered. For instance, there is a world of difference between being a shorthand typist sitting at a desk all day and being a conductress on a double decker bus running up and down stairs all day. Common sense can decide how long most women should continue with such occupations during pregnancy. The Maternity Allowance is payable after the 29th week of pregnancy, but it is obviously inadvisable for women to continue some energetic occupations until this stage of pregnancy and lighter or more acceptable work must be found for them.
It is stressed throughout this book that pregnancy imposes a certain amount of extra work, both physical and metabolic, upon the body, so that rest is essential. This does not mean that normal duties should not be continued, but extra duties which involve tiredness, fatigue or unnecessary physical exercise should be avoided.
Many women are accustomed to a certain amount of physical exercise or sport such as tennis, golf, cycling, swimming, walking or gymnastics and if they are used to this before the onset of pregnancy there is no reason why they should not continue during the pregnancy provided it progresses normally. They must, however, avoid undue tiredness and exhaustion. They should consult their doctor as to when they should start giving up their particular sport because they must not continue merely as a matter of principle. A woman should not commence such extra physical exercise for the first time during her pregnancy. It cannot be too strongly emphasized that if you go around your normal daily duties you have adequate exercise. Extra exercise is not necessary. The main need during your pregnancy is rest not physical exertion.
There is really no limit to the amount of walking you may do during pregnancy. Ordinary daily duties involve a good deal of walking and if you feel like going out for a walk to get some extra exercise, there is no reason why you should not do so. You should not, however, go on hiking expeditions. By walking you are both enjoying yourself and helping to keep your body fit, but you are not doing anything specific for the benefit of your pregnancy or your unborn baby. Always stop when you become tired. You must never allow yourself to get exhausted.
Swimming does not harm pregnant women. It is a mistake to suggest you should not swim while you are pregnant. Certain precautions, however, must be observed. Women who are not used to physical exercise or who do not swim frequently should avoid going in the water during the early part of pregnancy at the time when they would normally have been having a period, that is at the 4th, 8th and 12th week of pregnancy. This precaution is less important if you do take frequent physical exercise or swim at least once or twice a week, but even then it Is important that you should never become overtired. Swimming in very cold water is not advisable especially as there is more likelihood of cramp during pregnancy. Diving from heights of 3 ft. or less is not harmful to any experienced swimmer but high diving must be avoided by all women throughout their entire pregnancy.
Apart from simple, ordinary, common-sense restrictions, dancing can be continued until the onset of labour. The amount of energy and exercise involved depends on the type of dancing and both exercise and energy should be restricted as pregnancy advances. Acrobatic dancing is, of course, forbidden at any stage during pregnancy.
No harm will result from riding a bicycle at any stage of pregnancy. However, even in early pregnancy reflexes are not as rapid as usual and any accident may result in a miscarriage. Women who cycle in early pregnancy should be ultra-careful. They should not become overtired and should certainly not take part in rallies or races of any kind. As pregnancy advances a woman’s balance becomes affected and this together with the gradually enlarging abdomen makes cycling increasingly difficult. It should be discouraged during the second half of pregnancy for, although it is highly unlikely that a baby will be injured even if there is a direct blow on the abdomen, an accident might predispose to miscarriage or premature labour.
You should not ride horseback at any time in pregnancy. Not only is the actual exercise undesirable, but there is always the risk of damage or injury resulting from a fall.
Water Skiing and Snow Skiing
Water and snow skiing are not advisable especially for the inexperienced. Even experienced skiers will find that their balance and judgment are disturbed during pregnancy and this increases as pregnancy advances.
This is also better avoided during pregnancy, mainly because a woman’s judgment is impaired and this might adversely affect her reactions, with dangerous results. Underwater diving is rigidly forbidden in the later stages of pregnancy. Underwater swimming using a snorkel is allowed providing the swimmer is familiar with the apparatus.
The British are always going out ‘for a breath of fresh air’. What are the advantages of fresh air? Most scientists will agree that there is no particular advantage in breathing outside air especially if the ‘fresh air’ happens to be the exhaust ridden atmosphere in a city centre.
The amount of oxygen and other constituents is almost identical inside and outside your house and there cannot really be any scientific advantage in fresh air, but there are several small and unapparent advantages. The exercise in taking a short walk outside certainly does no harm and if you have been sitting around most of the day it certainly does quite a lot of good. The psychological effect of getting out is beneficial, especially getting out into the country for even a few hours, even if you only sit and gaze at the beautiful scenery once you have arrived there.
What about fresh air in the house? Should you open windows? The answer is yes. Artificial heating which dries the atmosphere in most homes is certainly not really beneficial, and without making you cold and uncomfortable a little fresh air is well worth it if only to maintain normal humidity. A window partly open at night is almost essential to avoid the discomfort of nasal congestion with the subsequent mouth breathing. You will find you sleep much better and your nose and mouth will be much more comfortable.
Lifting during Pregnancy
Hard physical exercise are and obviously the lifting of heavy weights are contra-indicated during pregnancy. It is often said that nothing should be lifted during pregnancy, except that which can be easily lifted with two hands without exerting undue effort. This is mainly meant to refer to furniture and other heavy weights. Even when the lightest objects have to be lifted from the floor it is far better to lift them by squatting down rather than by bending forwards with the knees straight, which adds to the natural strain on the back during pregnancy. Pregnant women should cultivate the principle of picking things up from the floor by squatting down on bent knees so that the buttocks come into contact with the ankles.
For the woman who has a young family there is the ever present problem of lifting the children. No one would ever deny a mother the right to lift her child, but she should learn to pick the child up from a squatting position and also adopt the favourite trick of kneeling down alongside or in front of her child in order to cuddle or console it. Looking after children can be one of the most tiring and tiresome occupations for a pregnant woman, but by careful thought a lot of the hard physical work of handling them can be eliminated.
The whole question of travel presents a simple yet difficult question. If you have a good, stable, normal pregnancy it will not come to any harm if you have to travel. There are, however, two simple exceptions to this rule. The first is horse-riding; the second is travelling in aircraft that are not pressurized, where at heights of over 5,000 ft. an undue strain may be imposed upon the oxygen supply to your baby.
Apart from the above two restrictions, there are one or two rules which ought to be obeyed. Do not travel over long distances unless it is essential. Travelling by train is usually more comfortable and causes less strain than travelling by car, especially for distances over 100 miles, unless you have a particularly good car and a very competent driver. When travelling by car never miss an opportunity to empty your bladder because another 50 kilometres of motorway with a baby bouncing on a full bladder is not very pleasant. Finally, remember that the emotional instability of pregnancy makes the readjustment to the time change of travelling across time zones, for example from London to New York, much more difficult and can impose quite a considerable strain upon you. If your pregnancy has not been stable, that is, if you have had any bleeding during the early part, or if you have suffered from a previous miscarriage or catastrophe, you should not undertake any journey that is not absolutely essential. If you have bled in early pregnancy then travel by aircraft even much later is not advisable because though it may not do the baby any harm there is always increased risk that the altitude changes may provoke premature labour.
Even if your pregnancy and past history have been absolutely normal, you should not travel abroad or for any great distance during the last six weeks and you should certainly stay fairly close to home for the last four weeks. It is as well to remember that airlines will not normally accept passengers who are more than 36 weeks pregnant. If your pregnancy has been normal and you happen to be returning from abroad after the 30th week you should get a short note from your doctor, stating your expected date of confinement and the fact that you have his permission to undertake the journey, to show to the airline authorities if necessary.
The majority of pills that are manufactured and prescribed for the control of travel sickness are very similar to those given for nausea and early morning sickness during pregnancy. If you are prone to travel sickness this will obviously become worse if you are already nauseated during the early part of your pregnancy. While the majority of travel pills are quite safe and may be taken in early pregnancy, you should never take them without the permission of your doctor.
There is no reason why you should not drive during pregnancy and, indeed, you may continue to drive until labour commences providing you obey certain simple regulations.
First, remember that your emotional balance tends to be rather disturbed, especially in early pregnancy, and your judgment is not quite as precise and accurate as when you are not pregnant. You should therefore drive with just that little bit more care and give everybody else just a little bit more room than usual. If you are involved in an accident in late pregnancy there is always a possibility of the steering wheel digging into your abdomen. Unless the accident is serious this is unlikely to harm your baby but even so it is an additional reason for driving with even greater care than usual.
Second, you will tire rather more easily and therefore should not undertake long journeys.
The Employment of Pregnant Women
The Maternity Allowance is normally payable for 11 weeks before the expected date of confinement, that is at the end of the 29th week of pregnancy.
Whether you work during pregnancy depends on individual circumstances and no generalization is possible, but certain basic rules can be laid down.
Providing pregnancy is normal there is no reason why a woman should not do reasonable work, on condition that it does not expose her to any risk of accident or undue tiredness. Most women are much happier, especially during their first pregnancy, if they continue with their job than they would be if they sat at home being generally bored. The money is probably important anyway. Women who already have children have a full-time job on their hands coping with the house and the children as well as with the new pregnancy. If there is any question or doubt in your mind you should discuss the whole question of work with your doctor or with the doctor at the hospital.
Even in a normal pregnancy it is not usually recommended to continue working after the end of the 29th week. A lot of women argue, however, that they have a sedentary occupation two minutes’ walk from home and might just as well go there and bash at the typewriter as stay at home and scrub the floor. Providing they are happy, have sufficient rest, are not becoming overtired and the pregnancy is normal there is no real reason why younger women should not continue a sedentary job, particularly in their first pregnancy and especially if they do not have far to travel. Each individual must, however, be judged on her merits and a compromise, such as part-time work, may be reached. If there has been any complication during the pregnancy or any abnormal past history, an increased amount of rest is usually prescribed so that employment is not generally possible.
Work is still a difficult problem to which there is no simple answer because each pregnancy is worth a different amount to each woman. For instance, a woman of 27 who is not married may wish to get rid of her pregnancy. If she has been married for only three months she may be quite happy and content to continue working. If she has already had one miscarriage she may consider doing less work or perhaps part-time work. If she has been married for five years and has had three miscarriages she will probably consider giving up work altogether. If she has been married for ten years and has had six previous miscarriages she may well consider not merely stopping work but going to bed and resting in bed for a considerable part of her early pregnancy.
Your feet are very important !
Care and attention to your feet are most important throughout the whole duration of pregnancy. One of the natural processes of pregnancy is that ligaments soften and therefore tend to stretch. This, of course, takes place in the pelvis where it is one of the major factors that enable normal and spontaneous delivery to occur. These changes are not limited, however, to the pelvic bones and ligaments, but occur elsewhere in the body particularly in the feet. A lot of care and attention must be paid to the feet if their ligaments are not to be stretched beyond return. There are two longitudinal arches and one transverse arch mainly supporting the normal function of the foot, and these must be preserved for its normal functioning and pain-free movement.
A combination of the weight increase of pregnancy and the softening of these ligaments can easily result in flattening of the normal arches of the foot with permanent injury to the foot architecture. This is far more likely to occur in a woman who is ill and tired than in one who is fit and well. Standing for long periods tends to stretch the ligaments and should be avoided if possible. This does not mean that a person should not exercise fully and normally; exercise is good for both the ligaments and the muscles of the foot.
Shoes that give adequate support to the feet are essential. Throughout pregnancy all shoes, including walking shoes and slippers, should have a similar height of heel and should provide the foot with satisfactory support. The habit of wearing 8 cm. heels during the day and casual shoes with no heels at all in the evening is to be deplored. Those who always walk barefoot at home may continue to do so but standing without shoes ought to be avoided.
Tights or stockings may be worn at the beginning and throughout the duration of pregnancy but stockings must be supported by some type of suspender. Garters are dangerous because they constrict the legs and cause varicose veins below the obstruction. Stockings that are supported by an elastic top have the same effect and should not be worn. Tying a knot in the top of a silk or nylon stocking should not be done under any circumstances, for a woman is much better without any stockings than with stockings supported by a tight knot. There is no harm in wearing short or ankle socks and no harm will come to the pregnant woman who docs not wear any stockings at all. There are many advantages in wearing tights throughout pregnancy.
A good support for the breasts is essential throughout pregnancy. Many women notice that the breasts enlarge rapidly at the beginning of pregnancy and again at about the 20th week, thereafter remaining approximately the same size until immediately before delivery. Most pregnant women need to buy a new brassiere at the beginning of pregnancy but should not do so until most of the initial breast enlargement has taken place, which is by about the 10th week. The enlargement in mid-pregnancy is due more to enlargement in the size of the chest than to actual enlargement of the breasts themselves. A suitable brassiere bought at about the 10th week of pregnancy which has the correct bust size and an adjustable back can accommodate the increase of chest size at the 20th week.
A brassiere bought for use in pregnancy must provide satisfactory and adequate support. It should have strong and fairly wide shoulder straps and the back should be wide, giving ample support under the arms with fastenings which allow room for expansion as the rib cage enlarges with the advancing pregnancy. Elastic shoulder straps cannot provide adequate support for the breasts during pregnancy and they are not recommended even if they are ‘more comfortable’. The advantage of having a well made and properly fitted brassiere cannot be emphasized too strongly.
Despite the popular misconception, the breasts do not contain muscle and if they are allowed to sag during pregnancy for lack of adequate support, no amount of exercise after delivery will return them to their former firmness. It is obvious, therefore, that good support is absolutely essential.
Whether you wear a brassiere at night as well as during the day is an individual decision, but if your breasts become unduly heavy or have a tendency to become pendulous, wearing a ‘ sleeping bra’ is probably advisable, especially during the second half of pregnancy.
Maternity or nursing brassieres. Owing to the increase in the size of the chest wall after the 20th week of pregnancy, women are advised not to buy maternity brassieres until near the end of pregnancy. Many makes and types of nursing brassiere are available and while some are satisfactory, many do not provide adequate support.
Nursing brassieres fall into three main groups. Those which open in the mid-line’ in front, those which have a removable panel on each breast, and those which can be undone at the back as an ordinary brassiere. The advantages of front fastenings where the child can be suckled at the breast without undoing the brassiere must be weighed against the less adequate support of such brassieres. Those which have a detachable panel on each breast suffer firstly because of the lack of support given to the breast and secondly because of the comparatively inadequate access to the breasts during feeding. After all the child feeds from the breast itself and not from the nipple and the surrounding two inches of breast tissue. One of the arts of breast feeding is the proper handling of the breast during feeding and this is made increasingly difficult if the breast itself is constricted by a brassiere. These disadvantages are weighed against the disadvantage of having to undress almost completely for every feed.
Abdominal Support in Pregnancy
Advice about abdominal support in pregnancy is contradictory. Women disagree about it when they are not pregnant, so why should agreement suddenly materialize when a woman becomes pregnant ?
Let us consider the woman who is pregnant for the first time and does not normally wear any abdominal support. Abdominal enlargement will not be a noticeable feature of pregnancy until the 16th week at the earliest. The first thing she will notice about her abdominal contour is that the waist fine disappears especially at the sides. Somewhere between the 16th and the 22nd week abdominal distension will commence. A person such as this invariably has good abdominal muscles and there is no need or indication for her to wear any abdominal support. After the 20th week a certain amount of aching in the lower abdomen may occur especially towards the end of the day. This usually goes after a short rest and if you have never worn any abdominal support you need not start now. Your muscles will respond normally to the pregnancy and providing you do not put on extra weight, they will return to normal after delivery. Here is a guarantee: if you are normal weight before your pregnancy, and use no special support, don’t wear one during pregnancy, don’t gain more than 22 lb.’ don’t have twins or extra amniotic fluid—then three months after delivery your abdomen will be as good as it ever was. No marks, just as flat, just as strong and just as nice in any bikini.
If the muscular discomfort persists or becomes worse it may be relieved by wearing a lightweight elastic abdominal support. A large or cumbersome maternity belt is not necessary. An elastic support gradually stretches as the pregnancy progresses but should continue to provide sufficient support for the lower abdominal muscles.
The girth of the abdomen will normally reach 100 cm. at the expected date of delivery and from the 34th week onwards the duration of pregnancy in weeks will be the same as the girth around the umbilicus in inches. Occasionally an excessive amount of water is formed in the uterus and when this happens abdominal enlargement becomes greater than normal. The girth will also be greater than normal in a twin pregnancy. When the abdomen is larger than usual there are many advantages in providing some support. This is best obtained by a lightweight maternity corset with expanding sides. A U-shaped front corset does not provide satisfactory support.
Women who normally wear some abdominal support will need to provide themselves with support during their pregnancy. They can use their usual abdominal supports during the first 20 weeks. After this a woman who is not overweight and whose pregnancy is proceeding normally may prefer to continue wearing her normal abdominal support which will gradually stretch as pregnancy advances but still give sufficient support to the anterior abdominal wall. Most women who are overweight will require some special maternity corset. This also applies to the woman having her second or subsequent child who has weak abdominal muscles and in whom the abdomen tends to become pendulous as pregnancy advances. It is essential that such a woman should have adequate abdominal support. This is particularly applicable to the person who has previously been delivered of twins, or who suffered from over-distension of the abdomen during a previous pregnancy or who gained too much weight during her pregnancy. Abdominal support should be put on first thing in the morning and should be kept on throughout the day, not put on late in the day when the abdominal muscles have become tired and have started to ache.
The baby inside the uterus lives in an environment surrounded by water. It is extremely difficult to damage or harm a child in the second half of pregnancy. Some women believe that supporting underwear may damage or deform their child. Tight underwear or clothes will not harm or damage a child or lead to congenital deformities. Even hundreds of years ago when it was the custom to bandage the abdomen so tightly that it was difficult to breathe there was no real evidence that it caused any harm to the unborn infant.
Despite many prejudices there is no reason why a woman should not continue to wear the type of underwear she wears in the non-pregnant state. There is no particular disadvantage in any material that is used for underwear. Tight fitting underwear may be uncomfortable and is to be discouraged. This is particularly applicable to tight knickers or pants which may cause discomfort and sweating in the groins and between the legs. People who are grossly overweight will notice that sweating in these areas may be particularly troublesome especially if they use underwear made from nylon or other non-absorbent materials. Cotton panties or disposable briefs have many advantages especially in hot weather or if there is an excess of vaginal discharge.
Care of the teeth in pregnancy is of the utmost importance because during pregnancy the teeth are very prone to decay. Any dental disease should be promptly treated.
There are supposed to be two main reasons for dental disease in pregnancy. First, and unlikely, the use of calcium by the baby tends to rob the mother of this vital element and she loses calcium from her bones and teeth. Second, and correct, infection in the gums, or gingivitis, predisposes the teeth to infection and decay.
Most people have a satisfactory diet but it has, nevertheless, always been considered necessary to give the pregnant woman dietary supplements of calcium in order to protect the teeth from decay. It is doubtful whether this does anything to protect the teeth or to reduce the amount of decay once the process has begun, but it may be given to protect her bones from losing calcium as a result of her baby’s demands.
The calcium in teeth is so firmly fixed that there is no way of extracting it. A human skeleton buried for 10,000 years will have healthy teeth and yet the bones may crumble. Women in some developing countries suffer from osteomalacia, caused by calcium deficiency resulting from many pregnancies, and while their bones become so soft that they actually bend, their teeth remain healthy. One of the most convenient methods of obtaining calcium is by drinking milk and the inclusion of milk in the diet is probably justified by this alone, but it does nothing to prevent dental decay.
Many local authorities have accepted that fluoride is important to the development of teeth and prevention of caries. However, there is still resistance to the idea that fluoride taken by the mothers may help the formation of her baby’s teeth. Fluoride tablets are available at most chemists.
The main cause of dental disease is gingivitis or inflammation of the gums which become softer and more vascular in pregnancy and are easily injured by food and coarse tooth brushes. Once injured it is easy for infection to be introduced. During pregnancy this happens around the teeth and destroys the delicate membrane between teeth and gums. When the membrane has been destroyed infection enters beside the tooth: the gums become red and swollen and recede to expose the sensitive part of the tooth which is more prone to decay. Careful dental hygiene in pregnancy is therefore essential if the teeth are to be protected from unnecessary damage.
Care of the teeth:
1. Clean the teeth in pregnancy as at any other time—after every meal if possible and always before retiring at night.
2. Use a medium brush, or a softer one if the gums have been bleeding. A medium or soft brush is better than a hard one as it gives more friction for the gums. Two or three brushes should be in use, giving each one time to dry before being used again.
3. No one particular paste or powder is better than another for stimulating the gums without causing irritation. It is in fact, preferable to change toothpastes from time to time unless your dentist recommends a particular brand.
4. Electric toothbrushes are very good especially for those people who are too lazy to use an ordinary toothbrush for 2 to 3 minutes in the proper way!
5. Some dentists believe that small doses of fluoride taken during pregnancy will protect the baby’s teeth from decay in later life. Ask your dentist for his advice.
6. Rinse with a mouthwash if the gums bleed; one part hydrogen peroxide and five parts water is useful as it helps to wash away the debris from between the teeth and helps to cleanse the mouth.
7. The gentle use of dental floss will help to remove food particles from between the teeth.
Most women notice no difference in their hair throughout pregnancy but some find that dry hair tends to become more dry, and greasy hair more greasy. It is therefore even more important to take particular care of your hair throughout the entire pregnancy and to use an appropriate shampoo for your own particular type of hair.
Before deciding to have a perm always tell your hairdresser that you are pregnant. This is particularly applicable if you have dry hair, because this type of hair always tends to crack and break, especially during the latter half of pregnancy.
On very rare occasions quite a lot of the hair breaks, some of it appearing to come out at the roots to such an extent that there is a very noticeable thinning of the hair itself. The exact reason for this is not known but it seems to be connected with the high progesterone levels in pregnancy. If this should happen to you, be careful not to brush your hair too vigorously and make sure that it is properly washed with a very mild shampoo. Your hair will return to normal after you have been delivered and such thinning of the hair does not usually recur in any subsequent pregnancy.
A lot of women complain that their hair is unmanageable in early pregnancy and if they happen to be feeling particularly tired or nauseated then it makes life even more tedious if extra time has to be spent on making the hair look nice and presentable.
Just as some women notice that their hair becomes fragile during pregnancy, so others notice that their nails become brittle, crack, break and also split. The cracking and breaking is bad enough, but split nails are very difficult to manage because any bit of dirt that gets into a split is extremely difficult to remove. There is no evidence to prove that nail varnish harms or drys the nails and, although this does seem to be generally accepted, few doctors would advise women against using nail, varnish if they wished to do so.
Brittle nails will obviously be more easily damaged by housework and other manual duties. They can be protected to a certain extent by wearing gloves for any chores that might damage them or make them unduly dirty.
An age old remedy for preventing the nails from cracking during pregnancy is to rub baby oil into the base of the nail at night. If your nails normally have a tendency to crack you should start doing this at the beginning of pregnancy. If your nails have begun to crack you will not notice any benefit until the massaged part of the nail has grown its full length, which takes approximately two months. It is very simple, quick and easy to do, and it can be quite effective.
The regulation of the bowels throughout pregnancy is most important and can be accomplished to a great extent by means of careful diet. Perhaps the most important aspect of diet is a satisfactory and adequate water intake. Pregnant women should drink at least four pints of fluid each day although they must be careful that the fluid is one which does not have a high calorie content. The best fluid of all is plain water. A good balanced diet is essential and this should contain a larger amount of roughage than normally. Roughage is found in green vegetables, fruit, oatmeal and wholemeal flour. Learn to spare the time to go to the toilet; hurry can destroy good bowel habits.
Taking strong purgatives is neither necessary or desirable in early pregnancy, and while mild preparations may become necessary later on, even they are better avoided if possible. For people who have never taken medicine to keep the bowels open a small dose of magnesium sulphate or one of the proprietary brands of fruit or health salts will probably be sufficient. If these prove inadequate a slightly stronger purgative such as Milpar may be necessary. Some women find that constipation is a very troublesome problem and may have to take a senna preparation such as tablets or granules of Senokot, though long, term use of senna may actually increase constipation.
The ideal should be to open the bowels normally at least once a day, but if one or perhaps two days pass in which the bowels are not open there is no need to take an extra large dose of purgative on the following day. The correct dose of any medicine habitually used to keep the bowels open is that amount which will open the bowels each day and no more.
Sexual Intercourse during Pregnancy
A great deal of advice has been given and written in books concerning sexual intercourse in pregnancy. There is no reason why normal intercourse should not continue throughout a normal pregnancy until labour begins. It is probably fair to add, however, that the pregnant woman should be treated with a modicum of respect. The breasts may become very tender in pregnancy and pressure can be quite painful so that technique may have to be changed accordingly. The enlarging abdomen will also dictate appropriate changes in technique (the normal position is not ideal in the circumstances).
There are, however, certain exceptions. Any woman who has suffered from a previous miscarriage ought to avoid intercourse for the first 14 weeks of pregnancy, and any woman who has suffered from recurrent miscarriages should avoid intercourse until this has been specifically permitted by the doctor. Any threat to miscarry, or bleeding at any stage in pregnancy, must automatically result in cessation of sexual intercourse until the doctor advises that it may be resumed. This is not only important in early pregnancy, but it is of the utmost importance during the last 10 or 12 weeks.
There is no chance of infection being caused by intercourse. In the past it was often stated that any woman who had intercourse after the 6th week of pregnancy ran the risk of creating infection not only in the uterus but in her baby. This is completely untrue. It is also untrue that sexual intercourse should stop at the 32nd week of pregnancy because of the danger of infection or harm to the baby or of premature labour.
The human female is one of the very few mammals to permit sexual intercourse during pregnancy and it is not surprising that occasionally the libido, or sexual desire, changes. Libido is often reduced in pregnancy, especially during the first 14 weeks, after which it increases till about the 30th week and then declines gradually as the expected date of confinement approaches. You should discuss this with your husband.
Frigidity, or lack of sexual desire, sometimes occurs in pregnancy. If this happens do not worry; your desire will return later. Occasionally loss of libido Will continue throughout pregnancy and it is a common symptom after delivery, sometimes lasting for several weeks or even months. When this happens you require gentle understanding until your sexual appetite returns, which it most certainly will, in due course.
Smoking in Pregnancy
Most people agree that heavy smoking should be discouraged at any time and this is certainly true during pregnancy. There is ample statistical evidence to show that women who smoke a large number of cigarettes during pregnancy have smaller babies than those who are non-smokers and that smoking after the 16th week probably causes both mental and physical retardation in later childhood. This is possibly the result of an adverse effect exerted by cigarette smoking on the placenta which may reduce the oxygen supply and the nutrition to the foetus in the uterus. The majority of women who smoke soon discover that a dislike of cigarettes is one of the earlier symptoms of pregnancy and is frequently associated with nausea and early morning sickness. They usually stop smoking for at least the first three months and this is certainly to be encouraged; nor should they start again.
Most doctors consider that smoking is positively harmful to the unborn child and they prefer women not to smoke during pregnancy. Smoking is absolutely forbidden in any woman who has or has suffered from kidney disease, raised blood pressure, pre-eclampsia, or any sort of bleeding at any stage during her pregnancy, who has been delivered of a dead baby or whose child has died within the first two weeks of life, because it may jeopardize placental development and function.
Pregnancy need not alter your previous habits and bathing or taking a shower is not contra-indicated during normal pregnancy. One word of warning, however, is that your baths should not be too hot or too long. There is a tendency to fainting in early pregnancy and if you get up quickly from a long hot bath you can quite easily feel dizzy or faint. Later in pregnancy you may feel clumsy and your balance may be slightly affected by your enlarged abdomen, so you must take the greatest care not to slip when getting into and out of the bath, especially if you use oil in your bath water.
In the old days bathing and swimming were not advised because it was thought that water entered the vagina and carried infection with it. This is not true. It is very unusual for bath water to enter the vagina and even if it does it will do no harm.
The vulva and the surrounding area should be washed as usual during pregnancy and particular care should be taken to wash all soap away and dry yourself adequately.
Douching is not a particularly British habit. Most authorities agree that it is not advisable during pregnancy because there is always a danger of the pressure forcing some water from the vagina through the cervix and into the uterus where it may jeopardize the continuation of pregnancy and even cause abortion, miscarriage or early labour. While she must never douche with a powerful Higginson’s or other form of syringe, there is no objection to a woman using a bidet at any stage during pregnancy unless she has suffered some vaginal bleeding, the bag of waters has ruptured or she is in labour.
Some women who have been douching almost daily for many years insist, very inadvisedly, on continuing during their pregnancy. Antiseptic solutions should never be used even in the non-pregnant state because these solutions may not only injure the vagina but also kill the normal defensive organisms which are naturally present there. Any woman who insists on using a douche during pregnancy must use a very low pressure apparatus with either plain water or water to which a small amount of salt has been added (1 teaspoon to the pint).
The care of the abdomen during pregnancy is very simple and yet very complicated. Various aspects will be found under the headings of exercise, clothing and care of the skin, but perhaps the most important of all is weight gain. The whole secret of preserving your figure and not getting stretch marks is the control of the amount of weight you gain during your pregnancy. This is emphasized repeatedly throughout this book. If you do not gain more than 9 kg. in weight throughout your pregnancy then your abdomen will return to normal after you have been delivered; the muscles and the skin will be just as good as they were before you became pregnant (that is providing you have not had twins).
The question of abdominal support is discussed on pages 160-2. The care of the skin of the abdomen should be similar to the care of the skin on the rest of your body. It is quite common for a pregnant woman to massage oil into her abdomen every night before going to bed. This is to be encouraged because it helps keep the skin in good condition and because it also means that these women are anxious to take care of themselves. However, if you put on too much weight, no amount of oil will prevent stretch marks.
The navel, or umbilicus, also needs special care during pregnancy. It should be gently cleaned and dried with cotton wool. At about the 30th week Of pregnancy it will commence to flatten and by the end of pregnancy it will almost certainly be completely flat. This is quite normal and it returns to its previous shape within a few days of delivery.
Foetal Movements (Quickening)
The growing baby begins to move as soon as its muscles have developed. The first muscles form alongside the spine as early as the 8th week of pregnancy, and shortly afterwards the baby is making his earliest primitive movements. Muscles can develop only if they are exercised frequently so that their gradual formation and growth in the arms and legs is associated with an increase in both the amount and the strength of foetal movement. By the 12th week they are sufficiently powerful to be detected by the use of medical apparatus. However, you will not be aware of these movements until the uterus is sufficiently enlarged to allow them to be transmitted from the uterus to the delicate nerve endings in your anterior abdominal wall.
During your first pregnancy you will notice foetal movements somewhere between the 18th and 20th week, but do not be alarmed if movements are not felt until about the 24th week. During subsequent pregnancies movements will usually be felt somewhere between the 16th and 18th week, although some mothers claim that they feel them as early as the 14th week.
The earliest movements are very difficult to identify since they are usually felt as vague flutterings or butterflies in the lower abdomen, which are very similar to the sensation caused by wind rumbling around the intestine. Gradually, day by day, the movements become stronger and more persistent until, even in the first pregnancy, it is obvious that your baby is moving. As he becomes more mature, the character of the movements changes until he produces thumping or kicking movements which become more powerful as pregnancy progresses.
Your baby will not move continuously. The earliest movements may be intermittent and indeed it may be a considerable time before you are aware of the fact that foetal movements are actually occurring. This is partly because of their gentleness, but also because of their intermittent nature.
It is not known if babies go to sleep in the uterus, but they do lie quietly without moving for periods of up to several hours, and nearly always (often at about the 20th week) a baby will lie quiescent for up to 24 hours. This lack of movement does not mean that your baby has come to any harm: he always starts moving again, usually more vigorously than before. Unless a woman has been informed that this may happen it is likely to cause her undue concern.
Babies may develop a rhythmic type of movement in late pregnancy felt as a jerking every few seconds for up to several hours. This is due to hiccoughing and may be present after the birth. It does no harm.
Many women say that the baby is more active as soon as they go to bed at night. This is probably because they are more conscious of movements while resting quietly than when they are up and about with other things to occupy their thoughts.
A child who moves a lot in the uterus is not necessarily destined to be an active or athletic person, nor is a child who moves very little necessarily destined to be slow and lethargic. Similarly, the sex of the child cannot be foretold by the degree of movement within the uterus.
The majority of movements of the mature foetus are gentle because the baby’s head is engaged in the pelvis and he does not have such a comparatively large space in which to move. These can best be described as squirming movements caused by the infant exercising not only his arms and legs but also his spine. He will occasionally kick or squirm in a particular place which becomes tender and painful. When this happens there is no cause for concern; just wait until he moves into a more comfortable position. Most of the dramatic movements of the foetus within the uterus come from the feet; the back and the head have a squirming type of movement. When the head is presenting the feet will be found in the upper part, or at the fundus, of the uterus, so that most of the more violent type of movement will be felt there. After about the 24th week your baby may often produce sudden thumps and kicks after a time of comparative quiet. These can be, and often are, most disconcerting owing to the ease with which they may disturb your train of thought or interrupt a conversation.
The most active foetal movements usually occur between the 30th and 32nd week of pregnancy. Your baby is, by now, very strong and has plenty of room in the uterus in which to move, kick and even punch. It is surprising that comparatively violent movements of a baby are seldom, if ever, painful.
When the head is situated over the brim of the pelvis it rotates and moves and may cause considerable discomfort, especially to the bladder, resulting in frequency of micturition and sometimes difficulty in holding water. When the head is engaged in the pelvis a different type of pelvic discomfort is felt. The baby’s head can move even when it is engaged in the pelvis and this movement can result in pressure on nerves causing pain which may radiate down the front or back of the thigh and occasionally through to the back, even causing sciatica-like pain.
Since the foetus has to learn to use all his muscles while in the uterus, it follows that he must use his diaphragm and his respiratory muscles. There is quite a lot of evidence to show that babies do in fact inhale the amniotic fluid as well as swallowing large quantities which are then passed as urine.
Your baby will stay in the same position after the 32nd or 34th week of pregnancy because the head is fixed in the brim of the pelvis. The back remains on one particular side and therefore most of the movement caused by the legs and feet will be felt on the opposite side in about the same place until delivery. Babies do buck and hit the uterus with their buttocks and this is felt on the opposite side to the limbs.
All involuntary, or non-controllable, muscle (the heart, intestine, blood vessels, uterus) contracts and relaxes in a rhythmic manner throughout the life of its owner. Contractions and relaxations of the uterine muscle occur from the cradle to the grave although they become more marked during a woman’s reproductive life. They may be particularly noticeable on the first day of the menstrual period when they may manifest themselves as the cramp-like pains, called spasmodic dysmenorrhoea, so familiar to many women. The uterine muscle contracts normally at about 20 minute intervals throughout adult female life including pregnancy. During pregnancy, because of the relaxing effect of the hormone progesterone, the contractions are not usually noticeable until about the 20th week after which they may be felt regularly until delivery. They are felt as a tightness which spreads over the entire uterus and are occasionally associated with discomfort but not actual pain. These contractions, called Braxton Hicks’ contractions, are a normal phenomenon of normal pregnancy. The uterus can be felt to harden quite noticeably during the contraction which lasts for approximately 30 seconds before passing off as smoothly and as quietly as it began. They are probably of immense value to the foetus because they squeeze out any ‘stale’ blood in the large veins in the wall of the uterus which then refill with ‘fresh’ blood after the contraction has passed. As pregnancy advances towards term a woman is much more likely to be conscious of the Braxton Hicks’ contractions. However, even as term approaches, although she may sometimes feel slight discomfort, they will not become painful.
Some people consider that the onset of true labour is the conversion of painless Braxton Hicks’ contractions into the more forceful uterine contractions of labour, which, when they reach a certain pressure or tension, cause pain. The severity of this pain is directly related to the force of the contraction, which is the tension generated by the muscle.
Braxton Hicks’ contractions may be distinguished from true labour by the following characteristics:
1. They may occasionally be uncomfortable but they are not painful.
2. They last for approximately 30 seconds whereas the contractions of true labour are usually longer.
3. They are seldom more frequent than every 15 or 20 minutes, while the contractions of true labour occur with increasing regularity so that they are spaced 15,10, 5 and eventually 3 minutes apart.
4. True labour contractions become gradually harder and more prolonged as the interval between the contractions gets less.
5. Braxton Hicks’ contractions are never associated with a loss of blood whereas true labour contractions are frequently accompanied by the show which so often signals the onset of labour.
Braxton Hicks’ contractions occurring at night are often mistaken for the onset of true labour. If you are in any doubt, get out of bed and make yourself a warm drink with two codeine or aspirin tablets and you will probably settle down and return to sleep. If, in fact, true labour has begun the contractions will continue with renewed vigour and you will either be unable to sleep or will wake again.
Warnings: Symptoms of Danger
There are ten groups of symptoms which may occur during pregnancy that merit serious attention. They do not indicate that disaster has occurred or is likely to occur, but they should be considered seriously and reported to the doctor or midwife either immediately or as soon as is reasonably possible. The first five listed below should be reported immediately, while the second five may be reported at the earliest convenience, which usually means within 24 hours.
(1) Vaginal bleeding. When vaginal bleeding occurs in the first 28 weeks of pregnancy it indicates that the pregnancy is unstable and that there is a threat of miscarriage or abortion. If the amount of bleeding is slight, immediate rest in bed is indicated and the doctor can be notified as soon as reasonable, but if the bleeding is heavy or associated with pain you should go to bed at once and notify the doctor immediately. Any vaginal bleeding after the 28th week of pregnancy should be notified immediately to your doctor or the hospital with the exception of the pink, mucous stain which occurs at the onset of labour, and is usually accompanied by uterine contractions of which you will be aware.
(2) Severe continuous abdominal pain. Onset of severe, incapacitating, continuous abdominal pain should be notified immediately. This type of pain may be associated with some premature separation of the placenta or with any other acute abdominal emergency, but it is emphasized that this type of pain is continuous and not intermittent and usually occurs in the lower abdomen.
(3) breaking of the waters, or rupture of the membranes. When this occurs the onset of labour usually follows fairly quickly. Some types of miscarriage or abortion are preceded by rupture of the membranes and it is the first symptom to occur in approximately 40 per cent of premature labours. It is important, therefore, to notify your doctor or the hospital immediately so that arrangements can be made for your transfer to hospital, but be certain that the membranes have in fact ruptured and that the watery loss is neither urine nor bath water which has found its way into the vagina and is being expelled either minutes or hours after the bath. After the 36th week of pregnancy rupture of the membranes is of less importance because of the improved chance of foetal survival. However, even at this stage of pregnancy the doctor, midwife or hospital should be notified in order that the necessary arrangements can be made either for your immediate admission or for your delivery.
(4) Mistiness, difficulty and blurring of vision. In the second half of pregnancy this may be a symptom of pre-eclampsia or of raised blood pressure and if it occurs you should go to bed and notify your doctor at once.
(5) Continuous severe headache which is not relieved by aspirin, codeine or other simple headache remedies. Such a headache usually occurs either above and behind the eyes or over the back of the head. A severe headache over the front or the back of the head accompanied by some disturbance of vision may be a symptom of severe preeclampsia or raised blood pressure. It is emphasized that this type of headache continues for several hours and does not respond to the usual remedies. The headache which is felt as a pressure on the top of the head is not usually significant.
Symptoms not so urgent as the above five, but which warrant early notification to your doctor, midwife or hospital, are:
(1) Temperature. A rise in temperature to 101°F (38.5°C). Even if its cause is obvious some form of treatment will usually be necessary.
(2) Frequency and pain on micturition usually indicate the onset of a urinary tract infection and if they persist for several hours then treatment is indicated as soon as this can conveniently be arranged. Infections in the urine are discussed in particularly common during pregnancy.
(3) Swelling of the bands (including fingers), face and ankles, known as oedema, may occur at any stage of pregnancy and is frequently associated with preeclampsia, a raised blood pressure or excessive weight gain. A certain amount of swelling of the ankles is common in pregnancy, especially during hot weather, but excessive swelling of the ankles such that shoes cannot easily be put on is a warning sign. Swelling of the hands and fingers may cause stiffness of the fingers, especially in the morning and often a sensation of pins and needles in the hand.
(4) Absence of foetal movements. It cannot be emphasized too strongly that babies frequently stop moving for quite long periods during pregnancy. It is fairly common for a baby to stop moving at about the 20th or 22nd week for several days, and frequently for up to 24 hours during the latter part of pregnancy. However, if your baby does not move for longer than 48 hours tell your doctor as soon as it is convenient to do so.
(5) Excessive vomiting. A certain amount of sickness or vomiting is very common in the first 14 weeks of pregnancy. If, however, vomiting becomes so severe that no fluid or food can be retained then help should be sought. Sickness usually ceases after the 14th week, although occasional bouts of vomiting may recur. During the last three months of pregnancy most women vomit occasionally, but repeated, recurrent and severe vomiting is unusual and should be reported as soon as possible.
German Measles (Rubella)
German measles, or rubella, is a mild virus disease which may affect any human but does so only once during life. The rubella virus is one of the few organisms which has the ability to cross the placenta and cause direct infection of the foetus. If the mother is infected with rubella during the first 12 weeks of pregnancy (counting from the first day of the last menstrual period) it may disorganize the growth of the early foetal organs and thus cause congenital abnormalities such as deafness, blindness and congenital heart disease, or other types of abnormality. The actual instance or percentage of abnormality in cases of rubella has varied from country to country and still shows considerable variation. This is because the virus, like any other organism, varies in its virulence or ability to attack tissues, and also any community exposed to a virus for the first time will suffer more severely and will have more severe disease than a community in which the virus has become endemic. (An endemic infection is one in which the virus causes occasional outbreaks of disease within a community.)
The incidence of congenital abnormality varies from about 12 per cent in certain areas of Great Britain to about 30 per cent in certain parts of Australia. This means that even at the most conservative estimate a woman who develops rubella during the first 12 weeks of pregnancy has 5 times as great a chance of congenital abnormality in her child than she would otherwise have. At worst the incidence is about 12 times greater and the majority of countries who have legalized abortion under certain circumstances accept this probability of congenital abnormality in the foetus as one indication for termination.
Rubella in childhood is a mild disease that may pass unnoticed. A woman may be unaware that she has had the disease. Even the mildest attack confers immunity so that she cannot again have the infection and her unborn children are protected. Any pregnant woman who has not had rubella, or who is uncertain, must take purely common sense precautions.
If you are in the first 12 weeks of pregnancy you should studiously avoid any person who has, or has been in contact with, German measles. You must not feel afraid or embarrassed to refuse an invitation to people who have been in contact with rubella. If you explain that you are pregnant they will immediately understand and would not expect you to expose yourself to any possible danger. It is mainly children who develop rubella and the above comments are particularly applicable to children who are at a school in which rubella has occurred.
If you have young children who have not had rubella, they should or entertain their friends if there is any possibility that these have, or have been in contact with, rubella. If rubella is going round their school, keep them at home until you have consulted your doctor.
As a general precaution, women should encourage their daughters to have rubella between the ages of 3 and 16. This usually means specifically sending them to play with infected children. Once a girl has had rubella she cannot again be infected. Rubella inoculation of young girls and young married (non-pregnant) women is becoming established practice. This gives a mild attack of the disease which bestows permanent immunity.
If you have been in contact with someone who has rubella, who has recently had rubella, or who develops rubella within two or three days of seeing you, consult your doctor. A special injection, called gamma globulin, can be given to prevent rubella develops if it is given within ten days of contact with the disease. As gamma globulin is both expensive and in short supply, a blood test is usually done to ascertain whether you have previously had the disease, when sufficient antibodies will be detected circulating in your blood to protect you from a second attack.
If you actually develop the disease at any stage of pregnancy you should consult your doctor immediately. The very mild rash which is usually the main physical sign disappears after 12 or 24 hours. If you develop the disease after the 12th week of pregnancy it will be less serious from your baby’s point of view, but if you do develop the disease before the 12th week of pregnancy it is essential that the diagnosis should be confirmed by your doctor. If you fail to see your doctor when you have the rash it is still possible for the diagnosis to be confirmed by a blood test taken about two weeks later. This will show a high level of antibodies due to recent infection.
If it is confirmed that you have suffered from rubella in early pregnancy then the future of the pregnancy must be decided. Termination can be considered under the Abortion Act of 1967 for the reason that ‘there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped’. It may be that you do not wish to consider this, but if you do your doctor will discuss it with you. He will base his advice on careful consideration of the many aspects of the problem: the religious grounds, your age, the number of children that you have, how long you have been married, the ease or difficulty with which you establish a pregnancy, your own health and that of your children and husband. Termination of pregnancy is not to be entered upon lightly and obviously a serious discussion will need to take place between yourself, your husband and the doctor. If an antenatal test shows that you have never had rubella, you can be immunized after your baby has been born to avoid any future worry.
When to Call the Doctor
The main indications for calling your doctor or getting in touch with the hospital where there is a list of the ten warning symptoms together with an explanation of their urgency. Of course every symptom must be judged on its merit and it is just as wrong to suggest that you should call your doctor if you have a pain in your little finger as it is to suggest that you should not call him when you start bleeding profusely at the 26th week of your pregnancy. The guidelines have been laid down and the rest is really up to common sense. Make a careful note of your doctor’s surgery hours and the fact that during his surgery he usually makes out a list of the patients whom he is going to the end of his morning surgery. Your domiciliary midwife probably leaves to go on her morning rounds at about 8.30 a.m. There is always someone on duty at the hospital, but unless it is urgent or you are unduly worried they would obviously prefer to see you during antenatal clinic hours even if you do not have an appointment.
Everyone is exposed to what is known as background irradiation which is the amount of irradiation that they receive from the atmosphere. Since the effect of irradiation upon the body is cumulative, this must be added to the irradiation received from man-made sources, of which, in a civilized community, the most important is medical X-rays. It is a basic principle therefore that no one should be subjected to an X-ray unless there is a valid reason for the investigation. X-rays used for ordinary purposes of diagnosis are at such a low dose that they do no harm to ordinary tissues. Any X-rays upon the gonads (sex organs) may, however, cause disturbance of the very sensitive genes within the chromosomes in the reproductive cells of both the testis and the ovary and this may ultimately lead to abnormal formations, known as mutations. Such mutations may give rise to abnormalities in the offspring of later generations, even though the offspring of the present generation are perfectly normal. The developing gonads (testis and ovary) in the foetus are particularly sensitive to the damaging effects of X-rays and this is the main reason why X-rays should, if possible, be avoided during pregnancy.
Some authorities consider that X-rays of the foetus during pregnancy may lead to the development of leukaemia in childhood. This is not certain, but they certainly are of no benefit to the foetus and should be used only if the information obtained outweighs the disadvantages. They do not cause any abnormalities in the baby itself, neither do they cause any obvious damage to the foetus in early pregnancy other than as mentioned above.
X-rays of the chest taken during early pregnancy are usually performed with the abdomen protected by a lead screen. In this way the foetus receives no irradiation and cannot be harmed. Similarly, there is no danger to the foetus from necessary dental X-rays during pregnancy.
Immunization during Pregnancy
There is no objection to the standard immunization and vaccination procedures during pregnancy but for obvious reasons they should be avoided during the first 14 weeks. A smallpox vaccination certificate is valid for 3 years so if you are contemplating pregnancy, make sure it has not expired. If it has, or is due to expire within the next year, then revaccination before starting pregnancy is a wise precaution.
Primary smallpox vaccination, which is vaccination for the first time in a person’s life, should not be performed at any stage during pregnancy unless the woman has been in contact with smallpox or there is an epidemic. If you have never been vaccinated against smallpox, you are strongly advised not to go abroad during pregnancy. Get yourself vaccinated after your delivery—and then travel.
Infantile paralysis (poliomyelitis) may be particularly severe if contracted during pregnancy, so make sure you have had your poliomyelitis vaccination when contemplating pregnancy. If you have not been immunized against poliomyelitis, have this done as soon as possible.
Similarly, vaccinations against typhoid, paratyphoid, cholera or yellow fever may be given after the 14th week of pregnancy but are better avoided. There is no increase in the incidence of congenital abnormality or in the rate of abortion when immunization and vaccination have been performed during pregnancy.
Drugs in pregnancy are discussed. Generally, all drugs should be avoided during pregnancy except those that have been specifically permitted by your doctor or midwife. Tablets for nausea or early morning sickness will be prescribed if you are suffering to such an extent that you require treatment. Alkalis may be taken for indigestion; aspirin, codeine or paracetamol for any headache or other aches and pains.
If you arc contemplating pregnancy and are taking any drugs, tranquillizers or sleeping tablets, it is wise to ask your doctor about them before the onset of your pregnancy. If you are already pregnant, you should tell him, or the doctor at the antenatal clinic, as soon as possible. Thereafter you should not take any drugs unless they have been prescribed either by your doctor or by the antenatal clinic.