We Want To Have A Baby!
Now what?

By Marsha C. Solomon, M.D.

For many couples, planning to conceive can be an extremely overwhelming process. Introducing a new life into the world is a unique and life-changing experience that for some in today’s world may require extensive preparation on multiple levels. In addition, the conception process and resulting pregnancy can be quite stressful and confusing, especially in situations where pregnancy does not occur immediately or pregnancy complications occur. It is therefore beneficial for couples to have a reasonable understanding of conception, early pregnancy and its potential complications, pregnancy milestones, and what to expect from prenatal care.

The critical period for organ development in a fetus is between 17 and 56 days after fertilization, which occurs before most women are even aware that they are pregnant. Therefore, before attempting to conceive, each partner should be aware of his or her complete medical history and the female patient should undergo a general health assessment by her physician to ensure that any unresolved issues (medical conditions, lifestyle habits, immunizations, and medications) have been addressed. The female patient may also begin to take daily prenatal vitamins containing folic acid to aid in the protection of the fetus from neural tube defects.

A woman’s knowledge and understanding of her menstrual cycle can play a key role in becoming pregnant. The average menstrual cycle lasts for approximately 28 days, however may range from 21 to 36 days. One may determine the length of her cycle by recording the first day of menstrual bleeding (cycle day 1) on a calendar monthly. The number of days between the first day of bleeding in one cycle and the first day of bleeding in the next cycle will determine the cycle length. It is important to be aware that not every cycle is exactly alike, and it may be necessary to follow menstrual cycles for several months to determine average cycle length. Ovulation, or the release of the egg from the ovary, occurs at approximately mid-cycle (day 14 in a woman with a 28 day cycle). At the time of ovulation, a woman’s body temperature will increase by 1/10 to ½ of a degree and will remain elevated until the end of the cycle. Recording daily body temperatures and monitoring closely for this minor temperature shift may therefore be helpful in determining the time of ovulation. The most optimal time to attempt to conceive surrounds the time of ovulation, and successful fertilization most often occurs in the six-day period leading up to and including ovulation. Couples who have been timing ovulation correctly and attempting to conceive for at least one year without success should be evaluated for possible infertility issues.

Most women are unable to determine exactly when they become pregnant, however may experience symptoms such as nausea, fatigue, and breast tenderness even prior to missing a period. Home pregnancy tests measure urinary levels of pregnancy hormone and are relatively sensitive, however will not become positive until approximately 2 weeks following conception. If one suspects pregnancy, a urine or blood test should be performed for confirmation.

It is in early pregnancy, or the first trimester that the majority of miscarriages occur. Miscarriages, or spontaneous pregnancy losses, occur in approximately 15% of all pregnancies. They may often occur before a woman realizes that she is pregnant and may be incorrectly interpreted as an abnormally heavy cycle. Fifty percent of early miscarriages are caused by chromosomal abnormalities in the embryo or fetus, which are most commonly trisomies (extra chromosomes) and have no effect on a woman’s ability to conceive in the future. Any woman who experiences 3 consecutive miscarriages should consult with her physician prior to her next pregnancy. It is important for a pregnant woman to report any bleeding or pain to her physician, as these symptoms may be indicative of a threatened or inevitable miscarriage. More importantly, these symptoms could result from an ectopic pregnancy, or pregnancy outside of the uterus (most commonly in the fallopian tube), which is a medical emergency.

Once pregnant, prenatal care should begin as early as possible. An initial visit including a thorough history, examination, and blood testing should take place between 6 and 10 weeks of gestation. An early sonogram is often performed at this visit, and early fetal measurements are taken in order to determine both location and normalcy of the pregnancy, as well as the estimated due date. A pregnancy is counted in weeks (not months), with the estimated due date being at 40 weeks of gestation. Prenatal visits are initially scheduled at 4-week intervals, and increase in frequency to 2 weeks beginning at approximately 28 weeks gestation, and then to 1 week at approximately week 35-36. Each prenatal visit will consist of evaluation of vital signs and maternal weight, as well as measurements of uterine size to evaluate fetal growth, and fetal heart rate determination. Periodic laboratory tests, such as testing for pregnancy-induced diabetes, will also be conducted. An official sonogram, known as an anatomic survey, will be performed between 18 and 22 weeks gestation to fully evaluate the fetus for all structures as well as any abnormalities. The sex of the baby is often determined at this time.

An expectant mother will first feel the movements of her growing baby between 16 and 20 weeks of gestation. When the pregnancy reaches its 24th week, the fetus is officially considered to be viable, meaning that while still extremely premature, he or she is adequately developed to survive outside of mother’s body. The prematurity period officially ends at 37 weeks, 3 weeks prior to the due date, when the pregnancy is considered to be at “term”. It is as this time that the baby is considered to be completely matured and ready for delivery. The majority of first pregnancies will continue until or past the due date and may require induction of labor, which is commonly performed at 41 weeks. It is the aim of every obstetrician to deliver each baby via spontaneous vaginal delivery, as vaginal delivery poses less risk to both mother and baby than caesarian delivery. It is quite common, however, that a caesarian section will be performed secondary to failure of labor progression, fetal intolerance of labor, breech presentation, or other obstetrical emergencies.

While the process of childbearing may be stressful and difficult at times, it should not be forgotten that the creation and introduction of a new life is a very unique, emotional, intimate, miraculous, and often spiritual experience through which a couple may strengthen their bond and grow both as a couple and as a new family.

(Marsha C. Solomon, M.D. is a contributor to Island Vibes Magazine and writes about health and wellness. For comments, please feel free to contact her at drsolomon@islandvibesmag.com.)