Sister Lilian’s Pregnancy and Birth Companion

Sister Lilian’s

Pregnancy & birth companion

Human & Rousseau

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Introduction

We live in fortunate times for pregnancy and childbirth. Women have a wide range of choices that can help them fulfil the special dream they have for this amazing phase of their lives. Pregnancy and birth have, moreover, been far safer for many for some time.

Advances in medical care continue to ensure that health and pregnancy complications are mostly effectively managed. With good pregnancy care, women seldom need to worry about their babies’ or their own wellbeing. Should problems arise, they can be assured that they will be expertly cared for.

The emotional significance of carrying and giving birth to a baby is the one aspect that has not always received the same careful attention. This is a special time in the lives of every woman and couple, empowering them at the start of the challenging journey that is parenthood. Women have forty weeks of pregnancy at their disposal to find out about all their options for making the culmination of labour and birth a miraculous day in their lives. There is not only one correct way to have a baby; the best pregnancies and births are those most suited to the unfolding needs of each individual woman and baby.

Never before has there been the possibility to have optimal medical safety while enjoying the vast benefits of a more natural approach. This Companion will be the link to understanding how these two approaches can integrate and help fulfil your special dream. It will give you the wisdom you need to make the choices that are best for you.

It is natural to feel anxious in pregnancy – about the safety and health of your baby, about medical checkups, about a loss of privacy, about coping with labour, and about how you will feel both physically and emotionally after birth. Empower yourself with knowledge and tap into the wisdom of Mother Nature, while protected by the safety net of advanced medical care, to allay unnecessary fears and put your mind at ease. Pregnancy is an exciting part of life, an incredible time when your mind and body show you just what humans are capable of. Every woman deserves to and can enjoy this precious time.

Take this Companion along on the journey – it is dedicated to all women who carry the future of the world in their wombs. Embrace every new feeling with joy and wonder as your miracle baby grows. Play an active part in your pregnancy and birth, as they are your experiences. Pregnancy is not a medical condition, but a phase of life. Women are born with the ability to and talent for carrying and giving birth to a baby.

It is my wish that this Companion will stand by you, as an informative and nonjudgemental friend, every step of the way.

Sister Lilian

Part 1:

Preparing for Pregnancy

Ideally, prenatal care begins long before you are pregnant to enable you to conceive the healthiest baby possible, to make pregnancy and delivery easier and to enable you to best care for your planned-for baby. Your own reproductive health is one of the important preconception factors to consider.

Know your body

Most women are quite comfortable with the functions of their bodies by the time they plan a family, but it is distressing to see how many women – some pregnant – are uninformed about the most basic body processes. Life can and does unfold regardless of whether we have an intimate knowledge of the structure and functions of our bodies but I hope to shed light on the most important factors regarding pregnancy in the first section of this Pregnancy and Birth Companion for those who want to know more.

THE REPRODUCTIVE ANATOMY OF A WOMAN

THE MENSTRUAL CYCLE

Many women are unaware of the rhythm of their menstrual cycle. It is both interesting and helpful to be more observant as you plan for pregnancy. Amazingly, women who either live or work in close proximity tend to menstruate at about the same time. The phases of the moon seem to influence menstruation and other body fluids as they do the oceans. When a woman is not using hormonal contraceptives, ovulation will tend to occur at full moon and menstruation when the moon has waned.

Historically, we regard the first day of the menstrual period as the first day of the cycle and call it Day One. It would be more correct to see menstruation as the end of a natural cycle in which conception did not occur. The accompanying chart shows two menstrual cycles, the first in which conception did not occur and the second in which it did. This chart uses the convention of Day One as the first day of the menstrual period. Remember that ovulation will usually occur between nine and sixteen days before the next period. The length and regularity of your cycle, as well as general hormonal balance, will affect this. In addition, a woman’s emotions are closely linked to her endocrine system and the two can affect each other.

CHROMOSOMES

Every cell in the human body has 46 chromosomes, arranged in 23 pairs, one of which determines gender. In the female egg cell, called an ovum, the sex chromosomes are designated as XX, in the male sperm, XY. X’s produce female babies and Y’s male babies. When an ovum is fertilised by a sperm cell, 23 chromosomes from each join. If the X from the sperm’s sex chromosome unites with the X from the ovum, the baby will be a girl; if the Y of the sperm cell joins the mother’s X, a boy will be born. In effect, the father determines the baby’s gender. The other chromosomes combine to carry all the hereditary features from both parents and their families.

IMPORTANT HORMONES IN WOMEN

The endocrine system is very complex. Although it is not necessary to know about hormones in great detail, a brief overview of the most important ones for a woman’s reproductive function is informative. The various hormones occur in a dynamic balance, governed by the pituitary gland which is located in the middle of the brain.

OESTROGEN

•The word oestrogen is derived from the Greek words oistros, meaning ‘mad desire’ and gennan, ‘to produce’.

•Oestrogen is secreted by the ovaries, adrenal cortex and, in pregnancy, the placenta.

•It causes the typical female sexual characteristics at puberty.

•It is responsible for cyclic changes to the endometrium (inner lining of the womb) and the vagina.

•It sustains new life in the uterus.

•It is important for the metabolism of calcium.

•It can cause headaches, fatigue, irritability, tender breasts and water retention.

PROGESTERONE

•It is secreted by the corpus luteum (the place in the ovary where the monthly egg cell is shed), the adrenal glands and, in pregnancy, the placenta.

•It sustains the endometrium after ovulation in preparation for receiving the fertilised egg.

•It is responsible for the development of the placenta and is later also produced by the placenta.

•Progesterone affects the development of mammary glands.

FOLLICLE-STIMULATING HORMONE (FSH)

•This hormone is produced by the anterior pituitary gland.

•It is responsible for the maturing of the egg cell.

LUTEINISING HORMONE (LH)

•It is produced by the anterior pituitary gland.

•It stimulates ovulation.

•It is responsible for the development of the corpus luteum.

PROLACTIN

•It is produced by the anterior pituitary gland.

•It is co-responsible for lactation.

OXYTOCIN

•It is produced by the posterior pituitary gland.

•It is produced during lovemaking, in labour and for successful lactation.

•It causes smooth muscle cells to contract in the reproductive system and mammary cells.

HUMAN CHORIONIC GONADOTROPIN (HCG)

•This pregnancy hormone is produced by the immature, developing placenta as soon as the fertilised egg cell is implanted in the endometrium.

•Levels in the mother’s urine and blood can confirm pregnancy with great accuracy.

FERTILISATION

A baby girl is born with all the egg cells she will ever have, as opposed to a boy who constantly produces new sperm cells after puberty. During each month from puberty, one egg cell is released from one of the ovaries at the time of ovulation, usually alternating between the ovaries every month. The quality of ova deteriorates as a woman ages. This is one of the factors responsible for increased infertility and abnormalities of babies in older women.

Fertilisation is the penetration of an ovum (female egg cell) by a male sperm cell. The ovum is released from the ovary into the Fallopian tube and is moved along by the wave-like motion of the muscle fibres of the tube walls. If one of the myriad sperm cells released into the vagina during lovemaking meets the ovum and penetrates the egg cell’s ‘shell’, conception occurs. In a regular menstrual cycle, this will usually be about fourteen days before the next menstruation. The fertilised egg cell continues down the Fallopian tube until it reaches the womb, about seven to ten days after conception, where it nestles in the thickened endometrial lining of the uterus. This is called implantation.

A brief look at fertility

CONTRACEPTIVES AND PREGNANCY

Chemical contraceptives like hormone tablets (the pill) and injections are generally very effective. Oral contraceptives need to be taken exactly as prescribed to be effective. In other words, you should not skip a day. If you use the mini-pill (progesterone only), you need to take the pill at the same time every day. If you are taking antibiotics or have a digestive disturbance like vomiting or diarrhoea, oral contraceptives may not be effectively absorbed and you might fall pregnant. In this case, it is important to abstain from lovemaking or to use alternative contraceptive methods for the rest of the month, while continuing to take the pill. This does not apply if you are using injectable contraception.

Women do sometimes fall pregnant despite taking contraceptives correctly. In most cases this does not appear to hold any dangers for the pregnant woman or her developing baby although, according to research, malformations in babies are sometimes attributed to this. If, however, you cannot accept an unplanned pregnancy, consult your doctor to discuss termination as early as possible in the first trimester.

You should complete a full pack of the oral hormonal contraceptive pill before trying to fall pregnant, to disturb the hormonal balance as little as possible. It is generally advised to give your body about three months to adjust after prolonged use of contraceptives (hormonal and intrauterine devices), although many women fall pregnant almost immediately or even while using contraceptives without apparent problems. Homeopathic remedies can help the endocrine system to settle sooner and improve the likelihood of conception if your menstrual cycle is irregular.

Generally, the longer you have used hormonal contraceptives, the longer it takes to fall pregnant, but this remains a very individual matter. There are many factors that influence how long it takes to fall pregnant, but if you have not conceived within six to twelve months, you should see your gynaecologist for a general checkup. It is advisable to have a general examination when you stop using contraceptives or plan to fall pregnant and if you have difficulty falling pregnant. Your partner might need a checkup if nothing seems to be the matter with you. Research shows that the male partner experiences as many fertility problems as the female.

OVULATION

Ovulation is the release of an egg from a woman’s ovary. The woman is most likely to fall pregnant in the few days around this time. Traditionally, ovulation occurs close to midcycle or about fourteen days before the next menstruation in an average 28-day cycle. (Day One is the first day of the menstrual period.) Adjust this for a longer or shorter cycle where midcycle will be a few days later or earlier.

We are beginning to realise that menstruation should be seen as the culmination rather than the start of a woman’s cycle. From this point of view, ovulation and pregnancy become most likely as soon as a woman notices a moist vaginal discharge. In other words, the idea that ovulation will occur strictly fourteen days before a period is not necessarily true. Discharge might be a more accurate indicator.

There are also other symptoms of ovulation that are recognised by women who are finely attuned to the functioning of their bodies. You might experience pain in the region of the ovary that releases the egg that month. Basal temperature (early morning body temperature) can also help determine your time of ovulation. These natural family planning and contraception techniques can help increase fertility.

FERTILITY, AGE AND HEALTH

Fertility declines quite markedly from the age of about 35 years and this may contribute to prolonged conception problems. This does not happen overnight though, and in a time when couples are choosing to have babies later in life, it should not be an overriding concern. Read more about how age affects fertility in The best age to have a baby.

Cysts and fibroids in a woman’s reproductive organs (ovaries, Fallopian tubes or womb) may affect fertility, but often do not. Many women discover for the first time that they have cysts or fibroids when an early pregnancy scan is done. Often these have never worried them at all, other than making menstruation uncomfortable at times. Read more about this in The pregnant mom’s health.

Conditions like endometriosis are also associated with difficulty in conceiving. Endometriosis is a condition where the lining of the womb becomes much thicker than normal and similar tissue grows in places other than the womb, such as the abdominal cavity, on the Fallopian tubes and even in the lungs. Exposure to synthetic oestrogens (like those in contraceptives and from various environmental sources) may be a factor in endometriosis. There is often also a family tendency to this condition. Women with a perfectionistic nature, who are incredibly aware of time management and are driven to succeed, are more at risk than others.

Endometriosis causes severe pain, especially during menstruation. It is usually treated with a combination of medication and surgery to remove the tissue. Taking measures to relax and become less agitated about life often helps, although professional therapy to achieve this is sometimes required.

Many women benefit from consulting a homeopath about compromised fertility. The tissue-salt remedy Calc sulph offers a possible solution if the capsule of the female egg is not strong enough. This is not picked up easily but is one cause of ova disintegrating before they are fertilised. It may be well worth your while to see a homeopath before opting for an expensive fertility procedure.

GENETIC CONSIDERATIONS

Many prospective parents worry about whether their unborn child will be normal. The more anxious you are by nature, the more difficult you will find it to put this into perspective. Remember that most babies are born ‘normal’. The value of not stressing unduly about this in pregnancy is great. Rather deal constructively with anxiety.

If you are aware of hereditary problems in your family, it is advisable to seek advice from a genetic counsellor before starting a family. Much heartache can be avoided in this way. Expectant couples who are at risk of giving birth to a baby with a genetic problem would be well advised to undergo appropriate tests (see Testing in pregnancy, which will put their minds at rest, assist them in a possible decision to terminate the pregnancy or give them time to prepare for the extra challenges of parenting a special-needs baby.

I advise every expectant parent to read The Antenatal Testing Handbook: The Complete Guide to Testing in Pregnancy by Vivienne Parry and others for an excellent overview of the tests available. It addresses the questions relating to genetics that are uppermost in the minds of many before conception and during pregnancy.

The best age to have a baby

I doubt whether there is such a thing as a best age to start a family. There are advantages and disadvantages to different ages and circumstances, and it remains a very personal decision. Those who have difficulty conceiving envy others the relative luxury of being in a position to consider such a question. I hope this Companion will help you decide what is best for you.

For as long as women have had babies, they have had babies in their late thirties or forties – usually ‘laatlammetjies’ – many due to the lack or failure of contraception. Today it is frequently a conscious choice to start a family much later in life. The reasons for this development are many and varied:

•significant contraceptive advances made in the second half of the twentieth century;

•a range of career options for women;

•older single women are no longer seen to be ‘on the shelf’;

•divorce and remarriage with a desire for children from the new union;

•some women (and their partners) wish to enjoy their younger lives unencumbered by the demands of parenthood;

•many wish for greater financial and emotional security before embarking on the responsibility of parenthood;

•an apparent general decline in fertility of both women and men and an increase in menstrual cycle disturbances;

•women who choose not to marry but desire to have a child tend to do so in their thirties or forties rather than at a younger age.

Having a baby after the age of 35 is not massively more risky than having a child at a younger age. Risk does not suddenly emerge but each year might make one or other factor more significant. There might also be some risk from an older father’s side, although this is very difficult to research accurately.

There are certain benefits to having babies at an older age and these might even be favourable to both mother and baby. Research bears out that higher standards of education and improved socioeconomic status are linked to healthier pregnancies and babies in older mothers. Good maternal health and lifestyle are far more important than chronological age.

A common concern is genetic defects. Just as the ageing eggs might result in more miscarriages, this might also contribute to the slowly increasing risk of genetic abnormalities in babies born to women over the age of 35. The most common condition is Down’s syndrome. Whereas at the age of thirty the risk of Down’s syndrome is about one in 885, it increases to about one in 365 for a 35-year-old and one in 110 at forty. Although it causes great anxiety for those who face it, this is less than a one per cent risk. The risk is definite but not huge. While it does increase steadily with advancing age, most women over 35 have completely normal babies.

Health generally declines as you get older and conditions like diabetes and high blood pressure in pregnancy affect more women after the age of 35 (see Pregnancy complications. Other circulatory problems like varicose veins and blood clots are also slightly more likely (see Moans and groans in pregnancy. Babies born to older mothers are often smaller due to such health problems. This can make their start in life more difficult, but with good pregnancy care and the mother doing all she can to live healthily before and during pregnancy, these problems can be minimised and are usually easily treatable.

Many women who choose motherhood later in life are health conscious and have followed wise eating and exercise patterns for many years. They understand the need for a balanced life, although some are extremely ambitious and may neglect the need for rest and relaxation. Moderation, simplicity and wisdom are key ways to enhance the chances of a healthy pregnancy, birth and baby. Physical strength and stamina may have declined a little by the age of 35 or beyond, but if you take care and live healthily, this need not be of great concern.

Emotionally you are more mature and better able to deal with the ups and downs of parenting when you are slightly older. Your relationship is cemented in the confidence and caring that time brings so that the inevitable stresses of the baby phase are less likely to rock the boat. The desire for a baby is usually very strong later in life. Moms and dads who are able and willing to prioritise this phase are less upset by demands on their personal space and time. Although you are used to your routine and your own space, Baby is usually a very welcome addition to the family. Patience is a virtue that is required and is usually present in older parents.

Earlier financial concern is often over or substantially less when parents are older, removing one huge stress factor from the parenting equation. Money problems can lead to a whole array of insecurities and tensions which further complicate parenting. Babies and children are quick to notice undue stress in the home and this can make them unhappy, leading to a vicious cycle of ever-increasing tension. It’s not that a child costs so much; rather, the cost of living is the problem if you have not yet built up and consolidated your resources. This is particularly true if you do not have much support from your extended family.

You become so used to the independence of adult life that being on 24-hour call and having to respond to a baby’s often unpredictable patterns and needs might be quite challenging for older parents, especially if they are very ordered and goal-oriented. The playfulness that young parents are still in touch with can be a valuable parenting skill, making the task lighter, but older moms and dads can recultivate this.

Having a baby later in life may herald a change in friendships if your peers don’t have babies although, as more women choose this option, this is rapidly disappearing as a potential problem. By the time the children have grown up, you might feel there is less time left to enjoy what life offers, but most say that the extended time before starting a family satisfied that need.

Your relationship

We all know that babies don’t save marriages, yet it is amazing how often couples in an ailing relationship pin their hopes for family happiness on having a child. Sharing children can be good as you will often laugh about mannerisms and delightful personality traits peculiar to your child in the knowledge that only you, the father and mother, really understand and love your child that intensely. A child will not, however, heal a deep rift.

Perhaps our expectations of marriage or love partnerships are unrealistic, but just as we hone the qualities needed for our careers and practise them, we should do the same for this time-consuming and very important aspect of our lives. I believe the tools of the partnership trade are:

•respect for the individuality of the other;

•time invested in making your partner feel good;

•regular and non-sarcastic communication;

•the ability to forgive and ask for forgiveness.

Taking time to do things together is the fertile ground for nurturing and practising these skills. And when the honeymoon phase of your partnership inevitably starts to wane, remember that this is natural and that a strong, caring friendship will nourish the relationship in the long term.

Before you embark on the road to parenthood, be honest with yourself:

REALITY CHECK

•Are the problems you and your partner experience too deep to overcome?

•Do you fight continually in a destructive manner?

•Is there mutual respect?

•Do you enjoy a wide variety of similar interests and friendships?

•Do you support each other in your personal ambitions?

•Do you give each other space to develop individually?

If, despite sustained hard work at the relationship, you simply feel the rift widening, don’t make the mistake of having a baby. Once you have a baby, there is a sense in which you are tied together forever. How many amicable divorces do you know of, where the good of the children is placed above the good of the parents? And then, as if to rub salt into the wounds, issues of access and finance complicate both partners’ lives. Think further ahead to your child’s school functions, graduation and wedding. How much heartache and awkwardness awaits the whole family?

I am all for trying to save marriages and wish to encourage you to work at your relationship in a positive, caring spirit. But do not underestimate the pressure babies and children can place on an already tenuous partnership.

Preparing your mind and body for pregnancy

Increasingly, women and their partners are realising that preparing their bodies and minds for conception, pregnancy and parenthood is the very best form of preventative medicine. This is an excellent development. Moderate exercise contributes to a healthy pregnancy. Eating fresh, healthy food as often as possible and minimising processed and fast foods is a sure building block. Avoiding smoking and recreational drugs, restricting medicines to those that are really necessary and strictly limiting alcohol before and during pregnancy are essential to the equation.

Some supplements before conception, like folic acid, can improve overall health and ensure the best environment for conception. You cannot easily overdose on folic acid. Take about 400 mg daily from about three months before pregnancy and continue throughout the first trimester. You need only supplement with other vitamins and minerals if you are not eating healthily or are frequently unwell. Taking a general pregnancy supplement like those your doctor will prescribe or one of the well-known brands available in pharmacies and health stores is fine even before pregnancy.

THE IMPORTANCE OF INDIVIDUALITY

Most important of all is to recognise that you need appropriate individual preparation for the very best health for both the mom and baby. Try to recognise yourself in one or two of the following groups and apply the relevant nutritional and lifestyle advice. You will find that this makes deep psychobiological sense. The effect of a few adjustments will soon convince you that you can affect your pregnancy positively. The system of mind-body medicine has a long, rich history. Because it is a commonsense approach, you will see the benefits of adopting it as a way of life.

Throughout this Companion, I will refer to tips that are appropriate and helpful for each group, be it in pregnancy, labour or early parenting. These can be of great benefit.

GROUP 1: ENTHUSIASTIC BUT ANXIOUS

Are you one of those complex women whose mind is as lively as quicksilver, with lightning perception and a vision of a million things that you know you could do, if only your energy levels would not come in such short, sharp bursts? And if you could just force yourself to sleep more and a bit better, you know that all those creative juices would do more than flow; they’d gel into something quite amazing. Of course, ‘worry’ is your middle name and almost everything, from the smallest to the biggest issue, causes you concern. Your energy levels drop fast and your erratic eating habits do nothing to sustain you. You live with an underlying, trembling tension that makes you need quite a lot of reassurance. Impending pregnancy, birth and motherhood feed your stockpile of causes of anxiety, because you want to be the very best you can