Pregnancy: The Whole Story

Fertilization usually takes place in the fallopian tube. Only one of the millions of sperm will pass through the membrane of the ovum (female egg) achieving conception. Once the sperm has fertilized the ovum, enzymes in the egg alter the inner membrane and make it impossible for more sperm to enter. Once introduced, the nuclei of the sperm and the egg, each containing 23 chromosomes, unite to form one fertilized egg with the 46 chromosomes needed for human development. The whole process of intermingling takes 24 hours. The fertilized egg then travels to the womb where it embeds itself like a seed in the lining of the uterus and begins to grow.

Physical Changes in the Mother During Pregnancy
During the first trimester, the uterus, a small, hard, pear-shaped organ becomes a soft, spherical sac through which the baby can be easily felt. By the end of the first trimester, the uterus has expanded out from the pelvic cavity and touches the abdominal wall. It continues to grow and, at term, the uterus is between 500 and 1,000 times its prepregnant size. The actual growth of muscle fibers, not just the stretching of the uterus, is responsible for most of the increase in size. At the end of the ninth month, the uterus almost touches the mother’s liver just under the lower right rib.

The prepregnant cervix is firm and muscular. During pregnancy, from as early as the first trimester, the cervix begins to soften, caused by an increase in the number of blood vessels and mucus glands in the cervical lining. The cervix also becomes spongy in texture and creates a mucous plug that seals the cervical opening soon after fertilization takes place. This plug is released some time around the start of labor.

Soon after conception, the vagina experiences an increase in blood flow and as a result it takes on a violet hue. Throughout pregnancy, the vaginal wall thickens, elongates, and becomes looser and more elastic in order to prepare for the enormous amount of stretching that it will go through during the delivery. The opening to the vagina and the vulva become swollen and vaginal discharge becomes thick, white, and acidic, which helps guard against infection.

Within a couple of weeks of conception, the breasts can feel full, heavy, and sore. These sensations are due to the enlargement of ducts and lobules known as alveoli. During the first trimester, the breasts begin to increase in size. As time progresses, the areola, the pigmented area around the nipples, become wider and darker and the nipples themselves become larger and darker. After the first trimester, some women may notice a slight discharge of colostrum, a highly nutritious, yellowish liquid that the newborn suckles on until the milk comes in, around the third day after birth.

How to Have a Healthy Pregnancy
Although each individual responds to pregnancy differently, and there is no such thing as a perfect pregnancy, there are many ways to contribute to a healthy one. “Probably most important is that the woman realizes the physiological impact carrying a child has on her health and that she listens to her body’s needs,” says Dr. Linton. “Adequate rest, including naps, ‘mental’ breaks, and sufficient sleep, is essential. Maintaining a positive outlook and keeping stress to a minimum are beneficial to both mother and baby. Comfortably paced, regular, non-jarring exercise, such as low-impact aerobics, walking, yoga, and swimming, can increase stamina for labor, strengthen muscles used during delivery, and may enhance the ability to cope better with labor.”

Harmful Factors Affecting the Fetus Maternal exposure to alcohol and cigarettes, recreational drugs (marijuana, cocaine, heroin, and LSD), medications such as lithium (to treat depression) and tetracycline (an antibiotic), pesticides, petroleum products, heavy metals such as lead and mercury,19 caffeine,20 and even over-the-counter medicines such as aspirin can harm the fetus and should be limited if not avoided altogether. Recent research also suggests that mothers having high homocysteine levels (an amino acid linked to heart disease), being overweight, or having urinary tract infections can increase the risk of birth defects and later impairment to children, as can the use of the acne drug Accutane.

There are two periods of pregnancy when the maternal consumption of alcohol is particularly threatening to the development of the fetus: from the 12th to the 18th week and from the 24th to the 36th week. Experts at the U.S. National Institute of Alcohol Abuse and Alcoholism claim that three or four beers or glasses of wine a day can cause any one or more of the following defects: mental retardation, hyperactivity, a heart murmur, facial deformity such as a small head, or low-set ears. Consuming even small amounts of alcohol during pregnancy can increase the risk of newborn children developing behavioral problems later in life. In a study of 506 women, researchers found that children born to mothers who drank the equivalent of one cocktail a week during pregnancy were three times as likely to exhibit behavioral problems such as aggression, delinquent behavior, and attention problems by ages 6 to 7 compared to children born of mothers who completely abstained from alcohol from conception to birth. This was true after the researchers took into account other factors that can influence children’s behavior.

Cigarette smoking cuts the amount of oxygen available in the maternal blood, which directly affects the growth of fetal tissue. Studies have shown that babies born to mothers who smoke 13 or more high-tar cigarettes a day are smaller and in poor physical condition compared to those of nonsmoking mothers. In addition, more recent research has found that mothers who are heavy smokers (15 or more cigarettes per day) during pregnancy and shortly after birth are twice as likely to have babies who develop infant colic or who are fussier than normal and seemingly inconsolable.

Research also indicates that high levels of homocysteine may be a marker during pregnancy for preeclampsia and umbilical placental vascular disease. Moreover, infants born of mothers with high homocysteine levels tend to be born earlier than normal and to weigh significantly less at birth. Homocysteine has also been shown to cause birth defects.

Babies born of mothers who are overweight or obese prior to conceiving are 36% more likely to be born with a birth defect compared to babies born of women of normal weight, according to a recent study conducted by the CDC. The researchers noted that the study has “important implications for prevention, given the increasing prevalence of obesity.”

The CDC recently released a report that some women become pregnant while taking the acne drug Accutane, despite the fact that the drug causes severe birth defects and despite the fact that the drug contains a warning symbol to that effect on its packaging. According to the CDC, many women were unable to determine what the symbol meant. The CDC advises women taking Accutane to use two forms of birth control, be tested for pregnancy each month, and register with a survey that monitors the experiences of women who use the drug.

New research shows that urinary tract infections (UTIs) during the third trimester of pregnancy can increase the risk of mental retardation in infants by 40% and double the likelihood of fetal death, if left untreated. UTIs occur in approximately 5%-7% of all pregnancies. However, the research also showed that women who were treated with antibiotics within the first few days of UTI symptoms (burning sensations during urination and/or a frequent urgency to urinate) had no increased risk of their babies being harmed.

Over-the-counter drugs such as aspirin, when used during the first half of pregnancy, have been linked with lower-than-average IQs in those babies.30 Research into the effects of valium on chickens revealed an impairment of muscle-cell development in their chicks and suggests a possible risk in human pregnancy.

Environmental factors, such as pesticides, lead, and chemicals brought home from a work environment on a parent’s clothing, can harm an unborn child.32 X-ray exposure to the mother, as well as preconception X-ray exposure to the father, is also harmful.33 Although most studies have not substantiated the claim that video display terminals (VDTs) adversely affect the fetus, many individuals are not convinced. In 1991, in response to this concern, San Francisco, California, mandated that companies with 15 or more employees protect their workers against potential adverse health effects from VDTs. They were required to provide wrist rests, antiglare shields, adjustable chairs, and regular breaks from sitting in front of a VDT screen. Louis Slesin, publisher of Microwave News, claims that the effects of using VDTs during pregnancy are unknown. He points out that studies concluding that VDTs are not harmful to the fetus do not assess the situation accurately. As so many people are now using VDTs in their workplace, more reliable investigations need to be conducted.

Nutrition During Pregnancy
It is important to the health of both mother and fetus that the mother eats a well-balanced and varied diet. Fresh fruits and vegetables, whole grains, legumes, beans, and fish are essential. Limit refined sugars, processed foods, and saturated fats. Organically grown produce, meats, and poultry are preferable. However, if produce is not organic, it should be washed to remove as much of the agricultural chemical residue as possible.

Most physicians recommend eating plenty of dairy products during pregnancy, due to their calcium and protein content. Helen Burst also suggests her patients use milk products. “If a woman is lactose intolerant,” says Burst, “obviously you’re going to find other ways of getting her the protein. If she’s not lactose intolerant, I don’t see any problems in using milk and the dairy products.”

Other doctors are more wary about suggesting dairy as a mainstay of a pregnant woman’s diet. Lendon Smith, M.D., a pediatrician and author of several books on children’s nutrition, explains, “Many babies will develop a milk sensitivity before they are born because the mother followed the obstetrician’s dictum: ‘Drink a quart of milk every day so the baby will get the calcium.’ If a mother is already sensitive to dairy products and takes in milk, cheese, and ice cream, she may not be absorbing the calcium from those foods she is ingesting.” Foods such as nuts, soybean products such as tofu and soymilk, and goat milk products provide alternative sources of protein. Seaweed, green vegetables, and a mixture of sunflower, sesame, and pumpkin seeds are alternatives for calcium. No one food, including dairy, should be eaten on a daily basis, Dr. Smith advises, as this increases an individual’s chance of developing a food sensitivity. Although a well-chosen vegetarian diet may be healthy for some pregnant woman, vegetarians who consume no animal products at all, including dairy and eggs, should use a vitamin B12 supplement. This is especially true in light of a recent study which found that women who are deficient in B12 have a greater risk of infertility or repeated miscarriages. One woman in the study had suffered seven miscarriages before her B12 deficiency was discovered, and then went one to have three healthy children in separate pregnancies after supplementing with the vitamin.

“Women who are vegetarians must carefully combine their grains and beans in order to achieve adequate protein intake,” cautions Alan Gaby, M.D., past President of the American Holistic Medical Association and a noted nutritional expert. “Even with proper food combining, a protein supplement may be necessary for some vegetarian women. To assure adequate intake of vitamins and minerals, a well-formulated prenatal supplement should be used.”

The idea that a pregnant woman needs to eat for two is a myth. A baby is not a parasite that depletes the mother of all her nutrition. Both undereating and overeating have a negative impact, according to Dr. Linton. “The usual obstetric advice of increasing daily intake by 300 calories is not supported by all, and some nutritionists feel that hunger, not calorie counting, is a more reliable guide to eating during pregnancy,” she says. Eating five to six small, nutrient-dense meals a day is a sensible idea. Restricting weight gain, which was very popular 20 years ago, was thought to ease a woman’s labor. We now know that this is not necessarily so. Guidelines issued in 1990 by the Institute of Medicine, in Washington, D.C., recommend weight gains for healthy pregnant women. The range of optimal weight gains depends on the weight of the mother early in pregnancy:

• 28-40 pounds for “underweight” women
• 15-25 pounds for “overweight” women
• A minimum of 15 pounds for “obese” women

These guidelines “reflect current interests in preventing low–birth weight babies and thus reduce the incidence of infant mortality and mental and physical retardation.”39 Pregnancy is not the time to diet. Dr. Linton offers a simple formula. “If you are eating a whole foods diet, drinking plenty of water, and getting adequate exercise such as walking or swimming, then the weight you gain in your pregnancy is appropriate.”

Opinions vary on the amount of protein that is needed during pregnancy. The U.S. Recommended Dietary Allowance (RDA) indicates that a woman’s requirements rise from 46 g to 60 g per day. Some experts advocate consuming even more protein than the RDA. “I think that dietary protein is probably the most common nutrient deficiency in pregnancy,” says Timothy Birdsall, N.D. “Pregnant women need 70-100 g of protein daily, which most people will not get with a normal diet.” These levels of protein, adds Dr. Birdsall, help feed increasing blood volume and guard against complications during pregnancy, such as preeclampsia.

Helen Burst agrees with Dr. Birdsall’s sentiments. “I believe in protein and calorie increases during pregnancy and certainly when breast-feeding, too,” she says. “To me, the amounts given in the RDA are too low. You can make a significant difference in the birth weights of babies born to women eating a good balance of protein and calories.” Both Dr. Birdsall and Burst point out that a protein increase must be accompanied by more calories or the protein will be used for energy rather than the construction of tissues, such as blood, the placenta, and an expanding uterus.

Salt Intake During Pregnancy: Sodium is needed to maintain fluid balance and blood volume. For this reason, salt restriction is one common nutritional advisement that does not apply during pregnancy. Restricting sodium and using diuretics, once routine treatments to prevent preeclampsia and swelling, are not only unnecessary but also potentially harmful. It is best to use salt to taste.

If there is any concern that a mother’s diet does not provide all the vitamins and minerals needed for a healthy pregnancy, she may want to add a prenatal supplement. Requirements for many nutrients increase during this time and supplementing a poor diet results in a healthier pregnancy. Dr. Linton notes that it is most important for pregnant women to eat well and then use supplements to optimize their health. Supplements of specific vitamins and minerals can also be used as safe treatments to certain problems during pregnancy. For example, vitamin B6 may help alleviate morning sickness and calcium can decrease hypertension.

However, like any substance taken during this time, discretion should be used. “Ideally, we get our nutrients from foods,” says Dr. Birdsall. “The unfortunate part is that none of us live in an ideal situation. We’re all exposed to varying levels of toxins in our environment and in the food chain. Most of us are have levels of stress in our lives that deplete us of nutrients. Many of the foods we consume are deficient in nutrients compared to what they were 75 or 100 years ago.” A prenatal supplement, he explains, acts as an insurance policy, providing it contains reasonable amounts of vitamins and minerals.

Vitamin C is a nutrient that is chronically underdosed, according to Dr. Birdsall. He points out the vital role of vitamin C in the formation of collagen, a protein found in connective tissue, cartilage, and bone. Some doctors are concerned over a condition called rebound scurvy, thought to affect newborns whose mothers have ingested large amounts of vitamin C. In Dr. Birdsall’s experience and research, this is a very rare phenomenon. “I have only been able to find two documented cases of rebound scurvy in the medical literature,” he explains. If it does develop, he says, the infant recovers with no treatment in a relatively short period of time.

Folic acid, a B vitamin found in green leafy vegetables, nuts, and whole grains, can prevent neural tube defects in fetuses. However, artificial supplementation of folic acid can decrease zinc absorption, a mineral required for proper fetal growth and immunity.45 In unusually large doses (1,000 mcg), folic acid is associated with maternal infection and abnormally slow fetal heart rate.

Extra iron may be warranted if the mother’s hemoglobin tests suggest a deficiency. Yet routine supplementation of iron can block zinc absorption and has been linked with infection, cancer, and other conditions.

However, Dr. Birdsall states that iron is the only nutrient that the current dietary guidelines for pregnancy say should be supplemented and he sees adding this mineral to his pregnant patients’ regimen as valuable. Vitamin D should also be taken judiciously to avoid toxicity. The fetus can drain as much as 300 mg daily of calcium from the mother during the third trimester, in order to facilitate bone development. However, absorption of vitamin D (a nutrient that aids in calcium uptake) and calcium are enhanced during pregnancy. Consequently, some experts are debating whether the current RDA of 1,200 mg of calcium daily during pregnancy is perhaps too high. Excessive levels of this mineral in the body can result in its spillage into the urine. One in every 1,500 pregnant women who consumes high amounts of calcium may develop kidney stones, slightly higher than in nonpregnant women. Dr. Birdsall feels that physicians have tended to over-supplement pregnant women with calcium for two reasons: “We tend to ignore the relationship between calcium and the other minerals, particularly magnesium and zinc. And most of the research done on calcium supplementation is done with relatively inefficient forms of calcium.” Calcium citrate or citrate/malate are the most absorbable forms—the more efficiently the mineral is absorbed, the less you need to ingest.

While it is true that milk contains substantial amounts of this mineral, some experts question the availability of dairy’s calcium. “There is now some good research to indicate that dairy consumption by the mother can induce an allergic condition in the baby,” Dr. Birdsall says. Using alternative calcium foods, such as dark green leafy vegetables, and avoiding calcium-robbing foods, such as coffee, sugar, and salt, will ensure adequate nourishment for a pregnant woman. With regard to salt, pregnancy is not a time to restrict salt intake, but it should be used in moderation as large amounts will decrease available calcium. Calcium supplementation can also help ease leg cramps during pregnancy. Vitamins B6, D, and K, and boron are nutrients that are also involved in bone metabolism.

Contraindicated Vitamins, Minerals, and Herbs
Pregnant women should use caution in taking vitamins and minerals. One nutrient that should be supplemented with caution during pregnancy is vitamin A, which recent research shows can increase the risk of birth defects, such as heart abnormalities, cleft lip, or cleft palate. Doses of vitamin A as low as 15,000 IU have been associated with microcephaly, a congenital abnormal smallness of the head often seen in mental retardation. (However, no evidence exists linking similar or higher doses of vitamin A obtained through the diet to such birth defects.) “There is no question that very large doses of vitamin A can cause birth defects,” Dr. Gaby says. “What we do not know is the optimal intake of vitamin A for pregnant women, nor do we know the maximum safe level. Everyone agrees that 10,000 IU per day is safe. If there is a medical reason to take larger amounts of vitamin A during pregnancy, the risks should be carefully weighed against the benefits.”

Beta carotene, which is converted by the body into vitamin A, is relatively nontoxic and probably safe. However, Dr. Birdsall says, “I err on the side of caution in situations like that and normally would not, at least early in pregnancy, use high doses of beta carotene either.” Regarding the use of supplementation during pregnancy, only take what is absolutely necessary.

Although many herbs are useful during pregnancy and childbirth, there are many that are discouraged. According to Dr. Birdsall, herbs such as autumn crocus, barberry, goldenseal, juniper, male fern, mandrake, pennyroyal, poke root, rue, sage, southernwood, tansy, thuja, and wormwood may trigger a miscarriage. Use herbs with discretion and only under the guidance of a professional. “There are some herbs that are absolutely contraindicated in pregnancy,” Dr. Birdsall says. His list of herbs to avoid during this time includes some fairly common plants, such as the laxatives senna and cascara sagrada found in both herbal preparations and over-the-counter drugs. Senna encourages menstruation and may promote miscarriage.

Herbs with high concentrations of the alkaloid berberine, found in goldenseal, barberry, and Oregon grape root, should not be used during pregnancy. “Historically,” says Dr. Birdsall, “goldenseal was used to stop postpartum uterine hemorrhage and it does that because it causes strong uterine contractions.” Licorice contains estrogen-like substances and is to be avoided during pregnancy. Juniper can harm the fetus and possibly induce a miscarriage.

Preparing the Body for Childbirth
Ease the stress, pain, and anxiety precipitating and accompanying childbirth by taking the proper steps to prepare one’s body and mind. Exercises that strengthen the body are easy to do, but equally important are exercises that strengthen the intimacy between the expectant parents. Kegel Exercises: The muscle that surrounds the vagina is called the pubococcygeal (PC) muscle. It is usually in good tone; however, during pregnancy and childbirth it supports a lot of weight and can become slack. To keep the PC muscle toned, it is important to practice Kegel exercises on a daily basis, both before and after the birth.

To find your PC muscle, sit on the toilet and spread your legs apart. As you start to urinate, see if you can control the flow of urine without moving your legs. The PC muscle is the one you use to turn the flow on and off.

• Slow Kegels: Tighten the PC muscle as if to stop the urine. Hold for a slow count of three and then relax. Repeat ten times.
• Quick Kegels: Tighten and relax the PC muscle, as quickly as you can, five times. Relax and repeat ten times.
• Pull in, Push out: Pull up the entire pelvic floor as though trying to suck water into the vagina. Then push out or bear down as if trying to push the imaginary water out. This exercise uses the stomach and abdominal muscles as well as the PC muscle. Do this 4-5 times in a row. Repeat ten times.

Ideally you should repeat each of these exercises five times a day, beginning at the start of pregnancy. After a few months, you will notice an improvement in your performance and can gradually increase the amount of practice times each week. These exercises can be done anytime and anywhere: practice while driving the car, watching television, washing dishes, or waiting in line. They will enhance vaginal elasticity and improve bladder control. It is also good to practice during sexual intercourse as this can help elevate sexual awareness and pleasure.

Perineal Massage: The perineum is the area between the vagina and anus. During the last six weeks of pregnancy, it should be massaged daily in order to prepare for the stretching it will experience during birth. This technique can also help reduce the need for an episiotomy (a small surgical incision in the perineum made by obstetricians to facilitate the emergence of the baby) and protect against tearing. This technique should be delayed if there are any vaginal problems, such as an active herpes sore or vaginitis. It can be resumed when the vagina has healed. Perineal massage can be performed by you or your partner.

Roy Dittman, O.M.D., of Santa Monica, California, offers these guidelines for a perineal massage:
• Wash your hands. Have a mirror handy, and find a warm, private place to practice.
• Lubricate your perineum and your thumbs with vegetable oil, cocoa butter, KY jelly, or vitamin E oil. You can also use your own body secretions if you wish.
• Placing your thumbs about 1 1/2 inches inside your vagina, press down and to the sides at the same time. Gently and firmly stretch the skin until you feel a slight tingling or burning sensation. Continue to hold this pressure for an additional two minutes until the perineum becomes more numb and the tingling is not as distinct.
• Take 3-4 minutes to massage the oil along the outside of the lower half of the vagina. Avoid moving upward toward the urethra.
• Pulling gently outward or forward, massage the lower part of the vagina with your thumbs. This massage motion helps to stretch the perineal skin, similar to the way your baby’s head will stretch it during birth.

Intimacy During Pregnancy
A woman’s physical and emotional comfort with her pregnancy determine her sexual attitudes and enjoyment at this time. Her feelings are often influenced by her partner’s attitude to her appearance. This issue is complex and it is therefore vital that women and men discuss their feelings, fears, and beliefs about the changes that are shaping their lives and consequently affecting their lovemaking.

During pregnancy, a woman’s libido can oscillate from high to low. She may become anorgasmic for a period or the symptoms of pregnancy may dampen her sexual drive. During the latter months, the awkwardness of her shape may inhibit her from lovemaking. Some couples are concerned that intercourse may harm the fetus and it is reassuring for them to learn that the penis rarely touches the cervix. The vagina lengthens during sexual excitement and the mucous plug covering the cervical opening to the uterus also provides protection. Semen is rich in prostaglandins, natural bodily chemicals that can help ripen and soften the cervix, and intercourse may initiate uterine contractions. However, these actions will not induce labor unless a woman is nearing the end of her pregnancy.

Helen Burst feels that sexual activity should depend on how the woman feels. “There are many things in terms of alternatives to actual intercourse itself, if that is a problem,” she explains. “The only time that I restrict sex is if she’s having signs and symptoms of preterm labor.” Other exceptions to sex or orgasm during pregnancy would be cases in which vaginal bleeding occurs, if the woman experiences continuing or painful cramps after intercourse, or if the woman has a new sexual partner with a sexually transmitted disease or AIDS. If there is a history of preterm labor, Burst advises the use of condoms for sexual intercourse. The father or birth coach should participate in the many decisions and educational opportunities during pregnancy. This includes touring the hospital (if this is the chosen location for birth) and learning about the different stages of labor. The partner should discuss any concerns for the birth with both the pregnant woman and the birth attendant. He or she should feel free to disclose any feelings, positive or negative, surrounding the upcoming event, so that there are no uncertain feelings to hinder the support of the mother during labor.