Minimising the risk of Influenza A (H1N1) Infection from mother to baby

• The spectrum of disease of pandemic influenza A H1N1 09 in newborns is unclear
• Breast feeding should be strongly encouraged

Sensible efforts should be made to reduce the likelihood the baby will be infected, while minimising the effect on the mother-baby relationship. These include:

• treating the mother to reduce the risk of transmission (the mother is considered non-infectious after 72 hours of treatment with antiviral medicine)
• the mother and baby should sleep in separate beds
• when breast feeding, bathing, caring for, cuddling, or otherwise being within 1 metre of the baby, the mother should:
• wash her hands thoroughly with soap and water before interacting with the baby
• always use cough etiquette near the baby.

Although these measures can be ceased when the mother is no longer infectious, continued good hygiene should be encouraged at all times. These measures should apply to any carer or family member with influenza.

• Mothers requiring hospital care should not be prematurely discharged because they have influenza
• If discharged while still infectious, mothers should be provided with a sufficient supply of surgical masks to take home
• Prophylaxis is not recommended for the baby. Should the baby develop symptoms, the baby should be isolated from other babies, assessed urgently by a paediatrician, and if influenza is diagnosed, considered for treatment with antiviral medicine.

Source: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Prevention from Influenza A (H1N1) for Pregnant Women

To avoid influenza, it is recommended that pregnant women are advised to take sensible precautions including:

• Avoid close contact with people who have symptoms, if possible
• Wash hands with soap and running water or use an alcohol based hand rub after contact with symptomatic people or their secretions e.g. on used tissues
• Get immunised against influenza if they will be at any stage of pregnancy during winter
• Encourage symptomatic people in the household to keep at least 1 metre away and follow cough etiquette and good hand hygiene
• Avoid large, crowded gatherings during the influenza season.
• There is no recommendation for well people to wear surgical masks, or to exclude themselves from regular activities.

Source: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Coping with grief during pregnancy

Pregnancy is an emotional time, so it’s hardly surprising that it can trigger painful feelings of grief about the deaths of loved ones. If, for example, you recently lost a parent or a grandparent, or your partner died during your pregnancy, you may regret the fact that this special person in your life didn’t live long enough to meet your new baby. And, of course, the breakup of a marriage can trigger waves of grief that are not unlike the grief that many people experience following the death of a loved one. So if you find yourself unexpectedly single midway through your pregnancy, you may find yourself grieving the loss of your marriage and your hopes and dreams of co-parenting along with your ex.

A loved one’s death doesn’t have to be recent to trigger waves of emotion, incidentally. Some women who lost their mothers during childhood or their early teens find that they experience a period of “re-grieving” when they find themselves motherless during pregnancy. “I found myself with so many questions that a woman would normally ask her mother,” says Kelly, a 35-year-old mother of one. “It was the loneliest feeling in the world to realize that I didn’t have a mother to share my own journey to motherhood with.”

If you find that grief is affecting your ability to enjoy your pregnancy, you may want to talk to a friend who has been through a similar loss, find out if there is a grief support group operating in your community, or set up an appointment with a grief counselor who has experience with your particular type of loss.

Regardless of what type of support you line up for yourself, it’s important to find a healthy way to vent your feelings of loss so that you can break free from the tidal wave of grief that may threaten to drag you down and give yourself permission to look forward to the wonderful future that awaits you and your new baby.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

What’s up, doc? Things to talk about with your doctor

Fifteen years ago, women didn’t show up on their doctors’ doorsteps until they had missed their second period and were 99 percent sure they were pregnant. Today, most doctors recommend that their patients come in for a checkup before they start trying to conceive.

The reason for the change in thinking is obvious. Recent studies about the benefits of preconception health have served to hammer home an important message: It’s not enough to quit smoking, improve your eating habits, and start popping prenatal vitamins the moment the pregnancy test comes back positive. To give your baby the best possible start in life, you need to ensure that you are in the best possible health before you start trying to conceive.

Here’s why.

Even though today’s pregnancy tests are highly sensitive and allow women to test for pregnancy sooner than ever before, you probably won’t know for sure that you’re pregnant until at least four weeks after the date of your last menstrual period — perhaps even longer if your cycles are particularly lengthy or irregular. During this time when you’re wondering whether you’re pregnant, your baby’s major organs are being formed — a process that medical science refers to as either organogenesis or embryogenesis. That’s why it’s so important to be as healthy as possible before you start trying to conceive. This means setting up an appointment to see your doctor for a preconception checkup.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Are you anemic?

If you are anemic, the hemoglobin in your blood is insufficient to carry the amount of oxygen required to reach all of the cells in your body. This can cause serious problems during pregnancy by reducing the amount of oxygen your baby receives. If your anemia is significant, there is an increased risk for intrauterine growth restriction and also fetal hypoxia during labor. In addition, the mother will be less able to handle the blood loss associated with delivery (vaginal or cesarean) if she’s already significantly short on blood. Also, anemia that hasn’t been adequately evaluated may turn out to be a symptom of a more serious genetic or systemic disease.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Do you skip meals regularly?

If you’re in the habit of skipping meals, your body could be missing out on such important nutrients as folic acid, iron, and calcium. It’s particularly important to ensure that your diet contains adequate quantities of folic acid. Studies have shown that women who consume at least 0.4 mg of folic acid each day reduce their chances of giving birth to a child with a neural tube defect (for example, anencephaly or spina bifida) by 50 percent to 70 percent. Other studies have indicated that folic acid may help to reduce the risk of miscarriage as well as the odds that you will develop high blood pressure during pregnancy. There’s even some evidence that, when combined with an adequate intake of iron, folic acid may offer your baby-to-be a measure of protection against childhood leukemia.

To increase your intake of this important nutrient, you should consume foods that are naturally high in folic acid, such as oranges, orange juice, honeydew melon, avocados, dark green vegetables (broccoli, Brussels sprouts, romaine lettuce, spinach), asparagus, bean sprouts, corn, cauliflower, dried beans, nuts, seeds, bran cereals, whole-grain products, wheat germ, and fortified breakfast cereals. You should plan to talk to your doctor or midwife about whether it would be a good idea for you to take a folic acid supplement as well. (Most women find that it is difficult to get enough folic acid through diet alone.)

Because neural tube defects can occur very early on in pregnancy, it’s important to ensure that you have adequate levels of folic acid in your diet before you start trying to conceive. That’s why most doctors recommend that you consume adequate amounts of folic acid throughout your childbearing years. After all, nearly half (49 percent) of pregnancies are unplanned.

It’s also important to ensure that your diet contains sufficient quantities of iron. During pregnancy, a woman’s iron needs double. The extra iron is required to create additional red blood cells that carry oxygen from your lungs to all parts of your body as well as your growing baby.

If you find that you are tired all the time, it could be because you’re low on iron. Try boosting your iron intake by consuming iron-rich foods, such as whole-grain and enriched cereals, lean meats, dried peas and beans, dark green vegetables, and dried fruits. Because vitamin C helps your body absorb iron, consume these iron-rich foods with a glass of orange juice or other foods that are high in vitamin C, such as melons, strawberries, grapefruits, raspberries, kiwi, broccoli, tomatoes, sweet potatoes, and so on Finally, you’ll also want to ensure that your diet contains an adequate amount of calcium. A woman who is calcium-deficient prior to and during pregnancy may end up giving birth prematurely to a calcium-deficient baby. Just don’t go overboard in the calcium department: consuming more than 2,500 mg of calcium per day from supplements and food sources (e.g., milk, yogurt, cheese) puts you at increased risk of developing a urinary tract infection and it can make it more difficult for your body to absorb other important nutrients such as iron, zinc, and magnesium.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Have you been dieting recently?

Going on a crash diet right before you start trying to conceive is just plain bad news. While your objective may be noble — getting to a healthy weight before you embark on a pregnancy — you risk depleting your body of important nutrients at the very time when those nutrients are needed to grow a healthy baby. In fact, if the Fad Diet Du Jour that you’ve been following is overly strict, you may even stop ovulating entirely — your body’s way of switching into self-preservation mode in the face of a perceived “famine.”

Note: If you’re struggling with an eating disorder such as anorexia nervosa or bulimia nervosa, or if you have battled with such an eating disorder in the past, you’ll want to be upfront with your doctor or midwife about the situation. Studies have shown that women with eating disorders face an increased risk of miscarriage, obstetrical complications, of giving birth to a low-birth weight baby, and of developing postpartum depression.

That’s not to say that these problems are unavoidable, of course: you may simply require some added psychological support (and possibly some nutritional counseling as well) during your pregnancy.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Are you at a healthy weight?

It’s always best to try to embark on pregnancy at a healthy weight, if you can manage it. Here’s why:

■ Seriously underweight or overweight women don’t tend to ovulate as often as other women, something that can wreak havoc on a woman’s efforts to conceive.

■ Seriously underweight women are at increased risk of giving birth to a low-birth weight baby (a baby who weighs less than five pounds at birth and who may be at increased risk of experiencing some potentially serious health problems).

■ Seriously overweight women face a higher-than-average risk of experiencing pre-eclampsia, gestational diabetes, of requiring a labor induction and/or a cesarean section, and of giving birth to extremely large babies, babies with neural tube defects, babies with heart defects, or babies who are at increased risk of developing diabetes later in life.

■ If you’re not an ideal weight, you might want to try to lose weight or gain weight so that you reach a healthy range before you start trying to conceive. Just don’t try to lose a ton of weight overnight: that’s not healthy for you or the baby and may throw a wrench in your baby-making plans anyway by disrupting ovulation.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The Age issue to Having a Baby (part 3)

■ Get the scoop on your family’s reproductive history.

Find out if you have close female relatives who have had difficulty conceiving or who have had trouble with endometriosis, uterine fibroids, early menopause, or uterine abnormalities. Some of these conditions tend to run in families, so you’ll want to know upfront what you may be dealing with so that you can either seek treatment or fast-forward your baby-making schedule if it looks like you may be facing greater-than-average challenges on the reproductive front.

■ Choose your sexual partners with care.

Sexually transmitted disease (STDs) are just plain bad news for the female reproductive system, so take steps to protect yourself and your future baby-to-be. (Some STDs can be harmful — even deadly — to the developing baby, so you can’t be too careful on this front.)

■ Quit smoking.

While you’re no doubt aware of the terrible toll that smoking can take on your heart, lungs, and other organs, you might not realize that it can do a real number on your reproductive system, too. Studies have shown that women who smoke are 30 percent less fertile than other women. And, what’s more, they’re at increased risk of developing pelvic inflammatory disease. So smoking is just plain bad news for you and the baby you hope to have some day

■ Encourage your partner to safeguard his fertility, too.

Future fathers are sometimes guilty of assuming that fertility is “a girl thing” that they, as guys, don’t have to pay much attention to. That kind of thinking is dangerously outdated and could rob a guy of his chance to be a dad. In fact, in recognition of the fact that sperm quality does tend to deteriorate over time, The American Society of Reproductive Medicine is now recommending an age limit of 50 for sperm donors. But, of course, that’s not all a guy needs to think about on the fertility front. A man’s reproductive system can be damaged by sports injuries, exposure to toxic chemicals or radiation, the use of anabolic steroids, the use of certain types of medications that can hamper sperm production and/or reduce sperm counts — even by something as simple as carrying around too much weight. (Men who are significantly overweight tend to have excessively high levels of the female sex hormone estrogen, something that can affect a man’s fertility.)

And any dad who is actively trying to father a child should be laying off the alcohol, drugs, and cigarettes, too: these vices can interfere with a man’s ability to ejaculate and/or affect his overall fertility. (Just tell your guy the true high in life comes from being a dad!)

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The age issue to Having a Baby (part 2)

If you decide to put your baby-making plans on hold for the foreseeable future, but you’re still hoping to become a mother someday, it’s important that you take steps now to safeguard your future fertility. Here are the key points to keep in mind:

■ Choose a birth control method that is fertility enhancing.

The birth control pill (a.k.a. “the Pill”) gets top marks from fertility experts because it changes the consistency of your cervical mucus, making it more difficult for bacteria to pass through the mucus and into your uterus and tubes. The Pill also serves up some added benefits on the fertility

front: it helps to prevent ovarian cysts, halt the progression of endometriosis (a condition that can lead to fallopian tube scarring), to decrease the incidence of ovarian and uterine cancer, and to restore a normal hormonal balance in women who don’t ovulate. Of course, it doesn’t provide you with protection against sexually transmitted diseases, so that’s something you’ll want to keep in mind if you haven’t quite settled upon Mr. Right yet. A birth control method you might want to steer clear of until your baby-making days are behind you is the intrauterine device (IUD): it has been linked to an increase incidence of pelvic inflammatory disease — a major cause of infertility in women.

■ Pay attention to any gynecological red flags.

If you notice an unusual discharge from your breasts or detect any unusual menstrual bleeding, see your gynecologist sooner rather than later. The sooner you seek treatment for any hormonal imbalances or other gynecological health problems, the less likely these problems are to take a toll on your future fertility.

Continue…

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The Age issue to Having a Baby (part 1)

While you might be tempted to hold off on starting a family until you have your financial house in order, it might not be the wisest move from a biological standpoint. According to the American College of Obstetricians and Gynecologists, postponing motherhood indefinitely isn’t necessarily in the best interests of mother or baby. Not only do you risk missing out on the experience of motherhood entirely (the biological clock waits for no woman, after all), you face an increased risk of experiencing reproductive or other health problems, or of giving birth to a baby with health problems. Here’s what you need to know in order to be fully informed on the age issue:

■ Older mothers are less fertile than younger mothers.

According to the American Society for Reproductive Medicine, a woman over age 40 has just a 5 percent chance of conceiving during any given cycle as compared to the 20 percent odds enjoyed by a woman in her early 20s.

■ Older mothers face an increased risk of miscarriage.

According to a study reported in the British Medical Journal, by the time a woman reaches age 45, her odds of having a pregnancy end in miscarriage are roughly 75 percent.

■ Older mothers face an increased risk of giving birth to a baby with a chromosomal abnormality.

While a 25-year-old woman faces 1/476 odds of giving birth to a baby with a chromosomal abnormality such as Down syndrome, a 45-year-old woman faces 1/21 odds.

■ Older mothers are more likely to conceive twins or other multiples than younger mothers.

Because complications are more common in multiple pregnancies and multiples are more likely to be born prematurely, the rate of loss in multiple pregnancies tends to be higher than when a

woman is carrying a single baby.

■ Older mothers are more likely to develop complications during their pregnancies. Preeclampsia (extremely high blood pressure), placenta previa (when the placenta blocks the exit to the uterus), placental abruptions (the premature separation of the placenta from the uterine wall), gestational diabetes (a form of diabetes that is triggered during pregnancy), premature birth (birth before the 37th completed week of pregnancy), and intrauterine growth restriction (when the baby ends up being significantly smaller than what would be expected for a baby of a particular gestational age) are all more common in order mothers than in younger mothers. Women over the age of 40 are also more likely to have preexisting health problems such as coronary artery disease that may complicate their pregnancies — yet another reason to keep an eye on the biological clock.

■ Older mothers are more likely to require an operative delivery.

Forceps, vacuum extractions, and inductions are more common among older mothers, and, what’s more, older mothers are more likely to require a cesarean delivery than their younger counterparts. (A study reported in the medical journal Obstetrics and Gynecology noted that mothers over the age of 44 are 7.5 times as likely to require a cesarean delivery as younger mothers.)

Continue…

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004