Cover
Title Page
Introduction
Preparing for Pregnancy
Your Pregnancy Week by Week
Illness During Pregnancy
When Things Go Wrong
Labour and Delivery
Postpartum
Glossary
Useful Addresses
Index
Copyright
THIS IS NOT a book about having a baby at Queen Charlotte’s Hospital; it is a book written by a mother for mothers-to-be about what to expect during – and how to cope with – pregnancy and childbirth. It comes with the backing and the expertise of the staff of Queen Charlotte’s Hospital, one of the oldest and most respected maternity hospitals in the country.
It is widely recognised that women who read about pregnancy and childbirth and who learn about it from the experiences of other women are more likely to be more relaxed during pregnancy and to have a better experience of labour and delivery. This book is intended to help women understand the great physiological changes that take place during pregnancy, labour, delivery and the first few days postpartum, and to explain many of the physical and psychological effects of these changes. The book is written from a mother’s point of view, and tries to address and answer the questions that may be raised during your pregnancy.
The case studies from ‘real mothers’ which appear throughout the book serve as very useful illustrations of what certain experiences really feel like. Where there is more than one case study on the same subject, the contradictions between them further prove that every woman’s experience of pregnancy, labour and delivery is different: they help to build up a more complete picture.
Throughout the book, the word partner has been used to mean the woman’s husband, the baby’s father or the woman’s partner who will be assuming the role of father. This general term is intended to embrace a number of different situations, and I hope that it will not cause offence to any readers. During the entire period of the pregnancy the unborn child is called the foetus for simplicity’s sake (even though technically the foetus should be known as the embryo for the first two months). The foetus is referred to as ‘it’, because most women do not know the sex of their baby until the baby is born. In the chapters that deal with delivery and the postpartum period the baby is referred to as ‘he’ for the simple reason that it makes it easier for readers to distinguish between passages about the mother and the baby. I hope that this will not cause offence, especially as it is counterbalanced, purely by chance, by the fact that there are many more case studies from mothers of girls than of boys.
Doctors are usually referred to as he and midwives as she in this book. There are, of course, a significant percentage of female doctors, and there are a small number of male midwives; the terms he and she are used only to distinguish between references to doctors and midwives.
There are some sections in this book which may seem not to be relevant even to those who would like to read the book from cover to cover. Many women shy away from information on stillbirths and postnatal depression, for example, feeling that these are things that will not happen to them. Sadly, statistically, these things do happen; even if they do not happen to you, you may be better prepared to help a friend in need of support if you have read the relevant passages.
Any book on pregnancy is bound to be a little daunting to a first-time mother, describing as it does a great range of discomforts and problems which can arise during pregnancy, labour and birth. It may be reassuring for readers to know that for almost every woman I spoke to who had had a particular problem, there was another one who said ‘I’m not the person to speak to, I’ve had a really easy time of it!’
The very fact that you are reading this book probably means that you are already pregnant or that you have decided to start a family. If you are not yet pregnant, there are a number of things that you can do to improve your chances of conceiving quickly, and of having a safe pregnancy and a healthy baby with a good birth weight.
ONE OF THE first things you need to take into consideration is your partner’s attitude to starting a family. Pregnancy and caring for a baby are great undertakings, and you will need the support of your partner and your family if you are to enjoy them. No one can tell you when is the right time to have a baby – whether it is your first or a second or subsequent one – but you might need to think about timing a pregnancy according to your job, your partner’s job, your financial situation, moving house, a course of medication you may be on, illness in the family, and many other factors.
It goes without saying that your general state of health can have a great bearing on whether you conceive easily and have a trouble-free pregnancy. Your partner’s state of health is also important: a number of factors can lower his sperm count, so that you may have difficulty conceiving; some aspects of your partner’s health and lifestyle could even increase your chances of having a baby with certain abnormalities, however healthy you are yourself. The two most important elements in establishing a healthy lifestyle for both parents are nutrition and exercise.
If you have or can adopt a healthy balanced diet you will create the correct internal environment for conception and pregnancy. There are five main categories of ingredients that constitute a healthy diet:
Proteins: These are the building bricks for your body. The best sources of protein are meat, fish, eggs, cheese (and other dairy products), lentils, peas, beans and nuts. If you are a vegetarian – or more especially a vegan – you may need to read up in more specialised books to ensure that you have adequate sources of protein in your diet. Your requirement for protein rises markedly during pregnancy when you are literally ‘building’ a baby and a placenta as well as producing more blood. Dairy products are also important because they are a major source of calcium which is needed to build strong bones and teeth for your baby.
Starchy carbohydrates: Carbohydrates provide fuel for your body; the energy released from them maintains your metabolism and enables you to take exercise. Starchy carbohydrates are found in bread, pasta, rice, potatoes, breakfast cereals, semolina and other grain-based foods. Sugars contain another kind of carbohydrate from which the energy is more easily released by the body so that they give you a quicker ‘buzz’ of energy. The buzz is short-lived and brings with it many calories but little or no nutritional value.
Fibre: Fibre is the bulk in your diet which assists the passage of food through the digestive tract. This is particularly evident in the bowel, where fibre remains moist so that the stools are comfortably soft and are passed more easily. Most sources of dietary fibre also contain valuable amounts of vitamins and minerals. Good sources of fibre include wholegrain cereals and products made from them (such as wholemeal bread), green leafy vegetables, and fruit.
Fats and oils: Fats and oils are another source of energy, but they should not be the chief one. Most of the energy in your diet should be obtained from starchy carbohydrates, and you should limit the fatty foods in your diet and the fats that you use for cooking food. On the other hand, do not be tempted to have a diet very low in fat because fats and oils contain some much needed fat-soluble vitamins. Fats and oils are found in cooking oils, butter, lard and margarines as well as within other foods such as fatty meat, oily fish and nuts.
Fluids: Fluids are crucial to our health and survival; your body can survive longer without food than without fluid (not that you should be thinking of going without either at the moment!). If you are planning a pregnancy or are already pregnant you should try to drink about 1 litre (2 pints) of fluid a day. Spring water is the best and purest drink you can give your body; fruit juices and herbal teas are also good. Try to increase your intake of these and to reduce your consumption of coffee, tea and sugary drinks such as squash or cola.
Putting it all together: Try to eat a wide variety of foods and to have as many fresh and raw ingredients as possible; this will ensure that you are getting all the vitamins and minerals you need. Avoid processed foods (processing leaches out many of the vitamins and minerals in your food) whenever possible, and try to cut down on the salt that you use in cooking or add to food (too much salt in the diet can cause high blood pressure and fluid retention). It is also important to eat regularly, and to take time to sit down and eat meals slowly rather than grabbing them on the run.
Vitamins and minerals: If you follow the guidelines above you will probably have a full complement of vitamins and minerals in your diet, but it may be worth taking a multi-vitamin and -mineral supplement to ensure that you are not lacking in any of these vital micronutrients at a time when great demands are being made on your body. Supplements can be bought from chemists and health shops, and you may be able to find tablets specifically designed for pregnant women. Vitamin and mineral tablets should not be taken instead of a healthy diet; they should be used as a supplement to a healthy diet.
Folic acid: Folic acid is one of the B group vitamins, and research has shown that it plays an important role in ensuring that the fertilised egg implants in the uterine wall, in maintaining the pregnancy and even in the correct formation of the foetus’s cells. If your diet is deficient in folic acid you could become anaemic, and your chances of conceiving and having a healthy baby may be compromised (folic acid deficiency in mothers has been specifically linked with an increased incidence of spina bifida in their babies). Dietary folic acid is found in green leafy vegetables such as cabbage and spinach: these should anyway feature regularly in your diet because they contain many other vitamins and minerals and are good sources of fibre. To ensure that you are consuming the recommended daily allowance of folic acid you may want to take a supplement of folic acid while you are trying to conceive and for the first three months of pregnancy. (Once you are pregnant and you have your first appointment with your doctor he may automatically prescribe you supplementary folic acid during your pregnancy.)
If you already take regular exercise you will be aware of the benefits of exercise to your general health. Regular exercise improves your stamina and your fitness; your body repairs damage more easily, and is better prepared to take on extra demands such as those presented by pregnancy. You may notice that taking exercise makes you feel more energetic, helps you to sleep better, raises your morale and improves a number of minor complaints such as constipation and headaches.
When you are planning to start a family you need not make any changes to an existing fitness routine, except that – once you have stopped contraception – you should avoid very strenuous exercise at the time of each expected period (if you have conceived, the tiny fertilised egg is in greatest danger of being lost at this time and it can quite literally be dislodged if you take strenuous exercise).
If you do not take exercise regularly your planned pregnancy might be just the motivation you need to start. If you are not sure what sort of exercise you should take talk to your doctor or take advice from a local leisure centre. Walking briskly for 15 minutes three times a week would demand very little of your time and requires no special equipment but would make a noticeable difference to your level of fitness. Swimming is a very good form of exercise, using all the major muscle groups but not putting them under any strain, because your body is supported by the water.
It is important not to make too many demands on your body too quickly that might disturb your menstrual cycle, jeopardising your chances of conceiving easily. Start exercising gently and build up to a more demanding routine over a number of weeks. One of the problems with sticking to an exercise routine is maintaining the motivation and discipline; it may be easier for you if you exercise with your partner or a friend, or join a fitness class.
There are a number of other factors in your lifestyle that may affect your general health and these are outlined below and overleaf:
It has been established conclusively that smoking, alcohol and drugs are bad for the body and, taken excessively, can be fatal. The strains that they put on your body and your partner’s could compromise your chances of conceiving. Even if you do not smoke, drink or use drugs but your partner does, there is an increased risk of many abnormalities in your baby. If you smoke, drink excessively or use drugs once you have conceived, you run a higher risk of miscarrying or of having a baby with abnormalities or a low birth weight.
Smoking: Smoking can reduce the fertility of both parents, so that smokers tend to have more difficulty conceiving. If a woman smokes when she is pregnant, she makes extra demands on her body, reducing her fitness during pregnancy, and sapping her energy for childbirth. During the pregnancy the nicotine and poor oxygen levels in her bloodstream are transmitted to her baby. Smokers have a higher incidence of bleeding during pregnancy and of miscarriage; and babies born to smokers tend to be smaller, less developed and more prone to breathing problems than the babies of non-smoking women. Smoking is also directly related to a higher incidence of cot death.
Alcohol: Alcohol in a pregnant woman’s bloodstream is passed directly into the baby’s bloodstream through the placenta. Excessive drinking, especially in early pregnancy, can lead to abnormalities in the baby and low birth weight; in really extreme cases the baby’s life is threatened. Doctors have traditionally advised women to avoid alcohol altogether during pregnancy, but more recent research has shown that drinking in moderation – not more than a small glass of wine a day, for example – has no proven ill-effects on the baby. You should, however, never lose sight of the fact that alcohol is a drug and can be harmful to your baby.
Drugs: Using drugs can be damaging to the general health and the fertility of both parents, so that drug users (from the heroin addict to the social dope-smoker) may have difficulty conceiving. Drugs taken during pregnancy pass through the placenta into the baby’s bloodstream and can have very damaging effects; drug use in pregnant women is associated with miscarriage, premature delivery, low birth-weight babies, and babies with a range of abnormalities. If the mother is addicted to a drug and uses it regularly, the baby may well suffer from withdrawal symptoms when his own ‘supply’ is cut off when the umbilical cord is severed after delivery.
Giving up: Many women and couples use a pregnancy or planned pregnancy as a really good reason to give up smoking, excessive drinking or using drugs. It is not easy to give up an addictive chemical such as nicotine, and you will need a lot of help and support from your partner, your friends and family. It may also be a long process, so it is best to try and stop or cut down even before you start trying for a baby. If you need help weaning yourself off smoking, drinking or using drugs, your own doctor may be able to give you some advice or to put you in touch with groups and organisations who specialise in this (the addresses of a number of such organisations appear at the end of the book).
CASE STUDY: ‘It was easy giving up smoking at first because cigarettes just made me feel sick in the early weeks, but when I started feeling better it became quite hard. I really didn’t want to smoke for the sake of the baby, but that doesn’t stop you wanting them. It wasn’t helped by the fact that [my husband] carried on smoking. At least he would go outside to do it, but I think there should be a law against fathers smoking when the mother’s given up!’
If you have a medical problem – either a temporary one or a long term one such as diabetes or asthma – and you are planning to start a family, you may well need to talk to your doctor at length about the implications of the condition itself as well as the drugs used to treat it on your chances of conception, on your pregnancy and on the health of your baby.
In the first three months of pregnancy, the cells that make up the foetus begin to differentiate into the limbs and skeleton, the vital organs and the nervous system of your unborn child. While these crucial changes are taking place, the foetus is most sensitive to the chemical changes in the mother’s bloodstream caused by medication. Some medicines can produce malformations in the foetus if they are taken at this stage in the pregnancy. If you need to take medication regularly it is important that you speak to your doctor before you become pregnant, so that he can ensure that you are treated in a way that will minimise the risk to your baby once you conceive.
If you do need regular medication and you suddenly discover that you are pregnant, do not give up the medication without consulting your doctor. It may be more dangerous to you and your baby for you to go without the medication than to carry on taking it.
If you have a physical disability or suffer from chronic back pain, you may need to consult with your doctor, an obstetric physiotherapist and other relevant specialists before trying to conceive. They will be able to advise you about how the strains of pregnancy are likely to affect you physically, and how to plan for your antenatal care and your labour and delivery.
CASE STUDY: ‘I have always had problems with my back but nothing was going to stop me getting pregnant. I was told that I would be on bed rest from about four months onwards, and that’s about when I did have to give up trying to pretend I could cope. It’s been very boring and very painful, because I can’t use anything stronger than paracetamol which has no effect on the pain at all, like putting a plaster on an amputated leg! I’m very nearly there now, and I’m getting plenty of help lined up because the next problem is going to be lifting the baby.’
Your workplace may be a dangerous place for a pregnant woman: if your work is strenuous, especially if it involves lifting, it may compromise your chances of keeping your baby once you have conceived, and it will make unnecessary demands on your muscles and ligaments during pregnancy. A job that brings you in contact with X-rays, lead or other toxic chemicals could cause malformations in the unborn child. Working with cats or sheep can expose you to potentially dangerous micro-organisms: toxoplasmosis contracted from cats can cause foetal abnormalities; and chlamydia contracted from ewes and lambs can induce miscarriage.
If you think that the work you do is not compatible with pregnancy, you should speak to your doctor about the risks. He may advise you to leave your job before you even become pregnant. If you are not sure about the legal and financial implications of leaving your job because of a pregnancy or a planned pregnancy, contact your local Citizens’ Advice Bureau (they should be listed in the telephone directory).
If you are hoping to start a family you may need to think about whether the timing will fit in with existing or planned holidays. Vaccinations could be damaging to the foetus, so pregnant women are discouraged from travelling to countries for which vaccinations and malaria tablets are necessary. The stresses of travelling, especially long distance and to places that are very hot or at a high altitude, can make too many demands on your body when you are pregnant. If you have an exotic, long-haul holiday planned it would be better to go and enjoy it before embarking on a pregnancy.
In the early weeks of pregnancy you may feel too ill to travel, and in the last few weeks too tired – or wary of straying too far from your familiar hospital and midwife! (Most airlines will not, anyway, take passengers who are more than 36 weeks pregnant.) The second trimester (the middle months) is the best time for travel so long as you are not over-ambitious with your destination, and you check with your doctor before you leave. If you have had any complications with your pregnancy or suffer from high blood-pressure, your doctor may recommend that you stay close to home for your own and your baby’s safety. Even if you are limited in this way, the middle trimester is a good time to have a break and spend some time alone with your partner before your baby arrives.
As there is no guarantee how soon you will conceive, or how you will be feeling when you do, it is better not to plan extravagant holidays when you are trying for a baby. On the other hand, if you do not conceive straight away you might regret having no plans to go away to take your mind off it. If you are planning to go away, strike a happy balance and book a reasonable holiday to a British or short-haul destination.
The age of both parents can affect how easily they conceive: older couples do not usually conceive as easily as younger ones. Women over 35 and men over 40 have an increased risk of having a baby with chromosomal abnormalities such as Down’s Syndrome (this risk increases dramatically in a woman over 40 and a man over 55). Older women are also more likely to have multiple births, to develop problems – such as high blood pressure and diabetes – during pregnancy, and to need a Caesarean section.
If you are 35 or over and / or your partner is 40 or over, it may be worth talking to your doctor before you start trying for a baby so that he can give you advice about the special risks associated with conception, pregnancy and childbirth for older parents.
If you are planning your first pregnancy, you should ask your doctor to check whether you are immune to rubella (German measles). If you are not immune to German measles and you contract it during the first few months of your pregnancy it can have a very damaging effect on your unborn child: it may cause blindness, deafness, brain damage and heart defects. It is very important to ensure that you are immune to rubella before becoming pregnant.
If you have had German measles or were immunised at school, you will still be immune; it is very rare to lose your immunity, but if you are in any doubt it is worth going ahead with the test. A simple blood test will assess whether or not you are immune, and if you are not, you can be immunised with a single injection. This immunisation should not be carried out if you are already pregnant as it could have some of the same effects as the illness itself.
If you discover that you are not immune to rubella but you are already pregnant, your doctor may recommend that you have tests regularly to check that you have not contracted German measles. The illness is, anyway, becoming increasingly rare in Britain as babies are now usually immunised at 13 months; but you should be aware that there may be an increased risk of catching rubella if you travel abroad.
If you have the relatively rare Rhesus negative blood group you are likely to be aware of this already, but you may not know of its implications in connection with pregnancy and childbirth: a woman with Rhesus negative blood whose partner has Rhesus positive blood is likely to have a baby with Rhesus positive blood. This first baby is in no danger but, when it is delivered, the exchange of blood from the baby to the mother can cause the mother to build up antibodies to ‘fight off’ the Rhesus positive cells in her bloodstream. If she then has a second or subsequent Rhesus positive baby, that baby would be in danger of becoming anaemic because of the antibodies in the mother’s bloodstream. This problem can be averted if the mother is given an injection after the birth of the first Rhesus positive baby.
If you are planning to start a family and you do not know what your blood group is, it is worth having a blood test. This can be done from the same sample as a test for rubella immunity.
The pelvic floor is a part of your body that most women will not even know they have until they are well into their pregnancy, but many obstetricians and obstetric physiotherapists recommend doing pelvic floor exercises to strengthen this important group of muscles even before you conceive.
The pelvic floor muscles form a figure-of-eight configuration in your lower abdomen, supporting your uterus, bowel and bladder; you use them subconsciously to control the flow of urine from your bladder and to control your bowel movements. During pregnancy they help to support the growing uterus.
During pregnancy all your muscles loosen and relax under the effects of the hormone progesterone (this is to facilitate the process of childbirth), and this includes the pelvic floor muscles. Towards the end of your pregnancy you may find that you suffer from what is called stress incontinence. As the pelvic floor muscles relax, they can allow small amounts of urine to pass when they are put under sudden pressure, for example when you cough, sneeze, laugh or even just bend over. This can be embarrassing and, if you do not work on the pelvic floor muscles, it might continue long after you have had your baby.
Identifying and working on your pelvic floor muscles can help you to avoid what can turn into a long-term inconvenience and embarrassment. If you learn how to contract your pelvic floor muscles you will also know how to relax them and this could help you during the second stage of your labour, when you are actually pushing your baby into the world.
The simplest way to identify the pelvic floor muscles is to wait until you need to urinate and then to try and interrupt the flow of urine before you have finished. Although you only want to tighten the tiny but powerful sphincter muscle of your urethra (which releases urine from the bladder), you will actually feel the tightening throughout the pelvic floor, affecting your bowel, your vagina and your urethra. You can also identify the pelvic floor muscles by ‘squeezing’ your partner’s penis with the muscles of your vagina when you are making love.
The ways of identifying the pelvic floor muscles are also good ways of exercising them. If you regularly interrupt your flow of urine, you will gradually increase the strength of your pelvic floor muscles. At first you may be able to hold only the last few drops for a second or so, but as the muscles become stronger your control will improve dramatically so that you can ‘switch’ the flow of urine on and off several times in one sitting.
Your partner can help and encourage you to strengthen your pelvic floor muscles – and he may enjoy it too – if you practise squeezing his penis during love-making. Again, at first, you will probably manage only short squeezes, but as the muscles develop and you become more conscious of them you may be able to hold and release a strong squeeze several times in succession.
Once you have become familiar with the feeling of contracting your pelvic floor-muscles, you need no longer wait until you are on the loo or making love to exercise them! You can work them when you are lying in bed reading a book: contract them for a count of three and then release. Or tighten them in stages (this is more difficult), as if you were tugging gently higher and higher before releasing.
Exercising your pelvic floor muscles need not take any time out of your day – you can do it when you are doing other things, even standing on the bus! – and it does not require any special equipment, but it could make your delivery easier and may well save you from the embarrassment of stress incontinence.
It is very common for women to suffer from backache at some stage during pregnancy. Back pain might seem inevitable if you consider the extra demands that are made on your back: you put on weight, your entire shape and centre of gravity changes and the muscles and ligaments of the back are slackened by the effects of progesterone. A great deal of back pain could, in fact, be reduced or avoided altogether if more attention was paid to correct posture and to good back care (there is more information about posture and back care in the feature on Backache in Week 28 of the Your Pregnancy Week by Week chapter).
Queen Charlotte’s Hospital is one of several hospitals that have specialised obstetric physiotherapists, and they recommend that women think about their posture, and about how they lift things and bend over even before they become pregnant. It can take a long time to adapt and change postural habits, and the sooner you start the better. If you are prone to back pain, or are concerned about the effects that pregnancy might have on your back, speak to your doctor and he may be able to put you in touch with an obstetric physiotherapist. You may want to contact the Association of Chartered Physiotherapists in Women’s Health (their address appears at the end of the book).
Starting a family may not be as simple as you thought, you may already be astonished by how many things can affect conception, pregnancy and childbirth. Another factor that may affect when and how easily you conceive is the kind of contraception that you have been using.
If you use temporary barrier contraceptives – such as condoms, femidoms or a cap – your menstrual cycle will not have been disrupted, and you should be ovulating normally every month. You can simply stop using the contraceptive device and start trying to make babies. You may find that you conceive straight away, but you should not worry even if it takes several months.
If you use a more permanent barrier method – such as a coil – you will need to have the device removed by your doctor before you can conceive. Ask your doctor at which stage in your cycle it is best to have the device removed, and then make an appointment for the appropriate time. Once you have had the contraceptive device removed, your doctor may advise that you wait a couple of months before trying to conceive (you may be prone to infections of the cervix and even to miscarriage for a few weeks). In the intervening months you should use a barrier method of contraception, such as condoms, to ensure that you do not become pregnant.
If you use a chemical contraceptive – such as the pill, hormone injections or an implant – these actively disrupt your natural menstrual cycle, and you should talk to your doctor about discontinuing the contraceptive treatment. You will probably be advised to wait for about three months, or even up to six months, after discontinuing contraception before you start trying to conceive (some brands of implants claim that your cycle returns to normal as soon as they are removed). This will allow your own menstrual cycle to re-establish itself properly before you become pregnant. In order to ensure that you do not become pregnant, you should use one of the barrier methods, such as condoms, during these months.
You may resent the period of waiting after discontinuing contraception and before trying to conceive. If you do become pregnant very soon, there are few real risks to the baby but – because your cycle will have been disrupted – your pregnancy may be difficult to date. This not only means that you will not have a clear idea of your due date, it also means that medical professionals will not be able to judge whether the foetus is growing at the expected rate, because they will not know its exact age. Bearing in mind that many checks carried out on the foetus are directly related to its age and expected size, this could have even more serious implications.
When you are trying to start a family, especially if you have been trying for a few months without success, it is just as well to have a good understanding of how your monthly cycle works, and when you are most likely to be fertile.
You will probably know more or less how long your cycle is and how regular it is. An average menstrual cycle is about 28 days long, but it may be as short as 25 days or as long as 35 days, and it can vary from one month to the next. Some women find that a very irregular cycle can be settled down permanently by taking the pill for a few months to establish a regular 28-day cycle. To assess when your fertile period is, you need to know when you are ovulating.
When you ovulate, a mature egg is released by your ovary and is wafted by tiny hairs called cilia into the end of your fallopian tube to begin its journey to the womb. Before this egg dies (up to two days later) it can be fertilised by your partner’s sperm after love-making. The tiny spermatozoa travel all the way from your vagina, through your cervix and womb, and along your fallopian tube. This does not necessarily mean that fertilisation can take place only if you make love on the day of or the day after ovulation. Sperm can survive inside you for up to three days, so love-making can result in conception for a period of nearly a week, about three days on either side of the day on which you ovulate.
A small proportion of women are aware of a mild abdominal pain, known as the mittelschmerz, when they ovulate. Most have to do a simple calculation to work out when they ovulate and when their fertile period is.
Make a note of the day on which your next period is likely to start and then count back 14 days to establish approximately when you will ovulate. Most women ovulate 14 days before their period, regardless of the length of their cycle, although it can be between 12 and 16 days before.
An average 28-day cycle. Yours may be longer or shorter
Once you are aware of when you are ovulating you may notice that your vaginal discharge changes during the course of the month (some women have very little vaginal discharge and will not notice a difference, others will have noticed the changes for themselves). For about the first five days of your cycle you lose menstrual blood, which is followed by a thick, whitish discharge for several days. About a week later the vaginal discharge changes: it becomes clearer, more fluid, and stringy or slimy. This is your natural lubricant which facilitates love-making during your fertile period. Another week later, when your fertile period is over, the discharge will thicken and become white again, drying up towards the end of your cycle. Your next period heralds the start of the next cycle.
If you notice that your discharge becomes clear and slippery earlier or later in the month than this, it could mean that you are ovulating unusually early or late in your cycle. It is possible to establish fairly precisely when you have ovulated by checking your body temperature.
A woman’s body temperature drops to about 36.2°C (97°F) just before she ovulates and then rises back above the normal 36.4°C (97.4°F) to about 36.7°C (98°F) after ovulation. The rise in temperature, which can last through to the end of the cycle, is caused by the hormone progesterone which is released with the egg and raises the body’s metabolism.
A noticeable rise in temperature indicates that you have ovulated.
If you want to pinpoint exactly when you are ovulating – either because you have a very irregular cycle or because you have been trying for a baby for several months without success – you can try to establish when you ovulate by taking your temperature daily. Take your temperature regularly at the same time of day for a whole cycle and you should see a pattern similar to the one shown in the graph above emerging. (You can buy ovulation kits from chemists: they include a thermometer and specially designed charts to fill in with your daily temperature readings.)
Your fertile period is on either side of the sharp rise in temperature, which immediately follows ovulation. The time to make love to give yourself the best chance of conceiving is when your temperature has dropped. That is, just before ovulation. This gives the sperm the time to begin their journey towards the fallopian tube so that they are there and still alive when the egg is released.
Obviously, if you have a fever, the readings for that time will be distorted and difficult to interpret. Your ovulation may also be affected by a number of other factors such as a sudden increase in the amount of exercise you are taking, a crash diet or stress.
If you do not see an obvious dip-and-rise in your temperature chart for two or three successive months this could mean that you are not ovulating at all, even though you may be menstruating normally. You should talk to your doctor who may advise that you have more detailed tests to establish whether or not you are ovulating. He may ask you many questions about your lifestyle, especially your eating habits, to discover whether your ovulation has been temporarily interrupted or whether there is an underlying problem of infertility.
Some couples joke that they just have to sit on the same chair one after the other to conceive, whereas others can take up to a year, or longer, to conceive even if neither of them has any problems of infertility.
Making love at the right time of the month gives you the best chances of conceiving, but it certainly carries no form of guarantee. If you look at the mechanics of conception it can be a very ‘hit and miss’ affair: firstly the egg is released by the ovary, loose into your abdominal cavity. Admittedly, it is very near the end of the fallopian tube, but there is a chance that it will never enter the fallopian tube and will be lost in the abdominal cavity. Then it should be wafted into and along the tube by tiny finger-like projections called cilia. It only lives for about 24 hours, and if it is not fertilised in this time it will die. The dead egg will be wafted on into the uterus and washed away with your next period.
If you do make love at this time, your partner’s ejaculation will release around 200 million microscopic spermatozoa into your vagina. They are chemically programmed to head for the cervix, through the uterus to the egg in the fallopian tube. They are produced in their millions in order to increase the chances that just one will eventually fertilise the egg. Millions of them can be lost if the ejaculate drains out of your vagina. The same number may never reach further than the neck of the womb, and millions more may travel into the ‘wrong’ fallopian tube (your ovaries usually release an egg alternately each month; in the example illustrated below the egg has been released by the left ovary).
A few thousand spermatozoa will start the journey along the correct fallopian tube but only about 200 (1 in 1,000,000 of the original number released) will reach the egg and swarm around it until one manages to penetrate the outer layer of the egg and fertilise it. The outer layer of the egg immediately changes its chemical make-up, acting as a barrier to the other spermatozoa, protecting the genetic information which will become your baby. This whole process can happen in the space of an hour, but sometimes even the law of averages fails.
A doctor probably would not question your fertility unless you had been trying unsuccessfully to conceive for at least a year. This is because there are so many things, apart from the purely mechanical ones, that affect your chances of conceiving. The fertility of both partners can be temporarily compromised by changes to their lifestyle, and especially by stress.
The egg matures in the ovary (A) and is released into the end of the fallopian tube. Sperm is ejaculated into the vagina (B); thousands of spermatozoa may drain out of the vagina and thousands more may be lost in the ‘wrong’ fallopian tube (C). A few hundred may reach the ripe egg, and one single spermatozoa may fertilise the egg in the fallopian tube (D).
If you have been trying to conceive for more than three months, have a good look at your lifestyle, at what you eat, whether you smoke or drink, and how much pressure your job or your financial circumstances put on you, to see whether any of these factors could be reducing your chances of conceiving. Try to improve your chances by following the guidelines laid out at the beginning of this chapter, and by working out when you are ovulating as explained above. Make an appointment to see your doctor to discuss factors that could be affecting your fertility. He will probably reassure you that it is quite normal for conception not to take place straight away, and it can take up to a year for a healthy couple to conceive. He may arrange for you to have another appointment in about six months if you still have not conceived.
CASE STUDY: ‘We conceived our first baby very quickly but we tried for over a year before the second one came along. The disappointment of not conceiving is indescribable. Every month you have this terrible strain, and every day you worry: “shall I have a gin and tonic or will it hurt the baby?” and then every month you’re disappointed, you’ve taken all these precautions for nothing.’
If you are trying to help your chances of conceiving in every way, you can make a point of having intercourse when you know that you are ovulating. Some doctors advocate making love as often as possible at this time, but this might actually work against the law of averages. The sperm-producing cells in the man’s testicles cannot replenish the average 200 million spermatozoa per ejaculate if he is ejaculating several times a day. If each ejaculate contains a lower than average number of spermatozoa, the chances of conceiving after any one ejaculation are lowered.
On the other hand, if you abstain from love-making in the hopes of building up a large number of spermatozoa, the sperm-producing cells will not be stimulated to keep producing new cells so rapidly. You may well have a larger than average number of sperm in that one ejaculation, but they may not be replenished so quickly for the next time. It is a simple question of supply and demand, and although it varies from one man to another, your chances of conceiving are probably highest if you make love about once a day during your fertile period.
We are genetically programmed to enjoy sex in order to ensure that we propagate the species, but it is alarming how many couples who are having difficulties conceiving find that intercourse can become a chore, something that has to be done to order when the temperature chart says so. Try not to be obsessive about temperature charts and having intercourse at exactly the moment that your temperature drops. If you are familiar with your cycle, you should know in advance when your fertile period is likely to be. Far from spoiling your love-making by robbing its spontaneity, planning ahead for the days when you ‘should’ have intercourse can add its own element of fun. Do not lose sight of the fact that sex itself is pleasurable and not just a necessary step to having a baby.
By looking at the diagram of the vagina and the uterus in the section When will you Conceive? you can see that if you are in an upright position (for example, sitting astride your partner) during or immediately after making love, much of the ejaculate can be lost as it drains out of the vagina. If you make love in the missionary position or face-down with your bottom in the air (or if you move into a similar position immediately after your partner has ejaculated), the force of gravity will help the ejaculate to pass through your cervix and to the top of the womb where it can enter the fallopian tubes.
Some women say that they are aware of the moment of conception, whereas others can go through an entire pregnancy without realising it, and are astonished to produce a baby at all. These are obviously extremes, but your experience could be anywhere along the spectrum in between.
IF YOU HAVE been planning a pregnancy, especially if you have kept a note of your periods and have made love at your most fertile time of the month, you will be on the look-out for tiny clues in the days preceding your next period.
There are a number of different early warning signals that women may notice in the first few days after conception. A small minority say that they can feel a little twinge or just ‘something different’ in the area of the uterus; others notice changes to their sense of smell and taste, or experience tiredness or nausea as the hormones released by the fertilised egg kick in. Many women say that the first sign of pregnancy is a tingling feeling in their breasts, or that their breasts feel heavy.
Tingling, heavy breasts
Unexpected tiredness
Changes to sense of taste
Acute sense of smell
Frequent urinating
Feelings of nausea
CASE STUDY: ‘One morning I realised there was a tugging feeling in my breasts, as if a thread was attached behind the nipple and it was being pulled ever so gently backwards. They felt a bit heavy too, like just before a period, except that it was about a week until my next period was due.’
Most women first realise they are pregnant when they miss a period, but this is not conclusive proof of pregnancy: you can, for example, miss a period if you are under a lot of stress or if you suddenly start taking more exercise than usual. On the other hand, you may not actually miss your first period after conceiving; you may have what appears to be a period or some light bleeding at the time of your expected period.
You can confirm a pregnancy with a home testing kit as early as the first day of a missed period (some kits can give a positive result even before the first day of a missed period).
Pregnancy testing kits can be bought from most chemist shops, and they are very simple to use. They are urine tests designed to detect the presence of a hormone called human chorionic gonadotrophin (HCG). HCG is present in the mother from conception and is excreted in the urine.
The way kits work and display their results varies, so does their accuracy and the time when they should be used. You should check the manufacturer’s instructions and follow them carefully. Most kits are over 90% accurate if they are used in the early morning (when the urine is concentrated) on or later than the first day of a missed period. If the results of the test are positive, you should make an appointment to see your doctor. If you have a negative result after the first test, wait about a week and, if you still have not had a period, take a second test.
Testing kits can be costly, and free pregnancy testing is available from the NHS. Your local surgery or hospital will provide a sample bottle for your urine, and test it for HCG (if the urine test is not conclusive they may run a blood test for HCG). Results are available in one or two days.
You should arrange to see your doctor as soon as you think that you are pregnant. This is especially important if you are on any sort of medication, which might be dangerous for your baby. Your doctor will be able to give you advice about medication and other drugs, smoking, alcohol, exercise and nutrition in connection with your pregnancy.
You will probably not be examined if you are in the very early stages of pregnancy, but your GP will discuss any questions or anxieties that you might have. He will be able to tell you about antenatal care in your area, and he will help you to think about whether you want your antenatal care to be handled by the surgery, the local hospital or a midwife.
Most women attend all or most of their antenatal clinics at their local doctors’ surgery. If your GP’s workload allows, you may be offered the choice of seeing a midwife or your own GP for your antenatal check-ups.
In some areas a Domino Scheme (Domiciliary – in – out) is operated; in the Domino Scheme your antenatal check-ups are handled by one of a team of community midwives, often in your own home. One of thesm will accompany you to hospital for the birth of your baby, and will oversee your early transfer from hospital. The same midwives continue with your check-ups at home for at least the first ten days of your baby’s life. Queen Charlotte’s Hospital has piloted a one-to-one midwife scheme in which a woman sees the same midwife throughout her pregnancy, and is then delivered by her. Research has shown that this sort of continuity of care they feel more relaxed and confident during their pregnancy, and they may even need less intervention for labour and delivery.
Your doctor will ask you to make a ‘booking appointment’ – your first official antenatal check-up – for about the twelfth week of your pregnancy. In order to establish when that will be, he will ask you the date of the first day of your last period to date the pregnancy.