Article inspired and freely adapted from the American project “See me, Feel me”. Translation by Paola Banci
The journey of pregnancy is a beautiful and exciting time as parents prepare to welcome a new life into their family. The development of this life is complex and miraculous at the same time: sometimes, quite unexpectedly, things can go wrong.
About 2000 children are born dead every year in Italy, in half of the cases for no apparent reason. However, the most recent studies give us good news: there are some steps to be taken to increase the chances of giving birth to healthy babies, and to lower this dramatic event by about a third. In this article, we explain how!
Parents, we are born! … right from the pregnancy test, and sometimes even earlier!
Our parenting starts right when we think we want to be a parent.
The American project “See me, Feel me” is a project very similar to what, as CiaoLapo, we have been supporting for some time: increasing awareness of maternal and fetal health without alarmism or inappropriate medicalization. The reason we support maternal-fetal health care… are actually two reasons (plus one)!
- By listening to ourselves and our baby we can begin to know our baby before its birth. The shared participation in the changes of pregnancy and in the growth of our baby is one of the most beautiful and special experiences of pregnancy! It is also a great privilege, a small parental responsibility (compared to the big ones that will come later), but above all a rich and always different experience, pregnancy after pregnancy. In fact, each child has its own rhythm, its own pattern of habits and its own specific temperament, which in many cases is already recognized in utero.
- There are some conditions described in this article that can increase the occurrence of problems in pregnancy, including premature labor and delivery as well as fetal death. Having more information about yourself and your baby can increase the chance of a physiological birth and a healthy baby.
- As doctors, midwives and therapists who are experts in perinatal health and perinatal psychology, we believe that every mother can get to know her baby well. Maternal intuition and listening to the various signals and any symptoms are very important for the serenity and safety of pregnancy and should be the basis of any relationship with health care professionals and professionals.
Your prenatal health: things to think about before pregnancy
Unfortunately, in our country, with the exception of specific situations (women suffering from pathologies already known and treated as high-risk pregnancies from the very beginning), we only start to worry about the health of the pregnant woman when a problem occurs during pregnancy.
Sometimes, especially in some Italian regions, it takes more events (more early losses, or more premature births, or more stillbirths) to start examining in depth the health of the woman and her partner.
This latency between the event and the “diagnosis” obviously represents a great emotional burden for the couple, without considering that an abortion, a premature birth, the birth of a lifeless child are also demanding events for the mother’s body. Sometimes, despite the great progress made by medicine in recent decades, it is not possible to avoid the death of the embryo or fetus, but sometimes it is, and it is on these situations that we can intervene to promote a greater social and professional culture. .
Even if you have not had a previous antenatal bereavement, miscarriages, fetal pathology or perinatal deaths, it is always wise to check with your doctor before becoming pregnant. In fact, the first step to having a healthy baby is to be as healthy a mother as possible. Make an appointment with your family doctor or your trusted gynecologist (if you already have one) to check if there are any health situations, personal or family (inheritance for coagulation or metabolic problems, for example) to consider first and during pregnancy. Be sure to let him know that you intend to have a baby. Your doctor will evaluate your immune system, check for various common infections, or do other tests before pregnancy. Certain vitamins or supplements, such as folic acid, may be recommended to ensure your and your baby’s good health. Many common medicines (those requiring a prescription, over-the-counter or natural remedies) and diseases such as diabetes, autoimmune diseases, heart or thyroid problems, sleep disturbances, hypertension, infection, kidney problems or others, can constitute a predisposition to complications during pregnancy.
The risk of miscarriage, stillbirth, premature birth could be reduced with greater attention to your and your baby’s health.
Your doctor can help you develop a path suitable for the moment you are experiencing.
- If you smoke (even a few cigarettes) or use drugs (even sporadically), it is time to quit, including passive smoking (your partner or cohabitants should also quit!) Alcohol consumption must be stopped, even moderate drinking , even at meals. Your baby drinks the same alcohol you drink, but doesn’t have the enzymes to dispose of it. Smoking, alcohol or drug use has been proven to be harmful to you and your baby. Your doctor may recommend a specific program to help you quit.
- Adopt a healthy lifestyle. The preconception phase is the best time to do it! If you are overweight (even mildly), now is the time to start a healthy diet (we have numerous examples of the Mediterranean diet in our country that we can draw inspiration from to improve our nutrition) and an active lifestyle (walking every day for at least half an hour is a task that almost anyone can accomplish). Obese or overweight women are unfortunately more at risk of complications during pregnancy, such as high blood pressure, diabetes and stillbirth. However, an overweight person must eat in a varied and balanced way: you can discuss with your doctor or an experienced pregnancy dietician an adequate nutritional plan. If you feel stressed, tense or overloaded and therefore your mood is conditioned by a more or less constant tension, explore this situation thoroughly and find your healthy way to lower the tension. There are many simple techniques to reduce stress before and during pregnancy: moderate physical exercise, recovery of a good sleep-wake rhythm, mindfulness or yoga exercises, art therapy, up to targeted psychoeducation courses. This is very important especially for those who have been looking for a pregnancy for a long time and the pregnancy does not come.
- Review your family’s reproductive history: Ask family members of yours and your partner about the history of health situations during various pregnancies. Some genetic forms should be evaluated before or early in pregnancy. If your female relatives have had difficult pregnancies or have had problems getting pregnant, talk to your gynecologist or midwife, who will consider how to follow you during your pregnancy. If you cannot trace your family’s reproductive history, still inform your medical staff.
Know the risk factors
To date we still do not know why some children are born dead: there is a 30% of the total that apparently remains without cause. In many countries, population studies are underway that study the characteristics of mothers, children and pregnancies, to identify those traits in common that could represent risk factors.
However, there are some risk factors known to date. If any of these risk factors (single or multiple) are present, prenatal monitoring should begin as early as week 28. Prenatal tests include biophysical profiles, ultrasound ultrasound assessment of fetal growth and amount of amniotic fluid, fetal movement monitoring and other checks, which will be deemed appropriate by your doctor for your case.
If you have any of these risk factors, your doctor should consider special pregnancy monitoring:
- Maternal obesity
- Type 1 or 2 diabetes
- Use of alcohol, nicotine or drugs
- Infections of the mother (group B streptococcus)
- Syphilis, HIV or other sexually transmitted infections
- Maternal age over 35 years
- Gestational diabetes
- Hypertension (including pre-eclampsia and eclampsia)
- Other health problems of the mother (lupus, kidney problems, cardiovascular disorders, thyroid disorders or other chronic diseases)
- African-American ethnicity
- Previous problem pregnancies (premature births, miscarriages, neonatal deaths)
- Low socio-economic standard
- Multiple pregnancies (2, 3 or more twins)
- Gestations beyond the 40th week
- Retarded growth of the fetus
- Decreased movements of the fetus
- Pregnancy following the use of medically assisted procreation techniques.
See me – Look at me
Current technology allows us to have a better picture of the unborn child than it was in the past. By having constant monitoring during pregnancy, we will have more news about the health of the mother and the growth and development of the baby. For example, blood tests such as PAPP-A and AFP are indicators of how well the placenta is functioning. A periodic urine culture (much more than a simple urinalysis) is an additional means of monitoring for infections. The ultrasound visualizes the baby and his / her surroundings. At first, the doctor may do an ultrasound to confirm your pregnancy and determine the gestational age of the baby. Around the 20th week, a new ultrasound is useful to check the baby’s anatomy, in order to identify any pathologies. In this ultrasound, the measurements and position of the fetus and the characteristics of the umbilical cord and placenta should be evaluated. Knowing these factors will help you and your doctor determine if additional checkups will need to be done during pregnancy.
In the United States, where stillbirth is much higher than in Italy, many obstetricians have started adding ultrasound during the third trimester (28-30 weeks) to monitor the baby’s growth and position, amount of amniotic fluid, and all other situations.
With us, this ultrasound is already present in the health record: recent studies on growth deflection at term suggest the monitoring of fetal growth in the third trimester by midwives and possibly a fourth ultrasound after the 37th week.
Feel me – Feel me
Your baby’s movement can tell you a lot about his health and personality. Most women begin to feel small movements already around the 20th week (the famous flicker that we all feel, similar to a danced caress, to small steps …). At the 28th week the movements are regular and defined and can be easily recognizable: the children turn on themselves, as long as they can even go upside down, spread their legs and arms (like an angel in the snow!), Open and close their hands, pull elbows to the liver and stomach with the skill of a sniper, they touch the uterine wall, point the feet and the bottom, as if they were doing the dog position in Yoga … in short, they do all the colors, and each of them has its own favorite movements! Keeping your baby’s movements under control (a kind of kick counter) helps you understand the baby’s habits and well-being and can alert you to any uncomfortable situations (NB when you count the movements, the baby’s hiccups should NOT be considered) .
Every baby is different, and all babies get good naps during the day and at night. They cannot always move (and it is not necessary to make them move on command, waking them when they sleep …) but many women with full-term stillbirth have reported a progressive or sudden change in the baby’s habits. A recent Scandinavian study taught a group of pregnant women how to count fetal movements and found that compared to the control group, mothers who were trained to count movements were no longer anxious, but more involved and aware, and had fewer unfortunate events. compared to the control group. It is important to identify and understand if something seems to have changed or it seems to you that it is changing.
It must be remembered that: babies do not slow down / decrease movements at the end of pregnancy and usually do not sleep for more than 90 minutes at a time. If you notice anything other than this, have your doctor or midwife evaluated immediately.
If you notice changes in your baby’s movements or behavior, or have a feeling that something is different or not right, please contact your doctor right away or go to the hospital right away. It is important to indulge your instincts. Reduction or change in the baby’s movements can be a symptom of fetal distress or distress.
“The purpose of this information is not to scare you, but to make you your baby’s first advocate, as far as you are allowed!”
Believe in your instincts and do not let yourself be influenced by prejudices or superficial justifications (“it is normal that in the end it moves less!”, Or “you are just anxious!”, Are two prejudices that you must NEVER endorse).
Expectant mothers, especially primiparous and therefore without other reference and term experiences, must never be afraid of disturbing, or being excessive: on the contrary, being able to discuss perplexities, doubts or symptoms with their caregivers is an indicator of a valid therapeutic relationship.
How to do the kick-count
Choose a time of day when your baby is most active. Lie down or sit quietly and tune in to your baby’s movements. Take note of the time it takes him / her to make 10 movements (kicks, rolls, hisses, hits or beats). If you find that once these are different than usual or suddenly change, you and your baby will need to be tested right away. Don’t wait until the next day or your next doctor’s appointment to point out these things. If your child is having problems, time could make the situation critical. Ask your midwife for a visit now to let her know your feelings and assess the situation.
More information on fetal movement count on this page .
You are your baby’s voice. If you don’t feel right, don’t hesitate to ask more questions or ask for further evaluation.
Other considerations
New studies are continually being carried out with the aim of reducing the possibility of unsafe pregnancies. Some elements are emerging as potentially important even if these data have not yet been fully confirmed.
- High blood pressure is a known risk factor for pregnancy, but a recent study indicates that low blood pressure may also pose a risk, especially in the term. If you have low or borderline blood pressure, discuss it with your doctor.
- If you snore or have trouble breathing at night, talk to your doctor.Sleep apneas can be linked to high blood pressure or pre-eclampsia and can also be treated during pregnancy. Do your best to maintain a healthy sleep.
- It appears that sleeping on the left side can help reduce the risk of fetal death. Doctors, nurses and midwives often recommend standing on the left side to facilitate the blood supply to the baby during labor.
- Invasive tests appear to increase the risk of uterine and baby infections. Discuss with your doctor about the risks and benefits of any invasive procedure before doing it.
- The chance of high-risk pregnancy and stillbirth may be greater in extreme ages (under 20 and over 35). Even in African American women and migrant women in general, the risk of stillbirth is higher.
- Women who have lost a baby to stillbirth or have had premature births are more at risk than others.
