Gallbladder and Pregnancy

What is the gallbladder?

The gallbladder is a small, sac-shaped organ that sits just beneath the liver. Its purpose is to store bile, a substance that helps digest fats. As food enters the small intestine from the stomach, the gallbladder receives a signal to start contracting and release bile into the intestine.

Bile is composed of water, bile salts, and cholesterol, among other things. If the bile contains too much cholesterol and not enough bile salts, or the gallbladder doesn't empty properly, the gallbladder can form deposits, known as stones or gallstones. These stones are one form of gallbladder disease, but you can have stones and not notice any symptoms.

The term "gallbladder disease" covers inflammation, infection, stones, and blockage of the gallbladder.

What is biliary colic?

Biliary colic is the result of a blockage in the ducts of the gallbladder. If the bile is unable to exit the gallbladder, perhaps because of a gallstone, it can lead to inflammation or infection. And since the bile isn't entering the small intestine, the fat in the diet doesn't get broken down during digestion, and this can cause pain in the upper abdomen and back, as well as nausea and vomiting.

Biliary colic creates a sharp pain in the upper part of the abdomen that appears one to two hours after a meal that's high in fat. (Because dinner is usually the heaviest meal, the pain is more likely to occur at night.) The pain can last from a few minutes to several hours.

Some people also have pain between the shoulder blades or underneath the right shoulder. In addition to pain and nausea, biliary colic can cause gas, abdominal bloating, sweating, chills, or fever.

How does pregnancy affect the gallbladder?

Pregnancy hormones, particularly progesterone, cause muscular tissue throughout the body to relax, and this affects the gallbladder as well. The release of bile slows, and bile that doesn't get released can lead to the development of gallstones. Pregnant women who already have gallstones run a higher risk that these stones will block the release of the bile.

The problem in detecting the beginning of gallbladder disease during pregnancy is that the symptoms may be confused with morning sickness. However, if symptoms persist beyond the first trimester, or if you or your doctor suspects gallbladder-related problems, your doctor will likely recommend an ultrasound. Ultrasound is the most effective way to diagnose a gallbladder condition.

Of course, if you've had gallbladder problems before, let your doctor know so he can monitor you during pregnancy and prevent the disease from getting worse.

Am I at risk for gallbladder disease?

Women are far more likely to develop gallbladder disease than men are. You're more likely to develop gallbladder disease if you have a family history of the disease, are overweight (even if only moderately), have a high fat or high cholesterol diet, have diabetes, or are of Mexican or Native American origin.

Gallbladder disease used to be known as an older woman's affliction. But with more obesity among younger women, more younger women are being diagnosed with gallbladder disease.

Symptoms of gallbladder disease are more common in the third trimester or after delivery, but those at higher risk can develop the symptoms earlier in pregnancy.

Will gallbladder disease affect my baby?

Deposits or stones have no direct effect on your baby. However, your baby could be affected by the consequences of the disease. For instance, if you develop an infection, inflammation, or nausea and vomiting, these conditions can hinder your ability to nourish yourself and pass along adequate nutrition to your developing baby.

How is gallbladder disease treated during pregnancy?

In general, the goal of treatment during pregnancy is to reduce the symptoms and complications, and then treat the disease itself after pregnancy.

The first step in treating an inflamed gallbladder is to change your diet and eat fewer fatty foods. This means that the gallbladder will have to work less. For many women this step alone may be enough to relieve the symptoms. Regular exercise can also be helpful.

If your doctor prescribes a drug for a gallbladder problem and it doesn't provide adequate relief, he'll evaluate the effects of the disease and the risks of surgery. Given the risks, any surgery during pregnancy is generally avoided. But if the inflammation is severe, if there's an infection, or if the colic is acute, an operation may be necessary to prevent more serious complications.

If you need gallbladder surgery, it will probably be done laparoscopically. The surgeon makes two small abdominal incisions, inserting surgical instruments and a laparoscope. The laparoscope has a tiny camera that transmits a picture of the organs to a video monitor.

The gallbladder can then be removed without having to create a large incision. This means less pain and an easier recovery.

Can I develop gallbladder problems after pregnancy?

It's not uncommon for gallbladder disease symptoms to appear two to four months after delivery. This may be because pregnancy hormones aggravated the problem during the preceding nine months. Changes in your hormone levels after delivery may also be the culprit.

Gallbladder problems may also result from rapid weight loss after delivery. When you burn fat quickly, extra cholesterol accumulates in the bile, which can lead to gallstones.

To reduce your risk of developing gallstones after pregnancy, eat a high-fiber diet that includes plenty of fruit, vegetables, and whole grains. Try to keep your postpartum weight loss to no more than 2 pounds a week. And get plenty of exercise.

If you had gallbladder disease that was controlled during pregnancy and no surgery was required, it's important to have a follow-up evaluation. Symptoms can occur in the postpartum period or later in life, so have an evaluation when you're not in pain. Your doctor may recommend that you have the gallbladder removed to avoid an emergency situation later.

Source: BabyCenter

 

Torticollis in babies

Torticollis, or wryneck, literally means "twisted neck" in Latin. You may have woken up with torticollis after an uncomfortable night of sleep. In newborns, torticollis can happen due to positioning in the womb or after a difficult childbirth. This is called infant torticollis or congenital muscular torticollis.

It can be upsetting to see that your baby has a tilted head or difficulty turning his or her neck. But most babies don't feel any pain as a result of their torticollis. And, fortunately, the problem usually gets better with simple position changes or stretching exercises that can be done at home.

Torticollis is relatively common in newborns. Boys and girls are equally likely to develop the head tilt. It can be present at birth or take up to 3 months to develop.

No one knows why some babies get torticollis and others don't. Most doctors believe it could be related to the cramping of a fetus inside the uterus or abnormal positioning (such as being in the breech position, where the baby's buttocks face the birth canal). The use of forceps or vacuum devices to deliver a baby during childbirth also makes a baby more likely to develop torticollis.

These factors put pressure on a baby's sternocleidomastoid (stir-noe-kly-doe-MAS-toyd) muscle (SCM). This large, rope-like muscle runs on both sides of the neck from the back of the ears to the collarbone. Extra pressure on one side of the SCM can cause it to tighten, making it hard for a baby to turn his or her neck.

Signs and symptoms

Babies with torticollis will act like most other babies except when it comes to activities that involve turning. A baby with torticollis might:

tilt the head in one direction (this can be difficult to notice in very young infants)
prefer looking at you over one shoulder instead of turning to follow you with his or her eyes

if breastfed, have difficulty breastfeeding on one side (or prefers one breast only) work hard to turn toward you and get frustrated when unable turn his or her head completely

Some babies with torticollis also will develop a flat head (positional plagiocephaly) on one or both sides from lying in one direction all the time. Or they might develop a small neck lump or bump, which is similar to a "knot" in a tense muscle. Both of these conditions tend to go away as the torticollis gets better.

If you think your baby might have torticollis, ask your doctor to perform a physical examination on your baby, which involves seeing how far your baby can turn his or her head.

If a diagnosis is made, the doctor might teach you neck stretching exercises to practice with your baby at home. These exercises help loosen the tight SCM and strengthen the weaker one on the opposite side (which has weakened due to underuse). This will help to straighten out your baby's neck.

In certain cases, the doctor may suggest taking a baby to a physical therapist for more intensive treatment. After treatment has started, the doctor may examine your baby every 2 to 4 weeks to see how treatment is going.

If your baby is 6 weeks of age or younger and also has signs of an unstable hip, the doctor might order an ultrasound to see if your baby also has developmental dysplasia of the hip.

Although most torticollis cases are not related to other medical problems, congenital muscular torticollis can happen in children who have infections, fractures, reactions to certain medicines, or genetic conditions like Down Syndrome or Klippel-Feil Syndrome. If your child has torticollis and you are concerned that other medical problems may be present, talk to your doctor.

Treatment at home

The best way to treat torticollis is to encourage your baby to turn his or her head in both directions. This helps loosen tense neck muscles and tighten the loose ones. Rest assured that babies cannot hurt themselves by turning their heads on their own.

Here are some exercises to try:

When your baby wants to eat, offer the bottle or your breast in a way that encourages your baby to turn away from the favored side. (Use your child's desire to eat to encourage him or her along!)

When putting your baby down to sleep, position him or her to face the wall. Since babies prefer to look out onto the room, your baby will actively turn away from the wall and this will stretch the tightened muscles of the neck. Remember to always put your baby to sleep on his or her back, as this helps reduce the risk of SIDS.

During play, draw your baby's attention with toys and sounds to make him or her turn in both directions.

Don't Forget "Tummy Time"

Laying your baby on the stomach for brief periods while awake (known as "tummy time") is an important exercise because it helps strengthen neck and shoulder muscles and prepares your baby for crawling.

This exercise is especially useful for a baby with torticollis and a flat head — and can actually help treat both problems at once. Here's how to do it:

Lay your baby on your lap for tummy time. Position your baby so that his or her head is turned away from you. Then, talk or sing to your baby and encourage him or her to turn and face you. Practice this exercise for 10 to 15 minutes.

Outlook

Most babies with torticollis get better on their own through position changes and stretching exercises. It might take up to 6 months to go away completely, and in some cases can take a year or longer.

Stretching exercises to treat torticollis are most likely to work well if started when a baby is between 3 to 6 months of age. If you find that your baby's torticollis is not improving with stretching, talk to your doctor. Your baby may be a candidate for muscle-release surgery, a procedure that cures most cases of torticollis that don't improve with physical therapy alone.

A Mother's Gift

A Mother's Gift

by Janette Fisher 

From the very first time, you hold your child
Their first gift is your heart forever,
The love you give and they return
Is the bond that will hold you together

Throughout their life, your love will be
A light that guides their way
The beacon aglow in the darkness
Should they ever go astray

Your love will give them courage
When the way ahead is unclear
And will give them strength, when needed
To help overcome their fears

Your love will accept them for who they are
Whatever they say or do,
Your love will forgive unreservedly
Because they are a part of you

It's a love that will know no barriers
Have no bounds, no expectations
Your love will be unconditional,
Pure, with no complications

A love that remains as constant
As the stars in the heaven above
A gift no money on earth can buy,
The gift of a mother's love.

5 Way Pregnancy After Miscarriage is Different!!

1. Fear of the unknown. When I became pregnant with my daughter, I dreaded my first prenatal visit. Relief at seeing a heartbeat quickly turned to panic at learning my progesterone levels were low. As I filled the supplement prescription, I felt myself being submerged into an all-too-familiar nightmare. After each appointment, I waited to learn my "levels" like a prisoner waiting to hear her sentence. I felt trapped in a body that didn't work, that couldn't hold on to what mattered most. Even when I made it past the first trimester, my hesitations continued, shrouding every moment in a layer of anxiety and fear.
2. Loneliness. With my first pregnancy, we told our families right away. It was Christmas, and we were celebrating. I never dreamed I would be un-telling everyone a month later. With my next pregnancy, I was determined not to make the same mistake. We waited a long time before telling anyone, which made me feel protected, but also alone. My pregnancy became a secret to keep, instead of happy news to share. I held everything inside -- exactly when I needed my friends and family the most.
3. Guilt and self-doubt. During this time I often questioned my decisions, worried that any lapse in judgment might end my pregnancy. I was nervous to lift chairs at a work event, scared to help a family member carry luggage up the stairs. (Positions I found myself in because I was too afraid to tell anyone I was pregnant.) When you've had a miscarriage, it's easy to grab hold of the idea that by doing everything "right" you have some semblance of control -- and, by doing something "wrong," you're to blame for the loss. It's a heavy burden to bear.
4. Morning sickness envy. Most women dread morning sickness. I found myself longing for it. I craved the physical reassurance that things were "normal" inside me. I desperately wanted to know that my baby was there, growing and developing as expected. My lack of morning sickness felt like a punishment. Every moment I didn't feel nauseous was a reminder of how little I understood what was happening inside of me -- and how little I could control it.
5. Fear of joy. For a long time, I found myself prefacing every statement about my baby with "If we make it through the pregnancy" or "If the baby is born." I was afraid to be excited, terrified of letting in too much joy. I was uncomfortable buying furniture for the nursery, shopping for onesies, or even thinking of names. Looking back, I wish I had let myself enjoy it more. But my wounds were still fresh. I didn't want to indulge hopes that might lead to another heartbreak.
Sometime in my ninth month I began to relax, to feel hopeful that soon I'd hold my baby in my arms. I stopped saying "if" and started saying "when." When my daughter was born, I knew she was the baby I was meant to have. But as blessed as I am with my children, when I hear of a friend's miscarriage, I feel a pang in my heart. I'm glad that there's a day to shine a light on this issue -- for people to acknowledge and share their sadness about such a difficult subject. It was this openness -- talking with others who'd been through it -- that helped me get through those nine long months. Hopefully this openness will help others to know that there's light -- and even hope -- beyond the darkness.

Readings

Twin Pregnancy

One of the first questions a newly pregnant mother often asks is “Am I having twins?” And until it is confirmed that only one embryo is present, there is always the potential for this to be true.

For women who have a family history of twins, who have previously conceived with twins or have had fertility assistance, then the likelihood of having twins is higher. Because some types of fertility assisted conception do increase the likelihood of having a multiple birth, this is usually raised very early on in the pre-conception assessment and consent phases of treatment.

I’m having what?

Some women view the thought of having twins as being an absolute highlight, but others dread the possibility. Your own perception will be influenced by your personal experiences, history and supports.

For women who have been informed of the risk, or who have a history of twins in their biological family, having their own twin pregnancy confirmed is not such a shock. But for women who did not expect to conceive with more than one baby, or who may not having been planning to conceive at all, then finding out they are pregnant with twins can come as a real surprise.

Denial, shock, feeling numb and even angry are common emotions in the early days of having a twin pregnancy diagnosis. But with time reality soon descends and most women just learn to accept the fact that they are having two babies.

What’s so different about being pregnant with twins?

Twin pregnancy symptoms are not so much different to normal pregnancy symptoms, but they are felt much earlier. For the stage of gestation, twin pregnancy symptoms tend to be felt more clearly and with more emphasis before the normal gestational age and stage.

It is important to remember that just as every woman is unique and her pregnancy highly individual, there are some “classic” or standard symptoms which are attributed to twin pregnancy. Many of these are due to the elevated and more concentrated levels of hCG (Human Chorionic Gonadotrophin Hormone) which is the pregnancy hormone. It is primarily responsible for sustaining the embryo and maximising its chances of survival.

When twin pregnancy is more likely

For women over 30 years of age. In women who are peri-menopausal twins are more common.

In women who are taller than average, the odds are higher for having a twin pregnancy than for those of average or shorter height.

Women who are overweight with a BMI (Body Mass Index) of >25.

If you have a history of already having twins or if there are twins in your biological family e.g. your mother, aunts or sisters have had non-identical (fraternal) twins.

If you have had fertility assistance to conceive.

If you are of African American descent.

For women who have been pregnant previously.

Symptoms of twin pregnancy

Some women will “just know” they are pregnant with twins. This may be before they have even had confirmation that they are pregnant. They may dream, sense or have a vision or inherent belief that they are pregnant with twins.Some women will be told they are pregnant with twins by their partner, relatives, family or very close friend. Although there is often no evidence to support this claim, when their twin pregnancy is confirmed it really comes as no surprise.

Feeling very nauseous from early in the pregnancy. This is sometimes so extreme that the mother finds it difficult to tolerate anything but the blandest, easiest to digest foods.

Extreme intolerance to foods, smells, textures and appearance of some foods. Commonly meat, seafood, coffee and tea are the first substances to be found repugnant.

The uterus is “large for dates” which reflects the fact that two embryos, rather than one is present.

Extreme breast tenderness – to the point where it may be too uncomfortable to wear a bra. Some women find they need to wear crop tops or bandeau style tops as an alternative until their breasts become more comfortable.

Wanting and needing to pass urine much more frequently. Although urinary urgency is a common early pregnancy symptom, when pregnant with twins, this is much more magnified.

Utter exhaustion and a feeling of being unable to get through each day. This again, is a common pregnancy symptom but is exacerbated during a twin pregnancy.

Higher levels of hCG. This may be reflected in a very early pregnancy urine test. Even before a missed period, the level can be so high that there is an immediate, strong and clear positive confirmation on the pregnancy testing stick. For women who have undergone fertility assistance, blood tests may reflect a very high concentration of hCG early after conception.

Some women will experience more uterine cramping which is not associated with any blood loss. This can be a symptom of round ligament pain and is due to the uterus expanding relatively quickly.

A sense that your heart has to work harder than it usually does. Many women are aware that their resting heart/pulse rate is higher than normal. This is a sign of their heart having to pump out a greater blood volume with each heart muscle contraction in order to supply the uterus with oxygen saturated blood.

Moodiness, being prone to tears and feeling mentally unstable. Again, labile moods are a common pregnancy symptom, but when pregnant with twins, they tend to be more extreme.

You may find you can feel your baby/babies moving much earlier in your pregnancy. Women who are pregnant with twins say that they are conscious of feeling movements, known as quickening, earlier than the standard 15-16 weeks.

How is a twin pregnancy confirmed?

Although you, your partner or your health care practitioner may suspect you are pregnant with twins, it is not until twins are confirmed that you can be 100% sure.

Ultrasound, where two embryos are clearly defined on the screen.Hearing two, separate heartbeats on a Doppler.In the absence of sound ante-natal care, it is still possible that a twin pregnancy may not be evident until two babies are born.

Complications of a twin pregnancy

Unfortunately, the overall risks of pregnancy are increased during a twin pregnancy. But many women have an uneventful gestation and just because you are pregnant with twins, is not a guarantee you will have complications. But it does help to be informed and keep an open mind.

Premature birth – e.g. before 38 weeks of gestation.

Smaller babies with lower birth weight – simply because there have been two growing in the same space. One baby which is smaller than the other. It is common during twin pregnancy for one twin to receive more nutrition and space allocation than the other.

Preeclampsia.
This is why it is so important for you to have your BP monitored during your pregnancy. Fluid retention and passing protein in urine are other signs of preeclampsia.

Gestational diabetes.

What’s important to remember if pregnant with twins

Regular ante natal care with a qualified health care practitioner is essential.It may be worthwhile seeing an accredited practicing dietician to receive evidence based information on diet and meeting your body’s nutritional demands.

Allow yourself plenty of opportunity to rest. Growing twins and supporting them towards maturity takes a lot of energy. You may need to consider your work/leave entitlements and arranging regular home support and child care for older children.

You may need to have more regular ultrasounds than if you were carrying one baby.Your healthcare rebate and entitlements may be affected; find out early in your pregnancy what you are covered for, or consider accessing the public health system. Premature baby care can be extremely expensive. Find out your status and coverage early in your pregnancy to avoid unwanted and avoidable expenditures.

Plan for an earlier than expected delivery. Twins have a habit of coming early and it pays to be well organised.

Sex After C Section.

Regardless of the process you use to give birth (through a C section or normally) your body requires time to heal. According to many healthcare experts, you need at least six weeks of rest before you can have sex again. This is ample time for your cervix to close, any tears/repaired lacerations to heal, and for your post-delivery bleeding to cease.

You can also opt to wait longer before having sex if you feel the need to. Actually, some women will resume sex only a few weeks after giving birth while others prefer waiting longer than the six weeks. Some factors that can cause further delays in resuming your sex life include fatigue, fear of pain and stress. There are also many tips you can take while trying sex after c section to make the experience more pleasurable.

When to Have Sex after C Section

If you recently gave birth through a C section, it is normal to have doubts and questions regarding the appropriate time to resume your sex life. Most women assume they can have sex immediately since they did not give birth the normal way. However, this is very far from the truth.

After undergoing a C section, it is also required that you wait for at least 6 weeks before resuming sex. Actually, it is best to wait until your next doctor’s appointment before you resuming. During this checkup, the doctor will assess your incision and the healing process. They will also want to ensure that your post-delivery bleeding has stopped before they can give you the go ahead to have sex.

Is Sex Painful After C Section

Normally, you are bound to experience some pain during sex after having a C section. Some women complain of painful sex even after visiting the doctor and being given a go ahead for having sex. The type of pain mostly experienced by women during sex after a C section is more of a burning sensation than a stretching pain. Most women think that the pain is caused by abnormality in the vaginal path. However, if there were any abnormalities, the doctor should be able to pick it up during the six weeks examinations.

Some women who have had C sections for more than one child complain of painful sex each time they resume the activity after a C section. However, the pain ends after a few times. Using lubrication can go a long way towards easing the pain and discomfort. If you happen to experience discomfort and pain during sex, you can ask your partner to remain still until the pain subsides. Once the pain stops, you will be able to enjoy sex again.

On the other hand, if you feel that the pain is too much to bear, you can consider holding out for a few more weeks without sex before resuming. This gives your body more time to heal properly. After a few weeks, you will be able to enjoy sex without the pain.

Tips on Sex After C Section

If you decide to have sex as soon as your six weeks are up, there are tricks you can use to make it easier for your body and your healing incision.

Start with the positions you find most comfortable. For example, side by side or spooning would be a good idea. This will put the least pressure on your abdomen, which is where the incision was done. The abdomen remains sore for a while and you're advised to put the least pressure on it. As you recover, you can try out other positions. During the recovery process, you should consider oral sex over intercourse. It is not only comfortable, but also safer. Ask your partner to be careful not to blow air into your vagina as it can enter the bloodstream, and this can be dangerous.

Extra (supernumerary or accessory) nipples or breast tissue

Extra nipples or breast tissue is fairly common (1-6% of women) and is a result of incomplete regression of the mammary ridge (milk line) during the development of the embryo before birth.

What causes this? Extra breast tissue is a common developmental variation in human anatomy. Breast development begins around week four of gestation, with two parallel lines of glandular tissue called the milk line (or mammary ridge) extending from slightly beyond the underarm area, down the chest and abdomen, to the groin area and ending near the groin at the inner sides of the thighs (see figure).  Breasts eventually develop from these lines of tissue, and the remaining tissue regresses. Occasionally, there is an incomplete regression of the mammary ridge during embryo development, andextra (supernumerary) nipples and/or breast tissue forms, usually along this line but occasionally in other parts of the body. This can occur in both males and females. An extra nipple, areola, and/or glandular tissue may be present anywhere along this line (a nipple without glandular tissue is most common), and it is not at all unusual to have more than one.

What is typical when it comes to extra breast tissue? The term hypermastia (or polymastia, or ectopic breast tissue) refers to the presence of accessory mammary tissue in addition to the two main glands. It can occur in a number of different forms. Some examples include:

breast tissue with a nipple and areolabreast tissue with a nipple but no areolabreast tissue without a nipple (hyperadenia)nipple without glandular tissue (hyperthelia or polythelia)areola without nipple or glandular tissuean ectopic milk duct that leaks milk through the skin without visible breast tissue or nipple

Extra nipples usually occur right below the breasts or in the underarm area, and extra mammary tissue is usually located in the underarm area. Most studies show extra nipples to be more common in males, and they can sometimes run in families.

Accessory, or supernumerary, breast tissue is not functionally connected to the breast at all, even though it may be near the breast, in the underarm area or anywhere else along the milk line. This isdifferent than the breast tissue that normally extends into the underarm area, called the Tail of Spence (see figure), which is connected to the main ductal system of the breast.

What does it look like? Accessory breast tissue can appear as a complete breast if both a nipple, areola, and glandular tissue are present. If mammary tissue without a nipple or areola is present, it may appear as a lump or swelling under the skin. An accessory nipple may look like a freckle, a mole or a dimple, or it may look like a typical nipple (though it is usually smaller). Often, accessory nipples or breast tissue are not noticed until hormonal changes make them more apparent. Sometimes a new mom will not know she has accessory breast tissue until she notices milk dripping from a “freckle” or pore in the skin.

What happens during pregnancy & lactation? The hormonal changes during pregnancy and lactation can cause accessory breast tissue to increase in size and/or produce milk. You may also experience fluctuating swelling and/or tenderness (this may also occur during adolescence and/or menstruation). Accessory nipples and areolas may darken.  If you experience skin irritation when clothing rubs against an accessory nipple, try covering it with a bandaid or gauze.

As with any breast tissue, accessory breast tissue can become engorged at the beginning of lactation, and may leak milk. Accessory breast tissue does not typically produce much milk, and does not interfere with breastfeeding. The usual methods for easing engorgement can be helpful. If the extra breast tissue is not drained by a ductal system (so that no milk can leak or be expressed), comfort measures such as cold compresses can help until the extra tissue involutes and stops producing milk. Mothers with leaking milk from accessory nipples have found that a breast pad or sometimes just a bandaid can be effective for catching leaks. As with any leaking, applying pressure straight in toward the chest may help stop the leaking.

Uncommon problems: Since this is breast tissue, it has the potential for the same problems as any other breast tissue, including  inflammation, mastitis, abscesses, cysts, benign lumps, or malignant changes. The accessory nipple or breast tissue can be surgically removed, but this is not necessary unless it is causing problems. Some people do have accessory breast tissue or nipples removed for cosmetic reasons.

Article from kellymom.com

How Often Should I Feed My Baby Formula? 3 Things To Know

It’s often talked or written about how breastfed babies should be fed according to need. Feeding according to need means feeding your baby when she shows feeding cues (e.g. turning her head from side to side with mouth open, sucking on her hands, sticking her tongue out, wriggling). But what about bottle-fed babies? Should they be fed according to a feeding schedule or according to need? Well, as with breastfed babies, it’s appropriate to feed bottle-fed babies according to need, regardless of whether it’s breastmilk or formula in the bottle. So, how often should you feed your baby formula? Here are 3 things you should know:

#1: Different Babies Need Different Numbers Of Feeds Different babies show feeding cues at various time intervals – even time intervals between when an individual baby shows feeding cues varies. Feeding your baby when she shows feeding cues using a paced bottle feeding method (see below) helps her get the amount of milk she needs, as opposed to an arbitrary or caregiver derived amount.

#2: A Paced Bottle Feeding Method Helps Babies Better Control Their Intake When babies feed from a bottle, they cannot control their own intake as well as babies feeding at the breast. When a baby sucks at the breast, she’s in control of how much she drinks because she can suck in a way where she swallows or in a way where she doesn’t swallow. She can also be at the breast and not suck at all or she can just come off. When drinking from a bottle, the firm bottle teat inside a baby’s mouth gives her a strong stimulus to suck and when she sucks, she gets milk whether she needs the milk or not. The relatively fast and continuous flow of milk from a bottle means she needs to keep sucking or be flooded with milk. Nonetheless, you can help your bottle-fed baby to better be able to control her intake by using a paced bottle feeding method. You can read more about paced bottle feeding (also dubbed, bottle nursing) and other helpful bottle feeding tips here.

#3: Unsettled Behaviour Doesn’t Always Mean Your Baby Is Hungry Just like young breastfed babies, young bottle-fed babies also have periods where they cry a lot and sleep very little. These periods are often more about babies seeking emotional regulation as opposed to being hungry. During these times, breastfed babies often cluster feed , meaning they have a lot of short feeds close together. Because bottle-fed babies cannot control their intake like breastfed babies, during these periods, trying to settle your bottle-fed baby in ways other than with feeding or offering only small amounts at a time (e.g. about 30mL). … Feeding your bottle-fed baby according to her own individual need by using a paced bottle feeding method helps her get the amount of milk she needs.

American Sign Language

American Sign Language is a language where you communicate with your hands. This is the language that a deaf/hard of hearing person use in their daily lives. There is different types of Sign Language. For example there is American Sign Language, English Sign Language, French Sign Language, and Spanish Sign Language. These are just a few languages that I am aware of that have Sign Language. Learning Sign Language started young for me when I had a deaf friend in school I wanted to communicate with one summer. My 3rd grade teacher took the time to teach her class The Pledge of Allegiance for an assembly in school and that really took me to start looking up books for it. I am now teaching my children Sign Language to help with learning a language that can help with their attitudes a child endures.

These websites I am posting have info to help you start to learn this language that I enjoy learning each and every day. Any book store or library more than likely has books to help you learn to sign. There needs to be more people in this world to know this language as alot of people are developing hearing problems or becoming deaf at birth or getting sick and loses their hearing.

These shows are an influence to helping with Sign Language: Sue Thomas F.B.Eye, Switched at Birth are just a few.

What is American Sign Language?

American Sign Language (ASL) is a complete, complex language that employs signs made by moving the hands combined with facial expressions and postures of the body. It is the primary language of many North Americans who are deaf and is one of several communication options used by people who are deaf or hard-of-hearing.

Is sign language the same in other countries?

No one form of sign language is universal. Different sign languages are used in different countries or regions. For example, British Sign Language (BSL) is a different language from ASL, and Americans who know ASL may not understand BSL.

Where did ASL originate?

The exact beginnings of ASL are not clear, but some suggest that it arose more than 200 years ago from the intermixing of local sign languages and French Sign Language (LSF, or Langue des Signes Française).Today’s ASL includes some elements of LSF plus the original local sign languages, which over the years have melded and changed into a rich, complex, and mature language. Modern ASL and modern LSF are distinct languages and, while they still contain some similar signs, can no longer be understood by each other’s users.

How does ASL compare with spoken language?

The letters of the alphabet in
American Sign Language.

In spoken language, words are produced by using the mouth and voice to make sounds. But for people who are deaf (particularly those who are profoundly deaf), the sounds of speech are often not heard, and only a fraction of speech sounds can be seen on the lips. Sign languages are based on the idea that vision is the most useful tool a deaf person has to communicate and receive information.

ASL is a language completely separate and distinct from English. It contains all the fundamental features of language—it has its own rules for pronunciation, word order, and complex grammar. While every language has ways of signaling different functions, such as asking a question rather than making a statement, languages differ in how this is done. For example, English speakers ask a question by raising the pitch of their voice; ASL users ask a question by raising their eyebrows, widening their eyes, and tilting their bodies forward.

Just as with other languages, specific ways of expressing ideas in ASL vary as much as ASL users do. In addition to individual differences in expression, ASL has regional accents and dialects. Just as certain English words are spoken differently in different parts of the country, ASL has regional variations in the rhythm of signing, form, and pronunciation. Ethnicity and age are a few more factors that affect ASL usage and contribute to its variety.

How do most children learn ASL?

Parents are often the source of a child’s early acquisition of language, but for children who are deaf, additional people may be models for language acquisition. A deaf child born to parents who are deaf and who already use ASL will begin to acquire ASL as naturally as a hearing child picks up spoken language from hearing parents. However, for a deaf child with hearing parents who have no prior experience with ASL, language may be acquired differently. In fact, nine out of 10 children who are born deaf are born to parents who hear. Some hearing parents choose to introduce sign language to their deaf children. Hearing parents who choose to learn sign language often learn it along with their child. Surprisingly, children who are deaf can learn to sign quite fluently from their parents, even when their parents might not be perfectly fluent themselves.

Why emphasize early language learning?

Parents should introduce a child who is deaf or hard-of-hearing to language as soon as possible. The earlier any child is exposed to and begins to acquire language, the better that child’s communication skills will become. Research suggests that the first few years of life are the most crucial to a child’s development of language skills, and even the early months of life can be important for establishing successful communication. Thanks to screening programs in place at almost all hospitals in the United States and its territories, newborn babies are tested for hearing before they leave the hospital. If a baby has hearing loss, this screening gives parents an opportunity to learn about communication options. Parents can then start their child’s language learning process during this important early stage of development. For more information, see Communication Considerations for Parents of Deaf and Hard-of-Hearing Children.

What research is being done on ASL and other sign languages?

Simple phrases in American Sign Language.

The NIDCD supports research looking at whether children with cochlear implants become bilingual in spoken language and sign language in the same way that (or in different ways from how) hearing children become bilingual in both languages. This research will tell us more about how language development in children with cochlear implants might differ between hearing and nonhearing families and could offer important insights to help guide educational decisions and parent counseling.

An NIDCD-funded researcher is studying Al-Sayyid Bedouin Sign Language (ABSL), a sign language used over the past 75 years by both hearing and nonhearing people in an isolated Bedouin village in Israel. Because it was developed among a small group of people with little to no outside influence and no direct linguistic input, ABSL offers researchers the opportunity to document a new language as it develops and evolves. It can also be used to model the essential elements and organization of natural language.

Another NIDCD-funded research team is also looking at sign language systems that develop in isolation. The research team is learning more about how grammar is built and expanded in situations where there is little linguistic input. In one setting, they are observing “home sign” systems used by deaf children who live in isolation. In another, they are studying a family sign language that has been used and handed down over several generations on a remote fishing island.

Where can I find additional information about American Sign Language?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on American Sign Language:

• American Sign Language
• Deaf culture
• Cued speech

For more information, additional addresses and phone numbers, or a printed list of organizations, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free Voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Fax: (301) 770-8977
E-mail: nidcdinfo@nidcd.nih.gov

NIH Publication No. 11–4756
February 2014

http://www.nidcd.nih.gov/health/hearing/pages/asl.aspx

This image is the Alphabet for American Sign Language.

High Blood Pressure.

The American Heart Association has recommended guidelines to define normal and high blood pressure.

Normal blood pressure less than 120/80Pre-hypertension 120-139/ 80-89High blood pressure (stage 1) 140-159/90-99High blood pressure (stage 2) higher than 160/100

As many as 60 million Americans have high blood pressure.

Uncontrolled high blood pressure may be responsible for many cases of death and disability resulting from heart attack, stroke, and kidney failure.According to research studies, the risk of dying of a heart attack is directly linked to high blood pressure, particularly systolichypertension. The higher your blood pressure, the higher the risk. Maintaining lifelong control of hypertension decreases the future risk of complications such as heart attack and stroke

Hypertension is the medical term for high blood pressure. It is known as the "silent killer" since it has no initial symptoms but can lead to long-term disease and complications..

Many people have high blood pressure and don't know it.Important complications of uncontrolled or poorly treated high blood pressure includeheart attack, congestive heart failure, stroke,kidney failure, peripheral artery disease, andaortic aneurysms (weakening of the wall of the aorta, leading to widening or ballooning of the aorta).Public awareness of these dangers has increased. High blood pressure has become the second most common reason for medical office visits in the United States.How is blood pressure measured?

Blood pressure is measured with a blood pressure cuff and recorded as two numbers, for example, 120/80 mm Hg (millimeters of mercury). Blood pressure measurements are usually taken at the upper arm over the brachial artery.

The top, larger number is called the systolic pressure. This measures the pressure generated when the heart contracts (pumps). It reflects the pressure of the blood against arterial walls.The bottom, smaller number is called thediastolic pressure. This reflects the pressure in the arteries while the heart is filling and resting between heartbeats.

High Blood Pressure Symptoms^°¶{

High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.

Sometimes people with markedly elevated blood pressure may develop:

headachedizzinessblurred vision,nausea and vomiting, andchest pain and shortness of breath.

People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:

Heart attackHeart failureStroke or transient ischemic attack (TIAKidney failureEye damage with progressive vision lossPeripheral arterial disease causing leg painwith walking (claudication)Outpouchings of the aorta, called aneurysms

About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known asmalignant hypertension.

In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptomsMalignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.

It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart, other organs, and blood vessels.

positional plagiocephaly

Babies are born with soft heads to allow for the amazing brain growth that occurs in the first year of life. As a result, their heads are easily "molded."

Passage through the birth canal during childbirth can cause a newborn's head to look pointy or too long. So it's normal for a baby's skull, which is made up of several bones that eventually fuse together, to be a bit oddly shaped during the few days or weeks after birth.

But if a baby develops a lasting flat spot, either on one side or the back of the head, it could be flat head syndrome, also called positional plagiocephaly (pu-ZI-shu-nul play-jee-oh-SEF-uh-lee). Flat head syndrome usually happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles.

This problem does not harm brain development or cause any lasting appearance problems. And, fortunately, it does not require surgery. Simple practices like changing a baby's sleep position, holding your baby, and providing lots of "tummy time" can help.

Causes

The most common cause of a flattened head is a baby's sleep position. Because infants sleep for so many hours on their backs, the head sometimes flattens in one spot. Placing babies in devices where they lie down often during the day (infant car seats, carriers, strollers, swings, and bouncy seats) also adds to this problem.

Premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs and extreme fragility after birth, which usually requires a stay in the neonatal intensive care unit (NICU).

A baby might even start to develop flat head syndrome before birth, if pressure is placed on the baby's skull by the mother's pelvis or a twin. In fact, many babies from multiple births are born with heads that have some flat spots.

Being cramped in the womb can also cause torticollis, which can lead to a flattened head. Babies with torticollis have a hard time turning their heads because of tight neck muscles on one side of the neck. Since it's hard to turn the head, they tend to keep their heads in the same position when lying down. This can cause flattening.

Likewise, many babies who started out with flat head syndrome develop torticollis. Because it takes a lot of energy for them to turn their heads, babies with severe flattening on one side tend to stay on that side, so their necks become stiff from lack of use.

Signs and Symptoms

Flattened head syndrome is usually easy for parents to notice. Typically, the back of the child's head, called the occiput (AHK-suh-puht), is flattened on one side. There is usually less hair on that part of the baby's head. If a person is looking down at the baby's head, the ear on the flattened side may be pushed forward.

In severe cases, the head might bulge on the side opposite from the flattening, and the forehead may be uneven. If torticollis is the cause, the neck, jaw, and face may be uneven as well.

Diagnosis

Doctors usually diagnose flat head syndrome simply by looking a child's head. To check for torticollis, the doctor may watch how a baby moves the head and neck. Lab tests, X-rays, and computed tomography (CT scans) usually are not needed.

The doctor may monitor a child over a few visits to see how the shape of the head changes. If repositioning the child's head during sleep helps to improve the skull over time, the problem is likely due to flat head syndrome. If it doesn't, the cause could bedue to another condition, such as craniosynostosis (kray-nee-oh-sin-os-TOE-sis).

Craniosynostosis happens when a child's skull bones fuse together before they're supposed to (normally, around age 4). This fusion restricts brain growth and causes skull deformities. Children with craniosynostosis need treatment to correct the problem.

If the doctor suspects craniosynostosis or another condition, the child will be referred to a pediatric neurosurgeon or a craniofacial plastic surgeon who may order other tests, like X-rays or a CT scan.

Treatment

If your child has flat head syndrome that's caused by a sleeping or lying position, there is a lot you can do at home to help treat it:

Change the head position while your baby sleeps.Reposition your baby's head (from left to right, right to left) when your baby is sleeping on the back. Even though your baby will probably move around throughout the night, it's still a good idea to place your child with the rounded side of the head touching the mattress and the flattened side facing up. The American Academy of Pediatrics (AAP) does not recommend using any wedge pillows or other devices to keep your baby in one position.Alternate positions in the crib. Consider how you lay your baby down in the crib. Most right-handed parents carry small infants cradled in their left arms and lay them down with the heads to their left. In this position, the infant must turn to the right to look out into the room — and, indeed, torticollis to the right with flattening of the right side of the head is far more common than the left. Whichever side of your infant's head is flattened, you will want to position your baby in the crib to encourage active turning of the head to the other side.Hold your baby more often. Reduce the amount of time your child spends lying on the back or often being in a position where the head is resting against a flat surface (such as in car seats, strollers, swings, bouncy seats, and play yards). For instance, if your baby has fallen asleep in a car seat during travel, take your baby out of the seat when you get home rather than leaving your little one snoozing in the seat. Pick up and hold your baby often, which will take pressure off the head overall.Practice tummy time. Provide plenty of supervised time for your baby to lie on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, it helps babies strengthen their neck muscles and learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up.

As most infants with plagiocephaly have some degree of torticollis, physical therapy and a home exercise program will usually be part of the recommended treatment. A physical therapist can teach you exercises to do with your baby involving stretching techniques that are gradual and progressive. Most moves will involve stretching your child's neck to the side opposite the tilt. In time, the neck muscles will get longer and the neck will straighten itself out. Although they're very simple, the exercises must be done correctly.

For kids with severe flat head syndrome in which repositioning for 2-3 months doesn't help, doctors may prescribe a custom-molded helmet or head band. While helmets might not work for all children, some kids with severe torticollis can benefit from them.

The helmets work best if used between the ages of 4 and 12 months, when a child grows the fastest and the bones are most moldable. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth.

Never purchase or use any devices like these without first having your child seen by a doctor. Only a small percentage of babies wear helmets. The decision to use helmet therapy is made on a case-by-case basis (for example, if the condition is so severe that a baby's face is becoming misshapen).

Outlook

The outlook for babies with flat head syndrome is excellent. As babies grow, they begin to reposition themselves naturally during sleep much more often than they did as newborns, which allows their heads to be in different positions throughout the night.

After babies are able to roll over, the AAP still recommends that parents put them to sleep on their backs, but then allow them to move into the position that most suits them without repositioning them onto their backs.

As a general rule, once an infant can sit independently, a flat spot will not get any worse. Then, over months and years, as the skull grows, even in severe cases the flattening will improve. The head may never be perfectly symmetrical, but for a variety of reasons the asymmetry becomes less apparent as well. For example, in later childhood the face becomes more prominent in relation to the skull, hair thickens, and children are always on the go. Experience and clinical research have shown that by school age, a flattened head is no longer a social or cosmetic problem.

It's important to remember that having a flattened head does not affect a child's brain growth or cause developmental delays or brain damage.

Prevention

Babies should be put down to sleep on their backs to help prevent sudden infant death syndrome (SIDS), despite the possibility of developing an area of flattening on the back of the head.

However, alternating their head position every night when you put them down to sleep and providing lots of tummy time and stimulation during the day while they're awake can reduce the risk of flat head syndrome.

Stages of Pregnancy

A normal pregnancy usually lasts about 40 weeks, counting from the first day of a woman's last menstrual period, which is typically about two weeks before conception occurs. 

The stages of pregnancy are typically described in three-month periods known as trimesters. Each trimester lasts between 12 and 13 weeks. 

During each trimester, distinct changes take place in a pregnant woman's body as well as in the development of the fetus, and they will be described in greater detail below. 

Conception and implantation

About two weeks after a woman has her period, she ovulates and her ovaries release one mature egg. The egg can be fertilized for 12 to 24 hours after it's released as it travels down the fallopian tube toward the uterus. 

If an egg meets up with a sperm cell that has made its way into the fallopian tube, it combines into one cell, a process that's known as fertilization or conception. 

At fertilization, the sex of the fetus is already determined, depending on whether the egg receives an X or Y chromosome from a sperm cell. If the egg receives an X chromosome, the baby will be a girl; a Y chromosome means the baby will be a boy. 

According to the Cleveland Clinic, it takes about three to four days for the fertilized egg (or embryo) to move to the lining of the uterus, where it attaches or implants to the uterine wall. Once the embryo is implanted, the cells start to grow eventually becoming the fetus and the placenta, which is tissue that can transport oxygen, nutrients and hormones from the mother's blood to the developing fetus throughout pregnancy.

First trimester (weeks 1-12) changes in the mother's body

A woman will experience a lot of symptoms during her first trimester as she adjusts to the hormonal changes of pregnancy, which affect nearly every organ in her body. The pregnancy may not be showing much on the outside of her body, but inside many changes are taking place.  

Human chorionic gonadotrophin (hCG) is a hormone that will be present in a woman's blood from the time conception occurs. Produced by cells that form the placenta, hCG can be detected in a woman's urine about a week after a missed period and is responsible for a positive result on a home pregnancy test. 

Rising levels of pregnancy hormones may also bring on the waves of nausea and vomiting known as morning sickness that a woman typically feels during her first few months of pregnancy. Some smells may be more bothersome now and provoke queasiness. 

She will also feel more tired than usual, a symptom that's linked with rising levels of the hormone progesterone, which increases sleepiness. A woman's uterus is growing and begins to press on the bladder, causing her to urinate more frequently. 

Early in pregnancy, a woman's breasts will feel more tender and swollen, another side effect of rising pregnancy hormone levels. A woman's areolas, the skin around each of her nipples, will darken and enlarge.  

Her digestive system may slow down to increase the absorption of nutrients, but this might also lead to such common complaints as heartburn, constipation, bloating and gas, according to womenshealth.gov. 

In addition, a pregnant woman's heart will be working even harder, increasing the volume of blood it pumps to supply the uterus with the additional blood it needs to supply the fetus and elevating her pulse rate.  

As more blood circulates to a woman's face, it will give her skin a rosier complexion, described as a "pregnancy glow." 

Besides the physical changes in a woman's body, she will also experience emotional highs and lows in the early months of her pregnancy and throughout it. These emotions may range from weepiness, mood swings and forgetfulness to fear, anxiety and excitement. 

First trimester development of embryo/fetus  

A developing baby is called an embryo from the moment conception takes place until the eighth week of pregnancy. 

During the first month of pregnancy the heart and lungs begin to develop, and the arms, legs, brain, spinal cord and nerves begin to form, according to the American College of Obstetricians and Gynecologists (ACOG). 

The embryo will be about the size of a pea around one month into a pregnancy, Burch said. Around the second month of pregnancy, the embryo has grown to the size of a kidney bean, he explained. In addition, the ankles, wrists, fingers and eyelids form, bones appear, and the genitals and inner ear begin to develop. 

After the eighth week of pregnancy and until birth occurs, a developing baby is called a fetus.

By the end of the second month, eight to 10 of the fetus' main organs will have formed, Burch said, which is why he stresses to pregnant women that it's extremely important to not take harmful medications, such as illegal drugs during that time. The first trimester is also the period when most miscarriages and birth defects occur. 

During the third month of pregnancy, bones and muscles begin to grow, buds for future teeth appear, and fingers and toes grow. The intestines begin to form and the skin is almost transparent. 

Second trimester (weeks 13-27) changes in the mother's body

By the second trimester, some of the unpleasant effects of early pregnancy may lessen or disappear as the body adjusts to its changing hormone levels. Sleeping may get easier and energy levels may increase. 

Nausea and vomiting usually gets better and goes away. But other symptoms may crop up as the fetus continues its growth and development. 

Women feel more pelvic pressure, Burch said, adding that the pelvis feels heavy like something is weighing it down. 

A more visible baby bump appears as the uterus grows beyond a woman's pelvis, and the skin on her expanding belly may itch as its stretches, according to womenshealth.gov.

As the fetus is getting bigger and a woman is gaining more pregnancy weight in the front of her body, she may also experience more back pain, Burch said. 

Somewhere between the 16th and 18th week of pregnancy a first-time mother may feel the first fluttering movements of the fetus known as quickening, Burch said. If a woman has had a baby before, she is likely to feel the fetus kicking, squirming or turning even sooner because she knows what to look for and expect, he explained. 

The 20th week usually marks the halfway point of a woman's pregnancy. 

Burch encourages his patients to take a "baby-moon" — a mini-vacation or weekend getaway — during the second trimester, and he said the best time to get away is around the 28th week of pregnancy. A woman is generally feeling pretty good at this point, there's a lower risk of miscarriage and premature labor, and some health professionals may discourage airplane travel after the 36th week. 

Second trimester development of the fetus 

In the second trimester, the fetus is growing a lot and will be between 3 and 5 inches long, Burch said. Somewhere between 18 and 22 weeks an ultrasound may reveal the sex of the baby, if parents want to know it in advance. 

By the fourth month of pregnancy, eyebrows, eyelashes, fingernails and the neck all form, and the skin has a wrinkled appearance. Some other highlights this month include that the arms and legs can bend, the kidneys start working and can produce urine, and the fetus can swallow and hear, according to ACOG. 

In the fifth month of pregnancy, the fetus is more active and a woman may be able to feel its movements. The fetus also sleeps and wakes on regular cycles. A fine hair (called lanugo) and a waxy coating (called vernix) cover and protect the thin fetal skin. 

By the sixth month of pregnancy, hair begins to grow, the eyes begin to open and the brain is rapidly developing. Although the lungs are completely formed, they don't yet function. 

Third trimester (weeks 28-40) changes in the mother's body

During the third trimester, as a woman's enlarged uterus pushes against her diaphragm, a major muscle involved in breathing, she may feel short of breath because the lungs have less room to expand, according to Johns Hopkins Medicine. Her ankles, hands, feet and face may swell as she retains more fluids and her blood circulation slows. 

A mother-to-be will need to pee more frequently because more pressure will be placed on her bladder. She may also have more backaches and more pain in the hips and pelvis, as these joints relax in preparation for delivery. 

Her face may develop dark patches of skin, and stretch marks may appear on a woman's belly, thighs, breasts and backside. She may also notice varicose veins on her legs. 

Her breasts may experience some leakage of colostrum, a yellow liquid, as they get ready for breastfeeding, according to womenshealth.gov.

False labor, known as Braxton-Hicks contractions, may begin to occur as a woman gets closer to her due date. A "nesting instinct" may kick in as a woman and her partner baby-proof their home, shop for baby items, prepare the nursery and eagerly await their new arrival. 

It will become harder to find a comfortable sleeping position during the final weeks of pregnancy, so women may be extremely tired, Burch said. 

As delivery approaches, "some women love the experience of being pregnant, while others may feel like they don't want to go through it again," Burch said. 

Third trimester development of the fetus 

By the seventh month of pregnancy, the fetus kicks and stretches, and can even respond to light and sound, like music, Burch said. The eyes can open and close. 

During the eighth month of pregnancy, the fetus gains weight very quickly. Bones harden, but the skull remains soft and flexible to make delivery easier. Different regions of the brain are forming, and the fetus is able to hiccup, according to ACOG.

The ninth month is the home stretch of pregnancy and the fetus is getting ready for birth by turning into a head-down position in a woman's pelvis. The lungs are now fully mature to prepare for functioning on their own. The fetus continues to gain weight rapidly. 

Cholestasis of pregnancy

DEFINITION

Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but often on many other parts of the body.

Cholestasis of pregnancy can make you intensely uncomfortable but poses no long-term risk to an expectant mother. For a developing baby, however, cholestasis of pregnancy can be dangerous. Doctors usually recommend early delivery.

The term "cholestasis" refers to any condition that impairs the flow of bile — a digestive fluid — from the liver. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

SYMPTOMS

Intense itching is the predominant symptom of cholestasis of pregnancy. Most women feel itchy on the palms of their hands or the soles of their feet, but some women feel itchy everywhere. The itching is often worse at night and may be distressing enough that you can't sleep.

The itching is most common during the third trimester of pregnancy, but sometimes begins earlier. It may feel worse as your due date approaches. Once your baby arrives, however, the itchiness usually goes away within a few days.

Other less common signs and symptoms of cholestasis of pregnancy may include:

Yellowing of the skin and whites of the eyes (jaundice)
Nausea
Loss of appetite
When to see a doctor

Contact your pregnancy care provider promptly if you begin to feel persistent or extreme itchiness.

CAUSES

What causes cholestasis of pregnancy is unclear. There may be a genetic component, as the condition sometimes runs in families and certain genetic variants have been associated with it.

Pregnancy hormones also may play a role. Bile is a digestive fluid produced in the liver that helps the digestive system break down fats. It's possible that the increase in pregnancy hormones — such as occurs in the third trimester — may slow the normal flow of bile out of the liver. Eventually, the buildup of bile in the liver allows bile acids to enter the blood stream. Bile acids deposited in the mother's tissues can lead to itching.

RISK FACTORS

Factors that increase the risk of developing cholestasis of pregnancy include:

A personal or family history of cholestasis of pregnancy
A history of liver disease
A twin pregnancy
Some of these factors may have to do with heredity, and all probably have to do with increased levels of pregnancy hormones. After you've had the condition once, the risk of developing it during a subsequent pregnancy is high. About half to two-thirds of women experience recurrence of cholestasis of pregnancy.

COMPLICATIONS

For mothers, cholestasis of pregnancy may temporarily affect the way the body absorbs fat-soluble vitamins, but this rarely impacts overall nutrition. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies.

For babies, the complications of cholestasis of pregnancy can be more severe. For reasons not well-understood, cholestasis of pregnancy increases the risk of the baby being born too early (preterm birth). It also increases the risk of meconium — the substance that accumulates in the baby's intestines — getting into the amniotic fluid that surrounds the baby. If a baby inhales meconium during delivery, he or she may have trouble breathing. There's also a risk of fetal death late in pregnancy. Because of the potentially severe complications, your doctor may consider inducing labor around the 37th week of pregnancy.

PREPARING FOR YOUR APPOINTMENT

It's a good idea to be well-prepared for your appointment with your obstetrician or pregnancy care provider. Here's some information to help you get ready for your appointment, and what to expect from your pregnancy care provider.

What you can do

To prepare for your appointment:

Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
Make a list of any medications, vitamins and other supplements you take. Write down doses and how often you take them.
Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
Take a notebook or notepad with you. Use it to write down important information during your visit.
Think about what questions you'll ask. Write them down so you won't forget important points you want to cover.
For cholestasis of pregnancy, some basic questions to ask your pregnancy care provider include:

What is likely causing my symptoms?
Is my condition mild or severe?
Is it safe to continue the pregnancy?
How does my condition affect the baby?
What is the best course of action?
What kinds of tests do I need?
What are the alternatives to the primary approach that you're suggesting?
Are there any restrictions that I need to follow?
Will it be necessary to induce early labor?
Do you have any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

To better understand your condition, your pregnancy care provider might ask several questions, such as:

What symptoms are you experiencing?
How long have you been experiencing symptoms?
How severe are your symptoms?
Has your baby been active?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Have you been diagnosed with cholestasis during any previous pregnancies?

TESTS AND DIAGNOSIS

To diagnose cholestasis of pregnancy, your pregnancy care provider may:

Ask questions about your symptoms and medical history
Perform a physical exam
Send blood samples for lab testing to evaluate how well your liver is working and measure the amount of bile salts in your blood.

TREATMENTS

Treatment for cholestasis of pregnancy aims to relieve itching and prevent complications.

Relieving itching

To soothe intense itching, your pregnancy care provider may recommend:

Taking the prescription medication ursodiol (Actigall, Urso), which helps decrease the level of bile in the mother's bloodstream, relieves itchiness and may reduce complications for the baby
Soaking itchy areas in lukewarm water
You might be tempted to take an antihistamine or use an anti-itch (corticosteroid) cream to relieve the intense itching associated with this condition. Antihistamines are often ineffective and may pose risks to your developing baby. And if they do work, you may not feel the need to see your pregnancy care provider, delaying effective diagnosis and treatment. Corticosteroid creams and lotions don't work to relieve the itching of cholestasis of pregnancy. In addition, using too much corticosteroid cream may pose a risk to the baby.

Preventing complications

Because complications related to the baby's health can be serious, your pregnancy care provider may recommend close monitoring of your baby during pregnancy. Measures your pregnancy care provider might take include:

Nonstress tests and biophysical profile scores. These tests help monitor your baby's well-being. During a nonstress test, your pregnancy care provider will check how often your baby moves in a certain period of time and how much his or her heart rate increases with movement. The biophysical profile provides information regarding the volume of amniotic fluid, as well as fetal muscle tone and activity. While these tests can be reassuring, they can't really predict the risk of preterm birth or other complications associated with cholestasis of pregnancy.
Early induction of labor. Even if the prenatal tests appear normal, your pregnancy care provider may suggest inducing labor early — around 37 weeks or so. Because it's hard to predict when fetal death might occur, early delivery is sometimes the best and only way to prevent.

LIFESTYLE AND HOME REMEDIES

Unfortunately, itching due to cholestasis of pregnancy isn't very responsive to home remedies. To relieve itching, you might try:

Warm baths, which seem to lower the intensity of the itching for some women
Icing a particularly itchy patch of skin, which may temporarily reduce the itch

ALTERNATIVE MEDICINE

Research into effective alternative therapies for treating cholestasis of pregnancy is lacking, so doctors and other pregnancy care providers generally don't recommend alternative therapies.

One alternative therapy being studied for cholestasis of pregnancy is S-adenosyl-L-methionine (SAMe), a naturally occurring substance. You can get it through an injection into your muscle or through a vein (intravenously). Some evidence suggests that it may help relieve itching, though the risks to mother and baby of such an approach aren't well known. When compared with ursodiol in preliminary trials, SAMe wasn't as effective. Given that the way you take the medicine can be uncomfortable and inconvenient, its safety is unknown, and it doesn't appear to work as well as other more established medicines, doctors are hesitant to recommend it as a treatment.

Other alternative therapies, including guar gum, activated charcoal, milk thistle and dandelion root, are also being studied, but there's no evidence that these therapies work or are safe for pregnant women to take.

Always check with your doctor or health care provider before trying an alternative therapy, especially if you're pregnant.

fenugreek and breast milk supply

Fenugreek And Breast Milk Supply Fenugreek is enjoyed as a culinary herb/spice in many parts of the world such as France, India, Argentina, North Africa and in the Mediterranean countries.  Fenugreek has also been used for centuries as agalactagogue, which is a substance claimed to increase milk supply.  Even today, fenugreek is probably the most common herb used as a galactagogue.  When taken to help boost milk supply, fenugreek is used as a ground seed in capsule form, or in tea.  Some mothers say they find fenugreek to help increase their milk supply.  However, what does the scientific research say about fenugreek’s efficacy as a galactagogue? Is it safe, and should it be the first line treatment to increase milk supply?  Research About Fenugreek As A Galactagogue  Most of the research about fenugreek and breast milk production is anecdotal. What this means is some women have found fenugreek to be helpful at increasing milk supply.  However, there is a lack of scientific research to back up what some mothers have found. There have only been a limited number of studies about fenugreek as a galactagogue. Most of these studies are low to moderate quality and most didn’t find that fenugreek was as an effective in increasing milk supply.  Some of the problems with the research into fenugreek as a galactagogue include:  Lack of randomisation. The most important aspect of randomisation is that it helps ensure participants are objectively representative of the group being studied. If this doesn’t happen, it increases the risk of bias in the participant selection process. For example, if mothers who are very motivated to breastfeed and take fenugreek capsules are compared to mothers who take a placebo capsule yet are less motivated to breastfeed, then this can obviously affect the results. Randomisation helps prevent such an occurrence.Lack of placebo control group. Without a placebo group to compare against, it’s more difficult to know whether the treatment being studied had any effect. This is because it’s possible for participants to have a treatment effect due to other factors such as knowing one is receiving a treatment, attention from health professionals, and the expectations of a treatment’s effectiveness by those conducting the research study.In some studies, fenugreek was part of a mixture given to mothers. Hence, no single ingredient can be considered solely responsible for the mixture’s effects.Small number of study participants. The small number of participants in a study affects its reliability. Reliability refers to how consistently the study outcomes can be repeated amongst other people.  More well designed human research trials are needed before fenugreek’s potential efficacy as a galactagogue can be established.  Safety Of Fenugreek  Although more research is needed, if a mother wishes to try fenugreek to increase her supply, is it safe for her to do so?  Fenugreek is considered safe for breastfeeding mothers when used in moderation and is on the US Food and Drug Administration.  Leading breastfeeding researcher, Doctor Thomas Hale, classifies fenugreek in the Lactation Risk Category L3, which means moderately safe.  Overall, fenugreek appears to be generally well tolerated by adults, including breastfeeding mothers. However, some common side effects in breastfeeding mothers taking fenugreek include:  Diarrhoea and flatulenceSweat, urine, breastmilk and breastfed baby and mother may smell like maple syrup  It is important to use fenugreek with caution or avoid it if a mother has a history of:  Peanut or chickpea allergy. Fenugreek is in the same family as these and possibly other legumes. Hence, fenugreek may cause anallergic reaction in mothers who have an allergy to these.Diabetes. A typical dosage of fenugreek when used as a galactagogue is 1-6 grams daily. Dosages higher than this (e.g. 25 grams or more daily), fenugreek may cause lowering of cholesterol and blood sugar levels. It can also interact with warfarin to cause bleeding. Caution should be used in giving high dosages to women with diabetes or those taking warfarin. Some mothers have reported that fenugreek worsened their asthmasymptoms.First Line Treatments To Increase Supply  When it comes to trying to increase supply, in almost all cases, non-pharmacological methods should be tried first.  The first thing to determine if a mother feels she needs to increase supply is to work out whether her supply is truly low. To work out this, she needs to base her supply on the reliable signs of her baby’s milk intake and not the unreliable signs.  Secondly, the single most important factor to increase milk supply is to ensure milk is removed well and often. In terms of frequency, it’s common for breastfed babies to feed 8-12 times in a 24 hours period. Factors that can help milk to be removed well include:  Feeding according to a baby’s cuesGood positioning and attachmentRuling out any oral anatomical issues such as tongue-tieHaving a skilled breastfeeding expert, such as a lactation consultant, watch a breastfeed.  If a mother feels her milk supply is low, it’s important for her to seek assistance. For example, contacting a breastfeeding support organisation such as the Australian Breastfeeding Associationor La Leche League can help. Seeing a lactation consultant may also be helpful.  …  If a mother’s milk supply is truly low, despite milk being removed well and often, fenugreek may be something that may help. It’s always important to seek medical advice before taking any pharmacological substance, to help ensure its safety.

☆Pregnancy Pillows☆

To get comfortable some woman rely and swear by pregnancy pillows, here's the top 5 most recommended.

1. Boppy Total Body Pillow
What it is: The undulating curves of this pillow follow the line of a side-sleeping pregnant woman, helping to cradle her growing belly, tired head, and tense back. It even keeps knees apart! Later, it can double as a supportive nursing pillow or a backrest during storytime.
What to watch out for: Some say that over time the pillow's stuffing can develop frustrating clumps and lumps – the last thing you need when you're already tossing and turning.

2.Leachco Snoogle Total Body Pillow
What it is: This pillow shaped like a candy cane supports your back to soothe sciatica and lower back pain. It also tucks between your knees for help with back pain and temperature control, cradles your tummy, and props up your head to aid in breathing and ease heartburn and other pregnancy pitfalls. Snoogle fans appreciate its removable, washable case. And it can do double duty as a nursing support after your baby arrives.
What to watch out for: Make room for the Snoogle – make a lot of room. If you have a double bed, think carefully. It's best for queen beds and larger.

3.Boppy Prenatal Sleep Wedge
What it is: If the other pregnancy pillows make you feel like you're sleeping with a third, giant human, this smaller, lightweight option may suit you (and your partner!) better. The dense wedge is easy to place wherever you need it. It offers ergonomic support when used under the belly, and better hip, leg, and back alignment when used between the knees. Unlike some of the other pillows, the cover is truly easy to get on and off.
What to watch out for: You might want to try a thick, firm standard pillow or even a rolled-up blanket before buying this. Some moms say those DIY solutions perform just as well.

4.Sealy Sweet Pea 2-in-1 Maternity and Nursing Pillow
What it is: Trying to cut down on the sheer volume of baby gear? This pillow will help you sleep more soundly during pregnancy and later support your baby while you're nursing or bottle feeding. It's a smart design: The fuller end of the pillow aligns your tummy, hips, knees, and lower back when you're lying down.
What to watch out for: The thickness in the middle is too much for some smaller women to comfortably nestle between their legs. Others complain that the pillow isn't firm enough to support a brand-new baby.

5.Aller-Ease Body Pillow
What it is: Moms-to-be who swear by this rectangular pillow say that simple is better. Without all of the crazy curves or complicated shapes of other pregnancy pillows, all you have to do is wrap your body around this soft log. Those with stuffy noses and sensitivities to allergens also appreciate that it's got a pollen barrier, pet dander barrier, and a hypoallergenic fill.
What to watch out for: If you're looking for a firm pillow, this one might be too cushy.