Glucose Tolerance Test (GTT)

Gestational glucose intolerance is detected during pregnancy with the glucose tolerance test (GTT). This test is usually recommended around 24-28 weeks, and may be repeated around 32-34 weeks in mothers with high-risk pregnancies.

By identifying gestational glucose intolerance during pregnancy, the mother can alter her diet to keep her blood sugar from getting too high. Gestational glucose intolerance is more common in overweight women, older women, those with a family history of diabetes, or women who have previously delivered a baby weighing more than nine pounds.

The GTT is done at your doctor's office. You drink a glass of sweet liquid called glucola (it tastes like sweetened Coke or Pepsi) on an empty stomach, and then your blood sugar is checked one hour later. (An alternative to drinking the sugar-loaded liquid is to measure the blood sugar 1-2 hours after a big meal.) The result of the GTT should be available within a few hours. After ingesting the test "meal," it's important to stay active (e.g. walking) so your body has a better chance of metabolizing the sugar load than if you just sit there waiting to have your blood drawn.

If this one-hour screening test turns out to show high blood sugar, the doctor may recommend a more accurate three-hour test. Only around 15 percent of women with abnormal one-hour GTT will have an abnormal three-hour GTT test. If the three-hour test is abnormal, the doctor may recommend a diabetic diet throughout the rest of pregnancy. New research questions the value of routine screening for gestational glucose intolerance. A 1990 study of 1,307 women (533 of whom were not screened and 774 who were screened) showed that screening resulted in more tests and worry during pregnancy and a significantly higher cesarean rate in the screened mothers, but it did not decrease the number of large infants. These researchers concluded that the routine use of GTT caused more worry than the benefits derived. Discuss with your practitioner whether or not the GTT is necessary in your particular pregnancy.

Pregnancy Test

Are You Really Pregnant? Take a Test and Find Out!Most hopeful moms-to-be want to know if they are pregnant. In most cases, you can know for sure as soon as one week after conception. When implantation occurs, the developing placenta begins to produce the hormone HCGChuman chorionic gonadotropin. This hormone is detectable as early as one week after conception in your blood and 7 to 10 days after conception in your urine.

URINE TEST

The urine test is performed in your doctor's office or at home (if you follow the directions on a home pregnancy kit). A very early test may register negative if your body has not yet produced enough HCG to be detected. A repeat test a few days or week later may come out positive. By the way, a home pregnancy test is nearly 100 percent positive within 7 to 10 days after conception. Whether your test registers positive or negative, if you think you are pregnant, take care of yourself and your baby as if you were pregnant.

BLOOD TEST

A few drops of blood can let you know if you are pregnant as early as one week after conception. This blood test is performed in your doctor's office or a laboratory. Within a day or two, you will have the final results. The test is nearly 100 percent accurate, depending on no laboratory error.

SCREENING TESTS

At some time during your pregnancy your doctor will mention a certain test, such as a blood test, an ultrasound, or an amniocentesis. You may wonder if this test is really safe or even necessary. You deserve answers to these questions! After all, you are a key partner in making these decisions. Here are some basic facts about three common tests.

AFP (ALPHA-FETO PROTEIN) SCREEN

The AFP screen is the most commonly available prenatal screening test for birth defects. AFP, a natural substance produced by baby's liver, normally enters the mother's bloodstream during pregnancy. Maternal levels of AFP are elevated if the mother is carrying a baby with a neural tube defect, NTD, (the vertebrae that normally enclose the spinal cord fail to develop), because AFP leaks out of an open spinal column. These defects include spina bifida (in which the spinal cord is not enclosed in the spinal column, often cause paralysis from the waist down) and anencephaly (in which baby's brain is either severely underdeveloped or doesn't develop at all). AFP levels are lower than normal if the baby has Down syndrome or another chromosomal defect.

The AFP screen is performed on a small amount of blood taken from the mother's arm. This common test is safe and is done between the sixteenth and eighteenth week of pregnancy. You will know the score within one week.

While the AFP screen is safe, it can be traumatic and lead to unnecessary worries. A confirmed positive test will be followed by other tests, which carry greater risks and anxiety, and in most cases, you find out there was nothing to worry about in the first place (or nothing you want to do about it anyway).

To decide whether or not to have a prenatal screening test for birth defects, consider these questions:Would the results matter to you?Would you change the course of your pregnancy? Are the results of the test going to create or alleviate anxiety?Would having the test or not having the test worry you more or less?Would knowing about a birth defect before hand dampen the joy of your pregnancy?If so, would it be better for you to have the time to prepare to handle a special needs baby?

Keep in mind that this screening is not very accurate. Ninety-five to ninety- eight percent of "positive high" or "positive low" AFPs turn out to be false (i.e., the baby has neither a chromosomal abnormality nor a neural tube defect). If your AFP test is abnormally high or abnormally low, your healthcare provider may recommend that you have further tests, such as an ultrasound and/or amniocentesis.

TRIPLE SCREEN

A new test, called the "triple screen" (also known as the "prenatal risk profile" or "expanded AFP"), is used to screen for birth defects. The triple screen measures the following:Maternal levels of AFPHCG, human chorionic gonadotropin, which is elevated if mother is carrying a baby with some chromosomal abnormalitiesStroll, a byproduct of the hormone estrogen, which is lower if mother is carrying a baby with some chromosomal abnormalities

The triple screen raises the accuracy from twenty-five percent with the AFP alone to 60 percent. The triple screen may detect 70 percent of Down syndrome babies in women over age thirty-five, and sixty percent in women under age thirty-five.

Interviewing a Midwife

If your pregnancy begins low-risk and stays that way, you may prefer a high touch, low-tech birth with a midwife. If you are in good health, had no complications with previous births, and the medical system in your community is set up for midwife-attended births, then this alternative may be a consideration. When interviewing a midwife, ask the following questions:

• Where did you receive your education in midwifery? Are you also a nurse?
• Are you certified and by whom? Are you licensed?
• How long have you practiced? How many births have you attended?
• May I have the names of several mothers as references?
• Who is your backup doctor? May I meet this person ahead of time?
• What percentage of time is this doctor called in to assist?
• How long will it take the doctor to get to me in case of emergency?
• Who covers if you are on vacation or with another mother?
• Do you carry a pager?
• At what point during labor do I call you?
• What arrangements do you have to transport a home birthing mother or baby to the hospital if necessary?
• Are you certified in newborn resuscitation?
• Are you experienced at manually turning a baby who is presenting in a posterior position?
• What are you fees? Is the doctor's fee included in the fee I pay you?
• Do you offer postpartum care?

HOW TO FIND A MIDWIFE

To find a midwife in your community, check the following resources:

American College of Home Obstetrics
P.O. Box 508
Oak Park, IL 60303(708) 388-1461

Association for Childbirth at Home International
P.O. Box 430
Glendale, CA 91209(213) 667-0839

California Association of Midwives (CAM)
P.O. Box 417854
Sacramento, CA 95814
(800) 829-5791
(Request their publication Midwife Means "With Woman," An informative 56-page booklet about choosing and using a midwife.)

American College of Nurse-Midwives (ACNM)
1522 K Street NW, Suite 1120
Washington, D.C. 20005
(202) 347-5445

Informed Home birth and Parenting
P.O. Box 3675
Ann Arbor, MI 48106
(313) 662-6857

MANA (Midwives' Alliance of North America)
600 Fifth Street
Monett, MO 65708

10 Questions to Ask Your Doctor

1. What hospitals are you affiliated with? Some hospitals are high-tech, others are high-touch, still others are both.

2. What is your call schedule? Who covers for you, how often, and what are these doctors' birthing philosophies?

3. Can I exercise during pregnancy? If so, when should I slow down or stop?

4. How much weight can I safely gain? How much is too much?

5. Can I use a professional labor support person at the birth? Does your office provide referrals?

6. What is your recommended schedule for prenatal visits?

7. Do you believe in walking or changing positions during labor or will I be stuck in the horizontal position?

8. What are routine procedures during labor? Are ultrasound, intravenous fluids, and electronic fetal monitoring used?

9. What are your views on episiotomy? Is this routine or as needed?

10. What type of payment plan do you have? How does the insurance company participate?

Choosing an Obstetrician

Finding Dr. Right is not always easy. Ideally, you want a doctor who views you as a participant during the birthing process—not as a patient. Before you choose this healthcare profession, consider the following:

• Talk to friends or other health-care professionals and ask for recommendations.
• Narrow your list to several candidates, and then make an appointment to interview these physicians. (Let the receptionist know this is for an interview only so you are not charged.) Be sure the candidates you choose are listed on your insurance plan.
• Visit this doctor with your spouse and bring a list of important questions you want to ask. Talk to office personnel when you get to the appointment. Ask about the doctor's call schedule, vacation plans, accepted insurance plans, fees, hospital affiliations, and if the doctor is in solo practice, who covers for him or her.
• If there is time, chat with expectant moms in the waiting room to get a sense of the doctor's birthing philosophies.
• As you leave the interview, make sure you will have an "informed partnership." You want to know how this doctor approaches birth, and how the doctor manages birth. Is birth considered a healthy, normal process? Or is the doctor rigid and overly technical or medical in discussion and philosophy? Look for a balance between natural methods of pain control and medical management, as well as a supportive presence.
• Be flexible. Sometimes the unexpected happens during the birth process. Remind yourself that being able to "go with the flow" is vital to birthing a healthy baby.

Early Feelings of Mom-to-be

1. Hypersensitivity to odors. Certain strong smells—garlic, fish, or coffee—may "go right to your stomach," and trigger instant nausea. Some pregnant women complain that usual household odors that didn't bother them pre-pregnancy become intensely unpleasant.

• The family dog may smell more "doggy."
• A favorite perfume may turn your stomach.
• Favorite foods—broccoli, cauliflower, and fish—may set off the gag response.
• Normal masculine odors of your husband may repulse you.

2. Aversion to certain foods. Sometimes you will be unable to eat certain foods (meat, greens, milk) without gagging. At other times, only a few foods are palatable. Chances are your "cravings" will actually be for the few things you can stand to eat.

3. Afternoon, evening, or midnight sickness. The intestinal upsets of pregnancy can occur at anytime of the day or night and in any month of your pregnancy. The most common feelings include slight seasickness, feelings of breathlessness, dizziness, a sense of being suffocated, the dry heaves, and the full-blown whoopsies.

4. Constipation. Pregnancy hormones slow the action of your intestines. The slowing of your intestines plus their competition with the expanding uterus for room to work may leave you feeling constipated.

Pain Relief During Childbirth

By: Simone Butler

Giving birth is rightly regarded as an extremely uncomfortable and painful experience for many mothers, and while for some women labor goes quickly and relatively easily, for others it can turn into a real ordeal. Where our grandmothers had to go through the pain barrier more or less unaided, there are quite a few options available for todays pregnant women that can lessen or even completely remove the pain, allowing the joyfulness of giving birth a much greater chance to be appreciated.

- Birthing Pool

Being in water during the early stages of labor can greatly relieve the contraction pains in some women, as the bouyancy takes some of the pressure off the muscles of the lower back. Some women prefer to stay in the water right through to the later stages of labor, and some even choose to complete the birth in a birthing pool.

Birthing pools have become increasingly popular in recent years, as they are seen as a natural way of reducing pain, in line with today's widespread preference for keeping things simple and as close to nature as possible.

- TENS

A TENS machine is a small electronic device which you attach to your lower back with electrode pads. The machine passes a very slight electric current through the pads, which is intended to interfere with the pain signals, reducing the extent of the discomfort. The level of current can usually be increased during contractions, and then lowered back down as the pain subsides again. Some women find TENS machines to be highly effective, while for others the effect is minimal. The devices can usually be hired from the hospital, but are relatively cheap to buy yourself if you want to be sure that one will be available.

- Gas and Air

This is also known as entonox, and is a mixture of nitrous oxide and oxygen that is breathed in via a pipe whenever the mother-to-be feels the need. It is a very light method of pain relief, and is enough on it's own for some women, especially in straightforward births. The effect is more of a distraction from the pain than an actual reduction, but doesn't feature the drawbacks of the two more heavy-duty pain relief drugs below.

- Epidural

An epidural is an injection of pain relief drugs direct into the lumbar region, and is extremely effective at blocking pain. The initial injection must be performed by a doctor, although the drug levels can then be subsequently topped up by the midwife for as long as it is required. Early epidurals also interfered with movement, and so the entire birth had to be carried out lying down, but more advanced versions of the drugs used now allow the mother to walk around a little to relieve discomfort.

- Pethidine

This is the strongest pain relief option available in most cases, and is extremely effective in stopping pain over a 3 to 4 hour period. Unlike an epidural, it can't be used indefinitely, and only two doses are usually allowed, meaning it is less than ideal for labors lasting longer than 8 hours or so. The drug can also pass through to the infant, in some cases delaying the start of breathing. Antidotes are, however, available should this occur.

Although the choice of which method of pain relief to use is usually left up to the mother, most midwives recommend starting with the less invasive choices such as TENS and gas and air, only moving up to drug treatments if necessary later on.

About the author: Simone writes for http://www.nappiesfromhell.co.uk/

Morning Sickness : Causes and Cures

By: Simone Butler

Morning sickness is often the first sign of pregnancy, as it can start as early as 2 weeks after conception. Despite the name, the sufferer can feel ill at any time of the day, although as an empty stomach is thought to be one of the triggers then mornings are a common time for it to appear.

Not every pregnant woman will experience morning sickness, although most do to some degree, and it can vary from a feeling of mild nausea or queasiness ranging up to feeling truly dreadful and unable to keep any food or liquids down. The severity of the effects seems to be greatest in women with a history of migraine or travel sickness.

It's not known exactly what causes it, but most doctors agree that the changes in hormone levels that pregnancy triggers are the most major factor. One of the effects of these hormones is to change the way your digestive system works, which can lead to higher levels of acid.

Another possible cause is that many women experience a heightened sense of taste and smell while pregnant, which can make nausea feel worse when unpleasant or strong odours are around.

Finally, tiredness and stress play a part, and most pregnant women are tired and stressed a lot of the time!

Morning sickness can occur over the full range of your pregnancy, but most women find that it more or less disappears by around 14 weeks as hormone levels in the body stabilise.

There are dozens and dozens of traditional 'cures' for the feelings of nausea, with every mother having an opinion on the subject! The fact is that every woman's body is different and so no single thing will work for everyone. However, there are some simple things to try which can help most feel better.

As previously mentioned, an empty stomach can be a cause, so snack little and often to keep hunger at bay, and keep a couple of biscuits by your bed for if you wake up during the night.

Sucking on an ice cube can help, as can fizzy drinks. Fresh ginger is reputed to calm the stomach, so making a tea from crushed root ginger or even chewing on a piece can be worth a try.

Remedies for travel sickness can also help, so it might be worth trying the magnetic wristbands you can buy, but you should never take any medication while pregnant without consulting your doctor.

Morning sickness is a natural part of pregnancy and will not harm your baby in any way, but in severe cases you may be unable to keep any food or fluids down and if this continues you could become dehydrated, which is very dangerous for your baby. If your urine starts to become very dark in colour this is a sign that your fluid levels are too low, and you should speak to your midwife or doctor.

Finally, when you're in a bout of morning sickness, don't worry too much about what you're eating - getting enough energy is more important than a balanced diet at that moment, so if chocolate makes you feel better then go for it! You can always stock up on healthier foods when the sickness has abated a little.

About the author: Simone is a freelance writer currently contributing to http://www.nappiesfromhell.co.uk