The process of conception to birth begins with fertilisation, where a single sperm cell joins with a single egg. From this point on, the fertilized cell divides into an eventual embryo, which will then attach to the lining of the uterus. The cells will then continue to divide and will specialise until the baby is fully formed at around 40 weeks. Furthermore, the baby would be considered to be full term.
Pregnancy is split up into 3 sections called trimesters; the first trimester covers the first 2-12 weeks, the second will take place between 13-26 weeks and the duration of the third will cover 27-40 weeks.
Relatively 2 hours after the fertilisation, the zygote will have already begun to divide and it will continue to do so until the cells cluster to form a morula. The morula then leaves the fallopian tube and travels into the uterus 3-4 days after fertilisation. 6 days after fertilisation (3 weeks pregnant) the cells form a hollow cavity called a blastocyst which implants into the uterine lining.
At 4 weeks, the inner group of cells can be called an embryo. There are 3 layers of embryonic cells- the ectoderm, the endoderm and the mesoderm. These will specialise into different parts of the baby’s body. The outer cells at this point link with the mother’s bloodstream to form the placenta.
At 5 weeks the ectoderm folds to create the neural tube which will eventually become the baby’s central nervous system. Nearer the end of the 5 weeks, the foetus’s blood circulation begins and the heart quickly develops.
The mother will also experience amenorrhoea (a missed period).
In 6 to 7 weeks of pregnancy, the baby’s brain develops with the eyes and ears beginning to take shape. The baby’s circulation system also begins working as the heart starts to beat. Arms and legs begin to form as shown by the limb buds.
The baby can be classed as a foetus at around 8/9 weeks as the face begins to condition with the eyes becoming more obvious. Eye colour develops. Ridges in the more established limb buds mark where fingers and toes will be. Major internal organs advance.
At 10 to 12 weeks the foetus flourishes with organs and structures being fully formed but will continue to grow until delivery. Some slight movement even occurs but are unable to be felt by the mother. This marks the end of the first trimester.
At 13 to 20 weeks growth accelerates with the baby’s head and body becoming more proportional. Facial features develop as well as hair (including eyelashes and eyebrows) beginning to grow. After 16 weeks movement can be felt by the mother.
At around 21-24 weeks lanugo covers the baby. Lanugo is very fine, soft hair which possibly maintains the foetus’s body temperature in the womb and usually disappears at maturation.
Movement is now vigorous at 25 to 26 weeks of pregnancy with the foetus also consciously responding to touch and sound. Additionally, a sleeping pattern may begin at around 26 weeks the foetus’s eyes begin to open. This marks the end of the second trimester.
From 27-29 weeks the foetus’s heartbeat can be heard from a stethoscope. An abundance of vermix covers the baby, possibly to protect the foetus’s skin from the amniotic fluid and infection when delivered.
Throughout 30/32 weeks the foetus gains weight, plumping out the previously wrinkly skin. The baby may also prepare for delivery, moving down towards the mother’s cervix.
By 33-42 weeks the foetus engages and labour begins. If a baby is born before the 37th week it is classed as premature. The baby’s average weight is around 7.5 pounds with the placenta being about as long as the baby.
The development of the baby can be affected before conception, during pregnancy and possibly a year after. To give the baby the best start in life, it is important to take precautions to ensure the baby is healthy.
The first step to avoid any risks to the embryo is for both parents to actively plan for the pregnancy before trying to conceive. This allows improvement in both parents’ health, lifestyle and wellbeing. However, there may be some factors (such as genetics) that cannot be improved on and therefore it is important to talk to a doctor about any health problems that either mother or father may have to reduce the risk of any complications further along the line.
The chances of actually conceiving can be improved by the father consuming a balanced diet, resting and partaking in sobriety as circumstances such as being overweight, taking drugs and exhaustion can reduce the quality of sperm and thus the chances of fertilisation.
Furthermore, the mother needs to follow a diet incorporating vital nutrients that will be reserved for both mother and baby. Folic acid supplements can reduce neural tube defects and it enables the mother to have a healthy bloodstream.
Planning for the baby beforehand can significantly give the parents a chance to guarantee that they are physically and emotionally prepared to have a baby e.g. If the mother has a health condition such as diabetes, pregnancy can put a huge amount of strain on her body. To overcome this situation, it’s best to see a pre-conception councillor to have an insight on if it is safe for the mother to go through pregnancy. Additionally, having both parents being emotionally prepared can reduce the chances of post-natal depression further along the line.
Other factors that may affect the baby, is the mothers’ age and pregnancy experience e.g. if the woman is outside the age group of 18-30 years or are giving birth for the first time are more likely to experience difficulties during pregnancy and labour. Chromosomal abnormalities are also seen more in baby’s that are birthed from first-time mothers over the age of 35 then those who are not.
Obesity can also increase the risk of gestational diabetes so it is important to know the mothers BMI before getting pregnant. If the BMI is over 30 the mother has a chance to lose weight to reduce any complications in pregnancy. It is also more common for the mother to need an epidural when overweight as instrumental deliveries are more likely.
During the pregnancy, it is extremely important to take care of the mother to reduce the chances of harming the foetus. A healthy lifestyle and visiting an obstetrician regularly are the best way to maintain both mother and baby’s wellbeing.
Substance abuse is highly dangerous in pregnancy as any drugs taken are likely to pass through the placenta and into the foetus’ bloodstream. Even any prescribed medication needs to be spoken about to with a doctor before continuation to minimalize harm to the unborn child. With drugs such as cocaine and heroin, the baby can be born in a state of painful withdrawal. Even smoking cigarettes while with child puts the foetus at serious risk as smoking restricts the supply of oxygen. This puts immense strain on the baby’s heart.
Regarding drinking alcohol while pregnant, that also can lead to premature birth, long term harm and even a miscarriage, and this is no less dangerous than illegal drugs. It is known that drinking while pregnant can cause a condition called foetal alcohol syndrome. FAS is described as being “the biggest cause of non-genetic mental handicap in the western world” by FAS aware UK (2016). The condition can cause liver, kidney and bone difficulties as well as cognitive and growth impairments.
Any infection the mother possesses may also pass to the child. Cleanliness and caution are key to eliminate any potentially dangerous pathogens. Precautions to reduce contact with animals, insects and raw foods should be taken. STIs such as HIV is passed on through direct contact of bodily fluids such as blood, amniotic fluid and breastmilk. Although incurable, HIV can be treated and the risk of passing to the child can be reduced so it is essential to get the right medication by speaking to a doctor.
Healthy eating and exercise are highly encouraged in pregnancy. Although, its best to avoid very strenuous activity and exercise that involves the mother lying on her back as this can restrict blood flow to the uterus. The foetus is solely dependent on the mother for its nutrition and so a balanced diet including many fruits and green vegetables are essential.
Despite the most attention to care being taken during pregnancy, it is still important to maintain mother and baby’s wellbeing for the first year after. Rest, diet and health check-ups are essential.
Once the woman decides where she will give birth, she will arrange a booking appointment and will attend an interview where she will get her first set of tests. These tests give the mother and doctor an insight if there are any complications occurring or will do so in the future. Knowing about any risks gives the opportunity to prevent them.
After this the woman will see a group of professionals- including midwives, doctors, health visitors and obstetricians. The role of the health visitor and midwife is to ensure that both mother and baby maintain a positive wellbeing throughout pregnancy and the first year of the child’s life, whilst education the mother along them. The midwife will carry out the majority of antenatal checks and will attend delivery.
The first check is a medical and obstetric history check which shows the mothers previous health and pregnancy experience. This will reveal any known genetic problems, housing situation and the information used to calculate the due date. This will be followed by a medical examination showing the mothers current health. The doctor will listen to the mother’s heart and lungs, examining breasts for any lumps and if there is a presence of varicose veins or swelling.
Clinical tests will also begin- height, weight, blood pressure and urine tests will be recorded continuously with every antenatal appointment. Blood tests will also be taken in to determine the mothers blood group in case a blood transfusion is necessary. Haemoglobin tests will also determine if the mother is anaemic.
At around 10-13 weeks, the woman is offered a dating scan where an ultrasound will further determine the due date and if more than one foetus is present. The mother will also be given her antenatal notes which she will bring in to every appointment in the future.
At this stage the mother’s appointments to the GP/clinic/midwife will be monthly dependant on the complexity of the pregnancy. Clinical tests will continue and screening tests are introduced.
Weight gain should be steady, increasing by 0.5 kg per week. A rise in blood pressure could suggest pre-eclampsia. A persistence of sugar in the mother’s urine could suggest she has gestational diabetes. The foetal heart rate can also be heard at this stage where the average heart rate is 100/115 bpm. The size of the uterus or ‘bump’ is measured and any swelling is also examined.
At 11-13 weeks the baby’s sex is able to be determined through an ultrasound, however at 18-22 weeks a more detailed scan is taken to reveal that the correct amount of amniotic fluid surrounds the foetus and to examine the head and internal organs. The placenta is checked to ensure it’s the right size and working. Physical abnormalities can also be identified if present.
At 11-14 weeks a neural fold translucency test is offered to determine if the baby possesses down syndrome. Baby’s with down syndrome have a thicker fluid at the neck then those without. AFP testing at 15-18 weeks. Low levels of AFP relate to the foetus having down syndrome while higher levels can suggest there is more than one baby or that there is an increased chance of the baby having spina bifida. MSS testing is also offered at 15-16 weeks which can also determine if down syndrome is present. If any of these characteristics are present then they will be referred for amniocentesis or CVS testing.
Amniocentesis is a test to diagnose down syndrome where a fine needle is inserted into the uterus to collect amniotic fluid. The amniotic fluid carries some cells from the baby which will be sent off to a lab and processed in full detail. However, this method has a risk of harming the baby or even causing a miscarriage.
As the baby is now viable, visits to the GP/clinic/midwife become fortnightly and the same clinical tests are continued. Palpating is introduced to give the doctor an impression of the baby’s weight and position in the uterus.
After delivery, the baby’s apgar score is measured by checking heartbeat, breathing, muscle tone, reflexes and colour. This may be repeated if there is a cause for concern.
Neonatal tests will be carried out to check for any specific disorders. This includes the barlow test (for congenital dislocation of the hip) and the new-born bloodspot test (for phenylketonuria and CHT).
The midwife will now make sure both mother and baby re adjusting well after the delivery. She will check that the uterus is shrinking back to pre-pregnancy size, any stitches have healed, blood pressure is normal and if there are any concerns that the mother has. Ten days after the midwife will then check if the baby is making expecting progress. Six weeks after, a GP will or a doctor will check the mother’s weight, urine, blood pressure and again any concerns she has. She will also be offered a measles vaccine.
The baby’s heart, development, weight, length and behaviour will be examined and a PCH record will be filled out by the mother.
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