Gestational Diabetes

According to the American Diabetes Association 9.2% of pregnant women develop gestational diabetes, and after my endocrinologist visit today, I am one of them. Luckily for me, my doctor doesn't seem too worried and thinks I have a mild case which can be treated with meal planning and will go away after I deliver. But with this revelation and the need to double and triple check my portions (although I didn't think my portions were out of whack) and the need for daily glucose testing, I decided to write a post giving all of you some more information about gestational diabetes.

What is gestational diabetes?

According to the American Diabetes Association: Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia. If gestational diabetes is not effectively treated and managed, it can have negative effects on the mother and her child, so it is important to consistently consult with your doctor and follow the regiment that is prescribed to you.

How you baby can be affected:

Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.

This can lead to macrosomia, or a "fat" baby, these are the 15+ pound babies we sometimes hear about. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth, because their size makes it difficult, if not impossible to pass through the birth canal. This results in a large number of gestational diabetes babies being delivered via Cesarean section. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

How it's diagnosed

Around week 28 of your pregnancy you will have to schedule a glucose tolerance test at your doctor's office.  At this test the nurse will give you a glucose drink (pretty much pure sugar) for you to drink thirty minutes before your appointment.  After the thirty minutes is finished the nurse will draw your blood and that is it.  You will have to wait about a week depending on your doctor for results.  If the glucose levels are normal then you don't need to continue with any other tests.  If your glucose levels are high, then you will need to schedule a three hour glucose test.

With the three hour test you will need to fast. So from midnight the night before all the way to your test you cannot eat or drink.  When you get to the office the nurse will draw your blood again, this is the baseline to see what your glucose level is before you eat.  You then have five minutes to drink the glucose drink again.  Once you fish the drink, you will be sent to the waiting room to wait.  The nurse will then draw your blood every hour, on the hour for the next three hours.  During this time you CAN NOT eat or drink anything! Once the test is over you can eat, and you will have to wait a week or so for your results.  If your test come back normal then you don't have to do anything else and you do not have gestational diabetes, if the glucose levels are high, then you will need to follow up with a specialist.

Depending on the severity of the glucose levels the specialist will either put you on an insulin regiment, or will inform you that you need to to change your eating habits.  Either way, you will have to take your blood glucose levels several times a day.  If your levels are not that high, and you are successful with your meal plans your doctor MAY choose to cut back on the glucose testing.

How to treat gestational diabetes:

Because gestational diabetes can hurt you and your baby, you need to start treatment quickly.

Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections.

If you're testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.

• Before a meal (preprandial): 95 mg/dl or less
• 1-hour after a meal (postprandial): 140 mg/dl or less
• 2-hours after a meal (postprandial): 120 mg/dl or less

You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. Sticking with your treatment for gestational diabetes will give you a healthy pregnancy and birth, and may help your baby avoid future poor health.

Source: American Diabetes Association

Pregnancy Week 29

And the growing continues! Your little one now weighs in at nearly three pounds and measures about 17 inches!  Wile he is getting pretty close to his birth LENGTH, your little guy still has some more weight to pack on.  Over the next 11 weeks, he'll more than double-or even triple his weight!!! And as the weeks pass, and your baby continues to grow in weight and length, he will begin to run out of room in there, and things will become a lot more snug.  This will result in you feeling less kicks and more pokes from elbows or knees, and you will probably see more rolling lumps on your tummy as well!

Don't be surprised if you start to see varicose veins making an appearance on your legs, they are very common in pregnant women.  Varicose veins are swollen blood vessels that usually appear for the first time during pregnancy, especially if your mom or grandma had them.  So, if you want to know your chances at getting varicose veins, check out the gams of the women in your family to get a pretty good assessment of what you will see during your pregnancy.  The severity of varicose veins can vary from person to person.  Some ladies experience only a minor case of achiness and swelling, while others experience the full blown pain and bulging of blue veins, which usually occur from the ankle to the upper thigh. Again, if you want to get an idea of what's in your future in regards to varicose veins, talk to your mom and grandma to see how they fared.  To help reduce the severity and/or pain of varicose veins you should watch your weight (as much as you can), keep your blood flowing by doing light exercises such as walking and swimming, and avoiding heavy lifting as much as possible.

Week 28

Week 30

Pregnancy Week 28

At 28 weeks you are starting the third trimester, you have made it to the home stretch!  With this milestone, your little one is also settling into the head down position, and getting ready for delivery! By this time your little one is approximately 2.5 pounds and almost 16 inches long! Along with the increase in weight and length, you bundle is quickly adding new skills to his repertoire.  These skills include: blinking, coughing, sucking hiccuping, and taking practice breaths!!!  Something even more amazing, your little ones sleep cycle now includes the REM (rapid eye movement) phase, which means that he could be dreaming while inside your belly!

While it's great that your bug is beginning to settle into the head down position, the potentially painful part is that his head, and the weight of your uterus may now be sitting on your sciatic nerve, which runs through the lower part of your back, buttocks, and legs. This new pressure may cause pain and tingling in  your lower back, buttocks, and legs. This pain usually radiates down the back of your legs to your toes.  The best thing to do for sciatic nerve pain is take it easy and wait for your little bundle to wiggle his way off of your sciatic nerve.  

Week 27

Week 29

What the Heck Goes into a Birth Plan!?

So depending on where you are in your pregnancy, you may be getting ready to write your birth plan, but even if you're not ready to start writing it's always a good idea to start doing research as early as possible.  Nowadays, there are so many different theories and options for what kind of birth you are going to have.  Will it be 100% natural and "crunchy", will it be 100% medicated and "sterile", or a combination of both. Vitamin K shot, or not? Bath immediately after or not? There are so many options and choices you need to make (yep, parenting decisions start before birth) that it only makes sense to do as much research as you possibly can to make the decisions to give you the type of birth you really want.  But, it is important to understand that birth plans are NOT written in stone, they are a depiction of your ideal birth, and give the hospital or birthing center staff an outline of what you are trying to accomplish, but be aware that things may change.

For my birth plans I always put that unless it is a medical emergency where either my life or the life of my child is in immediate danger, ALL medical decisions must be discussed with me and my husband and that we be allowed to discuss our options in private before a decision is made.  I didn't have any issues with my birth plan not being followed at my first birth, which was a hospital birth, and I don't foresee an issue with this birth since it's at the same hospital.  It is very important to tour the hospital or birth center you are planning on delivering at, for two reasons. First it will give you an idea of what you need to bring when you pack your hospital bag, and second it will give you insight on what practices your hospital has for delivery, what options they give you (birthing tub) and if they are open to more natural birthing methods.  All of this information will help you to make your birth plan, and if your hospital is completely against the birth you want (most hospitals are moving towards becoming more accepting of natural births) you will then need to decide if you want to stay with the hospital or find a different option.

 I suggest working on your plan for several weeks; do your research, type it up, come back to it a week later and make any changes, discuss it with your doctor and make any changes you want after that. You should shoot for your birth plan that is 1-2 pages long, anything longer than that may be too detailed and micromanaged.  If you do this you are more likely to become disappointed with your birth, and nothing is guaranteed.  If you have micromanaged your birth plan down to the detail you are setting yourself up for failure.  You want your birth plan to express your overall goals for your delivery and list any important features that are key to your birth.  Once you plan has been written you need to print out about 4-5 copies and put them in your hospital bag. You want enough copies to give to your OB, the midwife/doula if one is present, and any nurses that will be present (keep in mind that you might not have the same nurse throughout labor and delivery due to shift changes) so you want to make sure you have enough copies for anyone that will be at the birth.

What should be in your birth plan?

You first want to list any allergies, or medical issues you have as they may become pertinent during your birth.

LABOR:

• Who should be allowed in the room during labor
• How do you want changes of your birth plan to be handled
• If you're unable to make decisions who should do it for you
• Do you want an epidural or not
• Is it okay for staff to ask you if you are in pain, can they use the 1-10 scale
• Can staff offer you pain medication or not.
• If there is a birth tub do you want to use it, how soon after arrival.
• Do you want freedom of movement during birth
• what does that mean to you
• walking around
• changing positions in bed
• What kind of fetal monitoring is okay with you
• Continuous
• Intermittent
• What would you like to happen if your labor stalls?
• wait to see if it starts up again naturally or get intervention
• Do you want to drink and eat during labor or not

DELIVERY:

• Do you want freedom of movement during delivery
• what does that mean to you? Any specific positions you want?
• Is it okay to push based on counting (the doctor counts 1-10 while you push and you push throughout the entire time) or do you want to push based on your feelings (no counting)
• Are you okay if your perineum is cut if needed, or would you prefer to tear.
• Do you want to pull your baby out?
• Are you okay with the use of forceps, vacuums, etc?

CONTINGENCIES:

• What do you want to happen in the case you have to have a c-section.
• Who should be with you
• how soon do you want to hold your child after the c-section.

POST DELIVERY:

• Is it okay if the cord is clamped immediately or do you want it to stop pulsating first?
• Who is going to cut the cord
• What is the minimum amount of time you want skin-to-skin contact before measurements are taken of you child.
• Do you want your placenta to be delivered naturally or removed?
• Can your baby receive a bath shortly after delivery or would you like to wait
• if you want to wait, how long
• Who will go with your baby, if anyone, during the bath?
• Do you want your child to receive the vitamin K and Hep B shots?
• Do you want your child to receive the antibacterial eye cream?
• Are you planning on breastfeeding? Can the hospital staff provide formula bottles while at the hospital?
• Will the baby sleep in the room with you or in the nursery.
• If you're having a boy, will he be circumcised or not?
• Are you cloth diapering? If so, are you doing so in the hospital or can staff put your baby in disposables?

Those are the main points that should be discussed within your birth plan.  Remember to be as succinct as possible, bullet points usually help with this.  I also like to bold the important parts like the "do's" and the "do not's" so the hospital staff's eyes are immediately drawn to those areas.  Remember that your birth plan is a guideline and there is not guarantee that your birth will go exactly as you want. The birth plan, will help to guide your medical staff so that they can work to try to make sure you get your dream birth.  A great way to help insure your birth plan is realistic is to talk to your doctor/midwife and tour the hospital/birthing center so you know what the policies are so you don't go into your birth with a birth plan that doesn't apply to the rules of the hospital/birth center. I hope this helps all of you and is a good guide to get you started.  If you have any trouble or questions feel free to ask!

Pregnancy Week 27

CONGRATULATIONS! You have reached the end of the second trimester!!!!! WOOT WOOT! This is probably going to be the time when all of the excitement also gets flooded with anxiety, because it is at this point you are preparing your registry, getting ready for your shower, and getting the nursery ready. And if you're like me, the fact that the nursery is only painted and nothing more, is probably sending you into a tailspin.

Also, this week your doctor is going to start measuring your little bundle from head to toe instead of crown to rump, so you are going to see a big jump in the size of your baby. Who is now approximately 15 inches long. The reason for this is before this week your little one was simply to small to get an accurate measure from head to toe. But now that he is packing on inches it is a lot easier for your doctor to get an accurate measurement.  Additionally, this week, your baby may now recognize your voice, so utilize any downtime you have to talk and sing to your belly, you may even notice an increase in fetal movement on certain songs! My daughter always wiggled and jiggled when I sung her a lullaby I made up for her, and it is still her favorite song at bedtime!

Don't be surprised if you are feeling a little puffy. About 75 percent of soon-to-be moms experience edema, or mild swelling of the hands, feet, and ankles, around this time in their pregnancy.  You may notice it throughout the day or only at the end of the day (like I do). If you haven't traded in your heals for flats yet I suggest you do so now because they will only make the edema worse. Seriously, I wore wedges for a total of 15 minutes today for part of our maternity pictures and I was able to leave an indent on the top of my foot from the swelling!  The reason for the edema is because of the build up of fluids in your body tissues thanks to increased blood flow and uterine vein on the vena cave (the large vein that moves the blood from your lower extremities to your heart).  While this puffiness is completely normal, if you don't experience a reduction in the swelling when you put your feet up for a few minutes, let your doctor know so they can make sure there aren't other issues at play.

Some other fun (or not so fun) symptoms you may be experiencing by this time in your pregnancy are: flatulence, occasional faintness or dizziness, restless leg syndrome, nasal congestion, symphysis pubis dysfunction (SPD) which is when the ligaments in your pelvic joints get too relaxed and stretchy, causing the pelvic joint to become unstable, which can cause pain in the pelvic region.  If this is happening discuss with your doctor if wearing a pelvic support belt would help ease the pain.  You may also experience bleeding gums, so brush gently, and changes in you skin, hair, and nails.  Some women report stronger, thicker hair and nails with glowing skin. Others report more fragile hair and nails and skin problems such as acne.  Either is normal, but if you have concerns or questions don't hesitate to call your practitioner.

Week 26
Week 28

Pregnancy Week 26

This week your little one weighs about two pounds and measures nine or more inches! Also this week, you little bug starts to open her eyes!!! Until this time her eyelids have been fused shut while the eye developed.  While there isn't much to see inside you belly, your little one is able to react to changes in lights and sounds. So if you shine a bright light on your belly, or there is a loud noise in your environment, you will most likely see an increase in fetal movements.

By this time you are probably not so happily part of the pregnancy insomnia club.  Sleepless nights have most likely become the norm whether it be from aching muscles, sciatic nerve pain, heartburn, going to the bathroom (constantly) or from all that movement your little one decides to do before bed, it's not a surprise getting a good nights rest has become elusive.  Consider it practice for when your bundle arrives!  To help with your restlessness there are many things you can do during the day and before bed.  I find that eating before I go to bed usually reduces the chances of waking up with the midnight munchies. Also, going to the bathroom right before I go to bed (and making sure to lean as far forward as possible to push out all the urine) helps prevent nighttime bathroom runs.  Also, getting a mild form of daytime exercise and fresh air can also help your insomnia.  I usually go out walking with my daughter, or take her to a park so we both get some exercise and some bonding time (two birds with one stone, yay!)

Some other fun symptoms that you may be experiencing this week are bloating, increased vaginal discharge, occasional headaches, forgetfulness, clumsiness, lower abdominal achiness (from all that stretching), and vision changes.  Keep in mind that these are all normal symptoms during pregnancy.  However if you are unsure of the frequency or intensity of your symptoms, or you just want some reassurance, don't hesitate to contact your doctor or other medical professional for advice.

Week 25
Week 27

Pregnancy Week 25

This week, your little one has grown to about nine inches in length, and has passed the pound and a half mark!!!  Under his skin, capillaries are forming and filling with blood! Along with the capillaries under his skin, the air sacs develop in his lungs (these are also filled with capillaries to supply blood to the lungs) these air sacs will get his lungs ready for the first breath he will take, moments after birth.  While those lungs aren't anywhere near ready to work yet, they are developing surfactant, a substance that will help them expand after birth.  In keeping with the breathing theme this week, your babies nostrils are starting to open up and his vocal cords are developing.  All of these put together mean he is getting everything in line to keep you up all night!  ;)

Last week I mentioned constipation as a common pregnancy symptom, and gave some basic methods to help ease the discomfort.  If you did find yourself straining to go you may have ended up with hemorrhoids.  Don't get down on yourself, more than half of all women experience the swollen, itchy veins, in the rectum.  While they won't hurt you or the baby, they are painful, so try to avoid them by not straining while you 'go', eating right, and doing your trusty Kegel exercises.  Kegel's will also help to keep your pelvic floor strong, which in turn may make effective pushing during labor more likely which then could result in quicker delivery and a reduced chance of hemorrhoids or hernias occurring during delivery.  Also, if you have a strong pelvic floor before you give birth, you're more likely to "bounce back" quicker after delivery and not have any or as much "leakage" when you laugh or jump after delivery.

Week 24
Week 26

Pregnancy Week 24

Week 24! Things are progressing steadily now and rapid changes in your body and in your baby's body are picking up pace! This week your little one is about 8 1/2 inches long and weighs about 1 1/2 pounds. He is also gaining weight steadily at a rate of about six ounces per week!  While you might not notice this increase, it's due in large part, to your baby accumulating baby fat (cute little rolls!), and from growing organs, bones, and muscles. That's right, this week you're growing he-man in your belly!!!  In addition to putting on more weight and filling out some rolls, his tiny ears are getting sharper and can hear very loud sounds.  Feel free to talk to your belly as much as possible, it promotes bonding for you, and as your little one's ears become sharper they will be able to hear lower decibels and get to know your voice!  Encourage daddy and any siblings to do the same, it's never too early to introduce the family!!!  One of my daughter's favorite things is to tell her little brother stories...and roar at him, because that gets him moving. LOL.

Along with all that (I told you we're picking up the pace this week) your little one's face is almost fully formed, complete with eyebrows, eyelashes, and hair...if you want to do a 4D ultrasound this would be the earliest I would suggest doing it, so your little love bug actually LOOKS human.

Just like every other week, your body is in for a lot of changes as well.  One of the more noticeable changes is with your belly button! Don't be surprised if you're in the majority of women whose belly button pops out...and don't worry if your innie never becomes and outie, that's normal too.  The reason for the button change is due to your swelling uterus pushing on everything in its path...including your belly button!  Again, if your innie stays and innie, that's okay too. This may be due to the placement of your uterus, the size of your belly button (how much is actually 'in', as well as how you are carrying.  If you do make the belly button change, reset assured everything should go back to normal after delivery, but don't be surprised if your belly button (and other parts of your body) might look a little stretched compared to before.  But remember, in the long run it's all worth it for that smiling little bundle!

Another fun update this week, don't be surprised if you are experiencing numbness in your wrists, and fingers.  This is likely due to carpel tunnel syndrome, but don't worry, the sensation will go away after you give birth...do you see a trend happening here?  Some other 'wonderful' symptoms you may be experiencing are constipation, headaches, lower abdominal achiness, backaches, leg cramps, vision changeless, and mild swelling of the feet and ankles.  Not everyone will have these symptoms, and remember if you're ever concerned about them, don't hesitate to contact your health care provider.  If you are experiencing any, or all, of these symptoms try to sit back and relax and let your muscles unwind; remember they are under a lot of stress.  As for the constipation. DO NOT STRAIN!  Straining to "go" can lead to hernias and hemorrhoids...not fun. Wheat germ added to oatmeal is great at...moving things along. I would also recommend drinking lots of water and eating a lot of fruits and vegetables to help keep things...soft. Get used to it, this is the kind of talk you are going to be experiencing for a LONG time once baby comes!

Week 23
Week 25

Pregnancy Week 23

You're 23 weeks pregnant!  And if you weren't constantly stuffing your face, forgetting where you put your car keys, and dealing with carpal tunnel you might be able to enjoy it...anyone else or just me? But in all seriousness, while you are most likely experiencing a lot of the symptoms I just listed (along with snoring and bleeding gums) you are most likely loving every second of it because those kicks and wiggles are becoming more pronounced and a lot more common! It kind of makes the trade off worth it huh?

This week your little one will begin to fatten up a bit, and by the end of the month he will be double the weight he is now!  At this stage your baby's organs and bones are visible through his skin, which has a red-blue tint to it because of the developing veins and arteries that are starting to form beneath.  But don't worry, as he packs on the pounds and gets some cute little rolls going, he will be a lot less transparent.

Now that you are well into your second trimester don't be surprised, or concerned, if you see a dark line down the middle of your belly.  This lovely line that most pregnant women get is called the linea nigra.  The interesting thing is that that line has always been on your belly. However, you probably never noticed it until those amazing pregnancy hormones caused the hyper pigmentation to highlight the line.  This is the same hyper pigmentation that has cased the darkening of your areolae and maybe even the areas around your forehead and cheeks. Some other changes in the color of your skin that may be happening this month are red palms and soles of your feet, bluish blotchy legs, heat rash, and skin tags...fun! These are all due to the pregnancy hormones, so don't be too concerned all of these will go away once your little one arrives. In the mean time, continue to put those creams on to keep your skin soft and moist.  If you are concerned with any of the changes you are experiencing, don't hesitate to contact your doctor, it's her job to put your mind at ease!

Week 22
Week 24

Pregnancy Week 22

This week your baby measures nearly eight inches and weighs about one pound! You now have a little doll inside you (size wise that is) or if you would like to stick to fruit, about the size of a mango.  This mango now has eyebrows, eyelashes, and maybe some hair!  If you've been suffering from heartburn during this pregnancy you chances of having a baby born with hair are greatly increased! This is most likely due to the hormones (it's always the hormones) that cause heartburn being linked in some way to the creation of hair! Granted it's not guaranteed, but for my first I had horrible heartburn the entire time and she was born with a full head of hair! I can't wait to see if the same will be true for this one, I hope so, it's the only silver lining when I'm dying from the burning!!!  In addition to it's new body hair and eyelashes, your little one is now able to perceive light and dark. You may notice more movement when you're out laying in the sun or walking around with a thin shirt.  As your pregnancy progresses you may also be able to shine a flashlight on your belly and watch the waves as your little one scoots away...weird I know.

Your little one can also hear your voice, your heartbeat, your gurgling stomach, and the whoosh-whoosh sound of the blood circulating through your body.  Something I found interested with my daughter was that after she was born she HATED those bear soothers that had a recorded heartbeat in them. I couldn't for the life of me figure out why she hated them so much, until I realized that because of my heart defects (one of which is my heart is turned around facing the wrong way) my heartbeat sounded different than what was "normal".  My daughter hated the soother because it wasn't the heartbeat she was used to!!! I think that is just amazing how your babies already know who "you" are before they actually meet you.

This week, along with your belly continuing to grow, don't be surprised if your feet start to as well.  This is because of the hormone relaxin, which loosens your pelvic ligaments to help accommodate your growing belly, also relaxes all of the other ligaments in your body.  This can result in the bones beneath the ligaments in your feet spreading out slightly.  This may leave you with a half or whole-shoe size increase at the end of this journey.  But be aware that this is not guaranteed, with my daughter I never had an increase in shoe size, and so far I haven't with this one either...and quite frankly I'm praying they don't because I am eyeing my pair of Louboutin heels and counting the days until I can wear them again! Speaking of heels, now is the time to put them away in your closet and pull out your most comfortable flats to help you keep your balance since your center of gravity is, and will continue to, shift throughout the rest of your pregnancy.

Week 21
Week 23

Pregnancy Week 21

You've got a baby bump, you've got a baby bump! If you haven't moved passed the "food baby" stage, this week it will happen! Don't be surprised if you wake up one morning and go "oh, wow!" your little 'maybe bump' will most likely bloom into an obvious BABY BUMP this week. Now if you have had an obvious baby bump before this, you will still see a noticeable growth, although it may be more difficult to tell since you see yourself every day.  I suggest wearing an outfit that you recently wore and washed, this comparison of your body in the same outfit a few days apart will really highlight the changes.  This happened to me today, I wore a maxi dress a few days ago, and I just washed it so I decided to wear it again (since it's a million degrees outside) and I was like "wow, I've grown a lot a three days!" Even my hubby noticed, so that should tell you something! But we didn't even realize it until we saw my bump in the same outfit only a few days apart. Anyway, there is a lot going on this week.

This week your baby is about 7 inches long and weighs about 11 ounces, about the size of a carrot. Also, this week your baby is beginning to swallow a bit of amniotic fluid each day for nutrition, hydration, and to practice digesting.  The really cool part about this is that now whatever you eat not only does he get via the umbilical cord, but he will TASTE when he swallows amniotic fluid! So expand your diet (but still eat healthy) so you can expose your little one to all sorts of different tastes, you never know what he will end up liking!

Now for your body, at this stage you might start noticing some stretch marks around your belly, butt, and breasts as they start to grow and stretch the skin.  Stretch marks can be pink, red, or purple, and occur when tissue under your skin gets torn as the skin stretches during pregnancy.  It's important to note, that not every woman gets stretch marks and a lot of research shows that your chances of getting them may be genetic. So, if you want to figure out what your odds are, look at your mom, sister, aunts, etc to see how they fared during their pregnancies.  But this is not always the case, if you gained weight rapidly or had a breast enlargement this may play a factor.  This is what happened to me during my first pregnancy.  I have breast implants so the skin was already stretched, and the stretching of the pregnancy caused me to get some stretch marks on my breasts.  This was the only place I got stretch marks and my mom never had any so I attribute them to the augmentation.  BUT, since they were not in my genetic make up (and the fact that I used cocoa butter) they ended up fading and being very light and almost unnoticeable.  There is no guarantee that cocoa butter will help prevent stretch marks, but what it can help prevent is you skin from getting so dry, which will then prevent you from scratching your stomach with MAY reduce stretch marks.  Also, using cocoa butter and a belly wrap after delivery may also help reduce the stretch marks you developed and prevent new ones from developing.

Additionally, you have probably already found out the sex of the baby through the 20 week ultrasound, so this may be the time you start thinking about your baby registry.  There is really no "right' time to do your registry, any time after 20 weeks should be fine.  It really just depends on your schedule (and the schedule of anyone going with you) and when your baby shower is going to be.  You want to make sure you give yourself enough time to make changes to your registry and that there is enough time to send out the shower invites to your guests.  I suggest doing your registry a couple months (2-3) before your shower date.  The reason for this is that scheduling can be tricky especially with doctor appointments, working, other kids, etc so having ample time will reduce stress. Also, I know from experience that people (myself included) tend to get a little "trigger happy" during registry time.  Don't be surprised if you find that you a scanning non-stop!  If you leave yourself a few months in-between the creation of your registry and your shower you will have time to view your registry online with a clear head and see what items you actually need and want.  You can take your time an add stuff you missed, remove items you decide are necessary, and adjust the quantities of items.  I also suggest reading reviews on the stores website for your registry items, it's always helpful to read what real mommies though of the product as they used it.  All of these strategies will hopefully help reduce your chances, of receiving something you don't really want, getting a bad product, or having to return items.  You can also check out my lists of the best and worst baby products for registries, these are items I've used and either recommend getting, or recommend running away from.

Week 20
Week 22

Pregnancy Week 20

Congratulations! You are now officially half way through your pregnancy! Take a moment to bask in the glorious fact that you are half way done with GROWING A FREAKING HUMAN BEING! Now that you have basked in the glory that is you, lets get started on some of the cold hard facts about week 20.

At this stage your little one is approximately the size of a Mango measuring 6.5 inches from crown to rump and weighing about 10 ounces.  At 20 weeks babies begin to be measured from crown to feet since they are now able to stretch out more and measurement is much easier.  I few are going from crown to feet, your little one measures closer to 10 inches and is about the length of a banana. This will also be the week you get to do the anatomy ultrasound! This is seriously the coolest test you will have done during your pregnancy, and it is also the time when you get to find out what you're having (if you haven't found out through genetic testing yet).  If your having a girl, her uterus is now fully formed with her ovaries holding up to 7 million eggs! When we were pregnant with Isabella our doctor was able to see her uterus and fallopian tubes during the anatomy ultrasound!  Now if you're having a boy (like I am this time around) his testicles are beginning to descend from the abdomen to the scrotum (kind of weird when you think about it).  By this point in your pregnancy you should be able to feel your little one moving inside of you because he has grown large enough that you will feel his tumbles (although you won't feel all of them).  These will usually feel like bubbles or popcorn popping so be on the look out!  If you haven't felt any of those sensations yet, don't worry about it, but let your doctor know so they can carefully review your ultrasound.

Now that you are half way through your pregnancy you will start showing a nice little bump (if you haven't already).  This will likely bring about smiles from passersby and a lot of very nice behavior, like opening doors for you and offering you seats in waiting rooms.  Although, unfortunately I wouldn't expect this behavior to be as consistent once your bundle is here, sad I know but from personal experience it's true.  In addition to the nice smiles you're getting, you will also notice you nails are getting stronger, unless they are getting dry and more brittle (I know, pregnancy is so contradictory). Also, your hair is thicker and more fuller, although this will occur all over your body so be prepared.  This is due to those ever present pregnancy hormones and the increased circulation which is pumping said hormones throughout your body in rapid succession.

Some symptoms you might have felt so far include, but are not limited to: heartburn/indigestion, increased vaginal discharge (yay), occasional headaches, occasional faintness/dizziness, leg cramps, mild swelling of ankles/feet, and maybe a protruding belly button.

Week 19
Week 21

What's in your bag?

As delivery approaches us mommies to be are constantly told to "have our bags packed and in the car." We are told this so much that it often becomes a daunting task, because it's OBVIOUSLY supper important (why would they be telling us all the time if it wasn't) but this is a totally new experience so we have NO IDEA what to bring.  If you are like me, and most first time moms you will probably pack WAY to much because girl code states: when in doubt, bring everything! So with this in mind I wanted to give everyone out there some advice on what to bring and not to bring.  Granted this is based on my personal experience so take it with a grain of salt, but I think that hearing various experiences helps you make more informed decisions. Now, before we even start packing you need to do some homework first.  The first thing you need to do is take a tour of the hospital or birth center you will be delivering at.  The reason I suggest this is because the tour guide will usually tell you an "extras" that the hospital/center gives and doesn't give so you know what will be waiting for you.  If the guide does not do this, feel free to ask questions like: "are there any necessities the hospital provides?" or "What are some items I need to bring for my stay here."  Bring a notebook and paper so you can take notes and remember what will be provided to you so your baby brain won't kick in while packing.  For instance I delivered at Good Samaritan Hospital in LA and I was provided with a fleece robe (so soft) fleece socks/booties with no-slip grips, diapers, large sanitary napkins, squirt bottle for after care (the doctor will explain what this is for), and out choice of a stroller or car seat...pretty cool. With this in mind I new there was a lot of "recommended stuff" I didn't need to bring because it would be provided for me. So here are my suggestions of what you NEED for your hospital stay when you deliver.

1) Baby book: Put this in there ASAP! I forgot to put mine in and the nurses offered to put my little's hand and foot prints in and I was (and still am) devastated I didn't get them.

2) The good camera and video camera: Even if you're not planning on doing a birthing video it's nice to have the option to take video once baby arrives, and yes, smartphones do take good pictures but I like the quality of a DSLR better.

3) Nursing bras and bra pads: You may already be in them depending on how big your boobs have grown, but make sure you pack at least two sets because you may leak while you are getting use to the whole breastfeeding thing.

Just because they're "granny panties' doesn't mean they can't be cute

4) Granny panties: You will NOT feel like getting into anything remotely sexy right after delivery, and besides you're going to be using those sanitary pads for a few weeks so you need something with a lot of coverage to hold them.

5) Pajamas and baggy pants/yoga pants: You will not be back to your pre-baby tummy right away no matter what. I was "all baby" and it still took a couple weeks for my uterus to go down enough to put on old pants. Besides, after all the work you're going to be doing, yoga pants will be WAY more comfortable.

6) Maternity clothes: Yeah, you will still need to be in maternity clothes for a little bit due to your uterus size (see #5) and while you may be able to squeeze into pre-pregnancy clothes, you'll be wanting to go with comfort at this point.

7) Hair brush, tooth brush, toothpaste: I would suggest buying travel sized items and just throwing them in so you don't accidentally forget to grab them on your way to the hospital, and don't forget a toothbrush and hair brush for daddy too!

8) Clothes for dad: Remember, he's going to be there just as long as you are so pack something for him too.

This is WAY over the top obviously, simple granola will do, he doesn't need a luxury meal.

9) Snacks for dad: Now my hubby didn't need these because I had a very short labor, but I would advise packing some little snacks just in case you guys are there for the long haul...just make sure he knows not to eat them in front of you.

10) Swaddling blankets and receiving blankets: Bring a few of these because while you're getting the hang of feeding, burping, and diaper changing yucky stuff WILL get on EVERYTHING. So pack a few of each.  With my first I think I packed three for each day (so six of each) and that was perfect. This also depends on the season you're delivering in, my daughter was born in December so I packed a lot more blankets.

11) Hospital and going home outfit for baby: The hospital outfits don't need to be anything too pretty (your bundle will probably be swaddled most of the time) but make sure you pack  cute going home outfit because you will be taking A LOT of pictures of it. I also suggest speaking with the grandparents and seeing if there are any cultural traditions regarding the going home outfit they want to provide.  My mom, always provides the going home outfit for all of her grandkids because she wants to follow the Colombian tradition of an all yellow outfit.

12) Birthing aids: This depends on what you are planning to use, if you are using a doula see if she will bring items such as birthing ball, heating pads, ice pads, etc.  These are all very specific to the type of labor you are planning to have and the pain management you are planning to use.

13) Boppy pillow: This was really helpful for when I wanted to put Isabella down but still wanted her close to me.  I would put the pillow on the bed in between my legs and be able to still have her close but have my hands free.

So those are my recommendations for what to pack in your hospital bag, also be sure to leave some room because people will be bringing you things while you're in the hospital.  I remember when we were leaving the hospital with Isabella it took at least an hour to go because my poor hubby had to take about a ten trips from our room to the car because of all the stuff we had.  I know some lists say to bring books, iPads, computers, etc but I found I didn't use any of those.  Mainly because we were too busy with our newborn (she slept in the hospital room with us) to use any of those things.  And when she was asleep we had visitors so we weren't using any of that stuff.  This is also where the hospital tour comes in handy, because we saw that the hospital had satellite TV so we knew we didn't need anything else.  Like I said, you're list is going to be very personalized based on where you are delivering, how you plan to handle pain, where the baby will be sleeping, etc.  There is not cookie cutter list for packing a hospital bag.  But it is important to realize that a lot of the items in other lists, or that you may think you need, you actually don't.  This is why I suggest the first step in packing your bag is to tour the hospital and ASK QUESTIONS!  I hope this list helped you guys!

Test, Test...

For every fun and truly amazing part of pregnancy, there is one not so fun and lets face it pretty damn sucky part.  And one of those pretty sucky parts (at least to me) are all the damn tests we need to do throughout pregnancy! Seriously, sometimes I think my Dr.'s office is actually a blood bank because of all the blood tests they run.  Now I don't know if any of you read American Baby but I received a copy in my registry packet and they had a very interesting article about all the tests that the typical pregnant woman will receive during her pregnancy.  I thought that it would be helpful to go over the tests and also put in any information I can give about my experiences with the tests.

• First trimester screen: Done between 11 and 14 weeks and all pregnant women are offered the test. This screening is a simple blood test that analyzes the plasma protein A (PAPP-A) and beta human chorionic gonadotropin (beta-HCG). An ultrasound measures the nuchal fold at the back of the baby's neck and examines the nasal bone.  This screening is used to assess your baby's risk of Down syndrome, Edward's syndrome, and Patau syndrome, which are all chromosomal abnormalities.  This test has an 88% accuracy and a 5% falls-positive risk.

• Cell-Free fetal DNA test: Done at 10 weeks and on.  Women 35 or older or those at a high risk for certain chromosomal abnormalities may take this instead of the first trimester screen.  This is another simple blood test.  It can detect the baby's risk for chromosomal abnormalities such as down syndrome, Edward's syndrome, and Patau syndrome.  Something else that is extremely cool about this test is that what it does is it separates the baby's DNA from the mommy's DNA and because of that it can tell you super early the sex of your baby, by looking at the chromosomes!  We did this test, not really to find out about chromosomal abnormalities, but because we were so excited to be able to find out the sex of the baby so early!  My doctor said that this test will soon take the place of the amnio (see later in the list).  This test has up to a 99% accuracy and a false-positive rate as low as 0.1%.

• Chorionic Villus Sampling: This is done between 10 and 14 weeks and is for women whose first trimester screen revealed a potential problem. This is primarily for women who are 35 or older or those who have a family history of a genetic disorder.  This test will determine if your baby has a chromosomal abnormality or other genetic disorder, and this test will also tell you the sex of the baby.  For this test the doctor will insert a thin, hallow tube through  the cervix or a needle into your abdomen to remove a sample of chorionic villi. This process takes about a minute.  Now there is a 1% risk of miscarriage for this procedure, so if your main reason behind it is to find out the sex, stick to the Cell-Free fetal DNA test.

• Multiple Marker Screen: This is done between 15 and 20 weeks. This test is for women who didn't take the first trimester screen; those who are at risk for chromosomal abnormalities; and those who had an abnormal ultrasound.  But, it could also be the preference of the doctor.  My doctor for instance does not offer the first trimester screening unless there is a family history, but she does do the multiple marker screen.  This test reveals your baby's risk of having a chromosomal abnormality or a neural-tube defect such as spina bifida. The screen also correctly identifies about 80% of women carrying a baby with Down syndrome, but it also has a false positive in roughly 7% of cases.  This tests is done by drawing your blood (yay) and it is analyzed for levels of four substances: maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG), estriol, and inhibin A.

• Amnio: This is done any time after 15 weeks gestation and is for women whose previous screening test revealed a potential problem, who are 35 or older, and who are at increased risk for certain conditions.  This test is like the CVS test in that it will show whether your baby has a chromosomal issues, and can be used to test for a gene disorder, such as cystic fibrosis. And this can also tell you the baby's sex as well.  In this test the doctor inserts a thin, hollow needle into your abdomen to remove some amniotic fluid, which contains cells with baby's chromosomes and DNA. You may feel pinching or stinging and some cramps.  It is important to note that there is a 0.5 percent risk of miscarriage as well as a small risk for rupture of the membranes.  However, I am not sure how long this test will continue to be in use.  According to my doctor the Cell-Free fetal DNA test is most likely going to take the place of the Amnio since it is so accurate and has no risk of miscarriage or membrane rupture. But, we don't know when or if this will actually happen.

• Anatomy Ultrasound: This is by far the best test of them all because you get to see such a detailed ultrasound of your baby!  This is done between 18 to 20 weeks and all pregnant women are offered this.  With this test you will learn your baby's location and heart rate and your amniotic fluid level.  You will also see if certain birth defects (such as heart defect, cleft palate, or limb abnormalities among others) are present.  It is also at this time most people find out the sex of the baby if they have not done the other tests.  During the screening the doctor or technician (my doctor sends all of her patients to a perinatologist which is someone specifically trained for determining defects through ultrasound and monitoring high risk pregnancies) will conduct a 20-minute sonogram (3D if you're lucky). Key areas like the brain, heart, spine, kidneys and other major organs will be looked at and assessed for abnormalities. My perinatologist was even able to tell us the sex of our first child without a doubt (he showed us her ovaries, and uterus).  It is pretty much an ultrasound of your baby while he is still in you! It is the coolest thing ever!

Now it is important to note that these are not all the tests that will be performed by your doctor (such as the test for gestational diabetes).  But these are the main ones that you will be talked to ab out.  It is also important to note that it is completely up to you and your partner as to what tests you have done, and don't have done. It is important to think about what information you do and do not want to have and when you will want to have it to make any decisions related to your pregnancy. Remember it is your baby and your pregnancy and you have the ultimate say as to what procedures are done.

Pregnancy Week 19

We have reached week 19!  If you have yet to feel those little wiggles and kicks you will be soon, as most women feel them around week 20.  If you're not sure if you've felt them yet, the first movements are usually described as butterflies fluttering in your stomach, or popcorn popping in your stomach.  They are very light and delicate at first so don't feel bad if you come to realize you've been mistaking those baby movements for gas!

This week your little one is about the size of a mango or sweet potato, approximately 6 inches long and half a pound! This is one of those weeks to be thankful we don't have a little window in our belly's to look in.  This is because this week your baby starts to get covered with the cottage cheese looking film called vernix caseosa.  This oh so beautiful film covers your baby's skin, protecting it from the amniotic fluid.  Even though the thought of your baby being dipped in cottage cheese makes your stomach a little queazy, it serves a very good purpose, without it your baby would looked wrinkled an prunish when he is born (think sitting in a pool for nine months-eewww).  But fear not, there vernix caseosa usually disappears as delivery come close, however some babies are born with the coating. However, after labor you're not looking  all that fresh yourself and quite frankly you don't care what the baby looks like, you're just so happy he is here!

Following the theme from last week, muscle pains are abound this week as well.  Once again this is due to your growing belly pushing your spine out of alignment and adding extra weight to your legs and hips.  So don't be surprised if you are getting ready to fall asleep when, BOOM massive leg cramp that has you thinking labor is going to be cake.  I usually ask my wonderful husband to massage my legs before going to bed and this usually helps, also a warm bath can also help.  Another trick for overall muscle relief is take a bath with epsom salt, however check with your OB to make sure there aren't any issues in your pregnancy that prevent the use of epsom salt. Additionally, you can do a prenatal massage to releave muscle pain, or try a prenatal chiropractor to help realign your spine and hips.  Once again, check you your health care provider before doing these and see if they have anyone they would recommend.

Along with the wonderful muscle pain you might also be experiencing tingling and numbness in your fingers and toes.  It feels weird but it is totally normal.  While no one really knows why it happens, one theory suggests that it may be a result of your swelling body tissue pressing on nerves...fun! However, I also suggest letting your health care provider know what's going on with you even if you think it's normal, because if it persist various symptoms could be signs of more serious issues.

So that's our overlook to pregnancy week 19.  While you may be an emotional eating machine who is plagued with muscle and joint pain, just remember the second you feel that wiggle or kick, every ache, midnight pee, or snack is completely worth it!

Week 18
Week 20

Pregnancy Week 18

Week 18, WOO HOO!!!  The little munchkin is now the size of a sweet potato (but MUCH cuter), and measures in at  about 5 1/2 inches and about 5 ounces.  If this is your first pregnancy this may be around the time you feel those first flutters!!!! This is because baby is now big enough to feel him twisting around in there.  If this s your second or more pregnancy, you may have felt your little one moving much earlier due to you knowing that "feeling".  If you haven't felt him move yet don't worry about it, many first time mommies don't feel the baby move until around 20 weeks!  If you are just bursting out of your skin waiting to feel those first flutters, you can try to sit or recline in a quiet room and just relax.  It is usually at this time that 1) baby will start to move because he's not being rocked to sleep by your movement and 2) you are more likely to feel those little flutters or bubbles when you are still and not distracted.  Now not only is your little sweet potato probably big enough to feel, he is learning to yawn, and hiccup; both of which you will begin to feel soon as well.  Along with these new skills he is developing his own personal set of toe and fingerprints!

At this point you've probably developed a true baby bump (I know I have).  Now this can be a double edge sword in that you actually LOOK pregnant and are no longer in that weird "she maybe pregnant, or she maybe fat" stage. For me, this really helps boost my self esteem, because while I always know my shape is due to my growing little boy, everyone else doesn't and it makes me a little self conscious (I know I'm not the only one), but now I can wear that obvious bump with pride! Now for the con of this new bump...MY FLIPPIN' BACK FEELS LIKE IT'S GOING TO FALL APART!!!!  I swear, every time I walk more than 20 feet, I feel like my spine is about to collapse and I'm going to fall into a heap of skin (dramatic I know, but it's true).  This is due to the fact that your uterus is now about the size of a cantaloupe, which results in your body's center of gravity shifting.  This pulls your lower back forward and pushes the abdomen out.  In addition to this, the join relaxing hormones, such as relaxin, are making your muscles and ligaments more elastic and more sensitive.  This all adds up to a painful lower back.  This may be worse for you if this is a subsequent pregnancy because your uteran muscles and ligaments never go back to their pre-baby settings, which results in them being weaker which each subsequent pregnancy, and this then can cause lower back pain earlier, and/or sciatic nerve and round ligament pain.  OUCH!

Week 17
Week 19