Questions & Answers
During pregnancy, a sense of becoming a parent develops differently in each partner. This is normal and should not alarm you. In fact, because they carry the baby, pregnant women feel a sense of motherhood from the very beginning of the pregnancy which then grows stronger over time.
For certain men, awareness that they are soon to become a father is gained more indirectly, and starts with a period of “mental gestation". Real events such as ultrasound exams, discovering the baby’s gender and ultimately meeting one’s child in the flesh turn fatherhood into an increasingly tangible role.
It is nevertheless very important for the father to get involved from the earliest stages of the pregnancy. This will reassure the mother-to-be, strengthen the couple’s relationship and help them prepare together for their imminent role as parents. Providing support – both physical (household chores) and moral (comfort and self-confidence) – to the future mother is crucial to creating a peaceful environment to welcome the baby1. With the consent of his partner, the future dad may choose to participate in medical appointments, childbirth and parenthood classes and the birth itself. Through these different steps, he will be more confident and reassured about the coming changes and able to fully take on his new role as a father.
TOver the course of your pregnancy, you will undergo several routine examinations designed to closely monitor not only your health but your baby’s as well. Included among these procedures are a series of ultrasound exams as well as prenatal screening for fetal abnormalities.
Except in specific cases such as a multiple pregnancy or a family history of twins, you will undergo three ultrasounds.
These exams are performed using a manual probe that delivers high frequency sound waves to obtain an image of the fetus on a screen. As long as they are used for medical purposes, these ultrasound waves pose no threat to you or your baby . Your first ultrasound, also referred to as a dating scan, will be performed around the 12th week of pregnancy (calculated based on your last menstrual period). As its name indicates, this ultrasound is used to evaluate the gestational age of the pregnancy by measuring the size of the baby's head, abdomen and thigh bone as well as spine length. It is also used to estimate your expected date of delivery and to assess any potential risk of genetic disorder.
Two other ultrasounds, called anatomy scans, are performed around 22 and 32 weeks and consist in a detailed assessment of your baby’s development. In particular, your baby’s physical characteristics and organs are analyzed to make sure there are no abnormalities or malformations. Nevertheless, even when skillfully executed, ultrasound is not infallible and has its limits. The 32 week ultrasound is used to locate the placenta and screen for any delays in intra-uterine growth.
During the ultrasound, you will be lying down comfortably on your back on an examination table, in a room that has been darkened to facilitate viewing of the images displayed on the screen. Before beginning the exam, the sonographer will apply a gel to your abdomen which allows the sound waves to be transmitted. The ultrasound lets you see your baby for the first time and can be a very moving experience!
Prenatal screening for fetal abnormalities begins with the first ultrasound. Between the 11th and 14th weeks of pregnancy, a collection of fluid, called nuchal translucency, becomes visible at the back of the fetus’s neck. Its thickness, the mother’s age, the size of the baby and the levels of certain pregnancy hormones are genetic disorder risk indicators. This data is especially useful for assessing the risk of trisomy 21 (Down Syndrome) and other less common disorders such as trisomy 13 (Patau syndrome), trisomy 18 (Edwards syndrome) and abnormalities affecting sex chromosomes X and Y).
These parameters can be used to calculate a probability threshold for abnormalities, but cannot be used to validate a diagnosis. Beyond a certain threshold, diagnostic exams can be performed. These tests consist in analyzing chromosomes inside the cells of the fetus (fetal karyotype) and require a tissue sample obtained through amniocentesis or chorionic villus sampling (CVS). These invasive procedures carry a low risk of miscarriage, although the rate has decreased (from 1 percent to 0.1 percent) according to recent data.
It was recently recommended that Non-Invasive Prenatal Testing (NIPT), which can take place starting from week 102, be performed before a karyotype analysis. NIPT is based on the presence of fetal DNA in the maternal blood and is performed through a simple blood draw. The blood sample undergoes laboratory analysis to determine if it contains more than the usual amount of chromosomes 21, 13, 18, X or Y2. By using NIPT, the number of unnecessary invasive exams can be decreased, thereby reducing the associated risks. However, if the result of NIPT is positive, karyotyping is the only way to establish a diagnosis.
It is a well-known fact that exercising is a smart way to stay healthy at every age. But now that you’re pregnant, you may be wondering whether it’s a good idea to continue or begin an exercise program.
Although previously unadvised, exercise during pregnancy is considered to be highly beneficial today. A 50 percent drop in the risk of gestational diabetes and a 40 percent drop in the risk of preeclampsia have been observed, accompanied by a more balanced diet and improved psychological condition , . Maintaining a reasonable degree of physical activity during your pregnancy is therefore recommended. Excluding special cases that require extra caution and rest such as multiple pregnancies or pathological conditions, 30 minutes of aerobic and muscle-building activity three to four times a week are recommended.
Your body’s center of gravity changes as your belly expands during pregnancy. Your ligaments become more flexible to better cope with the physical changes and prepare your pelvis for the birth. Therefore, choose sports that don’t require balancing, and avoid excessive stretching. Jogging, walking, recumbent bicycle and swimming are the physical activities most suited to your situation. Intense or endurance sports as well as combat sports should be avoided because of the prolonged effort they require and the risk of falling or being injured .
Lastly, be especially careful when resuming your exercise regime after giving birth. You will be able to resume your activity progressively. If you have any questions, don’t hesitate to contact your healthcare professional.
Pregnancy is a period filled with joy, wonder and emotion. But these happy feelings are often accompanied by functional disorders, also known as the aches and pains of pregnancy, caused by the changes occurring in your body.
Although most pregnant women experience these discomforts, symptoms are generally mild and temporary, mainly consisting in gastrointestinal issues, lower back pain and venous problems.
Nausea and vomiting, commonly known as morning sickness, may occur at the beginning of the pregnancy and disappear spontaneously between week 16 and 20. Its causes remain unknown, but are commonly believed to be an increase in the levels of the hormones HCG, progesterone, estrogen and ACTH. The use of natural remedies such as ginger supplements or acupuncture can bring relief. Constipation is another frequent side-effect of pregnancy, caused by hormone changes and the compression of the intestines by the uterus. It can be managed by increasing your fiber intake, drinking plenty of water and exercising.
Towards the end of the pregnancy, lower back pain and varicose veins may appear due to weight gain. Lower back pain, which is also linked to a relaxing of the ligaments and changes in posture, can by eased by water aerobics, massage and lumbar support belts. Relief for varicose veins can be obtained by wearing compression stockings or by improving circulation by walking, raising the legs and avoiding exposure to heat.
If, despite your efforts, you can’t find relief, do not self-medicate. Instead, contact your doctor for advice
When you are pregnant, especially for the first time, feelings of worry can set in. Many childbirth classes are available to help.
These classes are not mandatory, but are strongly recommended to future moms and dads alike, as they offer significant psychological and practical benefits. You will receive valuable information relating to your pregnancy, the physical changes affecting your body, the types of birth that exist, the role of your partner, caring for and feeding your baby, and pre- and post-natal monitoring. In addition, to relieve the minor aches and pains of pregnancy, you can benefit from alternative medicine such as phytotherapy, aromatherapy, homeopathy and acupressure.
Specific sessions are also available for pain management and building self-confidence, including prenatal hypnosis, relaxation and the Bonapace method. Methods focusing on posture and breathing, such as the De Gasquet method, help mothers-to-be gain a better understanding of their body and learn the breathing techniques and positions that are most appropriate to their situation. Most childbirth classes are reimbursed by the French national health insurance (Assurance Maladie) and each future mother can attend eight reimbursable sessions. Demand is high for these courses, so be sure to ask for information from your hospital physician or the establishment where you plan to give birth well in advance
During pregnancy, the mother is directly linked to her baby and provides all the substances it needs to grow via the blood and the placenta.
Everything the mother eats, drinks or absorbs is therefore, to a certain extent, shared with the baby. That’s why it is very important to eliminate or strictly limit the use of substances such as tobacco, alcohol, drugs and medicines, which harm the baby’s development as well as the mother’s health.
The consumption of these substances has been linked to several damaging consequences. Smoking is a risk factor for pregnancy complications and can cause miscarriage, placenta praevia, placental abruption, premature delivery and ectopic, or tubal, pregnancy. Furthermore, intrauterine growth delays and low birth weight have been observed, combined with a higher risk of developing post-natal respiratory conditions. Alcohol is a teratogenic substance which can potentially affect the development of the central nervous system. To date, a consumption threshold that does not alter fetal development has not been determined. The recommendation is therefore to avoid drinking alcohol, or reduce consumption to a minimum.
Lastly, the use of psychoactive substances such as drugs, antidepressants or psychotropic medications can provoke, in addition to a low birth weight, risk of malformation, withdrawal and toxicity. Nevertheless, suddenly ceasing to absorb these substances can be dangerous for the fetus. It is strongly recommended that you consult a healthcare professional to monitor the cessation process.
To ensure your baby receives all the nutrients required for healthy growth, and to cope with the new demands on your body, significant metabolic changes will take place throughout your pregnancy.
First, a gradual increase in your appetite will ensure a direct supply of the substances necessary to cover your new needs, as long you maintain a well-balanced diet. In addition, your body’s reserves will be mobilized to contribute to your baby’s development. This mechanism protects the baby from any fluctuations in your diet and ensures he or she always benefits from adequate nutritional intake. The placenta also plays a key role in supplying the fetus with maternal reserves.
In the face of these changes and adaptations, the recommended diet during your pregnancy will not greatly differ from your usual diet. Nevertheless, a few specific measures should be taken. A folic acid supplement, crucial to reducing the risk of certain neural tube defects, will be recommended before and during your pregnancy . A vitamin D supplement during the sixth month of pregnancy is also advised. If you eat a well-balanced diet, no other dietary supplements are necessary, and will only be prescribed in the event of a deficiency (vitamin D, iron, iodine or calcium).
To avoid infectious risk (toxoplasmosis, listeriosis and salmonellosis), thoroughly wash fruits and vegetables, thoroughly cook meat, fish and eggs and avoid touching dirt and objects contaminated by cat feces. Prefer pre-packaged cold cuts and avoid unpasteurized soft cheeses. All alcohol should also be avoided, and caffeine intake reduced. Lastly, weight gain is a normal, physiological result of pregnancy. Nevertheless, beware of excessive weight gain, particularly in expectant mothers who are overweight or obese.
Toxoplasmosis is an infection caused by the Toxoplasma gondii parasite. It generally causes no symptoms and is not contagious. Nevertheless, during pregnancy, this infection can be a risk factor for the fetus.
If you are planning to get pregnant or are already expecting, toxoplasmosis screening tests will be recommended to you. Screening consists in testing your blood for specific antibodies – anti-Toxoplasma immunoglobulins – produced by your body in response to this infection.
Before your pregnancy, if these antibodies are detected in your blood, it means you are immune to toxoplasmosis. In this case, no special measures are necessary during pregnancy, because you are no longer at risk for infection.
However, a negative blood test result means no antibodies were found in your blood; you have never been in contact with the toxoplasmosis parasite. Certain screening and prevention measures will be necessary and recommended in the event of pregnancy, to avoid all risk of infection.
Starting from your first prenatal visit up to the birth, blood tests will be prescribed to you each month to verify the absence of infection. In addition, everyday preventive measures involving basic hygiene will be recommended to you to avoid all possible contamination.
Toxoplasmosis can be present in different forms in meat or the excrements of certain animals, particularly cats. Scrupulous hand washing with soap and water, especially after handling raw meat or fruits and vegetables with soil on them, is crucial. Any meat you consume should be cooked at a temperature of over 68°C. It is also important to carefully wash raw produce and avoid eating it outside the home.
If you contract toxoplasmosis during your pregnancy, your gynecologist will advise you in getting the appropriate care. Once the diagnosis has been confirmed and the infection analyzed, you and your baby will receive the antibiotics best suited to your condition.
What is cytomegalovirus (CMV)?
It’s the virus that causes the highest number of infections transmitted from mother to fetus. Pregnant women can be contaminated by the saliva or urine of young children. One in three children carry the virus, with a higher risk if the child is in day care. CMV infection is almost always invisible in the mother.
What are the consequences?
If your first contact with CMV occurs during your pregnancy, your future baby could be infected. In this case, there may be no symptoms at birth. However, in certain rare cases, the child may be seriously affected (deafness, intellectual disability, delayed growth).
This risk can be easily prevented.
A simple blood draw to test for CMV* antibodies will reassure almost half of pregnant women. A negative test means you have never been in contact with the CMV virus and you need to protect yourself in order to protect your baby. You and your spouse or partner must avoid all contact with the urine and saliva of young children in your family and professional circles. To do so:
- Wash your hands carefully any time you are in contact with the urine of small children (diaper changing, potty, etc.)
- Don’t taste their bottles or food or lick their spoons
- Don’t use their personal items such as toothbrush, washcloth, etc.
- Avoid kissing them on the lips, and avoid contact with their tears or “runny nose”.
If your test becomes positive during your pregnancy, it means you have been infected. In certain cases it is possible to diagnose infection in your future baby during pregnancy:
- Your doctor will take the necessary measures
- The pediatrician will arrange for specific monitoring
* This test is recommended but is not mandatory.
Over the course of your pregnancy, your body will undergo many changes in response to new metabolic needs. In order to increase the availability of sugar, which is important for your baby’s development, your body produces insulin-impairing hormones. This means a large amount of sugar, or glucose, will circulate in your blood and remain available to the fetus.
In some cases, the body can’t control this metabolic modification and develops an intolerance. The inability to regulate glucose levels leads to hyperglycemia, an abnormally high level of sugar in the blood. This is gestational diabetes, a reversible condition which generally occurs during the third trimester of pregnancy. It is diagnosed with a specific glycemia test performed between the 24th and 28th weeks of pregnancy. Gestational diabetes can be asymptomatic or cause symptoms such as intense thirst, a frequent need to urinate and significant fatigue. In addition, babies of mothers with gestational diabetes tend to be larger than average, a condition known as macrosomia. This may lead your healthcare professionals to consider a C-section birth. Gestational diabetes can also trigger premature labor and cause glycemia regulation problems in the newborn. It also increases the risk of developing Type 2 diabetes in the mother and baby. It is therefore extremely important to control this disease, especially by adapting your diet and getting regular exercise to control your blood sugar level. If these measures are insufficient, an insulin treatment will be proposed.
During your pregnancy, you will be coping with many changes, which may also impact your sleep. Sleep is a vital function that is necessary to our well-being, and we spend close to one-third of our lives sleeping. It is a reversible behavioral state which, alternating with a state of wakefulness, establishes the pattern of our daily lives. Sleep consists in several stages (light, deep and paradoxical) which form a cycle that repeats itself throughout the six- to eight-hour resting period until you wake up.
Most pregnant women experience a decrease in the quality and duration of their sleep. This phenomenon usually intensifies as the pregnancy progresses.
During the first trimester, a sensation of fatigue sets in and you might feel the need to nap during the day. This is due to the overwhelming hormonal changes taking place in your body. In particular, higher levels of progesterone produce a soporific effect. However, sleep becomes less restorative and may be disrupted by minor discomforts relating to the pregnancy.
During the second and third trimesters especially, the amount of sleep you get will gradually diminish. In addition to sleep disturbances induced by the pregnancy, increased wakefulness at night may be caused by the moving fetus and uterine contractions combined with a more frequent need to urinate, occasional cramps and difficulty breathing due to the growing size of your baby. The closer you get to your due date, the more anxious you may feel, which does nothing to improve the quality of your sleep.
You can find relief for all of these issues by changing your habits. Solutions include reducing your work load, taking longer breaks throughout the day and having dinner earlier. If these steps are not enough, behavioral therapies such as relaxation, yoga, sophrology, acupuncture and homeopathy can help.
If you still can’t get relief or if your situation worsens, do not self-medicate. Instead, contact your doctor for advice.
Throughout your pregnancy – from fertilization until birth – your baby continually develops. During the first trimester, called the embryonic period, each organ begins to form. The second trimester marks the beginning of the fetal period, during which the organs will continue to develop and become fully functional. During these essential development phases, the embryo and fetus are particularly vulnerable. Certain very frequently used medicines may have an adverse affect on the baby’s development and should generally be avoided during pregnancy. Two types of drugs can be distinguished: teratogens, which can cause embryo malformations, and fetotoxic drugs, which can harm fetal growth, maturation and organ function. Exposure to certain medicines at the end of the pregnancy or during delivery can also result in neonatal effects.
Talking with your healthcare professionals and carefully following their recommendations is all the more crucial if you suffer from an acute or chronic condition. Special care must also be taken to avoid exposure to certain chemical substances, known as endocrine disruptors, commonly found in the environment (pesticides) and in everyday products such as cosmetics, toothpaste and hair colorants. Exposure to these substances can have harmful consequences on the healthy hormonal development of the fetus . Nevertheless, exposure can be easily avoided through greater vigilance and, if necessary, by changing your personal habits. Favoring natural cosmetics and food that has not been treated with pesticides, and, most importantly, heeding your doctor’s advice are good practices that should be applied throughout your pregnancy.
Your due date is approaching and soon you’ll be able to wrap your arms around your little bundle of joy!
In most cases, the birth will be a natural vaginal delivery. After the first stage of labor, your cervix will have fully dilated (10 cm) to allow the baby to come out. In general, a few weeks before the birth, the baby naturally moves into the most advantageous position for delivery, with the head turned downward (cephalic, or head-first, presentation) . However, some babies are positioned for birth with their feet or buttocks first (breech presentation), with the chin non-tucked, in a posterior position or a transverse lie position.
In certain cases, for example if signs of distress in the baby or extreme fatigue in the mother are observed, the medical staff may use techniques to accelerate the birth. This is referred to as an assisted delivery, performed with the help of instruments (forceps or vacuum devices) under general, local or epidural anesthesia. The use of these instruments can cause redness or mild bruising, but is painless for the baby.
In most cases, the birth goes smoothly, via a vaginal delivery. However, if there is a high risk for the baby or the mother, a caesarian will be performed. A caesarian, or C-section, is a surgical procedure that consists in an incision to the abdomen and uterus to extract the baby. If risks or complications relating to the delivery are detected in advance, a C-section can be scheduled. The procedure is generally performed under epidural anesthesia so you can fully enjoy the amazing experience of giving birth to your child. Barring certain specific cases, your partner can stay with and assist you.
Your third trimester of pregnancy has finally begun and your delivery date is fast approaching. What do you need to bring to the maternity and how do you know when it is time to leave?
As of the 36th week of pregnancy, your baby could be born at any time. Remember to pack your bag and have your maternity dossier ready. In general, your maternity will provide a list of what you will need for yourself and for your newborn. Besides personal hygiene products, find out what your hospital does and does not accept, to avoid carrying unnecessary weight. You should also prepare your maternity dossier, which includes your Carte Vitale, supplementary insurance card and birth plan.
Three distinct signs may indicate that labor has begun, letting you know it’s time to leave for the maternity: the loss of the mucus plug, the onset of contractions and the rupture of the membranes (when your water breaks).
The mucus plug is a collection of secretions whose purpose is to isolate the uterus during pregnancy, thereby protecting the fetus from infection. The plug is a translucent, gelatinous mass that may be greenish or brownish in color. Its loss can be confirmed several days prior to – or the same day as – the birth.
Unlike Braxton-Hicks contractions, which occur occasionally throughout the pregnancy, early labor contractions are regular and provoke cervical dilation. These contractions gradually increase in intensity and duration: when labor starts, they occur every 15 to 20 minutes and last 15 to 20 seconds, and gradually build to every two to three minutes, lasting 30 to 45 seconds, when the baby is close to coming out.
The membranes may rupture at any time during labor. When this occurs, you should always consult your doctor, whether or not you are having contractions. You will feel a trickle of a clear, watery substance, of variable quantity, caused by the rupture of the membranes surrounding your baby . If your contractions intensify, this is a sign that your labor has begun. Gather your things and get on your way to the maternity
Childbirth, especially for first-time mothers, begins with an initial phase of “pre-labor” which varies in duration. During pre-labor, it is important to remain as mobile as possible in order to “stimulate” the cervix. Exercises such as using a birthing ball, walking and massage, as well as the use of certain medicines, will offer pain relief and help you transition to the next phase. Labor truly begins when the cervix has dilated between two exams. At this time, you may have an epidural – the most effective method for managing pain.
What is epidural analgesia?
Epidural analgesia works by blocking the transmission of painful sensations sent by nerves in the uterus. It consists in using a special needle to insert a catheter (a very thin tube) into the epidural space of the lumbar region, at a distance from the spinal cord.
How is the epidural administered?
It is administered under local anesthesia and does not cause any pain. An IV will be inserted along with monitoring elements prior to the epidural. The catheter remains in place throughout the delivery. The procedure is performed to coincide with the rhythm of your contractions. Focusing on breathing and possibly using light hypnosis will help you to relax and arch your back.
How is the epidural’s effect maintained?
Your anesthesiologist will stay with you throughout the entire labor. However, you will have a “patient-controlled” pump that lets you – in a totally safe manner – self-administer a certain number of “boluses” based on your personal needs. This system makes it possible to comfortably balance out the doses you receive, in order to maintain a certain degree of feeling, especially the urge to push towards the end of labor.
What are the risks and drawbacks of epidural analgesia?
At the beginning, you may experience a momentary, non-alarming drop in blood pressure. You may also experience dizziness or nausea. Highly localized pain might be felt where the needle was injected, which may last several days but is not cause for worry. In some rare cases, “spinal headaches”, which worsen with movement, can develop. They are caused by a “hole” for which effective treatments are available. The incidence of more serious complications that can cause residual effects such as convulsions, paralysis and loss of feeling is close to zero. The benefits of an epidural largely outweigh the risks.
Are there any contraindications for an epidural?
In the weeks leading up to the birth, you will have a consultation with your anesthesiologist. At this time, a specific biological assessment will be prescribed in order to identify certain at-risk situations including blood coagulation problems, skin infections or certain heart-related illnesses. The findings will be updated on the day of delivery.
Childbirth consists in three stages: the dilation of the cervix, the birth of the child and the delivery of the placenta.
It generally takes anywhere from four to eight hours for the cervix to dilate, depending on whether or not it’s your first pregnancy. The amount of time necessary also varies from one woman to the next. Throughout this phase, your contractions will become increasingly frequent, intense and painful, causing your cervix to gradually expand to allow the baby to come out.
After your arrival at the maternity, your healthcare provider will check how far your cervix has dilated. If you are far along, you will be taken to a labor room and prepped for the delivery. Your baby’s state of health will also be monitored using sensors which are placed on your belly to record the baby’s heartbeat. At this time, you may receive an epidural anesthesia to relieve the pain caused by contractions.
Once your cervix has fully dilated (10 cm) , you will feel a strong desire to bear down, or push, once the baby has begun to descend into the birth canal. You are now entering the second stage of labor, which lasts around thirty minutes and ends with the birth of your baby. Your healthcare provider will make sure your baby’s head is visible (known as “crowning”) and will ask you to push. The emergence of the baby’s head is the most difficult part of childbirth. Sometimes a controlled incision of the perineum under local anesthesia (episiotomy) is necessary to avoid tearing. Next, your baby will turn in order to position his or her shoulders in your pelvis and, thanks to the pushing effect of your contractions, the rest of the body will easily glide out. After the birth, your caregiver will place your newborn on your tummy before cutting the umbilical cord and providing immediate care.
One last step awaits you in the half-hour following the birth of your child: the delivery of the placenta. During this stage, the contractions continue, helping you to push out the placenta. It is very important that the entire placenta be delivered, to avoid the risk of hemorrhage.
The pelvic floor is made up of the muscles, ligaments and tissues of the pelvis. It plays a dual role by supporting the genital and digestive organs and controlling their function.
The pelvic floor muscles may slacken for various reasons, in both men and women. This may result in varying degrees of urinary or fecal incontinence or, in the most severe cases, pelvic organ prolapse.
Beyond age or intense physical activity, pregnancy and childbirth are among the most frequent factors that weaken the pelvic floor in women. During these periods, the pelvic floor muscles can be stretched or torn since they are put under considerable strain, first by the physiological changes that come with pregnancy, and then by the act of giving birth itself.
In general, these reversible changes have no long-term effects and your body will recover naturally. However, a postnatal check-up (six to eight weeks after giving birth) will be recommended to verify your overall state of health. During this check-up, pelvic floor rehabilitation therapy might be prescribed to you. These sessions are performed by a midwife or a specialized physical therapist and are fully reimbursed. You will first be asked to describe any symptoms that have affected your everyday life since giving birth, such as incontinence or sexual dysfunction. This might make certain women uncomfortable. However, it is very important to inform your doctor honestly, in order to receive the post-partum care that is most suited to your needs. Following a manual examination of your pelvic floor, exercises to strengthen these muscles will be explained and prescribed1 to you. These exercises are also designed to help you identify the various pelvic floor muscles and teach you how to contract and release them.