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Your 40-week Journey : What's Happening to My Baby? Fetal development (part 1)

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Q: Is it true that much of the really important brain development happens in the first trimester?
A: Your baby's brain starts to develop soon after conception when brain cells begin to form at the tip of the embryo. After about three weeks, a structure called the “neural tube” begins to change in order to form the spinal cord, and the brain and brain cells (neurons) start to develop and send messages to each other. In the early weeks, brain cells multiply at a rate of about 250,000 per minute.

After about 20 weeks of pregnancy, the rate at which brain cells multiply begins to slow down and the brain starts to organize itself into over 40 systems to direct vision, language, movement, hearing, and other functions. By the time you are half way through your pregnancy, almost all the brain cells your baby needs for life are present.

During the third trimester, the connections between the brain cells start to mature and the baby's nervous system becomes more developed. Brain development is not totally complete by the time the baby is born and many important brain connections that help your baby develop skills and personality are made after the birth.

So, although fetal brain development occurs throughout pregnancy, and after, crucial foundations are certainly laid down during the first three months.

Q: Is there anything I can do to help the development of my baby's brain?
A: You can ensure that your diet includes good sources of omega-3 fatty acids, as these are thought to play an important part in the development of the brain. They can be found in oily fish such as mackerel and salmon (limit to one or two portions a week); omega-3 supplements designed to take in pregnancy are available.
Q: When will my baby's face be formed?
A: The development of the face starts as early as the sixth week of pregnancy, when grooves that will form the structures of the face and neck start to grow. A week later, the eye starts to develop and a primitive mouth and nose are evident. By the end of the first trimester, the face is well formed and has a definite human appearance, although the skin is still transparent. By the 24th week of pregnancy, the eye is fully developed, the eyebrows and lashes have formed, and the skin becomes less transparent, but the eye remains fused shut and does not open until around the 28th week of pregnancy.

During the last trimester, your baby's hair begins to grow on the head and fatty deposits give your baby rounded cheeks.

Q: I would like to communicate and bond with my baby before the birth. Is there anything I can do?
A: As your pregnancy progresses, there are many ways to focus on your baby and communicate with him, and these occasions are a chance for you to relax and take time out, too.
  • Relax in a warm bath and concentrate on feeling your baby's movements, imagining what he is doing inside you.

  • Talk to your baby. Your baby can detect sounds from outside the womb by 20–24 weeks and is especially likely to tune in to your voice. You can give a running commentary on your activities, or even read to your baby. Get your partner involved too!

  • Rub or massage your belly. You may find that your baby responds by kicking; it's almost like having a conversation!

  • Spend some time Making plans for your baby's arrival, for example, choosing colors for the nursery or even just buying a few onesies.

  • Sign up for birth preparation classes for you and your partner. This will give you both a chance to think about labor, birth, and your baby.

  • Start reading through a book of baby names and make a list of those you and your partner like.

  • Some couples enjoy taking regular photographs of their growing belly.

Q: I've got a busy career and have hardly thought about the baby. Will this stop us from bonding?
A: Even if you work full time during pregnancy, this doesn't have to have a negative effect on your relationship with your baby. As your baby grows, you will probably find that you start to develop a relationship with him or her as you anticipate your baby's movements and perhaps talk to your baby. Make sure you plan enough maternity leave before your due date since this gives you time for practical and emotional preparations, as well as time to rest. There is some evidence to suggest that too much stress in a mother can affect her unborn baby's brain development, although this is not conclusive. However, it does highlight the importance of regular opportunities to relax during pregnancy.
Q: I'm trying to get my partner involved; I keep letting him feel the baby move, what else can I do?
A: This is a common concern. Feeling the baby move inside you is a great way for your partner to begin to connect with the baby as a separate person and seeing the baby on an ultrasound scan can help too, as can hearing the heartbeat.

It is often difficult for partners to feel involved with a pregnancy since it is not physically happening to them and can feel like quite an unreal experience. Try to spend time together finding out about pregnancy, labor, and birth since this will help your partner feel as informed as you and discover ways to help you during the labor and birth and take care of the baby after the birth. Some of the suggestions in the section on Partner bonding may also help.

Q: My husband didn't talk about the baby before the scan. Now he is overly protective. Is this normal?
A: Many fathers-to-be find it difficult to come to terms with the fact that their partner is carrying their baby, and that the baby will eventually be born and bring all the joys, trials, and responsibilities of parenthood. This is all even harder to envisage when they are not physically experiencing the changes that pregnancy brings—not feeling the symptoms or feeling the movements. The ultrasound scan is often a pivotal point for partners—suddenly they are “face to face” with their baby, and it becomes more real. Perhaps your partner is now realizing his responsibilities and affection for the baby, and is showing these feelings by taking care of you. If you are finding that his attention is a little too much, you might want to discuss other ways he can feel involved with the pregnancy and prepare for the baby (see the section on Partner bonding)! Try to embrace his involvement and enthusiasm for the pregnancy—it is a great way for you to strengthen your relationship as a couple and prepare to face parenthood together.
Q: When can a baby first suck its thumb?
A: Ultrasound scans have shown unborn babies sucking their thumbs from as early as 12 to 14 weeks of pregnancy. However, this is likely to be a reflex at this stage as the brain does not have any conscious control over movement until the fetus is much more developed later on in pregnancy.

Some research has suggested that if an unborn baby shows a preference for sucking, for example, its right thumb, then it will prefer to lie with its head turned to the right after the birth. The same research also suggested that this preference in the womb could be used to predict right or left handedness in the baby as it grows older.

Q: When will I be able to hear my baby's heartbeat?
A: Your doctor or midwife should be able to hear your baby's heartbeat by the time you are 12 weeks pregnant using a handheld device called a Doppler. The heartbeat sounds very like a galloping horse, and the rate is usually somewhere between 120 and 160 beats per minute—around double the rate of your own pulse.

There are factors that can influence whether or not the heartbeat can be picked up. For example, if you are overweight, or the baby is in an awkward position, it may be harder to hear the heart. If your health-care provider is unable to locate the baby's heartbeat at 12 weeks, try not to worry. At this stage, the baby is only about 2 in (5 cm) long, so it's still very tiny! Your midwife will try again in a few weeks. Certainly, by 14 weeks it should be easier to pick up, and you'll be able to listen to the heartbeat.

Q: When will I first feel my baby move?
A: Although ultrasound scans have shown that babies may start to move slightly from around 6 weeks, it is not usually until the second trimester (16–20 weeks) that the fetus will make active movements. The sensation known as “quickening” is described as a fluttering type of feeling usually felt by mothers between 16 and 20 weeks, although exactly when a movement is felt can vary from woman to woman and may be affected by various factors. If it is your first baby, you may not notice any movement until later since you won't know what to expect. Also, if you are an active person, these slight flutters may be missed. Women with an anterior placenta (lying at the front of the womb) may feel movements later, as may larger women, since there is more flesh for the movement to be felt through. It is not until around 28 weeks that it becomes more important to monitor the pattern of movements. From this stage, the amount your baby moves, as well as the type of movement and the time it happens, are relevant since these indicate that the placenta is sustaining the pregnancy and your baby's muscles are developing. If you are concerned about lack of movement, contact your health-care provider or hospital.
Q: What sounds can my baby hear in the uterus?
A: The baby's outer ear is visible at around eight weeks and the first reaction to loud noises has been recorded at nine weeks. This has been measured in studies by playing a range of sounds through the mother's abdomen and recording any responses, such as movement, through ultrasound scans. It is thought that babies start off hearing low tones and then higher tones are heard later on as the hearing system continues to develop.

Studies also suggest that a fetus can determine its mother's and father's voice and the voices of close friends and family during pregnancy. One study revealed that not only did the fetus hear its mother's voice, but its heart rate decreased, indicating that her voice had a calming effect. By 26 weeks, hearing is considerably developed. Premature babies born at this time react to sounds, so they are living proof that babies inside the womb at that gestation can hear. Research also suggests that babies respond to stories read to them or music played during pregnancy after the birth.

Q: I'm 25 weeks' pregnant, and my baby seems to “jump” when it hears loud noises—is this likely?
A: Babies born prematurely react to sounds, and loud sounds will produce a “startle reflex,” so this provides strong evidence that babies inside the womb at that gestation will hear and react to loud sounds too, possibly with sudden movements.

Studies have shown that a baby can react to sounds from as early as nine weeks' gestation. As the fetus grows, the hearing develops, with babies responding to a greater range of sounds.

Q: My belly measurement has been the same for three weeks. Why isn't my baby growing?
A: In pregnancy, your abdomen is measured to establish the height of the top of the uterus, which indicates how the baby is growing. It is important to know whether the same person is measuring you, since there is an element of subjectivity depending on techniques. In early pregnancy, it is not necessary to measure you since this doesn't give an indication of fetal growth, but from 26–28 weeks, growth can be assessed this way. However, even with your own personalized growth chart and with the same person measuring you at the correct time, on their own these are not an accurate means of estimating your baby's growth. If there are any concerns, you will probably be referred to a consultant to decide whether you need further investigations, for example ultrasound scans. If you are at the end of your pregnancy, one possible explanation may be that your baby's head is engaging into the pelvis, so although your baby is still growing, some of his head has not been measured due to its position. If you are worried, talk to your midwife. If necessary, she can refer you for an ultrasound to assess interval growth.
Q: Do babies have hiccups in the womb? I'm sure I can feel them.
A: Babies hiccup from early in the third trimester. This is a normal phenomenon that is usually short-lived but often recurs at similar times each day. It feels like a quick, spasmodic sensation in your abdomen. Hiccups are not harmful to the baby and in fact are a sign that your baby is healthy, in the same way that your baby's movements are a positive sign.

It is thought that the hiccups may be caused when, occasionally, babies take a deep breath in and ingest the amniotic fluid that surrounds them. The sudden change in chest cavity pressure when they take in fluid can cause the hiccups, just as when we drink something fast. These deep breaths help to exercise breathing muscles and stimulate their lungs to produce “surfactant,” which is essential for the lungs to function. The baby cannot drown, since it receives its oxygen supply from the placenta.

Q: When will my baby grow fingernails?
A: Babies begin growing fingernails from the end of the first trimester and the nails reach the fingertips between 34 and 36 weeks of pregnancy. It is possible for babies to scratch themselves inside the womb and when they are newly born, even though their nails are soft in comparison to ours. The function of fingernails is to protect the pads of the fingers, particularly, when gripping; since babies have a grip reflex from birth, this protection is necessary right away.

After birth, cutting a baby's nails can be a cause of concern for parents. Newborn nails grow rapidly and the best time to shorten them is after a bath, when they are at their softest and the baby is more relaxed. There is some controversy over whether to use scissors, clippers, or simply bite them off. Scissors and clippers may easily cut the skin, but biting carries a higher risk of infection if the skin is broken. Pressing the nail helps to distinguish nail from skin. Using emery boards or simply peeling them off can be slightly safer options, or put your baby in scratch mittens.

Q: At what stage could my baby survive outside of the womb?
A: Until relatively recently, babies born under 28 weeks' gestation often did not survive. Today, with medical advances in neonatal intensive care units (NICUs), babies of 22 weeks' gestation have survived outside the womb, although this is still very rare. The guidelines for most hospitals is that 24 weeks is the earliest point at which they will resuscitate a baby, unless the baby shows signs of life at birth.

Extremely premature babies have an increased risk of disability, even with the best medical care, and often the delivery itself can put an enormous strain on the baby.

Very experienced doctors and nurses will be involved in the care of extremely premature births. If possible, the delivery should take place in a hospital with a dedicated neonatal intensive care unit (NICU). If this is not possible, babies are often transferred to a special center when they are stable enough to be moved.

Because each day and week is a milestone for your baby, the closer to your due date you deliver, the better the chances for your baby.

Q: I like to rub my belly and talk to my baby as even now I feel like my baby is here—is this crazy?
A: No, this is perfectly normal and may be soothing for him since babies can determine their mother's voice in the womb and sometimes their heart rate decreases in response. However, I wouldn't recommend that you rub your belly too vigorously or too often since, in some cases, this can cause contractions and may trigger a premature labor if you are around 37 weeks' gestation.

Many women feel that the mother-child bond is there before the baby is born. It is good that you are having these positive thoughts during your pregnancy, since this is an excellent foundation for your future relationship with your baby.

Q: Can my baby see bright lights? I'm 32 weeks' pregnant.
A: A baby's eye structures begin to develop from as early as 4–5 weeks, with the eyelids forming at around 8 weeks and closing between 9 and 12 weeks. By 24 weeks, all of the eye structures are fully developed and at around 28 weeks, the eyelids start to open and shut. Although we tend to presume the uterus is dark, this is not so. Between 30 and 32 weeks, the baby experiences light and dark environments, depending on where the mother is and the time of day. It has even been reported in studies that not only do babies react to light, but have been seen on ultrasound scans turning toward or away from a light source. When a baby is born, he reacts to lights by frowning or blinking and can see to a distance of around 6–8 in (15–20 cm) (the same distance to mom's face from the breast!).
Q: Is it normal for babies to stop moving around so much toward the end of pregnancy?
A: Toward the end of pregnancy, your baby's range of movements may change since there is less room for him to extend his limbs and trunk. However, the frequency typically remains pretty constant, and you should still be aware of a regular pattern of movement. Over the last 30 years, women have been actively encouraged to count how much their babies kick. However, this practice of counting how many kicks a baby makes is not an accurate indication of whether the baby is well and each baby makes a different number of kicks. Nowadays, women are encouraged instead to tune in to their babies' pattern of activity, including the type of movement they make and the periods when they are most active. Studies have shown that over 50 percent of women who had a stillbirth noticed a change in the pattern of movement. The general advice is, if you are worried about your baby's movement pattern you should call to your doctor or midwife. A short period of heart rate monitoring may serve to reassure everyone.
Q: When will my baby's head engage?
A: Engagement, when your baby's head moves from higher in your abdomen down into your pelvis in preparation for the birth, can happen at any time from 36 weeks until the onset of labor . The head tends to engage earlier in a first pregnancy.
Q: Can my baby's position in the womb affect when his head engages?
A: A baby's position can affect how it engages into the pelvis. For example, if the baby is lying in a “back-to-back” position, with his back lying along the mother's back, this can make it more difficult for the baby's head to move through the pelvis. Similarly, if the baby is in a breech, feet first, position or a transverse position , then engagement will not be possible unless the baby moves and a cesarean delivery may be necessary.

It is thought that the mother's level of activity and the positions she adopts can influence the position of the baby in the womb. Nowadays, it is more common for babies to lie in a back-to-back position and it is thought that this may be due to people leading a more sedentary lifestyle. In the past, when women were possibly more active, perhaps performing tasks such as scrubbing the floor on their hands and knees, there was less incidence of this position.

Q: Will my baby develop much in the last month of pregnancy?
A: During the final month of pregnancy, your baby is busy preparing for birth. He will be practicing breathing movements and sucking, and will start to turn toward light. You may notice that there are fewer vigorous movements now—this is natural since there is less space within the uterus. However, you should still be noticing plenty of nudges and wriggles. The downy hair that covered your baby's body starts to disappear and the hair on the head and your baby's nails continue to grow. Meconium, the waste product that will be your baby's first poop, starts to form in the bowels at this time. During this last month, most of your baby's organs are fully mature and the lungs will continue to develop. “Full term” is considered to be from 37 weeks.
Q: I feel very emotional at times and am scared that I won't love my baby—is this normal?
A: The feelings you have are not uncommon. An increase in hormones during pregnancy can cause some extreme and deep feelings, some of which may seem strange and irrational. Pregnancy is a major life event and, as well as the physical changes that are going on in your body, the emotional pressures are vast. There may be a range of pressures that are adding to how you are feeling, such as relationship problems, financial pressures, caring for other children, lack of space in your house, or returning to work after the birth. It is fine if these are occasional feelings, but if you find that you are constantly snapping or crying, tired, having difficulty sleeping and eating, or sleeping and eating too much, are unable to concentrate, feel reluctant to leave the house, feel sad and anxious most of the time, or have developed obsessive thoughts, then you need to speak to your midwife or doctor for help and advice as these may be symptoms of depression.
Q: I've recently lost a parent and am very traumatized. Can stress affect my baby's development?
A: This is a major life-changing event and with the additional fluctuation in hormone levels and the physical changes that are occurring in pregnancy, you are obviously under a great deal of stress. However, it may be helpful to bear in mind that your body is designed to deal with episodes of stress.

There are studies that have suggested that women experiencing long-term stress may have an increased risk of preeclampsia and premature birth, although how reliable this evidence is has been questioned. It has also been suggested that there may be a link between extreme stress in pregnancy and children becoming hyperactive, but again this is inconclusive. The most important thing to do, now that you have recognized you may be at risk of long-term stress, is to speak to your doctor or midwife, particularly since there has been a recent increase in levels of support and treatment offered to pregnant and new mothers in your situation, which may help to limit any adverse effects of stress and depression.

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