Move Baby Move

Week 19

Estimated reading time: 15 min reads

Your baby may now be sucking a tiny thumb, shifting a little head or creating other diminutive movements that you may begin to sense. Your voice, speaking, humming and crooning, is the most pronounced sound your baby is now hearing.

Now your baby is acquiring a white, slippery, cheese-like covering called vernix caseosa. This layer will form over baby’s fine hair (lanugo) which now jackets the skin. Although the amniotic fluid which fills your baby’s uterine environment will protect your baby from bangs and bumps, the vernix caseosa aids in protecting the baby’s fragile skin from scrapes and chaffing that may occur from your baby’s immersion in this fluid.

Little kidneys continue working as urine is expelled into the amniotic environment holding your baby. The placenta, a major part of your baby’s life support system, is also busy working to eliminate these waste products from your baby’s surroundings. The vagina and uterus may begin developing in baby girls.

Your baby is about 6 inches long and the size of a shiny green zucchini.

Preeclampsia

One pregnancy complication affecting thousands of women and babies that has risen by twenty-five percent over the last twenty years is “Preeclampsia.” This serious medical problem affects 5%-8% of all pregnancies and 15% of these women develop HELLP (Hemolysis Elevated Liver enzymes and Low Platelets) Syndrome. Preeclampsia is a major source of maternal and infant illness and death. It usually occurs during the last half of pregnancy and rarely before Week 20; it may also strike in the postpartum period.

If this is your first pregnancy, the symptoms of nausea, vomiting and lower backache may be present. How do you distinguish these symptoms from the onset of preeclampsia? Early in your pregnancy speak with your health care team about preeclampsia as the symptoms of preeclampsia usually begin after Week 20. Your health care team may recommend the PreeclampsiaScreenSM l T1. This simple first-trimester blood test could help determine if you are at low or high risk for preeclampsia.

You may be at risk for developing preeclampsia if any of the following apply to your Personal History:

  1. First pregnancy.
  2. Obesity (BMI>30).
  3. African-American or Caribbean descent.
  4. Over 35 or under 20 years of age.
  5. High blood pressure before becoming pregnant.
  6. High blood pressure or preeclampsia in previous pregnancies.
  7. Diabetes before or during pregnancy.
  8. Kidney disease.
  9. A mother or sister who had preeclampsia.
  10. Multiple gestations (e.g., twins, triplets).
  11. Rheumatoid arthritis, lupus or other autoimmune disorders
  12. Some blood clotting disorders.
  13. Polycystic ovarian syndrome.
  14. In vitro fertilization.
  15. Sickle cell disease.

Or your Family History:

  1. Preeclampsia.
  2. High blood pressure or heart disease.
  3. Diabetes

Early Onset Preeclampsia is defined as preeclampsia resulting in the delivery of your baby before Week 34; babies delivered earlier than expected may face lifelong disabilities. Early onset preeclampsia may result in sudden health complications for mothers and escalate their risk for long-term cardiovascular disease. Women who have had preeclampsia have roughly double the risk for heart disease and stroke over the next five to 15 years of their lives. Early onset preeclampsia contributes more to the morbidity and mortality of pregnant moms and their babies than preeclampsia acquired late in pregnancy.

Preeclampsia is typically hallmarked by an increase in blood pressure and signs of damage to another organ system, most often the liver or kidneys. A significant level of protein in the urine (proteinuria) is no longer a criterion for diagnosing preeclampsia, and may ultimately delay diagnosis and treatment. Preeclampsia may be diagnosed without proteinuria when there are signs of damage to other organs.

Symptoms of preeclampsia may include, but are not limited to:

  1. High blood pressure.
  2. Weight gain of more than 5 pounds in one week.
  3. Edema with swelling in the face, hands and feet.
  4. Nausea and vomiting.
  5. Headache.
  6. Blurred or altered visual disturbances.
  7. Chest pain or shortness of breath.
  8. Low back pain.
  9. Pain in the upper right abdomen area.
  10. Shoulder pain.

Remember that even a slight rise in your blood pressure may be a sign of preeclampsia. Women whose blood pressure had been normal or women who already have naturally high blood pressure may begin to see a change, usually after Week 20. Make sure you are evaluated at every visit to ensure that you are not exhibiting any signs or symptoms of preeclampsia. Call your health care team if you experience any symptoms of preeclampsia for the first time. If you are unable to reach them, go to the ER or the L&D to be evaluated by a health care provider.

“The earlier you know, the earlier you and your doctor can take steps to prevent or delay the onset of preeclampsia.”

HELLP syndrome is a life-threatening pregnancy condition and considered a severe variant of preeclampsia. Approximately 45,000 women will develop HELLP syndrome in the United States every year. The physical symptoms of HELLP syndrome may appear to be preeclampsia; it may sometimes be mistaken for the flu or gall bladder problems. It may include one or all of the following:

  1. Abdominal or chest pain and right upper quadrant pain (from liver swelling).
  2. Nausea/vomiting/indigestion with pain after eating.
  3. Headaches that won’t go away, even after taking medication such as Tylenol.
  4. Shoulder pain or pain when breathing deeply.
  5. Bleeding.
  6. Changes in Vision: blurred, seeing double or flashing lights.
  7. Swelling of the face or hands.
  8. Shortness of breath: breathing with difficulty, gasping.

The only cure for preeclampsia begins with the delivery of your baby. Your health care team will take many factors into account to manage your preeclampsia such as when to deliver, gestational age, the health of you and your baby and a careful evaluation of how the disease is progressing. Ultrasounds may be essential to monitor your baby’s growth and medications may be indicated for you. Hospitalization may also be required as your symptoms may unexpectedly worsen necessitating the need for the careful and precise monitoring of both you and your baby.

preeclampsialogo Preeclampsia Foundations states: “When we urge women to trust themselves, we are referring to the intuitive feeling that preeclamptic women often have that “something is not right.” While these feelings may be nothing, it is important for women to report any concerns and for care providers to be diligent, particularly if accompanied by other signs or symptoms.”

If left untreated, preeclampsia can be dangerous and even fatal for both you and your baby. To ensure your and your baby’s wellbeing and to reduce bad outcomes from preeclampsia, it’s important to:

  1. Know the warning signs listed above.
  2. Trust yourself.
  3. Attend regular prenatal visits.
  4. Have a strong partnership with your health care team.
  5. If warning signs develop, call you health care team ASAP!

For further information regarding the signs, symptoms, care, treatment and how both preeclampsia and HELLP syndrome may affect you and your baby, please visit the Preeclampsia Foundation and the Mayo Clinic.

The Preeclampsia Registry is the first and only global collection of detailed patient-reported information for use by researchers! If you would like to be a part of the solution to help accelerate the discovery of the causes and options for prevention, diagnosis and treatment of preeclampsia, please visit The Preeclampsia Registry.

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Stillbirth

Stillbirth. A word noiselessly tucked away and believed to be almost nonexistent. Then surprisingly, an ultrasound is ordered. A baby is motionless; the heartbeat is absent. The devastation of stillbirth arrives crushing all.

Stillbirth is not a cause of death but rather a term indicating a baby has died in utero. The universal definition of stillbirth varies which makes the gathering, compiling, comparing and frequency of stillbirth data extremely difficult to attain. According to the Centers for Disease Control and Prevention (CDC), stillbirth refers to the loss of a baby of twenty or more weeks gestation before or during delivery. Approximately, one out of every 160 pregnancies tragically end in stillbirth in the United States; this rate is more than ten times the number of babies lost to Sudden Infant Death Syndrome (SIDS).

Stillbirth is categorized by the CDC as either “early, late, or term:

  • An early stillbirth is a fetal death occurring between 20 and 27 completed pregnancy weeks.
  • A late stillbirth occurs between 28 and 36 completed pregnancy weeks.
  • A term stillbirth occurs between 37 or more completed pregnancy weeks.”

Why Project Alive & Kicking (PAK)

The moms of Project Alive & Kicking (PAK) delivered their babies in silence in various parts of the county. Not one had considered stillbirth as even a remote possibility so it sounded feasible when reassured by their health care teams that stillbirth was a “rare and infrequent event.” As paths crossed and stories exchanged, a collective query evolved, “How can stillbirth be considered rare or infrequent when we have all lost our babies?”

The grim yet scientific realities of stillbirth began to surface. We learned that 26,000 babies were stillborn every year in the USA and this figure skyrockets to three million stillbirths globally. It was obvious these massive figures boasted of nothing “rare or infrequent;” they justifiably expose incomprehension and confusion.

Ignited by our new stillbirth reality, we quickly agreed that no one should ever have to experience our pain and isolate grief. The time had come to rein in stillbirth.

Marketing and Sales Coordinator, PAK’s Co-founder and President, Nicola Swanson lost her niece at 37 weeks due to an Umbilical Cord Accident (UCA). Her loss kindled a newfound passion for promoting pregnancy education and awareness for all expecting moms.

Now the mother of three, Nicola realizes that every woman’s pregnancy journey involves time, care, knowledge and determination. She stresses to all expecting moms that There’s More to Pregnancy Than You Think. Understanding yourself, your baby and every step of your shared journey is every mom’s daily responsibility.

PAK’s Roots

In 2012 Project Alive & Kicking (PAK), a 501(c)(3) nonprofit organization was officially established. Empowering moms and saving babies became PAK’s number one priority. In guiding PAK’s quest to bring the peril of stillbirth resulting from an UCA to light, a carefully watched 40-week gestational journey with mom in the driver’s seat began to unfold. Prenatal knowledge, a newfound awareness of pregnancy and the tools needed to help expectant moms become proactive with their gestational journeys emerged.

We then learned that approximately 1200 women in the USA will experience complications during pregnancy or childbirth that prove fatal every year, and another 60,000 women will endure complications that are near fatal. Enter Maternal Morbidity and Mortality. Immediately we realized that the risks of pregnancy and delivery day are hidden alongside stillbirth. The Moms need to know!

Writer, editor, former lawyer, PAK’s Co-founder and Vice President Yelda Basar Moers lost her full-term daughter Olivia to an UCA four days past her due date. Yelda noticed Olivia’s movements had slowed down and mentioned this to her doctor at her last office visit. She was reassured by his words, “That babies slow down their movements at the end of the pregnancy.”

Searching for answers in the days and months following the loss of Olivia, Yelda attended an International Conference on Stillbirth, SIDS and Infant Survival in Baltimore, Maryland. She knows that the stars must have been aligned when she met Stacy Crews and Connie Hosker. After hearing about Project Alive & Kicking, Yelda wanted to get involved and turn her loss into positive energy by strengthening and empowering all pregnant moms and saving their babies.

Reflecting on Olivia’s stillbirth, Yelda admits, “If I knew then that cord issues and fetal distress could cause babies to slow down their movements, I would have insisted that he (her doctor) check her umbilical cord, or I would have pushed for more testing, more monitoring.” Yelda is now a firm believer in listening to her body and “to her Inner Voice that is sometimes whispering and sometimes screaming.” She penned PAK’s mission:

To empower expectant mothers by educating them about healthy pregnancies, fostering an awareness of their babies’ daily fetal movements, and the action they can take to help their babies come into the world thriving, alive and kicking.

PAK is here to help every mom have an amazing, fabulous, empowered pregnancy; and end stillbirth. Thanks to the Internet and social media, expecting moms are becoming inspired, knowledgeable and savvy. They are beginning to realize that stillbirth is a possible reality of pregnancy and they desperately want to keep themselves well while keeping their babies’ safe in utero.

Litigation Paralegal, PAK’s Co-founder and Chief Operating Officer Sarah Hosker was in London completing a study-abroad program when she learned of the death of her niece less than a month before her due date due to an UCA. This loss stirred her interest in raising pregnancy awareness.

Sarah’s knowledge of social media together with her love of reading and creativity were the perfect mix for her immersion in PAK. Sparking into every avenue of social media, PAK’s tagline “My Empowered Pregnancy” and mobile app, ME Preg became PAK’s pledge to every mom for a safe and healthy pregnancy.

The Causes

Babies are lost to stillbirth not only from the Umbilical Cord, but also from Group B Strep (GBS), Intrahepatic Cholestasis of Pregnancy (ICP), Preeclampsia and Gestational Diabetes to name a few. The CDC cites three broad categories contributing to stillbirth:

  • Problems with the baby (birth defects or genetic problems).
  • Problems with the placenta or umbilical cord (this is where the mother and baby exchange oxygen and nutrients).
  • Certain conditions in the mother (for example, uncontrolled diabetes, high blood pressure, or obesity).

No race, income level, age group or ethnicity is immune to stillbirth. Although the causes of many stillbirths are unexplained or unknown, there are additional maternal risk factorsthat may increase the likelihood of stillbirth. Thesefactors may not only increase the risk for a stillbirth but are also linked to serious pregnancy outcomes such as preterm birth. They include:

  • Being of black race
  • Being a teenager
  • Being 35 years of age or older
  • Being unmarried
  • Being obese
  • Smoking cigarettes during pregnancy
  • Having certain medical conditions, such as high blood pressure or diabetes
  • Having multiple pregnancies
  • Having had a previous pregnancy loss

Certified Financial Planner, PAK’s Co-founder and Secretary Stacy Crews, lost her full-term daughter Carly Elizabeth at 38-weeks gestation to an UCA. We all know that Christmas time is a hectic time of year for all moms with little ones in school. Stacy was busy all day with her son’s school Christmas party and that evening reflecting on the day thought to herself, “Wow, she sure has been quiet.” Later she headed to L&D to be checked. “I clearly remember thinking that the hospital staff was going to laugh at me and call me crazy for coming in. I’m eight months along with a textbook pregnancy. People don’t just lose healthy babies at that stage of their pregnancy. I passed the 12-week mark a long time ago! The thought that she could die absolutely never crossed my mind. At that time, I didn’t even know that women lost babies this late in pregnancy, especially healthy babies.”

Stacy is a founding member of PAK believing in their mission to educate and empower pregnant moms. She learned that not every pregnancy works out as planned. We need to work proactively to allow our babies the best outcome at birth and, “WE ONLY GET ONE SHOT AT THIS!” Stacy sums up her thoughts, “PAK is dedicated and motivated to provide the kind of education that pregnant moms need in a way that no other organization or website I know of can.”

The Loss 

For most expectant moms, a healthy delivery day is the eagerly awaited outcome. However, one percent of all moms globally will endure the desolation and agony of their babies being stillborn. The passage of a stillbirth mom is fraught with heartache and grief of the most profound kind. Please remember that numerous stillbirth moms were never considered “high risk.” They were healthy, happy, walking encyclopedias’ of pregnancy know how!

So, is it likely you will encounter a woman who will deliver a stillborn baby at some point in your lifetime? Yes.

The Yes 

In most cases of stillbirth, mom will notice a decrease in fetal movement, or an unusual level of activity for her baby (an increase or decrease in fetal movement), or sudden changes in fetal movement. She may also suddenly realize that her baby is not moving; she cannot needle her baby to give a kick or a punch. After calling her health care team she visits their office or goes to Labor & Delivery (L&D). An ultrasound is ordered. A baby is motionless; the heartbeat is absent. The devastation of stillbirth arrives crushing all.

Because of stillbirth’s profound odds, being familiar with the steps to navigate the loss will provide comfort and peace in the days ahead for all concerned.

If stillbirth happens prior to delivery, mom’s health care provider may induce labor or perform a Cesarean section (c-section) to deliver her baby. In some cases, mom may wait and go into labor on her own, which may happen within two weeks of her baby being stillborn.

If mom is a religious or spiritual person, she may wish for someone in her family to contact her religious affiliation. If none is known but a religious presence is requested, most hospitals have a chaplain who will provide this essential support before or following delivery. The nursing staff will be able to assist with this need.

 

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