CMV

Cytomegalovirus (CMV) is a common virus that is part of the herpes family of viruses. 
It causes few symptoms in most people. If you do experience symptoms, these may be similar to flu or glandular fever and include a high temperature (fever), a sore throat and swollen glands.
Many people are first infected with CMV as a child and do not even know they have been infected. However CMV can be caught at any age. Once you have been infected by CMV, the virus stays in your body for the rest of your life, but does not usually cause further problems.
However, CMV can sometimes recur, which can be a problem if you have a weakened immune system, due to chemotherapy for example. If this happens, the virus can affect your organs and cause problems such as ulcers, vision problems and pneumonia.
CMV can also cause serious problems if a woman has her first CMV infection during pregnancy as the infection can spread to the unborn baby (known as congenital CMV).
It is estimated that 1-2 babies in every 200 will be born with congenital CMV in the UK. Of these, only about 10% will have problems, but they can be serious and include things such as hearing loss and learning difficulties.

How does CMV spread?

CMV is spread through bodily fluids, such as saliva and urine. It can be passed on through close contact with young children, such as changing nappies, or can be spread from one person to another when kissing or having sex.

Can CMV be prevented?

It is not always possible to prevent the spread of CMV and most people don't need to worry about being infected, as the infection is usually mild.
You can reduce your chances of developing an infection by practising good hygiene, such as regularly washing your hands with warm water and soap. This is especially important after changing nappies.
If you have a weakened immune system, you can take further steps to reduce your chances of infection, including taking extra care washing yourself, your clothes and your bed linen regularly.
Possible vaccines for the condition are currently being researched, but will probably not become publicly available for several years.

Treating a CMV infection

As CMV causes no symptoms in most people it is not usually diagnosed. If you are at risk of complications, a blood test can determine if you have ever had CMV or if you have recently caught it for the first time. Blood, urine and saliva swab tests can be used to determine if a newborn baby has congenital CMV.
Most CMV infections are not treated. However, if you have mild symptoms, painkillers can help reduce any fever or pain.
CMV that has recurred in someone with a weakened immune system is usually treated with antiviral medicines, which slow the spread of the virus. In some cases, it may be necessary to be treated in hospital. 
Some babies with congenital CMV may also receive antiviral treatment.

fertility

Fertility tests

If you've tried unsuccessfully to get pregnant for a year or more through regular unprotected sex, it’s time to see your GP. If you're a woman over 35, or if you think that either partner may have a fertility problem, see your GP after six months of trying. A fertility problem could be because you've had surgery that may have affected your reproductive organs, or because you've had a sexually transmitted infection (STI), such as chlamydia, that may have damaged your fertility.
Many couples with fertility problems go on to conceive, with or without fertility treatment.

What to expect

If you make an appointment to see your GP because you're having trouble becoming pregnant, they will ask how long you’ve been trying. If it's been less than a year or you haven’t been having unprotected sex regularly, and there is no reason to suspect you may have a fertility problem, your GP may recommend you keep trying for a while to see if you conceive naturally. Having regular sex means having sex every two or three days throughout the month. You can find out more about maximising your chances of getting pregnant.

If you've been having regular unprotected sex for more than a year, your GP may recommend a range of tests to determine what's stopping you from conceiving.

Fertility tests

This page lists some of the most common initial fertility tests. Your GP can refer you for these tests, which will usually happen in hospital or at a fertility clinic.

Sperm test

In about one-third of cases, fertility problems are due to the male partner. Sometimes, a lack of sperm or sperm that are not moving properly can cause a failure to conceive. Your GP can arrange a sperm test. The male partner will be asked to produce a sperm sample and take it for analysis, probably at your local hospital.

Blood tests to check ovulation

Levels of hormones in a woman's blood are closely linked to ovulation, when the ovaries release an egg into the fallopian tubes. Hormone imbalances can cause ovulation problems, and a blood test can help determine whether this is happening. Going through a phase of not having periods, or having irregular periods, are also signs of ovulation problems. The most common cause of ovulation problems is polycystic ovary syndrome.

Test for chlamydia

Chlamydia is the most common STI in the UK. It can cause pelvic inflammatory disease and fertility problems. Your GP can refer you for a test for chlamydia. This can be a urine test or a swab from the urethra (the tube from which urine passes) or the neck of the cervix.

Ultrasound scan

An ultrasound scan can be carried out to check the woman's ovaries, womb and fallopian tubes. In a transvaginal ultrasound scan, which takes place in hospital, a small ultrasound probe is placed in the vagina. This scan can help doctors check the health of your ovaries and womb. Certain conditions that can affect the womb, such as endometriosis and fibroids, can prevent pregnancy from occurring. The scan can also check for blockages in your fallopian tubes (the tubes that connect the ovaries and the womb), which may be stopping eggs from travelling along the tubes and into the womb. The Human Fertilisation & Embryology Authority (HFEA) estimates that around one-third of women with fertility problems have blocked or damaged fallopian tubes.

X-ray of fallopian tubes

This is called a hysterosalpingogram (HSG). Opaque dye is injected through the cervix while you have an X-ray. The dye will help your doctors to see if there are any blockages in your fallopian tubes. Blockages can prevent eggs passing down the tubes to the womb, and so stop pregnancy occurring. Find out more about testing for and diagnosing infertility problems.

What's next?

In around 80% of cases of persistent failure to become pregnant, these tests will uncover a cause. In the remaining 20% of cases, no clear cause can be found.
Whether or not a clear cause is found, your GP can talk you through the next steps. This may include referral to a fertility clinic for further investigation or treatment. 

bleeding in pregnancy

Bleeding during pregnancy is relatively common. However, bleeding from the vagina at any time in pregnancy can be a dangerous sign, and you should always contact your midwife or GP immediately if it happens to you. Bleeding is not often caused by something serious, but it’s very important to make sure and to find out the cause straight away.
In early pregnancy you might get some light bleeding, called ‘spotting’, when the foetus plants itself in the wall of your womb. This is also known as implantation bleeding, and often happens around the time that your first period after conception would have been due.

Causes of bleeding

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy (when the foetus implants outside the womb, often in the fallopian tube). However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.

Miscarriage

If a pregnancy ends before the 24th week of pregnancy, it’s called a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way. Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can be other causes of miscarriage, such as hormone or blood-clotting problems.

Most miscarriages occur during the first 12 weeks (three months) of pregnancy and, sadly, most cannot be prevented. Find out more about symptoms of miscarriage.

Ectopic pregnancy

Ectopic pregnancies are less common than miscarriages, and affect approximately one in 100 pregnancies. Bleeding may be a sign of ectopic pregnancy, when a fertilised egg implants outside the womb, for example in the fallopian tube. The fertilised egg can’t develop properly and your health may be at serious risk if the pregnancy continues. The egg has to be removed – this can be through an operation or medicines. Find out more about symptoms of ectopic pregnancy.
In the later stages of pregnancy, vaginal bleeding can have many different causes. Some of the most common are:

Changes in the cervix

The cells on the cervix often change in pregnancy and make it more likely to bleed, particularly after sex. These cell changes are harmless, and are called cervical ectropion. Vaginal infections can also cause a small amount of vaginal bleeding.

A ‘show’

The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus that is known as a ‘show’. This occurs when the plug of mucus that has sealed the cervix during pregnancy comes away. This is a sign that the cervix is changing and becoming ready for labour to start. It may happen a few days before contractions start or during labour itself. Find out about signs of labour and what happens.

Placental abruption

This is a serious condition in which the placenta starts to come away from the inside of the womb wall. Placental abruption usually causes stomach pain, even if there is no bleeding. If it happens close to the baby’s due date, your baby may be delivered early.

Placenta praevia

Low-lying placenta (or placenta praevia) is when the placenta is attached in the lower part of the womb, near to or covering the cervix. This can block your baby’s path out of your body.
The position of your placenta is recorded at your anomaly scan.
If the placenta is still low in the womb, there is a higher chance that you could bleed during your pregnancy or at the time of the birth. This bleeding can be very heavy and put you and your baby at risk. You may be advised to come into hospital at the end of your pregnancy so that you can be given emergency treatment very quickly if you do bleed.
If the placenta is near the cervix or covering it, the baby cannot get past it to be born vaginally, and a caesarean will be recommended.
The Royal College of Obstetricians and Gynaecologists (RCOG) has more information on placenta praevia.

Vasa praevia

Vasa praevia is a rare condition, occurring in about one in 3,000 to one in 6,000 births. It occurs when the blood vessels of the umbilical cord run through the membranes covering the cervix. Normally the blood vessels would be protected within the umbilical cord. When the membranes rupture and your waters break, these vessels may be torn and this can cause vaginal bleeding. The baby can lose a life-threatening amount of blood and die.
It is very difficult to diagnose vasa praevia, but it may occasionally be spotted before birth by an ultrasound scan. Vasa praevia should be suspected if there is bleeding and the baby’s heart rate changes suddenly after the rupture of the membranes. It is linked with placenta praevia.

Finding out the cause of bleeding

To work out what is causing bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels. Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness.
If your symptoms are not severe and your baby is not due for a while, you will be monitored and, in some cases, kept in hospital for observation. You might have to stay in overnight, or until the birth, depending on the cause of the bleeding and how many weeks pregnant you are. This will enable staff to keep an eye on you and your baby so that they can act quickly if there are any further problems

sickness

What can I do to help relieve sickness and vomiting?

In most cases, as the symptoms are often mild, no specific treatment is needed. However, there are certain things that you may like to try to help relieve your symptoms. They include the following:

• Eating small but frequent meals may help. Foods high in carbohydrate are best, such as bread, crackers, etc. Some people say that sickness is made worse by not eating anything at all. If you eat some food regularly, it may help to ease symptoms. Eating a plain (or ginger) biscuit about 20 minutes before getting up is said by some women to help. Cold meals may be better if nausea is associated with food smells.
• Ginger. Some studies have shown that taking ginger tablets or syrup may be effective for relieving nausea and vomiting in pregnancy. However, care should be taken, as the quality of ginger products varies and they are not closely regulated in the UK. Before you take a ginger product, you should discuss this with a pharmacist or your GP.
• Avoiding triggers. Some women find that a trigger can set off the sickness. For example, a smell or emotional stress. If possible, avoid anything that may trigger your symptoms.
• Having lots to drink to avoid low body fluid (dehydration) may help. Drinking little and often rather than large amounts may help to prevent vomiting. Try to aim to drink at least two litres a day. Water is probably the best drink if you are feeling sick. Cold and sweet drinks can sometimes make symptoms worse in some people.
• Rest. Make sure that you have plenty of rest and sleep in early pregnancy. Being tired is thought to make nausea and vomiting during pregnancy worse.
• Acupressure. Some studies have shown that P6 (wrist) acupressure may be effective for relieving nausea and vomiting in pregnancy. Acupressure is the application of pressure only and does not need needles.

miscarriage

How common is miscarriage?

The charity Tommy's estimates one in four women experiences miscarriage at some point, and one in five pregnancies ends in this way.
The most common time for a miscarriage is in the first 13 weeks. This is termed an 'early' miscarriage.

What causes miscarriage?

Because miscarriage is common and most women go on to have a normal pregnancy later, a cause isn't usually sought until a woman has suffered three. Then tests may be done, including examination of tissue samples from the miscarried foetus.
However, it's thought that most miscarriages are the result of a genetic abnormality in the embryo or foetus.
Half of all early miscarriages are caused by a chance abnormality that's unlikely to happen again. Some genetic abnormalities, however, are inherited. If you have repeated miscarriages, this would be investigated as a possible cause.
Other less common causes of miscarriage include:

• Abnormal hormone levels - can affect the body's ability to nurture a pregnancy.
• Problems with the cervix - if it opens too soon it can lead to late miscarriage.
• Problems with the uterus - it may be unusually shaped, divided in two by a thin membrane or there may be fibroids, all of which can restrict space for the foetus.
• Blood clotting disorders - blood flow affects the way early pregnancy is nourished and, later, how the placenta safeguards the foetus.
• Infection - blood infections and food poisoning, such as listeria, can (very rarely) lead to miscarriage.

Other problems that can lead to the end of the pregnancy include:

• Blighted ovum - pregnancy hormones make your periods stop because an egg is fertilised and a sac develops, but the fertilised egg doesn't grow any further (also known as 'anembryionic pregnancy' or pregnancy without an embryo).

• Molar pregnancy - the trophoblast (which would become the placenta) becomes a mass of fluid-filled cells. There may be no embryo, or only the early signs of one. This is very unusual and requires careful monitoring as rarely a molar pregnancy can lead to a cancerous tumour.

• Ectopic pregnancy - the foetus starts to develop outside the womb, usually in one of the fallopian tubes. Symptoms include pain, fatigue and possibly bleeding. Surgery is required to end the pregnancy and prevent further complications

Who's at risk of miscarriage?

Although the reason for most early miscarriages isn't understood, you're at higher risk if you're older, have had fertility problems or previous miscarriages, if you're significantly underweight or overweight, if your partner's older, or if you drink alcohol regularly or in large amounts, or if who smoke.
One in four women who becomes pregnant will experience at least one miscarriage and some lose many babies (about one in 100 women suffers recurrent miscarriages).
Many more pregnancies are lost at such an early stage that the mother doesn't even realise she's pregnant. In fact, one estimate suggests 60 per cent of all conceptions, or potential pregnancies, are lost.
Working during pregnancy isn't relevant. A healthy diet appears to lower risk.

Symptoms of miscarriage

A woman experiencing a miscarriage may have any or all of the following symptoms:

• pain, caused by the contractions of the uterus
• bleeding from the vagina
• leaking of amniotic fluid (only happens in later miscarriages)

When the miscarriage takes place, the foetus is lost through the vagina, along with the placenta and membranes.
Occasionally, a 'missed' or 'delayed' miscarriage occurs. This is when the foetus dies but doesn't leave the womb. This may only show up during a routine scan.

Treatment of miscarriage

If you suspect you're about to have a miscarriage, speak to your doctor or midwife as soon as possible.
If you do miscarry, or know for certain a miscarriage is occurring, you may need to go into hospital to ensure all the pregnancy has come away. This is called 'evacuation of retained products of conception' and is done under general anaesthetic.
With a late miscarriage, you may be given medication to start labour or you can discuss letting nature take its course without inducing labour.

Recovering after a miscarriage

Physical recovery can take a few days. You'll probably start your periods again after four to six weeks.
Your emotional response will be individual to you and you may have a range of feelings. Fathers also grieve after pregnancy loss and may need space for their own feelings.
After a recently published study there has been some debate about when to start trying again, but the general consensus among specialists is still that, as long as you are emotionally ready, for most women there's no physical reason to wait before conceiving again. You may need time and space to come to terms with the emotional effects of the miscarriage. Talk to your GP if you are unsure.

Pregnancy after a miscarriage

If the miscarriage was caused by hormonal or blood-clotting problems, you may be given medication to help prevent this happening again. If there was a problem with the cervix opening too soon, a stitch ('cervical cerclage') may be put in place to keep it closed.
If the miscarriage appears to have happened by chance - even if you've had two - your GP may just reassure you and tell you to try again.
If it looks like there may be an identifiable cause, or you've had more than two or three miscarriages, you may be referred for investigations.
Statistics show that even after three or four miscarriages the chances of a successful pregnancy are still higher than a further miscarriage.

Could I have prevented my miscarriage?

Miscarriage is almost always something that's outside your control. Your doctor may be able to reassure you about this. Don't blame yourself for something you couldn't prevent.

YOU ....... week by week

at 0-8 weeks pregnant

Your pregnancy is dated from the first day of your last period, although conception usually takes place about two weeks after that, around the time that you ovulate (release an egg). In the first four weeks of pregnancy you probably won’t notice any symptoms. The first thing most women notice is that their period doesn’t arrive. Find out about the signs and symptoms of pregnancy.
By the time you are eight weeks pregnant you will probably have missed your second period, although a little bleeding occasionally occurs around the time you are six, seven or eight weeks pregnant. Always mention any bleeding in pregnancy to your midwife or GP, particularly if it continues and you get stomach pain.
Your womb has grown to the size of an apple by the time you are around seven or eight weeks pregnant. You’re probably feeling exhausted. Your breasts might feel sore and enlarged, and you are probably needing to urinate more often than usual.
Some pregnant women start to feel sick or tired or have other minor physical problems for a few weeks around this time. Most women stop having morning sickness and start to feel better by the time they are around 14 weeks pregnant

at 9-12 weeks pregnant

During this time your breasts will have got bigger, so consider wearing a supportive bra. You may also find that your emotions vary: you feel happy one moment and sad the next. Don’t worry – these feelings are normal and should settle down. You can find out more about feelings, worries and relationships in pregnancy.
If you haven't seen your midwife yet, contact your GP or maternity team for your booking appointment and to start your antenatal care. This appointment should take place by the time you are 12 weeks pregnant. You may be offered your first ultrasound scan when you’re between eight and 14 weeks pregnant: this can vary depending on where you live.

at 13-16 weeks pregnant

If you've been feeling sick and tired with morning sickness, you’ll probably start to feel better when you're around 13 or 14 weeks pregnant.
Some women start to feel sexy around this time, possibly due to pregnancy hormones or increased blood flow to the pelvic area. Some women don’t, and this is perfectly normal. You can find out more about sex in pregnancy.
You’ll notice a small bump developing as your womb grows and moves upwards. If you've been feeling the urge to urinate more often over the last few months, it’s because your womb was pressing on your bladder. This should ease off now.
See your doctor if you notice any pain when you urinate. Urinary infections can happen in pregnancy and it’s important to treat them quickly to reduce the risk of kidney infections

at 17-20 weeks pregnant

At 20 weeks pregnant, you're halfway through your pregnancy. You will probably feel your baby move for the first time when you're around 17 or 18 weeks pregnant. Most first-time mums notice the first movements when they are between 18 and 20 weeks pregnant. At first you feel a fluttering or bubbling, or a very slight shifting movement, maybe a bit like indigestion. Later, you can’t mistake the movements and you can even see the baby kicking about. Often you can guess which bump is a hand or a foot and so on.
You may develop a dark line down the middle of your tummy and chest. This is normal skin pigmentation as your tummy expands to accommodate your growing bump. Normal hair loss slows down, so your hair may look thicker and shinier.
You’ll be offered an anomaly scan when you are 18 to 20 weeks pregnant – this is to check for abnormalities in the baby. Your midwife or doctor can give you information about this and answer any questions. You can find out more about screening for foetal abnormality.
Common minor problems can include tiredness and lack of sleep. Sleeplessness is common, but there is plenty you can do to help you sleep including using pillows to support your growing bump. Some women also get headaches. Headaches in pregnancy are common, but if they’re severe they could be a sign of something serious.

at 21-24 weeks pregnant

 

Your womb will begin to get bigger more quickly and you will really begin to look pregnant. You may feel hungrier than before – try to stick to a sensible, balanced diet, and make sure you know what foods to avoid.
Not everybody gets stretch marks, but if you do develop them they will probably start becoming noticeable when you’re around 22 to 24 weeks pregnant. They may appear on your stomach, breasts and thighs. At first they look red and then fade to a silvery grey. Your breasts may start to leak a little pre-milk, and this is normal.

at 25-28 weeks pregnant

You may get indigestion or heartburn, and it might be hard to eat large meals as your baby grows and takes up some of the space where your stomach normally is. You may also find you are quite often getting tired.
You may have swollen face, hands or feet. This might be caused by water retention, which is normal (try resting and lifting up your swollen feet to ease it). Be sure to mention any swelling to your midwife or GP so that they can take your blood pressure and rule out a condition called pre-eclampsia, which can cause swelling.

at 29-32 weeks pregnant

As your bump pushes up against your lungs and you have extra weight to carry around, you may feel breathless.
Leg cramp at night is common around 29 to 32 weeks pregnant. You may find it hard to sleep because you can’t get comfortable. Try lying curled up on your side with a pillow between your legs and a cushion under your bump to see if it feels more comfortable. You might find you need to urinate a lot as well. You can find out about more common pregnancy health problems.
When you are 31 weeks pregnant, if this is your first baby, your midwife or GP should measure the size of your womb and check which way up the baby is. They will measure your blood pressure, test your urine for protein and discuss the results of any screening tests from your last appointment.

at 33-36 weeks pregnant

You need to slow down because the extra weight will make you tired, and you may get backache.
From about 34 weeks pregnant, you may be aware of your womb tightening from time to time. These are practice contractions known as Braxton Hicks contractions, and are a normal part of pregnancy. It’s only when they become painful or frequent that you need to contact your midwife or hospital.
Only around 5% of babies arrive on their due date. You can find out more about labour signs and what happens in labour.
If you have children already, you may want to make childcare arrangements for when you go into labour. Pack your bag ready for the birth if you are planning to give birth in hospital or a midwifery unit.
When you are around 36 weeks pregnant, make sure you have all your important telephone numbers handy in case labour starts.

at 37-40 weeks pregnant

When you are around 37 weeks pregnant, if it’s your first pregnancy, you may feel more comfortable as your baby moves down ready to be born, although you will probably feel increased pressure in your lower abdomen. If it’s not your first pregnancy, the baby may not move down until labour.
Most women will go into labour when they are 38 to 42 weeks pregnant. Your midwife or doctor should give you information about your options if you go to more than 41 weeks pregnant.
Call your hospital or midwife at any time if you have any worries about your baby or about labour and birth.

 

 

 

 

BABY ....... pregnancy week by week

your baby at 0-8 weeks pregnant

Three weeks after the first day of your last menstrual period, your fertilised egg moves slowly along the fallopian tube towards the womb. The egg begins as one single cell. Early on this cell divides again and again. By the time the egg reaches the womb, it has become a mass of more than 100 cells called an embryo, and is still growing. Once in the womb, the embryo burrows into the womb lining. This is called implantation.
In weeks four to five of early pregnancy, the embryo settles into the womb lining. The outer cells reach out like roots to link with the mother’s blood supply. The inner cells form into two and then later into three layers. Each of these layers will grow to be different parts of the baby’s body. One layer becomes the lungs, stomach and gut. Another becomes the heart, blood, muscles and bones.
The fifth week of pregnancy is the time of the first missed period, when most women are only just beginning to think they may be pregnant. Yet already the baby’s nervous system is starting to develop. A groove forms in the top layer of cells. The cells fold up and around to make a hollow tube called the neural tube. This will become the baby’s brain and spinal cord, so the tube has a "head end" and a "tail end". Defects in this tube are the cause of spina bifida.
At the same time, the heart is forming and the baby already has some of its own blood vessels. A string of these blood vessels connects the baby and mother and will become the umbilical cord.
By the time you are six to seven weeks pregnant, there is a large bulge where the heart is and a bump for the head because the brain is developing. The heart begins to beat and can be seen beating on an ultrasound scan. Dimples on the side of the head will become the ears, and there are thickenings where the eyes will be. On the body, bumps are forming that will become muscles and bones, and small swellings called limb buds show where the arms and legs are growing. At seven weeks, the embryo has grown to about 10mm long from head to bottom. This measurement is called the "crown-rump length".

your baby at 9-12 weeks pregnant

From the time you’re about eight weeks pregnant the baby is called a foetus, which means "offspring". By now the face is slowly forming. The eyes are more obvious and have some colour in them. There is a mouth and tongue. There are now the beginnings of hands and feet, with ridges where the fingers and toes will be. The major internal organs are all developing, such as the heart, brain, lungs, kidneys and gut.
At nine weeks of pregnancy, the baby has grown to about 22mm long from head to bottom. Just 12 weeks after conception, the foetus is fully formed. All its organs, muscles, limbs and bones are in place, and the sex organs are well developed. From now on, it has to grow and mature. The baby is already moving about but its movements can’t be felt yet.

your baby at 13-16 weeks pregnant

By about 14 weeks the heartbeat is strong and can be heard using an ultrasound detector. The heartbeat is very fast; about twice as fast as a normal adult’s heartbeat. At 14 weeks, the baby is about 85mm long from head to bottom.

your baby at 17-20 weeks pregnant

By the time you're 17 weeks pregnant, your baby is growing quickly. The body grows bigger so that the head and body are more in proportion and the baby doesn’t look as "top heavy". The face begins to look much more human, and the hair is beginning to grow along with the eyebrows and eyelashes. The lines on the skin of the fingers are now formed, so the baby already has his or her own individual fingerprints. Fingernails and toenails are growing and the baby has a firm hand grip.

your baby at 21-24 weeks pregnant

When you are around 22 weeks pregnant the baby becomes covered in a very fine, soft hair called lanugo. The purpose of this isn’t known, but it’s thought that it may be to keep the baby at the right temperature. The lanugo disappears before birth, though sometimes just a little is left and disappears later.
When you are 24 weeks pregnant, the baby has a chance of survival if he or she is born. Most babies born before this time cannot live because their lungs and other vital organs are not developed enough. The care that can now be given in neonatal (baby) units means that more and more babies born early do survive. But for babies born at around this time there are increased risks of disability

your baby at 25-28 weeks pregnant

By the time you are 25 or 26 weeks pregnant the baby is moving about vigorously and responds to touch and sound. A very loud noise may make her or him jump and kick. Your baby is also swallowing small amounts of the amniotic fluid in which it is floating and passing tiny amounts of urine back into the fluid. Sometimes the baby may get hiccups and you can feel the jerk of each hiccup.
When you are around 26 weeks pregnant the baby’s eyelids open for the first time. The eyes are almost always blue or dark blue, although some babies do have brown eyes at birth. It’s not until some weeks after the birth that your baby’s eyes become the colour that they will stay. You can find out more about your baby after the birth.
When you are 28 weeks pregnant, the baby will be perfectly formed but still quite small. The baby may also begin to follow a pattern for waking and sleeping. Very often this is a different pattern from yours, so when you go to bed at night, the baby may wake up and start kicking. The baby’s heartbeat can now be heard through a stethoscope. Your partner may even be able to hear it by putting an ear to your abdomen, but it can be difficult to find the right place.
The baby is now covered in a white, greasy substance called vernix. It is thought that this protects the baby’s skin as it floats in the amniotic fluid. The vernix mostly disappears before the birth.

your baby at 29-32 weeks pregnant

When you're 30 weeks pregnant the baby’s head-to-bottom length is about 33cm. The baby is growing plumper so the skin, which was quite wrinkled before, is now smoother. The white, greasy vernix and the soft, furry lanugo (fine hair) begin to disappear. By about 32 weeks the baby is usually lying with her or his head pointing downwards, ready for birth.

your baby at 33-36 weeks pregnant

By 33 weeks of pregnancy the baby’s brain and nervous system are fully developed. Your baby's bones are also starting to harden, even though the skull bones will stay soft and separated to make the journey through the birth canal (cervix and vagina) easier. Baby boys’ testicles are now beginning to descend from the abdomen into the scrotum

your baby at 37-40 weeks pregnant

In these last weeks, some time before birth, the baby’s head may move down into your pelvis and is said to be ‘engaged’. Sometimes the baby’s head doesn’t engage until labour has started. The amniotic fluid now turns into waste, called meconium, in the baby’s intestines, and the soft hair (lanugo) that covered your baby’s body is now almost all gone.

If your baby is overdue

Pregnancy normally lasts about 40 weeks (that's around 280 days from the first day of your last period). Most women go into labour a week either side of this date, but some women go overdue.
If your labour doesn't start by the time you are 41 weeks pregnant, your midwife will offer you a 'membrane sweep'. This involves having a vaginal (internal) examination that stimulates the cervix (neck of your womb) to produce hormones that may trigger natural labour. You don't have to have this – you can discuss it with your midwife.

If your labour still doesn't start naturally after this, your midwife or doctor will suggest a date to have your labour induced (started off).
If you don't want your labour to be induced and your pregnancy continues to 42 weeks or beyond, you and your baby will be monitored.
Your midwife or doctor will check that both you and your baby are healthy by offering you ultrasound scans and checking your baby's movement and heartbeat. If there are any concerns about your baby, your doctor will suggest that labour is induced.
Induction is always planned in advance, so you'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not.

Over 42 weeks pregnant

Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.
There is a higher risk of stillbirth if you go over 42 weeks pregnant, although most babies remain healthy. At the moment there is no way to reliably predict which babies are at increased risk of stillbirth, so induction is offered to all women who don't go into labour by 42 weeks.
Having induction of labour after the date your baby is due does not increase the chance (risk) of caesarean section. There is some evidence that it may slightly reduce the chance of having a caesarean section.

 around 14 weeks pregnant.

expressing breast milk

Expressing breast milk

Expressing milk means squeezing milk out of your breast so that you can store it and feed it to your baby at a later time.
You might want to express milk if you have to be away from your baby. This could be because your baby is ill or premature, or because you’re going back to work. You may want to express milk if your breasts feel uncomfortably full or if your baby isn’t sucking well but you still want to give them breast milk. You may also want to express some breast milk to use with your baby's first solid foods.

How do I do it?

You can express milk by hand or with a breast pump. Different pumps suit different women, so ask for advice or see if you can try one before you buy it. Always make sure that the container or pump is clean and has been sterilised before you use it.

Expressing by hand

You may find it easier to express milk by hand than to use a pump, especially in the first few days. It also means you won't have to buy or borrow a pump.
The following suggestions may help:
Before you start, wash your hands thoroughly with soap and warm water, and gently massage your breast.

Cup your breast just behind your areola (the darker part of your breast).
Squeeze gently, using your thumb and the rest of your fingers in a C shape. This shouldn’t hurt (don't squeeze the nipple directly as you’ll make it sore and unable to express).
Release the pressure then repeat, building up a rhythm. Try not to slide your fingers over the skin. At first, only drops will appear, but keep going as this will help to build up your milk supply. With practice and a little time, milk may flow freely.
When no more drops come out, move your fingers round and try a different section of your breast, and repeat.
When the flow slows down, swap to the other breast. Keep changing breasts until the milk drips very slowly or stops altogether.
If the milk doesn’t flow, try moving your fingers slightly towards the nipple or further away, or give the breast a gentle massage.
Hold a sterilised feeding bottle or container below your breast to catch the milk as it flows.

Cup feeding

Sometimes your baby may need extra milk or find it hard to feed from your breast. In this case, your midwife may suggest that you give your baby some expressed milk in a cup.
This should be done under the supervision of a midwife until you feel confident enough to avoid the risk of your baby choking.

Storing breast milk

You can store breast milk in a sterilised container:

• in the fridge for up to five days at 4°C or lower
• for two weeks in the ice compartment of a fridge
• for up to six months in a freezer

Breast milk must always be stored in a sterilised container. If you use a pump, always sterilise it before and after use.
See Sterilising bottles for more information.

Defrosting frozen breast milk

If you have frozen your milk, defrost it in the fridge before giving it to your baby. Once it’s defrosted, use it straight away. Milk that's been frozen is still good for your baby and better than formula milk. Don't re-freeze milk once it's thawed.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by placing the bottle in lukewarm water.
Don’t use a microwave to heat up or defrost breast milk as it can cause hot spots, which can burn your baby's mouth.
If you're planning to express your breast milk, you’ll need to use a sterilised container to put the breast milk in. You can then store your milk:

• in the fridge for up to five days at 4°C or lower
• for two weeks in the ice compartment of a fridge
• for up to six months in a freezer

Defrosting frozen breast milk

If you have frozen your milk, defrost it in the fridge before giving it to your baby. Once it's defrosted, use it straight away. Never re-freeze it after you have thawed it.

Fussy eaters

It's natural for parents to worry about whether their child is getting enough food, especially if they refuse to eat sometimes. Don't worry about what your child eats in a day, or if they don't eat everything in a meal. It's more important to think about what they eat over a week.

As long as your child is active and gaining weight, and it's obvious they're not ill, then they’re getting enough to eat, even if it may not seem like it to you.
It’s perfectly normal for toddlers to refuse to eat or even taste new foods.
As long as your child eats some food from the four main food groups (milk and dairy products, starchy foods, fruit and vegetables, protein), even if it’s always the same favourites, you don't need to worry. Gradually introduce other foods or go back to the foods your child didn’t like before and try them again.
The best way for your child to learn to eat and enjoy new foods is to copy you. Try to eat with them as often as you can so that you can set a good example.
These tips may help:

• Give your child the same food as the rest of the family, but remember not to add salt to your child's food. Check the label of any food product you use to make family meals.
• Eat your meals together if possible.
• Give small portions and praise your child for eating, even if they only manage a little.
• If your child rejects the food, don’t force them to eat it. Just take the food away without comment. Try to stay calm even if it’s very frustrating.
• Don’t leave meals until your child is too hungry or tired to eat.
• Your child may be a slow eater so be patient.
• Don’t give too many snacks between meals. Limit them to a milk drink and some fruit slices or a small cracker with a slice of cheese, for example.
• It’s best not to use food as a reward. Your child may start to think of sweets as nice and vegetables as nasty. Instead, reward them with a trip to the park or promise to play a game with them.
• Children sometimes get thirst and hunger mixed up. They might say they’re thirsty when really they’re hungry.
• Make mealtimes enjoyable and not just about eating. Sit down and chat about other things.
• If you know any other children of the same age who are good eaters, ask them round for tea. A good example can work well, as long as you don’t talk too much about how good the other children are.
• Ask an adult that your child likes and looks up to to eat with you. Sometimes a child will eat for someone else, such as a grandparent, without any fuss.
• Children’s tastes change. One day they’ll hate something, but a month later they may love it.

potty training

Potty training tips

Children are able to control their bladder and bowels when they’re physically ready, and when they want to be dry and clean. Every child is different, so it’s best not to compare your child with others.
Bear in mind the following:

• Most children can control their bowel before their bladder.
• By the age of two, some children will be dry during the day, but this is still quite early.
• By the age of three, 9 out of 10 children are dry most days. Even then, all children have the odd accident, especially when they’re excited, upset or absorbed in something else.
• By the age of four most children are reliably dry.

It usually takes a little longer to learn to stay dry throughout the night. Although most children learn this between the ages of three and five, it is estimated that a quarter of three-year-olds and one in six five-year-olds wet the bed.

When to start potty training

It helps to remember that you can’t force your child to use a potty. If they're not ready, you won’t be able to make them use it. In time they will want to use it; your child won’t want to go to school in nappies any more than you would want them to.
In the meantime, the best thing you can do is to encourage the behaviour you want.
Most parents start thinking about potty training when their child is around 18 to 24 months old, but there’s no perfect time. It’s probably easier to start in the summer, when washed nappies dry more quickly and there are fewer clothes to take off. Do it over a period of time when there are no great disruptions or changes to your child’s or your family’s routine.
You can try to work out when your child is ready. There are a number of signs that your child is starting to develop bladder control:

• They know when they’ve got a wet or dirty nappy.
• They get to know when they’re passing urine, and may tell you they’re doing it.
• The gap between wetting is at least an hour. (If it’s less, potty training may fail and at the very least will be extremely hard work for you.)
• They know when they need to pee, and may say so in advance.

Potty training is usually fastest if your child is at the last stage before you start the training. If you start earlier, be prepared for a lot of accidents as your child learns.

How to start potty training

• Leave a potty where your child can see it and can get to know what it’s for. If you’ve got an older child, your younger child may see them using it, which will be a great help. It helps to let your child see you using the toilet and explain what you’re doing.
• If your child regularly has a bowel movement at the same time each day, leave their nappy off and suggest that they go in the potty. If your child is even the slightest bit upset by the idea, just put the nappy back on and leave it a few more weeks before trying again.
• As soon as you see that your child knows when they’re going to pee, encourage them to use their potty. If your child slips up, just mop it up and wait for next time. It takes a while to get the hang of it. If you don’t make a fuss when they have an accident then they won’t feel anxious and worried and are more likely to be successful the next time.
• Your child will be delighted when he or she succeeds. A little praise from you will help a lot. It can be quite tricky to get the balance right between giving praise and making a big deal out of it, which you don’t want to do. Don't give sweets as a reward, as that can end up causing more problems. When the time is right, your child will want to use the potty and they will just be happy to get it right.

Teething

The teething process

Most babies start teething at around six months. However, all babies are different and the timing of teething varies.
Some babies are born with their first teeth. Others start teething before they are four months old, and some after 12 months. Early teething should not cause a child any problems, unless it affects their feeding.
A rough guide to the different stages of teething is:

• bottom front teeth (incisors) – these are the first to come through, at around five to seven months
• top front teeth (incisors) – these come through at around six to eight months
• top lateral incisors (either side of the top front teeth) – these come through at around nine to 11 months
• bottom lateral incisors (either side of the bottom front teeth) – these come through at around 10-12 months
• molars (back teeth) – these come through at around 12-16 months
• canines (towards the back of the mouth) – these come through at around 16-20 months
• second molars – these come through at around 20-30 months

Most children will have all of their milk teeth by the time they are two and a half years old.

Teething symptoms

Some teeth grow with no pain or discomfort at all. At other times you may notice that the gum is sore and red where the tooth is coming through, or that one cheek is flushed. Your baby may dribble, gnaw and chew a lot, or just be fretful.

Some people attribute a wide range of symptoms to teething, such as diarrhoea and fever. However, there is no research to prove that these other symptoms are linked.
You know your baby best. If their behaviour seems unusual, or their symptoms are severe or causing you concern, then seek medical advice. You can call NHS Direct on 0845 4647 or contact your GP.
Read more about spotting the signs of serious illness.

Teething tips

There are several ways you can help make teething easier for your baby. Every child is different, and you may have to try several different things until you find something that works for your baby.

Teething rings

Teething rings give your baby something to safely chew on, which may ease their discomfort and provide a distraction from any pain.
Some teething rings can be cooled first in the fridge, which may help to soothe your baby's gums. Follow the instructions that come with the ring so you know how long to chill it for. Never put a teething ring in the freezer as it could damage your baby's gums if it becomes very hard or cold.
Also, never tie a teething ring around your baby's neck, as it may be a choking hazard.
A useful alternative to a teething ring is a cold, wet flannel.

Teething gels

For babies over four months old, you can rub sugar-free teething gel on their gums. You can get teething gel from your local pharmacy.

Teething gels often contain a mild local anaesthetic, which helps to numb any pain or discomfort caused by teething. The gels may also contain antiseptic ingredients, which help to prevent infection in any sore or broken skin in your baby's mouth.
Make sure you use a teething gel specifically designed for young children and not a general oral pain relief gel, which is not suitable for children. Your pharmacist can advise you.
You should discuss with your GP the teething gel options for babies under four months old.

Chewing

One of the signs that your baby is teething is that they start to chew on their fingers, toys or other objects they get hold of.
Try and give healthy things for your baby to chew, such as raw fruit and vegetables. For example, pieces of apple and carrot are often ideal. You could also try giving your baby a crust of bread or a breadstick. Always stay close in case they choke.
It is best to avoid rusks because nearly all brands contain some sugar. Avoid any items that contain lots of sugar as this can cause tooth decay even if your child only has a few teeth.
Make sure you always supervise your child when they are eating.

Painkilling medicine

If your baby is in pain or has a raised temperature, you may want to give them a painkilling medicine that has been specifically designed for children. These medicines contain a small dose of paracetamol or ibuprofen to ease any discomfort. The medicine should also be sugar-free.
Always follow the dosage instructions that come with the medicine. If you are not sure, ask your GP or pharmacist.
Aspirin should not be given to children under 16 years old.

Cool drinks

Cool, sugar-free drinks will help to soothe your baby's gums and may help if they are dribbling excessively. The best option is to give them cool water – just make sure it is not too cold.

Comfort

Comforting or playing with your baby can sometimes distract them from the pain in their gums. Your baby may be feeling too irritable or restless to play, but at other times, it may be a good way of getting them to concentrate on something other than their teething pain.

Preventing rashes

If teething is making your baby dribble more than usual, make sure you frequently wipe their chin and the rest of their face. This will help to prevent them from developing a rash. You may also find it useful for your baby to sleep on an absorbent sheet.

What to avoid

In April 2009, The Medicines and Healthcare products Regulatory Agency (MHRA) issued advice regarding the use of oral pain relief gel containing an ingredient called salicylate salts in children under 16.
The advice was introduced as the salicylate salts have been found to have the same effect on the body as aspirin. Aspirin should not be given to children under 16 because it can potentially increase their risk of developing a rare but serious condition called Reye's syndrome (which can cause serious liver and brain damage).
It is recommended that you check with your GP or pharmacist before buying a teething gel, to make sure that it is suitable for your child and does not contain salicylate salts.

Sleep problems

If your child won’t go to bed

• Decide what time you want your child to go to bed.
• Close to the time that your child normally falls asleep, start a 20-minute ‘winding down’ bedtime routine. Bring this forward by 5-10 minutes a week (or 15 minutes, if your child is in the habit of going to bed very late) until you get to the bedtime you want.
• Set a limit on how much time you spend with your child when you put them to bed. For example, read only one story, then tuck your child in and say goodnight.
• Give your child their favourite toy, dummy (if they use one) or comforter before settling into bed.
• If your child cries, leave them for 5-10 minutes before going back in and settling them down again.
• Don’t pick them up or take them downstairs. If your child gets up, put them back to bed again.
• Leave a drink of water within reach and a dim light on if necessary.
• If you keep checking to see if your child is asleep, you might wake them up, so leave it until you're certain that they're asleep.
• You might have to repeat this routine for several nights.
• If you try this, you will need to try to be firm and not give in.

If you child keeps waking during the night
By the time your child is six months old, it’s reasonable to expect them to sleep through most nights. However, up to half of all children under five go through periods of night waking. Some will just go back to sleep on their own; others will cry or want company. If this happens, try to work out why your child is waking up.
For example:

• Is it hunger? If your child is a year or older, some cereal and milk last thing at night might help them to sleep through the night.
• Are they afraid of the dark? You could use a nightlight or leave a landing light on.
• Is your child waking up because of night fears or bad dreams? If so, try to find out if something is bothering them.
• Is your child too hot or too cold? Adjust their bedclothes or the heating in the room and see if that helps.

If there’s no obvious cause, and your child continues to wake up, cry or demand company, you could try some of the following suggestions:

• Scheduled waking. If your child wakes up at the same time every night, try waking them 15-60 minutes before this time, then settling them back to sleep.
• Let your child sleep in the same room as a brother or sister. If you think your child may be lonely, and their brother or sister doesn’t object, put them in the same room. This can help them both sleep through the night.
• Teach your child to get back to sleep by themselves. First check that everything is alright. If it is, settle your child down without talking to them too much. If they want a drink, give them water but don’t give them anything to eat. For this approach to work, you need to leave them in their cot or bed. Don't take them downstairs or into your bed. Let them cry for around 5-10 minutes before you check on them. Over the next few nights, gradually increase the amount of time you leave them before checking. It might take a week or two but if you keep the routine going, your child should start falling asleep on their own.
• Tackle it together. If you have a partner, agree between you how to tackle your child’s sleeping problems. You don’t want to try to decide what to do in the middle of the night. If you've both agreed what's best for your child, it’ll be easier to stick to your plan.