So You’re Pregnant … Now What?

Yahoo! The home pregnancy test turns out to be positive! You
are finally pregnant, and now after waiting patiently you are seeing
the doctor who delivers babies. You can hardly wait to hear all the
things that you will need. But instead, you are sitting in front of a
doctor who congratulates you … and then tells you to come back
when you are 12 weeks pregnant for your first prenatal exam. You
are shocked! There must be more to this visit! Perhaps your doctor
doesn’t understand what’s going on!

The reality is that even though so much is happening in the
development of the fetus at the embryonic and cellular level in the
first 12 weeks of your pregnancy, there just is not too much to it
on your end. I am not trying to sound negative about your new
exciting gift. The truth is that nobody wishes to hear the bad stuff.
So, please don’t be offended by my next statement. One in five
women will unfortunately have a natural miscarriage in the first
12 weeks—not because of any bad things she did before finding
out she was pregnant, but because of the laws of nature. That’s the
reason we try to avoid doing the first prenatal exam until we are
somewhat guaranteed that this vulnerable stage is likely to be over.
Thus, the first official pregnancy visit is the 12th-week first prenatal
visit. That said, I generally try to establish a few things during
your initial visit to me.

First, let’s see if you are truly pregnant. A positive reading is
usually determined eight days after conception. Urine tests vary
in the way they test positive for pregnancy. Some have a ‘control’
that shows you what the test part should look like if it is positive.
Others change colour or have a negative or blank space that will
develop into a +/plus sign if you are pregnant.
If urine is too diluted, pregnancy is sometimes not detected.
The urine of a pregnant woman contains the hormone human chorionic
gonadotropin (HCG), which is produced by the growing
placenta and fetus. The hormone is easier to detect if the urine is
concentrated, which is why the first morning urine is the most effective.
I am often faced with a urine pregnancy test with a very
faint positive line that is not easily detected. I have even found myself
in a situation where the woman has tested positive three times
at home and wanted official confirmation. When we tested her, the
test was negative because we saw her when the HCG in her urine
was more diluted.
If your periods are usually very regular, but you’ve missed one,
there could be many reasons other than pregnancy for missing it.
If I am uncertain why you are not testing positive, I can order a
quantitative b-HCG blood test, which is very accurate in detecting
pregnancy. If this is not an available option, another urine test can
be done one week later.
The next thing we need to do is to figure out how many weeks
pregnant you are.
This is calculated not from the day you conceived but from
the first day of your last menstrual period (LMP). In reality, a
pregnancy will usually last 38 weeks. Because we are adding two
weeks at the beginning, the pregnancy lasts around 40 weeks. We
then allow a further ten days over the due date.
Most women will go over their expected date of delivery

(EDD) so as a mind-set I advise patients to avoid disappointment
early by calculating the worst-case scenario and then adding ten
days to their due date. This way, the longest period they are going
to be pregnant is established.
What else?

Water Births
This topic often makes me want to crack up. All right—I know
what you are thinking. You are saying that this is very judgmental.
How dare he have such a closed mind! But just hear me out on this
I am often asked in all sincerity about this as an option for
childbirth. And I have seen the videos. The rationale for water
birth advocates that the baby who has floated in a pool of amniotic
fluid for the past 40 weeks should now be born into another body
of fluid.
Supposedly, the whole process is almost natural and most
pleasant for the baby. Furthermore, it is supposed to result in less
pain for the expectant mother. This is not the case!
Okay, here is the problem. Monitored care is the reason for the
current reduced infant-maternal mortality and morbidity rate in
the year 2006 in developed countries. This means that at specific
points during the first and second stages of labour, we monitor the
fetal heart and assess how the baby is doing. We look for changes
in the baby’s heart rate and its response to the contractions and to
pushing. This becomes impossible when you are immersed in a
pool of water.

And I also wonder how long you would wish to remain in the
water before it becomes cold (unless it is continuously reheated) or
you start to wrinkle up like a prune.
Finally, what is the point? For pain control? If I am in a hot
tub and I am passing a kidney stone, does this mean that my pain
will go? If that were the case, every emergency room would be
equipped with a hot tub for anyone passing a kidney stone. So, in
reality, the pain might be a little less, but overall, not by a whole
What about making it easier on the baby? Well why? The baby
is not a fish or amphibian. It is human. Humans live on land, not
in water. We are designed to have babies on dry land. And guess
what … babies are designed to take their first breath on land. If
they don’t, and they are born into water and the cord is clamped,
they have no means of getting oxygen—because they do not have
gills at birth. So, once born in water, they would have to come onto
dry land anyway to take their first breath, which is ultimately what
happens for all births without running the risk of not being able to
monitor the baby.
Part of the process of resuscitation in a newborn is to dry, suction,
and heat. All of these things are impossible to do in water.
I guess the whole concept is somewhat of a fantasy—almost
like having sex in water—it is way overrated.