Were Having a Baby 2012

8/19/2019 Were Having a Baby 2012

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We’re having a baby

A guidebook for expectant parents


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We’re having a baby 29th edition

THLNational Institute for Health and Welfare

Illustrations by Taru Castrén

Layout by Hanna Tennilä, Textop Oy

ISBN 978-952-245-256-6 978-952-245-331-0 (e-version)

Erikoismedia Graphic Oy

Helsinki 2012


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Babies are born into a variety of situations and dif-ferent kinds of families. The baby may be a first-born or one of many siblings. Some babies haveone parent, others have two. Some are born intotraditional nuclear families, others into stepfamilies.Some pregnancies are carefully planned, while oth-ers may come as quite a surprise.

This booklet contains information on pregnancy,birth and parenting. It also gives advice on how totake care of your baby and where you can find helpand support. In addition to this guide, your localprenatal and child health clinics are there on-handto offer support and advice on good parenting. Forfurther assistance, you can also contact your mater-nity hospital, as well as the many other organisa-

tions mentioned in this booklet that are dedicatedto child and family support. We hope that this booklet will be a useful guidein the preparations for a new addition to yourfamily.u

Dear Reader,


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ContentsPregnancyFrom conception to birth . . . . . . . 5Signs of pregnancy . . . . . . . . . .10Nutrition and pregnancy . . . . . . .13Risk factors. . . . . . . . . . . . . . .17

Exercise and fitness . . . . . . . . . .19Preparing for parenthood. . . . . . .20You and your partner . . . . . . . . . 23Antenatal care inthe prenatal clinics . . . . . . . . . .26Pregnancy at work and at home . .30What does a baby need? . . . . . . .32

The birthPreparing for birth . . . . . . . . . .34C-section . . . . . . . . . . . . . . . .35Onset of labour . . . . . . . . . . . .38The stages of labour . . . . . . . . .39Labour pains and pain relief . . . . .42

The newborn . . . . . . . . . . . . . .44Recovering from the delivery . . . . .48

Baby careFirst month . . . . . . . . . . . . . .54Breastfeeding . . . . . . . . . . . . . .60Hygiene . . . . . . . . . . . . . . . . .64

Sleep . . . . . . . . . . . . . . . . . .68

Growth and development . . . . . . .70Daily routines . . . . . . . . . . . . .76Safety . . . . . . . . . . . . . . . . . .79Starting supplementary food . . . . .81

When the baby is ill . . . . . . . . .84Organizing childcare . . . . . . . . . . 88

Services for families with children Prenatal and child health clinics . .90Social services centre . . . . . . . . . 91

Municipal day care . . . . . . . . . .92Organisations . . . . . . . . . . . . . .94Special situations . . . . . . . . . . .96

Social protection for familieswith childrenSocial protection for familieswith children . . . . . . . . . . . . . .99


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Pregnancy 5

Conception can occur during ovulation, which takes place approximately two weeks after the first day of menstruation.The ovum can be fertilised by male spermfor 24 hours. Fertilisation happens whenthe male sperm cell penetrates the femaleovum. The sperm can survive in the wom-an’s body for 2-4 days. The male sperm de-

termines the sex of your baby.

The expected date of deliveryThe due date, or expected date of delivery(EDD), is calculated from the first day of

your last menstruation. A normal pregnan-cy lasts between 32 and 42 weeks. To cal-culate the expected date of delivery, add 40

weeks (= 9 months and 7 days) to the date when your period last began. Most babiesare born during week 39 or 40. If yourmenstruation cycle is longer than 28 days,then conception will have taken place

more than two weeks after the first day of your latest period. Most pregnant womenhave an ultrasound scan in week 20. TheEDD is checked against the size of the ba-by. In later scans, the EDD will not be re-

vised.

PlacentaThe placenta begins to develop when the

fertilised ovum is embedded in the liningof the uterus a few days after conception. A

well-functioning placenta provides the ba-sis for the healthy development of the foe-tus. The placenta acts as the lungs, liver, in-testines, kidneys and source of nutritionfor the foetus. Nutrients and oxygen travelfrom the placenta to the foetus via the um-bilical cord. The veins in the umbilical cord

carry the baby’s blood to be oxidised in theplacenta and transfer the waste to themother’s circulation. The metabolism takesplace through a thin membrane: the bloodcirculations of the mother and the baby, al-though very close to each other, remainseparate. A fully developed placenta

weighs about 500 to 800 grams, and isshaped like a flat disc.

Many substances harmful to the foe-tus, such as nicotine and alcohol, can pass

From conception to birth


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6 Pregnancy

through the placenta. (See page 17.)

UterusThe uterus of a woman who is not preg-nant weighs 50 to 70 grams and is 7 to 9cm long. At the end of pregnancy, it weighsnearly 1 kg and has a volume of about 5 li-tres. During pregnancy, the uterus grows

with the baby. During the fourth month ofpregnancy, the uterus rises from the pelvis,

which results in visible changes in themother’s body: in week 16 the fundus ofthe uterus is halfway between the pelvis

and the navel, by week 24 it is up to thenavel, and by week 36 it is up to the dia-phragm. Accelerated growth of the uterusmay indicate a multiple pregnancy. Thefundus of the uterus usually drops a coupleof weeks before delivery and becomesround in shape. At the same time the babyusually turns head down ready for delivery.

Movements Women who are having their first babyusually feel its movements by week 20 or21. Mothers who have had previous preg-nancies can already feel the movementsaround week 18. At first, the movementsmay feel like ”bubbling” or ”fluttering”,before they develop into gentle kicks andbumps.

ContractionsThe uterus prepares gradually for the deliv-ery. During the last weeks the uterus tight-ens in ”practice contractions”. In the be-ginning, the contractions only last for a fewseconds, but towards the end of pregnancythey can last for up to 30 seconds. Contrac-

tions prepare the cervix for delivery. Duringthe final weeks of pregnancy, the cervixmay dilate a little, more if the pregnancy isnot the first. Experiencing painful contrac-tions during the second trimester may be asign of an infection, and you should con-tact your prenatal clinic immediately.

Pregnancy and well-being Although pregnancy is a natural condition,it is nevertheless a strain on the mother.The entire body must adapt to the new sit-

uation. Metabolism is enhanced, breathingand circulation become more efficient, andthe uterus grows. During pregnancy theplacenta secretes enzymes and hormones

which, together with the corpus luteumand pituitary gland, regulate these chang-es. Changes in the body also affect themental state, or moods, of the pregnant

woman. (See ”Preparing for parenthood”

on page 20.)Pregnancy affects women in different

ways: some suffer from several signs andsymptoms while others experience verylittle discomfort. Some symptoms arecommon at the beginning, while othersare typically experienced at later stages.

Although the symptoms may cause seriousdiscomfort to the mother, they seldom

pose any threat to the baby.During pregnancy, it is recommendednot to take any medications or naturalhealth products, not even cough drops,

without first consulting a doctor or anurse, because some drugs will be harmfulto the baby. When at the doctor’s or den-tist’s, always remember to tell them that

you are pregnant so that they can adjustthe treatment accordingly. Avoid x-rays. u


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Pregnancy Calendar

conception Takes place roughly two weeks

from the start of your period.

weeks 0-4 At two weeks, the embryo isthe size of a pinhead.

weeks 5-8 The foetus is now 1.5 cm long and has thebeginnings of arms and legs. The heart,

nose, ears and eyelids, the nervous system,

spine and umbilical cord start developing.

weeks 9-12 When the foetus is 10 weeks old, it is approx-

imately 3 cm long and weighs 20 grams. The

baby’s heartbeats can be heard. The foetusfloats in amniotic fluidprotected by the foetal

membrane and gets its food through theumbilical cord. The foetus now has an upper

and lower jaw and the beginning of a tongue.Teeth are beginning to develop in the gums.

weeks 13-16 When the foetus is 14 weeks old, it is ap-proximately 9 cm long, and weighs about

100 grams. The uterus is now about the sizeof a fist. The head is big, almost half the

length of the foetus, and the facial featuresstart developing. The ears and genitals de-

velop. The foetus practices swallowing andbreathing. It kicks, wiggles its toes and

thumbs, and turns its head, but the mother is

not yet able to feel these tiny movements.

weeks 17-20 When the foetus is 18 weeks old, it is 25 - 27cm long andweighs 250 - 300 grams. The

foetus has its own circulatory system, and its

Stop smoking and give up

alcohol! If you need support,contact your prenatal clinic.

Do not take any medications

during pregnancy without

frst consulting a doctor or

nurse! Check that your

medications can be safelyused during pregnancy.

The baby is well if the

mother is well:

healthy food, sufficient restand plenty of outdoor

activities are good for both.

The early pregnancy

ultrasound scan is done

between the weeks 10 and14, and is usually an internalscan done through the vagina.

To qualify for the maternity

beneft the mother must

have a medical examination either at the prenatal clinicor by a doctor before the end

of week 16.

Talk to the nurse about

antenatal classes.

To do listPregnancy timelineWeeks

Pregnancy 7


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8 Pregnancy

heart beats twice as fast as that of an adult.

A very fine down, known as lanugo, is nowcovering the baby’s entire body. Most of this

will disappear before birth. The baby haseyebrows. The placenta is almost as big as

the foetus. It protects the foetus from some

but not all harmful substances. If this is nother first pregnancy, the mother will now be

able to feel the movements of the baby.

weeks 21-24 When the foetus is 22 weeks old, it is ap-

proximately 30 cm long and weighs 400 -

600 grams. At his time even women who arehaving their first baby can feel the move-ments. The heartbeat is clearly audible. By

week 24, the fundus of uterus is up to thenavel. Accelerated growth of the uterus may

indicate a multiple pregnancy. The foetuspractices sucking, and its thumb often finds

its way into its mouth. The hair and nails are

growing, and the protective membrane is

starting to develop into skin. Most of thetime the baby is asleep, but it can be awak-ened by noise or vibration. A pregnancy ter-

minating before week 22 is called a sponta-neous abortion, or miscarriage. If born dur-

ing weeks 23 or 24, the baby may survive in

intensive care, although it is very premature.Developmental risks are great, and the se-

lection of a treatment regime must often be

given due consideration.


proximately 35 cm long and weighs about a

kilogram. The foetus moves a lot. It turnsand kicks so hard that the movements are

visible. The baby can open and close its eyesand has a firm grip. The fundus is up to the

navel now. You may be experiencing yourfirst contractions: your belly tightens for a

few seconds and then relaxes. The foetus

now looks like a real baby, but is a lot thin-

Most women have an

external scan some time

during weeks 18 - 21.The external scan is done

by rolling a transduceracross your tummy.

In week 22, you can

apply for maternity,

paternity and parentalallowance as well as for

the maternity beneft

(See “Benefits for families

with children”.)

Avoid excessive strain.Do not take the

contractions lightly.

Be alert to the reactions

of your body. Remember

to get enough rest!

Avoid any unnecessary

strain, especially if youhave contractions.



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ner. A baby born before 28 weeks is consid-

ered extremely premature. The lungs andother organs are not yet fully developed.

With intensive care the baby often survives,and the prognosis is better due to improved

treatment methods.


proximately 40 cm long and weighs about1.5 kg. Most children born during weeks

29 - 32 survive with intensive care, and theirrisk of handicap is small.

weeks 33-36 When the foetus is 34 weeks old, it is ap-proximately 47 cm long and weighs about

2.7 kg. It gains weight rapidly. The baby hasless room in the uterus and moves around

less than before. At this stage, most babiesturn head down ready for delivery. The ba-

by’s skin is covered with a creamy film

called vernix. The uterus reaches its highest

point and is up to your ribs. If there is risk ofpremature birth, the delivery will take placeclose to the neonatal intensive care unit. Ba-

bies born in week 35 seldom need intensivecare. Babies born before week 37 are con-

sidered premature, and the mother and

child may need to stay at the postnatal wardfor an extended period of time.

weeks 37-40 The uterus drops and the baby’s head willbecome engaged into your pelvis. Contrac-tions will become more frequent. The baby

is kicking so hard that he or she can push

away a book resting on your tummy. Atbirth, most babies are 49 - 52 cm long and

weigh 3000 - 4000 grams. The average preg-nancy lasts for 40 weeks, but deviating from

the average by one week is very common.

Avoid standing work,

lifting heavy objects and

other strenuous tasks.

Now is the perfect time

to get everything ready

for the baby.

In many municipalities,

you can visit the maternity

hospital in advance.

Go to the hospital if yourwater breaks, you have

contractions at regular

intervals, you are experienc-

ing pains, or if you are

bleeding. (See “Birth”.)

When the baby is ten days

over the expected date ofdelivery, the mother will go

to the hospital for a post-termfollow-up check.


Pregnancy 9


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10 Pregnancy

Feeling tiredSome expectant mothers are vital and en-ergetic, while others feel very tired duringthe first and last months of pregnancy. Ifpossible, rest during the working day. If

you feel extremely tired for more than two weeks, discuss it with your prenatal clinic’s

nurse or doctor. (See ”Anaemia”.)

Body temperatureDuring the early stages of pregnancy, thebody temperature may rise slightly. This isquite normal and does not need medicalattention. However, if you have a feverduring pregnancy, contact the prenatalclinic or your doctor.

Nausea and vomiting Almost one in every two expectant moth-ers suffer from nausea or ”morning sick-ness” during the first trimester (the firstthree months of pregnancy), especially inthe morning when the stomach is empty.It may be accompanied by dizziness andfainting when getting up. Nausea may be

triggered by certain smells or tastes, be-cause the sense of taste and smell isheightened during pregnancy. The morn-ing sickness and vomiting usually stop af-ter the first three months. It might help todrink a glass of water or juice before get-ting out of bed and eat something smallsuch as a biscuit or slice of bread as soonas possible after getting up. Get out of bedslowly, taking your time. You may be over-come by nausea during the day as well, if

Signs of pregnancy

your stomach becomes empty. This can beprevented by having snacks during theday. Violent vomiting is not a normal signof pregnancy and should always be treatedby a doctor.

Breasts

Your breasts will grow and they might feeltender and tight. Beginning from the sec-ond month, it is possible for your breaststo leak milk. At this stage your breasts willbe very sensitive to cold and should bekept warm at all times. You should buy asupportive maternity bra by the middle of

your pregnancy. During the winter, wear a warm woollen scarf around your breasts. Itmight be wise to avoid swimming in cold

water. Massage your nipples with a mois-


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Pregnancy 11

turising lotion available from the chemistto prepare the skin for breastfeeding. If

your nipples are small or turned inwards,stretch them daily starting a few monthsbefore the expected date of delivery so thatthe baby will be able to get a good grip.

Vaginal dischargeThe normal amount of vaginal dischargetends to increase during pregnancy. If thedischarge smells bad or itches, consult

your doctor as it may be a sign of an infec-tion. When washing, use only water as

soap may irritate the mucous membrane.

Vaginal bleedingPeriods will stop during pregnancy be-cause the lining of the womb that is dis-charged during menstruation is vital forpregnancy. Slight vaginal bleeding is ex-perienced by approximately 25% of wom-en around the time of normal menstrua-

tion. The bleeding is explained by the fer-tilised ovum being embedded in the liningof the uterus. If the bleeding is heavy andsimilar to regular menstruation, it may bea sign of miscarriage and you should con-tact the nurse or doctor at the prenatalclinic.

Urinating

In the early stages of pregnancy, and espe-cially before the time of the normal men-struation period, you may experience a

vague feeling of heaviness in the lower ab-domen. This is caused by the expanding

veins and enhanced circulation. Towardthe end of pregnancy, the need to urinateis more frequent as the uterus is pressingagainst the bladder. A swift kick from thebaby may cause the mother to have an”accident”.

SweatingSweating increases during pregnancy asmetabolic activity increases. Pay special at-tention to your personal hygiene.

HeartburnHeartburn is a common ailment towardsthe end of pregnancy. It is caused by regur-gitation of gastric acid. Heartburn is apainful burning feeling in your throat,chest or upper abdomen. It can be alleviat-ed by avoiding spicy and fried foods, coffeeand strong tea. The prenatal clinic will be

able to suggest safe medications to treatheartburn. It will discontinue as soon asthe baby is born.

Anaemia Anaemia may be the reason for feeling ex-tremely tired. Other symptoms includepaleness, palpitations, shortness of breathduring exercise and dizziness. Anaemia

occurs when there is not enough haemo-globin in your blood. Haemoglobin levelsoften decrease during pregnancy becausethere is more blood in your circulation. Ina sense, your blood is ”diluted”. If neces-sary, your doctor or nurse will prescribeiron supplements. Vegetables and fruit richin vitamin C as well as meat and fish en-hance iron absorption.

Varicose veins Varicose veins are enlarged veins that areswollen and raised above the surface of theskin. The condition tends to get worse dur-ing pregnancy when the expanding uterusputs pressure on the veins. Wearing spe-cialised compression stockings, which youput on before getting out of bed, help toalleviate the problem. It also helps if youcan put your feet up during the day and


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12 Pregnancy

place a pillow under your feet at night. Avoid wearing high-heeled shoes or shoesthat are too tight. Wear different shoesduring the day to give your feet a rest.

CrampsDuring pregnancy women tend to have legcramps. Painful leg cramps often occur atnight. The best way to relieve a cramp is tostretch the cramping muscles: straighten

your leg, take hold of your big toe and pull your leg up, or press it against the bed. Youcan try to relax the cramp by massaging

the muscle lightly. Use a cold pack (e.g. abag of frozen vegetables) for first aid. Keep

your feet warm during the night.

Constipation and piles As the uterus grows, it presses against therectum and thus increases the tendency todevelop piles. As piles are aggravated byconstipation, pay special attention to what

you eat and make sure that you exercisesufficiently. Fibre-rich foods and sufficientliquid intake help prevent constipation.

Wholemeal bread and porridge, vegeta-bles, berries and fruit are all good sourcesof fibre. If necessary, add bran or wheatgerm and dried fruit to your diet to en-courage regular bowel movements. Exer-cise and other physical activities will also

help.

Backache As the tummy grows, the back muscleshave to take a lot of strain, which may re-sult in back pain. Good posture and sup-port by the abdominal muscles (hold yournavel in as much as possible) will alleviatethe pain. Wearing a supportive maternitybra and comfortable shoes with flat heels

will ease the backache. Find a mattress

that supports your back without being toohard. Gentle massaging and rest will relaxtense back muscles. Light exercise tostrengthen the abdominal muscles is rec-ommended. Ask the prenatal clinic for ex-ercise instructions.

SwellingSome degree of swelling is normal unlessit is accompanied with rising blood pres-sure and protein discharges in urine. Asudden increase in weight (over 500 g per

week in a woman of normal weight) or

swelling accompanied by severe itchingmay be symptoms of a liver condition(hepatosis gravidarum). Contact the pre-natal clinic or your doctor.

Skin blemishesThe skin can get darker during pregnancy,especially the tips of the breasts andaround the genitals. A brown line often

appears stretching from the lower abdo-men to the naval, and brown spots (ch-loasma) appear on the face. These marks

will fade after delivery.

Stretch marksPregnant women may develop stretchmarks on their breasts, abdomen andthighs, caused by tearing of the dermis.

Massaging stretch marks with a moisturis-ing lotion may help during the early stagesof pregnancy. The red lines will usuallyfade after delivery. u


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Eating a well-balanced and varied dietkeeps the expectant mother healthy, con-tributes to the healthy development of thebaby, and prevents nutritional problems. Italso accelerates recovery from the birthand supports breastfeeding. A healthy

woman who has been eating a balancedand varied diet does not need to make any

major dietary adjustments during preg-nancy.

Some women will need iron, folic acidand calcium supplements to meet the add-ed demand during pregnancy. Multivita-min-mineral supplements are necessaryonly if the diet is not balanced. It is recom-mended that all pregnant women takesupplemental vitamin D. It is advisable to

avoid supplements containing vitamin A.

Energy requirementsDuring the first three months of pregnan-cy (the first trimester), there is virtually noneed for extra food. During the second andthird trimester the need for extra energycan be met with a slice of bread with aspread, a glass of milk, and an one piece of

fruit. Often the physical activity of thepregnant women decreases towards theend of pregnancy, which further decreasesthe need for additional energy. Thus, thereis no need to ”eat for two”, but to eat a

well-balanced and varied diet, and eat atregular intervals.

It is very important to maintain regularmeal times. Feeling tired or nauseous mayindicate that the expectant mother shouldget more rest and eat more regularly. It is

recommended that pregnant women eatseveral times a day: breakfast, lunch, din-ner, and 2 to 4 snacks in between.

Weight gainThe average total weight gain during preg-nancy is 12.5 kg. Weight gain is caused bythe growth of the uterus, foetus, placentaand breasts, and the increased amount ofblood and amniotic fluid. However, duringthe first trimester it is common to lose so-me weight. Women gain different amountsof weight, and recommendations are based

on the weight prior to pregnancy. Weight gain should be monitored forseveral reasons: Insufficient weight gainmay be an indication that the foetus is de-

veloping too slowly. A steady excessive in-crease in weight is a strain on the expect-ant mother. A sudden increase may be asign of too much fluid collecting in thebody (see ”Swelling”). Excessive weightgain during pregnancy may predispose the

woman to gestational diabetes, which is a

Nutrition and pregnancy


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14 Pregnancy

disorder of carbohydrate metabolism thatcan result in the excessive growth of thebaby and low blood sugar levels at birth.(See ”Weight control”on page 50.)

Putting on a lot of weight during preg-nancy predisposes the woman to beingoverweight after delivery as well. Obesityis a risk factor for many chronic diseases,such as Type 2 diabetes. Healthy eatinghabits and sufficient exercise help in con-trolling weight, and a positive mood willsupport these efforts.

A well-balanced diet during pregnancyEvery family has its own eating habits.Pregnant women should, however, pay at-tention to their eating habits and be pre-pared to make some adjustments to im-prove the well-being of the developing ba-by and herself. It will benefit the wholefamily to pay attention to the type andamount of fats they eat and their sugar and

salt intake.Milk, cheese and other dairy prod-

ucts are important sources of protein, cal-cium and other nutrients. There is an in-creased need for these during pregnancy,and it is recommended that pregnant

women eat dairy products even if they arenot normally part of the usual eating hab-its. To ensure a sufficient supply of calcium,

pregnant women should drink4 glasses (8 dl) of milk or other liquid dairyproducts daily. Select the non-fat or low-fat alternatives.

Bread and porridge , especially thosemade from wholemeal, contain lots ofminerals and vitamins. Wholemeal prod-ucts are also rich in fibre, which helps di-gestion and prevents constipation.

Vegetables, fruit and berries are richin vitamins, minerals and fibre. Because

they contain little energy, they are not fat-tening. Vegetables, fruit and berries shouldbe eaten in large quantities, preferably atevery meal, and at least 5 portions a day.Favour uncooked vegetables and include

vegetables of different colours in your diet.Use vegetables and fruit to increase the va-riety of flavours in your diet and to cut theamount of calories. Beans, lentils, seeds,peas and nuts all contain a lot of protein.Remember to rinse salads and other vege-tables carefully in order to avoid listeria.

Meats and sh are rich in protein,

which is important for the healthy devel-opment of the baby. Choose products

which are low in fat and salt. Avoid eatingliver and liver products during pregnancybecause they contain high levels of vita-min A. It is advisable not to eat more than200 g of liver pâté or sausage per weekand to eat a maximum of 100 g at a time.The recommendation is to eat fish 2 to 3

times a week. Avoid pike during pregnan-cy and while you are breastfeeding be-cause it contains high levels of mercury.Because of the risk of listeria, avoid vacu-um-packed raw-cured and cold-smokedfish products as well as unripened chees-es, blue cheese and cream cheeses madefrom unpasteurised milk.

SaltUse as little salt as possible, because itcauses swelling, burdens the kidneys andraises your blood pressure. Food cravings


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Pregnancy 15

during pregnancy may considerably in-crease the amount of salt intake, if thecraving is for salted snacks or other foods

with high levels of salt, such as saltedgherkins, pickles or salami-type sausage.Most seasoned salts and stock cubes con-tain 50% salt. In addition to salt, soup mix-tures and marinated poultry and meats al-so contain soy or sodium glutamate. Foradded flavour and to reduce your salt in-take, include plenty of vegetables and frui-tin your diet.

Sugar Reducing your sugar intake helpsprevent excessive weight gain and helpsprotect against tooth decay. Soft drinkshave high levels of sugar but contain noneof the nutrients you need, which is whysoft drinks are not part of a balanced diet.

According to current recommendations,drinks with artificial sweeteners, such as

aspartame, acesulfame, taumatine and su-cralose, are not forbidden during pregnan-cy and breastfeeding. The only exceptionsto this rule are cyclamate and saccharin,

which are not recommended during preg-nancy and breastfeeding. Liquorice shouldbe eaten only in moderate amounts, as itcontains high levels of glycyrrhizin, whichmay cause swelling and raise blood pres-

sure.

FatUse low-fat spreads on bread and toast.For cooking, use low-fat spreads, vegeta-ble oils and vegetable oil blends.

LiquidsDrink sufficient liquids during pregnancyand while breastfeeding. Fresh water anddiluted juice are the best alternatives forquenching thirst. Current recommenda-tions suggest that pregnant women shouldlimit their coffee consumption to 3 cups aday. For many, coffee is a cause of heart-

burn.

Vitamins and minerals The developing baby takes all the nutrientsit needs from the mother’s body, and rare-ly suffers from any deficiencies. The preg-nant women needs a rich supply of vita-mins and minerals for the safe develop-ment of the baby and for her own health.

The need for vitamin D increases dur-ing pregnancy. The best sources of vitaminD include fortified dairy products, marga-rines and fish. Using dairy products andmargarines fortified with vitamin D is safeand there is no danger of overdose. It isrecommended that all pregnant andbreastfeeding women take supplemental

vitamin D.

Folic acid or folate is a form of vita-min B. The need for folic acid increases


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16 Pregnancy

during pregnancy. Wholemeal and whole-grain products and uncooked vegetables,fruit and berries are rich in folic acid. Sup-

plemental folic acid is not needed if themother is eating a well-balanced and var-ied diet that includes wholemeal productsand 5–6 portions of fruit and vegetablesevery day.

Folate deficiency may be a contributingfactor in neural tube defects (NTD) in de-

veloping embryos. To ensure a sufficientsupply of folic acid in early pregnancy, it is

recommended to choose a multivitaminproduct containing 0.4 mg of folic acid.

Women are recommended to begin takinga folic acid supplement at the time whenthey stop using birth control or, at the lat-est, at the start of the menstrual period af-ter which they are hoping to become preg-nant. The recommendation is to continueto take a folic acid supplement until week

12+0 of the pregnancy. More informationon the recommendations on folic acid sup-plements is available in Finnish in the Min-istry of Social Affairs and Health publica-tion ‘The Child, Family and Food’ (Lapsi,perhe ja ruoka STM Julkaisuja 2004:11:pp.76-77; http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3555.pdf&title=Lapsi__perhe_ja_ruo-ka_fi.pdf).

The need for iron multiplies during

pregnancy. Iron is needed for making redblood cells and oxygen transport and forthe development and proper functioning

of the placenta. These are also very impor-tant for the baby. The main sources of ironinclude meat, fish and wholemeal grains.The iron from meat and fish is easily ab-sorbed. Foods rich in vitamin C enhanceiron absorption from wholemeal grainsand vegetables. Sometimes even a well-balanced diet cannot supply a sufficientamount of iron during pregnancy. Usually,

half of the needed iron is from food andthe other half from the mother’s iron re-serves or from iron supplements. The needfor iron supplements is individually as-sessed at the prenatal clinic.

Calcium is necessary for the develop-ment of the baby’s bones. The calcium in-take of most women is sufficient. If yourdiet does not include any dairy products,

you need to take calcium supplements. Ifthe need for calcium is satisfied by supple-ments only, the daily dose is 1000 mg. Cal-cium and iron supplements should be tak-en at different times.

Dental care and fluoridePregnant women should take extra care oftheir teeth. This is important for both themother and the baby, as tooth develop-mentstarts while the foetus is in the womb.


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Pregnancy 17

For teeth, the most important mineral isfluorine. Fluorinated toothpaste strength-ens the teeth when used daily. When nec-essary, the dentist might recommend fluo-ride tablets. Health care centres arrangedental care for pregnant women. u

InfectionsDuring pregnancy, it is especially impor-tant to avoid infections that could beharmful to the foetus. The risk of infectioncan be considerably reduced by carefullyfollowing the protective instructions. Tox-oplasmosis is a parasitic infection that canbe passed on from cats, guinea pigs andlaboratory animals. To prevent infection,

avoid contact with cat litter trays or soilthat may have been fouled by cats or otheranimals. Do not let the cat sleep in yourbed.

For pregnant women, listeria is a dan-gerous bacteria found in food products.The best way to avoid listeriosis is by

washing your hands thoroughly after han-dling meat, and storing raw meat away

from cooked food. Follow the instructions when heating processed foods and frozen vegetables. Fresh vegetables should becarefully rinsed. Avoid vacuum-packedcold-smoked and raw-cured fish products,blue cheese, cream cheeses, and cheesesmade from unpasteurised milk.

Sexually transmitted diseases and in-fections can be prevented by using a con-dom.

Risk factors

SmokingSmoking is harmful for both the motherand the baby. Cigarette smoke often caus-es nausea in expectant mothers. The nico-tine and carbon monoxide in the smokeare absorbed into the mother’s blood andtransfer via the placenta into the foetus.

Note! For the sake of the child’s healthas well as for the sake of their ownhealth, both parents should give upsmoking at the early stages of pregnan-cy, if not before.

They also impair the normal functioning ofthe placenta.

Nicotine levels are higher in the foetusthan in the mother. Babies born to smok-ers have low birth weight and are restlessand irritable more often than those born tonon-smokers. Smoking during pregnancymay have harmful effects on the develop-ment of the brain and lungs, and also in-

creases the risk of infection after birth.Support for giving up smoking is avail-

able from the prenatal clinic and throughthe Internet (www.stumppi.fi). Nicotinereplacement products other than the patchcan be used, if necessary.

Alcohol Alcohol causes foetal damage. When a

pregnant woman drinks alcohol, so doesher foetus, because alcohol passes throughthe placenta and travels via the umbilicalcord into the foetus. The blood alcohol lev-el can be higher in the foetus than in themother.

Note! Pregnant and breastfeeding wo-men should avoid alcohol completely to

prevent its harmful effects.


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18 Pregnancy

Binge drinking (consuming large quan-tities of alcoholic beverages) is particularlydangerous for the foetus. The body partsand organs develop during the first trimes-ter (the first three months of pregnancy),and a dangerous drinking pattern duringthe first trimester can result in foetal mal-formations, e.g. a congenital heart defect.Excessive alcohol use should be avoided

whenever there is a possibility of pregnan-cy. Pregnant women should avoid alcoholcompletely.

Alcohol slows down foetal growth

throughout the pregnancy and may resultin low birth weight. The foetal centralnervous system (CNS) is very vulnerable,and at worst the baby may suffer frommental retardation. Alcohol-related foetaldefects may cause problems associated

with attention span, learning, and linguis-tic development.

There is no safe amount of alcohol that

a woman can drink while pregnant. Exces-sive alcohol consumption during pregnan-cy increases the risk of miscarriage. Otherrisks include malfunctions of the placenta,bleeding and the resulting infections, andthe premature detachment of the placenta.Caesarean sections (C-sections) are morecommon among heavy drinkers.

There are several sources of support

and advice on giving up alcohol, such asthe prenatal clinic, the A-Clinic Founda-tion (www.a-klinikka.fi, tel. [09] 6220 290)and Alcoholics Anonymous (www.suome-naa.fi).

Illegal drugs All drugs pass through the placenta intothe foetus. Drugs restrict the growth of thebaby and may cause premature detach-ment of the placenta and premature birth.

Drug abusers often neglect their own well-being, are in bad physical condition, andsuffer from malnutrition and infections. Allof these pose particular risk during preg-nancy. The newborn may suffer from with-drawal symptoms and later defects. If theexpectant mother is a substance abuser(drugs or alcohol), she should seek help assoon as possible. The prenatal cclinic willassist in finding appropriate support.

Huumeambulanssi ry (www.huume-ambulanssi.fi) is an organisation providingsupport and advice on substance abuse

and assists people in finding help. The hel-pline service at (09) 278 7727 is availablefrom Monday to Thursday 5 pm to 12 am,and at weekends from Friday 6 pm to Sun-day 12 am.

Irti Huumeista ry (www.irtihuumeista.fi) is a non-governmental organisationthat provides information on drugs anddrug addiction and their effects on the

substance abuser and his or her family. Theorganisation provides advice, support andinformation by phone and email. The Na-tional Drug Service line (0203 22388)maintained by the organisation is availableMon-Fri from 9 am to 3 pm and 6 pm to 9pm.

Medication

Do not take any medications or naturalhealth products during pregnancy withoutfirst consulting a doctor or nurse. Furtherinformation on the effects of drugs on thefoetus is provided by the Teratology Infor-mation Service of the Hospital District ofHelsinki and Uusimaa, available Mon-Fri 9am - 12 pm (tel. [09] 471 76500). The Tera-tology Information Service is a nationalfreephone helpline aimed at preventingfoetal defects. The helpline also provides


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Pregnancy 19

information on infections, radiation andother external risk factors during pregnan-cy and breastfeeding.

Travelling Wearing a seatbelt is compulsory, also inthe back seat. Towards the end of pregnan-cy, wearing a seatbelt might feel uncom-fortable, but it is essential for the safety ofthe mother and the baby in case of acci-dent. If you will be travelling long distan-ces by car, be prepared to stop every fewhours for a quick stroll to stretch the legs.

Get as much exercise and fresh air as pos-sible during pregnancy. When the motheris in good physical condition, this will con-tribute to the healthy development of thebaby. Usually, the mother will be able toremain physically active throughout mostof the pregnancy.

During pregnancy your ligaments willloosen and your centre of gravity will moveforward, which may cause backache. Besensitive to your body’s reactions andmodify your exercise accordingly. It is ad-

visable to avoid activities involving leaps,stretching and other sudden movements.It might be wise to avoid swimming incold water, because of the risk of infectionsand contractions. Walking is an ideal dailyactivity during pregnancy. Light house-

Exercise and fitness

work is excellent exercise, but strenuouschores, such as washing rugs and movingfurniture, increase contractions and in-crease the risk of miscarriage. Ask the pre-natal clinic for exercise instructions. Thetraining programmes of pregnant athletesshould always be prepared in close co-op-eration with a doctor. u

Motorcycling is not recommended forpregnant women. Travelling by planes thatare not pressurised may cause the foetus tosuffer from oxygen deficiency. Airlineshave strict rules regarding travelling andpregnancy. It is advisable to check with

your airline restrictions they impose forlong-haul flights. u

THE MOTHER’S FITNESS CONTRIBUTES TO THE

BABY’S HEALTH AND DEVELOPMENT


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20 Pregnancy

Having a baby will affect family lifeHaving a baby is an enormous change forall members of the family. Pregnancy is thetime to prepare: hormonal and physicalchanges help the mother adjust to thecoming change. For the dads, one way ofpreparing is to support the mum and focus

on her experiences and feelings. Themothers are, in turn, encouraged to sharetheir feelings and experiences with theirpartners and to encourage the dad-to-beto put his hand on her tummy to feel themovements of the baby.

Preparing for parenthood

First-time parents are often unaware ofthe complete change in life and routinesthat having a baby brings. The new baby

will demand the parents’ full attention. Allthoughts, talk and actions will revolvearound the baby. You will therefore need to

prepare as much as possible for the babyduring pregnancy. Make room for the babyin your home and buy or borrow all of thebasic things that the baby will need, suchas clothes and a cot or crib. Think abouthow you want to arrange day care. Preg-


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Pregnancy 21

nancy is also the time to prepare mentallyfor the coming life change. However, it isnot possible to be prepared for everything– some things will always come as a sur-prise! Becoming a parent brings a long-term responsibility to care for your baby.Having worries or fears about the babyand how you are going to cope is perfectlynormal. Yet, having a baby is one of themost natural and richly rewarding experi-ences life can bring. Having an open mind

will help in solving many questions andproblems during pregnancy and after the

baby is born.

Fears and concernsDuring pregnancy the parents may be

worried about many different things: Willthe child be healthy? How will I knowhow to take care of a baby? What to do

when the baby cries? Will I make a goodmum/dad? Will I love my child? How will

we manage financially? A single parentmight also worry about being ”shorthand-ed”and how she will manage alone withthe baby.

Even when the pregnancy has beenplanned, it is quite common that the par-ents have second thoughts at some point.

You may be overwhelmed by the thoughtof being responsible for the life of another

human being and wish you could just can-cel the whole thing. These feel-ings are very common and

they will pass in time.Find someone who you can share yourfears and concerns

with. Rememberthat there is no

need to feel guiltyabout such thoughts

and feelings; processing your thoughts andfeelings is all part of becoming a parent.

Becoming a motherFor many women, pregnancy is a wonder-

ful and cherished time without any nega-tive experiences or complications. The ba-by grows in the safety of the womb andthe mother can continue with her normalactivities. However, as a mother, you willneed to review some of your choices andhabits concerning food, drink, exercise andrest. You will start seeing things from a new

perspective now that you are also respon-sible for the well-being and healthy devel-opment of your unborn baby (see ”Preg-nancy and well-being”on page 6).

Mood swingsHormonal changes can bring about severemood swings in the mother, causing her tobecome exceptionally emotional, tearful or

sensitive. The first pregnancy is especiallytesting. The pregnant mother needs to beassured and reassured that her partner stillloves and supports her. The developing ba-by exhausts the mother’s energy resources,and she will need a lot of rest. However,pregnancy is a natural condition, not an ill-ness. Sharing your thoughts and feelings

with your partner and other close friends

will help.

Physical changesThe female body goes through tremen-dous changes during pregnancy. Skin andother tissues are stretched to their limits.Breasts usually grow during pregnancy byat least one cup size, and the pelvisspreads. The body acquires a femininesoftness and lustre - the characteristic“glow”of the expectant mother. The centre


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22 Pregnancy

of gravity changes as pregnancy progress-es and this will affect balance. The changesare great, but they happen slowly as preg-nancy progresses. Your general mood de-pends greatly on how well you will be ableto accept these inevitable changes. The fa-ther can be a huge support during thistime by complimenting the mother on her

growing tummy and appearance and byenjoying together the changes that takeplace as the pregnancy advances.

Pregnancy and the fatherPregnancy and having a baby are demand-ing for the father as well. He is expected tobe supportive and understanding. Duringthe very early pregnancy, in particular, itcan sometimes be difficult to understand

why the mother is becoming so and emo-

tional. If the dad-to-be is aware of the hor-monal changes and other pregnancy-relat-ed changes, it will be easier to understandthe pregnant mother. Attending an ultra-sound scan is just as important for the fa-ther as it is for the mother: they will bothsee their baby for the first time.

The father may also have questionsand doubts about the life ahead of him.Men often wonder if they will be good fa-thers and a good example to their children,and how the family will cope financially inthe new situation. The responsibility may

feel overwhelming. Some men may feelthe need to savour their ‘freedom’ for aslong as possible. It is recommended thatthe dads-to-be share their feelings withother prospective fathers or experienceddads.

Support networksFor the mother, late pregnancy, childbirth

and maternity leave constitute a time when socialising with colleagues andfriends decreases. Nursing and caring forthe baby at home may make the motherfeel isolated, especially if there are no oth-er mothers with babies in the neighbour-hood or among her friends. Fathers onlong-term parental leave may also en-counter similar feelings of isolation. Since

there is less contact with other adults thanbefore, great expectations fall on the part-ner to listen and provide companionship.

Start building your social network al-ready during pregnancy and actively seekto make friends with people in the samesituation, e.g. with the parents in your an-tenatal class. Maternity and parental leaveprovide a chance to make new friends.Find peer support in parenting clubs, par-ent nights and family cafeterias organised


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Pregnancy 23

by the municipalities, church and theMannerheim League for Child Welfare(MLL). You can meet other parents with

young children in parks, playgrounds andopen day care centres.

Mothers, particularly single mothers,need special attention and support duringpregnancy. In addition to friends and rela-tives, the prenatal clinic’s nurse, a social

worker and health care centre psychologistare available to provide support. You canalso contact helplines, the child guidanceand family counselling centre, or the

church’s family guidance centres (see”Services for families with children” on-

page 90). Single parents will find peer sup-port from the association for single parents(visit ”Yksin- ja yhteishuoltajien liitto” at

www.yyl.fi). If you are pregnant without apartner, you can invite a doula (a trainedsupport person) to attend the birth. Formore information, please visit the Federa-tion of Mother and Child Homes andShelters’ site at www.ensijaturvakotienliit-

to.fi. For contact details type ”doula” in thesearch field. u

Relationship with

your partnerHaving a good, loving relationship with your partner is one of the most importantand rewarding things in life.

Such a relationship does not just hap-pen on its own, though. Firstly, to be ableto love another, you need to accept and

love yourself. Secondly, a good relation-ship must be nurtured: be caring and at-tentive, show affection, listen and interact.

At best, pregnancy can be a shared experi-ence that strengthens your relationshipand enhances the feminine and masculinetraits of both parents. On the other hand,unpleasantness, insults and unfair behav-iour during pregnancy will be forever re-membered unless they are talked throughand forgiven.

HouseworkCouples without children generally splithousework evenly without argument, butin families with young children houseworkis a major source of disagreement. House-

work is the responsibility of each and eve-ry family member; it should not be consid-

ered as ”helping mum”. If not before, dur-ing pregnancy all family members shouldparticipate in housework – not just theparents but the older children as well.

Dad’s share of housework increasesduring pregnancy, especially if the motheris suffering with contractions. During latepregnancy, the mother should avoid phys-ical strain, such as lifting heavy objects.

During the first week after birth, thebaby needs round-the-clock attention.

MOTHERS NEED SPECIAL ATTENTIONAND SUPPORT DURING PREGNANCY.

Cherish the love you have


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24 Pregnancy

If all housework is left to the moth-er, she will become over-exhaus-ted.

Sharing your feelingsIn a good relationship, you canopenly share everything that ison your mind: joys, sorrows,concerns, fears, hopes anddreams. Sharing your feelingsand thoughts is not alwayseasy and requires practice.

The following advicemight be helpful:

1) Listen to what yourpartner is saying. What ishe/she feeling? What ishis/her intention? Try not totake immediate offence. Was

what he/she said actually intend-ed to offend, or was it just worded a bit

clumsily?2) The individual is the best judge of his/

her own feelings. If your partner sayshe/she is afraid or troubled, don’t tellhim/her that there is nothing to beafraid of. Rather, ask what it is specifi-cally he/she is afraid of. Allow you part-ner to have the feelings he/she is expe-riencing and say, for example, ”You

must have felt terrible when you werebeing got at by your boss”etc.3) Tell your partner how you feel. If you

are angry, say ”Having to clean up after you makes me angry”, for example. Trynot to blame your partner, and avoidthe word ”always” in phrases such as”You are always so careless”. If you

want something, state it clearly. For ex-ample, ”Could you vacuum the house?”(instead of ”You never do anything”).

4) Respect each other. Never say things that you know are the

most hurtful to your partner, even when angry.

5) Digging up past faults is easy to do, butis poisonous to your relationship.Learn to forgive and forget.

Pregnancy and sexualityPregnancy may change the way you feelabout sex in one way or another. Nausea,fatigue and breast tenderness during earlypregnancy may cause your desires to de-cline. However, you might find that the lit-tle secret you are carrying makes sex during

IF HOUSEWORK IS LEFT ONLY TO THE MOTHER,

SHE WILL BECOME OVER-EXHAUSTED


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Pregnancy 25

early pregnancy thrilling in a new way.For many expectant mothers, the se-

cond trimester is a sexually fulfilling time.The increased blood flow to the vaginacauses a feeling of fullness and heightenedsensitivity. During this time, it is not un-common for women to masturbate morethan ever before. For many women, this isa peak erotic time in their life.

Many men enjoy their sexually moreactive partner. However, the new situationis likely to be confusing for the man as

well. He might worry about harming the

unborn child and avoid situations that willlead to sex. A normal pregnancy does notprevent the couple from having sex.

During late pregnancy, many womenfeel awkward and sexually unattractive,

while others enjoy sex right up to birth.Remember that sexual intercourse is justone aspect of sexuality. During this time

when your shared life is taking on new

forms,, maintain intimacy and affection bysaying and doing things you know willgive pleasure to your partner.

After the child is born, there will be aperiod when your sex life will have to beon hold. The parents can decide the lengthof that period, but it is recommended toput off sex for a couple of weeks, until the

vaginal discharge ends. However, there is

no need to refrain from showing affection!Hugs, caresses, kisses and nice words areespecially important when your means ofexpressing your sexuality are limited and

you are feeling unusually emotional. Hav-ing a satisfactory sex life in your relation-ship is a shared responsibility – it takestwo to tango!

Abuse is unacceptableIt is good to be an understanding partner,but there are limits as to what should betolerated. Physical and mental abuse arecrimes against another person and shouldnot be tolerated. Heavy blows to the areaof the abdomen may damage the womband the foetus. At worst, this may cause

the pregnancy to terminate. If you are be-ing abused, turn to your neighbours orfriends for help, or call the police, socialservices or a mother and child shelter.Sometimes the first priority is to remove

yourself from the abusive partner into asafe environment.

The emergency phone number is 112.The Emergency Response Centre staff will

tell you what you need to do and will alertthe necessary authorities. For the Police,dial 10022. Girls and women who have ex-perienced violence or the threat of vio-lence can receive help from the National

Women’s Line in Finland (www.naisten-linja.com) by calling the national tele-phone helpline (tel. 0800 02400). Help formen in finding an alternative to intimate

partner violence is provided by the”Lyömätön Linja”organisation. If you needhelp, call tel. (09) 612 66 212, or email [email protected]


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26 Pregnancy

Antenatal care is provided by pre-natal clinics to maintain the good

health of the expectant mother andthe unborn child, to promote ahealthy lifestyle for the whole fami-ly and to help the family prepare forthe new baby. The aims of antenatalcare include promoting the well-beingand good health of the prospectiveparents, supporting the parents intheir growth towards parenthood and

family life, and providing tools for pre- venting and solving possible problems intheir relationship. In particular, support isneeded in families expecting their first ba-by. The prenatal clinics are organisedaround the whole family, not just themother. Dads receive support in their per-sonal growth towards becoming fathersand advice on a healthy lifestyle and how

to best support the mother. Additionalsupport and advice is also provided by on-line clinics.

Antenatal care monitors possible prob-lems during pregnancy, takes action toprevent them and refers the mother forfurther examinations and treatment inhospital, if necessary. The prenatal clinicsand hospital maternity units also supportthe family if and when the mother hasfears relating to childbirth, suffers from de-

pression, or is having a multiple pregnancy.Care during pregnancy and childbirth is re-alised in close collaboration between theprenatal clinics and the hospital maternityunit.

A nurse or midwife and a doctor workat the prenatal clinic. Antenatal care in-cludes physical examinations, screeningtests, personal guidance and antenatal

classes. Your nurse or midwife may also visit you at home. During the course of anormal pregnancy, the expectant mothermakes 12 to 15 visits to the prenatal clinic.Of these, 2 to 3 are doctor’s appointments.Most health care centres offer ultrasoundscans at 12 to 16 weeks. The services of apsychologist, a nutritional therapist, aphysiotherapist and a social worker are al-so available for families.

Antenatal care in theprenatal

clinics


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Pregnancy 27

First visitThe mother’s overall health and possiblerisk factors are assessed at the prenatalclinic through examinations and a person-al interview. A blood sample is taken atthe first appointment to determine yourblood group, Rhesus factor and bloodhaemoglobin concentration. The sample

will also be tested to rule out syphilis. Aurine sample is tested for sugar levels,protein and bacteria. The expectant moth-er will be weighed, her height measuredand her blood pressure checked. With the

mother’s permission, the blood samplecan also be tested for HIV antibodies andhepatitis. Visits to the prenatal clinic al-

ways include personal discussions and advice.

Your doctor will perform an internalexamination at the first appointment todetermine the position of the womb andcheck that the size of the uterus corre-

sponds to the pregnancy weeks.

Follow-up visitsFollow-up appointments at the prenatalclinic are at early pregnancy every four

weeks, every two weeks from week 28, andonce a week from week 35.

During each visit, the mother is weighed, her blood pressure is taken and

her urine is tested for sugar. Blood haemo-globin is determined at least three timesduring pregnancy. The average weekly

weight gain is determined to ensure thepregnancy is progressing normally. Swell-ing is monitored, if present. Foetal heart-beat will be monitored at each visit and thebaby’s position will determined by externalexamination. If the need arises, the exam-ining doctor or nurse will refer the motherto the hospital maternity unit for further

testing. Topics concerning pregnancy,childbirth and parenting are discussed

with both the mother and father duringthe follow-up visits.

It is recommended that the expectantmother pays attention to the baby’smovements, especially in late pregnan-cy. If you are worried about the well-being of you or your baby, share yourconcerns with your nurse or doctor. Youcan discuss, in complete confidence, is-

sues concerning pregnancy, includingdepression, family problems and fears

with the doctors and nurses at the pre-natal clinic. If necessary, further supportis available through social workers,psychologists and specialists.

Intensive antenatal careSome expectant mothers receive intensiveantenatal care in, for example, the follow-ing situations:

u when the mother suffers fromprolonged or chronic diseases,

u multiple pregnancy,u mother having first baby at a very

young or relatively old age,u raised blood pressure and protein

found in urine (signs of pre-eclampsia,a condition requiring doctor’sattention),

u itching or yellow skin(signs of hepatosis gravidarum),

u certain inflammatory diseases atthe beginning of pregnancy,

u birth canal infections.


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28 Pregnancy

The majority of babies born in Finlandare healthy. This is mostly due to thegood health of Finnish women and the

regular visits to the prenatal clinic andmaternity unit where the health and well-being of the mother and baby areclosely monitored.

Screening programmes for chromo-somal and structural anomaliesIn compliance with a national screeningprogramme, all Finnish municipalities are

now (as of 2010) required to offer their res-idents screenings to determine foetal chro-mosome abnormalities and severe struc-tural abnormalities (the Government De-cree on Screenings (1339/2006) andamendments to it, http://finohta.stakes.fi/FI/sikioseulonnat/index.htm). Additionaltests offered include ultrasound scans andtests on maternal serum, as well as tests on

the amniotic fluid and the placenta, all of which are voluntary. The pregnant womandecides whether or not she wants to un-dertake the screening tests and any addi-tional tests. She also decides which screen-ing programme she wishes to take part in.

Screening tests are performed to de-tect any increased risk of disease or disa-bility or other health problems, so that thebirth and aftercare of the newborn can beplanned well in advance. The vast majori-ty of babies develop normally without se-

vere injury or disease. A screening result that indicates an in-

creased risk does not necessarily meanthat the baby will be born with a disabilityor disease. Furthermore, not all conditionsshow up in screenings, and no test canguarantee that the child will be healthy.

Although an increased risk of foetal ab-

normality is only found in a small percent-age of pregnancies, it is important that theparents-to-be discuss the risk of such a re-

sult and how they will feel about any fur-ther tests, and about continuing the preg-nancy and having a child with a dis-ability,or about terminating the pregnancy.

The early pregnancy ultrasound scan isperformed at weeks 10+0–13+6, either ex-ternally or internally. The primary purposeof this scan is to confirm the weeks of ges-tation and to verify the number of foetus-es. Structural abnormalities may be re-

vealed by the scan.The risk of chromosome abnormalities

can be assessed by performing an earlypregnancy combined screening. The bloodtest needed for early pregnancy serumscreening is taken at weeks 9+0–11+6, andthe NT scan (nuchal translucency scan) ofthe foetus is carried out at the same timeas the early pregnancy general ultrasound

scan, in week 11+0–13+6 of the pregnancy.If the first prenatal clinic appointment isafter week 11+6, a blood test may be of-fered as an alternative, for use in the sec-ond trimester serum screening in week15+0–16+6. However, the second trimesterserum screening is not as reliable in theassessment of the risk of chromosomal ab-normalities as the early pregnancy com-

bined screening. The results from screen-ing tests for chromosomal abnormalitiesand data on factors such as the duration ofthe pregnancy and the mother’s age areadded up in a special calculation pro-gramme to yield a risk factor, which indi-cates the probability for chromosomal ab-normality in the foetus. The probabilitythat the foetus has a specific abnormality isgiven as a ratio, for example 1:100, 1:250,1:1000 etc. If the probability of chromo-


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Pregnancy 29

somal abnormality is greater than the risklimits set, the pregnant woman is offeredfurther tests where the foetal chromo-

somes can be tested through placentaltests or amniocentesis. Examinations are voluntary and carry a slight risk of causinga miscarriage (at most 1 out of every 100pregnancies).

Many municipalities offer amniocen-tesis or placental tests to women over 40

without the preliminary screenings, as therisk of chromosomal abnormalities in-creases with age.

The second ultrasound scan is a moredetailed scan called a fetal structural sur-

vey, the baby’s major organs and skeletonare checked for severe structural abnor-malities in week 18+0–21+6, or alterna-tively after week 24+0. At this time, thenumber of foetuses and their status is alsochecked, and the duration of pregnancy,the amount of amniotic fluid, and the po-

sition and condition of the placenta are verified. The mother may be accompaniedto each scan by the father or some anothersupport person. Pregnancy can be termi-nated up until the end of week 24 (24+0)by permission of the National Supervisory

Authority for Welfare and Health (Valvira)if the foetus has been reliably tested tohave a severe disease or structural anoma-

ly. Guides for parents on the screeningtests are available at http://finohta.stakes.fi/FI/sikioseulonnat/index.htm.

Antenatal classesEvery prenatal clinic organises antenatalclasses to prepare the prospective parentsfor labour, childbirth and parenthood. It isrecommended that you attend your first

antenatal class during weeks 20 to 30.

Usually there are 4 to 5 meetings, some ofthem preferably after the baby is born. Theantenatal classes are usually held by a

nurse or some other health care profes-sional, and the topics covered include what happens during labour and how toprepare for it, breastfeeding and caring forthe newborn. Antenatal classes provide achance to learn how to care for the baby,to discuss changes in daily routines whenthere is a new baby in the house, to talkabout parenthood and relationships withother prospective parents, and to learn

about the services and benefits availablefor families with children. Antenatal class-es often include a visit to the hospital ma-ternity unit.

Prenatal clinics and dadsDads are welcome to attend each appoint-ment as well as the antenatal classes.Dads bring the male perspective into the

pregnancy discussion. The child will be-come attached to both the mother and thefather, so it is only natural that parentingis shared. A child needs the support andassurance of both mum and dad for his/her development. Shared parenting re-sponsibility gives dad a chance to realisehimself in new ways, while mum can havesome private time on her own. When both

parents participate in caring for the chil-dren, the relationship tends to be happier.However, as much as the dad might wishto be a caring and actively participatingfather, it is not always easy; changing yourlifestyle and starting to live on the baby’sterms may be difficult.

Prenatal clinics help mums and dadsform a positive yet realistic picture of life

with a new baby. The clinics strive to pro-

mote the mother’s and father’s commit-


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30 Pregnancy

ment to caring for the baby. Prenatal clinicsalso accommodate the men’s views andneeds as parents. Dads are advised on howthey can best support their partners during

labour and how they can participate in ca-ring for the baby.

The Older siblings and jealousyIf the baby is not the first child in the fam-

ily, it is a good idea to start preparing theother children for the new baby in ad-

vance. The age of the child dictates whento tell about the baby: immediately whenthe pregnancy has been confirmed, or lat-er when the pregnancy clearly begins toshow in the mother’s body, for example.Regardless of the moment, pregnancy willlast for a long time from the child’s per-

spective. However, the child should firsthear about the pregnancy from his/herown parents, not from other people.

For a first born, having a new baby inthe family is a huge experience and cancause envy and jealousy. These feelings willpass sooner if the older sibling is invited toparticipate in caring for the baby. If thechild’s cot or other items are to be handed

down to the baby, this should be done wellin advance before the baby moves in. Whenthe child asks you a question, try to give asimple and straightforward answer. If thefirst child is very young, you can say, for ex-ample, that ”Daddy gave mummy a babyseed and now there is a little baby growingin mummy’s tummy. When the baby isready, he or she will come out through aspecial opening (different from the ones forpee-pee and poo-poo) and the baby will be

our baby, and mummy and daddy will love

you and the baby just as much.”

Older childrenFor children over 10 years, the idea of anew baby may be very difficult to accept.They might have thought that ”my mumand dad don’t have sex”. The older chil-dren might also be uneasy about their sta-tus and fear losing their parents to the ba-

by. In such a situation, some childrenfreeze completely while others begin toexhibit problem behaviour. Talk with yourchildren about their feelings, expectationsand fears. Sometimes, talking with a friendof the family or a health care professionalor social worker can help both the childand the parents.

Sort your prioritiesThe new baby drains energy from the whole family during pregnancy and espe-cially in the first weeks after birth. Think inadvance what is important and what can

wait until later. The well-being of themother is a prerequisite for the well-beingand healthy development of the baby.

Work, cleaning, guests and travel can wait– the baby cannot. When the parents getenough rest, they will be able to better

Pregnancy at work and at home

Many prenatal clinics organise meetings for just the dads where they can share their ex-periences with other men in the same situ-ation. When the nurse comes to meet you

at home, schedule it so that the father willbe present as well. u


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Pregnancy 31

enjoy and care for the baby. It is recom-mended that you begin your maternityleave at least a month before the expecteddate of delivery. Remember, giving birthdemands more energy than running amarathon!

Risks at workThe superiors of expectant mothers are re-sponsible for ensuring safe working condi-tions and methods. A pregnant woman is

entitled to request being transferred toother jobs if the working environmentposes risks such as chemical substances,radiation or infectious diseases. If this isnot possible, the mother can apply for spe-cial maternity allowance from the SocialInsurance Institution (KELA) to begin ma-ternity leave at an earlier date.

Pregnant women should not do jobs

involving exposure to radiation (e.g. X-rays). They should also avoid physicalstrain, such as lifting or moving heavy ob-

jects. According to current knowledge, working by a computer monitor and usingphysical therapy equipment do not pose aradiation risk. If your job involves cominginto contact with anaesthetic gases, lead,mercury, cytostatic agents, carbon monox-

ide or carcinogens (cancer-causing sub-stances), consult your occupational healthcare representative to ensure the safety of

your working environment.Pregnant women should also carefully

investigate any social risks relating toparental leaves, discuss the statutory rightsand benefits with their superiors and havea preliminary discussion about returning to

work from maternity leave (see ”Benefitsfor families with children”on page 99).

Infectious diseases and vaccinationsIf a pregnant woman has never had the

common pox diseases or been vaccinatedagainst them, she might become infected

when working with children. If you havenever had chicken pox, you should be vac-cinated against it before becoming preg-nant. Avoid contact with people with anactive virus. Pregnancy should be taken in-to account when dividing the daily tasksin, for example, infectious disease depart-

ments in hospitals.If you work in the health care sector,

you might become infected with hepatitisB or HIV via the blood or excretions of in-fected patients. In the cleaning business,syringes and needles in waste bags maypresent a risk. Usually, a biohazard doesnot exist unless the patient’s blood comesinto contact with the worker’s circulation

via a wound or a needle prick. Reduce therisk by wearing protective gloves, usingdisposable instruments and avoidingmouth pipetting in the laboratory. There isa risk of cytomegalovirus infection if youare working in an institution where youcome into contact with infant excreta.Pregnant women should be removed fromthese environments. However, for most in-fections, it is sufficient to be aware of therisks and to protect yourself adequately. u


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32 Pregnancy

The package contains:(For photos of the contents, please visit www.kela. ).

Learn the policies and procedures inuse at your workplace. Discuss risksand biohazards with your superior,occupational health care services, or oc-cupational safety personnel.

Maternity packageThe Finnish maternity package deliveredfree of charge to expecting mothers is theonly one of its kind in the world. The ma-ternity package is a complete baby gear”starter pack”. The pack includes useful,high-quality clothes and other necessaryitems. Pregnant women must apply for thematernity package from the Social Insur-ance Institution (KELA). The application

can be sent together with the applicationfor maternity allowance. Another alterna-tive is to fill in an online application at

www.kela.fi/asiointi. You can log yourselfin with Finnish banks’ net bank user IDs,

What does a baby need?

but please note that the service is onlyavailable in Finnish and Swedish. You canclaim your maternity package from KELAor retrieve it from the post office a fewmonths before the estimated date of deliv-ery (see ”Maternity grant”on page 99).

The contents of the maternity packageand the fabrics for clothes and bed linenchange from time to time, but there are nomajor changes.

The clothes come in different sizes (60to 70 cm). A newborn is about 50 cm. If the

uBaby wear: wrap-tops, body suits,trousers, jumpsuits, top and trousers set,baby hats, socks, mittens, overalls, warmbooties, padded mittens, pramsuit

uLinens, towels, nappies: terrynappies,cloth nappy set, bath towel, sheet,blanket cover, blanket,sleeping bag (turnsinto a padded blanket)

uBaby care: mattress, mattress protector,hairbrush, disposable nappies, toothbrush,nail clippers, bath water thermometer,basic lotion, bib, book, toy

uOther: sanitary pads, condoms,bra pads, lubricant lotion, and pamphletson: relationships, breastfeeding, nutrition,cloth nappies, and safety while travelling


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Pregnancy 33

suit sleeves or legs are too long, shortenthem temporarily by sowing folds on theoutside or tying a knot at the end of verylong legs. You can also shorten pant legsby using socks or booties.

Somewhere to sleepThe maternity package comes in a boxthat is designed to double as a baby basket

when it is lined with fabric (e.g. a sheet).Use of a dark red fabric provides a sooth-ing colour that reminds the baby of the

womb. At first, the baby can also sleep in a

crib, carrycot, basket or other baby bed. Acot with bars will be necessary by the timethe baby starts turning and movingaround and the previous sleeping ar-rangement is no longer safe. When thechild is 1.5 to 2 years old, he/she will beable to climb out of the cot. At this time,the child can start sleeping in a children’sbed.

Acquiring and storing baby gearIn addition to the maternity package, it isadvisable to acquire additional clothesand linens, if possible, since babies tendto use up clothes quickly. It is not neces-sary to buy all items new; charity and sec-ond-hand shops sell baby wear and gearat reduced prices, and you can also look

for baby gear for sale in local newspapers,market notice boards as well as from on-line auctions and second-hand shops. It isalso relatively simple to make bed linen

yourself, or friends, relatives and neigh-bours may be willing to lend you someitems. There are also national organisa-tions that lend baby gear, such as theMannerheim League for Child Welfare(MLL) and Folkhälsan. Recycling is bene-ficial, since most clothes and items can be

used by several babies.Remember that the baby does not

need massive amounts of toys, equipmentand clothing. As a rule of thumb, havethree pieces of everyday clothing, such as

jumpsuits and body suits: “one for wear-ing, one for the wash, and one for drying”

As for other clothes, such as hats and over-clothes, three is often too many. However,if washing clothes is not easily accom-plished, it is wise to have several pieces ofclothing, since babies tend to use at leastone outfit per day. The first year is a time of

rapid growth, and your child will quicklygrow into and out of clothes. A 1-year-oldchild is 73 to 80 cm and weighs 10 to 12 kg.

The essential bigger purchases for thebaby include a tub, a pram and a car safetyseat, if the family travels by car. Use thecarrycot that fits inside the pram to trans-port the baby if the pram does not fit in-side the house or cannot be pushed all the

way to the front door. When buying prams,pay attention to safety, durability and size(will it fit into the lift?). Most modern ad-ditional features, such as air conditioning,have little effect on the well-being of thebaby. If it is possible to sleep the baby on abalcony, you can get a used pram in goodcondition at a very reasonable price tokeep on the balcony.

A couple of shelves or drawers isenough space for storing the baby’s clothes.It is possible to change nappies whilstholding the baby in your lap, but in manycases a proper changing mat or changingtop can be very useful (see ”A place forchanging”on page 57). A baby carrier, slingand baby sitter allow you to keep yourhands free. Baby carriers and slings are er-gonomically designed for the comfort ofboth the mother and the baby. u


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34 The birth

Antenatal classesPreparing for birth is one of the topics cov-ered in antenatal classes, with the aim ofproviding both the mother and the father

with information and guidance on birthand delivery so that when the time comesthey will be able to make informed deci-sions. Being prepared both physically andmentally will help the mother stay in con-

trol of the situation during delivery. It isimportant that the mother feels in control,and that the baby’s birth is as positive anexperience as possible.

In order to be able to function as effec-tively as possible during labour and deliv-ery, both parents must be familiar with thethree stages of labour, the standard labourand delivery procedures involved, and the

recommended breathing and relaxationtechniques and pain control options. La-bour, as the name implies, is hard work andrequires a great deal of mental and physicalenergy. Being able to relax between andduring contractions conserves the mother’sstrength. Preparing for birth in advanceusually eases the delivery process.

It is not always possible for the father

to attend the birth and, when this is possi-ble, it is ultimately the father’s own choice. Alternatively, the mother can also havesome other person as a companion, a closefriend, a relative or a doula (a persontrained in labour support), for example.

Whatever the decision, it should be madeas early as possible.

How to plan in advanceIn recent years, the emphasis has beenplaced on the fact that birth is a naturalevent. Hospital maternity unit staff aim tocreate a calm and comfortable atmospherefor the family, and provide the mother

with sufficient space to focus on the deliv-ery. In many units, a member of staff willhold a discussion with the parents before-hand on their thoughts and wishes related

to the oncoming birth. This discussion isthen continued during labour when con-sidering the available options and proce-dures that might assist in the delivery. Be-ing prepared is important, but it should beborne in mind that giving birth is always aunique experience and that the parents

Preparing for birth


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The birth 35

will be facing issues that cannot be consid-ered in advance, but must be decided uponas the situation arises.

Maternity units are equipped with dif-ferent kinds of birth stools and rockingchairs, birth pools and deep baths. Themother can decide which of the availableoptions she is willing to use, while the carepersonnel will assist and give advice onsuitable alternatives. The mother is free tomove around during labour and has theright to decide on the position most suita-ble for delivery. Alternative forms of pain

relief are also discussed with the mother.

Father’s roleIt is the role of the father (or some othercompanion) to support, encourage andrally the mother during labour. Givingbirth usually takes several hours, and sup-port and encouragement is much needed.Some very concrete supportive measures

include, for example, massaging the moth-er’s aching back, fetching something todrink, wiping away sweat and helping themother to relax. The presence of a closecompanion is a comfort to the mother andhelps her keep her spirits up.

Furthermore, this shared experienceoften strengthens the relationship.

When the father has witnessed the

birth of his own child, the relationship be-tween the father and the child forms im-mediately when the baby is lying on itsmother’s chest, seeking contact with itsparents. A strong bond is created when thebaby first opens its eyes and makes eyecontact with the faces close by. Some fa-thers find they feel a stronger sense ofcloseness - as if the baby was more their”own”- when they have been present dur-ing the birth. Fathers who have seen their

THE PRESENCE OF A CLOSE COMPANION

IS A COMFORT TO THE MOTHER

baby being born describe it as one of thefinest moments of their lives.

Anticipating the

delivery

methodMost babies (85%) are vaginally delivered

in a head down position. Presentation isassessed prior to birth, but cannot be abso-lutely determined as the situation can maychange quickly. It may become necessaryto induce labour, or there might be com-plications requiring specific procedures

during labour. Intervention is required inapproximately 15% of births. Interventionmethods include Caesarean section (C-section), vacuum extraction, forceps andassisted breech birth.

In approximately 3 percent of deliver-ies, the baby is in the breech position (the

baby is head up instead of head down). Abreech position (or any other abnormalpresentation) is usually detected at theprenatal clinic. You may be referred to thehospital, where a doctor will try to turn thebaby from the breech position to a head-down position. This procedure is alsocalled external cephalic version. However,if this is not successful and the baby re-

mains in the breech position, the final de-cision on the delivery method is made af-ter a thorough check at the hospital mater-nity unit, where the baby’s size and mot-her’s pelvic dimensions are carefully meas-ured. A baby in the breech position is oftenborn by caesarean section (C-section), es-pecially when it is the mother’s first deliv-ery, the mother has had previous caesa-rean sections or when the baby ispremature.


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An elective caesarean sectionIn Finland, approximately every sixth childis born by caesarean section and of thoseapproximately 50% are elective caesareansections. Typical reasons for a caesarean in-clude breech presentation, abnormal pla-cental position, the large size of the baby, a

decelerated growth rate and previous cae-sareans. Sometimes the mother experienc-es such fear of giving birth that vaginal de-livery is not possible.

A caesarean section is scheduled for atime when the baby is most likely to bebest prepared for life outside the womb,i.e. when the lungs have matured and oth-er risks remain as small as possible. How-

ever, a child born by elective caesareansection is at a higher risk of being slow toadapt and to develop wet lung syndrome,because the complicated mechanisms thatmature the lungs and are naturally activat-ed during vaginal delivery do not haveenough time to function adequately dur-ing a caesarean. In addition, both themother and the baby need more time to

recover.In the case of an elective caesarean, thehospital maternity unit staff provide advice

well in advance. Fathers are welcome toparticipate in elective caesarean sections.(For more information on Caesarean sec-tions, see page 40.)

Policlinic deliveryThe inpatient period following delivery hasbecome shorter, and so-called ”polyclinic

deliveries”have become possible, althoughthey are still quite rare. In a polyclinic de-livery, the family can take the baby home 6hours after birth, provided that there havebeen no complications. As in all deliveries,the mother and baby are the centre of at-tention and their well-being takes prece-dence over everything else.

Giving birth before reaching the hospitalSometimes the baby is born so fast that themother cannot make it in time to the hos-pital. Each year, some 50 women deliver

their baby on the way to the hospital andanother 50 have an unplanned home birth.In these cases, the first stage of labour pro-ceeds quickly to the second stage and themother feels the need to push suddenly,

while still at home or on her way to thehospital. Hence, the father or other com-panion has to play the midwife’s role. Thefirst priority is to stay calm. If possible, the

father should contact the hospital to re-ceive advice over the phone. Once the ba-by is born, he or she is bathed and thenplaced on the mother’s chest. Rememberto ensure that the baby is kept warm. It isadvisable to prepare for such a delivery, es-pecially when the hospital is far away or

when previous births have been quick.

Home birthHome birth is very rare in Finland, al-though it is also an option. Each year,about 10 mothers decide to give birth athome. Home births require considerablepro-activeness and initiative from themother. She will need to book a midwifeand acquire the necessary equipment.Mothers choosing home birth are also res-ponsible for all of the related expenses andany unexpected consequences. If you are


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interested in home birth, be sure to inves-tigate the option thoroughly before mak-ing your final decision.

Overdue pregnancyIf your pregnancy exceeds the estimateddelivery date by more than 10 days, basedon the measurements taken from an earlypregnancy ultrasound scan, it is consideredoverdue. You or your health nurse shouldmake an appointment at the hospital ma-ternity unit where a doctor will examinethe mother and the baby and, based on the

well-

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