Taking care of yourself when you are pregnant is very important, and does not only involve regular check-ups with the doctor, and a proper, balanced diet. In fact, making sure you stay healthy physically through regular exercise is equally essential to help you along with your pregnancy.

What’s your exercise plan?

Were you an avid jogger before you became pregnant? Or did you regularly go for swimming classes every week? Perhaps you were one of those whose exercise routines involved cleaning the house every once in a while. Regardless of how your exercise routine used to be, it is important that you start on an exercise plan now that you’re pregnant. If you have been exercising regularly before pregnancy, then by all means, continue with your routine with slight modifications that suit your condition. If you have never been much of a fitness freak before, don’t fear! Begin a new routine slowly and gradually build it up from there.

Baby, let’s move!

There are tonnes of ways to stretch your body, depending on your interests as well as what your doctor may advise you.

• Walking is the perfect way to start an exercise routine, especially if you did not exercise before pregnancy. It is safe, can easily be done and is easier on your knees compared with running. Do make sure that you warm up before you begin; start off slowly and gradually build up as you become stronger.
• Swimming on the other hand, may be one of the most appealing exercises – it helps tone your body without the added weight or stress to your joints as the water supports your weight. Swimming raises your heart rate and is a safe cardiovascular exercise according to many health care professionals.
• Many women have also turned to yoga as a way to keep fit even when not pregnant. Yoga has had a reputation for relieving stress and pressure on your body, with most forms safe for both you and baby. Some yoga instructors even have special classes for pregnant women! The most important thing to remember is not to overstretch and to avoid lying flat on your back for long periods.

Breathe in, breathe out

Antenatal classes can help you prepare for your baby’s birth, which also includes teaching you how to keep fit and well during pregnancy. Most classes often teach the proper technique of deep breathing that helps to improve blood circulation and boosts the flow of oxygen supplied to both you and your baby. These breathing exercises can also help your body remove wastes effectively as well as relaxes you and reduces stress. This is very important during labour as it helps you to relax when you most need to!

Avoid it!

Most exercises are safe and if done in moderation should not cause any injury to pregnant women. There are some activities that you should avoid however, especially those that include bouncing or jarring (movements that cause a lot of movements up and down), leaping, sudden changes in direction or those that carry a high risk of abdominal injury. Doctors also strongly advise against lying on the back for long periods of time, especially after 16 weeks as your growing baby may press against your main blood vessels.

Exercise is indeed beneficial as it generally makes you feel better as well as reduces the stresses of pregnancy. What’s more, exercise can prevent wear and tear of your joints due to hormonal changes during pregnancy. Furthermore, strong muscles and a fit heart helps ease labour and delivery while gaining control over your breathing can help you manage the pain. Always seek advice from your doctor before starting or continuing any exercises to ensure you get the optimum benefits from your regime.

Did you know that communication with your baby begins long before he is born? You don’t have to wait till he is in your arms; as young as 16 weeks, babies can start to hear your voice, as well as other sounds in the environment while still in the womb. In fact, a mother’s womb is the most stimulating and interactive environment for a baby to develop!

Is He Listening?

Babies live in an environment that is constantly filled with sounds, vibrations and motions. Although the womb is not the quiet place as previously once thought, your unborn can still hear voices and sounds from the outside world. At just 16 weeks, babies can start to hear, long before their ears are completely formed, which occurs only at 24 weeks old. A mother’s voice is the most powerful and easiest sound for baby to detect as it is transmitted directly to the womb through her own body.

Constantly talk to your baby, about anything and everything! Talk soothingly, tell him stories or nursery rhymes, read to him, play soothing music or just talk about your day as you go about it. It is only natural that babies form better connections with their mothers, as hers is the voice they hear everyday and for longer periods. Fathers can help establish their bond with baby by talking to him whenever possible. When he’s born, he’ll be able to recognise and be more responsive to his father’s voice as well.

Touch Your Baby!

As early as 15 weeks, you can already feel your baby move, although you may not actually feel kicks until about 20 weeks. At this stage, babies are responsive to your touch from outside the womb. By gently massaging or caressing your belly, you can help stimulate your baby to give you a response. When you feel your baby kick, you can press gently at the same spot to see if he responds with another kick. Some parents have reported that when they do press the belly, their baby responds by kicking the same spot again.

Give Your Baby the Best

During pregnancy, it is important that you eat a wide variety of foods to provide your baby with all the nutrients that he needs to develop healthily. Do eat plenty of fruits and vegetables as well as carbohydrates such as rice, bread and pasta – these should be of the wholegrain types. Take enough protein such as fish and dairy products like milk, cheese and yoghurt. And more importantly, increase food consumption that are rich in iron and zinc.

Enjoy Every Moment with Your Child!

Some experts worry that all these stimuli interfere with the natural development of your baby’s brain. There is still much to learn about the developing brain and the optimal conditions it needs to develop well. No parent would actually blast music next to his newborn’s ear when he is asleep, and the same goes for an unborn baby!

However, talking to your baby and playing “poke” games with him is not likely to bring on any negative side effects, and in many ways, it helps build a reassuring bond between parents and baby as a first step to communication. All in all, being pregnant is a wonderful experience and it should be enjoyed every step of the way!

Conceiving a baby is the beginning of the greatest adventure of a woman’s life. Whichever age you may be, be it a thriving, young lady in her 20s or an older, more secure woman in her 40s, age does matter to you and your unborn child. Read on to know how your age may affect your pregnancy.

When You are in Your 20s

An average woman’s fertility peaks at the age of 24, making the 20s the best decade for a woman to conceive and carry a baby. The eggs are less likely to have genetic abnormalities, while the risks of health complications (for the mother and the baby) are relatively lower compared to your older counterparts. You would also have more energy – able to recover quicker from looking after your little ones until wee hours of the morning.

In the early 20s, you are probably at the brink of starting your life, family and career and you may find it harder to keep up with the financial and emotional demands of having a child. However, as you age, you will probably gain the maturity and ability to handle the demands of parenthood.

Hitting the Terrific 30s!

Physically, turning 30 (and beyond) marks the beginning of the decline of a woman’s fertility. Note that being 30 and being 35 carries a big difference. The chances of you getting pregnant in your early 30s is only slightly lower than when you were in your late 20s, and the risks of your baby having a birth defect in only slightly higher. However, once you turn 35, the risks - rates of miscarriage, ectopic pregnancy, as well as complications related to pregnancy (high blood pressure, diabetes) - multiplies considerably.

At this age, you are more likely to be more secure financially and you and your partner are more likely to have settled into a comfortable rhythm. Women in their 30s will be able to draw on their life experiences in parenting. Additionally, they also have a lot of energy and resilience left in them, which is needed when parenting young children. Women in their 30s will be able to provide better (emotionally and financially) to their children.

Flaunting the 40s

While it seems wise to have children only after you are established in your career and relationship, the biggest downfall is that it is harder to conceive at this age. Egg viability drops significantly the older you become and if you do get pregnant, there is a 24-54% chance of miscarrying the baby as you age from 40-44 years. Pregnancy complications such as hypertension and diabetes are also likely to rise with age. According to fertility experts, it is almost impossible to get pregnant using your own eggs after you turn 46 and will need to use donor eggs to conceive.

That said, there are women who do get pregnant in their 40s, and with successful pregnancies. Older mums in general, tend to make wiser parenting decisions compared with younger mums. They also have job and financial security as well as a broad range of experience before settling down to have children. Women in their 40s have stable relationships with their partners, which lead to the solid foundation needed for raising a family.

Keeping Your Health in Check

All women age differently and there is no right time to start a family. While you may be physically fit to have a baby in your 20s, research indicates that mothers in their 30s and 40s are more capable financially and emotionally to care for their own and their baby’s wellbeing. Regardless of the age, there will always be challenges and it is up to you to determine how you will cope with the demands of parenthood.

Postpartum blues, also known as baby blues, are the common but mild form of depression a new mother experiences after labour and delivery. It usually develops within the first two weeks following childbirth. However, bear in mind that postpartum blues is not an illness and will automatically disappear on its own.

What Causes it?

The exact causes of postpartum blues are unknown, but many believe that the dramatic physical and hormonal changes in the mother’s body may produce chemical changes in the brain that results in the blues.

Husbands, Take Note!

The symptoms of postpartum blues are rather mild, yet they can take a toll on your wife. Women who generally have low self-esteem, lack emotional support, and have unreal perceptions of motherhood are at a higher risk for experiencing postpartum blues. Here are the symptoms that you should look for if you think your wife has developed postpartum blues:
• Depressed mood
• Have difficulties in sleeping
• Inability to enjoy pleasurable activities
• Feelings of inadequacy as a parent
• Fatigue

Chasing the Blues Away

After giving birth, you may feel exhausted, uncomfortable and sleep-deprived. Here are several steps you can take to beat the blues:

• Ensure that you get enough sleep. Sleep deprivation can exacerbate the blues. In fact, research has shown that sleep deprivation causes the brain’s emotional centres to be 60% more reactive. So, make an effort to rest. Even a ten-minute nap can do wonders to lift your mood.

• Talk to people. Do not be ashamed to share your feelings with your partner. When you share what you are feeling, it helps you to feel less overwhelmed. In fact, moms can consider joining support groups as this allows them to voice out their feelings and emotions in an educational and supportive environment.

• Allow yourself to cry. If you want to cry, let it out. Crying is actually a form of communication and believe it or not, crying is therapeutic and helps to relieve you of your tension and stress. Suppressing your emotions can only serve to prolong the blues.

• Eat healthy. What you eat does affect your mood. Keep track of what you are eating. Studies have shown that foods that are high in omega-3 fats like soybeans, walnuts, tofu and sardines can help to elevate your mood.

What Happens if the Blues Worsen?

If the blues do not lift in two weeks, there is a big possibility that you may be experiencing something more severe called postnatal depression. Seek medical attention immediately as staying in a prolonged state of postnatal depression can negatively interfere with your parenting experience.

How Can I Control My Mood Swings?

You cannot stop mood swings but you can control them. Here are some of the ways to do this:

• Manage your stress. Ensure you get plenty of rest. Get at least 8 hours of sleep. Maintaining a well-balanced diet and exercising more often also helps.
• Have fun! Do something that makes you feel good like watching a movie with your friends or pamper yourself at a spa.
• Don’t bottle up your feelings. Communicate with your partner. Share with him your worries or your feelings about the pregnancy. In addition, let him express his thoughts, too.
  Talking it out helps you de-stress.
• Strengthen your relationship with your spouse. Spend more time with your partner. If possible, go on a vacation. A strong connection with him provides you the support that you need during your pregnancy.
• Don’t overwork yourself. Take a timeout. Working too much will only add to your stress.

What if I Don’t Feel Any Better?

You have tried everything, yet your mood swings are still not improving. Take note that if your moods remain the same for more than 2-3 weeks, you may be suffering from depression, which is also known as antenatal depression. Antenatal depression is temporary and there are people who can help you through it. Hence, talk to your doctor about it.

Signs of Depression Include:

• Change in eating habits.
• Having difficulties concentrating.
• Feelings of worthlessness.
• Sleep disturbance.
• Increased irritability.

If you are showing any of these symptoms, it is important to seek treatment. It never hurts to get professional help.

Decisions,Decisions.

Mood swings during pregnancy is not common here. Mothers feeling the postpartum blues after the delivery is a more recognised condition. However, regardless of when you experience the blues, do avoid making major decisions such as quitting job, moving house, etc as the decisions may not be right with various affecting circumstances.

• Many women are delaying pregnancy well into their 30s and beyond. This delay may bring about age-related hormonal changes which can cause more than one egg to be released at a time.
• The increased use of fertility medications such as menotropins and clomiphene have artificially increased the number of pregnancies with more than one baby.
• The odds of having a multiple pregnancy also increases if the mother has had previous pregnancies or if the family has a history of fraternal twins or triplets.

Challenges You May Face
Obstetrician and Gynaecologist, Associate Professor Dr Tan Ay Eeng explains that the experience of multiple moms are indeed more demanding than singleton moms. “They definitely require a higher level of care throughout pregnancy,” she says. Dr Tan also highlighted four unique challenges that you may face if you are carrying twins or more:

Emotion. You may feel worried and uncertain. You may also lack confidence in coping with more than one baby at a time. These mixed emotions will definitely require more emotional support from your spouse and other family members.

Symptoms of pregnancy. You may experience heightened symptoms such as substantial weight gain, excessive stretch of the abdominal wall, poor sleep, swollen legs and others.

Antenatal care. You need to pay more attention to your pregnancy care with more frequent visits to the doctor’s office. You should also be prepared to be admitted to hospital for rest or other care if complications arise.

Complications. You may be at a higher risk of experiencing complications such as anaemia, hypertension, diabetes mellitus, premature labour, congenital abnormality of foetus, growth retardation and increased chance of LSCS (lower segment Caesarean section).

Breastfeeding twins or more is possible with proper feeding techniques and support from your spouse and other family members.

Challenges Babies May Face
“I have nonetheless been perpetually amazed at the patience of parents and more than often the long term outcome has been gratifying”, says Consultant Paediatrician and Neonatologist Dato’ Dr Musa Mohd Nordin. Apart from the perseverance of parents, Dr Musa is often inspired by the fighting spirit and the will to live which these tiny babies demonstrate despite the odds.

Foetal complications. Multiple babies may experience more unique problems such as twin to twin transfusions, whereby one baby would be anaemic whilst the other would have problems of receiving too much blood from the shared placenta. They would also be more likely to experience growth restriction inside the womb.

Delivery. There is an increased likelihood of a preterm delivery, which for twins, is six times higher than single babies.

Infant Complications. If multiple babies are born with premature organs, their lungs may be immature which could lead to respiratory distress syndrome (RDS). Besides that, they may also be at a higher risk of having an immature liver which could lead to jaundice. These complications and more may require the baby to be nursed in NICU (neonatal intensive care unit).

Birth defects. The incidence of congenital abnormalities is about 20% higher in multiple pregnancies. Heart anomalies comprise the largest category of malformation. Some rare abnormalities such as conjoint twins (siamese twins) and acardia (absence of the heart) are unique to twins. Many common anomalies such as clubfoot and excess fingers or toes are less serious.

Challenges Families May Face
“Multiple pregnancies come with multiple joys, multiple choices as well as multiple challenges on a combination of things such as time management, financial matters, health, couple relationship and so on,” noted Dr Anjli Doshi-Gandhi, Deputy Director-General (Policy), National Population and Family Development Board Malaysia.

It is a tough call for today’s parents of twins or more, especially for young couples struggling to juggle career, parenthood and most especially if they are living on their own. Couples need to work even harder to share responsibilities in raising their children, as every child deserves equal love, care, acceptance and nurturing to grow up happy and healthy.

Families of Twins Share Their Experiences
Positive Parenting is inspired by the resilience of these families with multiple babies. Here, we listen to their heartwarming experiences.

“As we have two sets of twins, we face a big financial burden. We normally plan a budget every month as we need to be really careful in our spending. Also, we do not just buy from any shop. We will hunt around for the cheapest possible products. Apart from being thrifty in our spending, we believe it’s important to invest in health insurance for the children as early as possible. We will never know when an emergency would arise,” shares Megat Syahrul Rizal Megat Ismail.

Parents:
Megat Syahrul Rizal Megat Ismail & Radin Diana R Ahmad
Twins:
Megat Amer Hakim & Putri Amera Syahirah (3½ years);
and Megat Ahmad Haikal & Putri Aqeela Hana (6 months)

“My wife’s family is very supportive and helpful. During the first few months, my wife faced some challenges, especially during her confinement. Thankfully, we have families who live near us. I used to play tennis a lot, but I know that there’s a greater need to be with my family. I always believe that as a family and most importantly, as husband and wife, we should work together to support each other by taking turns in caring for our twins as well as our eldest son. As they grow up, I think it gets easier for the both of us,” shares Mohd Azmir Ramli.

Parents:
Mohd Azmir Ramli & Azeleen Binti Mohd Razali
Twins:
Firash Hameez & Farish Hadeef (9 months)

“We never dreamed of having twins. It was a pleasant surprise as we already had four children before the arrival of the twins. Apart from the excitement of seeing double, we always appreciate them as individuals. One carries the books wherever she goes (even to sleep) and the other enjoys colouring and drawing. Both of them have different interests and you can’t compare them. One thing about having twins is that everything tends to be wonderful. When we see them after coming back from a hard day’s work, all the stress and tiredness seem to fade away,” shares Farehana.

Parents:
Mohd Naim b. Mohammad & Farehana Hanapiah
Twins:
Azra Sofiyah & Ayra Sofiyah (5 years)

“People assumed that as twins, we must be the same. We must go out together, have the same hobby, hang out with the same friends and see eye to eye on everything! They simply assumed that we don’t have our own individual life. As we grew older, our personalities seem to become more different. I’m the studious type while my brother is the total opposite. We are now heading towards different career paths, with me in the creative field and him in engineering. We both have our own identities as we excel in different areas,” shares Timothy.

Twins:
Timothy Khor & Jed Khor (19 years)

One or More
“Families who are expecting twins, triplets or more are often expected to face more challenges when it comes to experiencing pregnancy and the journey through birth and beyond,” says Datuk Dr Zulkifli Ismail, Consultant Paediatrician.

While you do not have the choice of control in determining a single or multiple pregnancy, you can prepare yourself for what is to come. Note that it is normal to feel puzzled and worried when you find out that you are expecting multiple babies. It is not surprising that you may wonder how you can handle the medical, physical and psychological challenges of having twins or more. Firstly, knowledge is power. As parents, you are responsible to learn everything you can to better equip yourself for a good pregnancy, birth and care of your babies. It is part and parcel of preparing yourself for parenthood.

Couples who plan to have babies should consider trying to have children at a younger age, preferably before the age of 35. This is to minimise the possible risk of pregnancy complications that comes with a late pregnancy. “If you do opt for IVF, do understand that the chances of conceiving multiple babies are higher. However, I am sure that it will still be an amazing journey to parenthood for you and your spouse!” he concludes.

Follow a routine ultrasound. This is especially important in a multiple pregnancy to watch for foetal anomalies.

B. Medication/ Supplements
Seek doctor’s advice. You may need to adjust the dosage of your medications because your blood volume may increase vastly during a multiple pregnancy. Seek your doctor’s advice concerning the dosage of your medication. Also, ask your doctor if you need an iron supplement because it is advisable to keep your iron levels high throughout your pregnancy.

C. Diet
Gain adequate weight. If you are carrying twins, you will gain about 18 kilograms in total. You tend to gain more weight during the first trimester. Your ideal weight can be acquired at the rate of at least half a kilogram a week. Do watch your diet carefully as excessive weight gain is not healthy and may lead to other problems.

Stay well-hydrated. Make sure you drink adequate amounts of water.

D. Physical Activity
Exercise with care. When you’re pregnant with twins or more, you’re actually going through a high risk pregnancy. Ask your doctor to recommend a safe exercise regime for you.

Rest more. You need to rest more than other pregnant women. Consider taking early leave from work.

E. Emotional
Be prepared to make more changes in life – (i.e. work, responsibilities, etc.). You need to recognise how emotionally and physically demanding a multiple pregnancy can be.

Join a multiple pregnancy support group. You may face special problems and it helps to share various physical, emotional, pregnancy and social issues you encounter with other mothers.

The services, role and availability of each one are different. Your choice depends on your needs, expectations, location and personal preference. Here are some points to help you get started:

Do you have a low- or high-risk pregnancy?
Low-risk pregnancies can be handled by most general practitioners (GPs) and midwives. An ob/gyn, a specialist trained in the female reproductive system, is able to handle both low and high-risk pregnancies, as well as perform Caesarean sections. Unusually high-risk or complicated pregnancies are referred to an ob/gyn with expertise in foetal-maternal medicine.

Who is available where you are?
Your choice of an obstetric caregiver depends on their availability in your area. Specialists are usually less available in rural areas and small towns whereas GPs are easily accessible in family clinics everywhere. Midwives for instance, can be found in the Government clinics known as Klinik Kesihatan Ibu & Kanak-Kanak (KKIK).

What is your budget?
Cost depends on the qualifications of the caregiver. Generally, midwife services are the most affordable and specialists’ the highest. Do check around as costs vary from clinic to clinic, hospital to hospital. The cost structures for private and government setups also differ.

How particular are you about the continuation of care?
Some women prefer to have one consistent caregiver while others do not have any particular preference. If you are one of the former, you may opt for the services of a dedicated ob/gyn who will see you through your pregnancy and delivery all the way to care after birth.

GPs or midwives, on the other hand, may provide pregnancy care but not be the ones to deliver your baby or provide post-natal care. Take KKIK clinics, for example. Pregnant women are cared for by midwives and then, passed on to a doctor in the hospital for delivery. They then return to KKIK for postnatal care.

What is the setup like?
Besides qualifications, you may want to know the clinic’s or hospital’s setup. Is it safe? Do you feel comfortable there? Is it easily accessible? What facilities are available? Are there emergency facilities such as an operation for the mother or a ventilator for a premature baby? Pay a visit and personally experience the setup. Some hospitals have antenatal classes where they bring you on a tour of their premises.

Try not to expose yourself to oil-based paints, lead, mercury or other substances containing solvents. This means no painting, wallpapering or furniture refinishing. However, if you must do them, do take precautions: work in a well-ventilated area, wear protective clothing and gloves and avoid drinking or eating in the work area.

Careful housecleaning

While no studies have been conducted on the harmful effects of chemical cleaning products on pregnant women, a little caution is always a good practice. When using products that may contain toxic substances, always wear gloves when using chemical cleaning agents and do not inhale any strong, caustic fumes. Most household cleaners are safe to use but avoid mixing ammonia with chlorine-based products as this is toxic!

Litter box dangers

Get someone else to clean your pet’s litter box. Cat faeces may contain harmful parasites which can lead to toxoplasmosis (a serious blood infection that can cause birth defects). If you must clean the litter box yourself, do wear gloves and a mask over your nose and mouth.

Buckle up

Always buckle up if you need to travel by car, no matter how short the trip. Position the shoulder strap between the breasts and away from the neck, and place lap belt below the abdomen and across the upper thighs.

Away with second-hand smoke

Second-hand smoke poses grave danger to your unborn baby, so stick to where the air is fresh. If you have a spouse, friends or colleagues who smoke, remind them not to light up when you are around.

• By motorbike. If possible do not travel by motorbike when pregnant. Besides the discomfortwhen heavily pregnant, there are no safety restraints on motorbikes. You also risk injuring yourself and baby, should you fall or meet a collision.

Safety Around The House

• Exposure to toxic substances. When housecleaning, wear gloves and try to avoid inhaling strong caustic fumes (eg from house paint and solvents). There is no evidence that the normal use of household cleaners causes birth defects. However, never mix ammonia with chlorinebased products. The combination produces toxic fumes.

Keep your house well ventilated.

• Cleaning Litter Boxes. Try not to clean up after your pets due to the r isk of infection by microorganisms found in their faeces. Cat faeces, for example, carry a parasite called toxoplasma that can cause toxoplasmosis, a rare but serious blood infection that can lead to birth defects (such as blindness, deafness and mental retardation). If you can’t assign this task to someone else, then practise caution by wearing rubber gloves and a facemask. Also, don’t do any gardening in areas where your pets may have urinated or passed motion.

Lovemaking

• Go ahead. Most miscarriages during the first trimester are usually a result of genetic defects, not lovemaking. So, if your pregnancy is normal and you are not at any risk of premature labour, then lovemaking can proceed until you reach the third trimester of your pregnancy.
  
  
• Refrain. Refrain from lovemaking in the last weeks of your pregnancy due to the risk of intrauterine infection. Your doctor might advise against lovemaking if you experience vaginal bleeding. He might also rule out lovemaking late in your pregnancy if you are expecting twins.
  

These are some of the exercises you can do while pregnant. Always consult your doctor/physiotherapist before starting on a new exercise.

• Walking/jogging at a speed comfortable to you. Never exercise at a pace at which you find it difficult to breathe or speak.
  
  
• Swimming, ideally in a treated pool; rivers, ponds and water holes contain bacteria and other contaminants that may give both of you an infection.
  
  
• If you must indulge your love of the sea, stay away from scuba until after you deliver. Snorkelling is much safer.
  
  
• Light weight-lifting exercises (provided you grip the weights firmly and don’t lift them over your head).
  
  
• Pelvic floor exercises are important now as well as when you deliver. The pelvic muscles support your bowel, bladder and womb; during pregnancy, they stretch out under the weight of your growing baby.

Exercising them will help keep them strong, preventing you from having an embarrassing leak from the bladder while coughing, sneezing or laughing.

In particular, the following exercises will help you tone the muscles that you will rely on during pregnancy and labour.

“Tailor sitting”. This is a posture exercise that strengthens the back and makes thigh and pelvic
muscles more flexible. It also improves bloodcirculation in your lower body.

• Sit with your back straight, knees bent and the soles of your feet together. Bring your heels as close to your body as possible.
  
  
• Grasp your ankles, and use your elbows to press your thighs down (within tolerance; don’t force). Hold for 20 seconds, then relax. Repeat several times.
  
  
• If you find this too difficult, practise by sitting straight against, not leaning on, a wall.

Squatting. Although you can do this exercise purely to tone muscles and improve flexibility, you should also use this position when you need to pick up objects from the floor.

• With your feet shoulder-distance apart, turn your legs outwards at a comfortable angle.
  
  
• Bend at the knees, keeping your back straight. Keep your heels on the ground the whole time. Stretch your inner thighs further by pressing them outwards with your elbows. It’s easier to do this with your hands clasped. Stay in this position for as long as you can balance without wobbling, and without your feet and calves going numb.

Now that you know you aren’t supposed to double your food intake for pregnancy, consider the following tips for gaining weight at a healthy rate in pregnancy:

• If just before conceiving you were outside the healthy weight range, ie overweight or underweight, bear in mind that you will need to gain less or more than the amount recommended above. A dietitian will be able to help you formulate a diet plan that will ensure you gain the right amount of weight.
  
  
• Eat a balanced diet with plenty of fresh fruits and vegetables, accompanied with at least 2 cups of low-fat milk daily (or the equivalent in dairy products, eg cheese and yoghurt).
  
  
• Prevent heartburn and gastric attacks by having healthful snacks between meals, or just having smaller meals at more frequent intervals.
  
  
• If you are often nauseous and vomit frequently, make up for the fluids lost by drinking water, unsweetened freshly squeezed fruit juice or milk.
  
  
• Monitor your weight gain at home by weighing yourself once or twice a week at about the same time of day, ie just before breakfast or before going to bed. Wear lightweight clothes and use the same scale each time.

Important: If you have suddenly gained more weight than usual and feel abnormally bloated, call your doctor. Water retention is a normal part of pregnancy, but it can also indicate pre-eclampsia, a condition of high blood pressure in pregnancy that needs medical attention.

Where the extra weight goes

You may wonder why you gain so much weight when, at the end of the day, baby will only weigh about 3 kg or so. This is where the rest of your weight gain goes:

• Placenta, a unique organ in the uterus that connects baby to you and enables you to supply him with everything he needs to grow. Soon after baby’s birth, the now obsolete placenta will be expelled from your body.
  
  
• Amniotic fluid, a clear water-like substance in which baby is suspended during pregnancy. It helps support baby’s body and protects him from injury when you move around or are suddenly jolted.
  
  
• Breast tissue, which expands in preparation for breastfeeding.
  
  
• Blood supply, which must increase in order to meet both your needs. As your body grows larger, you need more blood to circulate in your own body. And as baby grows and develops, he needs more and more, too.
  
  
• Fat stores — these are the body’s most efficient source of energy, which it will need very much when the time comes for you to deliver. Breast milk also contains a lot of fat, which is taken from the ‘stocks’ your body is now saving up.
  
  
• Uterus expansion, a necessary part of pregnancy. As baby grows bigger, the uterus also ‘grows’ to accommodate his size. This results in a corresponding gain in weight.
  

All of these are reasons why you should not try to prevent gaining weight while pregnant. If you limit your intake of certain foods, you may be affecting baby’s development or your body may compensate by contributing its stores to baby instead.

Checking on Mom

Your first antenatal check-up.
The doctor will go over your medical history, giving particular attention to your current health and lifestyle. You will also receive a physical examination that covers your blood pressure, heart, lungs, thyroid, breasts, and teeth. Similarly, you will take blood tests to check for possible anaemia and your status with regard to various diseases (eg rubella immunisation status, and hepatitis B and HIV carrier status).

Subsequent routine check-ups.
Unless you have a health or pregnancy problem (which may necessitate more frequent checkups), you will generally visit the doctor once a month until week 28, every fortnight after week 28 to week 36, and weekly from week 36 until delivery.

At each visit, the doctor will weigh you as well as take your blood pressure and analyse your urine. These procedures will help her look out for warning signs of preeclampsia – a combination of high blood pressure, fluid retention and protein in the urine. Also known as pre-eclamptic toxaemia, this condition affects 1 or 2 out of every 20 mothers, especially in the second half of their pregnancy. Mild preeclampsia is usually easy to treat but, if uncontrolled, it could lead to eclampsia and bring on seizures and coma.

Your urine sample will also be checked for the presence of infections and indications of gestational diabetes. This type of diabetes is induced by pregnancy and needs to be confirmed by a further test. Medication and careful dietary changes may be necessary to help bring high blood sugar under control. At 22 weeks or later, the doctor may vaccinate you against tetanus to prevent tetanus in your baby after birth. If this is your first pregnancy, the injection will be repeated a month later.

Checking on Baby

By feeling.
By palpating (using the fingertips to press) your abdomen, the doctor will be able to locate the top of your uterus to assess the foetus’ growth rate. From week 34 or 36, the doctor may also request that you monitor your baby’s movements. If baby’s oxygen supply is sufficient, he should move about at least 10 times over 12 hours. Baby may be more sluggish if he has a twin or a mother who smokes, has diabetes or high blood pressure.

By listening.
After week 14, the doctor will listen for baby’s heartbeat using either an electronic sonicaid or, after week 22, a trumpet-like foetal stethoscope. In the last 2 months of pregnancy and, if necessary, the doctor may perform a cardiotocography test which measures baby’s heart rate with an electronic monitor. Abnormal sounds, rhythms and heart rates may indicate a compromised baby.

Special tests for chromosomal abnormalities.

If you are over 35 of age or carry the risk of passing on certain birth defects or genetic diseases, the doctor may advise you to undergo some of the special tests below.

• Blood tests. The Triple Test at weeks 14-16 measures three blood chemicals (AFP, estriol and the pregnancy hormone called hCG) to detect the possibility of neural tube defects (eg spina bifida) and syndromes such as Down.

• Scans. The Nuchal Translucency Scan, using ultrasound, measures fluid accumulation at the back of baby’s neck. Conducted at weeks 10-12, it is used to detect possible signs of Down syndrome (a chromosomal disorder affecting development) and Turner syndrome (a chromosomal disorder affecting growth and sexual development in female babies).

• Invasive tests. Amniocentesis, which can be done any time beyond week 13, is where a needle is inserted through your abdomen to draw a sample of the fluid inside the uterus. The fluid is used to detect Down syndrome, and other chromosomal abnormalities. Another invasive test is Chorionic Villus Sampling which can be performed towards the end of the first trimester or later. It entails using a needle to extract miniscule tissue samples from the placenta to check for Down syndrome and blood disorders, such as thalassaemia major. These invasive tests are particularly important if the baby is suspected of chromosomal or certain genetic problems. Like any other mother, you would dearly wish for a normal, healthy child. Thus, you would do well by being receptive to good antenatal care and the tests that may come your way. No test is perfect and the findings may not always be accurate.

However, it always helps to know how you and your unborn child are doing. The information will put you in better stead to care for the both of you, and to ensure early intervention if either is in trouble.

When in pregnancy

Responding to Your Test Results

What happens if your doctor says there might be a problem in your pregnancy? Stay calm, and:

• Ask questions. Ask the doctor to explain the condition that your foetus has or is at risk of having, baby’s life expectancy and what problems he may have, physically and mentally. It may be difficult now, but it’s better to be prepared.
  
  
• Do your own research. Ask your doctor to refer you to experts on that condition, read books and articles about it, and try to make contact with parents of children who have it.
  
  
• Count your blessings. This is especially hard to do, but remember that with advances in medical screening and treatment technology, baby has a far better prognosis than a child born with the same condition as recently as 10 years earlier.

Physical Changes

Digestive System
What’s going on?
As you progress into your pregnancy, your uterus enlarges to accommodate your growing baby, and your abdomen follows through.Your uterus will rise from your pubic area in early pregnancy and reach the bottom of your rib cage late in the pregnancy. During its enlargement, other organs such as the bladder, kidneys, diaphragm and intestines will be pressed and their functions affected. Near the end of your pregnancy, your abdomen will sag lower and you will feel your baby settling down in your pelvis. These events, coupled with changes in your hormonal levels, often bring about morning sickness and constipation.

What you can do

 MORNING SICKNESS. Feeling nauseated is often an early sign of pregnancy. It can start from the 5th week and last till about the 15th week. However, there is a small possibility that it will come back later. ‘Morning sickness’ can happen at any time of the day, but most women find that there is a particular time of day when this happens. Smells of certain types of food or cigarette smoke can cause nausea, and tiredness can make it worse. To counteract nausea, try eating a couple of plain biscuits before getting out of bed. Avoid foods and smells that make you sick, and have small, frequent meals throughout the day. Drinking an infusion of ginger or chamomile tea can be helpful.

Breasts
What’s going on?
As early as the 2nd week after conception, your breasts and nipples may start to enlarge. The milk producing glands increase in size due to the high levels of estrogen and progesterone hormones produced in your body. The enlargement of breasts is partly due to fat gained during pregnancy, and they weigh about 0.45 kg to 1.36 kg of your total body weight. The tiny bumps on the areolae will also start enlarging to moisturize and soften the skin. At the 16th week of pregnancy, your areolae will grow larger and darker due to greater blood circulation and increased pigmentation. Blood vessels in your skin may also become engorged and more visible during pregnancy and your nipples may start to leak colostrum nearing delivery.Your breasts become fuller and heavier due to the change of hormone levels in the body. They also feel more tender and sensitive throughout pregnancy.

What you can do
In order to give comfort to your breasts during pregnancy, you are advised to choose a bra with a deep band under the cups, and broad shoulder straps with an adjustable back. Constantly check the size of your breasts, as they continue to swell throughout pregnancy. When your breasts become very heavy, wear a lightweight bra at night.

Rashes
What’s going on?
Pregnant women might develop rashes beneath their breasts or in the groin. This is particularly common in warm humid weather, and is caused by the irritating effect of perspiration on rubbing skin surfaces.

What you can do
You should wash and dry these areas often, and soothe the skin with calamine lotion or plain cornstarch. It is advisable to wear loose cotton clothing.

Increased Pigmentation
What’s going on?
Pregnant women might develop ‘stretch marks’ in the skin of the abdomen, breasts or thighs. The marks will appear as pinkish to reddish, slightly indented lines and are caused by the stimulation of the pigmentation producing cells, as a result of the higher levels of estrogen and progesterone in the body.You might also experience a dark line that goes from the navel to the pubic hair in the centre of the abdomen.

Dark brown pigmentation, commonly known as the ‘mask of pregnancy’, might also appear on the face – mostly on nose, cheeks and forehead – and neck. These changes will normally disappear or fade after pregnancy. It is important to note that they are not dangerous or suggestive of illness.

What you can do
STRETCH MARKS. There is nothing you can do, as the hormone change in your body is a natural process. These marks should disappear or change to a lighter tone once you give birth to your baby.

You might find the first session tiring. The second will be better and by the third, you will be able to feel the difference exercise makes to the way you feel. Keep it up and exercise will soon be a part of your every day. It’s best for you to want to exercise for your own good. But if this still isn’t enough to motivate you, do it for baby’s sake.

It’s Great To Exercise While Pregnant Because It …

• Improves your posture and relieves backache. When your abdomen increases in size, your posture will shift forward, putting your lower back muscles under a lot of strain. Exercise strengthens and tones those muscles, thus helping you to maintain good posture which goes a long way in keeping the backaches at bay.

• Improves blood circulation. It goes without saying that if you have good circulation, you would be more efficient at supplying baby with oxygen and nutrients through the blood that passes between the two of you through the placenta. But that’s not all – your improved circulation may help reduce the likelihood of you developing varicose veins, cramps and swelling in the feet and legs.

• Reduces constipation. It’s true! Exercising does help make bowel movements more regular.

• Helps you feel and sleep better. Having a baby puts you under a lot of stress. Exercise releases the 'feel-good’ hormones in your brain, called endorphins, which help to relieve stress. This gives you a more positive outlook about being pregnant.You will find that you can sleep better, too, once your mind is cleared of anxiety.

• Prepares you for birth. Giving birth is often a strenous event and you need to be fit and ready for it. With exercise, your heart and lungs will work better, giving you the stamina you need to huff and puff your way through labour. Stronger muscles (particularly in the abdominal and pelvic region) will help you cope with the strain and lessen the pain.

• Maintain healthy body weight. If you continue exercising and consuming a healthy diet, you will be less likely to gain excessive body weight which can cause complications for both you and baby during pregnancy and birth. Anyhow, women who are generally active during pregnancy find it easier to return to their prepregnancy body weight after giving birth.

Exercising To Stay Fit

• Start by being more active at home. It really doesn’t matter whether it’s sweeping the floor, pruning the shrubs or whatever else you fancy, so long as you get moving.

• Strengthen your heart and improve blood circulation with low-impact exercises that don’t put too much strain on the joints (eg stationary biking, swimming and walking).

• Avoid activities that involve deep bending and extending of the joints, jumping, jarring motions or rapid changes in direction.

• Do not strain to the extent that you can’t even talk while exercising.

• As a rule, the more advanced your pregnancy, the less intensive your exercise should be.

Exercising To Stay Strong

• Training with light weights is allowed but you should refrain from lifting them over your head.

• Avoid exercises that require you to hold your breath (eg while lifting healthy weights) or to exhale against a closed mouth and nostrils.

• Resistance training (like rowing or exercises that require pushing or pulling) are best kept at low intensity. Start taking exercise seriously! Do not let the discomfort during pregnancy hinder you from exercising or continuing an exercise programme. As long as you start slowly and exercise correctly, you can enjoy the assurance that it brings better health to you and your baby. Once you are physically prepared for labour and birth, you will feel better and have a happier disposition, too.

EXERCISE YOUR PELVIC FLOOR

Once pregnant, you should focus on your abdominal, lower back and pelvic floor muscles. If you are not familiar with the pelvic floor, it is a hammock of muscles that cradles and supports the womb.

During pregnancy, it goes soft and stretchy, and together with the weight of the baby, it gets pushed down. This makes you feel heavy and uncomfortable.You can reduce these discomforts by strengthening the pelvic floor through pelvic exercises.

The pelvic tilt is one such exercise. It can be done while kneeling, standing, sitting or even watching
TV. It will help to, help your pelvis move with greater ease, strengthen your stomach muscles and make your back more flexible.