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Week 17
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How Big Is Your Baby?

The crown-to-rump length of your baby is 4.4 to 4.8 inches (110 to 120mm: 11 or 12cm). Fetal weight has doubled in 2 weeks and is about 3.5 ounces (100g). By this week, your baby is about the size of your hand spread open wide.

How Big Are You?

Your uterus is 1.5 to 2 inches (3.8 to 5cm) below your bellybutton. You are showing more now and have an obvious ôswellingö in your lower abdomen. By this time, stretchy or maternity clothing is a must for comfort's sake. When your partner gives you a hug, he may feel the difference in your lower abdomen.

The rest of your body is still changing. A 5- to 10-pound gain (2.25 to 4.5kg) by this time is normal.

How Your Baby is Growing and Developing

If you look at the illustration on page 146, then look at earlier sections, very big changes are obviously occurring.

Fat begins to form during this week and the weeks that follow. Also called adipose tissue, fat is important to the body's heat production and metabolism.

At 17 weeks of development, water makes up about 3 ounces (89g) and fat 0.018 ounce (0.5g) of your baby's body. In a baby at term, fat makes up about 5.25 pounds (2.4kg) of the total average weight of 7.7 pounds (3.5kg).

You have felt your baby move, or you will soon. You may not feel it every day. As pregnancy progresses, movements become stronger and probably more frequent.

Changes in You

Feeling your baby move can reassure you that things are going well with your pregnancy. This is especially true if you've had problems.

As your pregnancy advances, the top of the uterus becomes almost spherical. It increases more rapidly in length (upward into your abdomen) than in width, so the uterus becomes more oval than round. The uterus fills the pelvis and starts to grow into the abdomen. Your intestines are pushed upward and to the sides. The uterus eventually reaches almost to your liver.

The uterus is not fixed in one place. Most attachments are located around the cervix (lower part of the uterus) and by the lower part of the body of the uterus. The uterus doesn't float around, but it is not firmly attached to one spot.

When you stand, the uterus touches the abdominal wall in the front. It may be felt most easily in this position. When you lie down, it can fall backward onto your spine and blood vessels (vena cava and aorta).

Round ligaments are attached to each side of the upper uterus and to the pelvic side wall. During pregnancy and the growth of the uterus, these ligaments are stretched and pulled. They become longer and thicker. Your sudden or mild movements can stretch and pull these ligaments, causing pain or discomfort called round-ligament pain. It doesn't signal a problem; it indicates your uterus is growing. Pain may occur on one side only or both sides, or it may be worse on one side than another. This pain does not harm you or the baby.

If you experience pain, it may feel better to lie down and rest. Talk to your doctor about the pain if it is severe or if other symptoms arise. Warning signs of serious problems include bleeding from the vagina, loss of fluid from the vagina or severe pain.

How Your Actions Affect Your Baby's Development

Quad-Screen Test

The quad-screen test can help your healthcare provider determine if you might be carrying a baby with Down syndrome. This blood test can also help rule out other problems in your pregnancy, such as neural-tube defects.

The quad-screen test is similar to the triple-screen (see the discussion in Week 15). Levels of alpha-fetoprotein, HCG and unconjugated estriol are checked. In addition, a fourth measurement, the level of inhibin-A, is determined. This fourth meas-

urement raises the sensitivity of the standard triple-screen test by 20% in determining whether a fetus has Down syndrome.

The quad-screen test is able to identify 79% of those fetuses with Down syndrome. It has a false-positive result of 5%.

Using Over-the-Counter Medications and Preparations

Many people don't consider over-the-counter (OTC) preparations as medication and take them at will, pregnant or not. Some researchers believe nonprescription or over-the-counter medication usage increases during pregnancy.

OTC medications and preparations may not be safe during pregnancy. Use them with as much caution as any other drug! Many over-the-counter preparations are combinations of medications. For example, pain medication can contain aspirin, caffeine and phenacetin. Cough syrups or sleep medications can contain as much as 25% alcohol. This is no different than drinking wine or beer during pregnancy.

My patient Catherine called because she had a chronic knee problem, and she used aspirin for pain and swelling. She asked if it was OK to use it during pregnancy. I told her that full doses of aspirin are not advised because aspirin use can increase bleeding. This could cause problems for Catherine or her baby if she bled during pregnancy or delivery. Under medical supervision, small doses may be used, but always discuss the situation with your healthcare provider.

Another medication to be careful with is ibuprofen, a popular product available in prescription and nonprescription forms. Experience with this medication during pregnancy is limited; it hasn't been available that long. There are no known benefits of taking ibuprofen during pregnancy, and there have been reports of possible harmful effects. Why take a chance? Ibuprofen products include Advil«, Motrin« and Rufen«.

Other popular over-the-counter products include naprosyn (Aleve«) and ketoprofen (Orudis«), both used to relieve pain or to reduce fever. Experience with these medications during pregnancy is limited. It is best to use them only under your doctor's supervision.

Talk to your doctor about taking any medication before you use it! Read package labels and package inserts about safety during pregnancyùnearly all medications contain this information. Some antacids contain sodium bicarbonate, which increases your intake of sodium (this can be important if you have water-retention problems) and can cause constipation and increased gas. Some antacids contain aluminum, which can cause constipation and affect the metabolism of other minerals (phosphate). Others contain magnesium; excessive use of these may cause magnesium poisoning.

Some over-the-counter medications and preparations can be used safely during pregnancy, if you use them wisely. Those you may safely use for a short period of time include acetaminophen (Tylenol), some antacids (Amphojel, Gelusil, Maalox, milk of magnesia), throat lozenges (Sucrets«), some decongestants (Sudafed«) and some cough medicines (Robitussin«).

If you think your symptoms or discomfort are more severe than they should be, call your doctor. Follow his or her advice. In addition, take good care of yourself. Exercise, eat right and keep a positive mental attitude about your pregnancy.

You Should also Know

Having a Baby Costs Money!

Every couple wants to know what it will cost to have a baby. There are really two answers to that questionùit costs a lot, and cost varies from one part of the country to another.

In determining how much it costs to have a baby in your area, you'll need to consider several different factors. It makes a big difference if you have insurance. If you don't, you will pay for everything.

If you do have insurance, you need to check out some things. Ask your employer the following questions.

ò What type of coverage do I have?

ò Are there maternity benefits? What are they?

ò Do maternity benefits cover Cesarean deliveries?

ò What kind of coverage is there for a high-risk pregnancy?

ò Do I have to pay a deductible? If so, how much is it?

ò How do I submit claims?

ò Is there a cap (limit) on total coverage?

ò What percentage of my costs are covered?

ò Does my coverage restrict the kind of hospital accommodations I may choose, such as a birthing center or a birthing room?

ò What procedures must I follow before entering the hospital?

ò Does my policy cover a nurse-midwife?

ò Does coverage include medications?

ò What tests during pregnancy are covered?

ò What tests during labor and delivery are covered?

ò What types of anesthesia are covered during labor and delivery?

ò How long can I stay in the hospital?

ò Does payment go directly to my healthcare provider or to me?

ò What conditions or services are not covered?

ò What kind of coverage is there for the baby after it is born?

ò How long can the baby stay in the hospital?

ò Is there an additional cost to add the baby to the policy?

ò How do I add the baby to the policy?

ò Can we collect a percentage of a fee from my husband's policy and the rest from mine?

Your insurance dictates a lot of the costs and decisions for you.

Having a baby generates different costs. One is the hospital. Much of the covered amount for the hospital is determined by the length of stay and the ôservicesö you use. In some cases, having an epidural or Cesarean section adds to this bill. Your doctor's bill is separate from this except under some plans. A pediatrician usually examines the baby, does a physical and sees the baby each day in the hospital. This is another cost.

When my first daughter was born in 1974, a normal delivery and 2-day hospital stay for my wife (no C-section, anesthesia or complications) cost a total of $600 for hospital, doctor, nursery and pediatrician. When my youngest daughter was born in 1985, a similar stay (again no anesthesia, C-section or complications) cost about $3500ùan increase of almost 600% in 11 years! Across the United States, 1997 prices for a delivery range from $6000 to $14,000, depending on complications and the type of delivery.

It would be nice to think about costs before pregnancy and be sure to have insurance to help out. However, many pregnancies are surprises.

What can you do? First, find the answers to your questions. Talk to your insurance carrier. Then talk to someone in your doctor's office who handles insurance claims. This person may have answers or know of resources you haven't thought about. Don't be embarrassed to ask questions. You will be happier if you get these issues resolved early. Pregnancy is not the time to cut corners to save money.

Call around so you can compare hospitals and prices. Sometimes it's worth spending a little more money to get more. When you call, ask for specifics about what is included in the prices you are quoted. You may get a price that seems lower and better than others but really doesn't cover everything you will want and need.

Today, some hospitals and medical centers offer ôpregnancy packages.ö A package can cover many services for one fee. Ask about it in your area.

You want to be prepared well in advance. The last thing you need at this time is an unpleasant surprise about what is covered or how much you will have to pay for medical services.

Costs of Having a Baby in Canada

The Canadian healthcare system is different from the healthcare system in the United States. Canadians pay a healthcare premium on a monthly basis. Cost varies depending on the province you live in. The doctor who delivers your baby is paid by the government. He or she submits the bill to the government, not you.

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