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Week 26
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How Big Is Your Baby?

Your baby now weighs almost 2 pounds (910g). By this week, its crown-to-rump length is around 9.2 inches (23cm). See the illustration on page 217. Your baby is beginning to put on weight.

How Big Are You?

The measurement of your uterus is about 2.5 inches (6cm) above your bellybutton or nearly 10.5 inches (26cm) from your pubic symphysis. During this second half of pregnancy, you will grow about 0.4 inch (1cm) each week. If you have been following a nutritious, balanced meal plan, your weight gain is probably between 16 and 22 pounds (7.2 to 9.9kg).

How Your Baby Is Growing and Developing

By now you have heard your baby's heartbeat at several visits. Listening to your developing baby's heart beat is very reassuring.

Heart Arrhythmia

When listening to your baby's heartbeat during pregnancy, you may be startled to hear a skipped beat. An irregular heartbeat is called an arrhythmia. This is best described by regular pulsing or pounding with an occasional skipped or missed heartbeat. Arrhythmias in a fetus are not unusual.

There are many causes of fetal arrhythmias. An arrhythmia may occur as the heart grows and develops. As the heart matures, the arrhythmia often disappears. It may occur in the fetus of a pregnant woman who has lupus.

If an arrhythmia is discovered before labor and delivery, you may require fetal heart-rate monitoring during labor. (This is discussed in Week 35.)

When an arrhythmia is detected during labor, it may be desirable to have a pediatrician present at the time of delivery. He or she will make sure the baby is all right and is treated right away if a problem exists.

Changes in You

You are getting bigger as your uterus, placenta and baby grow larger. Discomforts such as back pain, pressure in your pelvis, leg cramps and headaches may occur more frequently.

Time is passing quickly. You are approaching the end of the second trimester. Two-thirds of the pregnancy is behind you; it won't be long until your baby is born.

How Your Actions Affect Your Baby's Development

Seizures

A history of seizuresùbefore pregnancy, during a previous pregnancy or during this pregnancyùis information you must share with your doctor. Another term for seizure is convulsion.

Seizures can and usually do occur without warning. A seizure indicates an abnormal condition related to the nervous system, particularly the brain. During a seizure, a person often loses body control. The serious nature of this problem during pregnancy is compounded because of concern about the baby's safety.

Doctors describe different types of seizures. Seizures involving the entire body are called grand mal seizures. A grand mal seizure begins with the sudden loss of consciousness; the person usually falls to the ground. Arms and legs often move about, and sometimes bowel control is lost at the same time. Following a seizure, the person may be in a state of recovery that may last for several minutes. As it passes, there can be mental confusion, headache and drowsiness.

Another type of seizure is a petit mal seizure. This type also comes without warning. It is noted for its short duration and

minimal movement of arms or legs. It usually involves a loss of consciousness that lasts only a few seconds. Other types of seizures can also occur. They are not within the scope of this book.

If you have never had a problem with seizures, know that a short episode of dizziness or lightheadedness is not usually a seizure. Seizures are usually diagnosed by someone observing the seizure and noting the symptoms previously mentioned. An electroencephalogram (EEG) may be needed to diagnose a seizure. (In Week 31, seizures as they relate to eclampsia are discussed.)

Medication to Control Seizures

If you take medication for seizure control or prevention, share this important information with your doctor at the beginning of pregnancy. Medication can be taken during pregnancy to control seizures, but some medications are safer than others.

For example, Dilantin« can cause birth defects in a baby, which include facial problems, microcephaly (a small head) and developmental delay. Other medications are used during pregnancy for seizure prevention. One of the more common is phenobarbital, but there is some concern about the safety of this medication.

Seizures during pregnancy or at any other time require serious discussion with your doctor and increased monitoring during pregnancy. If you have questions or concerns about a history of possible seizures, talk to your doctor about them.

You Should also Know

Feeling Your Baby Move

The movement of your baby is usually very reassuring and a sensation most pregnant women enjoy. Your partner can experience and enjoy the baby's movements by feeling your abdomen when the baby is active.

Women often ask how often a baby should move. They want to know if they should be concerned if the baby moves too much or doesn't move enough. These are hard questions to answer because your sensation is different from that of another woman. The movement of each baby you carry may be different. It is usually more assuring to have a baby move frequently. But it isn't unusual for a baby to have quiet times when there is not as much activity.

If you've been on the go, you may not have noticed the baby move because you've been active and busy. It may help to lie on your side to notice if the baby is moving or is still. Many women report their baby is much more active at night, keeping them awake and making it hard to sleep.

If your baby is quiet and not as active as what seems normal or what you expected, discuss it with your doctor. You can always visit your doctor to hear the baby's heartbeat if the baby hasn't been moving in its usual pattern. In most instances, there is nothing to worry about.

Pain Under Your Ribs

Some women complain of pain under their ribs and in their lower abdomen when their baby moves. Is this pain normal?

This type of pain isn't an unusual problem, but it may cause enough discomfort to concern you. The baby's movement has increased to a point where you will probably feel it every day, and movements are getting stronger and harder. At the same time, your uterus is getting larger and putting more pressure on all your organs. Your growing, expanding uterus presses on the small bowel, bladder and rectum.

Jane asked me at her office visit why she was having ôsharp, stabbing painsö under her ribs. She wanted to know what she could do about them. I told her this was normal for some women. There wasn't much she could do about the pain or pressure she felt from the baby's movement. I advised her the best thing she could do was to lie on her side to relieve pressure in the area that was painful. If she felt pressure up under her right ribs, for example, she should lie on her left side.

If the pressure really is pain, don't ignore it. You need to discuss it with your doctor. In most cases, it isn't a serious problem.

Avoid Retin-A during Pregnancy

Many women are waiting until they're older to have their first baby, as evidenced by the interest in my book Your Pregnancy After 30. More older women are having a first baby than ever before! This increase in age raises questions and concerns that wouldn't have applied a few years ago.

One of these concerns is the use of Retin-A« (tretinoin), not to be confused with Accutane (isotrentinoin). Retin-A is a substance in cream or lotion form used by many women to help them get rid of fine wrinkles on the face. The medicine is also used by dermatologists to treat people with acne.

What course of action should you follow if you are now using Retin-A? Stop using it. We don't have enough data to know if it's safe to use during pregnancy. But we do know any type of medication you useùwhether taken internally, inhaled, injected or used topically (spread on the skin)ùgets into your bloodstream. Any substance in your bloodstream can be passed to your baby. Some medications a mother-to-be uses become concentrated in the baby. Your body can handle it, but your baby's body may not be able to. If some substances build up in the baby, they can have significant effects on its development.

I recommend you avoid using Retin-A during pregnancy. In the future, we may know more about its effects on a growing baby. It's best to avoid using it for the sake of your baby.

Steroid Creams and Ointments

Conditions sometimes arise during pregnancy that require treatment with creams or ointments. This treatment could include steroid preparations.

Consult your doctor. Any medication used on the skin can be absorbed into the body and passed on to the baby. Remember, don't use any medication, cream or ointment that you used before pregnancy without consulting your doctor first.

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