REPOST: Sleeping for Two: Sleep Changes During Pregnancy

Hormonal changes and physical discomfort can alter a woman's quality of sleep during pregnancy. LiveScience.com article shares most common sleep changes that may occur in each trimester. 

Mothers-to-be should spend at least eight hours in bed each night so they can get at least seven hours of sleep. | Image Source: livescience.com

Being pregnant can be a tiring experience for a woman's body. Both the physical discomforts of pregnancy as well as the emotional stress of this major life change can cause sleep problems and keep a mother-to-be awake at night.

Feeling exhausted is a common complaint during the first and third trimesters. But women might be caught off guard by how worn out they feel in the early months of pregnancy.

"A lot of women are totally surprised by how fatigued they feel during the first trimester," said Kathy Lee, a professor of nursing at the University of California San Francisco, who has studied how pregnancy affects sleep.

Women know about morning sickness in early pregnancy, but many first-time mothers say they had no idea about how tired they often feel at this stage, Lee said.

Sleeping for two

Similar to the advice that a pregnant woman should be "eating for two," health professionals should also be emphasizing the importance of "sleeping for two" during prenatal visits, Lee told Live Science.

One reason is that pregnancy can affect both the quantity of sleep a woman gets as well as the quality of it.

As their body changes and pregnancy discomforts make it more difficult to fall and stay asleep, mothers-to-be should spend at least eight hours in bed each night so they can get at least seven hours of sleep, Lee recommended.

Researchers have found that not getting enough sleep during pregnancy could affect a woman in ways that go beyond feeling exhausted during the day, irritability and poor concentration.

One of Lee's studies, published in the American Journal of Obstetrics and Gynecology (AJOG), found that first-time mothers who got less than six hours of sleep at night were 4.5 times more likely to have a C-section, and their average length of labor was 10 hours or longer compared with first-time mothers who slept seven hours or more.

"A woman really needs to go to bed earlier when she is pregnant," Lee said. Women need the extra rest, and they can't keep going on the same amount of sleep they got before becoming pregnant, she pointed out.

Pregnancy and fatigue

Researchers are still trying to figure out the exact reasons why pregnancy causes a woman to feel so exhausted, Lee said.

But to some extent, pregnancy-related fatigue is hormonal, she said. In the early phases of pregnancy, progesterone levels start to increase.

"Progesterone is a hormone that slows a woman down and mellows her out, and some women may perceive these effects as fatigue," Lee said.

Besides the influence of hormones, some of the sleepiness that women feel early in pregnancy could also be physiological as the uterus gets bigger and the fetus grows, coupled with pregnancy-related weight gain and fluid accumulation in the body, Lee said. These changes mean the body is working harder as the placenta forms to nourish the developing fetus, the blood supply increases and the heart beats faster.

And emotional factors can also play a role. The excitement and anticipation of having a baby as well as the fears of impending motherhood and the anxiety about labor and delivery can all be stressful and make a woman feel more tired than usual.

Here's what to expect in terms of sleep changes during the three stages of pregnancy.

Sleep and the first trimester

In the early months of pregnancy, rising progesterone levels may not only make a woman feel drowsy, but they may also be partly to blame for the frequent need to pee, which can also disrupt sleep and worsen sleepiness.

During the first trimester, the hormones leading to the bladder get sluggish, which increases a woman's urine production. This can cause her to wake up and need to go to the bathroom more frequently at night, Lee explained.

To reduce their nightly bathroom visits, women who are expecting may want to cut back on fluids in the evenings. However, they should not cut back on drinking plenty of fluids during the day because water and other liquids are important to help prevent constipation and excessive swelling, two common pregnancy discomforts.

Another factor that can rob a woman of the shuteye she needs is the nausea known as morning sickness, which can happen any time of the day or night. To relieve the queasiness, some women eat crackers or dry cereal before getting out of bed in the morning.

Women might also feel warm or hot when they sleep during pregnancy because of an increased metabolic rate, Lee said. A fan often helps to keep a woman cooler, she said, plus it can block out noise inside and outside the bedroom, including a snoring bed partner.

Bedmates are not the only ones who might be snoring. Snoring is common in pregnancy, and it can start in the first trimester in women who are already overweight or have allergies, Lee said.

Because of the many possible disruptions to sleep during pregnancy, napping is a good idea as long as a woman can fall asleep that night, Lee said.

But avoid using sleeping pills and even sleep-inducing supplements, such as melatonin, during pregnancy, Lee said.

Sleep and the second trimester
The second trimester of pregnancy is usually the best for women, Lee said. "Everything levels out and things aren't changing quite as fast."

Lee explained that hormonal changes, which are steep during the first trimester, level off during the second trimester, and then are steep again in the third trimester. 

Leg cramps may occur at night during the second trimester. And some pregnant women, especially if they anemic and have low iron levels, may experience restless legs syndrome beginning in the evening hours of the second trimester and becoming more severe in the third trimester, Lee said. This condition, in which the legs feel jumpy, as if they had ants crawling up and down their veins, can occur while sitting or lying down and might be extremely uncomfortable.

Often the only relief from the pain is from walking around, Lee said, but then a woman may not be able to fall back asleep.

Heartburn is another problem that can keep women awake at night. As pregnancy progresses and a woman's uterus gets bigger, it may press on her stomach, making a burning sensation more common.

Sleeping on the left side with the knees bent may be a better position for women who are experiencing heartburn during pregnancy, Lee said. Some women may also try sleeping with the head of the bed elevated or by propping their head on more pillows to ease the acid backwash of heartburn.

A lot of women say they have bizarre dreams related to their baby during pregnancy, Lee said. Although many women report strange dreams, the results from her research did not show any differences in dreaming across the trimesters compared with dreaming before a woman becomes pregnant.

"It might be that women are able to remember their dreams better during pregnancy because they are waking up more often," Lee told Live Science.

Sleep and the third trimester
As a woman's belly increases and the fetus is getting bigger and more active, Lee suggested that pregnant women sleep in any comfortable position they can find.

But she advised mothers-to-be to stay off their backs as much as possible because a heavy uterus can press on nerves in the spine and on a major vein that carries blood between the lower body and heart.  

The National Sleep Foundation recommends that pregnant women sleep on their left side, which may improve the flow of blood and nutrients to the developing fetus and to a woman's heart, uterus and kidneys.

Use pillows to be more comfortable, placing one between the knees, a second under the belly, and a third behind the back to support it and relieve pain, Lee advised.

Snoring is also a more common occurrence in the third trimester of pregnancy as a result of weight gain and more nasal congestion, Lee said. She recommended that women who have stuffy noses use nasal strips to help open up their nasal passages and improve their nighttime breathing. 

One study found that women who began snoring while pregnant may be at greater risk of pregnancy-related high blood pressure and preeclampsia, a condition of high blood pressure during pregnancy, compared with mothers-to-be who did not snore.

More interesting facts about pregnancy can be read by visiting this Louis Habash on Twitter account.

REPOST: No one needs to worry about 'pregnancy abs'

Have you heard about pregnancy abs? A 30-year-old model Sarah Stage started posting pregnant belly selfies on her instagram and proves that pregnancy is not an excuse to let yourself go and look well.

Sarah Staged (2nd Right) speaking about the controversy surrounding her 'pregnancy abs' Instagram posts | Image Source: dailylife.com.au

As any self-respecting pregnant woman knows, pregnancy is not an excuse to let yourself go and look, well, you know, pregnant. But it's no longer enough to just not gain weight. Mums-to-be now must also be as cut as a serpent's tooth.

Allow me to present to you... pregnancy abs.

The 'pregnancy abs' thing began after 30-year-old lingerie model Sarah Stage started posting belfies- pregnant belly selfies- at roughly the same frequency as pregnant women need to pee.

Stage's 1.2 million Instagram followers soon began following her pregnancy (and her six-pack) as closely as her obstetrician.

Initially her followers were full of praise and admiration for her tiny bump and visible abs. Some wished they looked like her when they were pregnant. Others wished they looked like Stage even when they're not pregnant.

"I look like this right now after eating a bowl of soup," wrote one follower of the model's barely-there belly. Even US Cosmopolitan appeared to be in awe, declaring: "Sarah Stage is so pregnant and so hot right now".

Bizarrely, US Cosmo also took the opportunity to provide other pregnant women with tips on how to get their own pregnancy six-pack.

"You can have insane abs during your pregnancy — here's how," promised one article.

It's simple! All you need to do is eat small meals to "maintain the integrity of the muscles so they don't stretch"- never mind the stretching from the growing baby- and exercise regularly. And, oh yes, it helps if you have the genetics of a supermodel.

To top it off, the site even enlisted the 'expertise' of personal trainer Franci Cohen, who said she "went back to teaching workout classes days after giving birth to each of her four children".

Hear that you lazy new mums who want to rest and recover from your pregnancy and birth?

While some gawked at Stage's tone stomach, others were quick to chime in with shaming comments. In fact, some of Stage's own followers decided they'd take it upon themselves to bring her down a peg or two.

Faster than you can say 'selfie stick', the concerned medical professionals of Instagram- also known as 'Complete Strangers With No Discernible Medical Training'- started accusing the model of causing harm to her unborn child.

"The baby is probably really small and I would imagine she will have a hard time making milk," wrote one critic."Where's this baby hiding at? Definitely not her tummy!!" snarked another.

Despite the wave of online concern, Dr Bill Batman, who manages shared care obstetrics at the Royal Women's Hospital, says it's impossible to know if Stage was jeopardising her baby's health from an Instragram photo.

"I would think that she probably isn't, but you can't tell just by looking at someone's abdominal musculature," Dr Bateman says.

And for those who are curious about how common "pregnancy abs" are, Dr Bateman has a reasurring (if predictable) message:

'I've never seen a pregnant patient with a six-pack and that includes women who are personal trainers and gym enthusiasts," he says. "These people haven't remotely come close to a six-pack, although they probably haven't been planning to."

If there's one thing we can take away from the whole pregnancy abs episode, it's that we, as a culture, have officially reached Peak Stupid.

Both sides of the 'pregnancy abs' kerfuffle have spectacularly missed the point. The issue is not that a woman somewhere has pregnancy abs. The real issue here is that people still feel entitled to weigh in on whether there's a right and a wrong way to do pregnancy.

There's not.

Every body is different. Is it really that shocking that an underwear model who's pregnant looks like an underwear model who's pregnant?

It's also not surprising that a woman who makes a living from taking photos of herself in her undies continues to do so when she's pregnant.

Sure, look at the Instagram feed if you want. But let's not turn 'pregnancy abs' into a moral or health issue. And let's not pretend that the same look is achievable for most women with some careful dieting and exercise.

But most of all, let's leave Stage's health, and that of her baby, to her and her medical professionals.

Get more helpful tips on pregnancy when you like Louise Habash on Facebook page.

How to deal with depression after a miscarriage

Image Source: pregnancybirthbaby.org.au

Miscarriage can happen to one in five pregnant women. It is defined as a spontaneous pregnancy loss and usually occurs during the first 20 weeks of conception. It's a painful experience -- physically and emotionally. It can certainly feel devastating for you and your partner but there are ways to get through these feelings of depression. Here are some tips from women who have suffered the same loss:

Don’t blame yourself. Do not blame your partner, either. Miscarriage can happen to anyone regardless of age or race. If you think that you did something to prompt spontaneous pregnancy loss, then learn from it and avoid doing the same in your next pregnancy.

Allow yourself to heal. I mean this as both emotionally and physically. Although your body may recover much faster than your broken heart, it is important to remember to take care of yourself. Give yourself some time to grieve. It won't be easy and you may want to take a couple of days off of work but it is necessary.

Image Source: fatherhood.about.com

Don’t push others away. You may feel like no one understands your pain (not even your partner) but that is not a reason to keep your feelings to yourself. Pushing people away will not help you overcome your feelings of anger, loneliness, and guilt. Let others help you get back on your feet.

Accept. Acknowledge that you have lost your child but do not think that this fact makes you less of a mother. Don't belittle yourself. Acceptance is the last stage of grief and you know you're on your way to recovery when you've finally accepted the reality of it all.

Image Source: bodyandsoul.com.au

Hello! I'm Louise Habash, a Texas-based obstetrician subspecializing in perinatology. Follow me on Twitter to learn more about the intricacies of pregnancy and motherhood.

REPOST: Daily Checkup: Preventive care is the key to dealing with high risk pregnancies

 The saying, "prevention is better than the cure," applies to everyone, most especially to pregnant women. Dr. Joanne Stone, Division Director of Maternal Fetal Medicine at Mount Sinai Hospital, talks about identifying potential threats as a way to avoid adverse outcomes in this New York Daily News article below:

The Division Director of Maternal Fetal Medicine at Mount Sinai Hospital, Dr. Joanne Stone specializes taking care of women who have high risk pregnancies. She has been working in the field for over 20 years. | Image Source: nydailynews.com

The Specialist

The Division Director of Maternal Fetal Medicine at Mount Sinai Hospital, Dr. Joanne Stone specializes taking care of women who have high risk pregnancies. She has been working in the field for over 20 years.

WHO’S AT RISK

What is considered a high risk pregnancy? “While there’s no absolute definition, in general there’s either something about the mother’s condition that places her at high risk or something specific to the pregnancy itself — for instance, if it’s twins, triplets, or there are fetal anomalies,” says Stone. “Age increases a woman’s risk for complications, as do many medical conditions including diabetes, ulcerative colitis and Crohn’s disease, obesity, and high blood pressure.” Pregnancy risks are elevated for women over the age of 35.

Pregnancy risk is assessed on a spectrum. “There are extremely high risk patients — like a woman who has a renal transplant and has had a heart attack,” says Stone. “A healthy 32-year-old woman carrying twins would be a much lower risk situation, but some women will still consider themselves at high risk in that case.”

The idea behind identifying the risk level of a pregnancy is to emphasize preventive care, not to raise expecting moms’ anxiety levels. “Identifying potential problems is a way of preventing adverse outcomes,” says Stone. “For instance, it’s important for women with diabetes to have excellent blood sugar control for two to three months before conception — then their risk of birth defects is no higher than the general population.”

Women who have been pregnant before can also be an increased risk. “A pregnancy is considered high risk if the mother obstetrical history includes premature birth, a prior still birth, multiple miscarriages, or having a baby that was extremely small,” says Stone. “The good news is that for women who have had a prior preterm labor and delivery, we have medications that have been proven to lower the risk of recurrent pre-term birth. For other women who have had a prior small baby or stillbirth, we can do a workup to try to identify and cause and help prevent in from happening again.”

SIGNS AND SYMPTOMS

By identifying high risk patients, doctors hope to prevent them from developing symptoms in the first place. “Prevention and management are our goals,” says Stone. “For instance, if you have a history of blood clots, we can put you on blood thinners to prevent that from occurring.”

If something does go wrong, there are some red flags to look out for. “One symptomatic disorder is preeclampsia, which can cause headache, visual changes, pain in the upper right side, and elevations in blood pressure,” says Stone. “Patients with some medication conditions, like significant kidney disease or diabetes, or who are carrying a pregnancy of multiple fetuses, are more likely to have pre-term labor. Its signs are feeling menstrual-type cramps that are getting worse, leaking fluid, and feeling a lot of pressure.”

TRADITIONAL TREATMENT

Any necessary treatment regimen will depend on the underlying condition or factor that makes the pregnancy high risk. “The management of diabetes is very different for pregnant women — their glucose control needs to be tighter than when they are not pregnant,” says Stone. “If the maternal blood glucose is too high, it crosses the placenta and causes the baby’s pancreas to start producing excess insulin.” These women are also at risk of the baby’s being big, so doctors perform more frequent ultrasounds.

Modern day technology allows doctors to track the fetus’ development much more carefully. “For women who have developed antibodies against the fetus’ red blood cells from a previous pregnancy, we can monitor the blood flow in the fetus’ brain to tell if the baby is getting anemic, in which case we can do an in utero blood transfusion,” says Stone. “In some cases, the fetus can develop a bladder outlet obstruction that can damage the kidneys, which we can fix by placing a shunt.”

There’s a long list of conditions that can raise a pregnancy’s risk of complications, but doctors can hold most of them in check. “There are very very few times when I counsel a patient that they shouldn’t get pregnant — the vast majority of diseases are manageable,” says Stone. “There's so much we can do to optimize the outcomes for patients, and most of them can do very very well."

RESEARCH BREAKTHROUGHS

Doctors are continually pushing forward with research projects. “At this point, we can now do in utero surgery for some babies who are diagnosed with spina bifida, an opening in the vertebral column,” says Stone. “This surgery can make a huge difference. We’re constantly doing research to improve outcomes for the major problems.

Questions for your doctor:

If you’re considering getting pregnant, ask you doctor, “Can I have a pre-conceptual consult?” It’s a good idea to go over your personal history, family history, and any medications you’re taking — for instance, you might need to swap out one of your medications for blood pressure, seizures, and depression. Be up-front about asking, “What screening do I need?” And follow up with, “Are there any tests that I don’t need?”

“Coming up with a management plan can help reduce adverse outcomes,” says Stone. “We now know so much about the diseases and about pregnancy — there’s a lot we can do to help women have the healthiest pregnancy possible.”

WHAT YOU CAN DO

Get informed .

If you have questions about what tests are appropriate for you, check the Choosing Wisely website — part of a campaign to help doctors and patients form a testing plan that is evidence-based, safe, not duplicative, and “truly necessary.” Mount Sinai also hosts a plethora of information on high risk pregnancies (mountsinai.org/patient-care/service-areas/obgyn-and-reproductive-services/areas-of-care/pregnancy-and-birth/maternal-fetal-medicine).

Keep moving.

“Exercise is good for the vast majority of patients — it helps control blood glucose and blood pressure,” says Stone. “Talk to your doctor about what exercise routine is right for you.”

Avoid high-mercury fish-and undercooked hot dogs.

Swordfish, mackerel, kingfish, and tilefish should be avoided entirely, and tuna should only be consumed in limited qualities; undercooked hot dogs are the “No. 1 culprit” for spreading listeria, a common food-borne bacteria.

Moderation is the watchword.

“Most things in moderation are okay — 1.5 cups of coffee a day has been shown to be safe,” says Stone. “And you can take a Tylenol if you have a headache.”

Don’t hesitate to call your doctor.

Raise your questions and concerns directly with your doctor. “There’s some good information on the Internet and some really bad information,” says Stone.

Find more expert tips for mom-to-bes by following this Louis Habash Facebook page.

Understanding morning sickness: Signs and symptoms

Image Source: parentables.howstuffworks.com

According to Morning Sickness USA, morning sickness affects 85% of pregnant women. Symptoms begin to manifest around the 4th week to 6th week of pregnancy. The following are the common symptoms women may experience with morning sickness:

• Nausea
• Sensitive sense of smell and taste
• Fatigue

Morning sickness is defined as a nauseous, queasy feeling in your stomach that may or may not cause vomiting. It is actually a misnomer because morning sickness can happen at any time of the day. It is caused by hormones and increased amount of stress and changes in the body aligned with the pregnancy. Though there isn’t any surefire cure to stop morning sickness, AmericanPregnancy.org created this list of tips to alleviate the feeling of nausea:

Image Source: americanpregnancy.org

• Eat small meals often
• Drink fluids 1/2 hour before or after a meal, but not with meals
• Drink small amounts of fluids during the day to avoid dehydration
• Eat soda crackers 15 minutes before getting up in the morning
• Eat whatever you feel like eating, whenever you feel you can
• Ask someone else to cook for you and open the windows or turn on fans if the odor bothers you

• Get plenty of rest and nap during the day
• Avoid warm places (feeling hot adds to nausea)
• Sniff lemons or ginger, drink lemonade, or eat watermelon to relieve nausea
• Eat salty potato chips ( they have been found to settle stomachs enough to eat a meal)
• Exercise

Generally, morning sickness will not harm you or your baby but there are extreme cases where women experience excessive vomiting and inability to keep food down. This condition is called hyperemesis gravidarum. Unlike common morning sickness, hyperemesis gravidarum can be harmful for the baby and should not be left untreated. You should raise any concerns with your attending gynecologist should symptoms appear and talk about proper treatment.

Image Source: peoplescommclinic.org

Get more helpful tips on pregnancy when you follow Louise Habash on Twitter.

REPOST: Kate Middleton Suffering from Hyperemesis Gravidarum. What Does It Mean?

Vomiting and nauseousness is often attributed to morning sickness among pregnant women but this article from Yahoo raises awareness regarding a more serious condition called hypermeses gravidarum (HG), a condition that even the British royalty is not immune to. Find out more about HG below.

Image Source: yahoo.com

For most people, a bout of vomiting is something akin to torture. So it’s easy to sympathize with pregnant-again Kate Middleton who, it’s just been revealed, is suffering from a debilitating condition called hyperemesis gravidarum (HG), which causes persistent nausea and vomiting to the point of weight loss and dehydration, apparently making standard morning sickness look like a walk in the park.

It’s the duchess’s second bout with the condition. She also suffered through it during her first pregnancy, with Prince George, who is now a year old. And now, not quite 12 weeks into her second pregnancy, she’s being treated for HG once again — which is not all that surprising, since women who have HG in one pregnancy tend to have it again, though often less severely than the first time around. “The Duchess of Cambridge’s second pregnancy with HG is a reminder: Women who experience this condition face an 80% chance of repeat diagnosis in future pregnancies,” noted a statement from the HER Foundation, a grassroots network of HG survivors and an information clearinghouse on the condition. “And while the severity and duration of symptoms vary among women, HG remains a debilitating and even life-threatening medical condition that can have serious consequences for the health of both mom and baby.”

Since the condition is genetic, 20 percent of women who are affected have a sister who also had HG, and 30 percent have a mother who had HG, Marlena Fejzo, of Harvard University, a leading researcher on HG, told Yahoo Health.

“It’s terrible,” said Fejzo, who is an advisory board member with the HER Foundation. Maternal complications of severe HG, she said, can include detached retinas, fractured ribs, blown eardrums and esophageal tears, she said, all a result of frequent vomiting, as well as malnutrition. Fejzo has found through her research that 18 percent of women who suffered through an HG pregnancy wind up with post-traumatic stress disorder, while 37 percent decide to not have any more children because they don’t want to endure HG again. In addition, 15 percent of HG sufferers wind up making the painful decision to abort, often referred to as a “therapeutic termination,” she said. There have also been a few reports of maternal deaths, as a result of stomach tears and bleeding. “So it’s very severe,” she noted.

“It is a devastating condition,” Dr. Irina Burd, director of research for the division of maternal fetal medicine at Johns Hopkins University in Maryland, told Yahoo Health. It’s also quite rare, affecting only about one to two percent of pregnant women. “We try to manage with a patient’s treatment at home, but it often winds up with a hospitalization,” Burd said. “Every patient and every situation requires a personalization of care.” The constant nausea and vomiting can lead to dangerous vitamin deficiencies, weight loss, and dehydration for the affected mom-to-be, which is why hospitalization is so often required, though Middleton has not yet reached that point this time around.

It’s not known what causes HG, although it’s widely understood to be related to rising levels of the pregnancy hormone, hCG (human chorionic gonadotropin), and how, in certain individuals, that may trigger the part of the brain affecting nausea and vomiting. “We are on the cusp [of understanding the root cause],” Fejzo said. “But as far as a genetic study and finding the cure, we’re just getting there.” Other factors triggering HG seem to include rising estrogen levels, gastrointestinal changes, and high-fat diets.

While effects on the fetus seem to be rare, some research has indicated that babies whose mothers suffered an HG pregnancy are more likely to be premature or have a low birth weight, or to be vitamin-K deficient, Fejzo noted.

Treatments vary greatly, Burd said, and often begin with dietary changes and the consumption of small, protein-filled snacks rather than large meals. If weight loss continues, and the patient is hospitalized, treatments can include pyridoxine, a high-dose vitamin B6, and doxylamine, an antihistamine, the combination of which can ease nausea, Burd explained. Reglan and Zofran have also been effective, Vincenzo Berghella, president of the Society for Maternal-Fetal Medicine, told Yahoo Health. “Even ginger, or those acupressure wristbands, like people use for seasickness, can help,” he said, adding that symptoms of HG most often spike between the 10th and 12th week of pregnancy, often subsiding between week 14 and 16. But for those for whom it lingers, life can be difficult.

“I wouldn’t wish hyperemesis gravidarum even on evil people,” wrote Parents blogger Kristen Kemp in a revealing first-person essay during news Middleton’s first difficult pregnancy. “Hyperemesis gravidarum (HG) tried to kill me during both of my pregnancies. I took gobs of medication, checked in for several stays at the hospital and, as a last resort, considered abortion at the suggestion of my ob-gyn.” She managed to move past that idea, although it was a very tough road — one that often had her questioning her sanity. But, she soon realized, “I had a freak illness, but I was not a freak. Just ask Kate Middleton.”

Find out more about the conditions that may arise during pregnancy and how to treat them by following Louis Habash on Facebook.

REPOST: Fetal Pain – When Does Pain Become Pain?

 Expecting mothers usually have a lot to worry about. One of these causes of anxiety for mothers is whether their babies feel any pain. This article from Brain Blogger discusses the subject of fetal pain in depth.

Image Source: brainblogger.com

Whether fetuses do indeed feel pain and, if they do, when do they acquire the ability to feel it are matters of great debate.

Fetal pain is a subject that is particularly prone to controversy, stretching far beyond its scientific aspects. And there is always increased attention to this topic whenever legislative changes regarding the intentional termination of pregnancy are impending.

Research on fetal pain is understandably complicated. The first and most obvious difficulty is that you cannot ask a fetus if something hurts and, therefore, there is never certainty that there is pain. When talking about pain, one must keep in mind its definition, which, according to the International Association for the Study of Pain, is: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

The emotional component of pain entails the need for consciousness to allow the recognition of the unpleasantness of a stimulus. It is this subjective cognitive component of pain that distinguishes it from nociception, which is defined as the neural processes of encoding actual or potentially tissue-damaging events.

Pain is a psychological state and therefore, when trying to infer whether fetuses can feel pain, not only the capacity to detect potentially painful stimuli, but also the capacity to consciously perceive them have to be evaluated. That possibility has to be inferred from data such as fetal anatomy, neurochemistry, behavior, the development of neural circuits, and the production of stress related hormones in response to stimuli. But even these aren’t easily studied.

In order for a stimulus to be perceived as painful, a whole circuitry has to be fully developed: information must travel from spinal cord neurons, whose axons project to the thalamus, which sends afferents to the cerebral cortex. From what research, within its limitations, has been able to determine, functional sensory fibers and spinal reflexes can be found by 20 weeks of gestation, as well as connections to the thalamus. However, this path becomes fully functional only in the third trimester, around 29 to 30 weeks’ gestational age, when mature projections from the thalamus to the cerebral cortex are present.

Although withdrawal reflexes in reaction to cutaneous stimulation are observable at earlier developmental stages, these do not imply effective pain perception since they are not specific to nociceptive stimuli and are not dependent on cortical mediation. Likewise, stress responses such as increased blood flow, heart rate and respiratory rate, as well as neuroendocrine changes that include increased production of catecholamines, cortisol, and other stress hormones, or increased beta-endorphin or noradrenaline release, can also be observed early in the second trimester, but again, these are not necessarily indicative of pain perception.

Overall, amidst the debate, with some arguing that fetusus can feel pain earlier by using subcortical structures, and others arguing that the fetus cannot feel pain by being maintained in a state of sedation in the womb, it is generally agreed that the minimal necessary neuronal pathways for pain are in place by 24 weeks gestation.

Learn more interesting facts about pregnancy and being a mother by following Louis Habash on Twitter.