Pregnancy encyclopedia: Hearing to Multiple marker/triple screen

Hearing -- your baby's development

If your baby has a hearing loss, her speech and language development may be affected. Your baby's hearing can be evaluated at any age by an audiologist. Hospitals may even test newborn hearing before discharge. Once hearing loss is identified, professional help is available to treat your baby. You can help by monitoring your baby's childhood diseases and language development.

Your baby may be at a higher than usual risk for hearing loss if one or more of these factors are present:

• a history of childhood hearing loss in a close relative
• bacterial meningitis
• congenital virus including toxoplasmosis, cytomegalovirus, herpes, rubella
• developmental problems of the head, face or neck
• Down syndrome
• a need for oxygen support after birth for more than 10 days
• blood transfusion(s) for jaundice
• birth weight of less than 3 pounds

If any of these factors apply to your baby, discuss this with your baby's health care provider. If you think your baby's hearing and language development may be abnormal, talk to your baby's health care provider.

Your baby's hearing and language development

	Your baby should:	You should:
By 4 months of age	occasionally stir or awaken from light sleep when there is a loud noise sometimes startle at a loud noise, like a dog barking or a dish crashing	imitate your baby's sounds talk, sing and read to your baby Use your baby's name often
By 7 months of age	turn his head from side to side toward sounds coo, gurgle, squeal and laugh startle or jump at loud noises	make simple speech sounds ("goo-goo") and see if your baby will imitate them reward your baby's attempts at speech with smiles and attention read, sing and play simple games with your baby

HIV screening

This blood test determines whether or not you have been exposed to HIV, the virus that causes AIDS. Heterosexual transmission is the leading cause of HIV infection for women. The Minnesota Commissioner of Health, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists recommend HIV testing for all pregnant women.

If you have HIV or AIDS, the earlier your health care provider knows, the better for your baby's health. Early attention and treatment can reduce your baby's chances of getting HIV to less than 10 percent. Without treatment, your baby's risk of getting HIV is 30 to 40 percent. Insurance cannot be denied or canceled on the basis of a positive HIV test result.

If you have HIV or AIDS, your health care provider will advise you not to breastfeed - you can pass the virus on to your baby in your breast milk.

Home care visit

Home visits from a registered nurse can be helpful during pregnancy (especially if you are on bedrest or there is concern about your health or the health of your baby) and during postpartum for follow-up care after birth.

A nurse can assess your situation, offer education, and help connect you with useful community resources like help with housework and childcare. After your baby's birth, a home visit from a nurse gives you an opportunity to ask questions in privacy and in a one-on-one setting. Ask your health care provider if this is appropriate for you.

Immunizations (shots)

Immunizations are a simple way to help keep your baby from getting some common childhood illnesses. Vaccines are made from the germs (or part of the germs) that cause disease. These weakened or dead germs won't cause your baby to get the disease. When the vaccine is injected (usually by a shot), it helps your baby build antibodies, which destroy the vaccine germs. This helps protect your baby against future infections.

According to the Centers for Disease Control and Prevention, the diseases that vaccines help prevent are:

• measles. Caused by a virus, measles causes a rash and a cold, but can lead to an ear infection, pneumonia and swelling of the brain. It is easily spread.
• mumps. Caused by a virus, mumps causes swelling of the cheeks and jaw. It can be spread.
• rubella (German measles). Caused by a virus, rubella causes a slight fever and rash. It can be spread.
• diphtheria. Caused by a bacteria, diphtheria causes breathing problems and can lead to heart failure or paralysis. It can be spread.
• tetanus (lockjaw). Caused by a bacteria, tetanus causes spasms of the jaw muscles. It cannot be spread.
• pertussis (whooping cough). Caused by a bacteria, pertussis causes severe coughing. It is easily spread.
• polio. Caused by a virus, polio causes a range of symptoms from muscle stiffness to paralysis. It can be spread.
• haemophilus influenza type B (hib disease). Caused by a bacteria, haemophilus influenza type B causes meningitis (swelling of the brain and spinal cord covering), pneumonia, swelling in the throat, and arthritis. It can be spread.
• hepatitis B. Caused by a virus, hepatitis B affects the liver and can cause liver infection or cancer at any age. It can be spread.
• varicella (chickenpox). Caused by a virus, varicella causes an itchy rash all over the body. It can be spread.
• pneumococcal disease. Caused by a bacteria, pneumococcal disease causes blood infection, meningitis, and middle ear infections. It can be spread.

For some of these diseases, several doses of vaccine are needed. Like all medicines, vaccines have some risk. Talk with your doctor about the risks before your child gets the shots. See the worksheet for the recommended immunization schedule.

Infant feeding

-- see Breast engorgement, Breast milk storage and thawing, Breast pumps, Breastfeeding after returning to work, Breastfeeding positions, Expressing breast milk, Sore nipples and Weaning.

Jaundice

A newborn's liver does not process red blood cell waste efficiently at first. This can result in a yellowing of the whites of your baby's eyes and a "tanned" appearance to your baby's skin. Jaundice can be treated by placing your baby "under the lights" in the nursery, though jaundice often goes away with frequent feedings and the passage of several days.

Kegel exercise

An exercise that strengthens the pelvic floor muscles.

Labor bag

A bag of items you'll find handy to use during your labor, both at home and when you're at the hospital. See the Labor Bag and Hospital Checklist (requires Adobe Reader) for items to pack.

Lanugo

Fine hair that appears on the shoulders, arms, face, and back of newborns. It will wear off within weeks.

Layette

Clothing and other items you'll need to care for your newborn. See the Layette Checklist (requires Adobe Reader) for a list of ideas.

Listeria

Listeria is a common bacteria that affects pregnant women more often than other healthy adults. Hormonal changes during pregnancy have an effect on your immune system that increases your chances of getting listeriosis (illness caused by listeria).

Listeriosis may cause flu-like symptoms (fever, chills, muscle aches, diarrhea or upset stomach). Call your health care provider. Antibiotics (medicines) are given to treat listeriosis.

Even if you do not show signs of illness, listeriosis can be transmitted to the fetus through the placenta. This can cause premature delivery, miscarriage, stillbirth, or serious health problems for your newborn. It's important to learn how to protect yourself and your unborn baby from foodborne illnesses. Getting in the habit of eating a safe and nutritious diet not only benefits your baby but will give you peace of mind.

Massage

Massage is sometimes called "communication without words" and the "most ancient of the healing arts." You may see a professional massage therapist for massage, but your newborn can also benefit from a massage -- from you.

Massage for your baby
For an infant massage, use only the very lightest of strokes -- your baby's skin and tissues are very tender and easily damaged. Undress your baby in a warm place and very lightly stroke your baby's arms and legs. Some colicky or upset babies find this very calming, and parents enjoy it, too.

Massage for you during labor
Massage can also help you during labor. You, your partner, or your labor companion can perform "effleurage," very light, gliding strokes to relax and soothe you. Make small circles with the fingers, thumb, or heel of the hand to encourage relaxation. Or simply apply pressure with a firm placement of the hand, which is helpful on your lower back if you have back labor.

Medicines used during labor and birth

Talk with your health care provider about which medicines might be used during your labor and birth. Not all medicines are available at all hospitals, nor are they all used by all health care providers. When your health care provider suggests a medicine, it is always OK for you to ask what the benefits and risks might be.

Pain medicine for labor

Medicine	Purpose	Method	Effects
Sedatives	To relieve anxiety, to help you work with contractions, and provide rest when you are exhausted and labor is not well established.	Shot or pill; takes effect quickly; lasts for several hours; ordered by a doctor or a midwife.	Has little effect on your baby, or may slow responses and breathing, but medicine can be given to your baby to help. If you don't want to sleep, you may not like the drowsy feeling.
Analgesics	To reduce and relieve pain and help you relax between contractions; you'll still feel contractions, but this "takes the edge off."	By injection or through intravenous line; takes effect very quickly; lasts up to 2 hours; ordered by a doctor or a midwife.	May slow baby's breathing and responses; you may feel dizzy or like you are floating; may slow labor down for a short time. If your baby is born rapidly, the effects of the medicine can be reversed with medicines given to your baby.
Paracervical	Numbs the nerves near the cervix, providing good relief for pain caused by cervical dilation.	Local anesthetic injected into the sides of the cervix; takes effect fairly quickly; lasts about 1 hour; given after you are dilated 4-5 cm; may be repeated; given by a doctor or mid-wife.	Baby's heart rate may slow temporarily, so it will be monitored; you may be asked to lie on your side and breathe oxygen.
Epidural	Relieves pain from below the breasts to mid-thigh for labor and birth; you'll probably still feel touch, movement, and pressure; you may still be able to move your legs; you can stay alert but can also rest or even sleep.	An anesthesiologist numbs the injection site, then places a small catheter in your back and medicine flows through it into the epidural space; takes effect within 5-10 minutes; lasts as long as needed; you may feel pressure or a feeling like a "shock" down your legs when the catheter is inserted.	Requires an IV, which you'll have for the rest of labor and birth; your blood pressure may drop; fetal monitoring will be used; you may feel numbness or tingling in your legs; you'll have to stay in bed and may have a bladder catheter; you have a chance of spinal headache and nausea; has little effect on your baby's responses after birth.
Intrathecal narcotics	Reduces pain, but you will feel touch and pressure; you may rest or get up and walk.	An anesthesiologist numbs the injection site, then injects the medication into your spinal fluid; takes effect within 5 minutes; lasts 1-2 hours; can be repeated once before second stage.	May lower your blood pressure and respiration, so there will be regular checks; you may be asked to breathe oxygen by mask or receive medicine to increase your blood pressure; for the first 30 minutes, an electronic fetal monitor will be used – after that, you can walk; you may feel nauseated and itchy; has little effect on your baby's responses after birth. If your baby is born rapidly, the effects of the medicine can be reversed with medicine.

Pain medicine for birth

Medicine	Purpose	Method	Effects
Pudendal	Numbs the vagina and perineum so you don't feel the episiotomy, forceps, or vacuum extractor.	Injection into the sides of the vagina; takes effect fairly quickly; lasts for a short time after birth; given by a doctor or a midwife.	You will still feel contractions but may have less of an urge to push; usually has no effect on your baby.
Local	Numbs the perineum for episiotomy and episiotomy repair.	Injected into the perineum; takes effect fairly quickly; lasts for a short time after birth; given by a doctor or a midwife.	Does not affect your baby.

Anesthesia medicine for Cesarean birth

Medicine	Purpose	Method	Effects
Epidural	Blocks pain and allows you to be awake for the birth; you may feel pressure and tugging.	An anesthesiologist places a small catheter in your back, and medicine flows through it into the epidural space; takes effect with-in 5-10 minutes; lasts as long as needed; more anesthesia is used than is used for a vaginal birth so you will not feel pain during surgery.	Oxygen will be given through a mask; you may feel nauseated.
Spinal	Blocks pain and allows you to be awake for the birth; numbs you from below the breasts to the toes; you'll be unable to move your legs.	Similar to epidural above, except medicine is injected directly into the spinal fluid; usually a one-time dose rather than a continuous infusion; lasts 30-60 minutes.	You will be given oxygen through a mask; you may feel nauseated; you have a small chance of headache later; you may need to lie flat for a time.
General	You are asleep during surgery; used in an emergency to allow baby's quick birth.	An injection through an IV makes you unconscious; then a tube in your throat gives you inhaled medicine; given by an anesthesiologist.	Your baby is born quickly, minimizing side effects; your baby may be a little sleepy; after the birth, you may feel groggy and have a sore throat.

Miscarriage

The spontaneous loss of a pregnancy before the baby can survive outside the uterus. Health care providers also use the term "spontaneous abortion."

Morning sickness

Especially in early pregnancy, and especially in the mornings, you may feel nauseated and queasy. You may even vomit. This sensation and the vomiting should lessen as your pregnancy progresses.

To reduce the effects of morning sickness, try:

• eating dry crackers before you sit up in bed in the morning
• eating small meals of nutritious carbohydrates frequently throughout the day
• eating six to seven small meals throughout the day,
• avoiding fluids with meals
• snacking on protein, like meat or cheese

Talk with your health care provider if you are vomiting more than twice a day.

Mucus plug

The cervix produces mucus all the time. During pregnancy, it forms a thick plug. Sometimes (but not always) toward the end of pregnancy, this mucus may come out in clumps, possibly tinged with blood. This is not a sign that labor is about to begin -- labor may be days to weeks away.

Multiple marker/triple screen

Multiple marker screening (MMS) is a blood test available to pregnant women as part of their prenatal care. MMS can tell you about your chance of having a baby with Down syndrome, trisomy 18 (a marker of a genetic defect), and a neural tube defect.

If you decide to have MMS, a small amount of blood is taken from your arm. The amount of certain hormones and proteins from the baby will be measured in your blood. If these suggest an increased chance for selected problems, follow-up tests to diagnose or exclude the concerns are available. Ask your health care provider about genetic counseling.


 

First published: 10/04/2002
Last updated: 10/04/2002

Reviewed by: Allina Patient Education, experts