#Prenatal Supplements for Twins

[thetwinsprenatal]

Supplements for Twins

Elevate your twin pregnancy journey with Supplements for Twins! Get expert-backed guidance on essential nutrients such as calcium, zinc, and inositol for optimal maternal and fetal health. Receive personalized supplementation advice and discover nutrient-rich food sources for a nourishing path for you and your little duo.

[ropertplant]

tonight's finale of severance will be cobel telling mark that the only reason he survived his botched brain surgery is because he's actually pregnant and the baby is absorbing all of the bad effects on his body and that's why they're at the birthing center the baby is NOTTT doing well and everything will be all better if he takes these prenatal supplements. and it's twins. with different moms. care to explain that, mark? and that's the cliffhanger

[majesticcatherine]

Some tidbits about postpartum haemorrhage and related complications part two (part one)

Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of high blood pressure and often a significant amount of protein in the urine or by the new onset of high blood pressure along with significant end-organ damage, with or without the proteinuria

When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances.

Pre-eclampsia increases the risk of undesirable as well as lethal outcomes for both the mother and the fetus including preterm labor. If left untreated, it may result in seizures at which point it is known as eclampsia.

Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus. It is also more frequent in a woman's first pregnancy and if she is carrying twins.

The underlying mechanisms are complex and involve abnormal formation of blood vessels in the placenta amongst other factors.

Most cases are diagnosed before delivery, and may be categorized depending on the gestational week at delivery.

Commonly, pre-eclampsia continues into the period after delivery, then known as postpartum pre-eclampsia.

Rarely, pre-eclampsia may begin in the period after delivery.

While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction.

Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a woman after twenty weeks of pregnancy.

Pre-eclampsia is routinely screened during prenatal care.

Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with pre-eclampsia, delivery of the baby and placenta is an effective treatment but full recovery can take days or weeks.

The point at which delivery becomes recommended depends on how severe the pre-eclampsia and how far along in pregnancy a woman is.

Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother's condition before delivery. Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bed rest and salt intake have not been found to be useful for either treatment or prevention.

Pre-eclampsia affects 2–8% of pregnancies worldwide. Hypertensive disorders of pregnancy (which include pre-eclampsia) are one of the most common causes of death due to pregnancy.

They resulted in 46,900 deaths in 2015. Pre-eclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes.

Women who have had pre-eclampsia are at increased risk of high blood pressure, heart disease and stroke later in life.

Further, those with pre-eclampsia may have a lower risk of breast cancer.

The word "eclampsia" is from the Greek term for lightning. The first known description of the condition was by Hippocrates in the 5th century BC.

An outdated medical term for pre-eclampsia is toxemia of pregnancy, a term that originated in the mistaken belief that the condition was caused by toxins.

Edema (especially in the hands and face) was originally considered an important sign for a diagnosis of pre-eclampsia.

However, because edema is a common occurrence in pregnancy, its utility as a distinguishing factor in pre-eclampsia is not high.

Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider.

Further, a symptom such as epigastric pain may be misinterpreted as heartburn.

Common features of pre-eclampsia which are screened for during pre-natal visits include elevated blood pressure and excess protein in the urine.

Additionally, some women may develop severe headache as a sign of pre-eclampsia.

In general, none of the signs of pre-eclampsia are specific, and even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice.

Diagnosis depends on finding a coincidence of several pre-eclamptic features, the final proof being their regression within the days and weeks after delivery.

The cause of preeclampsia is not fully understood. It is likely related factors such as:

Abnormal placentation (formation and development of the placenta)

Immunologic factors

Prior or existing maternal pathology – pre-eclampsia is seen more at a higher incidence in individuals with pre-existing hypertension, obesity, or antiphospholipid antibody syndrome or those with a history of pre-eclampsia

Dietary factors, e.g. calcium supplementation in areas where dietary calcium intake is low has been shown to reduce the risk of pre-eclampsia

Environmental factors, e.g. air pollution

Those with long-term high blood pressure have a 7 to 8 times higher risk than those without.

Physiologically, research has linked pre-eclampsia to the following physiologic changes: alterations in the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, oxidative stress, imbalance among vasoactive substances, decreased intravascular volume, and disseminated intravascular coagulation.

While the exact cause of pre-eclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to pre-eclampsia is an abnormally implanted placenta.

This abnormally implanted placenta may result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins along with inflammatory mediators into the maternal plasma.

A major consequence of this sequence of events is generalized endothelial dysfunction. The abnormal implantation may stem from the maternal immune system's response to the placenta, specifically a lack of established immunological tolerance in pregnancy.

Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with pre-eclampsia.

When pre-eclampsia develops in the last weeks of pregnancy or in a multiple pregnancy, the causation may in some cases, partly be due to a large placenta outgrowing the capacity of the uterus, eventually leading to the symptoms of pre-eclampsia.

Abnormal chromosome 19 microRNA cluster (C19MC) impairs extravillus trophoblast cell invasion to the spiral arteries, causing high resistance, low blood flow, and low nutrient supply to the fetus.

Despite a lack of knowledge on specific causal mechanisms of pre-eclampsia, there is strong evidence to suggest it results from both environmental and heritable factors.

A 2005 study showed that women with a first-degree relative who had a pre-eclamptic birth are twice as likely to develop it themselves.

Furthermore, men related to someone with affected birth have an increased risk of fathering a pre-eclamptic pregnancy.

Fetuses affected by pre-eclampsia have a higher chance of later pregnancy complications including growth restriction, prematurity, and stillbirth.

The onset of pre-eclampsia is thought to be caused by several complex interactions between genetics and environmental factors.

Our current understanding of the specifically heritable cause involves an imbalance of angiogenic factors in the placenta.

Angiogenesis involves the growth of new blood vessels from existing vessels, and an imbalance during pregnancy can affect the vascularization, growth, and biological function of the fetus.

The irregular expression of these factors is thought to be controlled by multiple loci on different chromosomes. Research on the topic has been limited because of the heterogeneous nature of the disease.

Maternal, paternal, and fetal genotypes all play a role as well as complex epigenetic factors such as whether the parents smoke, maternal age, sexual cohabitation, and obesity.

Currently, there is very little understanding behind the mechanisms of these interactions. Due to the polygenic nature of pre-eclampsia, a majority of the studies that have been conducted thus far on the topic have utilized genome-wide association studies.

One known effector of pre-eclampsia is the fetal loci FLT1. Located on chromosome 13 in the q12 region, FLT1 codes for Fms-like tyrosine kinase 1, an angiogenic factor expressed in fetal trophoblasts.

Angiogenic factors are crucial for vascular growth in the placenta. An FLT1 soluble isoform caused by a splice variant is sFLT1, which works as an antiangiogenic factor, reducing vascular growth in the placenta.

A healthy, normotensive pregnancy is characterized by a balance between these factors. However, upregulation of this variant and overexpression of sFL1 can contribute to endothelial dysfunction.

Reduced vascular growth and endothelial dysfunction manifest primarily in maternal symptoms such as renal failure, edema, and seizures.

However, these factors can also lead to inadequate oxygen, nutrient, or blood supply to the fetus. Furthermore, in this loci region, several single-nucleotide polymorphisms (SNPs) have been observed to impact the overexpression of sFL1.

Specifically, SNPs rs12050029 and rs4769613's risk alleles are linked with low red blood cell counts and carry an increased risk of late-onset pre-eclampsia.

Patau syndrome, or Trisomy 13, is also associated with the upregulation of sFLT1 due to the extra copy of the 13th chromosome.

Because of this upregulation of an antiangiogenic factor, women with trisomy 13 pregnancies often experience reduced placental vascularization and are at higher risk for developing pre-eclampsia.

Beyond fetal loci, there have been some maternal loci identified as effectors of pre-eclampsia. Alpha-ketoglutarate-dependent hydroxylase expression on chromosome 16 in the q12 region is also associated with pre-eclampsia.

Specifically, allele rs1421085 heightens the risk of not just pre-eclampsia but also an increase in BMI and hypertension. This pleiotropy is one of the reasons why these traits are considered to be a risk factor.

Furthermore, ZNF831 (zinc finger protein 831) and its loci on chromosome 20q13 were identified as another significant factor in pre-eclampsia.

The risk allele rs259983 is also associated with both pre-eclampsia and hypertension, further evidence that the two traits are possibly linked.

While the current understanding suggests that maternal alleles are the main hereditary cause of pre-eclampsia, paternal loci have also been implicated.

In one study, paternal DLX5 (Distal-Less Homeobox 5) was identified as an imprinted gene. Located on chromosome 7 in the q21 region, DLX5 serves as a transcription factor often linked with the developmental growth of organs.

When paternally inherited, DLX5 and its SNP rs73708843 are shown to play a role in trophoblast proliferation, affecting vascular growth and nutrient delivery.

Besides specific loci, several important genetic regulatory factors contribute to the development of pre-eclampsia.

Micro RNAs, or miRNAs, are noncoding mRNAs that down-regulate posttranscriptional gene expression through RNA-induced silencing complexes.

In the placenta, miRNAs are crucial for regulating cell growth, angiogenesis, cell proliferation, and metabolism.

These placental-specific miRNAs are clustered in large groups, mainly on chromosomes 14 and 19, and irregular expression of either is associated with an increased risk of an affected pregnancy.

For instance, miR-16 and miR-29 are vascular endothelial growth factors (VEGFs) and play a role in upregulating sFLT-1.

In particular, the overexpression of miRNA miR-210 has been shown to induce hypoxia, which affects spiral artery remodeling, an important part of the pathogenesis of pre-eclampsia.

Known risk factors for pre-eclampsia include:

Having never previously given birth

Diabetes mellitus

Endometriosis

Obesity

Advanced maternal age (>35 years)

Kidney disease

Untreated hypertension

Prior history of pre-eclampsia

Family history of pre-eclampsia

Antiphospholipid antibody syndrome

Multiple gestation

Having donated a kidney

Having sub-clinical hypothyroidism or thyroid antibodies

Placental abnormalities such as placental ischemia

Socioeconomics play a large role in the prevalence of these risk factors, and, like other processes, each risk factor plays a role in the likelihood of increased consequences (morbidity) to, and the complexity of care for, the hospitalized patient

Although much research into mechanism of pre-eclampsia has taken place, its exact pathogenesis remains uncertain.

Pre-eclampsia is thought to result from an abnormal placenta, the removal of which ends the disease in most cases.

During normal pregnancy, the placenta vascularizes to allow for the exchange of water, gases, and solutes, including nutrients and wastes, between maternal and fetal circulations. Abnormal development of the placenta leads to poor placental perfusion.

The placenta of women with pre-eclampsia is abnormal and characterized by poor trophoblastic invasion. It is thought that this results in oxidative stress, hypoxia, and the release of factors that promote endothelial dysfunction, inflammation, and other possible reactions.

In normal early embryonic development, the outer epithelial layer contains cytotrophoblast cells, a stem cell type found in the trophoblast that later differentiates into the fetal placenta. These cells differentiate into many placental cells types, including extravillous trophoblast cells.

Extravillous trophoblast cells are an invasive cell type which remodel the maternal spiral arteries by replacing the maternal epithelium and smooth muscle lining the spiral arteries, thus causing and maintaining spiral artery dilation.

This prevents maternal vasoconstriction in the spiral arteries and allows for continued blood and nutrient supply to the growing fetus with low resistance and high blood flow.

The clinical manifestations of pre-eclampsia are associated with general endothelial dysfunction, including vasoconstriction and end-organ ischemia.

Implicit in this generalized endothelial dysfunction may be an imbalance of angiogenic and anti-angiogenic factors. Both circulating and placental levels of soluble fms-like tyrosine kinase-1 (sFlt-1) are higher in women with pre-eclampsia than in women with normal pregnancy.

sFlt-1 is an anti-angiogenic protein that antagonizes vascular endothelial growth factor (VEGF) and placental growth factor (PIGF), both of which are proangiogenic factors.

Soluble endoglin (sEng) has also been shown to be elevated in women with pre-eclampsia and has anti-angiogenic properties, much like sFlt-1 does.

Both sFlt-1 and sEng are upregulated in all pregnant women to some extent, supporting the idea that hypertensive disease in pregnancy is a normal pregnancy adaptation gone awry.

As natural killer cells are intimately involved in placentation and placentation involves a degree of maternal immune tolerance for a foreign placenta, it is not surprising that the maternal immune system might respond more negatively to the arrival of some placentae under certain circumstances, such as a placenta which is more invasive than normal.

Initial maternal rejection of the placental cytotrophoblasts may be the cause of the inadequately remodeled spiral arteries in those cases of pre-eclampsia associated with shallow implantation, leading to downstream hypoxia and the appearance of maternal symptoms in response to upregulated sFlt-1 and sEng.

Oxidative stress may also play an important part in the pathogenesis of pre-eclampsia. The main source of reactive oxygen species (ROS) is the enzyme xanthine oxidase (XO) and this enzyme mainly occurs in the liver. One hypothesis is that the increased purine catabolism from placental hypoxia results in increased ROS production in the maternal liver and release into the maternal circulation that causes endothelial cell damage.

Abnormalities in the maternal immune system and insufficiency of gestational immune tolerance seem to play major roles in pre-eclampsia.

One of the main differences found in pre-eclampsia is a shift toward Th1 responses and the production of IFN-γ. The origin of IFN-γ is not clearly identified and could be the natural killer cells of the uterus, the placental dendritic cells modulating responses of T helper cells, alterations in synthesis of or response to regulatory molecules, or changes in the function of regulatory T cells in pregnancy.

Aberrant immune responses promoting pre-eclampsia may also be due to an altered fetal allorecognition or to inflammatory triggers.

It has been documented that fetal cells such as fetal erythroblasts as well as cell-free fetal DNA are increased in the maternal circulation in women who develop pre-eclampsia.

These findings have given rise to the hypothesis that pre-eclampsia is a disease process by which a placental lesion such as hypoxia allows increased fetal material into the maternal circulation, that in turn leads to an immune response and endothelial damage, and that ultimately results in pre-eclampsia and eclampsia.

One hypothesis for vulnerability to pre-eclampsia is the maternal-fetal conflict between the maternal organism and fetus.

After the first trimester trophoblasts enter the spiral arteries of the mother to alter the spiral arteries and thereby gain more access to maternal nutrients.

Occasionally there is impaired trophoblast invasion that results in inadequate alterations to the uterine spiral arteries. It is hypothesized that the developing embryo releases biochemical signals that result in the woman developing hypertension and pre-eclampsia so that the fetus can benefit from a greater amount of maternal circulation of nutrients due to increased blood flow to the impaired placenta.

This results in a conflict between maternal and fetal fitness and survival because the fetus is invested in only its survival and fitness while the mother is invested in this and subsequent pregnancies.

In pre-eclampsia, abnormal expression of chromosome 19 microRNA cluster (C19MC) in placental cell lines reduces extravillus trophoblast migration.

Specific microRNAs in this cluster which might cause abnormal spiral artery invasion include miR-520h, miR-520b, and 520c-3p.

This impairs extravillus trophoblast cells invasion to the maternal spiral arteries, causing high resistance and low blood flow and low nutrient supply to the fetus. There is tentative evidence that vitamin supplementation can decrease the risk.

Immune factors may also play a role

Testing for pre-eclampsia is recommended throughout pregnancy via measuring a woman's blood pressure.

Pre-eclampsia is diagnosed when a pregnant woman develops:

Blood pressure ≥140 mmHg systolic or ≥90 mmHg diastolic on two separate readings taken at least four to six hours apart after 20 weeks' gestation in an individual with previously normal blood pressure.

In a woman with essential hypertension beginning before 20 weeks' gestational age, the diagnostic criteria are an increase in systolic blood pressure (SBP) of ≥30 mmHg or an increase in diastolic blood pressure (DBP) of ≥15 mmHg.

Proteinuria ≥ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio ≥0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available).

Suspicion for pre-eclampsia should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten percent of individuals with other signs and symptoms of pre-eclampsia and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of pre-eclampsia:

Evidence of kidney dysfunction (oliguria, elevated creatinine levels)

Impaired liver function (noted by liver function tests)

Thrombocytopenia (platelet count <100,000/microliter)

Pulmonary edema

Ankle edema (pitting type)

Cerebral or visual disturbances

Pre-eclampsia is a progressive disorder and these signs of organ dysfunction are indicative of severe pre-eclampsia. A systolic blood pressure ≥160 or diastolic blood pressure ≥110 and/or proteinuria >5g in a 24-hour period is also indicative of severe pre-eclampsia. Clinically, individuals with severe pre-eclampsia may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe pre-eclampsia is a significant risk factor for intrauterine fetal death.

A rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is important to note but is not considered diagnostic.

There have been many assessments of tests aimed at predicting pre-eclampsia, though no single biomarker is likely to be sufficiently predictive of the disorder. Predictive tests that have been assessed include those related to placental perfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress. Examples of notable tests include:

Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion. This test has a high negative predictive value among those individuals with a history of prior pre-eclampsia.

Elevations in serum uric acid (hyperuricemia) is used by some to "define" pre-eclampsia, though it has been found to be a poor predictor of the disorder. Elevated levels in the blood (hyperuricemia) are likely due to reduced uric acid clearance secondary to impaired kidney function.

Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) have shown promise for potential clinical use in diagnosing pre-eclampsia, though evidence is insufficient to recommend a clinical use for these markers.

A recent study, ASPRE, known to be the largest multi-country prospective trial, has reported a significant performance in identifying pregnant women at high risk of pre-eclampsia yet during the first trimester of pregnancy. Utilizing a combination of maternal history, mean arterial blood pressure, intrauterine Doppler and PlGF measurement, the study has shown a capacity to identify more than 75% of the women that will develop pre-eclampsia, allowing early intervention to prevent development of later symptoms. This approach is now officially recommended by the International Federation of Gynecologists & Obstetricians (FIGO), However this model particularly predict pre-eclampsia with onset before 34 weeks' of gestation, while prediction of pre-eclampsia with later onset remains challenging.

Recent studies have shown that looking for podocytes (specialized cells of the kidney) in the urine has the potential to aid in the prediction of pre-eclampsia. Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for pre-eclampsia.

Pre-eclampsia can mimic and be confused with many other diseases, including chronic hypertension, chronic renal disease, primary seizure disorders, gallbladder and pancreatic disease, immune or thrombotic thrombocytopenic purpura, antiphospholipid syndrome and hemolytic-uremic syndrome.

It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation.

It is particularly difficult to diagnose when pre-existing conditions such as hypertension are present.

Women with acute fatty liver of pregnancy may also present with elevated blood pressure and protein in the urine, but differ by the extent of liver damage.

Other disorders that can cause high blood pressure include thyrotoxicosis, pheochromocytoma, and drug misuse.

Preventive measures against pre-eclampsia have been heavily studied. Because the pathogenesis of pre-eclampsia is not completely understood, prevention remains a complex issue. Some currently accepted recommendations are:

Supplementation with a balanced protein and energy diet does not appear to reduce the risk of pre-eclampsia. Further, there is no evidence that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C, D and E has no effect on pre-eclampsia incidence; therefore, supplementation with vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia.

Calcium supplementation of at least 1 gram per day is recommended during pregnancy as it prevents pre-eclampsia where dietary calcium intake is low, especially for those at high risk. Higher selenium level is associated with lower incidence of pre-eclampsia. Higher cadmium level is associated with higher incidence of pre-eclampsia.

Taking aspirin is associated with a 1 to 5% reduction in pre-eclampsia and a 1 to 5% reduction in premature births in women at high risk. The World Health Organization recommends low-dose aspirin for the prevention of pre-eclampsia in women at high risk and recommends it be started before 20 weeks of pregnancy. The United States Preventive Services Task Force recommends a low-dose regimen for women at high risk beginning in the 12th week. Benefits are less if started after 16 weeks. Since 2018 the American College of Obstetricians and Gynecologists has recommended low-dose aspirin therapy as standard preventive treatment for pre-eclampsia. There is a reported problem of its efficacy when combined with paracetamol. Supplementation of aspirin with L-Arginine has shown favourable results.

The study ASPRE, besides its efficacy in identifying women suspected to develop pre-eclampsia, has also been able to demonstrate a strong drop in the rate of early pre-eclampsia (-82%) and preterm pre-eclampsia (-62%). The efficacy of aspirin is due to screening to identify high risk women, adjusted prophylaxis dosage (150 mg/day), timing of the intake (bedtime) and must start before week 16 of pregnancy.

There is insufficient evidence to recommend either exercise or strict bedrest as preventive measures of pre-eclampsia.

In low-risk pregnancies, the association between cigarette smoking and a reduced risk of pre-eclampsia has been consistent and reproducible across epidemiologic studies.

High-risk pregnancies (those with pregestational diabetes, chronic hypertension, history of pre-eclampsia in a previous pregnancy, or multifetal gestation) showed no significant protective effect.

The reason for this discrepancy is not definitively known; research supports speculation that the underlying pathology increases the risk of pre-eclampsia to such a degree that any measurable reduction of risk due to smoking is masked.

However, the damaging effects of smoking on overall health and pregnancy outcomes outweighs the benefits in decreasing the incidence of pre-eclampsia. It is recommended that smoking be stopped prior to, during and after pregnancy

Some studies have suggested the importance of a woman's gestational immunological tolerance to her baby's father, as the baby and father share genetics. However, more recent studies have found no evidence that this is a risk factor for pre-eclampsia or other adverse pregnancy outcomes.

Several other studies have since investigated the decreased incidence of pre-eclampsia in women who had received blood transfusions from their partner, those with long preceding histories of sex without barrier contraceptives, and in women who had been regularly performing oral sex.

Having already noted the importance of a woman's immunological tolerance to her baby's paternal genes, several Dutch reproductive biologists decided to take their research a step further. Consistent with the fact that human immune systems tolerate things better when they enter the body via the mouth, the Dutch researchers conducted a series of studies that confirmed a surprisingly strong correlation between a diminished incidence of pre-eclampsia and a woman's practice of oral sex, and noted that the protective effects were strongest if she swallowed her partner's semen. A team from the University of Adelaide has also investigated to see if men who have fathered pregnancies which have ended in miscarriage or pre-eclampsia had low seminal levels of critical immune modulating factors such as TGF-beta. The team has found that certain men, dubbed "dangerous males", are several times more likely to father pregnancies that would end in either pre-eclampsia or miscarriage. Among other things, most of the "dangerous males" seemed to lack sufficient levels of the seminal immune factors necessary to induce immunological tolerance in their partners.

As the theory of immune intolerance as a cause of pre-eclampsia has gained prominence, women with repeated pre-eclampsia, miscarriages, or in vitro fertilization failures could potentially be administered key immune factors such as TGF-beta along with the father's foreign proteins, possibly either orally, as a sublingual spray, or as a vaginal gel to be applied onto the vaginal wall before intercourse.

More recent studies, though, have called these concepts into question. The human body contains a placental barrier to prevent the immune cells of the mother from destroying the cells of the placenta, and no definitive link has been found between partner selection and adverse pregnancy outcomes, despite many attempts by researchers.

The definitive treatment for pre-eclampsia is the delivery of the baby and placenta, but danger to the mother persists after delivery, and full recovery can take days or weeks. The timing of delivery should balance the desire for optimal outcomes for the baby while reducing risks for the mother. The severity of disease and the maturity of the baby are primary considerations. These considerations are situation specific, and management will vary with situation, location, and institution. Treatment can range from expectant management to expedited delivery by induction of labor or caesarean section. In the case of preterm delivery additional treatments including corticosteroid injection to accelerate fetal pulmonary maturation and magnesium sulfate for prevention of cerebral palsy should be considered. Important in management is the assessment of the mother's organ systems, management of severe hypertension, and prevention and treatment of eclamptic seizures. Separate interventions directed at the baby may also be necessary. Bed rest has not been found to be useful and is thus not routinely recommended.

The World Health Organization recommends that women with severe hypertension during pregnancy should receive treatment with anti-hypertensive agents. Severe hypertension is generally considered systolic BP of at least 160 or diastolic BP of at least 110. Evidence does not support the use of one anti-hypertensive over another. The choice of which agent to use should be based on the prescribing clinician's experience with a particular agent, its cost, and its availability. Diuretics are not recommended for prevention of pre-eclampsia and its complications. Labetalol, hydralazine and nifedipine are commonly used antihypertensive agents for hypertension in pregnancy. ACE inhibitors and angiotensin receptor blockers are contraindicated as they affect fetal development.

The goal of treatment of severe hypertension in pregnancy is to prevent cardiovascular, kidney, and cerebrovascular complications. The target blood pressure has been proposed to be 140–160 mmHg systolic and 90–105 mmHg diastolic, although values are variable.

The intrapartum and postpartum administration of magnesium sulfate is recommended in severe pre-eclampsia for the prevention of eclampsia. Further, magnesium sulfate is recommended for the treatment of eclampsia over other anticonvulsants. Magnesium sulfate acts by interacting with NMDA receptors.

Pre-eclampsia affects approximately 2–8% of all pregnancies worldwide. The incidence of pre-eclampsia has risen in the U.S. since the 1990s, possibly as a result of increased prevalence of predisposing disorders, such as chronic hypertension, diabetes, and obesity.

Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Nearly one-tenth of all maternal deaths in Africa and Asia and one-quarter in Latin America are associated with hypertensive diseases in pregnancy, a category that encompasses pre-eclampsia.

Pre-eclampsia is much more common in women who are pregnant for the first time. Women who have previously been diagnosed with pre-eclampsia are also more likely to experience pre-eclampsia in subsequent pregnancies. Pre-eclampsia is also more common in women who have pre-existing hypertension, obesity, diabetes, autoimmune diseases such as lupus, various inherited thrombophilias such as Factor V Leiden, renal disease, multiple gestation (twins or multiple birth), and advanced maternal age. Women who live at high altitude are also more likely to experience pre-eclampsia. Pre-eclampsia is also more common in some ethnic groups (e.g. African-Americans, Sub-Saharan Africans, Latin Americans, African Caribbeans, and Filipinos).

Eclampsia is a major complication of pre-eclampsia. Eclampsia affects 0.56 per 1,000 pregnant women in developed countries and almost 10 to 30 times as many women in low-income countries as in developed countries.

Complications of pre-eclampsia can affect both the mother and the fetus. Acutely, pre-eclampsia can be complicated by eclampsia, the development of HELLP syndrome, hemorrhagic or ischemic stroke, liver damage and dysfunction, acute kidney injury, and acute respiratory distress syndrome (ARDS).

Pre-eclampsia is also associated with increased frequency of caesarean section, preterm delivery, and placental abruption. Furthermore, an elevation in blood pressure can occur in some individuals in the first week postpartum attributable to volume expansion and fluid mobilization. Fetal complications include fetal growth restriction and potential fetal or perinatal death.

Long-term, an individual with pre-eclampsia is at increased risk for recurrence of pre-eclampsia in subsequent pregnancies.

Eclampsia is the development of new convulsions in a pre-eclamptic patient that may not be attributed to other causes. It is a sign that the underlying pre-eclamptic condition is severe and is associated with high rates of perinatal and maternal morbidity and mortality. Warning symptoms for eclampsia in an individual with current pre-eclampsia may include headaches, visual disturbances, and right upper quadrant or epigastric abdominal pain, with a headache being the most consistent symptom. During pregnancy brisk or hyperactive reflexes are common, however, ankle clonus is a sign of neuromuscular irritability that usually reflects severe pre-eclampsia and also can precede eclampsia. Magnesium sulfate is used to prevent convulsions in cases of severe pre-eclampsia.

HELLP syndrome is defined as hemolysis (microangiopathic), elevated liver enzymes (liver dysfunction), and low platelets (thrombocytopenia). This condition may occur in 10–20% of patients with severe pre-eclampsia and eclampsia and is associated with increased maternal and fetal morbidity and mortality. In 50% of instances, HELLP syndrome develops preterm, while 20% of cases develop in late gestation and 30% during the post-partum period.

Preeclampsia predisposes for future cardiovascular disease and a history of preeclampsia/eclampsia doubles the risk for cardiovascular mortality later in life. Other risks include stroke, chronic hypertension, kidney disease and venous thromboembolism. Preeclampsia and cardiovascular disease share many risk factors such as age, elevated BMI, family history and certain chronic diseases.

It seems that pre-eclampsia does not increase the risk of cancer.

Lowered blood supply to the fetus in pre-eclampsia causes lowered nutrient supply, which could result in intrauterine growth restriction (IUGR) and low birth weight. The fetal origins hypothesis states that fetal undernutrition is linked with coronary heart disease later in adult life due to disproportionate growth.

Because pre-eclampsia leads to a mismatch between the maternal energy supply and fetal energy demands, pre-eclampsia can lead to IUGR in the developing fetus. Infants with IUGR are prone to have poor neuronal development and in increased risk for adult disease according to the Barker hypothesis. Associated adult diseases of the fetus due to IUGR include, but are not limited to, coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), cancer, osteoporosis, and various psychiatric illnesses.

The risk of pre-eclampsia and development of placental dysfunction has also been shown to be recurrent cross-generationally on the maternal side and most likely on the paternal side. Fetuses born to mothers who were born small for gestational age (SGA) were 50% more likely to develop pre-eclampsia while fetuses born to both SGA parents were three-fold more likely to develop pre-eclampsia in future pregnancies.

Preeclampsia can also occur in the postpartum period or after delivery. There are currently no clear definitions or guidelines for postpartum preeclampsia, but experts have proposed a definition of new-onset preeclampsia that occurs between 48 hours after delivery up to 6 weeks after delivery.

The diagnostic criteria otherwise are essentially the same as for preeclampsia diagnosed during pregnancy. Similarly, many of the risk factors are the same, except that not having been pregnant previously does not seem to be a risk factor for postpartum preeclampsia. There are other risk factors related to the labor and/or delivery that are associated with postpartum preeclampsia like cesarean delivery and higher rates of intravenous fluids.

The American College of Obstetricians and Gynecologists recommends blood pressure evaluation for patients who have any hypertensive disorder of pregnancy within 7–10 days after delivery. Home blood pressure monitoring may increase the likelihood of measuring blood pressure during these recommended time periods.

In general, the treatment of postpartum preeclampsia is the same as during pregnancy, including using anti-hypertensive medications to lower blood pressure and magnesium sulfate to prevent eclampsia. The same blood pressure medications that are used during pregnancy can be used in the postpartum period. There may be other medications that can be used, when there is no longer concern for the developing fetus. In general, ACE inhibitors, beta-blockers, and calcium channel blockers all appear to be safe in lactating patients. There is no data showing that any one medication is most effective for postpartum blood pressure management. In addition, there is evidence that the use of a diuretic, furosemide, may shorten the duration of hypertension in patients with postpartum preeclampsia.

[sarveshhealthcityy]

Navigating High-Risk Pregnancies: Support and Care in Hisar

Introduction

Pregnancy is a beautiful journey, but for some women, it can be classified as a high-risk pregnancy, requiring specialized care and monitoring. If you are expecting a baby and have been told that your pregnancy is high-risk, it is essential to understand what this means and how you can ensure the best possible outcome for you and your baby.

For expectant mothers in Hisar, accessing the best gynaecologist and obstetrician is crucial in managing a high-risk pregnancy. This article will guide you through everything you need to know about high-risk pregnancies, from causes and complications to the best care options available in Hisar.

What is a High-Risk Pregnancy?

A high-risk pregnancy is one where the mother or baby faces an increased chance of complications. These complications may arise due to existing health conditions, pregnancy-related issues, or lifestyle factors. High-risk pregnancies require more frequent check-ups and, in some cases, specialized treatments to ensure the well-being of both the mother and the child.

Common Causes of High-Risk Pregnancies

Several factors contribute to a pregnancy being categorized as high-risk. Some of the most common causes include:

1. Maternal Age

Women under 18 or over 35 are more likely to experience pregnancy complications.

Advanced maternal age increases the risk of conditions like gestational diabetes, preeclampsia, and chromosomal abnormalities.

2. Pre-Existing Medical Conditions

Diabetes: Can lead to complications such as macrosomia (large baby) and preterm birth.

Hypertension: High blood pressure can result in preeclampsia, premature birth, or placental abruption.

Heart Disease: May limit the oxygen supply to the baby.

Autoimmune Disorders: Conditions like lupus can increase the risk of miscarriage or stillbirth.

3. Pregnancy-Related Conditions

Gestational Diabetes: Increases the risk of birth complications and the need for a C-section.

Preeclampsia: A serious condition causing high blood pressure and organ damage.

Multiple Pregnancies: Twins or more can result in premature birth and developmental concerns.

Placenta Previa: A condition where the placenta covers the cervix, leading to bleeding risks.

4. Lifestyle and Environmental Factors

Smoking and Alcohol Consumption: Increase the risk of birth defects and premature labor.

Obesity: Higher risk of gestational diabetes and labor complications.

Infections: Such as Zika virus, rubella, or HIV can affect the baby’s development.

Symptoms and Warning Signs of a High-Risk Pregnancy

If you are experiencing any of the following symptoms, seek immediate medical attention:

Severe abdominal pain or cramps

Persistent headaches

Vision changes (blurry or loss of vision)

Decreased fetal movement

Severe swelling in hands, face, or legs

Vaginal bleeding or fluid leakage

How to Manage a High-Risk Pregnancy

The key to successfully managing a high-risk pregnancy is early detection and continuous care. Here are the essential steps:

1. Find the Best Gynaecologist and Obstetrician in Hisar

Choosing an experienced doctor is crucial. A skilled gynaecologist and obstetrician in Hisar will guide you through prenatal care, necessary tests, and emergency interventions.

2. Regular Prenatal Check-Ups

Frequent visits help in early detection of potential issues and ensure timely medical interventions.

3. Maintain a Healthy Diet

Eat a balanced diet rich in proteins, vitamins, and minerals.

Stay hydrated and limit caffeine intake.

Avoid raw or undercooked foods to reduce the risk of infections.

4. Follow a Safe Exercise Routine

Engage in moderate exercises like prenatal yoga or walking.

Avoid strenuous workouts and heavy lifting.

Consult your doctor before starting any fitness regimen.

5. Manage Stress and Get Adequate Rest

Practice relaxation techniques like meditation and deep breathing.

Ensure 7-9 hours of sleep per night.

6. Take Prescribed Medications and Supplements

Folic acid, iron, and calcium supplements are essential.

Follow all medications prescribed by your doctor without self-medicating.

Advanced Medical Care for High-Risk Pregnancies in Hisar

Hisar is home to highly qualified gynaecologists and obstetricians who specialize in high-risk pregnancies. Some of the best medical facilities in the city offer:

24/7 emergency obstetric care

State-of-the-art neonatal intensive care units (NICU)

Advanced fetal monitoring and diagnostic tools

Multidisciplinary teams including dietitians, endocrinologists, and cardiologists

Choosing the Best Gynaecologist in Hisar for High-Risk Pregnancies

When selecting a gynaecologist in Hisar, consider the following factors:

Experience in high-risk pregnancies

Availability for emergency consultations

Hospital affiliation and facilities

Patient reviews and recommendations

Some of the reputed hospitals and clinics in Hisar provide world-class maternity care, ensuring that high-risk pregnancies are managed with precision and expertise.

Conclusion

A high-risk pregnancy can be a challenging experience, but with the right medical support and lifestyle choices, a healthy pregnancy and safe delivery are possible. If you are in Hisar, ensure you consult the best gynaecologist and obstetrician to receive personalized care, advanced monitoring, and expert medical guidance. Prioritizing your health and following professional recommendations will significantly improve the chances of a smooth pregnancy and a healthy baby.

If you or a loved one is facing a high-risk pregnancy, don’t hesitate to seek professional help from leading maternity specialists in Hisar. Your health and your baby’s well-being deserve the best care available!

[nrkss]

Why You Need a Feto Expert in Siliguri for Advanced Prenatal Care?

Pregnancy is a beautiful journey and is filled with challenges that a mother needs to overcome. To ensure the best health during this period along with the health of your unborn child, you need to give extra care and attention. A lot of things will change like your diet, shifts in emotional and physical aspects, the addition of a whole lot of medication and supplements and so much more needs to be taken care of. The path is not easy however medical care and advice will help immensely in navigating the difficult path.

Feto experts are highly skilled specialists who help in providing the diagnosis of the complications of the child in the womb while providing the right treatment for them. They are trained experts who are trained to give the best treatment option based on your condition. They work closely with other medical experts after the birth of the child in case any complications arise.

Whether you are in low-risk pregnancy or high-risk pregnancy, you should consult a feto expert in Siliguri. Pregnancy needs special care and with expert presence, it reduces the risk of complications and ensures a healthy successful pregnancy. Let's discuss why you need a feto to exert for advanced prenatal care.

Early Detection of Fetal Abnormalities

Feto experts use advanced medical technology to detect potential birth defects, genetic disorders, and other abnormalities early in the pregnancy journey. This helps in planning the child's condition much better and timely intervening in situations that need to be solved for effective treatment. Without a feto expert, the parent doesn't realize the unborn child's condition and without treatment at the right time, it gets worse after birth.

Management of High-Risk Pregnancies

High-risk pregnancies are very dangerous and the mother's condition along with the child must be put in monitoring to avoid and treat any potential complications. Situations such as pregnancy after 35, health conditions, miscarriage history, genetic disorders in the family, and several other conditions can influence the high risk of pregnancies. Such situations need special attention from a feto expert as they are trained in managing high-risk pregnancies.

Counseling and Support

Feto experts utilize their expertise in treating unborn child conditions by giving a detailed explanation of the test result and letting you understand its implication on your pregnancy. You can consult a feto expert, the best high-risk pregnancy doctor in Siliguri, to get to understand the condition of the baby in your womb in detail. Other than counselling they make sure to give you emotional support and guidance through the pregnancy. This helps especially during high-risk pregnancy dealing with complex situations.

When You Should Consider a Feto Expert

You might be wondering when you should consider a feto expert. Here are a few conditions, which if you have, you should consider visiting a feto expert.

If you have a family history of genetic disorders, you should consult a feto expert.

In case you are trying to conceive after 35

If you have a history of miscarriage

Multiple pregnancies can increase the complication of complications especially carrying twins and more.

Conclusion

A pregnancy has to overcome several difficulties which might lead to a disruption in their growth. It is essential to consult a Feto expert in Siliguri who helps to monitor the growth of the child and helps in finding any complications that arise during the growth of the child in the womb. Especially during high-risk pregnancy, special attention and monitoring are needed for a successful birth.

[divawomenshospital]

6 Tips to Prevent Having a High-Risk Pregnancy

Most pregnancies (about 92-94%) are normal. But it’s good to learn about common problems during pregnancy. This can help you make good choices for your health and your baby’s health. Every pregnancy is different. Some start with low risk, but problems like gestational diabetes or preeclampsia can happen later. Then, the mom and baby need special care. In other cases, the pregnancy is high-risk from the beginning.

Certain factors leading to a high-risk pregnancy are beyond your control. Carrying more than one baby, such as twins or triplets, often makes a pregnancy high-risk. However, there are steps you can take to improve your chances of having a healthy pregnancy. Learn about six things you can do to avoid a high-risk pregnancy and schedule your initial prenatal appointment now. Elevate your women’s health journey with Diva Women’s Hospital, recognized as the “Best OB/GYN in Ahmedabad.” Schedule your appointment now for unparalleled care and support.

Maintain or achieve a healthy weight before pregnancy

Being overweight or obese during pregnancy raises the chances of facing various issues such as high blood pressure, preeclampsia, gestational diabetes, and stillbirth.

If you’re thinking about getting pregnant, reaching a healthy weight before conception lowers the risk of complications. Adopt a nutritious diet and engage in regular exercise to shed excess weight and sustain a healthy body weight. During pregnancy, adhere to your doctor’s recommendations for weight gain to promote healthy labor and delivery.

Manage pre-existing health conditions

If you have health issues that aren’t under control, it can make your pregnancy riskier. Some common conditions that might affect your pregnancy are:

High blood pressure

Heart disease

Diabetes

Sexually transmitted diseases (STDs) and HIV

Autoimmune diseases like lupus or multiple sclerosis

Pregnancy can be tough on your body. Taking care of these health issues with medication and lifestyle changes before getting pregnant helps your body be at its best during pregnancy.

Take prenatal supplements

When you’re pregnant, your body requires additional nutrients to support your growing baby. Taking a prenatal vitamin or supplement can provide essential elements like folic acid, iron, protein, and calcium that may be lacking in your regular diet.

If you’re thinking about getting pregnant, it’s a good idea to start taking a prenatal supplement before you conceive. Additionally, taking prenatal vitamins after your baby is born can be beneficial, especially if you’re breastfeeding. Secure a healthy start for your little one! Schedule your prenatal checkups at Diva Women’s Hospital in Ahmedabad, where expert care meets compassion. Trust us for a journey to motherhood that prioritizes both you and your baby.

Avoid alcohol, tobacco, and drugs

Consuming alcohol, smoking, or using tobacco products, as well as taking drugs during pregnancy, can have a substantial impact on your baby’s health. Drinking alcohol during pregnancy raises the risk of Fetal Alcohol Spectrum Disorder, leading to severe birth defects.

Smoking cigarettes can result in low birth weight for babies. The use of illegal drugs or the misuse of prescription drugs can cause birth defects, and there’s a chance that babies may be born addicted to a drug used during pregnancy. It’s crucial to only take medications prescribed by your doctor during pregnancy.

Know the risks of older maternal age

The likelihood of pregnancy complications rises after the age of 35. Challenges such as difficulty conceiving, miscarriage, and genetic abnormalities in the baby become more prevalent. Fertility begins a gradual decline around age 30, accelerating for women aged 35 and older.

Common complications for mothers in this age group include:

Premature birth

Low birth weight

Gestational diabetes

Preeclampsia

The potential need for a cesarean (c-section) birth

Women in their 20s face the lowest risk of complications during pregnancy. If you’re pregnant or planning to conceive later in life, it’s advisable to discuss your risks with a specialist.

Regular doctor visits during pregnancy

Regular prenatal check-ups are vital to monitor your health and your baby’s growth. At each appointment, vital signs and the baby’s progress are assessed. If issues like gestational diabetes or preeclampsia are found, a treatment plan is developed for a healthy pregnancy and birth. Experience exceptional women’s care at Diva Women’s Hospital, your choice for the “Best OB/GYN in Ahmedabad.” Trust our expert team for personalized and compassionate maternity and gynecological services in Ahmedabad. Call us today: +91 9978872345  for excellence in women’s health.

Read More:- 6 Tips to Prevent Having a High-Risk Pregnancy

[nurvinaari1]

HIGH-RISK PREGNANCY: What to Do and What to Expect? Why to Worry?

High-risk pregnancies sound daunting. It is common in women with a medical history, a chronic illness, substance addiction, and other mental or physical health conditions that put the mother at a higher risk of miscarriage or pre-term labor. So, what exactly is a high-risk pregnancy? Does it mean you are supposed to seek help from the best obstetrician-Gynecologist in Thane West? Does it mean your child is at risk of abnormalities after birth?

Causes of High-risk Pregnancy

Pregnancy is the most beautiful yet unpredictable phase in a woman’s life. But, things get pretty complicated for those diagnosed with a high-risk pregnancy. To protect yourself and the child, you need to be extra careful with your medication, diet, health, and lifestyle. But, what exactly causes high-risk pregnancy, and who is at a higher risk?

Women above 35 years

Alcohol or drug addiction, smoking, and sedentary lifestyle

Chronic diseases, such as diabetes, hypertension, epilepsy, irregular thyroid levels, kidney diseases, heart diseases, asthma, or an existing infection

Complications during pregnancy, such as abnormal placenta position

Women carrying twins

Prior pregnancy complications, such as a history of miscarriage or premature birth

Some women might have a healthy pregnancy in the first trimester but may experience complications later. So, it is important to stay in touch with the gynecologist to monitor your blood sugar level, blood pressure, and thyroid levels. In addition, regular health checkups every few weeks are highly recommended for pregnant women.

How Can You manage High-risk Pregnancy?

High-risk pregnancy doesn’t mean you cannot have a healthy pregnancy or a healthy child. It, generally, implies you need special care and regular health monitoring. Here are a few things to consider to manage high-risk pregnancies.

Plan Your Pregnancy: A planned pregnancy can save you and your child from many pregnancy complications. It isn’t only for women exposed to high-risk pregnancy, but every couple trying to conceive should visit the maternity care in Thane to discuss their health with the gynecologist before getting pregnant. The doctor will recommend health supplements, especially folic acid, so you can gain weight before you get pregnant.

Get Regular Prenatal Care: Prenatal care is important for pregnant women, in general. But, it is a necessity for women with a high-risk pregnancy. Your gynecologist may refer you to a specialist to monitor your and the fetus’s health.

Avoid any Harmful Substance: Alcohol, drugs, and smoking increase your risk of miscarriage and pose a health risk for your child. Your gynecologist will give you a list of the items you need to avoid during and after the pregnancy to keep your baby safe. These mainly include alcohol and drugs. You should also aim to follow a healthy lifestyle with a nutritious and balanced diet.

Are Special Tests Necessary?

The doctor recommends additional tests for women with a high-risk pregnancy. It includes:

Targeted ultrasound

Prenatal screening

An ultrasound for cervical length

Lab tests

Invasive genetic screening

Biophysical profile

Note that certain pregnancy tests, like amniocentesis, should be taken only if prescribed by a gynecologist.

[soundsgoodfeelslikeshit]

Baby Pogue (Part 3)

Part 1: Part 2: Part 4:

Summary: You and JJ had decided to plan a little get together on John B’s dock sometime that week to let the rest of your friends know that you were expecting twins. Pregnancy symptoms started to hit you incredibly hard, and you tried to deal with the judgement of the island as they found out. 

“Hey John B.” You smiled into the phone. 

“Hey, how’d your appointment go?” He questioned, excitedly. 

“Great, we have an ultrasound to give you and the others. We wanted to meet up with everyone some time this week and just hang out.” You said as you looked over to JJ. 

“Yeah, we can do it at The Chateau tonight. You guys are still coming surfing right?” 

“Yeah, wouldn’t miss it. Don’t know if I can really surf, but we’ll see.” You said with a smile before saying your goodbyes. 

“You sure you still wanna go baby? You’ve been getting sick all morning.” JJ asked as he rubbed your back. 

“Yeah, I mean I can’t let it stop me from having a good day with my friends. It sucks, but it’s manageable. Worst case scenario I run to the grass or water and throw up again.” You said, causing JJ to laugh. 

You stood, walking over to your dresser and pulling out your favorite red bathing suit, hope it still fit. Not caring if JJ was watching you, you changed into the swim suit and looked in the mirror. Tears came to your eyes as you noticed the bottoms now fit weirdly due to your growing belly. 

“Hey, why are you crying?” JJ asked carefully as he wrapped his arms around your waist. 

“I- I’m getting fat J. It barely fits.” You whined. 

“Y/N, look at me,” He said turning your body to face his. “ You are not fat, you have two babies growing in there. Your stomach is going to grow and it’s healthy, it’s healthy to gain weight during pregnancy. It means you’re doing it right. Don’t stress baby, it’s not good for you or the babies. Plus you still look smoking hot, my beautiful, beautiful girl.” 

You laughed at his statement and placed a kiss to his lips. 

“Should I change my bottoms? I’m sure I have a bigger pair somewhere?” You questioned, feeling overwhelmed with emotions. 

“No, baby they look just fine on you. Let’s go pack some snacks and some drinks and get going. You look amazing.” 

You nodded your head, allowed him to wipe your tears, and then lead you down to the kitchen. Your mom and dad greeted you with a smile. 

“Why do you look so sad, sweetie?” Your dad questioned. 

“I just feel fat.” You sighed, feeling silly. 

“Your mother was the same way. You aren’t fat though and it’s completely healthy and natural to gain weight, especially with twins.” He said, giving you a hug. 

“That’s what J was saying.” You said with a sigh. 

Your mother handed you a bowl of fruit to eat, as you took your prenatal vitamins and iron supplements you needed since your iron levels had come back low on the blood work. You ate your fruit and watched as your mom threw a couple snacks and drinks into the cooler for the day. Once you ate and JJ finished eating you gave your parents a kiss on their cheeks and left. 

Despite the spot you surf at being a short walk from your house, you and JJ decided to drive there instead. He thought it would “keep you safer” so you went with it. Once you got there you saw you were the last ones to arrive. You let out a sigh and grabbed the cooler, as JJ grabbed your boards. 

“Hey, Y/N/N.” Kie greeted you with a smile. 

“Hey Kie.” You greeted as you set the cooler down. 

“You’re literally glowing this morning.” Sarah said. 

“I’m not feeling like I am, but thank you.” You smiled and reached to give her a hug. 

“Why what’s up?” Pope asked. 

“Pregnancy is just hitting me hard I guess.” You sighed. 

“Well you don’t look like it is. You’re doing amazing, Y/N/N.” John B said. 

You smiled gratefully at your friends, and then sat down into the sand.

Sarah and Kie sat down next to you, not wanting to leave you alone one the day you wanted to spend together.

“So how have you been feeling?” Kie asked.

“Mentally I’m pretty okay. I’m feeling good now, but this morning I had a breakdown about the way my body looks and is changing. Physically I’m getting sick every morning, sometimes different foods or smells will cause it. It’s a struggle but I wouldn’t change it. I don’t know if that makes sense.” You said with a laugh.

“It made perfect sense. I’ve heard that everyone is effected differently by pregnancy hormones. But we are here for you if you need it. I’ve been reading some things to help better understand to help.” Kie said pausing with a laugh. “But we are here to help.” She said finishing.

Sarah nodded rubbing her hand up your back.

“Plus it’s especially important to feel good now, and to get help when you need it.” She added.

You nodded your head in agreement.

“I’m excited to show you guys the ultrasound later, it makes it all feel so real.” You smiled.

“We can’t wait to see it. Also we want to plan a gender reveal party for you and a baby shower, nothing too big or extravagant. Just a close friends thing and maybe do like a cake reveal or something. Totally environmentally friendly per Kie’s wishes for you.” Sarah said.

“Yes environmentally friendly is a must. I’m down, but I’ll have to talk to JJ about it. He can be weird sometimes, especially because I’m ‘carrying special cargo’. But I’m sure he’ll be down.” You said laughing for mocking JJ. 

They smiled and laughed at you. 

“How is JJ taking everything?” Sarah asked curiously.

“Definitely overprotective. Way too worrisome, but if it makes him happy I’ll be happy. I’m glad he’s so cautious but I don’t want him to only worry about me. Makes me feel guilty.” You sighed picking at your nails.

“Don’t feel guilty. He loves you and wants the best for your child and you.” Kie said with a smile.

You nodded and gave a smile back, watching as the guys began to make their way back to you. JJ sat beside you and wrapped an arm around your waist.

“J, you’re wet.” You laughed.

“So, wanted to give you a hug.” He said smirking.

“You girls gonna swim?” John B questioned.

“Yeah, wanted to let you guys get to surf for a while.” Sarah said.

“Y/N/N can you swim?” Pope asked.

“Yeah, as long as I don’t get fucked up by the waves I’ll be alright.” You smiled. 

You sat and let the guys relax for a second before you all got up and walked towards the water. You didn’t want your pregnancy to stop you from doing normal everyday things, but you also wanted to be very cautious. You swam around in the water ducking under waves, enjoying the company of your friends. You were honestly quite worried about how having two children would impact seeing your friends. You definitely wouldn’t be drinking or smoking like you had before you got pregnant, and you hoped JJ would cut back too but you wouldn’t force him to. 

“What’s going on in that head of yours, pretty girl?” JJ asked, wrapping his arms around your waist. 

“Not much, just thinking about us.” You said with a smile. 

JJ smiled back and gave you a peck on the lips. 

“I think John B wanted to go out on the marsh. Is that something you want to do?” He questioned. 

You nodded your head and laughed as JJ screamed to your friends you were down. After that you all walked back up towards your stuff and began to get ready to head to John B’s dock.

................................................................................................

After spending the whole day on the marsh you were exhausted. You body was sore and your feet swollen. You had been “resting your eyes” against Pope’s shoulder as JJ drove the boat back to the dock.

“Wake up, Y/N/N,” you heard Pope say as he shook your shoulder.

You opened your eyes and looked to see the sun was beginning to set and you were back at the Chateau. You groaned and pulled away from Pope, mumbling an apology.

He helped you stand up and get off the boat. You groaned and mumbled a thank you as you stepped off the boat and onto the dock.

“Hey, baby you okay?” JJ asked quietly.

You nodded your head and allowed yourself to relax against his side. He wrapped his arm tighter around your waist and kissed your head.

“We have something to show you guys. I gotta go grab it but you’ll be excited.” JJ said getting up and heading to the car. You followed behind him quickly, not wanting to be questioned by your friends.

“We’re just gonna give it to them and tell them right?” JJ asked.

“Yeah, nothing special planned.” You said and nodded.

You grabbed your purse from the floor and grabbed the ultrasound. Once you and JJ were ready you walked back hand-in-hand.

“So what’s the news,” John B asked excitedly.

“We’re having twins,” JJ said with a smile. You handed the ultrasound to John B as everyone stood around it.

You watched as your friend’s eyes filled with tears.

“I’m so excited for you.” Kie exclaimed, pulling you both into a hug the rest of your friends joining shortly after.

The rest of the night was filled with drinks, you of course having water. They did a toast for you and JJ and spent the night laughing and planning.

[areptvclown]

Nesta groaned lacing her fingers together, stretching upwards with a restful sigh. Turning and twisting in her midnight blue comforter. Her face and mess of dark auburn tresses buried into her plush pillow. Reaching out for her husband's body. Though it wouldn’t surprise her if it was one of their toddlers instead. Still, they would receive the same touch. An arm curling around the middle and a swift peck on the check. The only difference would be how she said good morning. To their toddlers, it would be motherly full of warmth and affection. She’d run her fingers through their thick dark locks, cupping their little rosy cheeks. Until Cassian grabbed them, tickling the two and chasing them out of the bedroom. To Cassian, it would be a good morning prick which would entice him to flip her on her back. Murmuring some damned nonsense of how she loved his prick and he would show her. Or it would be her peppering kisses from his tousled hair down to the nape of his neck. He’d turn to her in a sleepy daze capturing her lips in a morning greeting.

This morning when she reached out there was nothing. No one. Not even the warmth of a body. Just a cold spot of silken sheets. She jumped up startled blue-grey eyes scanning the room for any of them. The only one in the room was her.

“Cassian?” Nesta knew it was ridiculous to call his name in a still room. If he was in the master bath she’d hear him. Loudly too. Always singing off-key or just generally making noise. No matter the time of day he seemed to hold a habit of slamming doors and cabinets, “Aidan? Audrey?” she called for their twins on the off chance they were once again hiding in the walk-in closet or under the bed. No giggles, singing, or cabinet slamming. Only silence.

Pulling the covers off, her bare feet touching the cool cherrywood flooring. Resting a hand over her three-month swollen belly as she walked towards the small black chaise next to the window. People thought they were crazy for having another while the twins were only four. They couldn’t help it and they only needed justification for themselves. Cassian and Nesta always wanted a big family. For Cassian growing up, it was only him and his mother. Things were always lonely and tight. For Nesta, it was troubling. Her mother left them with her father never bothering to contact them again. Her father did nothing but drink his days. She believed if she did nothing that he would eventually get his act together. He didn’t. He never did. Eventually, his sister took in the three girls. Elain and Feyre they loved and adored. Nesta was always pushed aside. Too much like her mother they would say. It took years later for some Illyrian idiot with a man bun crashing into her while leaving a creative writing class to melt the ice around her heart. But he did and with him, she wanted that chance. To fill her house with the laughter and love she never had. Things weren’t always easy for them, but their love and devotion to each other ran deep. Now with her successful career as a writer and his as a gym trainer with his equally successful lines of workout supplements, they had the means for that family and more.

Nesta pulled the sheer curtains apart looking down for any sight of her husband running with the kids. One twin up on his shoulders while Cassian chased the other. Possibly with him pinned to the ground and the two climbing on top of him. It didn’t matter, it was only eight in the morning. If Cassian had it his way. He would drag his wife and the kids outside the second the sun rose. They weren’t outside either. There was only one other place they could be. Nesta grabbed her charcoal robe, slipping into the sleeves and tying it loosely over her striped nightgown. She picked up a hair tie next to the cell, tying her hair in a bun while heading to the door. As she turned the knob, Nesta heard whispers through the doors and realized she should’ve checked the house first. Twisting the doorknob in her hand, silently she pulled it open.

“Daddy. What is book brinding?”

She heard Audrey ask, her shoulder-length hair still mused from sleep, thick and dark like her fathers. They all had their backs to her sitting at the dining table. Audrey on the left, Cassian in the center, and finally quiet little Aidan on the right. Nesta heard Cassian laugh at the innocent question. Folding her arms across her chest, she leaned against the door frame listening to the conversation.

“Bookbinding sweetheart. See it keeps the book together like this.”

“Oooh.”

“Will mommy like it?”

“Course she will, buddy. You and your sister made it.”

“You made it too!” the twins shouted in unison. Cassian shushed them both, “Oh right,” they’re voices lowered, “You made it too,” they repeated.

“Not really. I helped with the writing and tied it. The idea, the drawings, and the pictures you chose. That’s you guys. Daddy has something else planned. She’ll like it.”

“What is it?" Audrey asked. A childlike curiosity in her voice.

"Is it your prick?" Aidan questioned. Nesta stifled a laugh watching her husband's back straighten as he froze in his movements, "You always say she likes that."

"How many conversations do you kids listen to?"

"Oh. Lots," they spoke together.

"Yeah, let's not do that. Some conversations are for mommy and daddy only."

"But what is a prick? And why does mommy like yours so much?"

It was Audrey this time who asked. Nesta didn't have to see his face to know his tanned skin was draining and turning ghost white. By her guess, it was happening quickly. Cassian was good at many things, but awkward talks with almost five-year-olds were not one of those things. Pushing off the frame, she decided to make her presence known to the three most important people in her life.

"What are we doing?" she asked, her brows arched walking towards the dining table.

All three turned around at the same time. Looking like deers in headlights. The twins gasped, throwing their small hands over a squared object on the onyx table. Both of them fussing over who was louder and caused her to wake. Saying things like mommy needs sleep for the baby. The baby won't grow if you wake her up. Cassian hushed them both, pushing the chair out to go and greet his beloved. The twins followed suit.

Although Aidan and Audrey were twins. Their looks weren't similar except for their olive-toned skin. It seemed to be a mix of Cassian and Nesta. Aidan was a spitting image of his mother. Hair a deep golden hue like her and his eyes a marbled blend of grey and blue. Like a storm on the sea. His small child features were already strong like hers, both mother and son having sharp noses. He had his father's courageous and outspoken personality, but Nesta's love of reading. Aidan held an imagination that outweighed even his sisters of magic, fairytales, and dragons. He was still dressed in his pj's. A cheesy little blue and red set that read Mommy's little super hero on the front.

Audrey, on the other hand, looked at that of her father. Hair black as night and down to her shoulders. She liked it that way with bangs. It was like Cassian and auntie Amren. Her eyes were a bright amber with flecks of green throughout. Like sunbeams breaking through rich green leaves in a forest. Lips pouty and plush like him. She too loved reading, not as much as Aidan though. Audrey had a knack for adventure. Wanting to be the princess and yet wield a blade. She had her father's free spirit and her mother's stubbornness. Audrey stood there in her white and pink polka-dotted nightgown. A heart in the center with, Mommy's sweetheart embroidered. Standing close to Cassian. A daddy's girl through and through.

Cassian who stood there in the same wardrobe as the kids. A black shirt with black and red plaid bottoms. Grinning ear to ear at her, running his hair through his thick, wavy locks. He glanced at the kids to his sides, "Why don't you get the present?" they both nodded giggling. He stepped to Nesta, hand resting on her belly, kissing her sweetly, "Happy Mothers Day Nes."

"Thank you," giving him a chaste kiss, "What are you up to? Besides gifting your prick to me."

"Only gifting if it if you want it, sweetheart. I was thinking Amren and Valerian could watch the kids. Which I already asked. They said yes. We can go for brunch, get you one of those prenatal massages you like so much.."

She hummed, curling her arms around his waist. Resting her head against his chest. Cassian ran his fingers down her spine, "What if I want it?" She crooned.

"Insatiable woman," he teased, smirking at her.

"Let's call it a pregnancy craving."

He chuckled kissing the top of her head," Whatever you say. The kids have been working on this for a week by the way."

Aidan and Audrey returned shouting to Nesta to shut her eyes. She did as requested. Cassian guided her to the couch. The twins sat next to her and Cassian sat on the edge. Nesta felt a weight in her lap.

"Happy Mothers day!" they shouted in unison. Nesta flicked her eyes open to look at the item. She gasped. Her heart full looking at her gift. A book. They made her a book. Nesta Archeron wasn't someone who cried. So far in her life, she cried three times. When Cassian proposed, when they married, and when the twins were born. Now she supposed it was time for another. She could feel her eyes brimming with wetness. Overcome with emotion.

The cover was a drawing of what she guessed was Aidan and Audrey. It was a titled Why we Love Mommy. Nesta assumed the title was Cassian. It was too forward for a child. The sides of the book were laced together in a red ribbon. She opened the first page. It was a drawing of her and Cassian while she was pregnant. If the drawing didn’t give it away the sentence stating it would have. Some pages had photos of the four of them or Just Nesta and the kids. Most page was filled with inaccurate drawings and little stick figures. She loved it anyway. The bodies of themselves and then the twins when they showed in the book were far from proportionate. On one page Nesta's legs were as long as the drawn Cassian next to her. Sometimes the twins were taller than their parents. Her favorites were the ones of Cassian with circles as muscles playing his guitar while Nesta sat on the floor. Drawn with a long-armed Aidan and a book bigger than her head. The pages had simple sentences like: We love mommy for giving us a home in her tummy, We love when daddy plays music and Mommy reads to us, We love mommy’s pancakes. She didn't even realize tears were falling when she read the last page. There was a heart messily drawn and at the bottom, it read, We love mommy cause she’s pretty and strong, and she loves daddy and us bigger than space and dragons. It was a sentence only two four-year-olds could muster. It touched her in a way she couldn’t fathom. Her touchy pregnancy hormones had gotten the best of her. By now her tears were streaming down her face. Not from sadness, but affection.

"Nes?" he questioned handing her a tissue. She took it, nodding her thanks, dabbing at her tears.

"Do you like it, mommy?" The twins asked. She wrapped her arms around her babies. Planting a loving kiss on their heads. They hugged back as tightly as their little arms could.

"Yes. I love it very much. It's my favorite book," she shared a look with Cassian, her lips trembling but her smile wide. He reached out to squeeze her hand.

*******************************************************************************

a/n: This is actually part of series called: Mother’s Day in Velaris. Which atm has two parts. Nessian and Elriel (Which I’ll repost tonight). I still need to do Feysand and it will be complete.

Over the next week or so I am transferring my fics to tumblr. I kinda prefer the tumblr platform and I am on here more than ao3. So some of the fics I will be posting, yes you may have seen before, like this one.

Taglist: @slightlyrebelliouswriter23​ @hizqueen4life​ @clockworkgraystairs​ @b00kworm​ @negativenesta​ @sjm-things​​ @whataboutmyfries​​ @justgiu12​​ @illyrian-bookworm​​ @thesirenwashere​​ @ireallyshouldsleeprn​​ @vanessa172003​​ @thewickedkings​​ @sleeping-and-books​​ @thefolkofthefic​​ @yafandomsdotnet​​ @aknymph​ @alittledribbledrabble​ @iminsanenotobsessed​ @figuredihadanodustollensofalife​ @Df3ndyr @forbiddencorvidae​

want to be on my taglist? let me know!

[thetwinsprenatal]

Buy Prenatal Supplements

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[flutteringphalanges]

Summary: It is public knowledge that Zoe Van Helsing is the last of her blood line. Not to mention that, in a sense, Count Dracula is too. However, after an unexpected night of passion, both their lives dramatically change when Zoe becomes pregnant. Two unconventional parents, one extraordinary pregnancy. What could go wrong?

Rating: M

Pairings: Zoe Van Helsing/Dracula & Agatha Van Helsing/Dracula

Read on FFN and AO3

A/N: Thank you to all who have left kudos/comments/reviews and even have taken the time to read this story thus far! I'm having loads of fun writing this one and I'm hoping you are enjoying it too! Okay, enough of my blabber, here's the next chapter!

                                    Chapter Three

Gemellology. The scientific study of twins. One child out of every thirty two children born was a twin. In the United Kingdom alone, one in out of sixty five babies born were some number of multiples. And one, twin pregnancy, out of the billions of people in the world was the result of a paternal vampire. Singular. Unique. No one else on the planet would be like them. The statistics, though not publicly published, were there. Zoe had never felt so overwhelmed in her life.

"Because of your age, health complications, and the fact you are carrying twins, you're considered high risk," Dr. Clyde explained, Zoe sitting rather motionless as the doctor began to scribble instructions onto a pad.

"Is there something we should be concerned about?" Dracula inquired, his attention focused on the doctor. "Perhaps momentarily taking leave from her job?" Zoe didn't have to look over to know that the vampire was fighting a smirk.

"It's nothing you need stress about at this point," the doctor assured, smiling at Dr. Van Helsing. "We'll just have to schedule more routine visits and run some tests if need be. Monitoring you and making sure everything is going well with you and your babies is the important thing. Here," he held out a piece of paper that she hesitantly took. "Just some recommended prenatal vitamins, folate and iron supplements, the works."

"Iron, an important component of blood," Agatha commented. "Perhaps you consider increasing your dosage of that based on your fetuses' needs."

"Over the counter?" Zoe asked, ignoring the other two in the room. "Pharmacy?"

"Yes, whichever location is convenient to you," Dr. Clyde replied. "Generic or name brand doesn't matter. It is important to stay on them though, we strive for healthy babies." He reached out for Zoe's hand. "It was a pleasure meeting you, Dr. Van Helsing. They can schedule your next appointment up front. And congratulations again," he grinned at Dracula. "To the both of you."

"Thank you," the vampire answered. "This was quite the surprise for both of us. But I welcome this new chapter in our lives, isn't that right, darling?"

"Callous beast," Agatha frowned at Zoe's side. "This is why you never let your guard down with a vampire. Have you learned nothing?"

"Thank you, Dr. Clyde," the doctor exhaled, pushing herself out of the cot. "I'll see you soon I suppose."

Zoe did her best to ignore Dracula the moment she stepped back into the waiting room. She could sense him looming over her shoulder as she set up her next appointment. Blocking his view or not, she knew the man would find a way to attend. He was dreadfully good in that department. Still in shock over the whole experience, she made her way to the elevator.

"So twins," the vampire said, breaking the silence. "I cannot say that I was exactly expecting that. And both with beating hearts. How peculiar."

"I'd rather not discuss parenthood, especially with you," Zoe grumbled, pressing the down key. "You changing my appointment was inappropriate, even for you. Do you realize how late it is? I have to get up early for work tomorrow and-" The doctor was abruptly caught off when she felt a firm, cold grip on her shoulder.

"The Harker Foundation?" Dracula's amused expression had now darkened. "So you are really hellbent on going back there? After this?!" He motioned at her still flat abdomen. "That place. You know what it is. The purpose. What they are." The count touched her stomach, Zoe immediately swatted his hand away. "Do you know what they'd do to you if they found out? To them?"

"What I do isn't any of your concern," the doctor frowned deeply. "I hold high regards towards my job. Even with you gone, we've made progress."

"Then your intent is to experiment on them?" Dracula growled, Zoe beginning to feel slightly fearful. "And to think I was the one who was believed to be heartless-"

"I have absolutely no intentions to do anything of the sort you're accusing me of," she finally spat back. "Nor do I intend on informing people what I'm carrying. But I will say this, if I am truly hellbent on anything at this point, is keeping you out of my life." The elevator door opened but neither of them made a move to enter. "When you chose to leave the walls of the Foundation-"

"My prison," he corrected.

"...The institution, you made the choice to become not involved," it was an argument that didn't make much sense, but she needed something to go off on. "So now, like the Foundation, I'm choosing to be not involved with you. Not that our relationship was anything but distant acquaintances."

Dracula fell silent for a moment before letting out a low chuckle. "Are you trying to punish me, Zoe?" He asked, clearly amused. "Because if that is your goal, you are failing to achieve it."

"Leave," Agatha urged. "This is just going to keep going around in circles and despite being dead, it's giving me a headache."

"I'm done," the doctor said, finally walking into the elevator. "And if you had a shred of humanity left in you, you'd leave me be."

The vampire's mouth opened up to say something, but Zoe had already jammed the close button so hard the doors slid shut. She sighed, leaning against the wall as the speakers hummed a soft tune.

"Good girl," Agatha smiled. "Checkmate."

"The same goes for you," Zoe muttered, glaring at Agatha. "You're just as a thorn in my side as he is. Please...just give me peace."

The nun gave her a curious look before disappearing out of sight. How Zoe had kept from losing it, she wasn't sure. As the elevator doors opened and she stepped into the night, she began to question it all. Twins. Motherhood. Dracula. Her ghost of an aunt. Her eyes flickered down to the crumpled up piece of paper in her hands. The list of instructions the doctor gave her. Everything really was turning upside down.

                                         Two Months Later

Dracula seemed to heed her words from that night. Weeks had passed and Zoe had yet to see the vampire. Even at her appointments, she wasn't greeted to the unwelcome sight of the man. Agatha too had kept her distance, the doctor only seeing flickers of the woman occasional around her house. Life was turning out to be pretty alright-excluding the fact of the ever growing list of pregnancy symptoms she was starting to experience.

"That's your third bagel."

Zoe peered down at her plate, noting that she had indeed consumed yet another circular dough ball smothered with cream cheese. Her attention turned back to her former graduate student, Jack Seward, who'd joined her for lunch that day. He proved to be nice company, someone she could always count on.

"I'm hungry," she admitted. "A side effect of pregnancy."

"And you're still not going to tell me who the father is?" He inquired, smiling as Zoe went for another bite of her bagel. "I thought you never wanted kids."

"I didn't," she admitted. "But when I went into remission, something changed within me. I can't describe it. So I decided to try out in vitro fertilization," Zoe smirked. "Took the first time and now I'm having twins. You and I both know science is fascinating."

She gently placed a hand on her stomach that had already begun to swell. She had yet to feel anything other than bloating. But it was almost comforting. Knowing that she wasn't alone-well, besides Agatha's unwanted haunting. Everything had been running so smoothly, Zoe would almost forget at times that the twins weren't fully human.

"So the Foundation is still keeping tabs on Dracula," Jack said, taking a sip of his coffee. "You of all people must regret not having him around to study him."

Zoe nearly choked on her next bite. Coughing, she grabbed her glass of water and swallowed a few large gulps. Concern crossed the younger man's face, but the doctor waved away, nodding that she was fine.

"His whereabouts aren't a concern of mine," she inhaled. "His activity is being monitored and with that horrible lawyer of his, not much can be done."

"Has he tried to contact you?

"No," she replied. "Not recently."

"Recently?" Jack inquired, looking a little worried. "So he's tried in the past?"

This was the last subject she wanted to discuss. Thinking of a way out of it, she scrunched her face in displeasure. Placing her hands on her stomach, she tried to appear sick. Convincing.

"I'm feeling rather ill," Zoe lied, rising from the table. "Morning sickness. I should go home. I'll text you later. Thank you for lunch. It was great seeing you, Jack."

"But, I…"

Zoe had already hurried off towards her car before he could finish. Unlocking it, she threw her purse into the passenger seat and slid in. Dracula. Of all the subjects to discuss. The idea really did turn her stomach. Pulling out of the cafe parking lot, she started to make her way home. Some tea. Perhaps a movie. She needed to clear her mind.

The first thing she did when she walked through the door was collapse on the couch. Even though she wasn't going through chemotherapy treatments anymore, she still experienced extreme exhaustion. Pregnancy. The wonder of it all. Placing a hand on her stomach, she exhaled. It was hard to believe two tiny-well, babies, were growing in there. Surreal even. Zoe allowed her eyes to close, taking a moment to rest before going about her day. Peace of mind. That was the least she could ask for as she found herself drifting off…

A loud, but rhythmic knock startled Zoe from her slumber. She sat up abruptly, cursing herself from nodding off. She looked over at the time and to her horror realized the afternoon had become the night. Inhaling, she walked over to the door, wondering who it could be at this hour. Had she forgotten something and Jack came to return it? Certainly it wasn't the landlord. She always paid the rent on time. As she opened the door, she immediately realized her mistake.

"Good evening," the man said. "I apologize for the unannounced visit, I would have called but it appears you blocked my number. May I come in? I think there is a lot of catching up to do," his eyes fell onto her stomach, mouth twitching into a smile. "A lot."

Count Dracula.

God, smite her down where she stood.

[anxiouspregnantlady]

Lamaiam

Life after miscarriage after infertility after miscarriage.

I’m 28, married, and I long to have a baby.

I’ve lost three before they were born, including a pair of twins. My first miscarriage was in Jan 2019. We experienced infertility for more than a year after that. We found out we were pregnant again in June 2020 and miscarried a week after.

I don’t want to do IVF or IUI - I don’t think it will help the specific type of fertility issue I’m facing.

My whole life has become centered around my quest for a healthy, fertile body - and as a natural result, a healthy baby (and then a few after that).

Most days, I feel abso-fucking-lutely insane. Some days, I feel fine.

Here’s what I do, lifestyle & supplements wise:

Prenatals with folate

NAC

Fish oil

Extra folate + vitamin D

Thyroid supplements

Acupuncture weekly + chinese herbs (special formulation for me) twice a day

Mayan abdominal massage daily

Hypnotherapy for fertility daily

Did several months of talk therapy, but too $$

Yoga almost daily

Mostly fertility-friendly & low inflammatory diet (very low gluten/dairy/sugar/processed foods; mostly veggies & greens, berries, nuts & seeds, quinoa & brown rice, eggs, lentils, wild salmon, tofu small quantities of poultry/red meat)

Low impact strength training almost every day

I get pretty good sleep. Solid 8+ hours.

No caffeine (all decaf), except occasional green tea

Almost no alcohol (maybe 1-2 glasses of wine A MONTH)

In terms of diagnostics:

Hormone labs, baseline and all throughout luteal phase

Prolactin/thyroid/DHEA/testosterone

Lupus anticoagulants/Anticardiolipin

Follicular ultraound series (twice)

Semen analysis

HSG aka Hysterosalpingography

Endometrial biopsy

The only clinical significant diagnosis we’ve found in almost six months of testing is chronic endometritis (CE), which was mild, and which I’m being treated for via a course of doxycycline.

Anyway, now that we’ve got all the nitty gritty out of the way, this is going to be my space to RANT the hell as much as I want. 

[fauveshumankaiju]

uncle Ni...

He told Ni first.

Actually, he didn’t tell anyone at first. He threw up in the bathroom of the family practice clinic, then sat on the bench in front of the parking lot for an hour before driving to CVS to get mouthwash and splash some water on his face at the drinking fountain outside. After a little bit of vacillating he also grabbed some prenatal vitamins on the way out. If all else failed, he could always take them while not pregnant, after all. Baby vitamins probably wouldn’t hurt adult Rodan.

Then he sat at the beach for another hour, watching the water lap at the sand. It was fall and chilly and overcast, even in Monsuta, which was rarely properly cold.

He thought, for the first time in a while, about his own family. Wondered how they were doing, wherever they were. They didn’t seem to want to have a lot to do with him – he wondered if they would if they knew that he was involved with a foreign billionaire. He wondered if they knew how much he’d changed since he saw them last. Not that he particularly cared to find out.

One hand resting on his stomach, he stared up at the white sky and thought about what kind of a parent he’d make, if he ended up being one. It’d been a month, apparently; he couldn’t remember what he’d done in that past month, but he was a chemist. He handled all kinds of weird teratogens, he’d had a few glasses of wine, he definitely hadn’t taken his prenatal folate supplements. His brain was helpfully providing him with all the weird mutations he’d learned about in his undergrad intro to biochem courses, which really was NOT helping the anxiety. Of course he’d fuck this up before it even started.  How was he supposed to know he should be looking out for getting knocked up? He was a man, for god’s sakes, his anatomy was different from most, sure, but he dutifully stuck himself in the ass with a syringe once a month to claim the right to shave, sweat like a stuck hog and, oh, yeah, not get pregnant.  Turns out the last purported effect of hormones was false advertising.

After some more staring and shivering in misery, he went home.  Home being the Ghidorah’s apartment downtown – at least one of the brothers was bound to be there at any point in time and Rodan had a spare key if they weren’t. Ichi was usually flying around the world or in a conference call; Ni was in and out of town doing his own inscrutable work, but at least San might be there.

I can’t face San, he thought sickly as he locked his bike in the underground garage and keyed in to the elevator. He thought of San’s sharp, gentle face, the boyish joy on it when he found something new and interesting to play with. He would say whatever Rodan wanted him to say - even now that Rodan didn’t know what that would be. He’d bend over backwards to make Rodan happy even if it wasn’t what the Ghidorahs wanted. Rodan would say – “I wanna do this, high speed low drag, let’s have this baby and raise it and be domestic and shit, congrats on your new heir, I guess, I promise I didn’t do this intentionally to trap you and your rich powerful brothers into a relationship with me or something like that,” and San would be game. He could also say “I’m telling you this just to let you know, but there’s no way in hell that I’m gonna let this thing live rent-free in the body I spent my life trying to get, so it’s eviction time.” And San would be game for that, too.

San would be a pretty good dad, Rodan thought. Masochistic tendencies aside he was gentle and attentive to the things he wanted to keep safe.  He thought of the Dane bobbing a toddler on his knee while he watched cadaver dissection films and huffed in amusement.

The elevator up to the penthouse apartment had bizarre club-like lighting, low and purple-blue. It stuck out to him right now for some reason. Rodan studied himself in the elevator mirror as it dinged upwards. Small, lean, dressing nicer than he used to in black jeans and a bright button-down but still sporting his old red leather jacket and combat boots. He leaned in closer, staring himself in the eyes, evaluating. The face in the mirror looked back at him, brazen and daring.

30 and still sporting a mohawk. Bitching.  Didn’t look like much of a father, though.

Daddy, his mind (un)helpfully supplied.

The elevator opened and he let himself into the one door on the other side of the anteroom. Theirs was the only place on the top floor of the building; it had the best view of the city, the Monsuta bay arcing out into the distance through the floor-to-ceiling windows in the living room, the glinting buildings on view in Ichi’s rarely-used bedroom. Rodan liked the view, but the building itself was always a little cold for his taste.

He kicked off his boots into the hall closet when he got in, jangling his keys as advance warning.

“I’m home!” he called. He’d been out for the past few days and staying overnight at his own apartment, since it was closer to work. San had been bothering him about moving in with them for weeks but Rodan liked to try to preserve this last vestige of independence while he still could – the Ghidorahs were overgenerous with him, but life had always taught Rodan that other people’s kindness came with strings attached.

“On the couch,” Niels called from the long, flat couch in the living room.

Rodan dropped his shopping bag on the counter and joined the middle brother on the couch.  Ni was dressed in a devastatingly fashion-forward flightsuit, the top zipped down and tied about his waist over a sleeveless turtleneck. His eyes flicked upwards as Rodan collapsed onto the couch next to him – he didn’t respond, as usual.

“How’s it going?” Rodan ventured. It was hard to tell, with Ni, whether he was in a conversational mood, but it seemed rude not to greet him. Not that the middle Ghidorah ever had any compunction about that.

Ni was on his desk-sized tablet, surrounded by fabric swatches and upholstery books like a king holding a very strange patchwork court.  Peeking at the screen on his lap Rodan saw a collage of floor plans and schematics, probably for the Xilien apartment complex that was nearing completion on the south side of Monsuta. Once the building was done, Ni and San would get to work decorating while Ichi took care of the business side of the development business. Ichi didn’t talk about work at home, though, so Rodan’s familiarity with the corporation came mostly from watching Ni fling inspiration images across his tablet screen and fume over comically large paper architecture diagrams.

“Fine,” Ni tapped his pencil against his lips. “We are getting somewhere, finally.”

“Yeah?”

“M-hm. The issue with the climate control – it has all been sorted out. I’m going to start finishing the walls next week.”

“Wow, that’s a quick turnaround time for contracting.”

“Ech, there are only so many painting companies in this town, and they can only refuse so many of our generous offers.  Principles, money. No contest.” He sounded satisfied, which explained his unusually effusive mood.  After a second, he remembered politeness. “How are you?”

“Pregnant.”

“H-what?”

Rodan tapped himself on the stomach and smiled thinly.

Ni’s eyebrows shot up to his fringe. A moment. He cocked his head owlishly.  Rodan pursed his lips and nodded.

“How?”

“Are you asking about the mechanics? Because it’s like-“ Rodan made a circle with one thumb and forefinger and stuck the other pointer finger inside. “-you know..”

“Jesus kristus, stop that!”

“You do know something about sex, right? They had sex ed back in Denmark?”

Ni set his tablet briskly on the coffee table and collected himself for a second. Rodan almost had the good sense to be scared. Ni was normally restrained, cool and aloof, but this wasn’t a normal situation. This was a very Ni-will-lose-his-cool-and-get-real-scary situation.

“They don’t know about it yet,” Rodan supplied quickly. “I don’t know how to tell them. If. I tell them. I don’t need to, I could just take care of it on my own and it won’t be a problem. I thought that one of you should know about it, at least, so you can weigh in on it, since on a molecular level it’s technically genetically your kid too, so you have a say in what happens, and if you’re angry then at least I know Ichi definitely will be to so I can just figure out what to do based on what you do-“

Ni cut him off with a single finger and an icy stare. He’d pushed his sunglasses up to the top of his head after rubbing his face.

“... You talk so much.”

“Yeah, bastard, I’m nervous.”

“You think that we’re going to be unhappy about it.”

Rodan exhaled and settled back into the couch. Damn uncomfortable piece of furniture. “Well, yeah. I’m not exactly-“ he gestured at himself “prime 1-percent relationship material.”

Ni didn’t respond, staring at him.

“Not that I think I’m less than you guys, obviously, it’s just – if you had the choice, you probably would have wanted to be tied down to someone else. Someone you could be seen out with and not worry about what some gossip site would say about you slumming with your trashy American boyfriend. Someone Ichi could take to dinner parties in Europe, someone who could take San out every night when he gets into his weird moods, someone you could trust.  And this whole thing is just going to tie you down to me, and then I’m going to…” let you down, he thought lamely.

Ni was still staring at him. Rodan swallowed and looked away with weak finality.

In one swift movement the Dane swung over to the far side of the couch, slamming one leg down over Rodan’s lap to straddle him and planting his hands on his shoulders, pushing him into the couch. Rodan cursed and tried to grab his arms to push him off but he got batted away. Fuck, he forgot how strong Ni was. All that construction and jiu jitsu. Well, if he had to die, this wasn’t the worst way to go, strangled by his lovers’ twin brother.

But Ni wasn’t trying to kill him, at least not right now. In fact, it felt almost like he was trying to be gentle, which felt as unnatural as his attempts at speaking Spanish sounded.  His grip was soft as he raised a hand, reaching out to touch Rodan’s face, before deciding against it and resting it on his shoulder again. Rodan let out the breath he was holding.

“If they find out, they are going to do everything in their power to convince you to keep them.”

“Why would they do that?” Rodan breathed. Ichi, he meant. San, he couldn’t imagine having a strong opinion on his potential fatherhood.

“Because they’re our blood,” Ni said slowly, looking down at Rodan’s chest. “The thing that separates us from the rest of the world, those crass dumb creatures that we have to deal with outside, is our blood. It ties us together. It makes us who we are.  It’s inescapable and irrefutable. And now you share that blood, too. You and the children you’d have are part of our family no matter what. You understand that, Rodan, yes? You are part of our family now. You are Ghidorah.”  He clapped Rodan’s cheeks in his hands, part slap and part affectionate tap, like he always did to San. “If you talk about yourself like you did I’ll get very angry with you. You are Ghidorah. Nobody insults Ghidorah, even a Ghidorah.”

“You’re not… mad?”

Ni shrugged, then made a circle with the fingers of one hand and stuck his other hand’s pointer finger in. “I don’t know what else I expected when this started happening.”

“Yeah, well, my bad. I didn’t do my research.”

“Neither did we.”

“Don’t blame yourself, Ni, you’re, like, 99% not the father.”

“Genetically, you said, I might as well be.”

“Well – yeah, you got me there.” Rodan sighed, feeling himself relax. Then, a little more seriously - “So what do you think I should do?”

Ni looked down at him, arms crossed, his face arranged into a carefully neutral mask. “Do whatever you like. Don’t worry about Ichi and San, though. Your children will want for nothing with us as their fathers.  Just don’t tell them about your having them right now unless you’re completely sure you want to have the children.”

“Children?” Rodan scoffed. “Plural? No way in hell I’m doing this again. If I’m doing this at all.”

“Oh, of course,” Ni said casually. “They’re going to be twins, at least.”

“Oh! Are they.”

“Yes. They’re Ghidorah.”

“That’s a pretty bold declaration, Doctor Niels.”

“And mark my words, it’s true. We always come in multiples.”  Ni swung off of Rodan’s lap and pushed himself back into his couch corner where he stretched himself over the armrest like a cat.  Rodan suddenly missed his weight and the spicy smell of his aftershave and he had to mentally slap himself down when he had the split-second urge to go crawl into Ni’s lap. He might be surprisingly cool with being an uncle, but that didn’t mean that Rodan could push the tenuous peace that he’d been trying to build since they’d met.

He rested his head on the couch and stared up at the ceiling. Uncle Niels. He’d probably give the best presents.  Ni was up all night most nights anyway, he could feed the kid if they woke up. Probably not with the rest of the messy childcare business, but Rodan and San could probably take care of that, and Ni might even end up liking the kid once they were old enough to hold a conversation.

Oh, god, here he was thinking like he’d already made some kind of decision. What would Mothra do in this situation? She was the most has-her-shit-together person that he knew. She’d probably make a list of pros and cons, and then Goji would encourage her to stop thinking so hard about it and go with her gut, and then – yeah, not helpful.

Who was he kidding?  He was Rodan Rodan. He lived his life on the razor’s edge. He burned down a building and got himself tied up in a relationship with the violent-minded billionaires who owned it. Equations were for the lab, and even then, Rodan did his best work when he forgot about measurements and mathematics and went with his gut.  That’s what got him here, a priceless apartment in a beachside city with a job he loved and a life that never stopped being interesting and terrifying and beautiful. With three interesting and terrifying and beautiful partners who might consider staying with him here for a little while.

How do you feel, right now? He asked himself. Ni’s stylus tapped; the heating had turned on. Outside the clouds were boiling but the two of them were safe together, peaceful.

He didn’t know where he’d be in eight months, how he’d feel then, but right now? He smiled. He’d go with his gut.

[divawomenshospital]

Tips for Managing a High-Risk Pregnancy

Discovering pregnancy is a profound and joyful experience for every woman, marking a significant chapter in life. However, when a woman receives the news of a high-risk pregnancy, it can evoke feelings of fear and anxiety. It’s crucial to understand that with early and consistent antenatal care, women facing high-risk pregnancies can still nurture healthy babies while prioritizing their safety. High-risk pregnancies often include scenarios such as carrying multiples, such as twins or triplets. In such cases, expectant mothers are typically referred to a fetal specialist by their OB/GYN. These specialists are trained to provide guidance and support to women encountering unexpected challenges during their pregnancy journey. It’s a reminder that, even in high-risk situations, with the right care and expertise, the well-being of both the mother and child can be safeguarded. Experience exceptional care at Diva Women’s Hospital, recognized as the Best Women’s Hospital in Ahmedabad. Trust our team of the Best Obstetricians and Gynaecologists in Ahmedabad for your well-being.

Tips for Safe Pregnancy

Maintain or achieve a healthy weight before gestation

Maintaining or achieving a healthy weight before pregnancy is a vital tip for a safe and healthy pregnancy journey. Prioritizing a balanced weight not only enhances your overall well-being but also reduces the risk of complications during pregnancy. It can lead to a smoother gestational experience for both you and your baby. Consult with your healthcare provider to establish a personalized plan that aligns with your health goals before conceiving. Trust your well-being to the experts at Diva Women’s Hospital, home to the Best Obstetrician and Gynecologist in Ahmedabad.

Create a Plan with Your Health Care Providers

By proactively planning your maternal care and delivery, you can approach your due date with confidence and peace of mind. Consider various aspects of your care, including how any pregnancy-related conditions may impact your birth plan. It’s crucial to ensure seamless communication between your Maternal-Fetal Medicine specialist in Ahmedabad and OB/GYN, while diligently attending prenatal care appointments. Depending on your condition, the choice of delivery location may also play a pivotal role. Discuss your delivery options with your healthcare provider, as some hospitals may lack specialized Neonatal Intensive Care Units, potentially resulting in mother-baby separation in critical cases. Your proactive approach ensures the best care for both you and your newborn.

Manage pre-existing health conditions

Pregnancy is a transformative journey for your body, and pre-existing health conditions can elevate the risk factor. These conditions, including high blood pressure, heart disease, diabetes, sexually transmitted diseases (STDs), HIV, and autoimmune diseases like lupus or multiple sclerosis, require proactive management. Prioritizing your health with medications and lifestyle adjustments before pregnancy ensures that your body is in optimal condition to navigate the challenges of pregnancy effectively. Diva Women’s Hospital can be the last destination for the Best Gynecology Services and Fetal Medicine Support in Ahmedabad that you actually are looking for.

Take prenatal supplements

During pregnancy, your body requires an increased intake of specific nutrients to nurture your growing baby. Incorporating a prenatal vitamin or supplement into your routine provides essential nutrients like folic acid, iron, protein, and calcium, which may be insufficient in your regular diet. Consult with Dr.  Pooja Patel to discuss your nutritional requirements. Dr. Pooja Patel is renowned for her unwavering compassion, attentive care, and dedication. She is a highly regarded Obstetrician and Gynecologist practicing in the vibrant city of Ahmedabad, Gujarat. If pregnancy is on the horizon, considering a prenatal supplement even before conception is a wise choice. Additionally, continuing prenatal vitamins postpartum can be beneficial, especially if you’re breastfeeding.

Avoid alcohol, tobacco, and drugs

Consuming alcohol, smoking, or using tobacco and drugs during pregnancy poses severe risks to your baby’s health. Alcohol consumption during pregnancy heightens the risk of Fetal Alcohol Spectrum Disorder, leading to significant birth defects. Smoking cigarettes can result in low birth weight for your baby. Misusing prescription drugs or indulging in illegal substances can cause birth defects, and in some cases, babies can even be born addicted to drugs used during pregnancy. It’s essential to strictly follow your doctor’s prescribed medications during pregnancy to safeguard your baby’s well-being. Experience excellence in women’s healthcare at Diva Women’s Hospital. Your well-being is our priority.

Always Listen to Your Body

Embrace the wisdom within your body; it carries valuable messages. Embrace moments of stillness to attune to your body’s whispers. Grant yourself the gift of rest when needed, for nurturing a growing fetus demands your energy. Should anything seem amiss, promptly reach out to your OBGYN provider, ensuring your well-being remains a top priority. Experience the pinnacle of healthcare in Ahmedabad with Diva, your trusted partner in wellness. Discover excellence in obstetrics and gynaecology as we prioritize your health and well-being. Take the first step towards a healthier you, schedule your appointment with the best OBGYN in town at Diva today.

This Blog Published Here: https://divahospital.com/blog-post/tips-for-managing-a-high-risk-pregnancy/

[rookieinbflat]

Ours

Ethan x MC (Levin Stern)

WC: ~1700

Tags: @writerapprentice @vickypoochoices

Summary: you guys apparently love the domestic fluff so I’m going to be doing a little mini series about some Mini Ramseys

Levin can barely contain her excitement as she walks down the halls of Edenbrook, towards Ethan’s office. She’s basically running at this point, manoeuvring her way through the patients with a huge smile, the sort of smile that hurts your cheeks. Levin and Sienna had done the blood tests yesterday and the results just came back in. Curling her fingers into a loose fist, she raps her knuckles on the door to his office gently. He calls out for her to enter and when she opens the door, he looks up at her over the lenses of his glasses, he looks so hot in his glasses, she thinks to herself silently, though she’s said it to him out loud numerous times.

He smiles softly, her beauty never failing to impress him, “To what do I owe the pleasure?” She smirks at him, walking over to his desk and preaching herself by his left side, the skirt she’s wearing rides up over her legs and Ethan has to remind himself that they’re in the workplace. Ethan’s desk is littered with papers and medical journals, he’s writing his new book and the research seems almost endless, if only he could pull out of the contract with the publisher.

“I have some test results I wanted you to look over, the patient has been complaining of lower back pain, abdominal cramps and occasional nausea,” Levin hands him the stack of papers, printed in black and white.

Ethan looks over the blood tests, “Hm, I can't see anything wrong,” he murmurs, “except for here, c’mon Rookie, these are hCG positive,” he shakes his head, surprised she missed such obvious results, his eyes scan up to the corner of the page and looks at the patient name and age.

Stern, L E 17/09/1992

Levin braces herself as he puts the pieces together, his brows furrow and then he shoots out of his chair, gathering her in his arms and spinning the young doctor around his office. Levin squeals loud enough for the entire hospital to hear, but she doesn’t care, she’s excited and full of love. Ethan places her back down on the floor and holds her by the hips, “We’re gonna have a baby?” He asks with a twinkle in his blue eyes, the last time she saw this exact look was their wedding day.

“Actually, Dr Ramsey, I think you missed something in these results,” she smirks and picks up the results from the large oak desk, showing him the paper and pointing out numbers from the blood tests.

A small whisper escapes from his lips, “Twins?” Ethan is shellshocked, a baby was one thing but twins, my god, they were going to need to move, not to mention the cost of baby supplies and getting them on a waiting list for a good daycare, had Levin been taking prenatal supplements? She’s going to need a new car with a higher safety rating and cut back on the caffeine.

Levin looked up at him in awe, her gorgeous husband had been in this hospital since he was twenty-six and had rarely let his guard down, until now. Levin reaches up and places her soft hands on his cheeks, gently caressing them with her thumbs, “Babe, we're gonna get through this,” she reassures him with kind eyes, her voice is calm and soothing and Ethan feels like they’re the only two people in the universe, “together,” he lets out a breath he didn't realise he was holding and leans down to kiss her softly, his stubble tickling her lips.

He sighs, “We're going to have a family,” he says the words like he almost doesn’t believe them, “how far along?” He queries, his gorgeous wife looking up at him with chocolate brown eyes.

“About three months, we’ll need to ultrasound to confirm twins, but they run in my family so I’ve got a pretty good idea,” she chuckles and he throws the paper over his shoulder and all but drags her to obstetrics, plants her in a chair and boots up the ultrasound machine.

The gel he spreads across her torso is cold and she shivers, but when two little blobs start to show up on the ultrasound screen, she’s struggling to hold back tears. The increased hormones haven’t really helped the fact that Levin cries at just about anything, from a cute dog on the sidewalk, to mildly sad stories she sees on the internet. These babies were going to change their life, Levin has wanted this since the day they started going steady, after growing up in a big family, she’d always dreamed of starting her own and now here they were - at the beginning of that journey.

Ethan reaches over to take her hand in his and he squeezes it hard like she’s the only thing keeping holding him to Earth, “Ours.”

—————

The months that follow are a blur and Ethan has launched into full doctor mode - it's endearingly annoying. Levin sighs and rolls out of bed, it's a little past five am and even though she has a day off today, she can't bring herself to sleep in. She sits on the edge of the bed and stretches out of arms and shoulders before standing up to look in the mirror on the vanity. She’s showing now, her belly is round and stretch marks are littered across her hips, she’s had to buy maternity bras which probably run the same price as their utility bill. Levin runs her hands across the skin there, picturing the two little babies growing inside of her. Pregnancy has been both a miracle and a really weird experience. No one prepared her for the feeling of having twins do somersaults in her body, kicking and moving all the time.

Seven months down, two to go.

Levin used to cry a lot - sad movies, cute dogs, adoption videos, you name it and she’s probably cried over it, but since the ultrasound, she hasn’t cried once. Ethan jokes that the pregnancy hormones were better than any anti-anxieties he could prescribe. Ethan has cut back on work, he only goes in five days a week now, he leaves early in the morning and is always home by seven, usually six. They spend their weekends in the park or wandering around the city, looking at boutique baby stores and figuring out what they want their future life as a family to look like. He comes home with sorbet a lot, draws her baths and massages the tension out of her shoulder. They day he tells Naveen the news is the best day of his life, Naveen looks between the two of them with stars in his eyes, his dream of seeing his mentee living his life to the fullest more rewarding that any case he’s ever solved.

Levin attempts to pull her robe around her and walks out to the kitchen where Ethan is preparing breakfast. He does this every morning, no matter what time he has to be at the hospital and he's back every night for dinner. Levin thinks he's more nervous about the pregnancy than her, he spends all his spare time reading parenting books, medical journals on parenting, talking to obstetricians at the top of their field, childhood behavioural analysts. She knows that he's worried about being a good dad, but Levin has no doubts at all. She wouldn’t have gotten this far if she wasn’t completely and utterly sure of the fact that he was going to be the best dad for their children. Levin smiles and turns down the radio slightly, its Mozart and just a little bit loud for five am. She walks over to where he’s cooking eggs on the stovetop and wraps her arms around him, despite the obvious protrusion coming off of her torso.

“Morning,” she sighs lazily and he turns the heat off on the eggs so he can turn around to face her, kissing her softly.

“Morning Rookie, sleep alright?” Ethan brushes stray hairs out of her face and watches her with blue eyes that make her weak at the knees, “sorry if I woke you,”

“No, my body clock is still running on early morning wake-ups,” She shuffles him out of the way and places two eggs on her plate, along with a side of veggies and baked tofu. Ethan hands her a capful of the three different prenatal vitamins he's got her on and she washes them down with some water, “Thanks for making breakfast,” his smile could light up the city, she’s sure of it.

They sit down at the table and Ethan is flicking through his emails when something catches his eye, “Lev,” he lifts his chin, asking her to join him on the other side of the table, “the realtor just sent me this,” he turns the iPad so she can see and her eyes light up.

She gasps softly, “Oh my god, Ethan, it's beautiful,” she tells him, her smile is stretched bright across her face. They’ve been looking for houses since they found out she was pregnant but they’ve struggled to find the perfect place. Everything was too small, or too big, too far out of town or not enough space. Great real estate in Boston was not an easy thing to come by, and when it did come around it often didn't stay on the market for long.

Ethan feels anxiety bubble in his gut - it's getting closer and closer to go time. They were talking about baby names, nursery colours, preschools to send them to. He’s wracked with nerves but then he glances at Levin from the corner of his eye and he sees that smile that gives him a reason. If angels exist, she’s got to be one of them, Ethan is sure of it.

He wraps an arm around her and uses his other hand to navigate the webpage, “They have a viewing on Saturday,” he points out the dates and times, “I’m supposed to be at work but I’m sure I can swing an hour or so off to go with you,” he's smiling now too.

“If you can't make it I’m sure Sienna would come with me, it's not a huge problem,” before she can argue anymore he cuts her off with a kiss, his eyes soft.

“I’ll be there.” He says it with no room for protest so she relents, leans in slowly and tells him she loves him.

[momsavvyus]

Welcome to Motherhood

THE TEST CAME BACK POSITIVE, NOW WHAT?

But, what if you're not ready? You don't know if you'll be a good Mom.. Breathe! Everything will be OK.

Whether planned or by complete surprise, I'm more than sure you are wondering what to do next.

Focus on the basics right now doing so will set the tone for the next 9-10 months with minimal stress.

Step 1. Schedule an appointment with your Primary car physician.

They will confirm the pregnancy and advise you on choosing specialists to help monitor your pregnancy. Some family practice doctors provide prenatal care and attend deliveries.

How will they confirm? Most PCP will confirm via urine and/or blood. Me personally I'd prefer urine but the reality is that sometimes urine will not suffice, be prepared for blood work. Make sure you are hydrated, drink at least 16oz of water prior to your appointment. Trust me, you will be glad you did.

Step 2. Take a trip to your local Vitamin Shop or GNC and stock up on Prenatal Vitamins!

Prenatal care starts in the womb, keep your energy levels high by taking nutritional supplements to supply you and baby with essential minerals needed as you both develop.

Pros:Reduce the risk of a whole array of conditions, from the annoying to the harmful, including:

Anemia

Fatigue

Leg and muscle cramps

Low immunity

Postpartum depression

Weakness

Low appetite

Skin irritation

Brain fog

Cons: Honestly there aren't many cons vitamins are necessary however you may experience heightened pregnancy side effects such as

• Nausea. To avoid this, opt for a chew able vitamin vs a huge pill. If you don't mind taking pills try taking your prenatal vitamin with food (and never on an empty stomach). It also helps to take them at night, so you are asleep when the nausea would potentially kick in.

• Constipation. You have the iron content to thank for this.

• A change in urine color or odor. B vitamins, in particular, may be the contributing factor, though these are harmless changes.

Recommendations:

Ritual-Essential Prenatal (vegan)

Natures Way- Alive

Honest CODHA Complete

Pink StorkTotal Prenatal Plus (vegetarian)

Step 3.Find an (OB-GYN) or a nurse-midwife.

Which is the best recommendation?

Such a difficult question to answer and so subjective.

But really the question is ‘what are you looking for in your doctor?’ since every OBGYN has their own approach. It is more like a matchmaking service when deciding who to choose. Research both to see which is best for you.

(Keep an eye out for a separate post going into further detail.)

Step 4. Get Business Savvy

Speak to your Insurance provider. These key questions will provide you with a better understanding of what to look forward to financially.

Does the policy cover prenatal care?

Do I need a referral to see a specialist/OBGYN from my primary care doctor? (more details in step 5)

Are labor/delivery costs included?

What are the co-pays, coinsurance, and deductible amounts?

Is prenatal testing covered (ultrasounds, amniocentesis, genetic tests)?

How long after delivery is my hospital stay covered?

Will I need pre-authorization to receive prenatal care?

What hospitals and doctor’s offices are within the preferred provider network?

Are non-traditional deliveries covered (midwife, home-birth, etc.)?

Are private rooms covered or will I have to share a room?

Step 5. Consider your health history.

If you suffer with any chronic illnesses such as diabetes, high blood pressure, heart disease, epilepsy or a previous antenatal complication that might require special care then it is wise to try and see an OBGYN who has a special interest in caring for high-risk pregnancies.

Some doctors will have a special interest in IVF pregnancies and twin births which is a growing field as more women than ever are having their first baby after age 35 and often with the help of an IVF clinic to conceive.

Step 6. Select a hospital or birthing center.

YOU ARE IN CONTROL!

Now that you have a better understanding of what your insurance covers

You can chose where to give birth whether it be in your home, at a hospital or at a birthing center.

Do your homework, know your options and create a birthing plan. Remember your baby will come when he or she is ready, they have a plan of their own. Learning to accept, adjust and advance will help you deal with the reality that plans are ever changing,

Your plan is simply a guide, you may experience road blocks, detours and at some point you may have to negate your original plan.

Obstacles are necessary most end up working out BEST case scenario. I say that to say, do not get discouraged! If your plan doesn't pan out exactly as you envisioned it. Remain open minded and prepared to adapt. This is where you begin to create your new balance. Everything will be just fine, you got this!

Step 7. Its all in your mind!

A happy, healthy baby is every mothers dream. Remaining stress free & in positive spirits is the key! A positive attitude starts with healthy mindset. Understand perfection does not exist however progression is what matters most.

Here's how you can stay in positive spirits:

Eating well: a balanced diet will benefit you and baby. ditch the junk food and opt for healthier options. There's an alternative for everything now a days so do not worry you can satisfy your cravings the healthy way.

Staying active: We all want to snap back to our pre-baby bodies, do not be afraid to work out during your pregnancy (unless advised otherwise by your doctor). You will be glad you did. Muscle memory is real and though you may not be able to see your toes at the moment remember it is only temporary.

Getting enough sleep: enjoy it while you can, because you will not get a full 8hours of sleep for at least the next 24 months. Do not feel guilty for taking that mid-day nap or sleeping in until 12pm you are creating life and beauty sleep is essential to maintaining that pregnancy glow.

Build your village: Its tough if you are the first friend in your group to become pregnant. Who will you talk Mom & Baby stuff with? Having support from friends and family is vital. If you lack in either department now is the time to be open to creating new Mom bonds. Check recommendations below.

Communicate with your Partner: Vocalize what you need from them during this time. You guys are entering this journey together and should provide support for one another. Make it a priority to attend appointments together.

Draw closer to your family & friends: Lean on them! Let them know you are entering a new phase of your life and will need as much support as you can get. Be open and inviting, allow your family & extended family to attend doctors appointments with you. Those you select will begin to bond with you your partner and baby on a more intimate level.

Take parenting classes: Enroll in prenatal yoga, and join meet up groups. You'll be surprised at the life long connections you'll make, not to mention you'll have a list of friends to confide in & eventually schedule play dates with. You can also invite friends and family to these classes/meet ups.