1.1 At conception the woman’s egg becomes a zygote, having been fertilised. The zygote cells then divide repeatedly, creating a small ball of cells, which moves down the fallopian tube to the uterus. This is now known as a blastocyst, an inner group of cells with an outer shell. It continues to grow and attach to the blood-rich womb lining.
4 weeks after conception, the ball of cells is known as an embryo and will continue to grow. Over the next couple of weeks, the embryo will start to divide into 3 different layers. These layers are the building blocks from which major organs develop from. The top layer is where the neural tube develops, the start of the central nervous system which will soon form the spinal cord, brain and backbone. The middle and final layer will develop into other major organs such as the heart, stomach, liver, digestive and circulatory systems. The outer cells of the embryo begin to link into the blood supply, preparing to draw nutrients from it. This links to the placenta which attaches to the baby by the umbilical cord. Approximately 6 weeks into the pregnancy the baby will be surrounded by the amniotic sac which will protect them throughout the pregnancy. By week 7 the baby’s brain and heart are more complex, and the arm and leg joints are beginning to form. Over the next week the baby’s fingers and toes will become less and less webbed and by week 11 they won’t be webbed anymore. Taste buds are also now beginning to form.
Week 9 the embryo will now be known as a foetus. The heart has fully developed and the other vital organs; liver, kidneys, intestines, brain and lungs, will be fully functional but will need to continue to grow until the delivery. Distinct facial features will begin to develop now the baby is in the embryonic phase. By week 10 the baby has functional arm joints and will be actively moving around inside their mother.
Between weeks 12 and 16, the foetus will grow substantially to around 10cm and will now be done developing its vital organs and systems. The placenta will now be the foetus’ source of nourishment and the vital organs continue to mature. All of the foetus’ joints and limbs can move and fine, downy hair will grow all over the body, known as lanugo. This will however, disappear before birth and is the first type of hair that grows from hair follicles. Lanugo helps protect the skin and makes it easier for vernix caseosa, a fatty substance protecting the skin from the amniotic fluid, to adhere to the skin whilst also helping during the baby’s delivery.
Over the next 4 weeks (17-20) the baby will undergo another growth spurt and double in weight. The foetus will be very active as he/she can now yawn, twist and kick and will be working on his/her muscles. The baby’s cartilage will be turning into bone and the umbilical cord will become stronger and thicker. The vernix caseosa starts coating the skin, forming a protective, waterproof layer. From 19 weeks the baby’s nerve cells will start developing in the brain.
By week 21 the baby will be able to hear sounds inside and outside the mothers’ body. They may start to recognise and react to their parents’ voices and their hearing will continue to develop and become well establish within the next 2 weeks. The baby’s digestive and reproductive systems are also developing and preparing for after the delivery. He/she will be manufacturing meconium, a tarry black substance composed of the materials ingested so far in the pregnancy, such as mucus and lanugo.
The baby will gain weight rapidly over the next 4 weeks as they gain fat and muscle. He/she may start to swallow small amounts of amniotic fluid, possibly resulting in hiccups which may be felt as small jerks by the mother. They will start to make use of their bladder, passing small amounts of urine into the amniotic fluid. The baby will now have a heartbeat strong enough to be heard through a stethoscope and will be sleeping in cycles of 12-14 hours.
Between weeks 28 and 32 the baby will be practicing inhaling and exhaling as the lungs are maturing rapidly. The lanugo will start to fall out and the baby will begin to move to the birthing position. 3% of babies, however, will settle bottom first, known as the breech position. The baby’s nerve cells have developed so he/she can begin to make use of the 5 senses. Around week 30, the baby will be able to distinguish between light and dark.
Over the next few weeks (36-40) the lungs, brain and nervous system will have developed fully, although the skull bones will stay soft and slightly separated so that the delivery is easier. The baby’s skin will be getting smoother and smoother as he/she develops more fat. There will be less room for big movements and the head may be engaged already. By week 38 the baby is ready for the outside world, even though the due date will be week 40 as it is calculated from the first day of the mother’s last period.
1.2 Antenatal care is the care the mother will receive during her pregnancy to check the health of the baby. The mother will attend around 7-10 appointments depending on how many children they’ve had previously.
A balanced diet is essential for the baby’s healthy development so the mother will undergo various tests to asses her weight and height which is then used to calculate her BMI. The doctor needs to ensure the mother is in good condition to carry a baby so will advise the mother-to-be to eat healthily and if needed, lose a little weight.
Urine tests are also used to check for any infections. If protein and albumin are detected, an infection could be present and will need to be treated.
The mother’s blood pressure will be taken at almost every appointment as a rise in blood pressure could indicate pregnancy-induced hypertension. Pregnant woman should avoid stress as much as possible so as to not put pressure on the unborn baby.
Blood tests are performed regularly on pregnant women and help to screen for various conditions such as HIV, Syphilis and Hepatitis b, diabetes, Rhesus disease and anaemia.
Between weeks 15 and 20, amniocentesis tests can be carried out. The procedure consists of a needle extracting a sample of amniotic fluid which will be tested to rule out any abnormalities that could’ve occurred or may occur later in the pregnancy, such as Down’s syndrome, Spina bifida and sickle cell anaemia.
Immediately after birth the Apgar score test is carried out on the baby, a quick evaluation of the appearance of the baby, the baby’s pulse, reflexes and responses, muscle tone and movement as well as breathing rate and effort. These are scored out of 2. Any categories with a score of 0 will need urgent medical attention whilst a score of 1 would be given if the baby was struggling with any of the categories but nothing major enough to need immediate attention.
When the baby is around 5 days old, a blood spot test will be offered. This tests for any illnesses that may be present such as sickle cell disease, cystic fibrosis, congenital hypothyroidism and any metabolic diseases. Whilst this test is not compulsory, it is non-invasive and is done very quickly using a special device that collects 4 drops of blood onto a card to then be tested.
More postnatal checks will be undertaken to check both the mother’s and baby’s health. A visit is usually scheduled for around 6 weeks from the date of birth and a number of things are checked such as the weight and length of the baby as well as the weight and height of the mother, any stitches required after delivery can be checked or removed if needed and a cervical screening test may also be undertaken as after a pregnancy the mother’s short term risk for cancer increases due to the higher level of oestrogen.
These checks are the perfect time for the mother to ask questions and receive any help required. Any issues such as vaginal pain or the mother feeling particularly tired or depressed should be discussed with their doctor. Approximately 1 in 10 mothers go through postnatal depression and it is important that support is given through counselling, psychological therapy and/or antidepressants.
A Personal Child Health Record (PCHR) is often started during these checks, so the baby’s weight and height can be monitored, as well as any vaccinations given during the child’s early life. The baby’s heart, lungs, spine and genitals will also be checked by the doctor at 6 weeks to ensure correct development as well as checking the baby is generally happy and well-fed. For the child’s first year of life, regular visits will be made to the parents to assess the environment the baby is being brought up in.
1.3 It is important that a woman looks after her health when planning a pregnancy to reduce any risks or health issues for the expectant mother or the baby. Excessive smoking or drinking could impact the baby’s development and increase the chance of miscarriage so should be stopped at least 3 months before conception. Any medical conditions should be under control before pregnancy because conditions such as diabetes, obesity or asthma, which could affect the baby’s development, or could worsen due to the pregnancy. Before conceiving the parents should discuss certain things with a doctor such as the mother taking folic acid, as a lack of folic acid increases the baby’s risk of having spina bifida. Vaccines and screenings may be needed; for example, a Pap test and screenings for STIs, as well as ways to improve the mother’s overall health. Any health problems that run in the family should also be discussed, including any problems with previous pregnancies.
During the pregnancy, the mother’s immune system is affected resulting in the mother being more susceptible to bacteria, viruses, and parasites. Certain foods should be avoided to prevent illnesses such as Listeria and Toxoplasma as these can cause serious health problems to mother and/or the unborn baby. Examples of some foods to be avoided include soft cheese, some fish, and unpasteurised milk.
The main factors to impact the baby’s first year of life come under biological and environmental factors. The baby’s genetic makeup will determine certain things such as personality, intelligence and aggression, but these will also be affected by the baby’s environment. The baby’s upbringing by their parents/carers will influence certain characteristics and speed of development.