Perineum Massage
Education, Information, and Resources for 
"Pregnant Husbands" Dads, and Dads-To-Be

What is "Perineum Massage?

Husbands, Give Your Expecting-Wife a Perineum Massage to Help Protect Her Vulvovaginal and Perineum Area from Unnecessary Episiotomy - with up to 100 Stitches in this very sensitive area, as well as to prevent her vagina from tearing during childbirth.

Where is the "perineum"?

The perineum is the area located between your wife's vagina and her rectum. During labor and delivery, your wife's perineum is significantly stretched during vaginal delivery, and may tear, or be intentionally cut to prevent her vaginal area from tearing through a procedure called an episiotomy - which may later require 100 stitches or more. 

How To Give Your Wife a Perineum Massage

1.  Lubricate your fingers well with oil or water-soluble jelly. Some people have recommended wheat germ oil that is available at health food stores due to its high vitamin E content. However, other vegetable oils such as olive oil or water-based lubricants such as K-Y jelly or SurgiLube can also be used. 

Do not use mineral oil or petroleum jelly. 

After you have inserted your fingers into her vagina, be sure you wash your hands before placing your hands/fingers back into the lubricant jar again.

2.  Rub enough oil or jelly into the vaginal introitus and perineum area so that it allows your fingers to move smoothly over the tissue and lower vaginal wall.

3.  It is probably easiest for you to start by using your index fingers. Put the fingers (or thumb(s) well inside her vagina (up to the second knuckle) and move them upward along the sides of the vagina in a rhythmic U or sling-type movement. The massage will stretch the vagina (vaginal mucosa), the muscles surrounding the vagina, and the skin of the perineum. You can also massage by rubbing the skin of the perineum between the thumb and forefinger (thumb on the inside, finger on the outside or vice versa). In the beginning, this may will feel tight, but with time and practice, the tissues will relax and stretch.

4.  Your wife should concentrate on relaxing her vaginal muscles as you apply pressure. As you become comfortable with the Perineum Massage, increase the pressure just enough to make the perineum begin to sting from the stretching. You will need to ask your wife how much pressure to apply. This is the same vaginal stinging sensation that she will feel as your baby’s head is traveling through the vagina and at the end of the pushing stage.

5.  It is recommended that you perform Perineum Massage for 5-10 minutes daily from the 34th or 35th week of pregnancy until labor begins. 

Check with your Ob/Gyn if you or your wife have any questions.

Perineum Massage is only one way to help stretch the perineum. 

Remember, massage gently as vigorous massage could cause bruising or swelling. 

Do not perform Perineum Massage if your wife has an active vaginal infection or herpes lesions.

Before Pregnancy
If you are thinking about getting pregnant, or you are able to get pregnant, try to take care of your health as best as you can. Here’s what you can do:

• Get 400 micrograms (or 0.4 mg) of folic acid daily from foods fortified with folic acid, or a vitamin, or folic acid pill before you get pregnant and in the first three months while you’re pregnant. Folic acid (or folate) can help keep your baby from having birth defects. If you don't get enough folic acid, your baby’s spine may not form right. This is called spina bifida (spy-nuh bif-uh-duh). Also, without enough folic acid, your baby’s brain may not form or may only partly form. This is called anencephaly (an-en-seffelee). Many doctors will prescribe a vitamin for you that has folic acid. But you also can buy vitamins or folic acid pills at the drug store or grocery store. Taking folic acid in a pill is the best way to be sure you’re getting enough. You could get your folic acid though food alone, but it is hard to know if you’re getting enough. A healthy diet is always good for you and your baby though. Some foods with folate are leafy green vegetables, kidney beans, orange juice and other citrus fruits, peanuts, broccoli, asparagus, peas, lentils, and whole-grain products. Folic acid is also added to some foods like enriched breads, pastas, rice and cereals. 
  

  One half of all pregnancies are not planned! And women often don't realize that they are pregnant during the first couple of weeks. These are good reasons why you should always take care of your health. Your baby is counting on you for the best start at life!

• Start watching what you eat. Load up on your fruits, vegetables, and whole-grains (such as whole-wheat breads or crackers). Eat plenty of calcium-rich foods (such as non-fat or low-fat yogurt, milk, and broccoli) that your baby needs for strong bones and teeth. If you live in areas where fruits and vegetables aren’t in season, frozen vegetables are a good option. Avoid eating a lot of fatty foods (such as butter and fatty meats). Choose leaner foods when you can (such as skim milk, chicken and turkey without the skin, and fish). 

• Tell your doctor if you smoke or use alcohol or drugs. Quitting is hard, but you can do it. Ask your doctor for help.

• Get enough sleep (try to get seven to nine hours every night).

• If you can, control the stress in your life. When it comes to things like work and family, figure out what you can really do. Set limits with yourself and others. Don’t be afraid to say NO to requests for your time and energy.

• Move your body. Once you get pregnant, you cannot increase your exercise routine by much. So it’s best to start before the baby is on the way.

• Get any health problems under control. Talk to your doctor about how your health problems might affect you and your baby while pregnant. If you have diabetes, monitor your blood sugar levels. If you have high blood pressure, monitor these levels as well. If you are overweight, talk to your doctor about what a healthy weight is for you. Talk to your doctor about how your health problems might affect you and your baby while pregnant. There are things both you and your doctor can do to help you have a safe pregnancy and healthy baby.

• Ask your mother, aunts, grandmother and sisters about their pregnancies. Did they have morning sickness? Problems with labor? How did they cope with them?

• Find out what health problems run in your family. Tell these to your doctor. You can get tested before getting pregnant for some health problems that run in families (genetic testing).

• Make sure you have had all of your immunizations (shots), especially for Rubella (German measles). If you haven't had chickenpox or rubella, get the shots at least three months before getting pregnant.

• Get checked for hepatitis (hep-uh-tie-tus) B and C, sexually transmitted diseases (STDs), and HIV since these can harm both you and your baby. Tell your doctor if you or your sex partners have ever had an STD or HIV.

• Go over all of the medicines you take (prescriptions, over-the-counter medicines you buy without prescriptions, and herbals) with your doctor and ask if they are safe to take while you are trying to get pregnant or are pregnant.

Planning Conception

While planning to conceive, you may choose natural planning methods such as:

1.  The "ovulation method" which is a method used by couples trying to get pregnant, in which they have intercourse just before or after ovulation - and intercourse takes place just before or after ovulation. 

Or:

2.  The "symptothermal method" which is a method of pregnancy planning or birth control that combines certain aspects of the calendar, the basal body temperature, and the woman's cervical mucus methods. It takes into account all these factors as well as other symptoms a woman might have, such as slight cramping and breast tenderness (evaluating fertility based on your daily temperature). Remember: women are more likely to become pregnant if intercourse takes place just before or just after ovulation - which is the release of a single egg from a follicle that developed in the ovary. It usually occurs regularly, around day 14 of a 28-day menstrual cycle. This is because the unfertilized egg can live for only 12-24 hours in your body. If you have been trying for a few months with no results, don't get discouraged. Only 20% of women who are trying to get pregnant are successful on the first attempt, so don't lose hope or assume something is wrong.

Infertility

Women today are often delaying having children until later in life, when they are in their 30s and 40s. While many women in their 30s and 40s have no problems getting pregnant, fertility does decline with age. If you are over 40 and have not become pregnant after six months of trying, you should see your doctor for a fertility evaluation.

It is not uncommon to have trouble becoming pregnant or to experience infertility (inability to become pregnant after trying for one year). Overall, there are about 2.1 million married couples in America experiencing infertility, and some 9 million women have used fertility treatments. If you think that you or your partner may be infertile, you can discuss this with a health care provider who can recommend treatments such as drugs, surgery, or assisted reproductive technology.

Adoption and Foster Care

If infertility is a problem for you, other options you might want to consider are adoption and foster care. Adopting or becoming a foster parent could be one of the most rewarding experiences of your life. 

Fertility Awareness: The Menstrual Cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can be key to helping you plan a pregnancy, or avoid pregnancy. 

During the menstrual cycle (a total average of 28 days), there are two parts: 1. before ovulation: which is when a single egg from a follicle is released from one of the woman's two ovaries, that developed in the ovary. Ovulation usually occurs regularly, around day 14 of a 28-day menstrual cycle, which means 14 days after "day 1" of the woman's most recent menstruation or menstrual bleeding, and 2. after ovulation.

• Day 1 starts with the first day of your period.

• Usually by Day 7, a woman's eggs start to prepare to be fertilized by sperm.

• Between Day 7 and 11, the lining of the uterus (a woman's womb, or the hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum) which starts to thicken, waiting for a fertilized egg to implant there.

• Around Day 14 (in a 28-day cycle), hormones (which are substances produced by one tissue and conveyed by the bloodstream to another to effect a function of the body, such as growth or metabolism)
  cause the egg that is most ripe to be released, a process called ovulation. The egg travels down the woman's left or right fallopian tubes (part of the female reproductive system, these tubes carry eggs from the ovaries to the uterus (or womb) towards the uterus. If a sperm unites with the egg here, the egg will attach to the lining of the uterus, and pregnancy occurs.

• If the egg is not fertilized, it will break apart.

• Around Day 25 when hormone levels drop, it will be shed from the body with the lining of the uterus as a menstrual period.

The first part of the menstrual cycle is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern

If you are aware of when you are most fertile, this will help you plan or prevent a pregnancy. There are three ways that you can keep track of this time each month:

• Basal body temperature method - This involves taking your basal body temperature (your body's temperature when you're at rest) every morning before you get out of bed, and recording it on a fertility chart.  You will begin to know your own fertility pattern, and you can see the changes from month to month. During the menstrual cycle, your body temperature remains at a somewhat steady, lower level, and begins to slightly rise with ovulation. The rise can be a sudden jump or a gradual climb over a few days. The rise in temperature can't predict exactly when the egg is released, but your temperature rises between .4 to .8 degrees Fahrenheit on the day of ovulation. You are most fertile, and most likely to get pregnant during the two to three days just before your temperature hits the highest point (ovulation), and for about 12 to 24 hours after ovulation.
  
  A man's sperm can live for up to three days in your body and is able to fertilize an egg during that time. So, if you have unprotected sex several days before ovulation, there is a chance of becoming pregnant then. Once your temperature spikes and stays at a higher level for about three days, you can be sure that ovulation has occurred. Your temperature will remain at the higher level until your period starts.
  
  Basal body temperature differs slightly from woman to woman, but anywhere from 96 to 98 degrees orally is normal before ovulation, and anywhere from 97 to 99 degrees orally after ovulation. So, any changes that you chart are very small and are in 1/10 degree. You can buy an oral basal body temperature thermometer or an easy-to-read thermometer, which has the degrees marked in these small fractions, at a drug store. If you can't find it easily, ask the pharmacist to help you.

• Calendar method - This involves keeping a written record of each menstrual cycle on a regular calendar. The first day of your period is Day 1, which you can circle on the calendar. Continue doing this for eight to 12 months so you know how many days are in your cycle. The length of your cycle can vary from month to month, so write down the total number of days it lasts each time in a list. To find out the first day when you are most fertile, check your list and find the cycle with the fewest days. Then subtract 18 from that number. Take this new number and count ahead that many days on the calendar. Draw an X through this date. The X marks the first day you're likely to be fertile. To find out the last day when you are fertile, subtract 11 days from your longest cycle and draw an X through this date. This method always should be used with other fertility awareness methods, especially if your cycles are not always the same lengths.

• Cervical mucus method (also known as the ovulation method) - This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also cause changes in the kind and how much mucus you have just before and during ovulation. Right after your period, you usually have a few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the woman's vagina (which is the muscular canal that extends from the cervix to the outside of the body. The vaginal "walls" or vaginal mucosa, are lined with mucus membranes and tiny glands that make vaginal secretions) appears at the vaginal opening, and is usually white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation, which are called the "wet days," when the vaginal mucus becomes clear and slippery, like raw egg whites. Frequently, at this time, if you or your husband check the vaginal mucus with your fingers, the mucus can be stretched far apart without breaking between two fingers, such as the thumb and pointer finger. When the vaginal mucus can be separated apart between fingers, without breaking, or breaking after a considerable stretch, the woman is at her most fertile period. 

• About four days after the wet days begin, the mucus changes again. There is now much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. You can describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period, but maybe also a day or two before wetness begins. This method is less reliable for women whose mucus pattern is changed because of breastfeeding, use of oral contraceptives or feminine hygiene products, having vaginitis, sexually transmitted diseases (STDs), or surgery on the cervix.

To most accurately track your fertility, it is best to use a combination of all three methods, which is called the symptothermal method.

Infertility

It is not uncommon to have trouble becoming pregnant or to experience infertility. Infertility is defined as not being able to become pregnant, despite trying for one year, in women under age 35, or after six months in women 35 and over. Pregnancy is the result of a chain of events. As described in the Fertility Awareness (above) section, a woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

Reasons for Infertility

Age

There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30s and 40s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35.

As a woman ages, there are normal changes that occur in her ovaries and eggs. All women are born with over a million eggs in their ovaries (all the eggs that they will ever have), but only have about 300,000 left by the time a girl reaches puberty and her first menstrual period, or "menarche."  Then of these, only about 300 eggs will be ovulated during the reproductive years. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality.

"Ovarian Reserve" refers to the woman's health of the ovaries and eggs. It is an important factor in female fertility and decreases with age, and also refers to the number and quality of eggs in your ovaries and how well the ovarian follicles (each month, an egg develops inside the ovary in a fluid filled pocket called a follicle). This follicle releases the egg into the fallopian tube - respond to hormones in your body. As a woman reaches menopause (the end of menstrual bleeding, and ending of a woman's fertility), your ovaries don't respond as well to your hormones, and in time they may not release an egg each month. A reduced ovarian reserve is natural as a woman ages, but young women might have reduced ovarian reserves due to smoking, a prior surgery on their ovaries, or a family history of early menopause. Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down Syndrome.  Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage (early pregnancy loss).

Health Problems

Couples also can have fertility problems because of health problems, in either the woman or the man. Common problems with a woman's reproductive organs, like uterine fibroids - which are common, benign (noncancerous) tumors that grow in the muscle of the uterus, or womb. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain, and require treatment, endometriosis (a condition in which tissue that normally lines the uterus grows in other areas of the body, usually inside the abdominal cavity, but acts as if it were inside the uterus. Blood shed monthly from the misplaced tissue has no place to go, and tissues surrounding the area of endometriosis may become inflamed or swollen. This can produce scar tissue. Symptoms include painful menstrual cramps that can be felt in the abdomen or lower back, or pain during or after sexual activity, irregular bleeding, and infertility) and Pelvic Inflammatory Disease (an infection of the female reproductive organs that are above the cervix, such as the fallopian tubes and ovaries. It is the most common and serious problem caused by sexually transmitted diseases (STDs). PID can cause ectopic pregnancies, infertility, chronic pelvic pain, and other serious problems. Symptoms of PID include: fever, foul-smelling vaginal discharge, extreme pain, and vaginal bleeding)  can worsen with age and also affect fertility. These conditions might cause the woman's fallopian tubes (the left tube, right tube or both tubes) to be blocked, so the egg can't travel through the tubes into the uterus.

Some people also have diseases or conditions that affect their hormone levels, which can cause infertility in women and impotence and infertility in men. Polycystic ovarian syndrome (PCOS) is one such hormonal condition that affects many women, and is the most common cause of anovulation - or when a woman rarely or never ovulates. Another hormonal condition that is a common cause of infertility is when a woman has a 
luteal phase defect (LPD). A luteal phase is the time in the menstrual cycle between ovulation and the start of the next menstrual period. LPD is a failure of the uterine lining to be fully prepared for a fertilized egg to implant there. This happens either because a woman's body is not producing enough progesterone, or the uterine lining isn't responding to progesterone levels at some point in the menstrual cycle. Since pregnancy depends on a fertilized egg implanting in the uterine lining, LPD can interfere with a woman getting pregnant and with carrying a pregnancy successfully.

Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes, or surgery on the prostate gland.

If you or your partner has a problem with sexual function or libido, don't delay seeing your doctor for help.

Treating Infertility

You should talk to your doctor about your fertility if you:

• are under age 35 and, after a year of frequent sex without birth control, you are having problems getting pregnant, or

• are age 35 or over and, after six months of frequent sex without birth control, you are having problems getting pregnant, or

• believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).

Your doctor can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery, or Assisted Reproductive Technology.  Don't delay seeing your doctor because age also affects the success rates of these treatments.

Tests

The first step to treat infertility is to see a doctor for a fertility evaluation. He or she will test both the woman and the man, to find out where the problem is. Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape, and movement. Blood tests also can be done to check hormone levels. More tests might be needed to look for infection, or problems with hormones. These tests can include:

• an x-ray (to look at his reproductive organs)

• a mucus penetrance test (to see if sperm can swim through mucus)

• a hamster-egg penetrance assay (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs)

Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her doctor's office with an ultrasound test of the ovaries, or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test. FSH is produced by the pituitary gland.  In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen, and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include:

• an hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus)

• a laparoscopy (an exam of the tubes and other female organs for disease)

• an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal)

Other tests can be done to show whether the sperm and mucus are interacting in the right way, or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.

Drugs and Surgery

Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) uses special methods to help infertile couples, and involves handling both the woman's eggs and the man's sperm. Success rates vary and depend on many factors. But ART has made it possible for many couples to have children that otherwise would not have been conceived. ART can be expensive and time-consuming. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Also, some states have laws for infertility insurance coverage. Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Rhode Island, Texas, and West Virginia.

In vitro fertilization (IVF) is a type of ART that is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.

ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. And if a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.

A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.

1ST TRIMESTER OF YOUR/YOUR WIFE'S PREGNANCY

Changes in Your Body

During the first three months of pregnancy, or the first trimester, your body is undergoing many changes. As your body adjusts to the growing baby, you may have nausea, fatigue, backaches, mood swings, and stress. Just remember that these things are normal during pregnancy, as your body changes. Most of these discomforts will go away as your pregnancy progresses. And some women might not have any discomforts! If you have been pregnant before, you might feel differently with this pregnancy. Just as each woman is different, so is each pregnancy. And, as your body changes, you might need to make changes to your normal, everyday routine. Here are some of the most common changes or symptoms you might experience in your first trimester:

Tiredness

During your pregnancy, you might feel tired even when you've had a lot of sleep at night. Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest. After all, your body is working very hard to develop a whole new life. Tiredness will pass over time and be replaced with a feeling of well being and more energy. When you are tired, get some rest. Try to get about eight hours of sleep every night, and a nap during the day if you can. If you feel stressed, try to find a way to relax. You might want to start sleeping on your left side, if you find it more comfortable. This will relieve pressure on major blood vessels that supply oxygen and nutrients to the fetus. If you have high blood pressure during pregnancy, it is even more important to be on your left side when you are lying down.

Nausea and Vomiting

Usually called "morning sickness," nausea and vomiting are common during early pregnancy. For many women, though, it isn't limited to just the morning. Although it can seem like it will last forever, nausea and vomiting usually go away after the first trimester. Try some of these tips to help your nausea:

• Eat frequent, small meals (6 to 8 small meals a day, rather than 3 large meals).

• Avoid fatty, fried, or spicy foods.

• Try starchy foods, like toast, saltines, cheerios, or other dry cereals. Keep some by your bed and eat them before you get out of bed in the morning and when you get up in the middle of the night. Also keep some with you at all times, in case you feel nauseous.

• Try drinking carbonated drinks like ginger ale or seltzer water in between meals.

• Ask your doctor if you should stop taking your prenatal vitamin for a while if it adds to your morning sickness.

• Ask your doctor if you should take vitamin B6 treatments for severe nausea and vomiting that doesn't get better with the dietary changes listed above.

If you are vomiting a lot, you might want to call your doctor to make sure you don't get dehydrated (lose too much fluid in your body). When the nausea and vomiting begins to go away, try to resume a healthy eating plan, and take your prenatal vitamins.

Frequency of Urination

Running to the bathroom all the time? Frequent urination is common during pregnancy. Early in pregnancy, the growing uterus presses on your bladder. If you notice pain, burning, pus or blood in your urine see your doctor right away. You might have a urinary tract infection that needs treatment.

Constipation

As your uterus begins to expand, you might notice you're constipated. To prevent constipation, try to eat fresh or dried fruit, raw vegetables, and whole-grain cereals or breads everyday. Also, try to drink eight to ten glasses of water everyday. Some of these servings can be substituted with fruit or vegetable juice. Try to avoid caffeinated drinks (coffee, tea, colas, and some other sodas), since caffeine makes your body lose fluid and won't help with constipation.

Dizziness

Dizziness, feeling lightheaded, and even fainting can occur at any stage of pregnancy, since there now is extra blood going down towards your uterus and legs. You can help relieve these symptoms by lying down on your left side. Or to help prevent them, try moving around more instead of sitting or standing in one position for a long time.

Varicose Veins and Hemorrhoids

During pregnancy, pressure on the large veins behind the uterus causes the blood to slow in its return to the heart. This can lead to varicose veins in the legs and hemorrhoids (varicose veins in the vagina or around the anus). Varicose veins look like swollen veins raised above the surface of the skin. They can be twisted or bulging, and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg, anywhere from the groin to the ankle. You can try to prevent varicose veins during pregnancy by:

• Avoiding tight knee-highs or garters.

• Sitting with your legs and feet raised when possible. If you work at a desk, you can prop your feet up on a footstool, box or several books. Or when relaxing at home, keep your feet up on a footstool, some pillows on the couch, or another chair.

Leg Cramps

At different times during your pregnancy, you might have cramps in your legs or feet. This is due to a change in the way your body processes, or metabolizes, calcium. One way to prevent these cramps is to make sure to get enough calcium through non-fat or low-fat milk, and calcium-rich foods. You also get some calcium in your prenatal vitamin, but you might need to take a calcium supplement if you don't get enough through your diet. Talk with your doctor first about taking calcium supplements.

You can relieve leg and foot cramps by gently stretching the muscle. If you have a sudden leg cramp, flex your foot towards your body. If you point your foot to stretch your leg, the cramp could worsen. Wrapping a warm heating pad or warm, moist towel around the muscle also can help the muscle to relax.

Nosebleeds, Nasal Stuffiness, Bleeding Gums

These little discomforts are the result of hormonal effects on the tissues of your throat, mouth, and nose. They usually are not serious, and you might not even notice them. When you blow your nose, you might see a small amount of blood in the tissue. Blow gently, and stop a nosebleed by just squeezing your nose between your thumb and finger for a few minutes. See your doctor, though, if you have nosebleeds that do not stop in a few minutes or happen often. Any nasal stuffiness that you have during pregnancy should not be extreme and can be helped by drinking extra water, or with using a cool mist humidifier in your bedroom. Talk with your doctor before taking any over-the-counter or prescription medicines for colds or nasal stuffiness. You can help bleeding gums by brushing with a soft-bristled toothbrush and flossing daily.

Changes in Your Baby

By the end of this trimester, your baby is about three inches long and weighs about half an ounce. The eyes move closer together into their positions, and the ears also are in position. The liver is making bile, and the kidneys are secreting urine into the bladder. Even though you can't feel your baby move yet, your baby will move inside you in response to pushing on your abdomen.

Prenatal Care

Visits and Tests

During these special months of pregnancy, especially the early ones, visiting your doctor regularly is very important. Your doctor will schedule you for regular check-ups throughout the next nine months to keep your baby healthy and avoid problems with delivery. Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important! Pregnancy typically lasts 40 weeks, counting from the first day of your last menstrual period. The first trimester lasts 12 weeks, the second from 13 to the end of 27 weeks, and the third from 28 to 40 weeks. Your doctor will refer to your pregnancy by the age of the fetus in weeks.

During the first prenatal visit, your doctor will discuss important parts of your health history that may have some impact on your pregnancy. These include diseases, operations, and other pregnancies. There also will be questions about your family's health history. You will have a complete physical exam, lab tests, and a Pap test. From now on, your blood pressure, urine, and weight will be checked at every visit.

For special genetic or medical reasons, you may need other lab tests, like blood or urine tests, cultures for infections, or ultrasound exams. Your doctor will discuss them with you during your visits. Your doctor also will figure out your expected delivery date and answer questions about any concerns you might have.

Taking Care of Your Health

Smoking, Alcohol, and Drugs

By taking care of your health during pregnancy, you're also nurturing the new life inside of you.

• Quit smoking if you smoke, since smoking during pregnancy passes nicotine and cancer-causing drugs to your baby. Smoke also keeps your baby from getting needed nourishment while in your uterus, and raises the risk of fetal death and premature birth (a low-birth weight baby born too early).

• Quit drinking alcohol if you drink it. The exact amount of alcohol needed to cause problems in your baby is not known. But, drinking every day and drinking large amounts of alcohol once in a while both have been shown to have harmful effects on your baby.

• Tell your doctor if you are taking any medications or using illegal drugs. Some medicines can be harmful to your baby's development. Only take medicines prescribed or approved by your doctor. You should never take illegal drugs like marijuana, cocaine, heroin, speed (amphetamines), barbiturates, LSD, and others. Talk with your doctor right away if you need help with quitting smoking or drinking, or with a drug habit. You can also talk with a member of your faith community, a counselor, or a trusted friend.

A Healthy Diet

What you eat isn't only important for your own health anymore, but for the current and future health of your baby. Healthy foods are the building blocks for your growing baby since pregnancy is a complex time of developing new tissues and organs. Throughout pregnancy, try to make most of your food choices healthy ones.

Weight gain

Weight gain during your pregnancy depends on your height and how much you weighed before you became pregnant. All weight gain during pregnancy should be gradual, with most of the weight gained in the last trimester. During the first trimester, it is normal to gain only a small amount of weight, about one pound per month.

According to the American College of Obstetricians and Gynecologists (ACOG) if you were underweight before becoming pregnant, you should gain between 28 and 40 pounds during your whole pregnancy; if you were overweight, you should gain between 15 and 25 pounds during your whole pregnancy. Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later. Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

Exercise

If you have no medical problems with your pregnancy, regular physical activity (30 minutes per day, most days of the week), can help you have a more comfortable pregnancy and labor. It also helps to lower your risk for having health problems like high blood pressure and gestational diabetes. And you will have an easier time getting back into a healthy body shape and weight after the birth.

Normal, low-impact activities, like walking and swimming, that don't involve a lot of bouncing, stretching your muscles to their greatest extent, or deeply bending your joints, are good for you. Because your connective tissues stretch much more easily during pregnancy, high impact or high resistance exercises that involve a lot of bouncing and extreme muscle stretching can increase your risk of joint injury. If you haven't exercised regularly before becoming pregnant, you can still begin an exercise program. Just start slowly and progress gradually. Talk with your doctor first about what types of exercise or activities are best for you.

One type of exercise that can help your muscles prepare for delivery, help support your uterus during pregnancy, and help you to control your urine are pelvic floor exercises (also called Kegel exercises). Pelvic muscles are the same ones you use to stop and start your flow of urine. You can do this exercise standing, sitting, or lying down.

 
Bathing

Both baths and showers are fine to take during pregnancy, but very hot baths, hot tubs, and saunas can be harmful to the fetus, or cause you to faint. You also might want to avoid taking frequent bubble baths or baths with perfumed products that might irritate your vaginal area, and increase your risk of a urinary tract infection or yeast infection. Do not use vaginal douches, even vinegar-based douches, without first talking with your doctor. Although vaginal discharge tends to be heavier during pregnancy, you should see your doctor if you have vaginal itching, burning or a heavy discharge. You could have a urinary tract infection, yeast infection, viral or bacterial infection that needs treatment.

Caring for Your Mouth and Teeth

A pregnant woman's teeth and gums need special care. We know that pregnant women with gum disease problems are much more likely to have premature babies with low-birth weight. This may result from the transfer of bacterial microbes in the mother's mouth to the baby during the third trimester of pregnancy. The microbes can reach the baby through the placenta (a temporary organ joining the mother and fetus which supplies the fetus with blood and nutrients), through the amniotic fluid which is the fluid around the fetus, and through the layer of tissues in the mother's stomach.

Every expectant mother should have a complete oral exam prior to or very early in pregnancy. All needed dental work should be managed early, because having urgent treatment during pregnancy, while possible, can present risks. Interventions can be started to control risks for gum inflammation and disease. This also is the best time to change habits that may affect the health of teeth and gums, and the health of the baby. Remember to tell your dentist that you are pregnant! Brush with a soft toothbrush and floss gently at least twice a day. 

Sexual Relations

It is fine to have sexual intercourse throughout your pregnancy unless your doctor tells you otherwise. Some women who have had miscarriages need to avoid sexual intercourse during the first three months. You should contact your doctor if you have any of the following symptoms during sexual intercourse:

• pain in the vagina or abdomen

• bleeding from the vagina

• leaking of water (amniotic fluid) from the vagina

2ND TRIMESTER OF YOUR/YOUR WIFE'S PREGNANCY

Changes in Your Body

Most women find the second trimester of pregnancy to be easier than the first trimester, but it is important to stay informed about your pregnancy in this stage too. While you might notice that symptoms like nausea and fatigue are going away, you will see other new, more noticeable changes to your body. Your abdomen will expand as you gain weight and the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move! Many of the other symptoms you had in the first trimester might also continue, like constipation or leg cramps, so it is important to keep doing all of the healthy things you have already learned to help prevent or treat those symptoms. Here are some things you might experience during this trimester:

Aches and Pains

As your uterus and abdomen expands, you might feel pains in your abdomen, groin area, or thighs. You also can feel backaches or aching near your pelvic bone from the pressure of the baby's head, your increased weight, and the loosening joints in these areas. Lying down, resting, or applying heat can help resolve some of these aches and pains. If pains do not get better after rest, it is best to call your doctor.

Shortness of Breath

As your baby gets bigger inside your body, there will be increased pressure on all of your organs, including your lungs. You might begin to notice that you are short of breath or might not be able to catch your breath. Try taking deep, long breaths and try to maintain good posture so your lungs have room to expand. You might be able to breathe more freely at night by using an extra pillow or by sleeping on your side.

If you sleep on your left side, you will relieve pressure on major blood vessels that supply oxygen and nutrients to the fetus. If you have high blood pressure, it is even more important to be on your left side when you are lying down.

Stretch Marks and Other Skin Changes

You might have heard stories from family members or friends about the dreaded stretch marks from pregnancy. Stretch marks are red, pink, or purple streaks in the skin, usually over the thighs, buttocks, abdomen, and breasts. They are scars caused by the stretching of the skin, and usually appear in the second half of pregnancy. Only about half of all pregnant women get stretch marks though. They can start out as pink, reddish brown, or dark brown streaks, depending on your skin color. While creams and lotions can keep your skin well moisturized, they do not prevent stretch marks from forming. Most stretch marks fade after delivery to very light lines.

Besides stretch marks, you might notice other skin changes in the second half of your pregnancy. You might notice that your nipples are darker than before becoming pregnant, or that you have a dark line on your skin that runs down your abdomen from your belly button to your pubic hairline, called the linea nigra. You also might have blotchy brown pigmentations on your forehead, nose or cheeks. These skin changes are called melasma or chloasma. They are more common in darker-skinned women. These skin changes are caused by pregnancy hormones, and most of them will also fade or disappear after delivery.

Tingling and Itching

Tingling and numbness of the fingers and a feeling of swelling in the hands are common during pregnancy. These symptoms are due to swelling of tissues in the narrow passages in your wrists, and they should disappear after you deliver your baby. It also is common to feel itchy as your pregnancy progresses. Pregnancy hormones and your stretching skin, especially over your abdomen, probably are to blame for most of your discomfort. About 20 percent of all pregnant women have some kind of itching. And many pregnant women also get red and itchy palms and soles of their feet. Only in rare cases do pregnant women develop a condition called cholestasis of pregnancy, which is itching along with nausea, loss of appetite, vomiting, jaundice and fatigue. This condition is a sign of a serious liver problem. In general, itching most often goes away after delivery. In the meantime, you can relieve itching with moisturizers. You can also use only gentle soaps, and avoid hot showers or baths that can dry your skin. Try not to get over-heated since heat rash can make the itching worse.

Changes in Your Baby

By the 26^th week, your baby will weigh about 1¾ pounds and be about 13 inches long. With this growth comes the development of your baby's features, including fingers, toes, eyelashes, and eyebrows. Around the fifth month, you might feel your baby move! By the end of this trimester, all of your baby's essential organs like the heart, lungs, and kidneys are formed.

Prenatal Care

Visits and Tests

During the second trimester, your doctor will be able to see if your baby is developing in a healthy way and possibly see your baby’s sex. You will be offered screening tests to look for genetic birth defects. Birth defects result from problems with a baby’s chromosomes, part of his or her genes, which are passed down from both the mother and the father at conception. Even though most babies are born healthy, many genetic birth defects occur without a family history of that disorder. The risk for birth defects increases the most at the age of 35 and older. These are some of the tests that your doctor might offer you:

Screening Tests
Screening tests do not involve any risk to the fetus or to the mother. Screening tests give results in fractions or odds of having a birth defect, based on the mother’s age. So, although you will not receive a “yes” or “no” answer, women under the age of 35 will find out if their risk is as high as that of a 35 year old woman. For women over age 35, the tests help them find out if the risk for their age is increased or decreased.

• Targeted ultrasound – The best time to receive this test is between 18 and 20 weeks of pregnancy. Most major problems with the way your baby might be formed can be seen at this time. Some physical defects such as clubbed feet and heart defects may not be seen. Your doctor also will be able to see if your baby has any neural tube defects, such as spina bifida. In most cases, if you want to find out the sex of your baby, you can ask your doctor during this test. This test is not the most accurate for finding out whether your baby has Down syndrome.  Only 1 in 3 babies with Down syndrome may have an abnormal 2nd trimester ultrasound.

• Maternal serum marker screening (“the triple test”)–This test which looks for birth defects such as Down syndrome, trisomy 18, or an open neural tube defect, is usually given between 15 and 20 weeks of pregnancy. It involves giving a sample of your blood to look for 3 chemicals produced by the pregnancy: alpha-fetoprotein (AFP) (made by the liver of the fetus), and two pregnancy hormones, estriol and human gonadotropin. Higher levels of AFP are linked with open neural tube defects. In women age 35 and over, this test finds about 80% of fetuses with Down syndrome, trisomy 18, or an open neural tube defect. In this age group, there will be a false positive rate (having a positive result without actually having a fetus with one of these health problems) of 22%. In women under age 35, this test finds about 65% of fetuses with Down syndrome, and there is a false positive rate of about 5%.

• Nuchal translucency screening (NTS) – This new type of screening is offered between 11 and 14 weeks of pregnancy. It involves an ultrasound exam to look at the thickness at the back of the fetus’ neck combined with a blood test by sticking your finger to look at two proteins produced by the pregnancy. This test finds 90% of cases of Down syndrome and 97% of cases of trisomy 18. The false positive rate is about 5%. This test is not yet widely used, and not all doctors have access to it. In some cases, health insurance might not cover it. In England and in the United States, doctors who use the test feel that it is a good option for many women.

Diagnostic Tests
Diagnostic tests can give definite answers about whether your baby has a birth defect. But, unlike screening tests, they are invasive or present a risk of miscarriage. Amniocentesis and chorionic villus sampling (CVS) are the two most commonly used. Both tests are more than 99% accurate for finding these problems. These tests also can tell you your baby’s sex. In most cases, results take about two weeks.

• Amniocentesis – This test is performed in pregnancies of at least 16 weeks. It involves your doctor inserting a thin needle through your abdomen, into your uterus, and into the amniotic sac to take out a small amount of amniotic fluid for testing. The cells from the fluid are grown in a lab to look for problems with chromosomes. The fluid also can be tested for AFP.  About 1 in 200 women have a miscarriage as a result of this test.

• Chorionic villus sampling (CVS) – This test is performed between 10 and 12 weeks of pregnancy. It involves your doctor inserting a needle through your abdomen or inserting a catheter through your cervix to reach the placenta.  Your doctor will then take a sample of cells from the placenta that can be grown in a lab to look for problems with chromosomes. This test cannot find out whether your baby has open neural tube defects. About 1 in 200 women have a miscarriage as a result of this test.
  

When to Call Your Doctor

Now is a good time to learn the signs of pre-term or premature labor. Premature labor occurs when a woman has labor before she reaches the 37^th week of pregnancy, or three weeks before her due date. If you and your doctor see any symptoms of pre-term labor early, there is a better chance of stopping it. If symptoms are not treated, they can progress to repeated contractions that might cause the cervix to dilate (open) and cause an early birth of the baby. Premature babies need intensive care in the hospital after birth to help with their breathing, feeding, and regulation of body temperature.

Any woman can have pre-term labor, but some women have a higher risk because of problems with the uterus or placenta, or because of having had a pre-term birth with another pregnancy. Don't forget to drink plenty of water to keep from becoming dehydrated, especially in warm weather, since dehydration can cause pre-term labor.

Call your doctor right away if you have any of the following symptoms of pre-term labor:

• Contractions — You may or may not have pain, but your abdomen or stomach will get very hard (a feeling like it is tightening) and then relax, on and off.

• Menstrual-like cramping — You may or may not be uncomfortable with these cramps, but they feel like the cramps you can get before or when you start your menstrual period.

• Gas-type pains — Feels like sharp pains in your stomach, or like a stomach virus. You also can have diarrhea or nausea.

• Low pelvic pressure — Feels like the baby is putting a lot of heavy pressure down very low inside.

• Low backache — Can be a strong or a dull ache.

• Blood from your vagina — Can be either light spotting or more blood like during a menstrual period. Blood can be red or brown in color.

• Increased discharge from your vagina — Much more discharge than what you are used to during your pregnancy. Can even be a sudden gush of a lot of water, or a small trickle or leak of water that is continuous. Discharge can be watery, pinkish, or brownish in color.

Caring For Yourself

Make sure to continue the healthy behaviors that you learned in your 1st trimester to care for yourself and the precious life inside of you.

Weight Gain

Everyone gains weight at different rates, but on average, it is normal to gain about one pound per week, or about three to four pounds per month during this trimester.

3RD TRIMESTER OF YOUR/YOUR WIFE'S PREGNANCY

Changes in Your Body

You could still be having some of the same discomforts you had in your second trimester, but now you will notice that you may have to go to the bathroom more often or that you find it even harder to breathe. This is because the baby is getting bigger and it is putting more pressure on your organs. Don't worry, your baby is fine and these problems will lessen once you give birth. You also might have some of these changes:

Heartburn

As your baby gets bigger, your uterus pushes on your stomach and can cause heartburn, especially before bedtime or right after you eat. Continue to avoid greasy, fried foods and eat six to eight smaller meals instead of large meals. You also can take small sips of milk or eat small pieces of chipped ice. If your heartburn is severe and doesn't improve with these tips, talk with your doctor. Also talk with your doctor before taking an antacid medication.

Swelling

As you near the end of your pregnancy, you might notice more swelling than you had before, especially in your ankles, fingers and face. Continue to drink lots of fluids (water is best) and rest when you can with your feet elevated. If you notice sudden, extreme swelling in any of these areas, or have a rapid significant weight gain, call your doctor right away. This could be a sign of preeclampsia or toxemia. 

Hemorrhoids

You might begin to experience more discomfort from hemorrhoids now from the increased pressure of your growing baby on the veins in your rectum. You might also be constipated, which makes hemorrhoids worse because you might strain for a bowel movement. Try to avoid hemorrhoids by drinking lots of fluids and eating plenty of whole grains, raw or cooked leafy green vegetables, and fruits. Try not to strain for bowel movements, and always talk with your doctor before taking a laxative.

Tender Breasts

Your breasts have most likely increased in size and fullness as your pregnancy has advanced. As you near the end of your pregnancy, hormones in your body cause your breasts to increase even more in size, to prepare for breastfeeding. Your breasts can feel full and heavy, and they might be tender or uncomfortable. Wearing a well-fitting maternity or nursing bra will help you be more comfortable, because these types of bras offer extra support. Some pregnant women begin to leak colostrum in the third trimester. Colostrum is the first milk that your breasts produce for your baby. It is a thick, yellowish fluid that contains antibodies that protect new babies from infections. If leaking becomes a problem for you, you can purchase disposable or cloth nursing pads (that you can use when nursing your newborn) to place inside your bra.

Now and after delivery, it is a good idea to only wash your nipples with water instead of soap. Soap might cause the skin of your nipples to become dry, irritated and crack. If you do have skin cracks, which can be sore and painful, use a heavier cream that contains lanolin for extra moisture.

Changes in Your Baby

Your baby is still growing and moving, but now it has less room in your uterus. Because of this, you might not feel the kicks and movements as much as you did in the second trimester. During this final stage of your pregnancy, your baby is continuing to grow. Even before your baby is born it will be able to open and close its eyes and might even suck its thumb. As your body starts to prepare for the birth, your baby will start to move into its birth position. You might notice the baby "dropping," or moving down lower in your abdomen. This can reduce the pressure on your lungs and rib cage, making it easier to breathe or not to get out of breath so fast. As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor can check your progress with a vaginal exam. And, your visits to your doctor may increase the month before you give birth. The average baby is about 20 to 22 inches long and weighs approximately 7 1/2 pounds at birth, but anywhere between 5 pounds, 11 1/2 ounces and 8 pounds, 5 3/4 ounces is a healthy range for newborns.

Prenatal Care

Visits and Tests

Be sure to continue to visit your doctor, and ask him or her to answer your questions and address your concerns about labor and delivery. As the birth of your baby gets closer, you and your doctor will discuss what kind of delivery you will have. Some women need to have a cesarean section (c-section), in which a surgical incision is made in the abdomen and uterus to remove the baby. If you are able to plan on a non-surgical, vaginal birth, you may want to have your baby naturally, without medications, and you may want to take a childbirth class. Many women find childbirth classes very helpful, even if they have already had a baby. And, women also bring their partners or a friend or relative to these classes, particularly if this person will be with them to offer support and coaching during the birth of their baby.

Inducing Labor

Did you know that only five percent of babies are actually born on their due dates? If you have past your due date, this is normal and does not mean anything is wrong. In some pregnancies though, your doctor might have concerns about the baby's and/or your health, and labor needs to be induced. Inducing labor means that your doctor will start your labor through artificial means. Most doctors will wait one to two weeks after a woman's due date before considering inducing. Some reasons why a woman might need to have labor induced include:

• A woman might have a chronic illness like high blood pressure or diabetes that threatens the health of the baby.

• The baby might not be growing or thriving in the uterus. Sometimes, the uterus can become unhealthy for the baby.

• A woman might have the membranes that surround the fetus rupture (or have her "water break") without going into labor naturally within a reasonable amount of time.

Labor can be induced during a vaginal exam — your doctor might rupture or strip the membranes surrounding the fetus or insert a gel or suppository containing a hormone to stimulate contractions. A drug called Pitocin can also be given intravenously (put into your body through a vein in your arm or hand) to start contractions.

Deciding to Breastfeed or Bottle-Feed

If you haven't thought about whether you will breastfeed or bottle-feed your baby, this is the time to learn more about both, and make a decision about what you plan to do. Breastfeeding has many more advantages over formula for your health and your baby's health. Discuss breastfeeding with your doctor or with a pediatrician, and then make a decision that is right for you. Click here to learn more about the benefits of breastfeeding, how to make it work best for you, and for tips on breastfeeding after returning to work.

When to Call Your Doctor

Before your due date, make sure to talk with your doctor about how to reach him or her if you go into labor. It's also helpful to be familiar with the hospital or birthing center, where you should park, and where to check in ahead of time. Know that sometimes you can think you're in labor, but really are not (called false labor). This happens to many women, so don't feel embarrassed if you go to the hospital certain that you are in labor, only to be sent home! It's always better to be seen by a doctor as soon as possible once labor has begun. Here are the signs of true labor:

 Caring For Yourself

Make sure to continue the healthy behaviors that you learned in your first trimester. Many pregnant women feel great in their last trimester and still have lots of energy. But, your energy may lessen as you enter your 9^th month and you may begin to slow down. This is completely normal. It's important to get enough rest now, even though it might seem difficult to sleep as you get larger. Your baby's stretching movements, having to urinate often, and an increase in your body's metabolism might interrupt or disturb your sleep. And, if you are having any leg cramping, this can affect your sleep as well.

You might have a better night's sleep if you try to avoid eating large meals three hours before going to bed. You can also try some mild exercise like walking, which can help relieve stress and may improve sleep. Avoid long naps during the day. If you can't sleep because you are anxious about becoming a mother or about your labor and delivery, try talking with your partner or friends who've been through this before. You can also talk with your doctor or nurse.

Weight Gain

Everyone gains weight at different rates, but on average, it is normal to gain about one pound per week, or three to four pounds per month, during the third trimester. By the end of your pregnancy you should have gained, on average, about 25 to 30 pounds. About 7 1/2 pounds of that weight should be the baby.

Why is a healthy diet important before and during pregnancy?

What you eat every day, even before you are pregnant, is important for your health as well as for the health of your baby. Your diet before pregnancy and while you are pregnant should contain the vitamins and nutrients that your body will need to help your baby develop and grow the way he or she should. Practice healthy eating and take a multivitamin each and every day. Start this good habit before you become pregnant and continue eating healthy and taking a prenatal multivitamin throughout your pregnancy. If you need help choosing healthy foods or have questions about how to improve your diet for your future baby, ask a health professional at your doctor’s office or at a local clinic.

How should my diet change now that I am pregnant?

If you are eating a healthy diet before you become pregnant, you may only need to make a few changes to meet the nutritional needs of pregnancy. According to the American Dietetic Association, pregnant women should increase their usual servings of a variety of foods from the four basic food groups (up to a total of 2,500 to 2,700 calories daily) to include the following:

Fruits and Vegetables –

Seven or more servings of fruits and vegetables combined (three servings of fruit and four of vegetables) daily for vitamins and minerals. Fruits and vegetables with vitamin C help you and your baby to have healthy gums and other tissues, and help your body to heal wounds and to absorb iron. Examples of fruits and vegetables with vitamin C include strawberries, melons, oranges, papaya, tomatoes, peppers, greens, cabbage, and broccoli. Fruits and vegetables also add fiber and other minerals to your diet and give you energy. Plus, dark green vegetables have vitamin A, iron, and folate, which are important nutrients during pregnancy.

Whole-grains or Enriched Breads/Cereals –

Aim for nine or more servings. Whole grain products and enriched products like bread, rice, pasta, and breakfast cereals contain iron, B vitamins, some protein, minerals, and fiber that your body needs. Some breakfast cereals have been enriched with 100% of the folic acid your body needs each day. Folic acid has been shown to help prevent some serious birth defects. Choosing a breakfast cereal or other enriched grain products that contain folic acid is important before and during pregnancy.

 Dairy Products –

Aim for four or more servings of low-fat or non-fat milk, yogurt, or other dairy products like cheese for calcium. You and your baby need calcium for strong bones and teeth. Dairy products also have vitamin A and D, protein, and B vitamins. Vitamin A helps growth, resistance to infection, and vision. Pregnant women need 1,000 milligrams (mg) of calcium each day. If you are 18 or younger, you need 1,300 mg of calcium each day. Try to have low-fat or non-fat milk and milk products to lower your fat intake. Other sources of calcium include dark green leafy vegetables, dried beans and peas, nuts and seeds, and tofu. If you are lactose intolerant or can’t digest dairy products, you can still get this extra calcium. There are several low-lactose or reduced-lactose products available. In some cases, your doctor might advise you to take a calcium supplement.

Proteins –

Pregnant women need about 60 grams of protein per day. This is about the same as two or more 2-3 oz. servings of cooked lean meat, poultry without the skin or fish, or two or more 1 oz. servings of cooked meat. Don’t eat uncooked or undercooked meats or fish. These can make you sick. Pregnant women should avoid deli luncheon meats, also. Eggs, nuts, dried beans, and peas also are good forms of protein. Most women in this country have no problem getting at least this amount of protein each day. Protein builds muscle, tissue, enzymes, hormones, and antibodies for you and your baby. These foods also have B vitamins and iron, which is important for your red blood cells. Your need for protein in the first trimester is small, but grows in your second and third trimesters when your baby is growing the fastest, and your body is working to meet the needs of your growing baby.

Should I limit how much fish I eat when I’m pregnant?

Some fish have mercury, which, in high doses, can hurt your baby’s growing brain and nervous system. There are some fish you should NOT eat if you are pregnant. Here are some guidelines:

• Do not eat any shark, swordfish, king mackerel, or tilefish (also called golden or white snapper) because these fish have high levels of mercury.

• Do not eat more than six ounces of “white” or “albacore” tuna or tuna steak each week.

Limit your fish to no more than 2 servings (12 ounces total) per week. When you eat fish, choose shrimp, salmon, pollock, catfish, or “light” tuna as they are usually low in mercury. 

What other nutrients do I need for a healthy pregnancy?

Folic acid: Folic acid is an important vitamin for any woman who could possibly become pregnant. Folic acid is a B vitamin that helps prevent serious birth defects of a baby’s brain or spine (called neural tube defects) and other birth defects like cleft lip and congenital heart disease. Folic acid is needed very early in pregnancy, usually before a woman knows she is pregnant. That is why it’s so important that every woman who could possibly become pregnant gets enough folic acid every single day, starting at least one month before pregnancy. One easy way to ensure getting enough folic acid every day is to take a daily multivitamin. Most multivitamins sold in the U.S. contain enough folic acid for the day. Check the label! Your vitamin should contain 400 micrograms (400 mcg) or 100% of the Daily Value (DV) for folic acid. Another way to get enough folic acid is to eat a serving of breakfast cereal that contains 100% (DV) for folic acid, every day. Just check the nutrition label to be sure—look for “100%” next to folic acid. So, eat a healthy diet that contains plenty of fruits and vegetables, and don’t forget to get your folic acid. Every day!

Iron: You need iron to keep your blood healthy for you and your baby. Bones and teeth also need iron to develop properly. Too little iron can cause a condition called anemia. If you have anemia, you might look pale and feel very tired. Your doctor can check for signs of anemia through the routine blood tests that are taken in different stages of your pregnancy. All pregnant women should take a low-dose iron supplement, beginning at the first prenatal visit, or even before, when you are planning to get pregnant. Prenatal vitamins that your doctor prescribes or that you find over the counter usually have the amount of iron you need. Check the label to make sure they contain iron. If your doctor finds that you have anemia, he or she will give you a higher dose of iron supplements to take once or twice a day. You can help prevent anemia by eating more iron-rich foods like lean red meat, fish, poultry, dried fruits, whole-grain breads, and iron-fortified cereals.

Water: Water plays a key role in your diet during pregnancy. It carries the nutrients from the foods you eat to your baby and helps prevent you from getting constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Drinking enough water, especially in your last trimester, prevents you from becoming dehydrated. Not getting enough water can then lead you to have contractions and premature or early labor. Pregnant women should drink at least six eight-ounce glasses of water per day and another glass for each hour of activity. You can drink juices for fluid, but they also have a lot of calories and can cause you to gain extra weight. Coffee, soft drinks, and teas that have caffeine actually reduce the amount of fluid in your body, so they cannot count towards the total amount of fluid you need.

Should I take a multivitamin during my pregnancy?

Even women who plan carefully to eat healthy every day can be missing out on some important nutrients like folic acid, which helps prevent serious birth defects of your baby’s brain and spine. Those birth defects happen before most women know they are pregnant. To be certain that you are getting enough folic acid and other vitamins, it is helpful to take a daily multivitamin or prenatal vitamin, starting before you get pregnant. But, don’t overdo it—taking more than one multivitamin daily can be harmful.

How much weight should I gain during pregnancy?

You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Good rates of weight gain are about two to four pounds during the first three months of pregnancy and three to four pounds per month for the rest of the pregnancy. The average total weight gain should be about 25 to 30 pounds. But, the amount you gain might be slightly less or more, depending on your weight before you became pregnant and your height.

According to the American College of Obstetricians and Gynecologists (ACOG):

• If you were underweight before becoming pregnant, you should gain between 28 and 40 pounds.

• If you were overweight before becoming pregnant, you should gain between 15 and 25 pounds.

Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later.

Total weight gained during pregnancy includes six to eight pounds for the weight of the baby. The remaining weight consists of a higher fluid volume, larger breasts, larger uterus, amniotic fluid, and the placenta. Make sure to visit your doctor throughout your pregnancy so he or she can check on your weight gain.

Is it hard to lose weight after pregnancy?

It can be hard to lose weight after you have your baby if you gained too much weight during pregnancy. During pregnancy, fat deposits can increase by more than one-third of the total amount you had before becoming pregnant. If weight gain during pregnancy is normal, most women lose this extra weight in the birth process and in the weeks and months after birth. Breastfeeding also can help to deplete the fat gained during pregnancy by helping the body to expend at least 500 more calories each day. 

Should I avoid drinking alcohol while I am pregnant?

There is no safe time during pregnancy for you to drink alcohol. There is also no known safe amount of alcohol to drink during pregnancy. When you are pregnant and you drink beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into your blood. The alcohol in your blood goes to your baby through the umbilical cord. When the alcohol enters the baby's body, it can slow down the baby’s growth, affect the baby’s brain, and cause birth defects. Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in a person whose mother drank alcohol during pregnancy. Some people with FASD may have abnormal facial features and growth and central nervous system problems. People with FASD may have problems with learning, memory, attention span, communication, vision, and/or hearing. These problems often lead to problems in school and problems getting along with others. The effects of FASD last a lifetime. If you are pregnant and have been drinking alcohol, stop drinking now to protect your baby. If you need help to stop drinking, talk with your doctor or nurse. 

Should I avoid caffeine while I am pregnant?

Caffeine is a stimulant found in colas, coffee, tea, chocolate, cocoa, and some over-the-counter and prescription drugs. Consumed in large quantities, caffeine can cause irritability, nervousness and insomnia as well as low birth-weight babies. Caffeine is also a diuretic and can dehydrate your body of valuable water. Some studies show that caffeine intake during pregnancy can harm the fetus. Until more is known, you should avoid caffeine. Caffeine is an ingredient in many over-the-counter and prescription drugs. Talk with your doctor before taking any drugs or medicines while pregnant.

Why do pregnant women crave certain foods?

The "pickles and ice cream" choices and other appetite cravings of pregnant women might be reflections of the changes in nutritional needs. The fetus needs nourishment, and the mother’s body begins to absorb and metabolize nutrients differently. These changes help ensure normal development of the baby and fill the demands of lactation, or breastfeeding, after the baby is born.

Do I really need to "eat for two?"

While you are pregnant, you will need additional nutrients to keep you and your baby healthy. But, that does not mean you need to eat twice as much. You should increase your caloric intake with only 300 calories per day. A baked potato has 120 calories, so getting those extra 300 calories should not be that hard.

Make sure not to restrict your diet during pregnancy. If you do, you might not get the right amounts of protein, vitamins, and minerals that are necessary to properly nourish your unborn baby. Low-calorie intake can cause a pregnant mother’s stored fat to break down, leading to the production of substances called ketones. Ketones, which can be found in the mother's blood and urine, are a sign of starvation or a starvation-like state. Constant production of ketones can result in a mentally retarded child.

What about diabetes and nutrition during pregnancy?

If you already have diabetes and would like to get pregnant, your chances of having a healthy baby are good. But, it’s important to plan your pregnancy and follow these steps:

• Bring your diabetes under control before you get pregnant. Try to get your blood sugar under control three to six months before you get pregnant.

• Keep your blood sugar under control during your pregnancy. Keep food, exercise, and insulin in balance. Talk with your doctor or a registered dietitian to help you follow a special meal plan. Remember, as your baby grows, your body changes, and these changes will affect your sugar levels. If your blood sugar rises too high, the increased sugar crossing into the placenta can result in a large, over-developed fetus with birth defects or an infant with blood sugar level problems.

• Be sure to get enough of the B vitamin folic acid, every day. Women with diabetes might be at increased risk for having a baby with a serious birth defect. Getting enough folic acid each day can help reduce this risk.

Gestational diabetes is a form of diabetes that begins during pregnancy and usually goes away after the birth of the baby. If you have gestational diabetes, this means that you have a high amount of sugar in your blood during pregnancy. This form of diabetes can be controlled through diet, medication, and exercise, but if left untreated, gestational diabetes can cause health problems for both you and your baby. If you develop gestational diabetes, your doctor will refer you to a registered dietitian who can help you with special meal plans to control your blood sugar.

Why do I get morning sickness and nausea, and what can I do about it?

Morning sickness and nausea are common problems for pregnant women. Most nausea occurs during the early part of pregnancy and, in most cases, will subside once you enter the second trimester. For some women, morning sickness and nausea might last longer than the early stages of pregnancy or even throughout the entire nine months.

The changes in your body might cause you to be nauseated or to vomit when you smell or eat certain things, wh