Pregnancy and Childbirth

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

Whileplanning 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 afterovulation - 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 thewoman'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 breasttenderness (evaluating fertility based on your daily temperature). Remember:women are more likely to become pregnant if intercourse takes place just beforeor 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 firstattempt, so don't lose hope or assume something is wrong.

Infertility

Women today are often delaying having children until later in life, when theyare in their 30s and 40s. While many women in their 30s and 40s have no problemsgetting pregnant, fertility does decline with age. If you are over 40 and havenot become pregnant after six months of trying, you should see your doctor for afertility evaluation.

Itis not uncommon to have trouble becoming pregnant or to experience infertility(inability to become pregnant after trying for one year). Overall, there areabout 2.1 million married couples in America experiencing infertility, and some9 million women have used fertility treatments. If you think that you or yourpartner may be infertile, you can discuss this with a health care provider whocan recommend treatments such as drugs, surgery, or assisted reproductivetechnology.

Adoption and Foster Care

Ifinfertility is a problem for you, other options you might want to consider areadoption and foster care. Adopting or becoming a foster parent could be one ofthe most rewarding experiences of your life. 

Fertility Awareness: The Menstrual Cycle

Being aware of your menstrual cycle and the changes in your bodythat happen during this time can be key to helping you plan a pregnancy, oravoid 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 fromone 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 recentmenstruation 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.

Thefirst part of the menstrual cycle is different in every woman, and even can bedifferent from month-to-month in the same woman, varying from 13 to 20 dayslong. This is the most important part of the cycle to learn about, since this iswhen ovulation and pregnancy can occur. After ovulation, every woman (unless shehas a health problem that affects her periods) will have a period within 14 to16 days.

Charting Your Fertility Pattern

If you are aware of when you are most fertile, this will help you plan or prevent apregnancy. 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.

Tomost accurately track your fertility, it is best to use a combination of allthree methods, which is called the symptothermal method.

Infertility

Itis not uncommon to have trouble becoming pregnant or to experience infertility.Infertility is defined as not being able to become pregnant, despite trying forone 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 FertilityAwareness (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. Aman's sperm must join with (fertilize) the egg along the way. The fertilized eggmust then become attached to the inside of the uterus. While this may seemsimple, in fact many things can happen to prevent pregnancy.

Reasons for Infertility

Age

Thereare many different reasons why a couple might have infertility. One isage-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. Birthcontrol is easy to obtain and use, more women are in the work force, women aremarrying at an older age, the divorce rate remains high, and married couples aredelaying pregnancy until they are more financially secure. But the older youare, the harder it is to become pregnant. Women generally have some decrease infertility starting in their early 30s. And while many women in their 30s and 40shave no problems getting pregnant, fertility especially declines after age 35.

Asa woman ages, there are normal changes that occur in her ovaries and eggs. Allwomen are born with over a million eggs in their ovaries (all the eggs that theywill ever have), but only have about 300,000 left by the time a girl reachespuberty and her first menstrual period, or "menarche."  Then ofthese, only about 300 eggs will be ovulated during the reproductive years. Eventhough menstrual cycles continue to be regular in a woman's 30s and 40s, theeggs that ovulate each month are of poorer quality than those from her 20s. Itis 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 withage, and also refers to the number and quality of eggs in your ovaries and howwell the ovarian follicles (each month, an egg develops inside the ovary in a fluid filled pocket called afollicle). This follicle releases the egg into the fallopian tube - respond tohormones in your body. As a woman reaches menopause (the end of menstrualbleeding, and ending of a woman's fertility), your ovaries don't respond as wellto your hormones, and in time they may not release an egg each month. A reducedovarian reserve is natural as a woman ages, but young women might have reducedovarian reserves due to smoking, a prior surgery on their ovaries, or a familyhistory of early menopause. Also, as a woman and her eggs age, if she becomespregnant, there is a greater chance of having genetic problems, such as having ababy with Down Syndrome.  Embryos formed from eggs in older women also areless likely to fully develop, a main reason for miscarriage (early pregnancyloss).

HealthProblems

Couplesalso can have fertility problems because of health problems, in either the womanor the man. Common problems with a woman's reproductive organs, like uterinefibroids - which are common, benign (noncancerous) tumors that grow in themuscle of the uterus, or womb. Fibroids often cause no symptoms and need notreatment, and they usually shrink after menopause. But sometimes fibroids causeheavy 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, andinfertility) 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. Symptomsof PID include: fever, foul-smelling vaginal discharge, extreme pain, and vaginalbleeding)  can worsen with age and also affect fertility. These conditionsmight cause the woman's fallopian tubes (the left tube, right tube or bothtubes) to be blocked, so the egg can't travel through the tubes into the uterus.

Somepeople also have diseases or conditions that affect their hormone levels, whichcan cause infertility in women and impotence and infertility in men. Polycysticovarian syndrome (PCOS) is one such hormonal condition that affects manywomen, and is the most common cause of anovulation - or when a woman rarely ornever ovulates. Another hormonal condition that is a common cause of infertilityis when a woman has a 
luteal phase defect (LPD). A luteal phase is the time in the menstrual cyclebetween ovulation and the start of the next menstrual period. LPD is a failureof the uterine lining to be fully prepared for a fertilized egg to implantthere. This happens either because a woman's body is not producing enoughprogesterone, or the uterine lining isn't responding to progesterone levels atsome point in the menstrual cycle. Since pregnancy depends on a fertilized eggimplanting in the uterine lining, LPD can interfere with a woman gettingpregnant and with carrying a pregnancy successfully.

Certainlifestyle choices also can have a negative effect on a woman's fertility, suchas smoking, alcohol use, weighing much more or much less than an ideal bodyweight, a lot of strenuous exercise, and having an eating disorder.

Unlikewomen, some men remain fertile into their 60s and 70s. But as men age, theymight begin to have problems with the shape and movement of their sperm, andhave a slightly higher risk of sperm gene defects. They also might produce nosperm, or too few sperm. Lifestyle choices also can affect the number andquality of a man's sperm. Alcohol and drugs can temporarily reduce spermquality. And researchers are looking at whether environmental toxins, such aspesticides and lead, also may be to blame for some cases of infertility. Menalso can have health problems that affect their sexual and reproductivefunction. These can include sexually transmitted diseases (STDs), diabetes, orsurgery on the prostate gland.

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

Treating Infertility

Youshould 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).

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

Tests

Thefirst 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 problemis. Testing on the man focuses on the number and health of his sperm. The labwill 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. Moretests might be needed to look for infection, or problems with hormones. Thesetests 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)

Testingfor the woman first looks at whether she is ovulating each month. This can bedone by having her chart changes in her morning body temperature, by using anFDA-approved home ovulation test kit (which she can buy at a drug store), or bylooking at her cervical mucus, which changes throughout her menstrual cycle.Ovulation also can be checked in her doctor's office with an ultrasound test ofthe 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 helpscontrol the menstrual cycle and the production of eggs by the ovaries. Theamount of FSH varies throughout the menstrual cycle and is highest just beforean 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 cannotachieve 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)

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

Drugs and Surgery

Differenttreatments for infertility are recommended depending on what the problem is.About 90 percent of cases are treated with drugs or surgery. Various fertilitydrugs may be used for women with ovulation problems. It is important to talkwith your doctor about the drug to be used. You should understand the drug'sbenefits and side effects. Depending on the type of fertility drug and thedosage of the drug used, multiple births (such as twins) can occur in somewomen. 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 canbe corrected by surgery.

Assisted Reproductive Technology (ART)

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

Invitro fertilization (IVF) is a type of ART that is often used when awoman's fallopian tubes are blocked or when a man has low sperm counts. A drugis used to stimulate the ovaries to produce multiple eggs. Once mature, the eggsare 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 becomefertilized by the sperm and are dividing into cells. These fertilized eggs(embryos) are then placed in the woman's uterus, thus bypassing the fallopiantubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, butused when the woman has at least one normal fallopian tube. Three to five eggsare placed in the fallopian tube, along with the man's sperm, for fertilizationinside the woman's body. Zygote intrafallopian transfer (ZIFT), alsocalled tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from thewoman's ovaries are fertilized in the lab and placed in the fallopian tubesrather than the uterus.

ARTsometimes involves the use of donor eggs (eggs from another woman) or previouslyfrozen embryos. Donor eggs may be used if a woman has impaired ovaries or has agenetic disease that could be passed on to her baby. And if a woman does nothave any eggs, or her eggs are not of a good enough quality to produce apregnancy, she and her partner might want to consider surrogacy. Asurrogate is a woman who agrees to become pregnant using the man's sperm and herown egg. The child will be genetically related to the surrogate and the malepartner, but the surrogate will give the baby to the couple at birth.

Agestational carrier might be an option for women who do not have auterus, from having had a hysterectomy, but still have their ovaries, or forwomen who shouldn't become pregnant because of a serious health problem. In thiscase, the woman's eggs are fertilized by the man's sperm and the embryo isplaced inside the carrier's uterus. In this case, the carrier will not berelated 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

Duringthe first three months of pregnancy, or the first trimester, your body isundergoing many changes. As your body adjusts to the growing baby, you may havenausea, fatigue, backaches, mood swings, and stress. Just remember that thesethings are normal during pregnancy, as your body changes. Most of thesediscomforts will go away as your pregnancy progresses. And some women might nothave any discomforts! If you have been pregnant before, you might feeldifferently with this pregnancy. Just as each woman is different, so is eachpregnancy. And, as your body changes, you might need to make changes to yournormal, everyday routine. Here are some of the most common changes or symptomsyou might experience in your first trimester:

Tiredness

Duringyour pregnancy, you might feel tired even when you've had a lot of sleep atnight. 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. Tirednesswill pass over time and be replaced with a feeling of well being and moreenergy. When you are tired, get some rest. Try to get about eight hours of sleepevery night, and a nap during the day if you can. If you feel stressed, try tofind a way to relax. You might want to start sleeping on your left side, if youfind it more comfortable. This will relieve pressure on major blood vessels thatsupply oxygen and nutrients to the fetus. If you have high blood pressure duringpregnancy, it is even more important to be on your left side when you are lyingdown.

Nausea and Vomiting

Usuallycalled "morning sickness," nausea and vomiting are common during earlypregnancy. 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 goaway 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.

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

Frequency of Urination

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

Constipation

Asyour uterus begins to expand, you might notice you're constipated. To preventconstipation, try to eat fresh or dried fruit, raw vegetables, and whole-graincereals or breads everyday. Also, try to drink eight to ten glasses of watereveryday. Some of these servings can be substituted with fruit or vegetablejuice. Try to avoid caffeinated drinks (coffee, tea, colas, and some othersodas), since caffeine makes your body lose fluid and won't help withconstipation.

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 canhelp relieve these symptoms by lying down on your left side. Or to help preventthem, try moving around more instead of sitting or standing in one position fora long time.

Varicose Veins and Hemorrhoids

Duringpregnancy, pressure on the large veins behind the uterus causes the blood toslow in its return to the heart. This can lead to varicose veins in the legs andhemorrhoids (varicose veins in the vagina or around the anus). Varicose veinslook like swollen veins raised above the surface of the skin. They can betwisted or bulging, and are dark purple or blue in color. They are found mostoften on the backs of the calves or on the inside of the leg, anywhere from thegroin 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

Atdifferent times during your pregnancy, you might have cramps in your legs orfeet. 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 calciumthrough non-fat or low-fat milk, and calcium-rich foods. You also get somecalcium in your prenatal vitamin, but you might need to take a calciumsupplement if you don't get enough through your diet. Talk with your doctorfirst about taking calcium supplements.

Youcan relieve leg and foot cramps by gently stretching the muscle. If you have asudden leg cramp, flex your foot towards your body. If you point your foot tostretch 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

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

Changes in Your Baby

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

PrenatalCare

Visitsand Tests

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

Duringthe first prenatal visit, your doctor will discuss important parts of yourhealth history that may have some impact on your pregnancy. These includediseases, operations, and other pregnancies. There also will be questions aboutyour 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 bechecked at every visit.

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

Taking Care of Your Health

Smoking, Alcohol, and Drugs

Bytaking care of your health during pregnancy, you're also nurturing the new lifeinside 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

Whatyou eat isn't only important for your own health anymore, but for the currentand future health of your baby. Healthy foods are the building blocks for yourgrowing baby since pregnancy is a complex time of developing new tissues andorgans. Throughout pregnancy, try to make most of your food choices healthyones.

Weight gain

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

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

Exercise

Ifyou have no medical problems with your pregnancy, regular physical activity (30minutes per day, most days of the week), can help you have a more comfortablepregnancy and labor. It also helps to lower your risk for having health problemslike high blood pressure and gestational diabetes. And you will have an easiertime 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 ofbouncing, stretching your muscles to their greatest extent, or deeply bendingyour joints, are good for you. Because your connective tissues stretch much moreeasily during pregnancy, high impact or high resistance exercises that involve alot of bouncing and extreme muscle stretching can increase your risk of jointinjury. If you haven't exercised regularly before becoming pregnant, you canstill begin an exercise program. Just start slowly and progress gradually. Talkwith your doctor first about what types of exercise or activities are best foryou.

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

 
Bathing

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

Caring for Your Mouth and Teeth

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

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

Sexual Relations

Itis fine to have sexual intercourse throughout your pregnancy unless your doctortells you otherwise. Some women who have had miscarriages need to avoid sexualintercourse during the first three months. You should contact your doctor if youhave 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

Mostwomen find the second trimester of pregnancy to be easier than the firsttrimester, but it is important to stay informed about your pregnancy in thisstage too. While you might notice that symptoms like nausea and fatigue aregoing away, you will see other new, more noticeable changes to your body. Yourabdomen will expand as you gain weight and the baby continues to grow. Andbefore this trimester is over, you will feel your baby beginning to move! Manyof the other symptoms you had in the first trimester might also continue, likeconstipation or leg cramps, so it is important to keep doing all of the healthythings you have already learned to help prevent or treat those symptoms. Hereare some things you might experience during this trimester:

Aches and Pains

Asyour uterus and abdomen expands, you might feel pains in your abdomen, groinarea, or thighs. You also can feel backaches or aching near your pelvic bonefrom the pressure of the baby's head, your increased weight, and the looseningjoints in these areas. Lying down, resting, or applying heat can help resolvesome of these aches and pains. If pains do not get better after rest, it is bestto call your doctor.

Shortness of Breath

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

Ifyou sleep on your left side, you will relieve pressure on major blood vesselsthat 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

Youmight have heard stories from family members or friends about the dreadedstretch marks from pregnancy. Stretch marks are red, pink, or purple streaks inthe skin, usually over the thighs, buttocks, abdomen, and breasts. They arescars caused by the stretching of the skin, and usually appear in the secondhalf of pregnancy. Only about half of all pregnant women get stretch marksthough. 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 wellmoisturized, they do not prevent stretch marks from forming. Most stretch marksfade after delivery to very light lines.

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

Tingling and Itching

Tinglingand numbness of the fingers and a feeling of swelling in the hands are commonduring pregnancy. These symptoms are due to swelling of tissues in the narrowpassages in your wrists, and they should disappear after you deliver your baby.It also is common to feel itchy as your pregnancy progresses. Pregnancy hormonesand your stretching skin, especially over your abdomen, probably are to blamefor most of your discomfort. About 20 percent of all pregnant women have somekind of itching. And many pregnant women also get red and itchy palms and solesof their feet. Only in rare cases do pregnant women develop a condition called cholestasisof pregnancy, which is itching along with nausea, loss of appetite,vomiting, jaundice and fatigue. This condition is a sign of a serious liverproblem. In general, itching most often goes away after delivery. In themeantime, you can relieve itching with moisturizers. You can also use onlygentle soaps, and avoid hot showers or baths that can dry your skin. Try not toget over-heated since heat rash can make the itching worse.

Changes in Your Baby

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

Prenatal Care

Visits and Tests

Duringthe second trimester, your doctor will be able to see if your baby is developingin a healthy way and possibly see your baby’s sex. You will be offeredscreening tests to look for genetic birth defects. Birth defects result fromproblems with a baby’s chromosomes, part of his or her genes, which are passeddown from both the mother and the father at conception. Even though most babiesare born healthy, many genetic birth defects occur without a family history ofthat disorder. The risk for birth defects increases the most at the age of 35and 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. Screeningtests give results in fractions or odds of having a birth defect, based on themother’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 thatof a 35 year old woman. For women over age 35, the tests help them find out ifthe 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.

DiagnosticTests
Diagnostic tests can give definite answers about whether your baby has a birthdefect. But, unlike screening tests, they are invasive or present a risk ofmiscarriage. Amniocentesis and chorionic villus sampling (CVS) are the two mostcommonly 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 takeabout 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.
  

Whento Call Your Doctor

Nowis a good time to learn the signs of pre-term or premature labor. Prematurelabor occurs when a woman has labor before she reaches the 37^th weekof pregnancy, or three weeks before her due date. If you and your doctor see anysymptoms of pre-term labor early, there is a better chance of stopping it. Ifsymptoms are not treated, they can progress to repeated contractions that mightcause 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 withtheir breathing, feeding, and regulation of body temperature.

Anywoman can have pre-term labor, but some women have a higher risk because ofproblems with the uterus or placenta, or because of having had a pre-term birthwith another pregnancy. Don't forget to drink plenty of water to keep frombecoming dehydrated, especially in warm weather, since dehydration can causepre-term labor.

Callyour doctor right away if you have any of the following symptoms of pre-termlabor:

• 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

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

Weight Gain

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

3RDTRIMESTER OF YOUR/YOUR WIFE'S PREGNANCY

Changes in Your Body

You couldstill 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 orthat you find it even harder to breathe. This is because the baby is gettingbigger and it is putting more pressure on your organs. Don't worry, your baby isfine and these problems will lessen once you give birth. You also might havesome of these changes:

Heartburn

Asyour baby gets bigger, your uterus pushes on your stomach and can causeheartburn, especially before bedtime or right after you eat. Continue to avoidgreasy, 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 yourheartburn is severe and doesn't improve with these tips, talk with your doctor.Also talk with your doctor before taking an antacid medication.

Swelling

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

Hemorrhoids

Youmight begin to experience more discomfort from hemorrhoids now from theincreased pressure of your growing baby on the veins in your rectum. You mightalso be constipated, which makes hemorrhoids worse because you might strain fora bowel movement. Try to avoid hemorrhoids by drinking lots of fluids and eatingplenty of whole grains, raw or cooked leafy green vegetables, and fruits. Trynot to strain for bowel movements, and always talk with your doctor beforetaking a laxative.

Tender Breasts

Yourbreasts have most likely increased in size and fullness as your pregnancy hasadvanced. As you near the end of your pregnancy, hormones in your body causeyour breasts to increase even more in size, to prepare for breastfeeding. Yourbreasts can feel full and heavy, and they might be tender or uncomfortable.Wearing a well-fitting maternity or nursing bra will help you be morecomfortable, because these types of bras offer extra support. Some pregnantwomen begin to leak colostrum in the third trimester. Colostrum is the firstmilk that your breasts produce for your baby. It is a thick, yellowish fluidthat contains antibodies that protect new babies from infections. If leakingbecomes 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.

Nowand after delivery, it is a good idea to only wash your nipples with waterinstead 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

Yourbaby 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 didin the second trimester. During this final stage of your pregnancy, your baby iscontinuing to grow. Even before your baby is born it will be able to open andclose its eyes and might even suck its thumb. As your body starts to prepare forthe birth, your baby will start to move into its birth position. You mightnotice the baby "dropping," or moving down lower in your abdomen. Thiscan reduce the pressure on your lungs and rib cage, making it easier to breatheor not to get out of breath so fast. As you near your due date, your cervixbecomes thinner and softer (called effacing). This is a normal, natural processthat helps the birth canal (vagina) to open during the birthing process. Yourdoctor can check your progress with a vaginal exam. And, your visits to yourdoctor may increase the month before you give birth. The average baby is about20 to 22 inches long and weighs approximately 7 1/2 pounds at birth, butanywhere between 5 pounds, 11 1/2 ounces and 8 pounds, 5 3/4 ounces is a healthyrange for newborns.

Prenatal Care

Visits and Tests

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

Inducing Labor

Didyou 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 iswrong. In some pregnancies though, your doctor might have concerns about thebaby's and/or your health, and labor needs to be induced. Inducing labor meansthat your doctor will start your labor through artificial means. Most doctorswill 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.

Laborcan be induced during a vaginal exam — your doctor might rupture or strip themembranes surrounding the fetus or insert a gel or suppository containing ahormone to stimulate contractions. A drug called Pitocin can also be givenintravenously (put into your body through a vein in your arm or hand) to startcontractions.

Deciding to Breastfeed or Bottle-Feed

Ifyou 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 youplan to do. Breastfeeding has many more advantages over formula for your healthand your baby's health. Discuss breastfeeding with your doctor or with apediatrician, and then make a decision that is right for you. Click here tolearn more about the benefits of breastfeeding, how to make it work best foryou, and for tips on breastfeeding after returning to work.

When to Call Your Doctor

Beforeyour due date, make sure to talk with your doctor about how to reach him or herif you go into labor. It's also helpful to be familiar with the hospital orbirthing 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 (calledfalse labor). This happens to many women, so don't feel embarrassed if you go tothe hospital certain that you are in labor, only to be sent home! It's alwaysbetter to be seen by a doctor as soon as possible once labor has begun. Here arethe signs of true labor:

Signs of Labor Contractions at regular and increasingly shorter intervals that also become stronger in intensity. Lower back pain that doesn't go away. You might also feel premenstrual and crampy. Your water breaks (can be a large gush or a continuous trickle) and you have contractions. A bloody (brownish or blood-tinged) mucous discharge. This is the mucous plug that blocks the cervix. Labor could be at any time, or days away. Your cervix is dilating (opening up) and becoming thinner and softer (also called effacement). During a pelvic exam, your doctor will be able to tell if these things are happening.

 Caring For Yourself

Makesure 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 ofenergy. But, your energy may lessen as you enter your 9^th month andyou may begin to slow down. This is completely normal. It's important to getenough 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 inyour body's metabolism might interrupt or disturb your sleep. And, if you arehaving any leg cramping, this can affect your sleep as well.

Youmight have a better night's sleep if you try to avoid eating large meals threehours 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 theday. If you can't sleep because you are anxious about becoming a mother or aboutyour labor and delivery, try talking with your partner or friends who've beenthrough this before. You can also talk with your doctor or nurse.

Weight Gain

Everyonegains weight at different rates, but on average, it is normal to gain about onepound 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 30pounds. About 7 1/2 pounds of that weight should be the baby.

Whyis a healthy diet important before and during pregnancy?

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

Howshould my diet change now that I am pregnant?

Ifyou are eating a healthy diet before you become pregnant, you may only need tomake a few changes to meet the nutritional needs of pregnancy. According to theAmerican Dietetic Association, pregnant women should increase their usualservings of a variety of foods from the four basic food groups (up to a total of2,500 to 2,700 calories daily) to include the following:

Fruitsand Vegetables –

Sevenor more servings of fruits and vegetables combined (three servings of fruit andfour of vegetables) daily for vitamins and minerals. Fruits and vegetables withvitamin C help you and your baby to have healthy gums and other tissues, andhelp your body to heal wounds and to absorb iron. Examples of fruits andvegetables with vitamin C include strawberries, melons, oranges, papaya,tomatoes, peppers, greens, cabbage, and broccoli. Fruits and vegetables also addfiber and other minerals to your diet and give you energy. Plus, dark greenvegetables have vitamin A, iron, and folate, which are important nutrientsduring pregnancy.

Whole-grainsor Enriched Breads/Cereals –

Aimfor nine or more servings. Whole grain products and enriched products likebread, rice, pasta, and breakfast cereals contain iron, B vitamins, someprotein, minerals, and fiber that your body needs. Some breakfast cereals havebeen enriched with 100% of the folic acid your body needs each day. Folic acidhas been shown to help prevent some serious birth defects. Choosing a breakfastcereal or other enriched grain products that contain folic acid is importantbefore and during pregnancy.

 DairyProducts –

Aimfor four or more servings of low-fat or non-fat milk, yogurt, or other dairyproducts like cheese for calcium. You and your baby need calcium for strongbones and teeth. Dairy products also have vitamin A and D, protein, and Bvitamins. Vitamin A helps growth, resistance to infection, and vision. Pregnantwomen 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 andmilk products to lower your fat intake. Other sources of calcium include darkgreen leafy vegetables, dried beans and peas, nuts and seeds, and tofu. If youare lactose intolerant or can’t digest dairy products, you can still get thisextra calcium. There are several low-lactose or reduced-lactose productsavailable. In some cases, your doctor might advise you to take a calciumsupplement.

Proteins–

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

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

Somefish have mercury, which, in high doses, can hurt your baby’s growing brainand nervous system. There are some fish you should NOT eat if you are pregnant. Hereare 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.

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

Whatother nutrients do I need for a healthy pregnancy?

Folicacid: Folic acid is an important vitamin for any woman who couldpossibly become pregnant. Folic acid is a B vitamin that helps prevent seriousbirth defects of a baby’s brain or spine (called neural tube defects) andother birth defects like cleft lip and congenital heart disease. Folic acid isneeded 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 becomepregnant gets enough folic acid every single day, starting at least one month beforepregnancy. One easy way to ensure getting enough folic acid every day is to takea daily multivitamin. Most multivitamins sold in the U.S. contain enough folicacid 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 getenough 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 offruits 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 teethalso need iron to develop properly. Too little iron can cause a condition calledanemia. If you have anemia, you might look pale and feel very tired. Your doctorcan check for signs of anemia through the routine blood tests that are taken indifferent stages of your pregnancy. All pregnant women should take a low-doseiron supplement, beginning at the first prenatal visit, or even before, when youare planning to get pregnant. Prenatal vitamins that your doctor prescribes orthat you find over the counter usually have the amount of iron you need. Checkthe label to make sure they contain iron. If your doctor finds that you haveanemia, he or she will give you a higher dose of iron supplements to take onceor twice a day. You can help prevent anemia by eating more iron-rich foods likelean red meat, fish, poultry, dried fruits, whole-grain breads, andiron-fortified cereals.

Water:Water plays a key role in your diet during pregnancy. It carries the nutrientsfrom the foods you eat to your baby and helps prevent you from gettingconstipation, hemorrhoids, excessive swelling, and urinary tract or bladderinfections. Drinking enough water, especially in your last trimester, preventsyou from becoming dehydrated. Not getting enough water can then lead you to havecontractions and premature or early labor. Pregnant women should drink at leastsix eight-ounce glasses of water per day and another glass for each hour ofactivity. You can drink juices for fluid, but they also have a lot of caloriesand can cause you to gain extra weight. Coffee, soft drinks, and teas that havecaffeine actually reduce the amount of fluid in your body, so they cannot counttowards the total amount of fluid you need.

ShouldI take a multivitamin during my pregnancy?

Evenwomen who plan carefully to eat healthy every day can be missing out on someimportant nutrients like folic acid, which helps prevent serious birth defectsof your baby’s brain and spine. Those birth defects happen before most womenknow they are pregnant. To be certain that you are getting enough folic acid andother 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 onemultivitamin daily can be harmful.

Howmuch weight should I gain during pregnancy?

Youshould gain weight gradually during your pregnancy, with most of the weightgained in the last trimester. Good rates of weight gain are about two to fourpounds during the first three months of pregnancy and three to four pounds permonth for the rest of the pregnancy. The average total weight gain should beabout 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.

Accordingto 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.

Checkwith your doctor to find out how much weight gain during pregnancy is healthyfor you.

Recentresearch shows that women who gain more than the recommended amount duringpregnancy and who fail to lose this weight within six months after giving birthare at much higher risk of being obese nearly 10 years later.

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

Isit hard to lose weight after pregnancy?

Itcan be hard to lose weight after you have your baby if you gained too muchweight during pregnancy. During pregnancy, fat deposits can increase by morethan one-third of the total amount you had before becoming pregnant. If weightgain during pregnancy is normal, most women lose this extra weight in the birthprocess and in the weeks and months after birth. Breastfeeding also can help todeplete the fat gained during pregnancy by helping the body to expend at least500 more calories each day. 

ShouldI avoid drinking alcohol while I am pregnant?

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

ShouldI avoid caffeine while I am pregnant?

Caffeineis a stimulant found in colas, coffee, tea, chocolate, cocoa, and someover-the-counter and prescription drugs. Consumed in large quantities, caffeinecan cause irritability, nervousness and insomnia as well as low birth-weightbabies. Caffeine is also a diuretic and can dehydrate your body of valuablewater. Some studies show that caffeine intake during pregnancy can harm thefetus. Until more is known, you should avoid caffeine. Caffeine is an ingredientin many over-the-counter and prescription drugs. Talk with your doctor beforetaking any drugs or medicines while pregnant.

Whydo pregnant women crave certain foods?

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

DoI really need to "eat for two?"

Whileyou are pregnant, you will need additional nutrients to keep you and your babyhealthy. But, that does not mean you need to eat twice as much. You shouldincrease your caloric intake with only 300 calories per day. A baked potato has120 calories, so getting those extra 300 calories should not be that hard.

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

Whatabout diabetes and nutrition during pregnancy?

Ifyou already have diabetes and would like to get pregnant, your chances of havinga healthy baby are good. But, it’s important to plan your pregnancy and followthese 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.

Gestationaldiabetes is a form of diabetes that begins during pregnancy and usually goesaway after the birth of the baby. If you have gestational diabetes, this meansthat you have a high amount of sugar in your blood during pregnancy. This formof diabetes can be controlled through diet, medication, and exercise, but ifleft untreated, gestational diabetes can cause health problems for both you andyour baby. If you develop gestational diabetes, your doctor will refer you to aregistered dietitian who can help you with special meal plans to control yourblood sugar.

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

Morningsickness and nausea are common problems for pregnant women. Most nausea occursduring the early part of pregnancy and, in most cases, will subside once youenter the second trimester. For some women, morning sickness and nausea mightlast longer than the early stages of pregnancy or even throughout the entirenine months.

Thechanges in your body might cause you to be nauseated or to vomit when you smellor eat certain things, when you are tired or stressed, or for no apparent reasonat all. Nausea in early pregnancy is a condition that often can be managed bychanging when and what you eat. Try these tips:

• Eat smaller meals each day, such as six to eight small meals instead of three larger ones.

• Avoid being without food for long periods of time.

• Drink fluids between, but not with, meals.

• Avoid foods that are greasy, fried, or highly spiced.

• Avoid foul and unpleasant odors.

• Rest when you are tired.

Severenausea and vomiting in pregnancy is rare, but if it occurs, it can cause you tobecome dehydrated. If you feel that your nausea or vomiting is keeping you fromeating right or gaining enough weight, talk with your doctor.

Whatis depression?

Depressioncan be described as feeling sad, blue, unhappy, miserable, or down in the dumps.Most of us feel this way at one time or another for short periods. But trueclinical depression is a mood disorder in which feelings of sadness, loss,anger, or frustration interfere with everyday life for an extended time.Depression can be mild, moderate, or severe. The degree of depression, whichyour doctor can determine, influences how you are treated.

Howcommon is depression during and after pregnancy?

Depressionthat occurs during pregnancy or within a year after delivery is called perinataldepression. The exact number of women with depression during this time isunknown. But researchers believe that depression is one of the most commoncomplications during and after pregnancy. Often, the depression is notrecognized or treated, because some normal pregnancy changes cause similarsymptoms and are happening at the same time. Tiredness, problems sleeping,stronger emotional reactions, and changes in body weight may occur duringpregnancy and after pregnancy. But these symptoms may also be signs ofdepression.

Whatcauses depression?

Theremay be a number of reasons why a woman gets depressed. Hormone changes or astressful life event, such as a death in the family, can cause chemical changesin the brain that lead to depression. Depression is also an illness that runs insome families. Other times, it’s not clear what causes depression.

DuringPregnancy:

During pregnancy, these factors may increase a woman’s chance ofdepression:

• History of depression or substance abuse

• Family history of mental illness

• Little support from family and friends

• Anxiety about the fetus

• Problems with previous pregnancy or birth

• Marital or financial problems

• Young age (of mother)

AfterPregnancy

Depression after pregnancy is called postpartum depression or peripartumdepression. After pregnancy, hormonal changes in a woman's body may triggersymptoms of depression. During pregnancy, the amount of two female hormones,estrogen and progesterone, in a woman's body increases greatly. In the first 24hours after childbirth, the amount of these hormones rapidly drops back down totheir normal non-pregnant levels. Researchers think the fast change in hormonelevels may lead to depression, just as smaller changes in hormones can affect awoman's moods before she gets her menstrual period.

Occasionally,levels of thyroid hormones may also drop after giving birth. The thyroidis a small gland in the neck that helps to regulate your metabolism (how yourbody uses and stores energy from food). Low thyroid levels can cause symptoms ofdepression including depressed mood, decreased interest in things, irritability,fatigue, difficulty concentrating, sleep problems, and weight gain. A simpleblood test can tell if this condition is causing a woman's depression. If so,thyroid medicine can be prescribed by a doctor.

Otherfactors that may contribute to postpartum depression include:

• Feeling tired after delivery, broken sleep patterns, and not enough rest often keeps a new mother from regaining her full strength for weeks.

• Feeling overwhelmed with a new, or another, baby to take care of and doubting your ability to be a good mother.

• Feeling stress from changes in work and home routines. Sometimes, women think they have to be "super mom" or perfect, which is not realistic and can add stress.

• Having feelings of loss — loss of identity of who you are, or were, before having the baby, loss of control, loss of your pre-pregnancy figure, and feeling less attractive.

• Having less free time and less control over time. Having to stay home indoors for longer periods of time and having less time to spend with the your partner and loved ones.

Whatare symptoms of depression?

Anyof these symptoms during and after pregnancy that last longer than two weeks aresigns of depression:

• Feeling restless or irritable

• Feeling sad, hopeless, and overwhelmed

• Crying a lot

• Having no energy or motivation

• Eating too little or too much

• Sleeping too little or too much

• Trouble focusing, remembering, or making decisions

• Feeling worthless and guilty

• Loss of interest or pleasure in activities

• Withdrawal from friends and family

• Having headaches, chest pains, heart palpitations (the heart beating fast and feeling like it is skipping beats), or hyperventilation (fast and shallow breathing)

Afterpregnancy, signs of depression may also include being afraid of hurting the babyor oneself and not having any interest in the baby.

Whatis the difference between “baby blues,”postpartum depression, and postpartumpsychosis?

Thebaby blues can happen in the days right after childbirth and normally go awaywithin a few days to a week. A new mother can have sudden mood swings, sadness,crying spells, loss of appetite, sleeping problems, and feel irritable,restless, anxious, and lonely. Symptoms are not severe and treatment isn’tneeded. But there are things you can do to feel better. Nap when the baby does.Ask for help from your spouse, family members, and friends. Join a support groupof new moms or talk with other moms.

Postpartumdepression can happen anytime within the first year after childbirth. A womanmay have a number of symptoms such as sadness, lack of energy, troubleconcentrating, anxiety, and feelings of guilt and worthlessness. The differencebetween postpartum depression and the baby blues is that postpartum depressionoften affects a woman’s well-being and keeps her from functioning well for alonger period of time. Postpartum depression needs to be treated by a doctor.Counseling, support groups, and medicines are things that can help.

Postpartumpsychosis is rare. It occurs in 1 or 2 out of every 1000 births and usuallybegins in the first 6 weeks postpartum. Women who have bipolar disorder oranother psychiatric problem called schizoaffective disorder have a higher riskfor developing postpartum psychosis. Symptoms may include delusions,hallucinations, sleep disturbances, and obsessive thoughts about the baby. Awoman may have rapid mood swings, from depression to irritability to euphoria.

Whatsteps can I take if I have symptoms of depression during pregnancy or afterchildbirth?

Somewomen don’t tell anyone about their symptoms because they feel embarrassed,ashamed, or guilty about feeling depressed when they are supposed to be happy.They worry that they will be viewed as unfit parents. Perinatal depression canhappen to any woman. It does not mean you are a bad or “not together” mom.You and your baby don’t have to suffer. There is help.

Thereare different types of individual and group “talk therapies” that can help awoman with perinatal depression feel better and do better as a mom and as aperson. Limited research suggests that many women with perinatal depressionimprove when treated with anti-depressant medicine. Your doctor can help youlearn more about these options and decide which approach is best for you andyour baby. The next section contains more detailed information about availabletreatments.

Speakto your doctor or midwife if you are having symptoms of depression while you arepregnant or after you deliver your baby. Your doctor or midwife can give you aquestionnaire to test for depression and can also refer you to a mental healthprofessional who specializes in treating depression.

Hereare some other helpful tips:

• Try to get as much rest as you can. Try to nap when the baby naps.

• Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest!

• Ask for help with household chores and nighttime feedings. Ask your husband or partner to bring the baby to you so you can breastfeed. If you can, have a friend, family member, or professional support person help you in the home for part of the day.

• Talk to your husband, partner, family, and friends about how you are feeling.

• Do not spend a lot of time alone. Get dressed and leave the house. Run an errand or take a short walk.

• Spend time alone with your husband or partner.

• Talk with other mothers, so you can learn from their experiences.

• Join a support group for women with depression. Call a local hotline or look in your telephone book for information and services.

• Don’t make any major life changes during pregnancy. Major changes can cause unneeded stress. Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

Howis depression treated?

Thereare two common types of treatment for depression.

• Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act.

• Medicine. Your doctor can give you an antidepressant medicine to help you. These medicines can help relieve the symptoms of depression.

Womenwho are pregnant or breastfeeding should talk with their doctors about theadvantages and risks of taking antidepressant medicines. Some women areconcerned that taking these medicines may harm the baby. A mother’s depressioncan affect her baby’s development, so getting treatment is important for bothmother and baby. The risks of taking medicine have to be weighed against therisks of depression. It is a decision that women need to discuss carefully withtheir doctors. Women who decide to take antidepressant medicines should talk totheir doctors about which antidepressant medicines are safer to take whilepregnant or breastfeeding.

Whateffects can untreated depression have?

Depressionnot only hurts the mother, but also affects her family. Some researchers havefound that depression during pregnancy can raise the risk of delivering anunderweight baby or a premature infant. Some women with depression havedifficulty caring for themselves during pregnancy. They may have trouble eatingand won’t gain enough weight during the pregnancy; have trouble sleeping; maymiss prenatal visits; may not follow medical instructions; have a poor diet; ormay use harmful substances, like tobacco, alcohol, or illegal drugs.

Postpartumdepression can affect a mother’s ability to parent. She may lack energy, havetrouble concentrating, be irritable, and not be able to meet her child’s needsfor love and affection. As a result, she may feel guilty and lose confidence inherself as a mother, which can worsen the depression. Researchers believe thatpostpartum depression can affect the infant by causing delays in languagedevelopment, problems with emotional bonding to others, behavioral problems,lower activity levels, sleep problems, and distress. It helps if the father oranother caregiver can assist in meeting the needs of the baby and other childrenin the family while mom is depressed.

Allchildren deserve the chance to have a healthy mom. All moms deserve the chanceto enjoy their life and their children. Don’t suffer alone. If you areexperiencing symptoms of depression during pregnancy or after having a baby,please tell a loved one and call you doctor or midwife right away.

What is prenatal care?

Prenatalcare means health care during your pregnancy before your baby is born. Take careof yourself and your baby by:

• Getting early prenatal care. If you know you are pregnant, or think you might be pregnant, call your health care provider as soon as possible and schedule a visit.

• Getting regular prenatal care. Follow your health care provider's schedule for visits and don't miss appointments.

• Doing everything you can to keep yourself and your baby healthy during your pregnancy.

Why is prenatal care so important?

Prenatal care is important because, by seeing you regularly, your health careprovider has the chance to find problems early so that they can be treated assoon as possible. Other problems might also be prevented. Many studies haveshown that early and regular prenatal care is important for the health of bothmothers and their babies.

I am thinking about getting pregnant. How can I take care of myself?

Takingcare of yourself before you get pregnant helps you have a healthypregnancy and lowers your chances of having a baby born with a birth defect.Here are ways to take care of yourself before you get pregnant:

• Eat healthy foods, exercise regularly (30 minutes per day for most days of the week is best), and get enough rest and sleep. Talk to your health care provider about what kinds of food and exercise are best for you.

• Take 400 micrograms (mcg) of folic acid (one of the B vitamins) every day. The best way to do this is to take a daily multivitamin pill that contains this amount of folic acid. Getting enough of the synthetic (manufactured) form of folic acid every day before you get pregnant and during early pregnancy can help prevent certain birth defects. Many breakfast cereals and other grain products have folic acid added to them, but only certain cereals contain 400 mcg of folic acid per serving. Check the label on your multivitamin or cereal to find the amount of folic acid in the food.

• See your health care provider for a complete check up. Make sure that you have had all your shots, especially for rubella (German measles). Rubella can cause serious birth defects. Chickenpox is another illness you want to avoid during pregnancy. If you have had chickenpox and rubella in the past, you should be immune to them.

• Tell your health care provider about any prescription or nonprescription medicines (including herbal remedies) you are taking. Some medicines are not safe to take during pregnancy.

• Stop smoking cigarettes, drinking alcohol, or taking drugs. Ask your health care provider for help. You can also get help with alcohol and drugs by talking with a member of your faith community, a counselor, or a trusted friend.

I just found out that I am pregnant. How can I take care of myself?

Hereare ways to take care of yourself and the precious new life growing inside you:

• Continue taking your multivitamin with 400 micrograms (mcg) of folic acid every day.

• Get early and regular prenatal care. It doesn't matter if this is your first pregnancy or if you already have children - it is really important to see a health care provider during your pregnancy. Your health care provider will check at each visit to make sure that you and the baby are healthy. If there are any problems, action can be taken right away to help you and the baby.

• Eat a healthy diet that includes fruits, vegetables, grains and calcium - rich foods. Choose foods low in saturated fat.

• Unless your health care provider tells you not to, try to be physically active for 30 minutes, most days of the week. If you are pressed for time, you can get your activity in through 10 minute segments, three times a day.

• If you smoke, drink alcohol, or use drugs, STOP. These can cause long-term damage to your baby. Talk with your health care provider about steps to take to stop smoking. Talk with a member of your faith community, a counselor, a trusted friend, or your health care provider if you are concerned about your alcohol or drug use.

• Ask your health care provider before taking any medicine, even over-the-counter medicines. Some medicines are not safe to take during pregnancy.

• Avoid hot tubs or saunas and x-rays during pregnancy.

• Do not empty the cat litter when you are pregnant. It may contain a parasite that causes an infection called toxoplasmosis,  which can cause birth defects. Also, use gloves when working in garden areas used by cats.

• Don't eat uncooked or undercooked meats or fish.

• Stay away from toxic chemicals like insecticides, solvents (like some cleaners or paint thinners), lead, and mercury. Most dangerous household products will have pregnancy warnings on their labels. Ask your health care provider about products if you are unsure.

• Limit or eliminate your caffeine intake from coffee, tea, sodas, medications, and chocolate.

• Many women continue working through pregnancy. Staying active might help you stay healthier. If you have a question about the safety of your particular job, talk with your health care provider.

• Get informed. Read books, watch videos, go to a childbirth class, and talk with experienced moms.

• Ask your health care provider about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby.

I am not thinking about getting pregnant right now, but heard that all women should take folic acid every day?

All women of childbearing age, with even a remote chance of getting pregnant,should try to make sure they get enough folic acid. The reason is that manypregnancies are not planned. Many women don't know they are actually pregnantearly in their pregnancies, and certain birth defects happen in the very earlypart of pregnancy. Taking 400 micrograms (mcg) of folic acid every day will helpprevent certain birth defects that happen in the early part of pregnancy. If awoman begins taking vitamin pills in the second or third month of pregnancy, itmay be too late to prevent birth defects. Folic acid may also have other healthbenefits for women besides preventing birth defects.

How often should I see my doctor during pregnancy?

Your health care provider will give you a schedule for your prenatalvisits. You will have visits more often as you get closer to the end of yourpregnancy. An average pregnancy lasts about 40 weeks. A typical scheduleincludes visiting your health care provider:

• about once each month during your first six months of pregnancy, then

• every two weeks during the next two months, and then

• weekly until the delivery date.

Ifyou are over 35 or your pregnancy is high risk because you have certain healthproblems (like diabetes or high blood pressure), your health care provider willprobably want to see you more often.

What happens during prenatal visits?

At your first prenatal visit, your health care provider will talk to you aboutyour health history and your family health history and do a physical exam. Thephysical exam will include checks of your blood pressure, height and weight, andan exam of your pelvic organs. There will be tests of your blood and urine. Yourhealth care provider will be able to tell you when to expect that your baby willbe born. This visit is also a chance for you to learn about staying healthyduring pregnancy.

Atyour later prenatal visits, your health care provider will check how you aredoing and how the baby is developing. You may have a number of tests done asyour pregnancy progresses. Ultrasound exams are often used to check on thebaby's growth and health. You may have more urine and blood tests as well asspecial tests if needed. 

I am in my late thirties and I want to have a child now. Should I do anything special?

As you get older, there is more chance of having a baby born with a birthdefect. However, most women in their late thirties and early forties havehealthy babies. See your health care provider on a regular basis before you getpregnant and be sure to go for exams throughout your pregnancy. Your health careprovider probably will want to do some special tests to check on your baby'shealth.

Womentoday are often delaying having children until later in life, when they are intheir thirties and forties. While many women in their thirties and forties haveno difficulty getting pregnant, fertility does decline with age. For women over40 who cannot get pregnant after six months of trying, it is recommended thatthey see their health care provider for a fertility evaluation. It is notuncommon to have trouble becoming pregnant or experience infertility (inabilityto become pregnant after trying for one year).

Signs of Labor

Remember the signs of true labor, so that you will know when you are having the"real thing:"

• Contractions at regular and increasingly shorter intervals that also become stronger in intensity.

• Lower back pain that doesn't go away. You might also feel premenstrual and crampy.

• Your water breaks (can be a large gush or a continuous trickle) and is accompanied by contractions.

• A bloody (brownish or blood-tinged) mucous discharge. This is the mucous plug that blocks the cervix. Labor could be at any time, or days away.

• Your cervix is dilating (opening up) and becoming thinner and softer (also called effacement). During a pelvic exam, your health care provider will be able to tell if these things are happening.

Birthing Options

Youmay have several options available for where you will have your baby, includingat home, in a birth center, or at a hospital. Birth centers usually canadminister intravenous fluid, pain medications, and oxygen, and are able torepair episiotomies. They also have basic equipment to start emergency treatmentif it is necessary. Hospitals have more advanced medical equipment to care for ababy whose health or life is in danger, and will be able to provide a cesareansection or epidurals, if necessary. If your pregnancy is considered to be athigh risk (as in women who smoke, or use drugs, or have medical complicationsdue to a known condition), home births are not recommended.

Youalso can choose what type of health care provider you would like to deliver yourbaby. An obstetrician (OB) is a medical doctor who specializes in prenatal careand in delivering babies in a hospital. A certified nurse midwife (CNM) alsospecializes in prenatal care and labor and delivery, and can deliver your babyat the hospital, in a birth center, or at home. There are other types ofmidwives as well. Some women also choose to have a doula assist withlabor and delivery. A doula is a professional support person who helps givephysical support, such as advice on breathing, relaxation, movement andpositioning during labor. Doulas also give continuous emotional support andcomfort to women and their partners during labor and birth. Doulas and midwivesoften work together during a woman's labor.

Youmay also be interested in taking childbirth preparation classes, such as Lamaze,which emphasizes minimal medical intervention, teaches coping methods for laborand delivery, and helps guide new parents in the many decisions they will makebefore and during the birth process.

Managing Pain

Oneof the things you may be most concerned with is the amount of pain you may haveduring labor. Childbirth is different for all women, and no one can predict howmuch pain you will have. During the labor process, your health care providershould ask you if you need pain relief, and will help you decide what option isthe best for you. Your options may include a local or intravenous analgesic(pain relieving drug), an epidural (injection which blocks pain in the lowerpart of your body), spinal anesthesia (used when the delivery will requireforceps, or a pudendal block, which numbs the vulva, vagina and anus during thesecond stage of labor and during delivery.

Yourprogression through the different stages of labor and delivery will determinehow quickly the baby is coming, and whether you have time to get to thehospital, birth center, or back home to deliver. Having information about yourchoices for birthing will help with some of the stress you may feel duringlabor.

Afterthe Baby is Born

Thejoys and challenges of motherhood are about to begin. Remember to take care ofyourself too! Caring for a new baby can be fun but it is also hard work. Howmuch and how often should you feed the baby? What do you do when the baby iscrying, or sick? How do you prevent accidents? These questions can beoverwhelming at first, but you will quickly adjust. A new baby needs constantcare, but you will be skilled at taking care of your child in no time. There arepeople out there, including your family, friends, doctor, and support groups,that will help you get through it. You are not alone.

Youhave experienced nine months of changes in your body. Those changes willcontinue in the next couple of months as you decide whether or not to breastfeedand as your body starts to recover from having the baby. It is important tofollow your doctor's advice and take care of yourself during this time.

Getting Rest

Thefirst few days at home after having your baby are a time for rest andrecuperation, physically and emotionally. You need to focus your energy onyourself and on getting to know your new baby. Even though you may be veryexcited and have requests for lots of visits from family and friends, try to getas much rest as possible. Don't expect to keep your house perfect. You may findthat all you can do is eat, sleep and care for your baby. And that is perfectlyokay. Learn to pace yourself from the first day that you arrive back home. Tryto lie down or nap while the baby naps. Don't try to do too much around thehouse. Allow others to help you and don't be afraid to ask for help withcleaning, laundry, meals, or with caring for the baby.

Physical Changes

Afterthe birth of your baby your doctor will talk with you about things you willexperience as your body starts to recover.

• You will have spotting or bleeding, like a menstrual period off and on for up to six weeks.

• Your abdomen, vulva, vagina and pelvic area have been through a natural, yet significant experience. These areas will begin to heal, however, they will be sore. Your vagina, which is normally a very small muscle that will typically only snugly fit a tampon, or your husband's penis, has been greatly enlarged, by many times, to allow for the passage of your baby. Not only will your vulva and vagina be sore, along with the nearly non-stop needs of a crying newborn baby, the very thought of resuming sexual intercourse, may be unthinkable!  

• You might also have swelling in your legs and feet. You can reduce swelling by keeping your feet elevated when possible.

• You might feel constipated. Try to drink plenty of water and eat fresh fruits and vegetables.

• Menstrual like cramping is common, especially if you are breastfeeding. Your breast milk will come in within three to six days after your delivery. Even if you are not breastfeeding, you can have milk leaking from your nipples, and your breasts might feel full, tender or uncomfortable.

• Follow your doctor's instructions on how much activity, like climbing stairs or walking, you can do for the next few weeks.

• Doctors usually recommend that you abstain from sexual intercourse for four to six weeks after birth. Before resuming sexual intercourse, talk with your doctor about your plan for birth control since you can become pregnant again. Breastfeeding alone does not protect you from getting pregnant again.

Regaining a Healthy Weight and Shape

Bothpregnancy and labor can affect a woman's body. If you are trying to lose someadditional pregnancy weight, make sure you do it in a healthy way and consultyour doctor before you start any type of diet or exercise plan. If you want todiet and are breastfeeding, it is best to wait until your baby is at least twomonths old. During those first two months, your body needs to recover fromchildbirth and establish a good milk supply. Then when you start to lose weight,try not to lose too much too quickly. This can be harmful to the baby becauseenvironmental toxins that are stored in your body fat can be released into yourbreast milk. Losing about one pound per week (no more than four pounds permonth) has been found to be a safe amount and will not affect your milk supplyor the baby's growth.

Youcan safely lose weight by consuming at least 1800 calories per day with awell-balanced, nutritious diet that includes foods rich in calcium, zinc,magnesium, vitamin B6, and folate. Diets in which you consume less than 1500calories per day are not recommended at any point during breastfeeding. This canput you at risk for a nutritional deficiency, lower your energy level, and loweryour resistance to illness.

Feeling Blue

Inaddition to the physical changes to your body, you may feel sad or have the"baby blues." This can be a very normal phase following childbirth.Fifty to 75 percent of new mothers feel a little sad or depressed after givingbirth. Your hormone changes, your feelings of anxiety about caring for a newbaby, and your lack of sleep all will affect your emotions. Be patient withyourself. These feelings are normal and should get better over time. Be aware ofyour feelings and continue to talk with your family, friends, and your doctor.If you are extremely sad or are unable to care for yourself or your baby, callyour doctor right away. You might have a serious condition called postpartumdepression. Other signs of this condition include:

• feeling restless or irritable

• feeling sad, depressed or crying a lot

• having no energy

• having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing)

• not being able to sleep or being very tired, or both

• not being able to eat and weight loss

• overeating and weight gain

• trouble focusing, remembering, or making decisions

• being overly worried about the baby

• not having any interest in the baby

• feeling worthless and guilty

• being afraid of hurting the baby or yourself

• no interest or pleasure in activities, including sex

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 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.

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