Before Pregnancy

How will my body change during pregnancy?

Your body goes through incredible changes during pregnancy! Your breasts enlarge, and the number of milk ducts to produce breast milk actually increases. Your organs are crowded by your enlarging uterus, which may cause more frequent urination, heartburn or indigestion. Your legs, feet and hands may swell. Your hair and skin often undergo changes.

If I want to get pregnant soon, when should I stop my birth control pills?

Most doctors recommend staying off the pill for two or three normal menstrual cycles before trying to get pregnant. Use some other form of contraception, such as a barrier method (condom), until you want to get pregnant.

Can I have a successful pregnancy even though I have chronic health problems?

Yes, in many cases. Women with health problems can have successful pregnancies and healthy babies. It is very important for you to discuss your particular situation with your doctor before becoming pregnant. Follow his or her instructions carefully.

I have diabetes, and I really want to have a baby. Is it possible?

Progress has been made in handling diabetes during pregnancy; however, diabetes can still have serious effects during pregnancy. Risks to you and your baby can be decreased with good control of your blood sugar. Discuss your concerns with your doctor before you try to conceive.

Will pregnancy affect my asthma?

There is no way to predict ahead of time if pregnancy will affect your asthma. About 50% of women see no change in their asthma during pregnancy. About 25% have improved symptoms, while 25% have increased problems.

Is my asthma medication safe to take during pregnancy?

Most medications prescribed for asthma are safe to use during pregnancy. Discuss your medication use with your doctor.

I have high blood pressure, and I want to get pregnant. How will my blood pressure affect pregnancy?

High blood pressure can cause problems for the mother and baby. These include kidney damage, stroke or headaches in the mother-to-be and decreased blood flow to the fetus. The decreased blood flow can cause intrauterine-growth restriction (IUGR, inadequate growth of the fetus).

Can I continue taking my blood-pressure medication during pregnancy?

Some medications are safe to take during pregnancy; others are not. Do not stop or decrease any medication on your own! Discuss your situation with your doctor.

I've been anemic in the past. Should I start taking iron now?

Your doctor can check you for anemia. Pregnancy puts great demands on your body's iron supplies. Many women start taking vitamins or iron before getting pregnant. Because you have had a problem in the past, it's better to discuss this with your doctor before pregnancy.

I take medication for a thyroid problem. Do I need to change the dosage or stop taking it if I want to get pregnant?

Don't make any changes without first consulting your doctor. Medication for thyroid problems is very important during pregnancy.

I want to be pregnant soon. I love hamburgers, French fries and other junk food. Will this be a problem when I get pregnant?

A recent study showed that women who eat high amounts of saturated fat—the kind found in cheese and red meat—in the year before they got pregnant had a higher risk of suffering severe morning sickness during pregnancy.

The best plan is to start eating nutritiously before you get pregnant. By the time many women know they're pregnant, they are 7 or 8 weeks into the pregnancy—or more! The early weeks of pregnancy are important in the development of your baby.

I don't really like to work out. Is exercise that important?

Exercise is good for you, whether or not you are pregnant. Develop a good exercise program before getting pregnant to help you feel better, control weight and increase stamina. Exercise can also help make labor and delivery easier.

How can I find and maintain a good exercise program?

Find an exercise you enjoy and can do in any type of weather. Information on various types of exercise programs is available from your local hospital, your doctor and health clubs. The American College of Obstetricians and Gynecologists (ACOG) has tapes available on exercise during and after pregnancy. Ask your doctor for information on ordering them.

I've tried to stop smoking, but I don't know if I can. Can cigarette smoking harm a growing baby?

Smoking can affect pregnancy and fetal development. Low birthweight and a slower growth rate are problems in babies born to mothers who smoke. For your health and the health of your baby, try to stop smoking before you consider pregnancy.

My friend told me she stopped drinking alcohol before she got pregnant, but I don't drink very much. Do I have to stop drinking before I get pregnant?

In the past, we believed a little alcohol was OK during pregnancy, but times have changed. Most doctors believe it's best not to drink any alcohol during pregnancy. Every time you take a drink, your baby does too! Stop using alcohol from the time you are preparing to conceive until after your baby is born.

My job requires me to stand for a 10-hour shift; I'm used to it. Will this be a problem when I am pregnant?

Studies have shown that women who stand for a long time each day have smaller babies. If you have had premature deliveries or an incompetent cervix in the past, or if your job requires that you stand a lot, discuss the situation with your doctor.

Your Health & Medical Concerns

What can I expect on my first prenatal visit?

Your first visit may be one of your longest. You will be asked a lot of questions, and you will undergo a physical exam. Lab tests may be ordered now or at your next visit.

How often will I have to go to the doctor?

In most cases, you will go every 4 weeks for the first 7 months, then every 2 weeks until the last month, then once a week. If problems arise, more frequent visits may be necessary.

I feel so nauseated in the morning that I can't eat anything. Does this last throughout pregnancy?

Nausea is typically the worst at the beginning of pregnancy; most often it is bad in the morning and improves during the day. Morning sickness usually begins around week 6 and lasts until week 12 or 13, when it lessens and disappears.

I have nausea and vomiting, but it's only at night. Is this the same thing as morning sickness?

Nausea and vomiting with pregnancy can occur at any time of the day or night. Sometimes it lasts all day long.

I'm nauseated every morning but don't throw up. My friend had to go to the hospital for I.V.s when she had morning sickness. Is this the same thing?

Probably. An early symptom of pregnancy for many women is nausea, with or without vomiting. A more serious condition, called hyperemesis gravidarum, results when a woman experiences a great deal of vomiting and the inability to eat foods or to drink fluids. If a woman has this problem, she may need to be treated in the hospital with I.V.s (intravenous fluid) and medicines for nausea.

How does my health affect my baby?

Your baby is totally dependent on you for all its needs. To make sure he or she gets the best possible start in life, it's important for you to eat right, get enough rest and stay as healthy as possible throughout your pregnancy.

I've heard environmental poisons can be dangerous to a pregnant woman. What are they?

Environmental poisons and pollutants that can harm a developing fetus include lead, mercury, PCBs and pesticides.

How can I protect myself against environmental poisons?

The safest course is to avoid exposure, through the foods you eat or the air you breathe. Thoroughly wash all fruits and vegetables before eating. It may not be possible to eliminate all contact. If you know you will be around certain chemicals, wash your hands thoroughly after exposure.

I've had a lot of problems with heartburn during my pregnancy. What causes it?

Discomfort from heartburn is one of the most common complaints during pregnancy. It may begin early in pregnancy, although it generally becomes more severe as pregnancy progresses. Heartburn is caused by reflux (regurgitation) of stomach contents into the esophagus.

I've never had hemorrhoids before, and now I do. Why?

Hemorrhoids are caused by increased blood flow in the pelvis and the increased weight and size of the uterus, which blocks blood flow.

Will my allergies cause problems during pregnancy?

Your allergies may change during pregnancy. Sometimes they get worse; sometimes they improve.

What can I do for my allergies while I'm pregnant?

Drink plenty of fluid, especially during hot weather. If you're sensitive to certain foods, be careful about what you eat. Avoid anything you might be sensitive to, such as animals or cigarette smoke.

Can I take my regular allergy medications while I'm pregnant?

Ask your doctor or pharmacist before taking any medication, whether it's a prescription or over-the-counter (OTC) medication. Don't assume it's OK. It's safer and easier to ask ahead of time rather than take a chance with a medication.

My doctor says I have anemia now that I'm pregnant. What is it?

Anemia is a common medical problem in many pregnant women. The number of red blood cells in your blood is low; the quantity of these cells is inadequate to provide the oxygen your body needs.

Why does anemia occur so often in pregnancy?

Your blood volume increases up to 50% during pregnancy. Blood is made up of fluid and cells. The fluid usually increases faster than the cells. This may result in a drop in your hematocrit (the amount or percent of red cells in the blood). This drop can result in anemia.

At my last appointment my doctor said my blood pressure was up. Should I be concerned?

It's normal for your blood pressure to change a little during pregnancy. It often decreases a little during the 2nd trimester of pregnancy and increases toward the end of pregnancy.

My friend said she had gestational diabetes while she was pregnant. What is it?

Sometimes called pregnancy-induced diabetes, gestational diabetes happens in about 10% of all pregnancies. With this problem, your blood sugar is too high. This can cause problems for you associated with too much weight gain. Problems for the baby include birth defects and a large baby.

Why is diabetes serious in pregnancy?

Diabetes can cause medical problems that could be serious for you and your baby. If your diabetes is not treated, you expose your baby to a high concentration of sugar, a condition called hyperglycemia, which is not healthy for the baby.

Uncontrolled diabetes puts you at significantly increased risk of miscarriage and problems at the time of birth. The most common fetal problems are heart, genitourinary and gastrointestinal problems. Diabetes can also cause large babies.

How is diabetes diagnosed?

Diabetes is diagnosed with blood tests: a fasting blood-sugar or a glucose-tolerance test. This test is usually done around 28 weeks of pregnancy.

Tests on You & Your Growing Baby

My friend had a pregnancy test called a quantitative HCG test because she was having problems; the result was a number. What kind of test is it?

A quantitative HCG (human chorionic gonadotropin) test is a blood test done in the 1st trimester if there is concern about miscarriage or ectopic pregnancy. The test measures the hormone HCG, which is produced early in pregnancy and increases rapidly. Two or more tests done a few days apart are more useful than one test because it is the change in the amount of the hormone that is significant. An ultrasound is often done when a quantitative HCG test is ordered.

I'm confused about ultrasound and sonograms. What's the difference?

Ultrasound, sonogram and sonography refer to the same test. Ultrasound is a valuable medical tool, especially in pregnancy.

What exactly is an ultrasound?

Ultrasound is a test that gives a 2- or 3-dimensional picture of the developing embryo or fetus. It involves the use of high-frequency sound waves made by applying an alternating current to a transducer. This transducer is placed on the abdomen or in the vagina. Sound waves projected from the transducer travel through the abdomen or vagina, bounce off tissues and bounce back to the transducer. Reflected sound waves are translated into a picture

What is a 3-dimensional ultrasound?

This ultrasound test is available in some areas. It provides clear, detailed pictures of the fetus in the womb. They're so clear, the image almost looks like a photograph. For the pregnant woman, the test is almost the same as a regular ultrasound. The difference is that computer software translates the picture into a 3-D image. At this time, this advanced ultrasound is used when there is suspicion of abnormalities and the doctor wants to take a closer look

Can an ultrasound help determine when I'm due?

Yes. Your doctor can take measurements of the baby with an ultrasound, then compare these measurements with charts that have averages to help approximate your due date.

Will I be able to find out if I am having a boy or girl when I have my ultrasound?

This is the most common question expectant parents ask. If you are 18 weeks' or more when you have an ultrasound, you may be able to determine the sex of your baby, but don't count on it. It isn't always possible to tell the sex if the baby has its legs crossed or is in a breech position.

Even if your doctor makes a prediction, keep in mind that ultrasound is a test, and tests can sometimes be wrong. Don't start buying for one sex or the other based on an ultrasound. If you do buy anything, save the receipts!

I'm supposed to have an ultrasound next week, and they told me to drink 32 ounces of water before I come and not to empty my bladder. Why?

Your bladder is in front of your uterus. When your bladder is full, your uterus rises out of the pelvis and becomes easier to see. When your bladder is empty, your uterus is farther down in your pelvis, and it's harder to see it. The full bladder acts as a window from the outside of your abdomen into your uterus. With a vaginal ultrasound, your bladder doesn't have to be full.

I heard some women talking about amniocentesis. Is this test for everyone?

No, not all pregnant women need amniocentesis.

When is the test done?

Amniocentesis is usually performed for prenatal evaluation between 16 and 20 weeks of pregnancy. Some doctors use amniocentesis at 11 or 12 weeks of pregnancy. However, risks are higher when it is done at this time; the test is still considered experimental when done this early.

How is amniocentesis performed?

Ultrasound is used to locate a pocket of fluid where the fetus and placenta are out of the way. Skin over the abdomen is cleaned and numbed with a local anesthetic. A long needle is then passed through the abdomen into the uterus, and fluid is withdrawn from the amniotic cavity with a syringe.

If I wouldn't end my pregnancy regardless of the baby's condition, why have amniocentesis?

If your doctor suggests it, you should seriously consider having the test. If a problem is detected, you and your family can prepare for it. You can gather information about the problem. The test may also indicate the need for additional tests to determine if the fetus might have other problems. If any are found, you and your physician can take steps to ensure a smooth delivery and have any necessary procedures done as soon after the birth as possible. It is still a personal decision. Discuss it carefully with your doctor and your partner.

A friend told me about a blood test she had that can detect problems with the baby. What is it?

You probably mean the maternal alpha-fetoprotein (AFP) test. It is a blood test done on you to determine abnormalities in your baby. Measurement of the amount of alpha-fetoprotein in your blood can help your doctor predict problems, such as Down syndrome and spina bifida.

Is the AFP test done on all pregnant women?

At this time, it is not performed on all pregnant women. However, it is required in some states, such as California and New York. If the test is not offered to you, discuss it with your doctor.

When is the AFP test done?

It is usually performed between 16 and 20 weeks of pregnancy. Test results must be correlated with the mother-to-be's age and weight, and the gestational age of the fetus. If AFP detects some problem, additional, more definitive testing is usually ordered.

What kind of abnormalities can AFP detect?

The test is designed to detect babies with the following conditions:

* neural-tube defects
* severe kidney disease
* severe liver disease
* esophageal or intestinal blockage
* Down syndrome
* urinary obstruction
* osteogenesis imperfecta (fragility of the baby's bones)

I've heard that if I have an alpha-fetoprotein test, chances are rather high that it will be abnormal, even if there are no problems. Is this true?

Yes. The test is not specific enough. For example, if 1,000 women are tested, 40 tests will come back abnormal. Of those 40 tests, only 1 or 2 actually have a problem. So if you have AFP and your test result is abnormal, don't panic. Another AFP test will be done to correlate results, and an ultrasound will be performed. Be sure you understand what false-positive and false-negative test results mean. Ask your doctor to explain what each result can mean to you.

I've heard about a test called chorionic villus sampling. What is it?

Chorionic villus sampling (CVS) is done to detect genetic abnormalities. Sampling is done early in pregnancy, usually between the 9th and 11th weeks.

How is the test done?

Ultrasound is used to locate the fetus and the placenta. A small piece of tissue is removed from the placental area with an instrument placed through the cervix or with a needle inserted through the abdomen.

Are there risks in having CVS done?

There is a small risk of miscarriage with this procedure. Only someone with experience should perform this test.

Is CVS better than amniocentesis?

CVS can be done much earlier in pregnancy, and results are available in about a week. If the woman decides to terminate the pregnancy after learning results of the test, the procedure can be performed earlier in pregnancy and may carry fewer risks. On the other hand, the risk of disturbing a normal pregnancy is slightly higher with CVS than with amniocentesis.

My friend told me about a special stethoscope that my doctor will use to let me hear my baby's heartbeat. What is it?

You're probably referring to a doppler. It is not actually a stethoscope. It magnifies the sound of the baby's heartbeat so you can hear it.

When will I be able to hear the baby's heartbeat?

Around the 12-week visit. If your doctor doesn't offer it to you, ask about it.

I'm close to delivery, and my doctor said I will have a pelvic exam the next time I come to the office. Why now, when I haven't had one for so long?

A pelvic exam is needed late in pregnancy because it tells us a lot of things:

* presentation of the baby: whether the baby is head first or in a breech position
* dilatation of the cervix: how much the cervix has opened
* effacement: how much the cervix has thinned
* shape and size of your birth canal or pelvic bones
* station: how low the baby is in your birth canal

When my obstetrician does a pelvic exam, does that tell him when I will go into labor?

No. At this point in your pregnancy, labor might start at any time, no matter what condition your cervix is in.

I take thyroid medication. Is it necessary during pregnancy?

Yes, it's very important to continue taking your thyroid medication throughout your pregnancy. Be sure your doctor knows what you take.

I asked my doctor for a prescription for Accutane to treat my acne, but she told me she couldn't prescribe it because I'm pregnant. Why?

Accutane (retinoic acid isotretinoin) is a common treatment for acne. However, pregnant women must not take it! There is a higher frequency of miscarriage and fetal malformation if a woman takes Accutane during the 1st trimester of pregnancy.

Is it OK for a pregnant woman to take medicines that don't require a prescription?

Over-the-counter (OTC) medications should be taken with care during pregnancy. Many OTCs contain aspirin, caffeine or phenacetin—all should be avoided during pregnancy. Limit your use of cough syrups, which may contain as much as 25% alcohol. Be careful with medications containing ibuprofen, such as Advil, Motrin and Rufen. Avoid newer medicines, such as Aleve and Orudis, until we know more about them and their safety in pregnancy. Read package labels, and ask your doctor or pharmacist before taking anything.

Are any vaccines regarded as safe for a pregnant woman?

Vaccines generally regarded as safe during pregnancy are tetanus, influenza (flu), diphtheria and rabies. Others may be safe, but we are unsure about them at this time, so avoid them.

Nutrition, Exercise & Weight Management

I've heard that during pregnancy I'm eating for two. Is this true?

What the old adage "a pregnant woman is eating for two" actually means is that you must be concerned about nutrition for yourself and for your growing baby. However, many women take this to mean they can eat twice as much, which is incorrect! Be smart about your food choices—you must eat wisely for both of you.

Do I need to increase the number of calories I consume now that I'm pregnant?

Yes. Most experts agree that a normal-weight pregnant woman needs to increase her caloric intake by 300 to 800 calories a day. These extra calories are important for tissue growth in you and your baby. Your baby is using the energy from your calories to create and store protein, fat and carbohydrates, and to provide energy for its own body processes. Expect to gain some weight during your pregnancy—it's natural and normal.

I'm confused about what I should eat every day. Can you recommend a healthful eating plan?

It's a good idea to eat a variety of foods throughout pregnancy. Below is a list of daily servings from six food groups:

* Dairy products—4 to 5 servings a day
* Protein sources—3 to 4 servings a day
* Vegetables—at least 4 servings a day
* Fruits—2 to 4 servings a day
* Breads, cereal, pasta and rice—6 to 11 servings a day
* Fats/flavorings—3 to 5 servings a day

I've heard I should eat foods that contain choline and DHA. Why?

Choline and docosahexaenoic acid (DHA) can help build baby's brain cells during fetal development and breastfeeding. Choline can be found in milk, eggs, whole-wheat bread and beef. DHA is found in fish, egg yolks, poultry, meat, canola oil, walnuts and wheat germ. If you eat these foods during pregnancy and while you're breastfeeding, you help your baby obtain these important supplements.

I've heard that I shouldn't use artificial sweeteners while I'm pregnant. Is this true?

Aspartame and saccharin are the two most widely used artificial sweeteners. Recently, there has been controversy as to the safety of aspartame. Substitute foods that do not contain the sweetener for products you usually use because at this point we are unsure about its safety for pregnant women and their developing babies.

Pregnant women who suffer from phenylketonuria must follow a low-phenylalanine diet or their babies may be born mentally retarded and suffer from delayed development. The phenylalanine in aspartame contributes to phenylalanine in the diet. Saccharin, although it is not used as much today as in the past, is still found in many foods, beverages and other substances. Saccharin is not safe to use during pregnancy.

I've been craving certain foods now that I'm pregnant. Is this normal?

For many women, cravings during pregnancy are normal. Cravings for particular foods during pregnancy can be both good and bad. If you crave foods that are nutritious and healthful, eat them in moderate amounts. If you crave foods that are high in sugar and fat, and loaded with empty calories, be very careful about eating them.

I feel so nauseous that I can't eat anything. Is this dangerous?

Nausea, also called morning sickness, is usually not dangerous because it doesn't last too long. It becomes dangerous when you are unable to eat an adequate amount of food or drink enough fluid.

Nausea is typically the worst during the beginning of pregnancy. It usually lessens and disappears after the 1st trimester, and you'll feel better for the rest of your pregnancy.

My doctor told me to drink lots of water every day, but it's hard to do. Do I really need it?

Water is necessary for your body to process nutrients, develop new cells and sustain blood volume. You may also feel better if you drink more fluid than you normally do. Your blood volume increases during pregnancy; drinking extra fluids helps you keep up with this change.

What do you suggest about caffeine intake during pregnancy?

Limit your caffeine intake during pregnancy and breastfeeding. Read labels on foods, beverages and over-the-counter medications to find out about caffeine content. Eliminate as much caffeine from your diet as possible.

How important is it for me to take prenatal vitamins?

It's very important to take prenatal vitamins for your entire pregnancy. Sometimes late in pregnancy a woman stops taking them—she gets tired of taking them or she decides they aren't necessary. The vitamins and iron in prenatal vitamins are essential to the well-being of your baby, so be sure you take them until your baby is born.

How are prenatal vitamins different from other vitamins?

The main difference is that prenatal vitamins also contain iron and folic-acid supplements.

Will I have to change my exercise program during pregnancy?

Changes in your body due to pregnancy will cause you to change the way you exercise. Your center of gravity changes, so you will need to adjust your exercise for that. As your abdomen grows larger, you won't be able to do some activities very comfortably and you may have to stop other activities all together.

I feel a lot hotter when I exercise during pregnancy. Is this normal?

When you're pregnant, you normally feel warmer than usual. You'll feel warmer, too, when you exercise, so try to avoid becoming overheated during workouts. Work out in a well-ventilated room, and drink lots of water while you exercise.

Expecting Two or More Babies

How does a multiple pregnancy occur?

The babies may come from a single egg that divides after fertilization, or more than one egg may be fertilized.

I heard the incidence of multiple births is on the increase. Why is that?

Researchers believe two factors are responsible for this increase. One is the wider use of fertility drugs or in vitro fertilization, which can result in multiple births. The second is the growing number of women who are having babies at an older age. We know the chance of twins increases as a woman gets older.

When is a multiple pregnancy most often discovered?

A multiple pregnancy is usually found during the 2nd trimester because the woman is larger than expected and growth seems to be too fast.

I'm expecting more than one baby; what do I have to keep in mind during my pregnancy?

One of the most important things you must remember with a multiple pregnancy is to take things more slowly, from the beginning of your pregnancy until delivery. Taking care of yourself is the best way to take care of your developing babies.

Changes in Your Developing Baby

How does my baby change during the 1st trimester?

This trimester is the one of greatest change for a developing fetus. In the first 13 weeks of development, your baby grows from a collection of cells the size of the head of a pin to a fetus the size of a softball. Organs begin developing, and your baby begins to look more normal.

How does my baby change during the 2nd trimester?

At the beginning of the 2nd trimester (14th week), your baby weighs less than 1 ounce (28g) and is only about 4 inches (10cm) long. By the end of this trimester, your baby is almost 9 inches (22cm) long and weighs close to 1-½ pounds (0.7kg).

How does my baby change during the 3rd trimester?

Your baby weighs about 1-½ pounds (0.7kg) at the beginning of this trimester (27th week), and its crown-to-rump length is under 9 inches (22cm). When it is delivered, your baby weighs close to 7-½ pounds (3.4kg) and is about 21 inches (53cm) long.

I'm 13 weeks' pregnant and read that my baby's head is about half or 50% of its body length. Can this be true?

Yes, at this point the head is about half the crown-to-rump length (measurement from top of the head to the baby's buttocks). In 2 months, when you are 21 weeks' pregnant, the head will be about ⅓ of the fetal body. At birth, your baby's head will be ¼ the size of its body.

Does my baby open its eyes inside my uterus?

Eyelids cover the eyes and are fused or connected around 11 to 12 weeks. They remain fused until about 27 to 28 weeks, when they open.

Changes in You

What changes will I see during the 1st trimester?

You will see very little change in yourself, although your baby is growing and changing quite rapidly. You may not even realize you are pregnant until the middle or close to the end of this trimester! You will experience very little weight gain during this time—probably no more than 5 pounds (2.25kg) for the entire 13 weeks. Your abdomen will grow a little—you may be able to feel your uterus about 3 inches (7.6cm) below your bellybutton. You won't feel the fetus move during this time.

What changes will I see during the 2nd trimester?

Others will be able to tell you are pregnant during this trimester. You will be able to feel your uterus about 3 inches (7.6cm) below your bellybutton at the beginning of this trimester. By the end of this trimester, you will feel your uterus about 3 inches (7.6cm) above your bellybutton.

Average weight gain for the 2nd trimester is a total (including weight from the 1st trimester) of 17 to 24 pounds (7.65 to 10.8kg). You will also begin to feel your baby move during this time.

What changes will I see during the 3rd trimester?

You will experience a great deal of change because your baby is growing so much. You will be able to feel your uterus about 3 inches (7.6cm) above your bellybutton at the beginning of this trimester. By delivery, your uterus is 6-½ to 8 inches (16.5 to 20.3cm) above your bellybutton.

Your baby gains a lot of weight during this time, even though you may not. Total weight gain by delivery is 25 to 35 pounds (11.25 to 15.75kg) for the average woman.

My cousin said that with her second and third pregnancies, her body started to change much earlier than with her first pregnancy. Why?

The way a woman's body responds to pregnancy is influenced by her previous pregnancies. Skin and muscles stretch to accommodate the enlarged uterus, placenta and baby. Stretched muscles and stretched skin are never exactly the same again. They may give way faster to accommodate the growing uterus and baby with subsequent pregnancies, which causes a woman to show sooner and to feel bigger.

I'm 11 weeks' pregnant, but I don't even show yet. Should I be concerned?

No. A lot has been happening with the development of your baby's organs and organ systems. However, friends are probably not yet able to tell you're pregnant. You may be able to feel your uterus down by your pubic bone or your clothes may be getting a little snug.

If this is your first pregnancy, it often takes longer to see a change in your tummy. If you have had other pregnancies, you will probably show sooner. Don't despair—you'll be getting larger soon, then everyone will know you're pregnant!

A dark vertical line has appeared on my abdomen. What is it?

It is called the linea nigra and appears on many women during pregnancy. It often fades markedly after pregnancy, but it may never fully disappear.

I've got brown patches on my face that I never had before. What are they?

These patches are called chloasma or mask of pregnancy and are believed to be caused by the hormonal changes brought about during pregnancy. Usually these dark patches disappear completely or get lighter after your baby is born. (Oral contraceptives often cause similar pigmentation changes.)

The skin over my abdomen itches the worst. What causes this?

As your uterus grows and fills your pelvis, abdominal skin and muscles must stretch to accommodate it. Stretching of the skin causes abdominal itching in many women.

A friend mentioned Braxton-Hicks contractions. What are they?

They are painless, nonrhythmical contractions you may feel when you place your hands on your abdomen. You may also feel them in the uterus itself. These contractions may begin early in your pregnancy and are felt at irregular intervals. They are not signs of true labor.

When I move or get up, it hurts on the lower part of my sides. Should I worry?

What you are describing is usually called round-ligament pain. There are ligaments on either side of the uterus; as your uterus gets bigger, these ligaments stretch and get longer and thicker. Quick movements can stretch the ligaments, and that hurts. This is not harmful to you or your baby, but it can be uncomfortable.

I just found out I'm 9 weeks' pregnant, and I have to go to the bathroom all the time. Does this last all through pregnancy?

One of the first symptoms of early pregnancy is frequent urination. This problem continues off and on throughout pregnancy; you may have to get up to go to the bathroom at night when you never did before. It usually lessens during the 2nd trimester, then returns during the 3rd trimester, when the growing baby puts pressure on the bladder.

I'm 15 weeks' pregnant and felt my baby move already. Is there something wrong?

The first time a woman feels her baby move is different for every woman. It can also be different from one pregnancy to another. One baby may be more active than another, so you feel movement sooner.

I'm in the early part of my second trimester, and I haven't felt my baby move yet. Is that OK?

Yes, it's all right. The normal time to feel movement is between 16 and 20 weeks.

A friend of mine is 26 weeks' pregnant. Her doctor wants her to keep track of her baby's movements. Why?

A doctor may have a mother-to-be monitor her baby's movements around this time if she has had a difficult pregnancy, if she had a previous stillbirth or if she has a medical condition, such as diabetes. Recording movements at certain times each day may provide the doctor with additional information about the status of the fetus. Between 20 and 32 weeks of pregnancy, the fetus can move between 200 and 500 times a day, including kicking, rolling or wiggling.

I'm 13 weeks' pregnant, and my breasts are getting bigger. Isn't this a little early?

Many changes occur in your breasts during pregnancy. After about 8 weeks, it's normal for your breasts to start getting larger. You may even notice they are lumpy or nodular. These are all normal changes in pregnancy.

I've noticed some fluid coming from my breasts, staining my clothes. I'm only about halfway through my pregnancy. Is this breast milk already?

No, it isn't. During the 2nd trimester, a thin yellow fluid called colostrum is formed; it is the precursor to breast milk. Sometimes it will leak from the breasts or can be expressed by squeezing the nipples. Don't try to express the fluid. Wear breast pads if you have problems with leakage.

Every time I go to the doctor, my stomach is measured with a tape measure. Why?

As you progress in your pregnancy, your doctor needs a point of reference to measure how much your uterus is growing. Some measure from the bellybutton to the top of the uterus. Others measure from the pubis symphysis, the place where pubic bones meet in the middle-lower part of your abdomen, to the top of the uterus.

I'm due in a couple of weeks, and I've noticed a change in the shape of my abdomen—it seems lower. Should I be concerned?

Often a few weeks before labor begins or at the beginning of labor, the head of your baby begins to enter the birth canal, and your uterus seems to drop a bit. This is called lightening. Don't be concerned if this occurs.

A friend told me a baby can hear inside the womb. Is this true?

Yes. Life inside the womb may be like living near a busy freeway. The developing baby hears a constant background of digestive noises and the maternal heartbeat. The fetus also hears the mother-to-be's voice, although it may not hear higher-pitched tones.

Does my growing baby respond to sounds?

There is evidence that by the 3rd trimester, the fetus responds to sounds it hears. Researchers have noted fetal heart-rate increases in response to tones it hears through the mother's abdomen.

Lifestyle Changes

I smoke cigarettes every day. Should I stop?

Yes! A pregnant woman who smokes one pack of cigarettes a day (20 cigarettes) inhales tobacco smoke more than 11,000 times during an average pregnancy! Tobacco smoke inhaled by the mother can affect a growing baby.

I want to quit smoking. Is it OK for me to use the Nicoderm patch or Nicorette gum while I'm pregnant?

The stop-smoking patches and gum contain many of the same substances that cigarettes do. The specific effects of Nicoderm and Nicorette on fetal development are unknown. However, if you are pregnant, researchers advise not using either of these stop-smoking systems because you and your baby might be exposed to the harmful substances you are trying to avoid.

Is it all right to drink alcohol while I'm pregnant?

Alcohol use by a pregnant woman carries considerable risk. Even moderate use of alcohol has been linked to an increase in the chance of miscarriage. Excessive alcohol consumption during pregnancy can result in abnormalities in the baby. Chronic use of alcohol during pregnancy can lead to fetal alcohol syndrome (FAS).

Other Prenatal Concerns

I usually lie on my stomach when I sleep. Will I be able to do this as I get bigger?

Lying directly on your stomach isn't a good idea. It puts a lot of pressure on your growing uterus, which will be a comfort problem later. The bigger you get, the harder it is to lie on your stomach.

My sister said it's not good for me to lie on my back during pregnancy. Does she know what she's talking about?

After 16 weeks (about 4 months) of pregnancy, it's best not to lie on your back when you sleep or rest. Lying on your back can place the uterus on top of important blood vessels (inferior vena cava and aorta) that run down the back of your abdomen. This can decrease circulation to your baby and to parts of your body. It may also be harder for you to breathe when you lie on your back.

My friend told me that I should pick my baby's pediatrician before the baby is born. Is this true?

Yes. You can interview a pediatrician to help you build the right partnership for your child's health and well-being. Talk with the pediatrician about the care of your baby, ask questions about feeding and receive some guidelines about dealing with a new baby.

How do I find a pediatrician?

Ask your doctors, friends, co-workers and family members for references to pediatricians they know and trust. If you cannot find one that way, contact your local medical society and ask for a reference.

Problems & Warning Signs

I'm 7 weeks' pregnant and started to bleed a little last night. It scares me. What should I do?

Call your doctor about any bleeding; he or she may want you to have an ultrasound. This early in pregnancy, you are probably worrying about having a miscarriage. Be assured that bleeding during pregnancy is not unusual and doesn't always mean a problem. About 1 woman in 5 bleeds sometime in early pregnancy.

I've heard about diabetes that occurs only during pregnancy. What is it?

Some women develop diabetes only during pregnancy; it is called gestational diabetes. It affects about 10% of all pregnancies. After pregnancy, nearly all women with gestational diabetes return to normal, and the problem disappears.

This is my first pregnancy, and I'm very nervous about having a miscarriage. What exactly is a miscarriage?

A miscarriage is a loss of a pregnancy before 20 weeks of gestation. An embryo or a fetus is delivered before it can survive outside the womb. This may also be called a spontaneous abortion. Loss of the fetus after 20 weeks is a stillbirth.

Why do miscarriages occur?

Most of the time we don't know—a miscarriage can happen for many different reasons. The most common finding in early miscarriages is abnormal development of the early embryo. Research indicates that more than half of these miscarriages have chromosomal abnormalities. Outside factors can also cause miscarriage. Maternal factors are also believed to be relevant in some miscarriages.

Do miscarriages occur very often?

Miscarriages occur in 1 out of every 4 pregnancies; about 25% of all pregnancies end in miscarriage.

What is an ectopic pregnancy?

Ectopic pregnancy, sometimes called tubal pregnancy, occurs about once in every 100 pregnancies. An ectopic pregnancy happens when implantation of the embryo occurs outside the uterine cavity, usually in the Fallopian tube. It can also occur on the ovary, in the entrance to the tube, at the point the tube joins the uterus and at the mouth of the uterus. An ectopic pregnancy is serious because heavy bleeding may result when it ruptures.

Childbirth

I heard a woman describe her baby as "dropping." Does this mean the baby was falling out?

No, it doesn't. The feeling of having your baby drop, also called lightening, means the baby's head has moved down deep into your pelvis. It is a natural part of the birthing process and can happen a few weeks to a few hours before labor begins.

Does the water usually break before a woman goes into labor?

Sometimes the water breaks shortly before labor begins. However, in most cases, a doctor will rupture the membranes after the woman goes to the hospital and is in labor.

What is preterm birth?

Preterm birth refers to a baby born more than 4 weeks early. It is also called premature birth.

What will my doctor tell me to do if I go into labor too early?

It is important to try to halt the contractions. Most doctors start by recommending bed rest and increased fluids to stop labor. Bed rest means lying in bed on your side. Either side is OK, but the left side is best.

I've heard all sorts of stories about labor, but I don't really know what it is. Can you explain it for me?

Labor is defined as the dilatation (stretching and expanding) of your cervix. This occurs when your uterus, which is a muscle, tightens (contracts) to squeeze out its contents (your baby).

I've heard about different stages of labor. What are they?

Labor is divided into three stages—each stage is distinctly different and has a specific purpose.

What is the 1st stage of labor?

Stage 1 of labor is the longest and consists of three phases—early, active and transition. The first stage of labor usually lasts 6 to 8 hours but can be longer for a first birth.

In the early phase, labor is just getting started and dilatation of the cervix has just begun. In the active phase, the cervix dilates at a fairly constant rate; transition includes complete dilatation. Contractions help the cervix dilate and thin out. They also help move the baby down the birth canal for delivery.

At the transition phase, the pace and intensity of labor increases, signaling that labor is moving into the second stage.

What is the 2nd stage of labor?

In stage 2 of labor, you are fully dilated and begin to push. Contractions change and become much harder, longer and more frequent. Along with your pushing, these contractions help deliver the baby. This stage can take 2 hours or longer. Anesthesia at this point, especially an epidural block, may prolong this stage of labor because your urge to push is decreased. At the end of the second stage, your baby is born.

What is the 3rd stage of labor?

Stage 3 of labor is usually short. During stage 3, the uterus contracts and expels the placenta (afterbirth). You will be given oxytocin to help contract the uterus.

When I am in labor, how is it determined that I will need a Cesarean delivery?

Each situation and each labor must be considered individually. A reason for a Cesarean delivery in the 1st stage of labor is if the cervix stops dilating; say, you get to be 5cm and then don't dilate any more. In the 2nd stage of labor, a reason for a Cesarean delivery could be fetal distress or if you can't push the baby out.

What is back labor?

Back labor occurs when the baby comes out through the birth canal looking straight up. This type of presentation often causes lower back pain.

My doctor was mentioning fetal monitoring during labor and delivery. What is this?

In many hospitals, a baby's heartbeat is monitored throughout labor, making it possible to detect any problems early so they can be resolved.

What is an epidural block?

With an epidural block, a tube is inserted into a space outside the mother's spinal column in the lower back. Medication is administered through the tube for pain relief. The tube remains in place until after delivery so additional medication can be administered when necessary, or it can be given continuously with a pump.

An epidural causes some loss of sensation in the lower part of the body. It helps relieve painful uterine contractions, pain in the vagina and rectum as the baby passes through the birth canal and the pain of an episiotomy. A woman can still feel pressure, so she can usually push adequately during vaginal delivery.

An epidural block is not effective in some women. Because an epidural may make it harder to push, vacuum extraction or forceps may be necessary during delivery.

My doctor just told me I may need to have a Cesarean delivery, and I'm scared. What is it exactly?

When a woman has a Cesarean delivery (also called a C-section), her baby is delivered through an incision made in her abdominal wall and uterus.

How is a Cesarean delivery done?

The doctor makes an incision through the skin of the abdominal wall down to the uterus, then cuts the wall of the uterus. He or she cuts the amniotic sac containing the baby and placenta, and removes the baby through the incisions. After delivering the baby, your doctor removes the placenta and closes the uterus in layers with sutures that are absorbed (they don't have to be removed), then the abdomen is sewn together.

If I have to have a Cesarean, can I be awake?

With most Cesarean deliverys, the anesthesiologist will give you an epidural or a spinal anesthetic. You are awake with these.

I've heard that once you have a Cesarean, you must always have one. But don't some women deliver vaginally after having a Cesarean?

In the past it was believed that once a woman had a Cesarean delivery, all later deliveries would have to be Cesarean also. Today it is becoming more common for women who have had a Cesarean delivery to deliver vaginally with later pregnancies. This is called vaginal birth after Cesarean (VBAC).

What is an episiotomy?

An episiotomy is a surgical incision in the area behind the vagina, above the rectum; it is made during delivery to avoid tearing the vaginal opening or rectum.

Will I have to have an episiotomy?

This is something you need to discuss at your prenatal visits. Most women having their first or second baby will have an episiotomy. The more children a woman has had, the less likely she will need an episiotomy. It depends on the size of the baby. There are some situations that do not require an episiotomy, such as a small baby or a premature baby. Often the decision cannot be made until the time of delivery.

How painful is an episiotomy?

After delivery of your baby, the most painful part of the birth process might be your episiotomy. Don't be afraid to ask for help with this pain. Many options are available for pain relief, including pain medication, ice, sitz baths and laxatives.

I heard a woman at the doctor's office say her baby was in a breech position. What did she mean?

A breech presentation means the baby is not in a head-down position, and the legs or buttocks come into the birth canal first.

If my baby is breech, is that bad?

Early in pregnancy, breech is common. By the last 4 to 6 weeks, your baby should be in a head-down position. If your baby is breech when it is time to deliver, your doctor may try to turn the baby or you may need a Cesarean delivery.

What happens to my baby after it is born?

First, the baby's mouth and throat are suctioned to clear out any secretions. Then the doctor clamps and cuts the umbilical cord. The baby is wrapped in clean blankets and may be placed on your abdomen. At 1 minute and 5 minutes after birth, Apgar scores are recorded to show the baby's response to birth and to life outside the womb. An ID band is placed on the baby's wrist. Usually a brief physical or an assessment is done right after delivery. The baby receives eye drops to prevent infection and is given a vitamin-K shot to prevent bleeding.

You will be asked if you want your baby to receive the hepatitis vaccine. You may want to discuss this with your doctor or your baby's pediatrician. The vaccine is given to protect the baby against hepatitis in the future.

When the initial evaluation is complete, the baby is returned to you.

What is a postterm birth?

Babies born 2 weeks or more past their due date are considered postterm or overdue births. Babies that are 41 weeks are not considered postterm.

How common is postterm birth?

About 10% of all babies are born more than 2 weeks past their due date.

Is a postterm birth dangerous for my baby?

Carrying a baby longer than 42 weeks can cause some problems for the fetus and the mother. Most pregnancies do well. Doctors conduct tests on these babies and induce labor, if necessary.

After Your Baby is Born

How long will I have to stay in the hospital?

Most women are discharged within a day or two, if labor and delivery are normal and the baby is doing well. If you have a Cesarean delivery, you will stay a few days longer.

What happens during my recovery from a vaginal delivery?

Hospital staff will check your blood pressure and bleeding closely for the first few hours after the birth. They will offer you medication for pain relief and encourage you to nurse your baby. The pressure that was exerted on your urethra during delivery may make it a bit more difficult to urinate after baby's birth. This will slowly clear up.

What happens during recovery if I have a Cesarean delivery?

You will be in a recovery area where a nurse will monitor you. You will be offered pain medication. After about an hour, you will be moved to your room.

Are there any activities I should avoid after my baby is born?

Avoid lifting any objects heavier than the baby the first few weeks. If possible, avoid climbing stairs whenever you can.

My friend said she was really tired after her baby was born. Is this normal?

Many women are surprised by how tired they are emotionally and physically the first few months after the birth of the baby. Your aerobic capacity can increase as much as 20% in the 6 weeks following baby's birth. This is good news if you feel overly fatigued. As your hormones return to a normal level, you'll probably have more energy. Take time for yourself—you'll have a period of adjustment.

I've heard I should get lots of sleep after the baby is born. Why?

Sleep and rest are essential after the baby is born to help you get back in shape. To get the rest you need, go to bed early when possible. Try taking a nap or resting when baby naps.

I've heard about feeling blue after the baby is born. Is that normal?

After your baby is born, you may feel sad and cranky. It's called postpartum distress syndrome (PPD), or the baby blues; up to 80% of all women experience this. It usually appears between 2 days and 2 weeks after the baby is born. The drop in estrogen and progesterone after delivery may contribute to the problem. The situation is temporary and tends to leave as quickly as it comes.

Will I ever regain the tightness of my abdominal skin now that my baby is here?

For some women, skin returns to normal naturally. For others, it never returns to its prepregnancy state. Abdominal skin is not like muscle, so it can't be strengthened by exercise. One of the main factors that affect your skin's ability to return to its prepregnancy tightness is connective tissue, which provides suppleness and elasticity. As you get older, your skin loses connective tissue and elasticity. Other factors include your state of fitness before pregnancy, heredity and how greatly your skin was stretched during pregnancy.

I thought I'd feel thinner now that I'm no longer pregnant, but I still feel fat. What can I do about my weight?

It's normal to lose 10 to 15 pounds (4.5 to 6.75kg) immediately after your baby is born. Extra weight may be harder to lose. Your body stored about 7 to 10 pounds (3.15 to 4.5kg) of fat to provide energy for the first few months after birth. If you eat properly and get enough exercise, these pounds will slowly come off.

I really want to get back to exercising now that my baby is here. How should I approach exercise?

Do something you enjoy, and do it on a regular basis. Walking and swimming are excellent exercises to help you get back in shape. However, before you start any postpartum exercise program, check with your doctor. He or she may have some particular advice for you.

What will my postpartum checkup cover?

You will have a physical exam, similar to the one at your first prenatal exam. Your doctor will also do an internal exam. If you had any birth tears or incisions, he or she will examine them to see how they are healing. This is a good time to discuss birth control, if you haven't already made plans.