20 facts of a preggo 20 facts of a preggo
1. You look at your belly in the mirror instead of your face.
2. Where you once believed you were fearless, you now find yourself afraid.
3. The sacrifices you made to have a child no longer seem like sacrifices. (everything you give up is worth it.)
4. You respect your body...FINALLY.
5. You have stronger opinions and are stronger willed. (some people call this "mood swings")
6. You respect your parents (especially your mother) and love them in a new way.
7. You find that your baby's pain feels much worse than your own.
8. You finally understand what all the other mommies meant when they said, "I am complete"
9. You believe once again in the things you believe in when you were a child. (hurray for santa clause!)
10. You lose touch with the people in your life that you should have lost touch with a long time ago.
11. You heart breaks much more easily.
12. You think of your baby 986,234,852,947 times a day. In fact, you're so busy with this that you don't have time for anything else!
13. Food that don't go together taste so good! (Thank God for french fries dipped in ice cream!!!)
14. You no longer like it when you guys check you out. In fact, it offends you.
15. You think before you speak, and you learn to expand your vocabulary. (The word "bottom" now replaces "ass")
16. Bodily functions are no longer repulsive.
17. You see beauty in the ugliest babies, and you find yourself saying, "aww, look how cute that baby is."
18. You realize that you can love someone before you even meet them.
19. If you have a son, you no longer curse men.
20. Your love becomes limit-less...like a super human power.
FETAL DEVELOPMENT- From conception to birth
DAY 1: fertilization: all human chromosomes are present; unique human life begins.
DAY 6: embryo begins implantation in the uterus.
DAY 22: heart begins to beat with the child's own blood, often a different type than the mothers'.
WEEK 3: By the end of third week the child's backbone spinal column and nervous system are forming. The liver, kidneys and intestines begin to take shape.
WEEK 4: By the end of week four the child is ten thousand times larger than the fertilized egg.
WEEK 5: Eyes, legs, and hands begin to develop.
WEEK 6: Brain waves are detectable; mouth and lips are present; fingernails are forming.
WEEK 7: Eyelids, and toes form, nose distinct. The baby is kicking and swimming.
WEEK 8: Every organ is in place, bones begin to replace cartilage, and fingerprints begin to form. By the 8th week the baby can begin to hear.
WEEKS 9 AND 10: Teeth begin to form, fingernails develop. The baby can turn his head, and frown. The baby can hiccup.
WEEKS 10 AND 11: The baby can "breathe" amniotic fluid and urinate. Week 11 the baby can grasp objects placed in its hand; all organ systems are functioning. The baby has a skeletal structure, nerves, and circulation.
WEEK 12: The baby has all of the parts necessary to experience pain, including nerves, spinal cord, and thalamus. Vocal cords are complete. The baby can suck its thumb.
WEEK 14: At this age, the heart pumps several quarts of blood through the body every day.
WEEK 15: The baby has an adult's taste buds.
MONTH 4: Bone Marrow is now beginning to form. The heart is pumping 25 quarts of blood a day. By the end of month 4 the baby will be 8-10 inches in length and will be one half of its birth weight.
WEEK 17: The baby can have dream (REM) sleep.
WEEK 19: Babies can routinely be saved at 21 to 22 weeks after fertilization, and sometimes they can be saved even younger.
WEEK 20: At 20 weeks the baby recognizes its' mothers voice.
WEEK 25: The baby can respond to outside noise.
MONTHS 5 AND 6: The baby practices breathing by inhaling amniotic fluid into its developing lungs. The baby will grasp at the umbilical cord when it feels it. Most mothers feel an increase in movement, kicking, and hiccups from the baby. Oil and sweat glands are now functioning. The baby is now twelve inches long or more, and weighs up to one and a half pounds.
MONTHS 7 THROUGH 9: Eyeteeth are present. The baby opens and closes his eyes. The baby is using four of the five senses (vision, hearing, taste, and touch.) He knows the difference between waking and sleeping, and can relate to the moods of the mother. The baby's skin begins to thicken, and a layer of fat is produced and stored beneath the skin. Antibodies are built up, and the baby's heart begins to pump 300 gallons of blood per day. Approximately one week before the birth the baby stops growing, and "drops" usually head down into the pelvic cavity.
Morning Sickness: Causes, Concerns, and Treatments
Why do they call it morning sickness when I feel nauseated all day long?
"Morning sickness" is really a misnomer. (In fact, the technical medical term is "nausea and vomiting of pregnancy.") For some pregnant women, the symptoms are worst in the morning and ease up over the course of the day, but they can strike at any time and last all day long.
About three quarters of pregnant women experience nausea and sometimes vomiting during their first trimester. The nausea usually starts around six weeks of pregnancy, but it can begin as early as four weeks. It tends to get worse over the next month or so.
About half of the women who get it feel complete relief by about 14 weeks. For most of the rest, it takes another month or so for the queasiness to ease up, though it may return later and come and go throughout pregnancy.
What causes nausea and vomiting during pregnancy?
No one knows for sure what causes nausea during pregnancy, but it's probably some combination of the many physical changes taking place in your body. Some possible causes include:
• Rapidly rising levels of the hormone human chorionic gonadotropin (hCG) during early pregnancy. No one knows how hCG contributes to nausea, but the timing is right: Nausea tends to peak around the same time as levels of hCG.
Estrogen, another hormone that rises rapidly in early pregnancy, is also considered a prime suspect, and it's possible that other hormones play a role as well.
• An enhanced sense of smell and sensitivity to odors. It's not uncommon for a newly pregnant woman to feel overwhelmed by the smell of a bologna sandwich from four cubicles away, for example, and that certain aromas instantly trigger her gag reflex. This may be a result of higher levels of estrogen.
• A tricky stomach. Some women's gastrointestinal tracts are simply more sensitive to the changes of early pregnancy.
You may have heard that morning sickness can be caused by a vitamin B deficiency. While taking a vitamin B6 supplement does seem to help ease nausea in many pregnant women, this doesn't mean they have a vitamin deficiency. In fact, at least one study has shown no significant differences in the levels of B6 in women with morning sickness and those without.
No one knows why B6 is helpful. There's also some evidence that taking a multivitamin at the time of conception and in early pregnancy helps prevent severe morning sickness, but again, no one knows why.
Some researchers have proposed that certain women are psychologically predisposed to having nausea and vomiting during pregnancy as an abnormal response to stress. However, there's no good evidence to support this theory. (Of course, if you're constantly nauseated or vomiting a lot, you certainly may begin to feel more stressed!)
Are some pregnant women more likely than others to feel nauseated?
You're more likely to have nausea or vomiting during your pregnancy if any of the following apply:
• You're pregnant with twins or higher multiples. This may be from the higher levels of hCG, estrogen, or other hormones in your system. You're also more likely to have a more severe case than average. On the other hand, it's not a definite thing — some women carrying twins have little or no nausea.
• You had nausea and vomiting in a previous pregnancy.
• You have a history of nausea or vomiting as a side effect of taking birth control pills. This is probably related to your body's response to estrogen.
• You have a history of motion sickness.
• You have a genetic predisposition to nausea during pregnancy. If your mother or sisters had severe morning sickness, there's a higher chance you will, too.
• You have a history of migraine headaches.
• You're carrying a girl. One study found that women with severe nausea and vomiting were 50 percent more likely to be carrying a girl.
Pregnancy Symptoms You Should NEVER Ignore How do you know whether that sudden ache is normal or warrants a 2 a.m. call to your doctor or midwife? Here's a rundown of symptoms that should set off your warning bells. But even if you don't see your symptom on this list, it's better to err on the side of caution and make that call than to agonize for hours, wondering whether you've pulled a ligament or gone into preterm labor. *Note that some of these symptoms may be more or less urgent depending on your particular situation or health history and on how far along you are in your pregnancy. Ask your practitioner to review with you which signs warrant an urgent call at various points in your pregnancy.
• Your baby is moving or kicking less than usual (once he begins moving regularly). Ask your caregiver if you should monitor your baby's activity by doing daily "kick counts." She can give you specific instructions on how to count and when to call.
• Severe or persistent abdominal pain or tenderness.
• Vaginal bleeding or spotting.
• An increase in vaginal discharge or a change in the type of discharge — that is, if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged). Note: After 37 weeks, an increase in mucus discharge is normal and may indicate that you'll be going into labor soon.
• Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it's a new problem for you), menstrual-like cramping or abdominal pain, or more than four contractions in an hour (even if they don't hurt) before 37 weeks.
• Painful or burning urination, or little or no urination.
• Severe or persistent vomiting, or any vomiting accompanied by pain or fever.
• Chills or fever of 100 degrees Fahrenheit or higher.
• Visual disturbances such as double vision, blurring, dimming, flashing lights, or "floaters" (spots in your field of vision).
• Persistent or severe headache, or any headache accompanied by blurred vision, slurred speech, or numbness.
• Any swelling in your face or puffiness around your eyes, anything more than a little swelling in your hands, severe and sudden swelling of your feet or ankles, or a rapid weight gain (more than 4 pounds in a week).
• A persistent or severe leg cramp or calf pain that doesn't ease up when you flex your ankle and point your toes toward your nose or when you walk around, or one leg being significantly more swollen than the other.
• Trauma to the abdomen.
• Fainting, frequent dizziness, a rapid heartbeat, or heart palpitations.
• Difficulty breathing, coughing up blood, or chest pain.
• Severe constipation accompanied by abdominal pain or severe diarrhea that lasts more than 24 hours.
• Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body.
• Any health problem that you'd ordinarily call your practitioner about even if it's not pregnancy related (like worsening asthma or a cold that gets worse rather than better). Just call a little sooner than you would normally.
If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and call your healthcare provider. Your practitioner expects such calls. If there's a problem, you'll get help right away. If nothing's wrong, you'll be reassured.
Your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal." Do yourself and your baby a favor and get any unusual symptoms checked out.
Finally, if you're near your due date, check out the signs of labor so you'll know what to look for and when to call your caregiver
(Can daddies have PREGNANCY SYMPTOMS?! Question: Can daddies have pregnancy symptoms?) The answer: YES.
As strange as it may sound, some men start to feel pregnant while their partner is expecting. They even exhibit similar symptoms. The phenomenon is called Couvade Syndrome, or "Sympathetic Pregnancy."
"Couvade" comes from the french word couvee, meaning "to hatch." It has come to mean a man that has sypathetic pregnancy. So, yes, this means that the daddy is so excited about the baby, or so worried about the pain/discomfort you go through, that he experiences many of the pregnancy symptoms mommies go through, such as: cravings, weight gain, morning sickness, and a change in sexual appetite. Obviously, though, it is impossible for a man to experience EVERYTHING that a mother goes through during pregnancy.
Generally, couvade syndrome begins in the end of the first trimester and increases in severity until the third trimester. The only known cure for couvade is--- birth.
Some people have doubted the reality of couvade syndrome. These doubters say that the weight gain that the father may experience is caused by the eating habits of the mother, nerves, or other changes that pregnancy makes in one's life. The vomiting? Of course, that is blamed on nerves, too. What do the dads have to say about this? They don't know what to think about vomiting, weight gain, and changes in sexual appetite. How can you tell everyone at work that you need to lie down because you have morning sickness?!? And, of course, they would stop vomiting if they could. This is something that has been researched and found to be quite real. Some men are more susceptible to couvade than others. For instance if you and your partner have experienced infertility or if you were adopted, you could be more likely to experience couvade syndrome. So, guys, know that you are not alone, and that you have the medical community backing you up. Eat some crackers, get out of bed slowly, drink some ginger tea and try to get a bit of rest and know that birth is right around the corner. And don't shove her out of the way of the toilet!
Fetal Movements: Feeling Your Baby Move
FETAL MOVEMENTS: Feeling Your Baby Move
When should I start to feel my baby move?
You probably won't feel your baby kick until sometime between 16 and 22 weeks, even though he started moving at 7 or 8 weeks and you may have already witnessed his acrobatics if you've had an ultrasound.
Veteran moms tend to notice those first subtle kicks — also known as "quickening" — earlier than first-time moms. (A woman who's been pregnant before can more easily distinguish her baby's kick from other belly rumblings, such as gas.)
Your build may also have something to do with when you'll be able to tell a left jab from a hunger pang. Thinner women tend to feel movement earlier and more often than women who carry more weight.
What does it feel like?
Women have described the sensation as being like popcorn popping, a goldfish swimming around, or butterflies fluttering. You'll probably chalk up those first gentle taps or swishes in your belly to gas or hunger pains, but once you start feeling them more regularly, you'll recognize the difference. You're more likely to feel these early movements when you're sitting or lying quietly.
How often should I feel movements?
At first the kicks you notice will be few and far between. In fact, you may feel several movements one day and then none the next. Although your baby is moving and kicking regularly, many of his jerks and jolts aren't yet strong enough for you to feel. But later in the second trimester, those reassuring kicks will become stronger and more regular.
If you're tempted to compare notes with other pregnant women, don't worry if your experience differs from that of your friends. Every baby has his own pattern of activity, and there's no correct one. As long as your baby's usual activity level doesn't change too much, chances are he's doing just fine.
Do I need to keep track of the kicking?
Once you're feeling kicks regularly, pay attention to them and let your practitioner know right away if you notice a decrease in your baby's movement. Less movement may signal a problem, and you'll need a nonstress test or biophysical profile to check on your baby's condition.
Once you're in your third trimester, some practitioners will recommend that you spend some time each day counting your baby's kicks. There are lots of different ways to do these "kick counts," so ask for specific instructions.
Here's one common approach: Choose a time of day when your baby tends to be active. (Ideally, you'll want to do the counts at roughly the same time each day.) Sit quietly or lie on your side so you won't get distracted. Time how long it takes for you to feel ten distinct movements — kicks, twitches, and whole body movements all count. If you don't feel ten movements in two hours, stop counting and call your midwife or doctor.
Tanning during pregnancy- not a good idea! ***TANNING DURING PREGNANCY:
Using a tanning bed during pregnancy is DEFINITELY NOT a good idea. There's no conclusive evidence that they're DIRECTLY harmful to a developing fetus, but there is plenty of proof that they're dangerous to you, which in turn, CAN then make it dangerous to your baby.
Tanning beds pose the same dangers as the sun: They emit ultraviolet (UV) radiation, which causes skin cancer. Don't believe anyone who tells you that because tanning booths emit only UVA rays they're not hazardous to your health.
One study suggests that visiting a tanning booth ten times in a year can double your chances of developing melanoma — one of the most deadly types of cancer. Melanoma is the only type of cancer that spreads to the placenta, and that could be disastrous for both you and your baby.
Being in a small enclosed room while in a hot tanning bed can also increase your blood pressure (as well as taking hot baths)- and a high blood pressure is NOT good for the baby. It takes an even blood pressure for your blood to disperse evenly throughout your body in order to reach your uterus. When your blood pressure is high, your blood does not disperse evenly.
As far as the whole "cooking the baby" thing goes: that is just a wifes tale- the baby doesn't feel the rise in temperature- it just has to do with the blood pressure...
***SMOKING DURING PREGNANCY:
Smoking during pregnancy will expose your baby to nicotine, carbon monoxide, and other harmful toxins that can stunt his growth — including brain growth. An expecting mom with a pack-a-day habit will reduce her baby's birth weight by about half a pound, on average. (Remember, "average" means that some babies are far more affected than others.) This is significant because low birth weight is one of the main factors linked to newborn illness, disability, and death.
Cigarette smoking is also associated with increased risk for many pregnancy complications. These include premature labor, ectopic pregnancy (in which the fertilized egg implants outside the womb), miscarriage, placenta previa, placental abruption, vaginal bleeding, and premature delivery.
The long-term consequences of smoking during pregnancy can linger far after childbirth. Recent studies suggest that babies born to mothers who smoked are more likely to have learning problems, short attention spans, and hyperactivity disorders. They're more vulnerable to breathing problems such as asthma. Smoking during pregnancy can also put your baby at risk for sudden infant death syndrome (SIDS).
Drinking During Pregnancy- NOT a good idea!
How much alcohol is too much?
Alcohol and pregnancy don't mix. That's because is it known to be harmful to a developing baby- even though no one knows EXACTLY what harmful effects even the smallest amount of alcohol has on a developing baby. All public health officials in the United States recommend that mothers-to-be play it safe by steering clear of alcohol entirely.
"We don't really know what a safe level of alcohol consumption is for a pregnant woman — and it's probably different for every woman because no one metabolizes alcohol in the same way," says Pam Phipps, research manager of the fetal alcohol and drug unit in the Department of Psychiatry and Behavioral Sciences at the University of Washington in Seattle. "Since it's impossible to identify a safe dose, we advise abstinence." So do experts at the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.
What effects could alcohol have on my baby?
When you drink, the alcohol quickly travels through your bloodstream to your baby. Your baby may end up with higher levels of blood alcohol than you have. Basically, if you are getting drunk, your baby is getting drunk- and the effects of drinking can be MUCH greater on your baby than you.--- I mean, think about it: you wouldn't give your newborn a shot of vodka, would you?
Drinking endangers your growing baby in a number of ways: It increases the risk of miscarriage and stillbirth. As little as one drink a day can increase the odds for low birth weight and raise your child's risk for problems with learning, speech, attention span, language, and hyperactivity. And some research has shown that expectant moms who have as little as one drink per week are more likely than nondrinkers to have children who later exhibit aggressive and delinquent behavior.
The most severe result of alcohol use is fetal alcohol syndrome (FAS), a permanent condition characterized by poor growth, abnormal facial features, and damage to the central nervous system. Babies with FAS grow poorly in the womb or after birth, or both. In addition to abnormal facial features, they may have abnormally small heads and brains; heart, spine, and other anatomical defects. The central nervous system damage may include mental retardation, delays in physical development, vision and hearing problems, and a variety of behavioral problems.
Frequent drinking (seven or more drinks per week, including mixed drinks, wine, and beer) or binge drinking (five or more drinks on any one occasion) greatly increases the risk that your baby will suffer from FAS. But babies whose moms drink less can also develop this syndrome. And babies exposed to alcohol in utero — even if they don't have full-blown FAS — may still be born with some of these birth defects or later exhibit a number of mental, physical, or behavioral problems.
According to the Centers for Disease Control, fetal exposure to alcohol is one of the main preventable causes of birth defects and developmental problems in this country. More than 10 percent of women in the United States drink during pregnancy, and one in 30 pregnant women drink frequently or binge drink: The babies of all these women are at risk. So whether you have a severe drinking problem or a more moderate one, if you find yourself unable to completely give up alcohol, it's vital to get help as soon as possible. Talk to your provider about counseling or treatment options.
What about "nonalcoholic" beer and wine?
The term "nonalcoholic" is a bit misleading when it comes to the supposedly alcohol-free versions of beer and wine. In fact, all "nonalcoholic" beers and many nonalcoholic wines do contain some alcohol, typically less than half a percent. While few would say that the trace amount of alcohol in an occasional glass of nonalcoholic beer is going to harm your baby, it's something to be aware of — especially if you drink these beverages often or in large amounts. So before you drink up, read labels carefully and remember that "nonalcoholic" and "alcohol-free" aren't interchangeable terms: Drinks labeled nonalcoholic can contain trace amounts of alcohol, while those labeled alcohol-free can't.
PRETERM LABOR AND BIRTH
What are preterm labor and preterm birth?
If you start having regular contractions that cause your cervix to begin to open (dilate) or thin out (efface) before you reach 37 weeks of pregnancy, you're in preterm labor, also known as premature labor. If you deliver your baby before 37 weeks, it's called a preterm birth and your baby is considered premature.
About a quarter of all preterm births are intentional. For example, your medical team might decide to induce labor early or perform a cesarean section if you have a serious medical condition such as severe or worsening preeclampsia or if your baby has stopped growing.
The rest are known as spontaneous preterm births. You may end up having a spontaneous preterm birth if you go into labor prematurely, if your water breaks early (called preterm premature rupture of the membranes or PPROM), or if your cervix dilates prematurely with no contractions (called cervical insufficiency).
About 12 percent of babies in the United States are born prematurely. This number has gone up over the years, partly because more women are pregnant with twins or higher order multiples, who tend to arrive early.
Preterm birth can cause health problems or even be fatal for the baby if it happens too early. The more mature a child is at birth, the more likely it is that he will survive and be healthy.
Premature babies born between 34 and 37 weeks generally do very well. If you go into labor before 34 weeks, your medical team may be able to delay your labor for a few days so your baby can be given corticosteroids to help his lungs develop faster, which increases his chance of survival.
What causes spontaneous preterm birth?
Although the cause is often unknown, a variety of factors play a role in preterm birth:
• Certain genital tract infections, such as chlamydia, bacterial vaginosis (BV), and trichomoniasis, are associated with preterm delivery.
Substances produced by bacteria can weaken the membranes around the amniotic sac and cause it to rupture early. Even when the membranes remain intact, bacteria can cause preterm labor if they get into the amniotic fluid or sac.
You may have been checked for chlamydia and gonorrhea at your first prenatal visit, and you would have been treated immediately if you'd tested positive for either of these sexually transmitted infections.
If you've had a previous preterm birth, you may also have been screened for bacterial vaginosis. Although some studies show that treating BV in the second and third trimesters reduces the risk of preterm labor in women with a history of preterm birth, other research has found that it makes no difference. So experts don't agree on whether it's worthwhile to test pregnant women who don't have symptoms. (If you have symptoms of bacterial vaginosis, you'll be tested and treated with antibiotics, if needed.)
You probably won't be tested for trichomoniasis unless you have symptoms. Some research suggests that treating women for trichomoniasis during pregnancy actually increases the risk of preterm birth.
• Having a problem with the placenta, such as placenta previa or placental abruption.
• Having structural abnormalities of the uterus or cervix, such as a cervix that's shorter than 25 millimeters and that effaces or dilates without contractions (cervical insufficiency).
• Having an excessively large uterus, which is often the case when you're pregnant with multiples or have too much amniotic fluid.
• Certain chronic maternal illnesses may be related to preterm labor, such as diabetes, sickle cell anemia, severe asthma, lupus, inflammatory bowel disease, and chronic active hepatitis. Other conditions to watch for include non-uterine infections, such as a kidney infection or pneumonia; abdominal surgery, such as having your appendix taken out; trauma to the abdomen; and periodontitis (a gum infection that goes into the bone and other tissues that support your teeth).
What are my chances of having a spontaneous preterm birth?
Although it's impossible to say whether you'll give birth prematurely, you may be at increased risk if you:
• Previously had a preterm delivery (the earlier in gestation your baby was born and the more spontaneous preterm births you've had, the higher your risk)
• Are pregnant with twins or higher order multiples
• Are younger than 17 or older than 35
• Are African American (17.4 percent of African American babies are born prematurely)
• Don't gain enough weight during your pregnancy
• Were underweight before you got pregnant
• Are short
• Have had vaginal bleeding in more than one trimester
• Smoke, abuse alcohol, or use drugs (especially cocaine) during pregnancy
• Gave birth in the last 18 months (particularly if became pregnant within six months of giving birth)
And here are a few suspected risk factors that researchers are looking at:
A few studies have found an association between high levels of stress and preterm birth. The theory is that severe stress can lead to the release of hormones that can trigger uterine contractions and preterm labor.
Experts have also been studying occupational factors to see what effect having a physically demanding job or working long hours has. One study showed that moms-to-be who had to stand for more than 40 hours a week or who had extremely tiring jobs were more likely to have preterm deliveries.
Finally, some researchers are studying the role of genetic factors because preterm birth seems to be more common in some families. Genetics may help explain the different rates seen among various races, even when other risk factors are taken into account.
Are there tests that can predict my chances of having a preterm delivery?
Two screening tests are available for women who are having symptoms of preterm labor or who are otherwise at high risk for it. A negative result is particularly useful because it can put your mind at ease and help you avoid unnecessary interventions and time in the hospital.
The American College of Obstetricians and Gynecologists doesn't recommend either test for all pregnant women because studies haven't shown the tests to be useful for women who aren't at high risk and have no symptoms.
Measuring the length of your cervix
Your practitioner may have checked the length of your cervix at your first prenatal visit so she could monitor changes as your pregnancy progressed. If your cervix is getting shorter in midpregnancy, it's beginning to thin out (efface) and that could lead to a preterm delivery.
If you're at high risk for cervical insufficiency — because your cervix is abnormally short, for example — or if you later have symptoms that indicate your cervix is changing (such as pelvic pressure, backache, or increased mucus discharge), your practitioner may recommend an ultrasound to measure your cervix more accurately and look for signs that it's changing.
If the ultrasound shows that your cervix is starting to change, your practitioner may recommend that you cut back on physical activity and work, abstain from sex, and stop smoking if you haven't already. Depending on your situation and your baby's gestational age, you could have another ultrasound within the next few weeks.
If you're less than 24 weeks pregnant and your cervix is changing but you're not having any contractions, your practitioner may recommend a cerclage, a procedure in which a band of strong thread is stitched around your cervix to help hold it closed. However, the procedure is not without risks and there's considerable controversy about whether it's effective enough to be worthwhile in this situation.
Women who may benefit most from a cerclage include those who've had three or more unexplained second-trimester losses or preterm births. If you're in this group, you're likely to get a cerclage at 13 to 16 weeks, before your cervix starts to change.
Fetal fibronectin screening
This test is usually reserved for women who are having contractions or other symptoms of preterm labor. Fetal fibronectin (fFN) is a protein produced by the fetal membranes. If more than a small amount turns up in a sample of your cervical and vaginal secretions between 24 and 34 weeks, you're considered to be at higher risk for preterm delivery.
A positive fFN result might prompt your practitioner to give you drugs to hold off labor as well as corticosteroids to help your baby's lungs mature more quickly.
However, the test is actually more accurate at telling you when you won't deliver than when you will. If you have a negative fFN result, it's highly unlikely that you'll deliver within the next two weeks. A negative result can put your mind at ease and help you avoid hospitalization or other unnecessary treatment.
Another technique, called home uterine activity monitoring (HUAM), is not thought to be useful in predicting preterm birth. To use it, you have to wear a sensor around your abdomen that records daily uterine activity. This system is expensive and has not helped reduce the preterm delivery rate in the United States.
Is there anything else I can do if I'm at high risk?
Take care of yourself. If you eat well, get plenty of rest, start your prenatal care early and see your practitioner regularly, manage your stress level, and pay attention to your dental health, you're already doing a lot to ensure a healthy, full-term pregnancy.
Take time to tune into the changes that are happening in your body during pregnancy. Spend some quiet time each day by yourself, so you can focus on your baby's movements and take note of any unusual aches or pressures.
Learn the signs of preterm labor (below) and let your practitioner know right away if you notice any of them. The most important development in the management of preterm labor in the past 50 years has been the use of corticosteroids to speed up the development of the baby's lungs before birth. The earlier you realize you're in preterm labor, the more likely it is that your baby will be able to benefit from this treatment.
Your practitioner might consult with a high-risk specialist (a perinatologist) or refer you to one, particularly if you've had a preterm delivery before. If you've had a second-trimester loss or a spontaneous preterm birth and are carrying only one baby, the specialist may consider treating you with a progesterone compound called 17 alpha hydroxyprogesterone caproate, or 17 P for short.
Studies have shown that weekly injections of this hormone, starting in the second trimester and continuing until 36 weeks, significantly reduced the risk of a repeat preterm delivery for women in this situation. Studies are under way to determine whether 17P will help reduce the rate of preterm deliveries in other high-risk groups, such as women carrying twins.
(The FDA has not yet approved 17P for manufacture by pharmaceutical companies, and only a limited number of pharmacies are set up to make it, so the treatment is not widely available.)
Finally, some practitioners will suggest bedrest, though there's no evidence that it will help prevent preterm birth.
What are the symptoms of preterm labor?
Call your midwife or doctor right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):
• An increase in vaginal discharge
• A change in the type of discharge — if it becomes watery, mucus-like, or bloody (even if it's pink or just tinged with blood)
• Any vaginal bleeding or spotting
• Abdominal pain, menstrual-like cramping, or more than four contractions in one hour (even if they don't hurt)
• An increase in pressure in the pelvic area (a feeling that your baby is pushing down)
• Low back pain, especially if you didn't previously have back pain
These symptoms can be confusing because some of them, such as pelvic pressure or low back pain, occur during normal pregnancies, too, and sporadic early contractions may just be Braxton Hicks contractions. But it's always better to be safe than sorry, so call your midwife or doctor right away if you're experiencing anything unusual.
What will happen if I start having preterm labor?
If you have signs of preterm labor or think you're leaking amniotic fluid, call your practitioner, who will probably have you go to the hospital for further assessment. You'll be monitored for contractions (your baby's heart rate will be monitored at the same time) and examined to see whether your membranes have ruptured. Your urine will be checked for signs of infection, and cervical and vaginal cultures may be taken as well. You may also be tested for fetal fibronectin.
If your water hasn't broken, your practitioner will do a vaginal exam to assess the state of your cervix. A practitioner will often do an abdominal ultrasound as well, to check the amount of amniotic fluid present and confirm the baby's growth, gestational age, and position. Finally, some practitioners will do a vaginal ultrasound to double-check the length of your cervix and look for signs of effacement.
If all the tests are negative, your membranes haven't ruptured, your cervix hasn't dilated after a few hours of monitoring, and you and your baby appear healthy, you'll most likely be sent home.
Although each practitioner may manage the situation a little differently, there are some general guidelines. If you're less than 34 weeks pregnant and found to be in preterm labor, your membranes are intact, your baby's heart rate is reassuring, and you have no signs of a uterine infection or other problems (such as severe preeclampsia or signs of a placental abruption), your practitioner will probably attempt to delay your delivery.
First, you'll be put on an IV and given antibiotics to prevent group B streptococcal infection in your baby. This is done just in case a culture shows you're a carrier, as it takes 48 hours to get results. You'll most likely be given medication to try to stop contractions long enough so your baby can be given corticosteroids to speed up the development of his lungs.
If you're in a small community hospital where special neonatal care is not available for a preterm infant, you'll be transferred to a larger institution at this point, if possible. You and your baby will be monitored throughout labor if it does continue.
If your water breaks before 37 weeks but you're not having contractions, your medical team may decide to induce labor, try to delay labor, or choose to wait for the onset of labor, which could happen within hours or take up to a week in the hospital. In any case, you'll be given antibiotics to protect against group B strep and other infections.
Experts differ on what to do in this situation. Waiting to deliver buys your baby more time to mature but increases your risk of infection, which could be dangerous for you and your baby.
Of course, if you develop symptoms of infection, you'll be induced immediately. If your baby's in distress, you'll need to deliver right away, often by cesarean section.
In most cases, if you're in premature labor after 34 weeks, you'll be allowed to deliver your baby. Babies born between 34 and 37 weeks of gestation who have no other health problems generally do fine (although the earlier they're delivered, the higher the risk of a problem). These babies may need a short stay in the neonatal nursery and may have a few short-term health issues, but in the long run, most of them do as well as full-term babies.
What to pack for the hospital For labor
• Your birth plan.
• Your insurance card and any hospital paperwork you need.
• Your eyeglasses, if you need any. Even if you usually wear contacts, you'll probably need or want to take them out at some point during your stay.
• A hair band and barrettes, if you think you might want them.
• Lip moisturizer.
• A bathrobe, nightgown, slippers, and a couple of pairs of socks. Hospitals provide gowns for you to use during labor and afterward, but most will allow you to wear your own clothes if you prefer. Choose something loose and comfortable that you don't mind getting ruined. You'll need to wear a gown instead of pants so that your practitioner can check your cervix. Choose a top with short, loose sleeves so you your blood pressure can be checked easily and so you can slip your top off easily if you want to change and have an IV in place. You might also want to bring your own slippers and robe for walking around during the early stages of labor. If you don't want to risk soiling your robe, you can ask for a second hospital gown to wear as a robe to cover your backside.
• Something to read, if you're so inclined. One husband we know spent the early stages of labor reading The Lion in Winter while his wife read The English Patient. "In retrospect, I should have brought the National Enquirer or Vogue — something trashy with pictures," she says.
• Massage oils or lotions, music, an extra pillow, whatever you need to help you relax. (If you do bring your own pillow, be sure to use a patterned or colorful pillowcase so it doesn't get mixed up with the hospital's.) You might consider bringing tennis balls or a rolling pin in case you have back labor and need them for massage.
• Talismans, a picture of someone or something you love, anything you find reassuring.
For your partner/labor coach
• Money for parking and change for vending machines.
• A few basic toiletries, such as a toothbrush, toothpaste, shampoo, deodorant.
• A change of clothes
• Some snacks and something to read during the early stages.
• A camera/video camera and film or tape or a memory card and batteries. Someone has to document the big event! (NOTE: Not all hospitals allow videotaping of the birth itself, but there's usually no rule against taping during labor or after the birth.)
• A bathing suit. If your partner wants to take a bath or shower during labor, you may want to jump in with her.
Postpartum
• A fresh nightgown.
• Snacks! After many hours of labor, you're likely to be pretty hungry and you don't want to have to rely on the hospital's food. So bring your own crackers, raisins, and granola bars.
• A nursing bra, breast pads, and maternity underwear, if you'd prefer not to wear the net panties they'll give you at the hospital. Chances are, whatever underwear you do wear the first few days will get stained, even with sanitary pads (which the hospital provides).
Also bring some of your OWN pads to place into your panties- the ones the hospital gives you are like giant boats!
• Toiletries. Toothbrush, toothpaste, hairbrush, lip balm, deodorant, and makeup, if it's important to you. Hospitals will have soap, shampoo, and lotion, but you might prefer your own brands.
• Your address book and prepaid phone card or cell phone. After the baby's born you'll want to call family and friends to let them know the good news. Note: Some hospitals don't allow cell phones to be used in the labor and delivery area, so you may want to ask about it ahead of time.
• A going-home outfit. Bring something roomy and easy to get into — believe it or not, you'll probably still look 5 or 6 months pregnant — along with a pair of flat shoes. The last thing you'll be worrying about when you go home is whether your outfit is fashionable.
For your baby
• An infant car seat. You can't drive your baby home without one!
• A going-home outfit (one-piece stretchy outfits are easiest) and a snowsuit if it's very cold
• A receiving blanket (a heavy one if the weather's cold)
• A pair of socks or booties
• A cap (although they'll usually give you one at the hospital)
• Baby nail clippers or emery board. "The hospital where my son was born didn't supply clippers for fear of liability, and as a consequence my son gouged his face before he was 12 hours old.
Also bring some baby mittens, so that your baby doesn't scratch his/her face! Their nails can usually be really long after they're first born!
What not to bring
• Jewelry
• Lots of cash, credit cards, or any other valuables
• Work. Yes, we actually know fast-track types who have sent business e-mails from the hospital room, made work-related phone calls, and reviewed spreadsheets.
SIGNS OF LABOR
Is there any way to predict when I'm going to go into labor?
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start. Your body actually starts "preparing" for labor up to a month before you give birth. You may be blissfully unaware of what's going on or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
* Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
* You note an uptick in Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. However, if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called "false labor."
* Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts — but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor's imminent.) When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
* You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that's sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor. The plug may come out all at once in a lump, or as increased vaginal discharge over the course of several days. The mucus may be tinged with blood (which may be brown, pink, or red), which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some bloody discharge even when labor isn't going to start in the next few days. In either case, if you see more than a few spots of blood, be sure to call your caregiver immediately because it could be a sign of a problem.
* Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, the fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions sometime before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby will be at increased risk for infection without the amniotic sac's built-in protection against germs.
How can I tell if my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks. It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together. In some cases, though, the onset of strong, regular contractions comes with little or no warning — it's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when it's time to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center. These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — and your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job. And the truth is, your practitioner can tell a lot by the tone and tenor of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, be sure to call your practitioner right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, and is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby's less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), fever, severe headaches, vision changes, or abdominal pain.
• You start having contractions before 37 weeks or you have any other signs of preterm labor
THE STAGES OF LABOR
What stages will I go through during labor and childbirth?
The process you'll go through during labor and childbirth can be divided into three stages:
The first stage begins with the onset of contractions and ends when the cervix is fully dilated. This stage is divided into two phases, known as early and active labor. During early labor, your cervix gradually effaces (thins out) and dilates (opens). That's followed by active labor, when your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as "transition."
The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is often referred to as the pushing stage.
The third and final stage begins right after the birth of your baby and involves the separation and delivery of the placenta.
For first-time moms who are at least 37 weeks along, labor and delivery takes an average of 15 hours, although for plenty of women it lasts more than 20 hours, and for a lucky few it's over much sooner. For women who've been through labor before, deliveries average around eight hours.
*First stage: Early labor
Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you're officially in early labor. But unless your labor starts very suddenly and you go from no contractions to fairly regular contractions right away, it can be tricky to determine exactly when true labor starts. That's because these early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may immediately precede them and contribute to so-called "false labor." (If you're not yet 37 weeks and you're noticing contractions or other signs of labor, call your caregiver immediately so she can determine whether you're in preterm labor.)
During early labor, your contractions will gradually become longer, stronger, and closer together. While the experience of labor varies widely, typically it might start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, though the contractions will still tend to be mild and last less than a minute.
Sometimes early labor contractions are quite painful (though they may be dilating your cervix much more slowly than you'd like!). If your labor is typical, though, your contractions now won't require the same attention that later ones will. You'll probably find that you can still talk through them and putter around the house. You may even feel like taking a short walk. If you feel inclined to relax instead, take a warm bath, watch a video, or doze off between contractions if you can.
You may also notice increasing mucousy vaginal discharge, which may be tinged with blood — the so-called "bloody show." This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you're not having contractions yet.
Otherwise, if you're at least 37 weeks along, and unless your caregiver has advised you differently, expect to sit out early labor at home. (When to call your midwife or doctor and when she's likely to have you go to the hospital or birth center are things to discuss ahead of time at your prenatal visits.) Early labor ends when your cervix is about 4 centimeters dilated and your progress starts to accelerate.
How long it lasts
It's not easy to say how long this phase typically lasts or even (after the fact) how long it lasted for a particular woman. The length of early labor depends in large part on how ripe your cervix is at the beginning of labor and how frequent and strong your contractions are. With a first baby, if your cervix isn't effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter. If your cervix is already very ripe or if this isn't your first baby, it's likely to go much more quickly.
Coping tips
Don't become a slave to your stopwatch just yet — it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously.
Meanwhile, it's important to do your best to stay rested, since you may have a long day (or night) ahead of you. Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to go to the bathroom often even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
*First stage: Active labor
Active labor is when things really get rolling. Your contractions become more frequent, longer, and stronger, and your cervix begins dilating faster, going from about 4 to 10 centimeters. (The last part of active labor, when the cervix dilates from 8 to 10 centimeters, is called transition, which is described separately in the next section). In contrast to early labor, you'll no longer be able to talk through the contractions. Toward the end of active labor your baby may begin to descend, though he might have started to descend earlier or he might not start until the next stage.
As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. (Some prefer a call sooner, so clarify this with your caregiver ahead of time.) In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes, although some women may never have them more often than every five minutes, even during transition.
How long it lasts
Labor varies widely, but on average it takes about six hours for a woman having her first baby to go from 4 centimeters to full dilation. That's if she's not being given oxytocin (Pitocin) or using an epidural, though. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labor is likely to go much more quickly.
Coping tips
Breathing exercises, relaxation techniques, and a good labor coach can be a huge help now. Massage and lots of gentle encouragement are lifesavers, too. When you get to the hospital or birth center, you should be able to move freely around the room after your caregiver evaluates you, as long as you don't have any medical or obstetric complications.
You may find that it feels good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to take a warm shower or bath, if you have access to a tub, or to ask your partner for a massage. If you've already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to talk to your provider about getting an epidural or systemic medication.
*Second Stage: Transition
The last part of active labor — when your cervix dilates from 8 to a full 10 centimeters — is called the transition period because it marks the transition to the second stage of labor. This is the most intense part of labor. Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more, and you may find yourself shaking and shivering.
By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously — to "push" — and may even start making deep grunting sounds at this point. There's often a lot of bloody discharge. You may also feel nauseated or even vomit now.
On the other hand, some babies descend earlier and the mom feels the urge to push before she's fully dilated. And some babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and every birth.
If you've had an epidural, you'll feel varying amounts of pressure, depending on the type and amount of medication you're getting, and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.
How long it takes
Transition can last anywhere from a few minutes to a few hours. It is much more likely to be fast if you've already had a vaginal delivery.
Coping tips
If you're laboring without an epidural, this is when you may begin to lose faith in your ability to cope, so you'll need lots of extra encouragement and support from those around you. The good news is that if you've made it this far without medication, you can usually be coached through transition — one contraction at a time — with constant reminders that you're doing a great job and that the end is near.
*Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them. Many women find their contractions in the second stage easier to handle than during active labor because bearing down offers some relief. Other women don't like the sensation of pushing.
If your baby's very low in your pelvis, you may feel an involuntary urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you won't have this sensation right away. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push.
Waiting a while may make you less exhausted and frustrated in the end. However, in many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent — so let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. If you have an epidural, the loss of sensation makes it hard to feel what you're doing, so you'll need explicit coaching to help you to push effectively.
Your baby's descent may be rapid or, especially if this is your first, gradual. With each contraction, the force of your uterus — combined with the force of your abdominal muscles if you're actively pushing — exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression. Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of different positions during the second stage.
After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible, a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vagina and perineum. A slow, controlled birth can help prevent you from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.
YOUR chin.
After his head emerges, your doctor or midwife will suction his mouth and nose and feel around his neck for the umbilical cord. (No need to worry. If the cord is around his neck, your caregiver will either slip it over his head or, if need be, clamp and cut it.) His head then turns to the side as his shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as his shoulders emerge, one at a time, followed by his body.
Once he hits the atmosphere, your baby needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby's mouth and nasal passages again if he seems to have a lot of mucus. If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket — and perhaps given his first hat — to prevent any heat loss. Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long it lasts
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.
*Third stage: Delivering the placenta
Within minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall. When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.
How long it lasts
On average, the third stage of labor takes about five to ten minutes, though it can last up to 30 minutes or more.
And then what?
After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that it remains firm, and massage your uterus if it isn't. This is important because, as it contracts, the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.
If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but hold your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse within the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers your body to release oxytocin, the same hormone that causes contractions, and helps your uterus stay well contracted.
If you're not nursing or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll probably be given other medications as well.
Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. (If you've had a baby before, you may continue to feel occasional contractions for the next day or two.)
These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also find that you get a case of the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.
Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to see if you have any tears that need to be stitched. If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches — it can be a great distraction. Or, if you feel too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. (This takes just a second and doesn't hurt.) Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his birth.
What Happens to Your Baby After Delivery What Happens to Your Baby Immediately After Delivery
What will happen to my baby immediately after birth?
Newborn babies don't have good temperature control, so it's very important that they be kept warm and dry. If you have a vaginal delivery and you and your baby are both in good condition, he can be placed directly onto your abdomen and dried off there. He'll be covered with a warm towel or blanket and given a cap to keep him from losing heat through his head.
Skin-to-skin contact will help keep your baby warm and let the two of you start bonding as well. (Don't worry about bonding if you can't hold your baby right away because one of you needs immediate medical care. There'll be plenty of time for bonding later.)
Your practitioner will clamp the umbilical cord in two places and then cut between the two clamps. (Your partner can do the honors if he or she wants to!) Your caregiver will collect a tube of blood from the cord to check your baby's blood type and possibly use for other tests as well.
During your baby's birth, your caregiver may have suctioned your baby's mouth and nose before the delivery of his shoulders. If your baby still seems to have too much fluid in his mouth or nose, she may do further suctioning at this time.
While you and your baby are locking eyes, he'll be closely observed to ensure that he continues to do well. At one and five minutes after birth, an Apgar assessment will be done to evaluate your baby's heart rate, breathing, muscle tone, reflex response, and color. Your caregiver can do these simple assessments while your baby is resting on your belly.
When can I start breastfeeding?
Babies tend to be very alert right after birth, so now's a good time to begin breastfeeding if you're both willing. There's no need to panic if your newborn seems to have trouble finding or staying on your nipple right after birth — he may just lick your nipple at first. Most babies will eventually begin to nurse within the first hour or so, given the opportunity.
Don't be shy about asking your caregiver or nurse to help you get started while you're still in the birth room (or recovery room if you had a c-section). Later, when you get to the postpartum unit, there may be a lactation consultant available for one-on-one coaching or group breastfeeding classes. You should be able to find out ahead of time what resources are available. Be sure to ask for all the help you need.
What if my baby has problems at birth?
If your baby has any problems at birth that require extra observation or a full-fledged resuscitation (or anything in between), your practitioner will quickly clamp and cut the cord. Your baby will then be dried off and placed on a radiant warmer in your birthing room. The warmer allows him to be left naked without getting cold so his medical team can do whatever is necessary to help him make the transition to life outside the womb.
An Apgar assessment will be done, as will more suctioning, if needed, and whatever other interventions are necessary. If your baby needs further care after being stabilized, he may be taken to an intensive care nursery. But if he's doing well and needs no more assistance, he'll be swaddled in a warm blanket and brought to you so you can nuzzle, bond, and breastfeed.
What if I have a c-section?
If you have a c-section, your baby will be handed to a nurse or pediatrician as soon as he's delivered and taken to a radiant warmer. He'll be dried off, his mouth and nasal passages will be suctioned, an Apgar assessment will be done, and he'll get any other attention he might need.
In many hospitals, if your baby is doing well, he'll be swaddled in a warm blanket and brought to your partner (who'll be sitting by your head) to hold while you're being stitched up. This way, you can admire and kiss your baby while you're still in the operating room. Afterward, in the recovery room, you can begin to breastfeed if you want.
When do they do the ID bands and footprints?
Whether your baby is lying on your body or on a radiant warmer, a nurse will put ID bands on you, your baby, and your partner minutes after the delivery (and certainly before taking your baby out of the room for any reason).
She'll also footprint your baby. Most hospitals routinely make two copies of the baby's footprint, one for his hospital record and the other as a keepsake for you. (If they don't usually do this and it's something you'd like, be sure to ask for a copy.)
What else will happen in the first hour?
A nurse will put antibiotic ointment or drops in your baby's eyes within an hour after birth. The ointment or eyedrops are required by state law in the United States to help prevent eye infections — some of which can cause blindness — from a variety of bacteria that your baby could have been exposed to just before or during birth, including gonorrhea and chlamydia.
She'll also weigh your baby and give him an injection of vitamin K to help his blood clot. She may measure his length and head circumference, or that may be done later by the pediatrician.
What else will be done for my baby before we leave the hospital?
After your baby's temperature has remained stable for at least a few hours, a nurse will give him a sponge bath and wash his hair if needed. Baths usually take place in the nursery so the baby can be put under radiant heat to warm up afterward, but you can ask for your child to be bathed in your room if you want.
Your baby will get a complete pediatric exam. Like the bath, this is usually done in the nursery but can be done in your room, instead. After the exam, you can ask to have your baby back or have him taken to sleep in the nursery. If you're breastfeeding, it makes sense to keep the baby in your room, as you'll probably need to feed him every few hours.
What tests will be done on my baby?
When your baby is 48 hours old, his heel will be pricked and a small amount of blood taken to test for phenylketonuria (PKU), hypothyroidism, and other disorders. All 50 states require newborn screening tests (sometimes referred to as "the metabolic screen"). But the number and type of genetic and metabolic disorders tested for vary widely from state to state, from as few as four conditions to more than 40.
If you live in a state that does only limited testing you can pay for additional testing, but you may need to make arrangements ahead of time. If you deliver at a birth center or at home, you'll need to bring your baby to the doctor for these tests before he's a week old. And if you give birth in a hospital but are discharged early — within 24 hours after delivery — your baby will need repeat testing one to two weeks later because the screening test done for PKU in the first day of life isn't always accurate.
Many hospitals routinely perform newborn hearing tests before your baby is discharged. In some states it's required by law. (Both the March of Dimes and the American Academy of Pediatrics recommend testing for all babies.)
If your HIV status is unknown, your baby's cord blood may be tested for the virus. (In some states, this is required.)
Will my baby get a hepatitis B shot?
Your baby will probably get his first dose of the hepatitis B vaccine before being discharged from the hospital. If you're a hepatitis B carrier or your status is unknown, your baby should definitely be vaccinated within 12 hours of birth. (If you're sure that you, other family members, and anyone who will be caring for your baby are all negative for hepatitis B, the first dose can be delayed and given sometime before he's 2 months old.)
Babies of mothers who are known hepatitis B carriers will also receive an injection of hepatitis B immune globulin (HBIG) within 12 hours of birth. If your hepatitis B status is unknown, your blood will be drawn for testing, and if you're found to be positive, your baby should receive a dose of HBIG as soon as possible.
When are circumcisions done?
If you've decided that you want your baby boy to be circumcised (and aren't planning to have a ritual circumcision performed later), it's usually done a day or two after birth.
Breastfeeding Breastfeeding: Getting Started
How to start breastfeeding
The first time you hold your newborn in the delivery room, put his lips to your breast. Your mature milk hasn't come in yet, but your breasts are producing a substance called colostrum that will help protect your baby from infection.
Try not to panic if your newborn seems to have trouble finding or staying on your nipple. Breastfeeding is an art that requires patience and lots of practice. No one will expect you to be an expert in the beginning, so don't hesitate to ask a nurse to show you what to do while you're in the hospital. (If you have a premature baby, you may not be able to nurse right away, but you should start pumping your milk. Your baby will receive this milk through a tube or a bottle until he's strong enough to nurse.)
Once you get started, remember that nursing shouldn't be painful. Pay attention to how your breasts feel when your baby latches on. His mouth should cover a big part of the areola below the nipple, and your nipple should be far back in your baby's mouth. If latch-on hurts, break the suction — by inserting your little finger between your baby's gums and your nipple — and try again. Once your baby latches on properly, he'll do the rest.
How often you should nurse
Frequently. The more you nurse, the more quickly your mature milk will come in and the more milk you'll produce. Nursing for ten to 15 minutes per breast eight to 12 times every 24 hours is pretty much on target. According to the latest guidelines from the American Academy of Pediatrics (AAP), you should nurse your newborn whenever he shows signs of hunger, such as increased alertness or activity, mouthing, or rooting around for your nipple. Crying is a late sign of hunger — in other words, ideally you should start feeding your baby before he starts crying.
During the first few days, you may have to gently wake your baby to begin nursing, and he may fall asleep again in mid-feeding. To make sure your baby's eating often enough, wake him up if it's been four hours since the last time he nursed. Once your baby becomes alert for longer periods, you can settle into a routine of feeding every one to three hours (less at night as he starts to sleep through).
How to get comfortable
Since feedings can take up to 40 minutes, pick a cozy spot for nursing. Hold your baby in a position that won't leave your arms and back sore. It works well to support the back of your baby's head with your hand, but the position you choose really depends on what's comfortable for you. If you're sitting, a nursing pillow can be a big help in supporting your baby. Don't feed until you and your baby are comfortable because you'll be sitting (or lying) in that position for a while.
What you should eat
A normal healthy diet is all you need while you're nursing. Experts used to recommend that nursing moms get an extra 400 to 500 calories a day, but new research shows that you don't need that calorie boost, says breastfeeding expert Kathleen Huggins, author of The Nursing Mother's Companion. You'll want to maintain a well-balanced diet for your own health, but you don't need to follow complicated dietary rules to successfully nurse your baby.
You may want to limit caffeine, and avoid chocolate, spicy foods, and other irritants that get into breast milk and can bother your baby. Be sure to drink lots of fluids — the oxytocin released by your body while you breastfeed will make you thirsty and help remind you to drink.
Remember that although breastfeeding is natural, it can be difficult in the first days of your baby's life. Take the time to get encouragement and advice from a lactation consultant or friends who have nursed — their support and tips will be invaluable.
Problems you may encounter
Although women have nursed their babies for centuries, breastfeeding doesn't always come easily. Many women face difficulties early on. Some of the most common problems you may encounter in the first six weeks include:
• Engorgement: an overfull breast
• Sore nipples
• Mastitis: a breast infection
Don't suffer in silence. Call a lactation consultant or your doctor (especially if you think you may have a breast infection) if your physical discomfort is getting in the way of nursing properly.
What you may be feeling
Some women adjust to breastfeeding easily, encountering no major physical or emotional hurdles. But many new moms find it hard to learn — so if you're feeling discouraged, you're not the only one.
It's normal to feel overwhelmed by your baby's constant demands in the beginning. If you feel like giving up (or just want professional advice), consider calling an international board-certified lactation consultant (IBCLC). These experts in the art of breastfeeding will watch you nurse your baby and make recommendations. You can also talk to your doctor or midwife about any health concerns that may be getting in the way of successful breastfeeding.
Where to get help
Breastfeeding help and support is just a phone call away. La Leche League International, an organization that offers encouragement and support to women who want to breastfeed their babies, can send you information or put you in touch with a La Leche League chapter near you. You can reach LLL headquarters or get advice from LLL's breastfeeding hotline by calling (800) 525-3243. If you attend local meetings, you can meet other new moms and get breastfeeding assistance.
A board-certified lactation consultant can also offer advice on how to breastfeed properly and give you hands-... To find one near you, call the International Lactation Consultant Association at (919) 861-5577 or use that association's online lactation consultant finder. You can also call the hospital where you delivered your baby, your doctor or midwife, or your child's pediatrician for a referral.
Caring for your newborn
Caring for Your Newborn: Tips for New Parents
The first few weeks with your newborn will be chaotic. Here are a few tips from experienced parents to help make life easier.
Prepare as much as you can ahead of time
"Find a good lactation consultant, preferably before you give birth. My son had major feeding problems the first week or two, and it would have been much easier if I had lined someone up for consultations ahead of time. It would have saved me many tears and feelings of inadequacy during a hormonally tumultuous period."
— Mary, Tampa, Florida
"Stock up on food and other necessities. I was totally unprepared for how overwhelmed I'd be — meaning, I had zero time or inclination to go grocery shopping and make meals. I spent a lot of time leading up to my son's birth getting his room ready, etc., when I should have been making and freezing meals. Pizza delivery and take-out can only get you so far."
— Leslie Cannon, Overland Park, Kansas
"Take a class on infant care through your hospital. It will teach you the basics on holding, bathing, feeding, etc. It will make you feel much more comfortable in the first few weeks when your baby seems so fragile."
— Diana Cacciapaglia, Orange, California
"I assumed I wouldn't need a breast pump until I went back to work. But my milk wasn't coming in and I needed the pump's extra help to 'pull' out my breast milk. If I had bought a breast pump before I had my son and used it to coax the milk down, it probably would have saved us a lot of grief."
— Julie, Oregon
Ask for -- and accept -- help
"Use your resources — Mom, Grandma, your hospital's staff, the pediatrician, friends with kids. They love to answer questions, and remember that no question is dumb."
— Jodi, Randolph, Massachusetts
"Accept help whenever offered! If friends ask you what they can do, suggest they prepare meals for you or babysit your older children. Hire someone to clean; send the little ones to day camp. Nobody will accuse you of being selfish or a bad mother. It's the only way to keep your sanity. (And it will allow you to spend time alone with your new bundle of joy.)"
— Marti Kelley, San Antonio, Texas
Let the machine get it
"One thing that we did to survive the first weeks with our newborn was to leave a baby update as our answering machine message. Getting rest and sleep was so difficult those first few weeks that we turned off the ringer on the phone, changed the message periodically, thanked people for calling to check in on us and asked them to leave their messages. We promised we would get in touch with them when it was convenient. We found that people enjoyed calling to see what the new information was — the latest weight and height from the doctor visit or other tidbits such as, 'Dad changed his first diaper,' or 'We gave Hunter his first bath,' etc. It was a great way to keep people informed without getting overwhelmed by well-meaning interruptions."
— Janet Salisbury, Indianapolis, Indiana
"If phone calls are important, people will call back. My fiancé didn't understand why I wouldn't answer the phone when he was at work until he stayed home one day. Sometimes it's easier to let voicemail pick up a call, and you can return it when you feel up to it."
— Tarita Cain, Atlanta, Georgia
Accept visitors only when you're ready
"Get together with your husband and decide what your policy will be on visitors. Include some rules for relatives and friends who sometimes believe they have a right or a duty to spend every second of the day with you and the baby. Yes, you will need lots of help, but that doesn't mean the end of your privacy, and not every visitor will be helpful."
— Poli de Zubiria, Colombia
Rest up
"The one thing I remember the most was trying to nap while the baby did. Let the household chores wait. You need your sleep much more than the house needs a vacuuming!"
— Donna Fleming, Essex, Vermont
"During my daughter's first six weeks, I learned that all the articles that tell you to rest when the baby does are actually right. Whenever my daughter took her naps, I usually caught up on housework, but by 7 p.m. I was sound asleep on the floor. Whatever else you do, make sure you get your rest. It will help you and the baby."
— Misty Lawrence, Springfield, Missouri
"The worst thing I ever tried with my daughter was co-sleeping. I was so worried I was going to roll over on her that I couldn't sleep. My restlessness meant zero sleep for her, so she was exhausted, too. After a week or two of this, I finally just put her to sleep in her crib. I still had to get up to nurse, but the few hours of sleep I got between feedings made all the difference."
— Hannah, Vancouver, British Columbia
Go outside
"I remember the days this past summer of pacing around the house with a fussy baby while the sun was shining so brightly outside. When I took the baby out, I would still be holding him, so it didn't seem like much of a break. Then one day it dawned on me! I put a big comforter on the grass under a tree and put a baby quilt on top of that. Now, every day that it's nice outside, we lie in the yard. We've been doing this since Noah was a month old and he loves it! Make sure you dress your baby appropriately and be sure to stay out of the sun. It's a very relaxing way to share the outdoors with your baby."
— Tracie Smith, St. Lucas, Iowa
Know your limits
"If you're at the end of your rope because your baby won't stop crying, and he's not hungry, cold, wet, sick or hurt, and you're afraid you're going to hurt yourself or the baby, put him in a safe place (on his back or side in a crib, for example). Then step out of the room for five or ten minutes until you've calmed yourself down."
— Gabriel's mother, Leesburg, Virginia
Trust your gut
"I just went with my instincts — no matter what they were. I knew that I was going through a difficult time and that I would make mistakes, but I needed to do that so I could learn what was best for my baby and me. The postpartum period can do crazy things to your mind. You second-guess yourself incessantly, but you'll find that your instincts will pull you through. There's no need to justify anything to anyone — you must concentrate on you and your little one."
— Mary Kae Selan, Pickerington, Ohio
Tell yourself: This, too, shall pass
"When you start out, you think, 'I'm never going to be good at this,' and then it becomes second nature. The child becomes an integral part of your life so that you couldn't imagine a time when you weren't a parent. So relax, enjoy the good and bad times, because your baby grows up so fast. Everything passes. Eventually, every child will sleep more (and so will you), and every child will be more independent. You'll never forget the first time your baby smiles at you or the first time she looks at you and calls you 'Mama' or 'Dada' or the times she falls asleep on your chest. It makes all the other frustrating stuff pale in comparison.
— Scott and Dorinda Legg, Atlanta, Georgia
Body changes after giving birth
Body changes after the baby
*How much weight will I lose after having my baby?
You probably won't return to your pre-pregnancy weight for some time, but you will lose a significant amount of weight immediately after delivery. Subtracting one 7- to 8-pound baby, another pound or two of placenta, and another 2 pounds or so of blood and amniotic fluid leaves most new moms about 12 pounds lighter.
The weight keeps coming off, too. All the extra water that your cells retained during pregnancy, along with fluid from the extra blood you had in your pregnant body, will be looking for a way out. So you'll produce more urine than usual in the days after birth — an astounding 3 quarts a day — and you may notice yourself perspiring a lot, even while you sleep. By the end of the first week, you'll lose about 4 pounds of water weight. (The amount varies depending on how much water you retained during pregnancy.)
*How come I can't tell when I need to pee?
It's not uncommon to feel as if you don't have to pee much in the first day after you give birth, especially if you had a prolonged labor, a forceps or vacuum-assisted vaginal delivery, or an epidural. This is caused by your bladder becoming temporarily less sensitive. But with all the extra fluid your kidneys are processing, your bladder fills up rapidly, so it's essential for you to urinate frequently even if you don't have the urge to.
If too much urine accumulates in your bladder, you might have a hard time making it to the toilet without leaking. More important, though, your bladder could become over-distended. This can cause urinary problems and also makes it harder for your uterus to contract, leading to more afterpains and bleeding.
If you can't pee within a few hours after giving birth, a catheter will be put in your bladder to drain the urine. (If you deliver by c-section, you'll have a urinary catheter for the surgery and the following 12 hours or so.) Let the nurse know if you're having difficulty urinating or are only producing a small amount of urine when you pee. If your bladder gets too full, it can actually prevent you from being able to urinate.
*How long will it take for my uterus to shrink?
By the time you give birth, your uterus is about 15 times heavier (not including its contents!) and holds at least 500 times more than before you conceived. Within minutes after your baby is born, contractions cause your uterus to begin to shrink, clenching itself like a fist, its crisscrossed fibers tightening in the same way they do during labor. This may cause you to feel cramps known as afterpains.
For the first couple of days after birth, you can feel the top of your uterus at or a few finger widths below the level of your belly button. In a week your uterus weighs about a pound — half what it weighed at delivery. After two weeks it's down to a mere 11 ounces and located entirely within your pelvis. By four to six weeks, it's back to its normal pre-pregnancy weight of about 2 1/2 ounces. This process is called involution of the uterus.
*Why am I bleeding?
After your baby's born, cells that form the lining of the uterus begin to slough off. This results in a discharge called lochia that lasts for weeks. For the first two to four days, lochia contains a fair amount of blood, so it appears bright red and menstrual-like. It gradually gets lighter in color, turning pinkish, and finally fading to white or yellow-white, with the amount tapering off over time before it stops.
*What's going on with my breasts?
Hormonal changes after delivery prompt your breasts to start producing milk. When your baby nurses during the first few days after birth, he's getting colostrum, a thick yellowish substance that your breasts produced during pregnancy. His suckling triggers the release of the hormones prolactin, which stimulates milk production, and oxytocin, which causes the milk sacs and ducts to contract, propelling the milk to your nipples. (This is the so-called "letdown" reflex.)
If those first breastfeeding sessions cause some abdominal cramping, it's because oxytocin also triggers uterine contractions. Once your milk comes in, usually a few days after delivery, your breasts may get swollen and lumpy and feel tender and uncomfortably full. This is called engorgement, and it should subside in a day or two. Nursing your baby often is the best thing you can do for relief. In fact, frequent nursing right from the beginning sometimes prevents engorgement altogether.
Even if you're not breastfeeding, you'll begin to produce milk, and a few days after you give birth, your breasts will become engorged and feel swollen and uncomfortable. This discomfort may last a couple of days or so. In the meantime, wear a supportive bra around the clock and put cold packs on your breasts, which will ease the swelling and help inhibit milk production. (Be sure to cover the cold packs with cloth to protect your skin.) It can take several weeks for your milk to dry up completely
If you need to, you can take acetaminophen or ibuprofen for pain relief. If you're extremely uncomfortable, you can express just enough milk to make the situation more tolerable. This may prolong the process, however, because stimulating your nipples and emptying your breasts signals your body to make more milk. Avoid applying warmth to your breasts since this, too, can encourage milk production.
*Why am I losing my hair?
If your hair got thicker during your pregnancy, you may now start to shed it in handfuls. This happens to some new moms around one to four months after having their baby. Don't worry — you won't go bald. Just as high estrogen levels caused you to lose less hair during pregnancy, decreasing estrogen levels postpartum may cause you to shed more. It's replaced by new hair, though, and the shedding tapers off, so your hair should be back to normal within a year. On the bright side, if you suffered from excess facial and body hair during pregnancy (the result of an increase in hormones called androgens), you can expect to lose that hair three to six months after having your baby.
*What's going on with my skin?
Hormonal changes, stress, and the fatigue brought on by new parenthood may affect your skin along with the rest of your body. Some women who had perfectly clear skin during pregnancy will have more breakouts in the months following delivery. On the other hand, if you suffered from acne during pregnancy, particularly if it appeared for the first time or got worse, you may begin to see some improvement now.
If you have chloasma (darkened patches of skin on your lips, nose, cheeks, or forehead), it'll begin to fade in the months after giving birth and probably go away completely, as long as you protect your skin from the sun. Any stretch marks you developed will gradually become lighter in color, though they won't disappear altogether.
*Will my vagina and perineum ever get back to normal?
Once you give birth, the space inside your vagina will always be a little larger than it was before your first pregnancy. Right after delivery, the vagina remains stretched open and may be swollen and bruised. Over the next few days, any swelling you might have starts to go down, and your vagina begins to regain muscle tone. In the next few weeks, it will gradually get smaller. Doing Kegel exercises regularly helps restore muscle tone.
If you had an episiotomy or a tear, your perineum needs time to heal, so it's a good idea to wait until after your six-week postpartum checkup to resume having intercourse. You may even have some tenderness after that, too, so be sure to go slowly. Consider starting out being on top of your partner or lying side-by-side so you can control the depth of penetration. In any case, if you find intercourse painful, wait a little longer. (If you want to make love, you can figure out other ways in the meantime!)
When you start having sex again, you'll probably find that you have less vaginal lubrication that you did when you were pregnant, due to lower levels of estrogen. This dryness will be even more pronounced if you're breastfeeding, because nursing tends to keep estrogen levels down. Using a lubricant (usually found near the condoms or the tampons and sanitary pads in the drugstore) helps reduce any discomfort. Be sure to get a water-based lubricant. This is particularly important if you're using a barrier method for birth control, since oil-based lubricants can weaken latex and cause a condom to break.
*Why am I feeling so moody?
Hormonal dips and surges may contribute to any emotional swings you're feeling now, along with discomfort you're still experiencing from labor and birth, the physical demands of caring for a new baby, and the emotional adjustment to motherhood. Whatever the cause, it's common to feel a little blue, usually beginning a few days after giving birth and lasting for a few days. If the feeling doesn't go away on its own in the first few weeks or you find that you're feeling worse rather than better, be sure to call your caregiver. You may be suffering from postpartum depression, a more serious problem that requires treatment.
Postpartum Depression
*I love my baby. So why do I feel so blue?
You've just given birth to a wonderful baby, and everyone's ecstatic. Everyone, that is, except you. If this is supposed to be such a happy time, why do you feel so low?
You're not alone. Some degree of emotional vulnerability is natural and expected after childbirth. Up to 80 percent of new mothers experience the baby blues, a form of depression that begins a few days to a week after delivery and generally lasts no longer than two weeks. If you have the blues, you may be weepy, anxious, and unable to sleep. You may also be irritable or moody.
Moms often feel better after getting some rest and a helping hand with the baby. But if your blues — or those of someone you love — have lasted more than two weeks, read on.
*Could I be suffering from postpartum depression?
If your mood doesn't lift after two weeks, you may have postpartum depression (PPD). Up to 20 percent of new mothers experience clinical depression, which can surface any time within the first postpartum year.
Symptoms of PPD include:
• insomnia
• weepiness or sadness
• diminished interest in once pleasurable activities
• difficulty concentrating
• change in appetite
• anxiety
• moodiness and irritability
• withdrawal from family and friends
• excessive guilt
• panic attacks (symptoms include a racing heart, dizziness, confusion, and feelings of impending doom)
• suicidal, scary, or constant negative thoughts
Your healthcare provider can best determine whether you have PPD, but you may spot some clues yourself. Experts say that if you can't sleep when your baby sleeps, no matter how hard you try or how tired you are, you may have PPD.
Some women with PPD believe they can't adequately care for their baby. Others worry they might even harm their baby. One New York mother remembers falling asleep in a rocker one evening while holding her newborn son, and later waking up convinced she had dropped him on his head. No amount of reassurance from her husband that she hadn't hurt the baby would change her mind.
It's important to know the difference between normal postpartum emotional changes and ones that signal a need for further support. It's not just what you're feeling that indicates something may be amiss, but the frequency, intensity, and duration of those feelings. In other words, many new mothers feel sad and anxious periodically during the first few months after childbirth. But if you're crying all day for several days in a row or are having panic attacks, contact your doctor or midwife.
PPD can strike any woman, either immediately after the birth of her baby or many months later. Unfortunately, the medical community has a long history of misunderstanding and misdiagnosing PPD. Sometimes healthcare providers don't take a new mother's concerns seriously, brushing them off as hormonal shifts and part of adjusting to motherhood.
Our society also makes it difficult to admit to having negative feelings about motherhood or your baby. When mothers express feelings such as ambivalence, fear, or rage, they can frighten themselves and those close to them.
Note: A few new mothers experience postpartum psychosis (PPP), a severe yet rare illness characterized by hallucinations, bizarre thinking, paranoia, mania, delusions, and often suicidal impulses. PPP requires immediate medical intervention because of the increased risk of suicide for the mother and harm to the baby.
*What causes depression after childbirth?
Experts agree there's no single cause but rather a combination of hormonal, biochemical, environmental, psychological, and genetic factors. Genetics may play the largest role in postpartum depression, as the single greatest risk factor for PPD is a personal history of depression.
*Am I at risk for PPD?
Some women are more likely than others to get PPD. You're more at risk for PPD if:
• you or anyone in your family has a history of depression or other mental illnesses, or you were prone to bouts of intense anxiety or depression while you were pregnant
• your pregnancy wasn't planned or was unwanted
• your spouse or partner is unsupportive
• you're having marital difficulties
• you're feeling stressed by external events such as financial problems or the loss of a job
• you've recently become separated or divorced
• you went through a serious life change such as a big move at or around the time you had your baby
• you had obstetric complications
• you experienced early childhood trauma, have suffered from abuse, or come from a dysfunctional family
• you or anyone in your family has a history of thyroid problems. (Thyroid dysfunction doesn't mean you'll have PPD, but it can predispose you to postpartum thyroid problems, which may have symptoms similar to those of PPD. It's a good idea to have your thyroid tested if you're feeling low, especially if you have a family history of thyroid problems.)
Remember, though, that these risk factors don't actually cause PPD. Many women with a number of them never get depressed. Others with just one risk factor, or even none, end up with a full-blown major depression.
*What can I do to cope?
If your "baby blues" last longer than two weeks, or if a loved one is concerned about how you're doing, talk to your healthcare provider. She can diagnose your symptoms, refer you to a specialist if needed, and recommend treatment. If you think you might hurt yourself or your baby, or if you feel incapable of responsibly caring for your newborn, seek professional help immediately.
In addition to getting expert help, here are ways to cope with postpartum depression:
Be good to yourself. Make sure your own basic needs are met: Try to sleep and eat well, and try not to feel guilty about the way you feel. Just because you have PPD doesn't mean you are a bad mother or don't love your child.
Ask for support. Part of being a good mother is knowing when to ask for help — so don't be afraid to ask for it during this difficult time. Help comes in many forms, ranging from friends who cook meals and fold your laundry to therapy.
Share your feelings with others. Tell someone you trust about how you feel. Call a sympathetic friend. Join a mothers' group for support, or chat with moms on our Dealing With the Baby Blues and Postpartum Depression bulletin boards. You may be surprised at how many women are experiencing similar feelings. If you have a supportive partner, make sure he knows what's going on and how he can help.
Don't neglect your "outside." Taking care of your physical self can sometimes help you feel better inside. Have your partner or a friend watch your baby so you can take a relaxing shower. Put on makeup if you usually wear it. Although your maternity clothes may still fit, pack them away. Go on a shopping trip just for yourself and buy something new for your postpartum wardrobe. Wear a favorite outfit on especially difficult days to give yourself a boost.
Sleep when your baby sleeps. It's age-old advice, but it works. The rigors of caring for a newborn, coupled with exhaustion and sleepless nights, will almost certainly bring on the blues. To fight fatigue and depression, you need rest. Have a relative or friend watch your baby, even if only for an hour, and sleep. If no one's available, consider hiring a postpartum doula or a sitter experienced with newborns.
Venture outdoors. Put your baby in a stroller and take a walk around the block, or meet a friend at a nearby café . The fresh air, sunshine, and company will do you and your baby a world of good. If even a brief excursion is too much for you right now, then just go outside, close your eyes, take a deep breath, and sit in the sunshine for a few minutes. It will help.
Slow down. Your baby's arrival is a good reason to take it easy. Resist the temptation to do the laundry while your baby sleeps, and let the rest of your chores wait. Have food delivered, or ask your partner to get takeout on the way home. If the phone always rings at the wrong time (for example, when you're trying to get the baby to sleep, or when you're finally sitting down for a much-needed break), turn off the ringer and return calls when it's convenient. If you're on maternity leave, banish all thoughts of the work awaiting you at the office. Don't worry — you'll get back on track soon enough.
*Is it safe to take antidepressants while breastfeeding?
The effects of antidepressant medications on nursing babies haven't been widely studied, so there isn't much data to go on. That said, many doctors feel that the benefits of breastfeeding are so great that they outweigh the possible risks of using most antidepressants while nursing. If you're breastfeeding, be sure to bring this up with your doctor when discussing antidepressants. (For details on specific medications, see our chart on drug and breast milk interactions.)
*My partner has PPD. How can I make life easier for her?
The postpartum period is hard on fathers, too. After all, you're also busy tending to your baby's needs, so make sure you get a lot of rest. In the meantime, offer your partner help whenever she needs it, and try not to judge her. It can be difficult to adjust to a partner with PPD, especially if you expected life after the baby's birth to be a joyous time for your family. But remember — your support is vital to her recovery.
Talk to your partner's obstetrician, midwife, or therapist to better understand what she's going through. You can't fix this, but you can be there for her. What's important is that she seek proper treatment.
***For more information, contact:***
Postpartum Stress Center
(610) 525-7527
Postpartum Support International
(800) 944-4773
National Institute of Mental Health
(800) 421-4211
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1. You look at your belly in the mirror instead of your face.
2. Where you once believed you were fearless, you now find yourself afraid.
3. The sacrifices you made to have a child no longer seem like sacrifices. (everything you give up is worth it.)
4. You respect your body...FINALLY.
5. You have stronger opinions and are stronger willed. (some people call this "mood swings")
6. You respect your parents (especially your mother) and love them in a new way.
7. You find that your baby's pain feels much worse than your own.
8. You finally understand what all the other mommies meant when they said, "I am complete"
9. You believe once again in the things you believe in when you were a child. (hurray for santa clause!)
10. You lose touch with the people in your life that you should have lost touch with a long time ago.
11. You heart breaks much more easily.
12. You think of your baby 986,234,852,947 times a day. In fact, you're so busy with this that you don't have time for anything else!
13. Food that don't go together taste so good! (Thank God for french fries dipped in ice cream!!!)
14. You no longer like it when you guys check you out. In fact, it offends you.
15. You think before you speak, and you learn to expand your vocabulary. (The word "bottom" now replaces "ass")
16. Bodily functions are no longer repulsive.
17. You see beauty in the ugliest babies, and you find yourself saying, "aww, look how cute that baby is."
18. You realize that you can love someone before you even meet them.
19. If you have a son, you no longer curse men.
20. Your love becomes limit-less...like a super human power.
FETAL DEVELOPMENT- From conception to birth
DAY 1: fertilization: all human chromosomes are present; unique human life begins.
DAY 6: embryo begins implantation in the uterus.
DAY 22: heart begins to beat with the child's own blood, often a different type than the mothers'.
WEEK 3: By the end of third week the child's backbone spinal column and nervous system are forming. The liver, kidneys and intestines begin to take shape.
WEEK 4: By the end of week four the child is ten thousand times larger than the fertilized egg.
WEEK 5: Eyes, legs, and hands begin to develop.
WEEK 6: Brain waves are detectable; mouth and lips are present; fingernails are forming.
WEEK 7: Eyelids, and toes form, nose distinct. The baby is kicking and swimming.
WEEK 8: Every organ is in place, bones begin to replace cartilage, and fingerprints begin to form. By the 8th week the baby can begin to hear.
WEEKS 9 AND 10: Teeth begin to form, fingernails develop. The baby can turn his head, and frown. The baby can hiccup.
WEEKS 10 AND 11: The baby can "breathe" amniotic fluid and urinate. Week 11 the baby can grasp objects placed in its hand; all organ systems are functioning. The baby has a skeletal structure, nerves, and circulation.
WEEK 12: The baby has all of the parts necessary to experience pain, including nerves, spinal cord, and thalamus. Vocal cords are complete. The baby can suck its thumb.
WEEK 14: At this age, the heart pumps several quarts of blood through the body every day.
WEEK 15: The baby has an adult's taste buds.
MONTH 4: Bone Marrow is now beginning to form. The heart is pumping 25 quarts of blood a day. By the end of month 4 the baby will be 8-10 inches in length and will be one half of its birth weight.
WEEK 17: The baby can have dream (REM) sleep.
WEEK 19: Babies can routinely be saved at 21 to 22 weeks after fertilization, and sometimes they can be saved even younger.
WEEK 20: At 20 weeks the baby recognizes its' mothers voice.
WEEK 25: The baby can respond to outside noise.
MONTHS 5 AND 6: The baby practices breathing by inhaling amniotic fluid into its developing lungs. The baby will grasp at the umbilical cord when it feels it. Most mothers feel an increase in movement, kicking, and hiccups from the baby. Oil and sweat glands are now functioning. The baby is now twelve inches long or more, and weighs up to one and a half pounds.
MONTHS 7 THROUGH 9: Eyeteeth are present. The baby opens and closes his eyes. The baby is using four of the five senses (vision, hearing, taste, and touch.) He knows the difference between waking and sleeping, and can relate to the moods of the mother. The baby's skin begins to thicken, and a layer of fat is produced and stored beneath the skin. Antibodies are built up, and the baby's heart begins to pump 300 gallons of blood per day. Approximately one week before the birth the baby stops growing, and "drops" usually head down into the pelvic cavity.
Morning Sickness: Causes, Concerns, and Treatments
Why do they call it morning sickness when I feel nauseated all day long?
"Morning sickness" is really a misnomer. (In fact, the technical medical term is "nausea and vomiting of pregnancy.") For some pregnant women, the symptoms are worst in the morning and ease up over the course of the day, but they can strike at any time and last all day long.
About three quarters of pregnant women experience nausea and sometimes vomiting during their first trimester. The nausea usually starts around six weeks of pregnancy, but it can begin as early as four weeks. It tends to get worse over the next month or so.
About half of the women who get it feel complete relief by about 14 weeks. For most of the rest, it takes another month or so for the queasiness to ease up, though it may return later and come and go throughout pregnancy.
What causes nausea and vomiting during pregnancy?
No one knows for sure what causes nausea during pregnancy, but it's probably some combination of the many physical changes taking place in your body. Some possible causes include:
• Rapidly rising levels of the hormone human chorionic gonadotropin (hCG) during early pregnancy. No one knows how hCG contributes to nausea, but the timing is right: Nausea tends to peak around the same time as levels of hCG.
Estrogen, another hormone that rises rapidly in early pregnancy, is also considered a prime suspect, and it's possible that other hormones play a role as well.
• An enhanced sense of smell and sensitivity to odors. It's not uncommon for a newly pregnant woman to feel overwhelmed by the smell of a bologna sandwich from four cubicles away, for example, and that certain aromas instantly trigger her gag reflex. This may be a result of higher levels of estrogen.
• A tricky stomach. Some women's gastrointestinal tracts are simply more sensitive to the changes of early pregnancy.
You may have heard that morning sickness can be caused by a vitamin B deficiency. While taking a vitamin B6 supplement does seem to help ease nausea in many pregnant women, this doesn't mean they have a vitamin deficiency. In fact, at least one study has shown no significant differences in the levels of B6 in women with morning sickness and those without.
No one knows why B6 is helpful. There's also some evidence that taking a multivitamin at the time of conception and in early pregnancy helps prevent severe morning sickness, but again, no one knows why.
Some researchers have proposed that certain women are psychologically predisposed to having nausea and vomiting during pregnancy as an abnormal response to stress. However, there's no good evidence to support this theory. (Of course, if you're constantly nauseated or vomiting a lot, you certainly may begin to feel more stressed!)
Are some pregnant women more likely than others to feel nauseated?
You're more likely to have nausea or vomiting during your pregnancy if any of the following apply:
• You're pregnant with twins or higher multiples. This may be from the higher levels of hCG, estrogen, or other hormones in your system. You're also more likely to have a more severe case than average. On the other hand, it's not a definite thing — some women carrying twins have little or no nausea.
• You had nausea and vomiting in a previous pregnancy.
• You have a history of nausea or vomiting as a side effect of taking birth control pills. This is probably related to your body's response to estrogen.
• You have a history of motion sickness.
• You have a genetic predisposition to nausea during pregnancy. If your mother or sisters had severe morning sickness, there's a higher chance you will, too.
• You have a history of migraine headaches.
• You're carrying a girl. One study found that women with severe nausea and vomiting were 50 percent more likely to be carrying a girl.
Pregnancy Symptoms You Should NEVER Ignore How do you know whether that sudden ache is normal or warrants a 2 a.m. call to your doctor or midwife? Here's a rundown of symptoms that should set off your warning bells. But even if you don't see your symptom on this list, it's better to err on the side of caution and make that call than to agonize for hours, wondering whether you've pulled a ligament or gone into preterm labor. *Note that some of these symptoms may be more or less urgent depending on your particular situation or health history and on how far along you are in your pregnancy. Ask your practitioner to review with you which signs warrant an urgent call at various points in your pregnancy.
• Your baby is moving or kicking less than usual (once he begins moving regularly). Ask your caregiver if you should monitor your baby's activity by doing daily "kick counts." She can give you specific instructions on how to count and when to call.
• Severe or persistent abdominal pain or tenderness.
• Vaginal bleeding or spotting.
• An increase in vaginal discharge or a change in the type of discharge — that is, if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged). Note: After 37 weeks, an increase in mucus discharge is normal and may indicate that you'll be going into labor soon.
• Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it's a new problem for you), menstrual-like cramping or abdominal pain, or more than four contractions in an hour (even if they don't hurt) before 37 weeks.
• Painful or burning urination, or little or no urination.
• Severe or persistent vomiting, or any vomiting accompanied by pain or fever.
• Chills or fever of 100 degrees Fahrenheit or higher.
• Visual disturbances such as double vision, blurring, dimming, flashing lights, or "floaters" (spots in your field of vision).
• Persistent or severe headache, or any headache accompanied by blurred vision, slurred speech, or numbness.
• Any swelling in your face or puffiness around your eyes, anything more than a little swelling in your hands, severe and sudden swelling of your feet or ankles, or a rapid weight gain (more than 4 pounds in a week).
• A persistent or severe leg cramp or calf pain that doesn't ease up when you flex your ankle and point your toes toward your nose or when you walk around, or one leg being significantly more swollen than the other.
• Trauma to the abdomen.
• Fainting, frequent dizziness, a rapid heartbeat, or heart palpitations.
• Difficulty breathing, coughing up blood, or chest pain.
• Severe constipation accompanied by abdominal pain or severe diarrhea that lasts more than 24 hours.
• Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body.
• Any health problem that you'd ordinarily call your practitioner about even if it's not pregnancy related (like worsening asthma or a cold that gets worse rather than better). Just call a little sooner than you would normally.
If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and call your healthcare provider. Your practitioner expects such calls. If there's a problem, you'll get help right away. If nothing's wrong, you'll be reassured.
Your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal." Do yourself and your baby a favor and get any unusual symptoms checked out.
Finally, if you're near your due date, check out the signs of labor so you'll know what to look for and when to call your caregiver
(Can daddies have PREGNANCY SYMPTOMS?! Question: Can daddies have pregnancy symptoms?) The answer: YES.
As strange as it may sound, some men start to feel pregnant while their partner is expecting. They even exhibit similar symptoms. The phenomenon is called Couvade Syndrome, or "Sympathetic Pregnancy."
"Couvade" comes from the french word couvee, meaning "to hatch." It has come to mean a man that has sypathetic pregnancy. So, yes, this means that the daddy is so excited about the baby, or so worried about the pain/discomfort you go through, that he experiences many of the pregnancy symptoms mommies go through, such as: cravings, weight gain, morning sickness, and a change in sexual appetite. Obviously, though, it is impossible for a man to experience EVERYTHING that a mother goes through during pregnancy.
Generally, couvade syndrome begins in the end of the first trimester and increases in severity until the third trimester. The only known cure for couvade is--- birth.
Some people have doubted the reality of couvade syndrome. These doubters say that the weight gain that the father may experience is caused by the eating habits of the mother, nerves, or other changes that pregnancy makes in one's life. The vomiting? Of course, that is blamed on nerves, too. What do the dads have to say about this? They don't know what to think about vomiting, weight gain, and changes in sexual appetite. How can you tell everyone at work that you need to lie down because you have morning sickness?!? And, of course, they would stop vomiting if they could. This is something that has been researched and found to be quite real. Some men are more susceptible to couvade than others. For instance if you and your partner have experienced infertility or if you were adopted, you could be more likely to experience couvade syndrome. So, guys, know that you are not alone, and that you have the medical community backing you up. Eat some crackers, get out of bed slowly, drink some ginger tea and try to get a bit of rest and know that birth is right around the corner. And don't shove her out of the way of the toilet!
Fetal Movements: Feeling Your Baby Move
FETAL MOVEMENTS: Feeling Your Baby Move
When should I start to feel my baby move?
You probably won't feel your baby kick until sometime between 16 and 22 weeks, even though he started moving at 7 or 8 weeks and you may have already witnessed his acrobatics if you've had an ultrasound.
Veteran moms tend to notice those first subtle kicks — also known as "quickening" — earlier than first-time moms. (A woman who's been pregnant before can more easily distinguish her baby's kick from other belly rumblings, such as gas.)
Your build may also have something to do with when you'll be able to tell a left jab from a hunger pang. Thinner women tend to feel movement earlier and more often than women who carry more weight.
What does it feel like?
Women have described the sensation as being like popcorn popping, a goldfish swimming around, or butterflies fluttering. You'll probably chalk up those first gentle taps or swishes in your belly to gas or hunger pains, but once you start feeling them more regularly, you'll recognize the difference. You're more likely to feel these early movements when you're sitting or lying quietly.
How often should I feel movements?
At first the kicks you notice will be few and far between. In fact, you may feel several movements one day and then none the next. Although your baby is moving and kicking regularly, many of his jerks and jolts aren't yet strong enough for you to feel. But later in the second trimester, those reassuring kicks will become stronger and more regular.
If you're tempted to compare notes with other pregnant women, don't worry if your experience differs from that of your friends. Every baby has his own pattern of activity, and there's no correct one. As long as your baby's usual activity level doesn't change too much, chances are he's doing just fine.
Do I need to keep track of the kicking?
Once you're feeling kicks regularly, pay attention to them and let your practitioner know right away if you notice a decrease in your baby's movement. Less movement may signal a problem, and you'll need a nonstress test or biophysical profile to check on your baby's condition.
Once you're in your third trimester, some practitioners will recommend that you spend some time each day counting your baby's kicks. There are lots of different ways to do these "kick counts," so ask for specific instructions.
Here's one common approach: Choose a time of day when your baby tends to be active. (Ideally, you'll want to do the counts at roughly the same time each day.) Sit quietly or lie on your side so you won't get distracted. Time how long it takes for you to feel ten distinct movements — kicks, twitches, and whole body movements all count. If you don't feel ten movements in two hours, stop counting and call your midwife or doctor.
Tanning during pregnancy- not a good idea! ***TANNING DURING PREGNANCY:
Using a tanning bed during pregnancy is DEFINITELY NOT a good idea. There's no conclusive evidence that they're DIRECTLY harmful to a developing fetus, but there is plenty of proof that they're dangerous to you, which in turn, CAN then make it dangerous to your baby.
Tanning beds pose the same dangers as the sun: They emit ultraviolet (UV) radiation, which causes skin cancer. Don't believe anyone who tells you that because tanning booths emit only UVA rays they're not hazardous to your health.
One study suggests that visiting a tanning booth ten times in a year can double your chances of developing melanoma — one of the most deadly types of cancer. Melanoma is the only type of cancer that spreads to the placenta, and that could be disastrous for both you and your baby.
Being in a small enclosed room while in a hot tanning bed can also increase your blood pressure (as well as taking hot baths)- and a high blood pressure is NOT good for the baby. It takes an even blood pressure for your blood to disperse evenly throughout your body in order to reach your uterus. When your blood pressure is high, your blood does not disperse evenly.
As far as the whole "cooking the baby" thing goes: that is just a wifes tale- the baby doesn't feel the rise in temperature- it just has to do with the blood pressure...
***SMOKING DURING PREGNANCY:
Smoking during pregnancy will expose your baby to nicotine, carbon monoxide, and other harmful toxins that can stunt his growth — including brain growth. An expecting mom with a pack-a-day habit will reduce her baby's birth weight by about half a pound, on average. (Remember, "average" means that some babies are far more affected than others.) This is significant because low birth weight is one of the main factors linked to newborn illness, disability, and death.
Cigarette smoking is also associated with increased risk for many pregnancy complications. These include premature labor, ectopic pregnancy (in which the fertilized egg implants outside the womb), miscarriage, placenta previa, placental abruption, vaginal bleeding, and premature delivery.
The long-term consequences of smoking during pregnancy can linger far after childbirth. Recent studies suggest that babies born to mothers who smoked are more likely to have learning problems, short attention spans, and hyperactivity disorders. They're more vulnerable to breathing problems such as asthma. Smoking during pregnancy can also put your baby at risk for sudden infant death syndrome (SIDS).
Drinking During Pregnancy- NOT a good idea!
How much alcohol is too much?
Alcohol and pregnancy don't mix. That's because is it known to be harmful to a developing baby- even though no one knows EXACTLY what harmful effects even the smallest amount of alcohol has on a developing baby. All public health officials in the United States recommend that mothers-to-be play it safe by steering clear of alcohol entirely.
"We don't really know what a safe level of alcohol consumption is for a pregnant woman — and it's probably different for every woman because no one metabolizes alcohol in the same way," says Pam Phipps, research manager of the fetal alcohol and drug unit in the Department of Psychiatry and Behavioral Sciences at the University of Washington in Seattle. "Since it's impossible to identify a safe dose, we advise abstinence." So do experts at the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.
What effects could alcohol have on my baby?
When you drink, the alcohol quickly travels through your bloodstream to your baby. Your baby may end up with higher levels of blood alcohol than you have. Basically, if you are getting drunk, your baby is getting drunk- and the effects of drinking can be MUCH greater on your baby than you.--- I mean, think about it: you wouldn't give your newborn a shot of vodka, would you?
Drinking endangers your growing baby in a number of ways: It increases the risk of miscarriage and stillbirth. As little as one drink a day can increase the odds for low birth weight and raise your child's risk for problems with learning, speech, attention span, language, and hyperactivity. And some research has shown that expectant moms who have as little as one drink per week are more likely than nondrinkers to have children who later exhibit aggressive and delinquent behavior.
The most severe result of alcohol use is fetal alcohol syndrome (FAS), a permanent condition characterized by poor growth, abnormal facial features, and damage to the central nervous system. Babies with FAS grow poorly in the womb or after birth, or both. In addition to abnormal facial features, they may have abnormally small heads and brains; heart, spine, and other anatomical defects. The central nervous system damage may include mental retardation, delays in physical development, vision and hearing problems, and a variety of behavioral problems.
Frequent drinking (seven or more drinks per week, including mixed drinks, wine, and beer) or binge drinking (five or more drinks on any one occasion) greatly increases the risk that your baby will suffer from FAS. But babies whose moms drink less can also develop this syndrome. And babies exposed to alcohol in utero — even if they don't have full-blown FAS — may still be born with some of these birth defects or later exhibit a number of mental, physical, or behavioral problems.
According to the Centers for Disease Control, fetal exposure to alcohol is one of the main preventable causes of birth defects and developmental problems in this country. More than 10 percent of women in the United States drink during pregnancy, and one in 30 pregnant women drink frequently or binge drink: The babies of all these women are at risk. So whether you have a severe drinking problem or a more moderate one, if you find yourself unable to completely give up alcohol, it's vital to get help as soon as possible. Talk to your provider about counseling or treatment options.
What about "nonalcoholic" beer and wine?
The term "nonalcoholic" is a bit misleading when it comes to the supposedly alcohol-free versions of beer and wine. In fact, all "nonalcoholic" beers and many nonalcoholic wines do contain some alcohol, typically less than half a percent. While few would say that the trace amount of alcohol in an occasional glass of nonalcoholic beer is going to harm your baby, it's something to be aware of — especially if you drink these beverages often or in large amounts. So before you drink up, read labels carefully and remember that "nonalcoholic" and "alcohol-free" aren't interchangeable terms: Drinks labeled nonalcoholic can contain trace amounts of alcohol, while those labeled alcohol-free can't.
PRETERM LABOR AND BIRTH
What are preterm labor and preterm birth?
If you start having regular contractions that cause your cervix to begin to open (dilate) or thin out (efface) before you reach 37 weeks of pregnancy, you're in preterm labor, also known as premature labor. If you deliver your baby before 37 weeks, it's called a preterm birth and your baby is considered premature.
About a quarter of all preterm births are intentional. For example, your medical team might decide to induce labor early or perform a cesarean section if you have a serious medical condition such as severe or worsening preeclampsia or if your baby has stopped growing.
The rest are known as spontaneous preterm births. You may end up having a spontaneous preterm birth if you go into labor prematurely, if your water breaks early (called preterm premature rupture of the membranes or PPROM), or if your cervix dilates prematurely with no contractions (called cervical insufficiency).
About 12 percent of babies in the United States are born prematurely. This number has gone up over the years, partly because more women are pregnant with twins or higher order multiples, who tend to arrive early.
Preterm birth can cause health problems or even be fatal for the baby if it happens too early. The more mature a child is at birth, the more likely it is that he will survive and be healthy.
Premature babies born between 34 and 37 weeks generally do very well. If you go into labor before 34 weeks, your medical team may be able to delay your labor for a few days so your baby can be given corticosteroids to help his lungs develop faster, which increases his chance of survival.
What causes spontaneous preterm birth?
Although the cause is often unknown, a variety of factors play a role in preterm birth:
• Certain genital tract infections, such as chlamydia, bacterial vaginosis (BV), and trichomoniasis, are associated with preterm delivery.
Substances produced by bacteria can weaken the membranes around the amniotic sac and cause it to rupture early. Even when the membranes remain intact, bacteria can cause preterm labor if they get into the amniotic fluid or sac.
You may have been checked for chlamydia and gonorrhea at your first prenatal visit, and you would have been treated immediately if you'd tested positive for either of these sexually transmitted infections.
If you've had a previous preterm birth, you may also have been screened for bacterial vaginosis. Although some studies show that treating BV in the second and third trimesters reduces the risk of preterm labor in women with a history of preterm birth, other research has found that it makes no difference. So experts don't agree on whether it's worthwhile to test pregnant women who don't have symptoms. (If you have symptoms of bacterial vaginosis, you'll be tested and treated with antibiotics, if needed.)
You probably won't be tested for trichomoniasis unless you have symptoms. Some research suggests that treating women for trichomoniasis during pregnancy actually increases the risk of preterm birth.
• Having a problem with the placenta, such as placenta previa or placental abruption.
• Having structural abnormalities of the uterus or cervix, such as a cervix that's shorter than 25 millimeters and that effaces or dilates without contractions (cervical insufficiency).
• Having an excessively large uterus, which is often the case when you're pregnant with multiples or have too much amniotic fluid.
• Certain chronic maternal illnesses may be related to preterm labor, such as diabetes, sickle cell anemia, severe asthma, lupus, inflammatory bowel disease, and chronic active hepatitis. Other conditions to watch for include non-uterine infections, such as a kidney infection or pneumonia; abdominal surgery, such as having your appendix taken out; trauma to the abdomen; and periodontitis (a gum infection that goes into the bone and other tissues that support your teeth).
What are my chances of having a spontaneous preterm birth?
Although it's impossible to say whether you'll give birth prematurely, you may be at increased risk if you:
• Previously had a preterm delivery (the earlier in gestation your baby was born and the more spontaneous preterm births you've had, the higher your risk)
• Are pregnant with twins or higher order multiples
• Are younger than 17 or older than 35
• Are African American (17.4 percent of African American babies are born prematurely)
• Don't gain enough weight during your pregnancy
• Were underweight before you got pregnant
• Are short
• Have had vaginal bleeding in more than one trimester
• Smoke, abuse alcohol, or use drugs (especially cocaine) during pregnancy
• Gave birth in the last 18 months (particularly if became pregnant within six months of giving birth)
And here are a few suspected risk factors that researchers are looking at:
A few studies have found an association between high levels of stress and preterm birth. The theory is that severe stress can lead to the release of hormones that can trigger uterine contractions and preterm labor.
Experts have also been studying occupational factors to see what effect having a physically demanding job or working long hours has. One study showed that moms-to-be who had to stand for more than 40 hours a week or who had extremely tiring jobs were more likely to have preterm deliveries.
Finally, some researchers are studying the role of genetic factors because preterm birth seems to be more common in some families. Genetics may help explain the different rates seen among various races, even when other risk factors are taken into account.
Are there tests that can predict my chances of having a preterm delivery?
Two screening tests are available for women who are having symptoms of preterm labor or who are otherwise at high risk for it. A negative result is particularly useful because it can put your mind at ease and help you avoid unnecessary interventions and time in the hospital.
The American College of Obstetricians and Gynecologists doesn't recommend either test for all pregnant women because studies haven't shown the tests to be useful for women who aren't at high risk and have no symptoms.
Measuring the length of your cervix
Your practitioner may have checked the length of your cervix at your first prenatal visit so she could monitor changes as your pregnancy progressed. If your cervix is getting shorter in midpregnancy, it's beginning to thin out (efface) and that could lead to a preterm delivery.
If you're at high risk for cervical insufficiency — because your cervix is abnormally short, for example — or if you later have symptoms that indicate your cervix is changing (such as pelvic pressure, backache, or increased mucus discharge), your practitioner may recommend an ultrasound to measure your cervix more accurately and look for signs that it's changing.
If the ultrasound shows that your cervix is starting to change, your practitioner may recommend that you cut back on physical activity and work, abstain from sex, and stop smoking if you haven't already. Depending on your situation and your baby's gestational age, you could have another ultrasound within the next few weeks.
If you're less than 24 weeks pregnant and your cervix is changing but you're not having any contractions, your practitioner may recommend a cerclage, a procedure in which a band of strong thread is stitched around your cervix to help hold it closed. However, the procedure is not without risks and there's considerable controversy about whether it's effective enough to be worthwhile in this situation.
Women who may benefit most from a cerclage include those who've had three or more unexplained second-trimester losses or preterm births. If you're in this group, you're likely to get a cerclage at 13 to 16 weeks, before your cervix starts to change.
Fetal fibronectin screening
This test is usually reserved for women who are having contractions or other symptoms of preterm labor. Fetal fibronectin (fFN) is a protein produced by the fetal membranes. If more than a small amount turns up in a sample of your cervical and vaginal secretions between 24 and 34 weeks, you're considered to be at higher risk for preterm delivery.
A positive fFN result might prompt your practitioner to give you drugs to hold off labor as well as corticosteroids to help your baby's lungs mature more quickly.
However, the test is actually more accurate at telling you when you won't deliver than when you will. If you have a negative fFN result, it's highly unlikely that you'll deliver within the next two weeks. A negative result can put your mind at ease and help you avoid hospitalization or other unnecessary treatment.
Another technique, called home uterine activity monitoring (HUAM), is not thought to be useful in predicting preterm birth. To use it, you have to wear a sensor around your abdomen that records daily uterine activity. This system is expensive and has not helped reduce the preterm delivery rate in the United States.
Is there anything else I can do if I'm at high risk?
Take care of yourself. If you eat well, get plenty of rest, start your prenatal care early and see your practitioner regularly, manage your stress level, and pay attention to your dental health, you're already doing a lot to ensure a healthy, full-term pregnancy.
Take time to tune into the changes that are happening in your body during pregnancy. Spend some quiet time each day by yourself, so you can focus on your baby's movements and take note of any unusual aches or pressures.
Learn the signs of preterm labor (below) and let your practitioner know right away if you notice any of them. The most important development in the management of preterm labor in the past 50 years has been the use of corticosteroids to speed up the development of the baby's lungs before birth. The earlier you realize you're in preterm labor, the more likely it is that your baby will be able to benefit from this treatment.
Your practitioner might consult with a high-risk specialist (a perinatologist) or refer you to one, particularly if you've had a preterm delivery before. If you've had a second-trimester loss or a spontaneous preterm birth and are carrying only one baby, the specialist may consider treating you with a progesterone compound called 17 alpha hydroxyprogesterone caproate, or 17 P for short.
Studies have shown that weekly injections of this hormone, starting in the second trimester and continuing until 36 weeks, significantly reduced the risk of a repeat preterm delivery for women in this situation. Studies are under way to determine whether 17P will help reduce the rate of preterm deliveries in other high-risk groups, such as women carrying twins.
(The FDA has not yet approved 17P for manufacture by pharmaceutical companies, and only a limited number of pharmacies are set up to make it, so the treatment is not widely available.)
Finally, some practitioners will suggest bedrest, though there's no evidence that it will help prevent preterm birth.
What are the symptoms of preterm labor?
Call your midwife or doctor right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):
• An increase in vaginal discharge
• A change in the type of discharge — if it becomes watery, mucus-like, or bloody (even if it's pink or just tinged with blood)
• Any vaginal bleeding or spotting
• Abdominal pain, menstrual-like cramping, or more than four contractions in one hour (even if they don't hurt)
• An increase in pressure in the pelvic area (a feeling that your baby is pushing down)
• Low back pain, especially if you didn't previously have back pain
These symptoms can be confusing because some of them, such as pelvic pressure or low back pain, occur during normal pregnancies, too, and sporadic early contractions may just be Braxton Hicks contractions. But it's always better to be safe than sorry, so call your midwife or doctor right away if you're experiencing anything unusual.
What will happen if I start having preterm labor?
If you have signs of preterm labor or think you're leaking amniotic fluid, call your practitioner, who will probably have you go to the hospital for further assessment. You'll be monitored for contractions (your baby's heart rate will be monitored at the same time) and examined to see whether your membranes have ruptured. Your urine will be checked for signs of infection, and cervical and vaginal cultures may be taken as well. You may also be tested for fetal fibronectin.
If your water hasn't broken, your practitioner will do a vaginal exam to assess the state of your cervix. A practitioner will often do an abdominal ultrasound as well, to check the amount of amniotic fluid present and confirm the baby's growth, gestational age, and position. Finally, some practitioners will do a vaginal ultrasound to double-check the length of your cervix and look for signs of effacement.
If all the tests are negative, your membranes haven't ruptured, your cervix hasn't dilated after a few hours of monitoring, and you and your baby appear healthy, you'll most likely be sent home.
Although each practitioner may manage the situation a little differently, there are some general guidelines. If you're less than 34 weeks pregnant and found to be in preterm labor, your membranes are intact, your baby's heart rate is reassuring, and you have no signs of a uterine infection or other problems (such as severe preeclampsia or signs of a placental abruption), your practitioner will probably attempt to delay your delivery.
First, you'll be put on an IV and given antibiotics to prevent group B streptococcal infection in your baby. This is done just in case a culture shows you're a carrier, as it takes 48 hours to get results. You'll most likely be given medication to try to stop contractions long enough so your baby can be given corticosteroids to speed up the development of his lungs.
If you're in a small community hospital where special neonatal care is not available for a preterm infant, you'll be transferred to a larger institution at this point, if possible. You and your baby will be monitored throughout labor if it does continue.
If your water breaks before 37 weeks but you're not having contractions, your medical team may decide to induce labor, try to delay labor, or choose to wait for the onset of labor, which could happen within hours or take up to a week in the hospital. In any case, you'll be given antibiotics to protect against group B strep and other infections.
Experts differ on what to do in this situation. Waiting to deliver buys your baby more time to mature but increases your risk of infection, which could be dangerous for you and your baby.
Of course, if you develop symptoms of infection, you'll be induced immediately. If your baby's in distress, you'll need to deliver right away, often by cesarean section.
In most cases, if you're in premature labor after 34 weeks, you'll be allowed to deliver your baby. Babies born between 34 and 37 weeks of gestation who have no other health problems generally do fine (although the earlier they're delivered, the higher the risk of a problem). These babies may need a short stay in the neonatal nursery and may have a few short-term health issues, but in the long run, most of them do as well as full-term babies.
What to pack for the hospital For labor
• Your birth plan.
• Your insurance card and any hospital paperwork you need.
• Your eyeglasses, if you need any. Even if you usually wear contacts, you'll probably need or want to take them out at some point during your stay.
• A hair band and barrettes, if you think you might want them.
• Lip moisturizer.
• A bathrobe, nightgown, slippers, and a couple of pairs of socks. Hospitals provide gowns for you to use during labor and afterward, but most will allow you to wear your own clothes if you prefer. Choose something loose and comfortable that you don't mind getting ruined. You'll need to wear a gown instead of pants so that your practitioner can check your cervix. Choose a top with short, loose sleeves so you your blood pressure can be checked easily and so you can slip your top off easily if you want to change and have an IV in place. You might also want to bring your own slippers and robe for walking around during the early stages of labor. If you don't want to risk soiling your robe, you can ask for a second hospital gown to wear as a robe to cover your backside.
• Something to read, if you're so inclined. One husband we know spent the early stages of labor reading The Lion in Winter while his wife read The English Patient. "In retrospect, I should have brought the National Enquirer or Vogue — something trashy with pictures," she says.
• Massage oils or lotions, music, an extra pillow, whatever you need to help you relax. (If you do bring your own pillow, be sure to use a patterned or colorful pillowcase so it doesn't get mixed up with the hospital's.) You might consider bringing tennis balls or a rolling pin in case you have back labor and need them for massage.
• Talismans, a picture of someone or something you love, anything you find reassuring.
For your partner/labor coach
• Money for parking and change for vending machines.
• A few basic toiletries, such as a toothbrush, toothpaste, shampoo, deodorant.
• A change of clothes
• Some snacks and something to read during the early stages.
• A camera/video camera and film or tape or a memory card and batteries. Someone has to document the big event! (NOTE: Not all hospitals allow videotaping of the birth itself, but there's usually no rule against taping during labor or after the birth.)
• A bathing suit. If your partner wants to take a bath or shower during labor, you may want to jump in with her.
Postpartum
• A fresh nightgown.
• Snacks! After many hours of labor, you're likely to be pretty hungry and you don't want to have to rely on the hospital's food. So bring your own crackers, raisins, and granola bars.
• A nursing bra, breast pads, and maternity underwear, if you'd prefer not to wear the net panties they'll give you at the hospital. Chances are, whatever underwear you do wear the first few days will get stained, even with sanitary pads (which the hospital provides).
Also bring some of your OWN pads to place into your panties- the ones the hospital gives you are like giant boats!
• Toiletries. Toothbrush, toothpaste, hairbrush, lip balm, deodorant, and makeup, if it's important to you. Hospitals will have soap, shampoo, and lotion, but you might prefer your own brands.
• Your address book and prepaid phone card or cell phone. After the baby's born you'll want to call family and friends to let them know the good news. Note: Some hospitals don't allow cell phones to be used in the labor and delivery area, so you may want to ask about it ahead of time.
• A going-home outfit. Bring something roomy and easy to get into — believe it or not, you'll probably still look 5 or 6 months pregnant — along with a pair of flat shoes. The last thing you'll be worrying about when you go home is whether your outfit is fashionable.
For your baby
• An infant car seat. You can't drive your baby home without one!
• A going-home outfit (one-piece stretchy outfits are easiest) and a snowsuit if it's very cold
• A receiving blanket (a heavy one if the weather's cold)
• A pair of socks or booties
• A cap (although they'll usually give you one at the hospital)
• Baby nail clippers or emery board. "The hospital where my son was born didn't supply clippers for fear of liability, and as a consequence my son gouged his face before he was 12 hours old.
Also bring some baby mittens, so that your baby doesn't scratch his/her face! Their nails can usually be really long after they're first born!
What not to bring
• Jewelry
• Lots of cash, credit cards, or any other valuables
• Work. Yes, we actually know fast-track types who have sent business e-mails from the hospital room, made work-related phone calls, and reviewed spreadsheets.
SIGNS OF LABOR
Is there any way to predict when I'm going to go into labor?
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start. Your body actually starts "preparing" for labor up to a month before you give birth. You may be blissfully unaware of what's going on or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
* Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
* You note an uptick in Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. However, if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called "false labor."
* Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts — but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor's imminent.) When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
* You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that's sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor. The plug may come out all at once in a lump, or as increased vaginal discharge over the course of several days. The mucus may be tinged with blood (which may be brown, pink, or red), which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some bloody discharge even when labor isn't going to start in the next few days. In either case, if you see more than a few spots of blood, be sure to call your caregiver immediately because it could be a sign of a problem.
* Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, the fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions sometime before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby will be at increased risk for infection without the amniotic sac's built-in protection against germs.
How can I tell if my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks. It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together. In some cases, though, the onset of strong, regular contractions comes with little or no warning — it's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when it's time to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center. These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — and your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job. And the truth is, your practitioner can tell a lot by the tone and tenor of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, be sure to call your practitioner right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, and is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby's less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), fever, severe headaches, vision changes, or abdominal pain.
• You start having contractions before 37 weeks or you have any other signs of preterm labor
THE STAGES OF LABOR
What stages will I go through during labor and childbirth?
The process you'll go through during labor and childbirth can be divided into three stages:
The first stage begins with the onset of contractions and ends when the cervix is fully dilated. This stage is divided into two phases, known as early and active labor. During early labor, your cervix gradually effaces (thins out) and dilates (opens). That's followed by active labor, when your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as "transition."
The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is often referred to as the pushing stage.
The third and final stage begins right after the birth of your baby and involves the separation and delivery of the placenta.
For first-time moms who are at least 37 weeks along, labor and delivery takes an average of 15 hours, although for plenty of women it lasts more than 20 hours, and for a lucky few it's over much sooner. For women who've been through labor before, deliveries average around eight hours.
*First stage: Early labor
Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you're officially in early labor. But unless your labor starts very suddenly and you go from no contractions to fairly regular contractions right away, it can be tricky to determine exactly when true labor starts. That's because these early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may immediately precede them and contribute to so-called "false labor." (If you're not yet 37 weeks and you're noticing contractions or other signs of labor, call your caregiver immediately so she can determine whether you're in preterm labor.)
During early labor, your contractions will gradually become longer, stronger, and closer together. While the experience of labor varies widely, typically it might start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, though the contractions will still tend to be mild and last less than a minute.
Sometimes early labor contractions are quite painful (though they may be dilating your cervix much more slowly than you'd like!). If your labor is typical, though, your contractions now won't require the same attention that later ones will. You'll probably find that you can still talk through them and putter around the house. You may even feel like taking a short walk. If you feel inclined to relax instead, take a warm bath, watch a video, or doze off between contractions if you can.
You may also notice increasing mucousy vaginal discharge, which may be tinged with blood — the so-called "bloody show." This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you're not having contractions yet.
Otherwise, if you're at least 37 weeks along, and unless your caregiver has advised you differently, expect to sit out early labor at home. (When to call your midwife or doctor and when she's likely to have you go to the hospital or birth center are things to discuss ahead of time at your prenatal visits.) Early labor ends when your cervix is about 4 centimeters dilated and your progress starts to accelerate.
How long it lasts
It's not easy to say how long this phase typically lasts or even (after the fact) how long it lasted for a particular woman. The length of early labor depends in large part on how ripe your cervix is at the beginning of labor and how frequent and strong your contractions are. With a first baby, if your cervix isn't effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter. If your cervix is already very ripe or if this isn't your first baby, it's likely to go much more quickly.
Coping tips
Don't become a slave to your stopwatch just yet — it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously.
Meanwhile, it's important to do your best to stay rested, since you may have a long day (or night) ahead of you. Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to go to the bathroom often even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
*First stage: Active labor
Active labor is when things really get rolling. Your contractions become more frequent, longer, and stronger, and your cervix begins dilating faster, going from about 4 to 10 centimeters. (The last part of active labor, when the cervix dilates from 8 to 10 centimeters, is called transition, which is described separately in the next section). In contrast to early labor, you'll no longer be able to talk through the contractions. Toward the end of active labor your baby may begin to descend, though he might have started to descend earlier or he might not start until the next stage.
As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. (Some prefer a call sooner, so clarify this with your caregiver ahead of time.) In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes, although some women may never have them more often than every five minutes, even during transition.
How long it lasts
Labor varies widely, but on average it takes about six hours for a woman having her first baby to go from 4 centimeters to full dilation. That's if she's not being given oxytocin (Pitocin) or using an epidural, though. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labor is likely to go much more quickly.
Coping tips
Breathing exercises, relaxation techniques, and a good labor coach can be a huge help now. Massage and lots of gentle encouragement are lifesavers, too. When you get to the hospital or birth center, you should be able to move freely around the room after your caregiver evaluates you, as long as you don't have any medical or obstetric complications.
You may find that it feels good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to take a warm shower or bath, if you have access to a tub, or to ask your partner for a massage. If you've already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to talk to your provider about getting an epidural or systemic medication.
*Second Stage: Transition
The last part of active labor — when your cervix dilates from 8 to a full 10 centimeters — is called the transition period because it marks the transition to the second stage of labor. This is the most intense part of labor. Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more, and you may find yourself shaking and shivering.
By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously — to "push" — and may even start making deep grunting sounds at this point. There's often a lot of bloody discharge. You may also feel nauseated or even vomit now.
On the other hand, some babies descend earlier and the mom feels the urge to push before she's fully dilated. And some babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and every birth.
If you've had an epidural, you'll feel varying amounts of pressure, depending on the type and amount of medication you're getting, and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.
How long it takes
Transition can last anywhere from a few minutes to a few hours. It is much more likely to be fast if you've already had a vaginal delivery.
Coping tips
If you're laboring without an epidural, this is when you may begin to lose faith in your ability to cope, so you'll need lots of extra encouragement and support from those around you. The good news is that if you've made it this far without medication, you can usually be coached through transition — one contraction at a time — with constant reminders that you're doing a great job and that the end is near.
*Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them. Many women find their contractions in the second stage easier to handle than during active labor because bearing down offers some relief. Other women don't like the sensation of pushing.
If your baby's very low in your pelvis, you may feel an involuntary urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you won't have this sensation right away. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push.
Waiting a while may make you less exhausted and frustrated in the end. However, in many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent — so let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. If you have an epidural, the loss of sensation makes it hard to feel what you're doing, so you'll need explicit coaching to help you to push effectively.
Your baby's descent may be rapid or, especially if this is your first, gradual. With each contraction, the force of your uterus — combined with the force of your abdominal muscles if you're actively pushing — exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression. Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of different positions during the second stage.
After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible, a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vagina and perineum. A slow, controlled birth can help prevent you from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.
YOUR chin.
After his head emerges, your doctor or midwife will suction his mouth and nose and feel around his neck for the umbilical cord. (No need to worry. If the cord is around his neck, your caregiver will either slip it over his head or, if need be, clamp and cut it.) His head then turns to the side as his shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as his shoulders emerge, one at a time, followed by his body.
Once he hits the atmosphere, your baby needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby's mouth and nasal passages again if he seems to have a lot of mucus. If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket — and perhaps given his first hat — to prevent any heat loss. Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long it lasts
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.
*Third stage: Delivering the placenta
Within minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall. When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.
How long it lasts
On average, the third stage of labor takes about five to ten minutes, though it can last up to 30 minutes or more.
And then what?
After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that it remains firm, and massage your uterus if it isn't. This is important because, as it contracts, the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.
If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but hold your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse within the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers your body to release oxytocin, the same hormone that causes contractions, and helps your uterus stay well contracted.
If you're not nursing or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll probably be given other medications as well.
Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. (If you've had a baby before, you may continue to feel occasional contractions for the next day or two.)
These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also find that you get a case of the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.
Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to see if you have any tears that need to be stitched. If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches — it can be a great distraction. Or, if you feel too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. (This takes just a second and doesn't hurt.) Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his birth.
What Happens to Your Baby After Delivery What Happens to Your Baby Immediately After Delivery
What will happen to my baby immediately after birth?
Newborn babies don't have good temperature control, so it's very important that they be kept warm and dry. If you have a vaginal delivery and you and your baby are both in good condition, he can be placed directly onto your abdomen and dried off there. He'll be covered with a warm towel or blanket and given a cap to keep him from losing heat through his head.
Skin-to-skin contact will help keep your baby warm and let the two of you start bonding as well. (Don't worry about bonding if you can't hold your baby right away because one of you needs immediate medical care. There'll be plenty of time for bonding later.)
Your practitioner will clamp the umbilical cord in two places and then cut between the two clamps. (Your partner can do the honors if he or she wants to!) Your caregiver will collect a tube of blood from the cord to check your baby's blood type and possibly use for other tests as well.
During your baby's birth, your caregiver may have suctioned your baby's mouth and nose before the delivery of his shoulders. If your baby still seems to have too much fluid in his mouth or nose, she may do further suctioning at this time.
While you and your baby are locking eyes, he'll be closely observed to ensure that he continues to do well. At one and five minutes after birth, an Apgar assessment will be done to evaluate your baby's heart rate, breathing, muscle tone, reflex response, and color. Your caregiver can do these simple assessments while your baby is resting on your belly.
When can I start breastfeeding?
Babies tend to be very alert right after birth, so now's a good time to begin breastfeeding if you're both willing. There's no need to panic if your newborn seems to have trouble finding or staying on your nipple right after birth — he may just lick your nipple at first. Most babies will eventually begin to nurse within the first hour or so, given the opportunity.
Don't be shy about asking your caregiver or nurse to help you get started while you're still in the birth room (or recovery room if you had a c-section). Later, when you get to the postpartum unit, there may be a lactation consultant available for one-on-one coaching or group breastfeeding classes. You should be able to find out ahead of time what resources are available. Be sure to ask for all the help you need.
What if my baby has problems at birth?
If your baby has any problems at birth that require extra observation or a full-fledged resuscitation (or anything in between), your practitioner will quickly clamp and cut the cord. Your baby will then be dried off and placed on a radiant warmer in your birthing room. The warmer allows him to be left naked without getting cold so his medical team can do whatever is necessary to help him make the transition to life outside the womb.
An Apgar assessment will be done, as will more suctioning, if needed, and whatever other interventions are necessary. If your baby needs further care after being stabilized, he may be taken to an intensive care nursery. But if he's doing well and needs no more assistance, he'll be swaddled in a warm blanket and brought to you so you can nuzzle, bond, and breastfeed.
What if I have a c-section?
If you have a c-section, your baby will be handed to a nurse or pediatrician as soon as he's delivered and taken to a radiant warmer. He'll be dried off, his mouth and nasal passages will be suctioned, an Apgar assessment will be done, and he'll get any other attention he might need.
In many hospitals, if your baby is doing well, he'll be swaddled in a warm blanket and brought to your partner (who'll be sitting by your head) to hold while you're being stitched up. This way, you can admire and kiss your baby while you're still in the operating room. Afterward, in the recovery room, you can begin to breastfeed if you want.
When do they do the ID bands and footprints?
Whether your baby is lying on your body or on a radiant warmer, a nurse will put ID bands on you, your baby, and your partner minutes after the delivery (and certainly before taking your baby out of the room for any reason).
She'll also footprint your baby. Most hospitals routinely make two copies of the baby's footprint, one for his hospital record and the other as a keepsake for you. (If they don't usually do this and it's something you'd like, be sure to ask for a copy.)
What else will happen in the first hour?
A nurse will put antibiotic ointment or drops in your baby's eyes within an hour after birth. The ointment or eyedrops are required by state law in the United States to help prevent eye infections — some of which can cause blindness — from a variety of bacteria that your baby could have been exposed to just before or during birth, including gonorrhea and chlamydia.
She'll also weigh your baby and give him an injection of vitamin K to help his blood clot. She may measure his length and head circumference, or that may be done later by the pediatrician.
What else will be done for my baby before we leave the hospital?
After your baby's temperature has remained stable for at least a few hours, a nurse will give him a sponge bath and wash his hair if needed. Baths usually take place in the nursery so the baby can be put under radiant heat to warm up afterward, but you can ask for your child to be bathed in your room if you want.
Your baby will get a complete pediatric exam. Like the bath, this is usually done in the nursery but can be done in your room, instead. After the exam, you can ask to have your baby back or have him taken to sleep in the nursery. If you're breastfeeding, it makes sense to keep the baby in your room, as you'll probably need to feed him every few hours.
What tests will be done on my baby?
When your baby is 48 hours old, his heel will be pricked and a small amount of blood taken to test for phenylketonuria (PKU), hypothyroidism, and other disorders. All 50 states require newborn screening tests (sometimes referred to as "the metabolic screen"). But the number and type of genetic and metabolic disorders tested for vary widely from state to state, from as few as four conditions to more than 40.
If you live in a state that does only limited testing you can pay for additional testing, but you may need to make arrangements ahead of time. If you deliver at a birth center or at home, you'll need to bring your baby to the doctor for these tests before he's a week old. And if you give birth in a hospital but are discharged early — within 24 hours after delivery — your baby will need repeat testing one to two weeks later because the screening test done for PKU in the first day of life isn't always accurate.
Many hospitals routinely perform newborn hearing tests before your baby is discharged. In some states it's required by law. (Both the March of Dimes and the American Academy of Pediatrics recommend testing for all babies.)
If your HIV status is unknown, your baby's cord blood may be tested for the virus. (In some states, this is required.)
Will my baby get a hepatitis B shot?
Your baby will probably get his first dose of the hepatitis B vaccine before being discharged from the hospital. If you're a hepatitis B carrier or your status is unknown, your baby should definitely be vaccinated within 12 hours of birth. (If you're sure that you, other family members, and anyone who will be caring for your baby are all negative for hepatitis B, the first dose can be delayed and given sometime before he's 2 months old.)
Babies of mothers who are known hepatitis B carriers will also receive an injection of hepatitis B immune globulin (HBIG) within 12 hours of birth. If your hepatitis B status is unknown, your blood will be drawn for testing, and if you're found to be positive, your baby should receive a dose of HBIG as soon as possible.
When are circumcisions done?
If you've decided that you want your baby boy to be circumcised (and aren't planning to have a ritual circumcision performed later), it's usually done a day or two after birth.
Breastfeeding Breastfeeding: Getting Started
How to start breastfeeding
The first time you hold your newborn in the delivery room, put his lips to your breast. Your mature milk hasn't come in yet, but your breasts are producing a substance called colostrum that will help protect your baby from infection.
Try not to panic if your newborn seems to have trouble finding or staying on your nipple. Breastfeeding is an art that requires patience and lots of practice. No one will expect you to be an expert in the beginning, so don't hesitate to ask a nurse to show you what to do while you're in the hospital. (If you have a premature baby, you may not be able to nurse right away, but you should start pumping your milk. Your baby will receive this milk through a tube or a bottle until he's strong enough to nurse.)
Once you get started, remember that nursing shouldn't be painful. Pay attention to how your breasts feel when your baby latches on. His mouth should cover a big part of the areola below the nipple, and your nipple should be far back in your baby's mouth. If latch-on hurts, break the suction — by inserting your little finger between your baby's gums and your nipple — and try again. Once your baby latches on properly, he'll do the rest.
How often you should nurse
Frequently. The more you nurse, the more quickly your mature milk will come in and the more milk you'll produce. Nursing for ten to 15 minutes per breast eight to 12 times every 24 hours is pretty much on target. According to the latest guidelines from the American Academy of Pediatrics (AAP), you should nurse your newborn whenever he shows signs of hunger, such as increased alertness or activity, mouthing, or rooting around for your nipple. Crying is a late sign of hunger — in other words, ideally you should start feeding your baby before he starts crying.
During the first few days, you may have to gently wake your baby to begin nursing, and he may fall asleep again in mid-feeding. To make sure your baby's eating often enough, wake him up if it's been four hours since the last time he nursed. Once your baby becomes alert for longer periods, you can settle into a routine of feeding every one to three hours (less at night as he starts to sleep through).
How to get comfortable
Since feedings can take up to 40 minutes, pick a cozy spot for nursing. Hold your baby in a position that won't leave your arms and back sore. It works well to support the back of your baby's head with your hand, but the position you choose really depends on what's comfortable for you. If you're sitting, a nursing pillow can be a big help in supporting your baby. Don't feed until you and your baby are comfortable because you'll be sitting (or lying) in that position for a while.
What you should eat
A normal healthy diet is all you need while you're nursing. Experts used to recommend that nursing moms get an extra 400 to 500 calories a day, but new research shows that you don't need that calorie boost, says breastfeeding expert Kathleen Huggins, author of The Nursing Mother's Companion. You'll want to maintain a well-balanced diet for your own health, but you don't need to follow complicated dietary rules to successfully nurse your baby.
You may want to limit caffeine, and avoid chocolate, spicy foods, and other irritants that get into breast milk and can bother your baby. Be sure to drink lots of fluids — the oxytocin released by your body while you breastfeed will make you thirsty and help remind you to drink.
Remember that although breastfeeding is natural, it can be difficult in the first days of your baby's life. Take the time to get encouragement and advice from a lactation consultant or friends who have nursed — their support and tips will be invaluable.
Problems you may encounter
Although women have nursed their babies for centuries, breastfeeding doesn't always come easily. Many women face difficulties early on. Some of the most common problems you may encounter in the first six weeks include:
• Engorgement: an overfull breast
• Sore nipples
• Mastitis: a breast infection
Don't suffer in silence. Call a lactation consultant or your doctor (especially if you think you may have a breast infection) if your physical discomfort is getting in the way of nursing properly.
What you may be feeling
Some women adjust to breastfeeding easily, encountering no major physical or emotional hurdles. But many new moms find it hard to learn — so if you're feeling discouraged, you're not the only one.
It's normal to feel overwhelmed by your baby's constant demands in the beginning. If you feel like giving up (or just want professional advice), consider calling an international board-certified lactation consultant (IBCLC). These experts in the art of breastfeeding will watch you nurse your baby and make recommendations. You can also talk to your doctor or midwife about any health concerns that may be getting in the way of successful breastfeeding.
Where to get help
Breastfeeding help and support is just a phone call away. La Leche League International, an organization that offers encouragement and support to women who want to breastfeed their babies, can send you information or put you in touch with a La Leche League chapter near you. You can reach LLL headquarters or get advice from LLL's breastfeeding hotline by calling (800) 525-3243. If you attend local meetings, you can meet other new moms and get breastfeeding assistance.
A board-certified lactation consultant can also offer advice on how to breastfeed properly and give you hands-... To find one near you, call the International Lactation Consultant Association at (919) 861-5577 or use that association's online lactation consultant finder. You can also call the hospital where you delivered your baby, your doctor or midwife, or your child's pediatrician for a referral.
Caring for your newborn
Caring for Your Newborn: Tips for New Parents
The first few weeks with your newborn will be chaotic. Here are a few tips from experienced parents to help make life easier.
Prepare as much as you can ahead of time
"Find a good lactation consultant, preferably before you give birth. My son had major feeding problems the first week or two, and it would have been much easier if I had lined someone up for consultations ahead of time. It would have saved me many tears and feelings of inadequacy during a hormonally tumultuous period."
— Mary, Tampa, Florida
"Stock up on food and other necessities. I was totally unprepared for how overwhelmed I'd be — meaning, I had zero time or inclination to go grocery shopping and make meals. I spent a lot of time leading up to my son's birth getting his room ready, etc., when I should have been making and freezing meals. Pizza delivery and take-out can only get you so far."
— Leslie Cannon, Overland Park, Kansas
"Take a class on infant care through your hospital. It will teach you the basics on holding, bathing, feeding, etc. It will make you feel much more comfortable in the first few weeks when your baby seems so fragile."
— Diana Cacciapaglia, Orange, California
"I assumed I wouldn't need a breast pump until I went back to work. But my milk wasn't coming in and I needed the pump's extra help to 'pull' out my breast milk. If I had bought a breast pump before I had my son and used it to coax the milk down, it probably would have saved us a lot of grief."
— Julie, Oregon
Ask for -- and accept -- help
"Use your resources — Mom, Grandma, your hospital's staff, the pediatrician, friends with kids. They love to answer questions, and remember that no question is dumb."
— Jodi, Randolph, Massachusetts
"Accept help whenever offered! If friends ask you what they can do, suggest they prepare meals for you or babysit your older children. Hire someone to clean; send the little ones to day camp. Nobody will accuse you of being selfish or a bad mother. It's the only way to keep your sanity. (And it will allow you to spend time alone with your new bundle of joy.)"
— Marti Kelley, San Antonio, Texas
Let the machine get it
"One thing that we did to survive the first weeks with our newborn was to leave a baby update as our answering machine message. Getting rest and sleep was so difficult those first few weeks that we turned off the ringer on the phone, changed the message periodically, thanked people for calling to check in on us and asked them to leave their messages. We promised we would get in touch with them when it was convenient. We found that people enjoyed calling to see what the new information was — the latest weight and height from the doctor visit or other tidbits such as, 'Dad changed his first diaper,' or 'We gave Hunter his first bath,' etc. It was a great way to keep people informed without getting overwhelmed by well-meaning interruptions."
— Janet Salisbury, Indianapolis, Indiana
"If phone calls are important, people will call back. My fiancé didn't understand why I wouldn't answer the phone when he was at work until he stayed home one day. Sometimes it's easier to let voicemail pick up a call, and you can return it when you feel up to it."
— Tarita Cain, Atlanta, Georgia
Accept visitors only when you're ready
"Get together with your husband and decide what your policy will be on visitors. Include some rules for relatives and friends who sometimes believe they have a right or a duty to spend every second of the day with you and the baby. Yes, you will need lots of help, but that doesn't mean the end of your privacy, and not every visitor will be helpful."
— Poli de Zubiria, Colombia
Rest up
"The one thing I remember the most was trying to nap while the baby did. Let the household chores wait. You need your sleep much more than the house needs a vacuuming!"
— Donna Fleming, Essex, Vermont
"During my daughter's first six weeks, I learned that all the articles that tell you to rest when the baby does are actually right. Whenever my daughter took her naps, I usually caught up on housework, but by 7 p.m. I was sound asleep on the floor. Whatever else you do, make sure you get your rest. It will help you and the baby."
— Misty Lawrence, Springfield, Missouri
"The worst thing I ever tried with my daughter was co-sleeping. I was so worried I was going to roll over on her that I couldn't sleep. My restlessness meant zero sleep for her, so she was exhausted, too. After a week or two of this, I finally just put her to sleep in her crib. I still had to get up to nurse, but the few hours of sleep I got between feedings made all the difference."
— Hannah, Vancouver, British Columbia
Go outside
"I remember the days this past summer of pacing around the house with a fussy baby while the sun was shining so brightly outside. When I took the baby out, I would still be holding him, so it didn't seem like much of a break. Then one day it dawned on me! I put a big comforter on the grass under a tree and put a baby quilt on top of that. Now, every day that it's nice outside, we lie in the yard. We've been doing this since Noah was a month old and he loves it! Make sure you dress your baby appropriately and be sure to stay out of the sun. It's a very relaxing way to share the outdoors with your baby."
— Tracie Smith, St. Lucas, Iowa
Know your limits
"If you're at the end of your rope because your baby won't stop crying, and he's not hungry, cold, wet, sick or hurt, and you're afraid you're going to hurt yourself or the baby, put him in a safe place (on his back or side in a crib, for example). Then step out of the room for five or ten minutes until you've calmed yourself down."
— Gabriel's mother, Leesburg, Virginia
Trust your gut
"I just went with my instincts — no matter what they were. I knew that I was going through a difficult time and that I would make mistakes, but I needed to do that so I could learn what was best for my baby and me. The postpartum period can do crazy things to your mind. You second-guess yourself incessantly, but you'll find that your instincts will pull you through. There's no need to justify anything to anyone — you must concentrate on you and your little one."
— Mary Kae Selan, Pickerington, Ohio
Tell yourself: This, too, shall pass
"When you start out, you think, 'I'm never going to be good at this,' and then it becomes second nature. The child becomes an integral part of your life so that you couldn't imagine a time when you weren't a parent. So relax, enjoy the good and bad times, because your baby grows up so fast. Everything passes. Eventually, every child will sleep more (and so will you), and every child will be more independent. You'll never forget the first time your baby smiles at you or the first time she looks at you and calls you 'Mama' or 'Dada' or the times she falls asleep on your chest. It makes all the other frustrating stuff pale in comparison.
— Scott and Dorinda Legg, Atlanta, Georgia
Body changes after giving birth
Body changes after the baby
*How much weight will I lose after having my baby?
You probably won't return to your pre-pregnancy weight for some time, but you will lose a significant amount of weight immediately after delivery. Subtracting one 7- to 8-pound baby, another pound or two of placenta, and another 2 pounds or so of blood and amniotic fluid leaves most new moms about 12 pounds lighter.
The weight keeps coming off, too. All the extra water that your cells retained during pregnancy, along with fluid from the extra blood you had in your pregnant body, will be looking for a way out. So you'll produce more urine than usual in the days after birth — an astounding 3 quarts a day — and you may notice yourself perspiring a lot, even while you sleep. By the end of the first week, you'll lose about 4 pounds of water weight. (The amount varies depending on how much water you retained during pregnancy.)
*How come I can't tell when I need to pee?
It's not uncommon to feel as if you don't have to pee much in the first day after you give birth, especially if you had a prolonged labor, a forceps or vacuum-assisted vaginal delivery, or an epidural. This is caused by your bladder becoming temporarily less sensitive. But with all the extra fluid your kidneys are processing, your bladder fills up rapidly, so it's essential for you to urinate frequently even if you don't have the urge to.
If too much urine accumulates in your bladder, you might have a hard time making it to the toilet without leaking. More important, though, your bladder could become over-distended. This can cause urinary problems and also makes it harder for your uterus to contract, leading to more afterpains and bleeding.
If you can't pee within a few hours after giving birth, a catheter will be put in your bladder to drain the urine. (If you deliver by c-section, you'll have a urinary catheter for the surgery and the following 12 hours or so.) Let the nurse know if you're having difficulty urinating or are only producing a small amount of urine when you pee. If your bladder gets too full, it can actually prevent you from being able to urinate.
*How long will it take for my uterus to shrink?
By the time you give birth, your uterus is about 15 times heavier (not including its contents!) and holds at least 500 times more than before you conceived. Within minutes after your baby is born, contractions cause your uterus to begin to shrink, clenching itself like a fist, its crisscrossed fibers tightening in the same way they do during labor. This may cause you to feel cramps known as afterpains.
For the first couple of days after birth, you can feel the top of your uterus at or a few finger widths below the level of your belly button. In a week your uterus weighs about a pound — half what it weighed at delivery. After two weeks it's down to a mere 11 ounces and located entirely within your pelvis. By four to six weeks, it's back to its normal pre-pregnancy weight of about 2 1/2 ounces. This process is called involution of the uterus.
*Why am I bleeding?
After your baby's born, cells that form the lining of the uterus begin to slough off. This results in a discharge called lochia that lasts for weeks. For the first two to four days, lochia contains a fair amount of blood, so it appears bright red and menstrual-like. It gradually gets lighter in color, turning pinkish, and finally fading to white or yellow-white, with the amount tapering off over time before it stops.
*What's going on with my breasts?
Hormonal changes after delivery prompt your breasts to start producing milk. When your baby nurses during the first few days after birth, he's getting colostrum, a thick yellowish substance that your breasts produced during pregnancy. His suckling triggers the release of the hormones prolactin, which stimulates milk production, and oxytocin, which causes the milk sacs and ducts to contract, propelling the milk to your nipples. (This is the so-called "letdown" reflex.)
If those first breastfeeding sessions cause some abdominal cramping, it's because oxytocin also triggers uterine contractions. Once your milk comes in, usually a few days after delivery, your breasts may get swollen and lumpy and feel tender and uncomfortably full. This is called engorgement, and it should subside in a day or two. Nursing your baby often is the best thing you can do for relief. In fact, frequent nursing right from the beginning sometimes prevents engorgement altogether.
Even if you're not breastfeeding, you'll begin to produce milk, and a few days after you give birth, your breasts will become engorged and feel swollen and uncomfortable. This discomfort may last a couple of days or so. In the meantime, wear a supportive bra around the clock and put cold packs on your breasts, which will ease the swelling and help inhibit milk production. (Be sure to cover the cold packs with cloth to protect your skin.) It can take several weeks for your milk to dry up completely
If you need to, you can take acetaminophen or ibuprofen for pain relief. If you're extremely uncomfortable, you can express just enough milk to make the situation more tolerable. This may prolong the process, however, because stimulating your nipples and emptying your breasts signals your body to make more milk. Avoid applying warmth to your breasts since this, too, can encourage milk production.
*Why am I losing my hair?
If your hair got thicker during your pregnancy, you may now start to shed it in handfuls. This happens to some new moms around one to four months after having their baby. Don't worry — you won't go bald. Just as high estrogen levels caused you to lose less hair during pregnancy, decreasing estrogen levels postpartum may cause you to shed more. It's replaced by new hair, though, and the shedding tapers off, so your hair should be back to normal within a year. On the bright side, if you suffered from excess facial and body hair during pregnancy (the result of an increase in hormones called androgens), you can expect to lose that hair three to six months after having your baby.
*What's going on with my skin?
Hormonal changes, stress, and the fatigue brought on by new parenthood may affect your skin along with the rest of your body. Some women who had perfectly clear skin during pregnancy will have more breakouts in the months following delivery. On the other hand, if you suffered from acne during pregnancy, particularly if it appeared for the first time or got worse, you may begin to see some improvement now.
If you have chloasma (darkened patches of skin on your lips, nose, cheeks, or forehead), it'll begin to fade in the months after giving birth and probably go away completely, as long as you protect your skin from the sun. Any stretch marks you developed will gradually become lighter in color, though they won't disappear altogether.
*Will my vagina and perineum ever get back to normal?
Once you give birth, the space inside your vagina will always be a little larger than it was before your first pregnancy. Right after delivery, the vagina remains stretched open and may be swollen and bruised. Over the next few days, any swelling you might have starts to go down, and your vagina begins to regain muscle tone. In the next few weeks, it will gradually get smaller. Doing Kegel exercises regularly helps restore muscle tone.
If you had an episiotomy or a tear, your perineum needs time to heal, so it's a good idea to wait until after your six-week postpartum checkup to resume having intercourse. You may even have some tenderness after that, too, so be sure to go slowly. Consider starting out being on top of your partner or lying side-by-side so you can control the depth of penetration. In any case, if you find intercourse painful, wait a little longer. (If you want to make love, you can figure out other ways in the meantime!)
When you start having sex again, you'll probably find that you have less vaginal lubrication that you did when you were pregnant, due to lower levels of estrogen. This dryness will be even more pronounced if you're breastfeeding, because nursing tends to keep estrogen levels down. Using a lubricant (usually found near the condoms or the tampons and sanitary pads in the drugstore) helps reduce any discomfort. Be sure to get a water-based lubricant. This is particularly important if you're using a barrier method for birth control, since oil-based lubricants can weaken latex and cause a condom to break.
*Why am I feeling so moody?
Hormonal dips and surges may contribute to any emotional swings you're feeling now, along with discomfort you're still experiencing from labor and birth, the physical demands of caring for a new baby, and the emotional adjustment to motherhood. Whatever the cause, it's common to feel a little blue, usually beginning a few days after giving birth and lasting for a few days. If the feeling doesn't go away on its own in the first few weeks or you find that you're feeling worse rather than better, be sure to call your caregiver. You may be suffering from postpartum depression, a more serious problem that requires treatment.
Postpartum Depression
*I love my baby. So why do I feel so blue?
You've just given birth to a wonderful baby, and everyone's ecstatic. Everyone, that is, except you. If this is supposed to be such a happy time, why do you feel so low?
You're not alone. Some degree of emotional vulnerability is natural and expected after childbirth. Up to 80 percent of new mothers experience the baby blues, a form of depression that begins a few days to a week after delivery and generally lasts no longer than two weeks. If you have the blues, you may be weepy, anxious, and unable to sleep. You may also be irritable or moody.
Moms often feel better after getting some rest and a helping hand with the baby. But if your blues — or those of someone you love — have lasted more than two weeks, read on.
*Could I be suffering from postpartum depression?
If your mood doesn't lift after two weeks, you may have postpartum depression (PPD). Up to 20 percent of new mothers experience clinical depression, which can surface any time within the first postpartum year.
Symptoms of PPD include:
• insomnia
• weepiness or sadness
• diminished interest in once pleasurable activities
• difficulty concentrating
• change in appetite
• anxiety
• moodiness and irritability
• withdrawal from family and friends
• excessive guilt
• panic attacks (symptoms include a racing heart, dizziness, confusion, and feelings of impending doom)
• suicidal, scary, or constant negative thoughts
Your healthcare provider can best determine whether you have PPD, but you may spot some clues yourself. Experts say that if you can't sleep when your baby sleeps, no matter how hard you try or how tired you are, you may have PPD.
Some women with PPD believe they can't adequately care for their baby. Others worry they might even harm their baby. One New York mother remembers falling asleep in a rocker one evening while holding her newborn son, and later waking up convinced she had dropped him on his head. No amount of reassurance from her husband that she hadn't hurt the baby would change her mind.
It's important to know the difference between normal postpartum emotional changes and ones that signal a need for further support. It's not just what you're feeling that indicates something may be amiss, but the frequency, intensity, and duration of those feelings. In other words, many new mothers feel sad and anxious periodically during the first few months after childbirth. But if you're crying all day for several days in a row or are having panic attacks, contact your doctor or midwife.
PPD can strike any woman, either immediately after the birth of her baby or many months later. Unfortunately, the medical community has a long history of misunderstanding and misdiagnosing PPD. Sometimes healthcare providers don't take a new mother's concerns seriously, brushing them off as hormonal shifts and part of adjusting to motherhood.
Our society also makes it difficult to admit to having negative feelings about motherhood or your baby. When mothers express feelings such as ambivalence, fear, or rage, they can frighten themselves and those close to them.
Note: A few new mothers experience postpartum psychosis (PPP), a severe yet rare illness characterized by hallucinations, bizarre thinking, paranoia, mania, delusions, and often suicidal impulses. PPP requires immediate medical intervention because of the increased risk of suicide for the mother and harm to the baby.
*What causes depression after childbirth?
Experts agree there's no single cause but rather a combination of hormonal, biochemical, environmental, psychological, and genetic factors. Genetics may play the largest role in postpartum depression, as the single greatest risk factor for PPD is a personal history of depression.
*Am I at risk for PPD?
Some women are more likely than others to get PPD. You're more at risk for PPD if:
• you or anyone in your family has a history of depression or other mental illnesses, or you were prone to bouts of intense anxiety or depression while you were pregnant
• your pregnancy wasn't planned or was unwanted
• your spouse or partner is unsupportive
• you're having marital difficulties
• you're feeling stressed by external events such as financial problems or the loss of a job
• you've recently become separated or divorced
• you went through a serious life change such as a big move at or around the time you had your baby
• you had obstetric complications
• you experienced early childhood trauma, have suffered from abuse, or come from a dysfunctional family
• you or anyone in your family has a history of thyroid problems. (Thyroid dysfunction doesn't mean you'll have PPD, but it can predispose you to postpartum thyroid problems, which may have symptoms similar to those of PPD. It's a good idea to have your thyroid tested if you're feeling low, especially if you have a family history of thyroid problems.)
Remember, though, that these risk factors don't actually cause PPD. Many women with a number of them never get depressed. Others with just one risk factor, or even none, end up with a full-blown major depression.
*What can I do to cope?
If your "baby blues" last longer than two weeks, or if a loved one is concerned about how you're doing, talk to your healthcare provider. She can diagnose your symptoms, refer you to a specialist if needed, and recommend treatment. If you think you might hurt yourself or your baby, or if you feel incapable of responsibly caring for your newborn, seek professional help immediately.
In addition to getting expert help, here are ways to cope with postpartum depression:
Be good to yourself. Make sure your own basic needs are met: Try to sleep and eat well, and try not to feel guilty about the way you feel. Just because you have PPD doesn't mean you are a bad mother or don't love your child.
Ask for support. Part of being a good mother is knowing when to ask for help — so don't be afraid to ask for it during this difficult time. Help comes in many forms, ranging from friends who cook meals and fold your laundry to therapy.
Share your feelings with others. Tell someone you trust about how you feel. Call a sympathetic friend. Join a mothers' group for support, or chat with moms on our Dealing With the Baby Blues and Postpartum Depression bulletin boards. You may be surprised at how many women are experiencing similar feelings. If you have a supportive partner, make sure he knows what's going on and how he can help.
Don't neglect your "outside." Taking care of your physical self can sometimes help you feel better inside. Have your partner or a friend watch your baby so you can take a relaxing shower. Put on makeup if you usually wear it. Although your maternity clothes may still fit, pack them away. Go on a shopping trip just for yourself and buy something new for your postpartum wardrobe. Wear a favorite outfit on especially difficult days to give yourself a boost.
Sleep when your baby sleeps. It's age-old advice, but it works. The rigors of caring for a newborn, coupled with exhaustion and sleepless nights, will almost certainly bring on the blues. To fight fatigue and depression, you need rest. Have a relative or friend watch your baby, even if only for an hour, and sleep. If no one's available, consider hiring a postpartum doula or a sitter experienced with newborns.
Venture outdoors. Put your baby in a stroller and take a walk around the block, or meet a friend at a nearby café . The fresh air, sunshine, and company will do you and your baby a world of good. If even a brief excursion is too much for you right now, then just go outside, close your eyes, take a deep breath, and sit in the sunshine for a few minutes. It will help.
Slow down. Your baby's arrival is a good reason to take it easy. Resist the temptation to do the laundry while your baby sleeps, and let the rest of your chores wait. Have food delivered, or ask your partner to get takeout on the way home. If the phone always rings at the wrong time (for example, when you're trying to get the baby to sleep, or when you're finally sitting down for a much-needed break), turn off the ringer and return calls when it's convenient. If you're on maternity leave, banish all thoughts of the work awaiting you at the office. Don't worry — you'll get back on track soon enough.
*Is it safe to take antidepressants while breastfeeding?
The effects of antidepressant medications on nursing babies haven't been widely studied, so there isn't much data to go on. That said, many doctors feel that the benefits of breastfeeding are so great that they outweigh the possible risks of using most antidepressants while nursing. If you're breastfeeding, be sure to bring this up with your doctor when discussing antidepressants. (For details on specific medications, see our chart on drug and breast milk interactions.)
*My partner has PPD. How can I make life easier for her?
The postpartum period is hard on fathers, too. After all, you're also busy tending to your baby's needs, so make sure you get a lot of rest. In the meantime, offer your partner help whenever she needs it, and try not to judge her. It can be difficult to adjust to a partner with PPD, especially if you expected life after the baby's birth to be a joyous time for your family. But remember — your support is vital to her recovery.
Talk to your partner's obstetrician, midwife, or therapist to better understand what she's going through. You can't fix this, but you can be there for her. What's important is that she seek proper treatment.
***For more information, contact:***
Postpartum Stress Center
(610) 525-7527
Postpartum Support International
(800) 944-4773
National Institute of Mental Health
(800) 421-4211
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