OBSTETRICS

Pregnancy

Labor, Delivery and Postpartum Care

What is a preconception care checkup?
The goal of this checkup is to find things that could affect your pregnancy. Identifying these factors before pregnancy allows you to take steps that can increase the chances of having a healthy pregnancy and a healthy baby. During this visit, your health care provider will ask about your diet and lifestyle, your medical and family history, medications you take, and any past pregnancies.

Who should have a preconception care checkup?
If you are planning to become pregnant, it is a good idea to have a preconception care checkup. The first 8 weeks of pregnancy are key for the baby growing inside you. Most of the baby’s major organs and body systems have begun to form. Your health and nutrition can affect your baby’s growth and development in these early weeks.

Why is a healthy diet important?
Your body needs a regular supply of nutrients to grow, replace worn-out tissue, and provide energy. How much of each nutrient you need each day is called the dietary reference intake. You can get your daily dietary reference intake of nutrients from food as well as from supplements. However, most of your nutrients should come from the foods you eat.

How can I make sure my diet is healthy?
To be sure that your diet gives you enough nutrients, you need to know which ones are in the foods you eat. The U.S. Department of Agriculture’s food-planning guide called MyPlate (www.choosemyplate.gov) can help you make healthy food choices. MyPlate takes into account your age, sex, and how much you exercise every day.

How can being overweight affect my pregnancy?
Excess weight during pregnancy is associated with several pregnancy and childbirth complications, including high blood pressure, preeclampsia, preterm birth, and gestational diabetes. Obesity during pregnancy also is associated with macrosomia, defined as a larger than normal baby, as well as an increased risk of birth injury and cesarean delivery. It also increases the risk of birth defects, especially neural tube defects (NTDs). Having too much body fat may make it more difficult for your health care provider to monitor your baby with ultrasound and to hear the baby’s heartbeat.

How can I lose weight if I am overweight?
To lose weight, you need to use up more calories than you take in. The best way to lose weight is by making a few changes in your diet and by being more physically active. Cutting back on the number of calories you consume is a good first step. Exercise burns calories and helps you lose weight. In certain situations, medications or weight-loss surgery can be considered.

How can being underweight affect my pregnancy?
Being underweight also poses risks during pregnancy. It increases the risk of having a low birth weight baby. These babies are at risk of problems during labor and may have health and behavioral problems that last into childhood and adulthood. Being underweight during pregnancy also increases the risk of preterm birth.

Should I take a vitamin supplement?
Although most of your nutrients should come from the foods you eat, it is a good idea to start taking a prenatal vitamin supplement before pregnancy. Prenatal vitamin supplements contain all the recommended daily vitamins and minerals you will need before and during your pregnancy.

Why is it important for me to get enough folic acid before I get pregnant?
Folic acid helps prevent NTDs when taken before pregnancy and for the first 3 months of pregnancy. It is recommended that all women (even if they are not trying to get pregnant) consume 0.4 milligrams (400 micrograms) of folic acid a day.

Why is it important for me to get enough iron?
Iron also is important during pregnancy. It is used to make the extra blood needed to supply oxygen to the baby. Not getting enough iron can be a problem for some women.

Can my lifestyle affect my pregnancy?
Smoking, drinking alcohol, and drug use during pregnancy can have harmful effects on a baby’s health. The time when the fetus is most vulnerable to the harmful effects of these substances is during the first trimester of pregnancy. Stopping harmful behavior before pregnancy may reduce or even eliminate the risks of some birth defects that occur early in pregnancy.

How can my environment affect my pregnancy?
Some substances found in the home or the workplace may make it harder for a woman to conceive or could harm her fetus. If you are planning to get pregnant, look closely at your home and workplace. Think about the chemicals you use in your home or garden. Find out from your employer whether you might be exposed at work to toxic substances such as lead or mercury, chemicals such as pesticides or solvents, or radiation.

Can medical conditions I have affect my pregnancy?
Some medical conditions—such as diabetes, high blood pressure, depression, and seizure disorders—can cause problems during pregnancy. If you have a medical condition, your health care provider will discuss with you the changes that you need to make in order to bring your condition under control before you try to get pregnant.

Can the medications I take affect my pregnancy?
Some medications, including vitamin supplements, over-the-counter medications, and herbal remedies, can be harmful to the fetus and should not be taken while you are pregnant. It is important to tell your health care provider about all of the medications you are taking during your preconception care checkup. Do not stop taking prescription medication until you have talked with your health care provider.

If I have an infection, can it affect my pregnancy?
Infections can harm both the mother and the fetus. Some infections during pregnancy can cause birth defects or illnesses in the baby.Infections passed through sexual contact—sexually transmitted diseases (STDs)—also are harmful during pregnancy. Many types of STDs may affect your ability to become pregnant. They also may infect and harm your baby. If you think you or your partner may have an STD, get tested and treated right away.

Can I prevent infections?
Vaccination (also called immunization) can prevent some infections. Some vaccines are not safe to use during pregnancy. It is important to know which vaccines you may need and to get them before becoming pregnant.

What if I had a problem with a previous pregnancy?
Some pregnancy problems may increase the risk of having the same problem in a later pregnancy. These problems include preterm birth, high blood pressure, preeclampsia, and gestational diabetes. However, just because you had a problem in a past pregnancy does not mean it will happen again—especially if you receive proper care before and during your pregnancy.

Why is it important for my partner and me to share our family health histories with my health care provider?
Some health conditions occur more often in certain families or ethnic groups. These conditions are called genetic or inherited disorders. If a close relative has a certain condition, you or your baby could be at greater risk of having it.

Glossary
Calories: Units of heat used to express the fuel or energy value of food.

Depression: Feelings of sadness for periods of at least 2 weeks.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Gestational Diabetes: Diabetes that arises during pregnancy.

Neural Tube Defects (NTDs): Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Preterm: Born before 37 weeks of pregnancy.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

How does pregnancy begin?
Fertilization, the union of an egg and a sperm, is the first step in a complex series of events that leads to pregnancy. Fer-tilization takes place in the fallopian tube. During the next few days, the fused egg and sperm move through the fallopian tube to the lining of the uterus. There it implants and starts to grow. The cluster of cells that reaches the uterus will become the fetus and the placenta. The placenta functions as a life-support system during pregnancy. It delivers oxygen, nutrients, and hormones from mother to fetus.

How long does a normal pregnancy last?
A normal pregnancy lasts about 280 days (about 40 weeks), counting from the first day of your last menstrual period. A normal range, however, is from as few as 259 days to as many as 294 days (37–42 weeks). The 40 weeks of pregnancy are divided into three trimesters. Each trimester lasts about 12–13 weeks each (or about 3 months).

How does the uterus change during pregnancy?
During pregnancy, the lining of a woman’s uterus thickens and its blood vessels enlarge to nourish the fetus. As pregnancy progresses, the uterus expands to make room for the growing baby. By the time your baby is born, your uterus will be many times its normal size.

What happens during the first month of pregnancy?
During the first month of pregnancy, the following occurs: The fertilized egg attaches to the lining of the uterus. Some of these cells will grow into a baby. Other cells will form the placenta. Arms and legs begin to form. The brain and spinal cord begin to form. The heart and lungs begin to develop. The heart begins to beat near the end of this month.

What happens during the second month of pregnancy?
During the second month of pregnancy, the following occurs: Eyelids form, but remain closed. The inner ear begins to develop. Bones appear. Ankles, wrists, fingers, and toes form. The genitals begin to develop. By the end of the month, all major organs and body systems have begun to develop.

What happens during the third month of pregnancy?
During the third month of pregnancy, the following occurs: Twenty buds for future teeth appear. All internal parts are formed, but are not fully developed. Fingers and toes continue to grow. Soft nails begin to form. Bones and muscles begin to grow.
The intestines begin to form. The backbone is soft and can flex. The skin is almost transparent. The hands are more developed than the feet. The arms are longer than the legs.

What happens during the fourth month of pregnancy?
During the fourth month of pregnancy, the following occurs: Eyebrows, eyelashes, and fingernails form. Arms and legs can flex. External sex organs are formed. The skin is wrinkled and the body is covered with a waxy coating (vernix) and fine hair (lanugo). The placenta is fully formed. The outer ear begins to develop. The fetus can swallow and hear. The neck is formed. Kidneys are functioning and begin to produce urine.

What happens during the fifth month of pregnancy?
During the fifth month of pregnancy, the following occurs: The sucking reflex develops. If the hand floats to the mouth, the fetus may suck its thumb. The fetus is more active. You may be able to feel movement. The fetus sleeps and wakes regularly. Nails grow to the tips of the fingers. The gallbladder begins producing bile, which is needed to digest nutrients. In girls, the eggs have formed in the ovaries. In boys, the testicles begin to descend from the abdomen into the scrotum.

What happens during the sixth month of pregnancy?
During the sixth month of pregnancy, the following occurs: Real hair begins to grow. The brain is rapidly developing. The eyes begin to open. Finger and toe prints can be seen. The lungs are fully formed, but not yet functioning.

What happens during the seventh month of pregnancy?
During the seventh month of pregnancy, the following occurs: The eyes can open and close and sense changes in light. Lanugo begins to disappear. The fetus kicks and stretches. The fetus can make grasping motions and responds to sound.

What happens during the eighth month of pregnancy?
During the eighth month of pregnancy, the following occurs: With its major development finished, the fetus gains weight very quickly. Bones harden, but the skull remains soft and flexible for delivery. The different regions of the brain are forming.
Taste buds develop and the fetus can taste sweet and sour. The fetus may now hiccup.

What happens during the ninth month of pregnancy?
During the ninth month of pregnancy, the following occurs: The fetus usually turns into a head-down position for birth. The skin is less wrinkled. The lungs mature and are ready to function on their own. Sleeping patterns develop. The fetus will gain about ½ pound per week this month.

Glossary
Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Fertilization: Joining of the egg and sperm.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Hormones: Substances produced by the body to control certain functions.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Sperm: A male cell that is produced in the testes and can fertilize a female egg cell.

What is a birth defect?
A birth defect is a condition that is present at birth and affects how a baby looks, functions, or both. Some birth defects can be seen right after the baby is born, such as a clubfoot or extra fingers or toes. Special tests may be needed to find others, such as heart defects or hearing loss. Some birth defects are not noticed until later in life.

What causes birth defects?
Some birth defects are caused by genes that can be passed down from parents to children. Others result from a problem with chromosomes. A small number of birth defects are caused by exposure during pregnancy to certain medications, infections, and chemicals. For many birth defects, the cause is not known.

What can I do before or during pregnancy to decrease my risk of having a baby with certain birth defects?
Most birth defects cannot be prevented because their cause is not known. For a few birth defects, you may be able to decrease your risk by taking certain steps:

See your doctor before becoming pregnant.
Know your risk factors.
Take a daily multivitamin before and during pregnancy.
Maintain a healthy weight.
Use medications wisely.
Take care of medical conditions before pregnancy.
Do not use alcohol or illegal drugs.
Prevent infections.
Avoid known harmful agents.
Why should I see my health care provider before becoming pregnant?
Scheduling a health care visit before becoming pregnant is a good idea. Along with getting advice about diet and exercise from your health care provider, you can discuss whether you have any factors that increase the risk of having a child with a birth defect. If you have a medical condition, you also can discuss any special care that you may need before or during pregnancy.

What factors increase the risk of having a baby with a birth defect?
You may be at an increased risk of having a baby with a birth defect if you are older, have a family or personal history of birth defects, have had a child with a birth defect, use certain medicines around the time you become pregnant, have a medical condition such as diabetes or obesity, use recreational drugs or drink alcohol during pregnancy. If you have any risk factors, your health care provider may recommend special tests or other steps that may help reduce your risk. For example, if you have a personal or family history of birth defects, genetic counseling and testing may be recommended.

Why is taking a multivitamin important before and during pregnancy?
Prenatal vitamin supplements contain the recommended amounts of the vitamins and minerals you will need during your pregnancy, such as vitamins A, C, and D; folic acid; and minerals such as iron. Taking 400 micrograms of folic acid daily for at least 1 month before pregnancy and during pregnancy helps prevent major birth defects of the baby’s brain and spine called neural tube defects. Most prenatal and “women’s formula” multivitamin supplements contain 600–800 micrograms
of folic acid.

What do I need to know about taking medications during pregnancy?
A few medications have been linked to birth defects. You should tell anyone who prescribes drugs for you that you are pregnant or thinking of becoming pregnant. This includes doctors you see for non-pregnancy problems, mental health care providers, and your dentist. Also, check with your health care provider before taking any over-the-counter drug, such as pain relievers, laxatives, cold or allergy remedies, vitamins, herbal products, and skin treatments. A good source for information about the safety or risk of specific drugs and other agents during pregnancy is the Organization of Teratology Information Specialist’s web site at www.otispregnancy.org.

How can obesity have an impact on my pregnancy?
Women who are obese (defined as having a body mass index [BMI] of 30 or greater) when they become pregnant have an increased risk of having babies with certain birth defects than women who are a normal weight. Among the most common obesity-related birth defects are neural tube defects, heart defects, and cleft palate. If you are planning a pregnancy, the best way to prevent problems caused by obesity is to be at a normal weight before you become pregnant.

Why is it important to talk to my health care provider if I have certain medical conditions and am thinking of becoming pregnant?
Some medical conditions—such as diabetes, high blood pressure, and seizure disorders—may increase the risk of having a baby with certain birth defects. If you have a medical condition, see your health care provider to discuss any changes you need to make in your diet, medication, or other areas to bring the condition under control before you try to become pregnant.

Why is it important for me to not drink alcohol during pregnancy?
Alcohol use during pregnancy is a leading cause of birth defects. “Fetal alcohol spectrum disorders” is a term that describes different effects that can occur in the fetus when a woman drinks during pregnancy. These effects may include physical, behavioral, and learning disabilities that can last a lifetime. One of the most serious effects of drinking during pregnancy is fetal alcohol syndrome. Birth defects caused by alcohol are 100% preventable by avoiding all alcohol while you are
pregnant.

How can recreational drug use affect my pregnancy?
Use of illegal drugs (such as heroin, cocaine, methamphetamines, and marijuana) and prescription drugs used for nonmedical reasons (such as oxycodone) can harm your baby. Some drugs cause growth problems in the baby. Others may cause longterm emotional, behavioral, and learning problems. Many drugs increase the risk of preterm birth and other serious birth problems. You should avoid all use of these drugs during pregnancy.

What infections should I be concerned about and how can I reduce my risk of getting them during pregnancy?
Some infections can increase the risk of birth defects and other problems during pregnancy for you and your growing baby:

Rubella (German measles) is a viral infection that usually causes a mild rash and a low fever. Having rubella during pregnancy can cause miscarriage or result in deafness, intellectual disability, heart defects, and blindness in your newborn. There is a vaccine against rubella, but it is not recommended for pregnant women. If you have not already had the disease or been vaccinated, you should be vaccinated against rubella and wait at least 1 month before becoming pregnant.

Toxoplasmosis is a disease caused by a parasite that lives in soil. You can become infected by eating raw or undercooked meat or unwashed vegetables or by coming into contact with animal feces, especially from cats that go outdoors. If you are infected for the first time while you are pregnant, you can pass the disease on to your baby. Toxoplasmosis can cause birth defects, including hearing loss, vision problems, and intellectual disability. Make sure that you eat well-cooked meat and wear gloves while gardening or handling unwashed vegetables. If you have an outdoor cat that uses a litter box, have someone else empty it. If you must empty the litter box, use gloves and wash your hands well after doing so.
Sexually transmitted infections (STIs) can cause serious birth defects. Treating an STI—preferably before you become pregnant—may prevent or reduce harm to the fetus.

Cytomegalovirus (CMV) is a common viral infection. Most CMV infections cause no significant problems. If you are infected for the first time when you are pregnant, CMV can infect the fetus. In a small number of cases, the infection can cause intellectual disability, hearing loss, and vision problems. CMV can be spread by contact with an infected child’s urine or other body fluids. Pregnant women who work with young children, such as day care workers or health care workers, should take steps to prevent infection, such as wearing gloves when changing diapers. Frequent handwashing also is recommended.
What precautions can I take to limit my exposure to agents that can cause birth defects?
A few precautions that are recommended for all pregnant women include the following:

Limit your exposure to mercury by not eating eat shark, swordfish, king mackerel, or tilefish. Limit eating white (albacore) tuna to 6 ounces a week. You do not have to avoid all fish during pregnancy. In fact, fish and shellfish are nutritious foods with vital nutrients for a pregnant woman and her growing baby. Be sure to eat at least 8–12 ounces of low-mercury fish and shellfish per week.

Avoid exposure to lead. Lead can be found in old paint, construction materials, alternative medicines, and items made in foreign countries, such as jewelry and pottery.

Avoid taking high levels of vitamin A. Very high levels of vitamin A have been linked to severe birth defects. Your prenatal multivitamin should contain no more than 5,000 international units of vitamin A.

Glossary
Body Mass Index (BMI): A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Clubfoot: A birth defect in which the foot is misshaped and twisted out of position.

Cytomegalovirus (CMV): A virus that can be transmitted to a fetus if a woman becomes infected during pregnancy. It can cause hearing loss, intellectual disability, and vision problems in infected infants.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Fetal Alcohol Syndrome: A pattern of physical, mental, and behavioral problems in the baby that are thought to be due to alcohol abuse by the mother during pregnancy.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Folic Acid: A vitamin that has been shown to reduce the risk of certain birth defects when taken in sufficient amounts before and during pregnancy.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed down from parent to offspring.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Obesity: A condition characterized by excessive body fat.

Preterm: Born before 37 weeks of pregnancy.

Rubella: A virus that can be passed to the fetus if a woman becomes infected during pregnancy and that can cause miscarriage or severe birth defects.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Toxoplasmosis: An infection caused by Toxoplasma gondii, an organism that may be found in raw and rare meat, garden soil, and cat feces and can be harmful to the fetus.

Why are tests done during pregnancy?
A number of lab tests are suggested for all women as part of routine prenatal care. These tests can help find conditions that can increase the risk of complications for you and your fetus.

What tests are done early in pregnancy?
The following lab tests are done early in pregnancy:
Complete blood count (CBC)
Blood type
Urinalysis
Urine culture
Rubella
Hepatitis B and hepatitis C
Sexually transmitted diseases (STDs)
Human immunodeficiency virus (HIV)
Tuberculosis (TB)

What is a CBC and what can the results show?
A CBC counts the numbers of different types of cells that make up your blood. The number of red blood cells can show whether you have a certain type of anemia. The number of white blood cells shows how many disease-fighting cells are in your blood, and the number of platelets can reveal whether you have a problem with blood clotting.

What is blood typing and what can the results show?
Results from a blood type test can show if you have the Rh factor. The Rh factor is a protein that can be present on the surface of red blood cells. Most people have the Rh factor—they are Rh positive. Others do not have the Rh factor—they are Rh negative. If your fetus is Rh positive and you are Rh negative, your body can make antibodies against the Rh factor. In a future pregnancy, these antibodies can damage the fetus’s red blood cells.

What is a urinalysis and what can the results show?
Your urine may be tested for red blood cells (to see if you have urinary tract disease), white blood cells (to see if you have a urinary tract infection), and glucose (high levels may be a sign of diabetes). The amount of protein also is measured. The protein level early in pregnancy can be compared with levels later in pregnancy. High protein levels in the urine may be a sign of preeclampsia, a serious complication that usually occurs later in pregnancy or after the baby is born.

What is a urine culture test and what can the results show?
A urine culture tests your urine for bacteria, which can be a sign of a urinary tract infection.

What is rubella and what do test results for this disease show?
Rubella (sometimes called German measles) can cause birth defects if a woman is infected during pregnancy. Your blood is tested to check whether you have had a past infection with rubella or if you have been vaccinated against this disease. If you have not had rubella previously or if you have not been vaccinated, you should avoid anyone who has the disease while you are pregnant because it is highly contagious. If you have not had the vaccine, you should get it after the baby is born, even if you are breastfeeding. You should not be vaccinated against rubella during pregnancy.

What are hepatitis B and hepatitis C and what do test results for these diseases show?
Hepatitis B and hepatitis C viruses infect the liver. Pregnant women who are infected with hepatitis B or hepatitis C virus can pass the virus to their babies. All pregnant women are tested for hepatitis B virus infection. If you have risk factors, you also may be tested for the hepatitis C virus.

Which STD tests are done in pregnant women?
All pregnant women are tested for syphilis and chlamydia early in pregnancy. Syphilis and chlamydia can cause complications for you and your baby. If you have either of these STDs, you will be treated during pregnancy and tested again to see if the treatment has worked. If you have risk factors for gonorrhea (you are aged 25 years or younger or you live in an area where gonorrhea is common), you also will be tested for this STD.

Why are all pregnant women tested for HIV?
If a pregnant woman is infected with HIV, there is a chance she can pass the virus to her baby. HIV attacks cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS). If you are pregnant and infected with HIV, you can be given medication and take other steps that can greatly reduce the risk of passing it to your baby.

Which pregnant women should be tested for TB?
Women at high risk of TB (for example, women who are infected with HIV or who live in close contact with someone who has TB) should be tested for this infection.

What tests are performed later in pregnancy?
The following tests are done later in pregnancy:
A repeat CBC
Rh antibody test
Glucose screening test
Group B streptococci (GBS)

When will I be tested for Rh antibodies?
If you are Rh negative, your blood will be tested for Rh antibodies between 28 weeks and 29 weeks of pregnancy. If you do not have Rh antibodies, you will receive Rh immunoglobulin. This shot prevents you from making antibodies during the rest of your pregnancy. If you have Rh antibodies, you may need special care.

What is a glucose screening test and what can the results show?
This screening test measures the level of glucose (sugar) in your blood. A high glucose level may be a sign of gestational diabetes. This test usually is done between 24 weeks and 28 weeks of pregnancy. If you have risk factors for diabetes or had gestational diabetes in a previous pregnancy, screening may be done in the first trimester of pregnancy.

What is GBS and why are pregnant women tested for it?
GBS is a type of bacteria that lives in the vagina and rectum. Many women carry GBS and do not have any symptoms. GBS can be passed to a baby during birth. Most babies who get GBS from their mothers do not have any problems. A few, however, become sick. This illness can cause serious health problems and even death in newborn babies. GBS usually can be detected with a routine screening test that is given between 35 weeks and 37 weeks of pregnancy. For this test, a swab is used to take samples from the vagina and rectum.

What happens if my GBS screening test result is positive?
If your GBS test result is positive, antibiotics can be given during labor to help prevent the baby from becoming infected.

What is the difference between screening tests and diagnostic tests for birth defects?
Screening tests are done during pregnancy to assess the risk that the fetus has certain common birth defects. A screening test cannot tell whether the baby actually has a birth defect. There is no risk to the fetus with having screening tests.

Diagnostic tests actually can detect many, but not all, birth defects caused by defects in a gene or chromosomes (see FAQ094 Genetic Disorders). Diagnostic testing may be done instead of screening if a couple has a family history of a birth defect, belongs to a certain ethnic group, or if the couple already has a child with a birth defect. Diagnostic tests also are available as a first choice for all pregnant women, including those who do not have risk factors. Some diagnostic tests carry risks, including a small risk of pregnancy loss.

What is the first step in screening for birth defects?
Screening for birth defects begins by assessing your risk factors. Early in your pregnancy, your health care provider may give you a list of questions to find out whether you have risk factors, such as a personal or family history of birth defects, belonging to certain ethnic groups, maternal age of 35 years or older, or having preexisting diabetes. In some situations, you may want to visit a genetic counselor for more detailed information about your risks.

What is a carrier test?
A carrier test can show if you or your partner carry a gene for a certain disorder, such as cystic fibrosis. Carrier tests can be done before or during pregnancy. Carrier testing often is recommended if you or your partner have a genetic disorder, have a child with a genetic disorder, have a family history of a genetic disorder, or belong to an ethnic group that has an increased risk of specific disorders. Also, cystic fibrosis carrier screening is offered to all women of reproductive age because it is one of the most common inherited disorders.

What are other types of screening tests for birth defects that can be performed during pregnancy?
Screening tests include an ultrasound exam in combination with blood tests that measure the levels of certain substances in the mother’s blood.

What are the types of diagnostic tests for birth defects that can be performed during pregnancy?
Diagnostic tests for birth defects include amniocentesis, chorionic villus sampling, and a targeted ultrasound exam.

Can I choose whether or not to have testing for birth defects?
Whether you want to be tested is a personal choice. Knowing beforehand allows the option of deciding not to continue the pregnancy. If you choose to continue the pregnancy, it can give you time to prepare for having a child with a particular disorder and to organize the medical care that your child may need. Your health care provider or a genetic counselor can discuss the options with you and help you decide.

Glossary
Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV).

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Antibiotics: Drugs that treat certain types of infections.

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Bacteria: One-celled organisms that can cause infections in the human body.

Carrier: A person who shows no signs of a particular disorder but could pass the gene on to his or her children.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Chlamydia: A sexually transmitted disease caused by bacteria that can lead to pelvic inflammatory disease and infertility.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Cystic Fibrosis: An inherited disorder that causes problems in digestion and breathing.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Gene: A segment of DNA that contains instructions for the development of a person’s physical traits and control of the processes in the body. Genes are the basic units of heredity and can be passed down from parent to offspring.

Genetic Counselor: A health care professional with special training in genetics and counseling who can provide expert advice about genetic disorders and prenatal testing.

Gestational Diabetes: Diabetes that arises during pregnancy.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Gonorrhea: A sexually transmitted disease that may lead to pelvic inflammatory disease, infertility, and arthritis.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Rh Factor: A protein that can be present on the surface of red blood cells.

Rh Immunoglobulin: A substance given to prevent an Rh-negative person’s antibody response to Rh-positive blood cells.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Syphilis: A sexually transmitted disease that is caused by an organism called Treponema pallidum; it may cause major health problems or death in its later stages.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Tuberculosis (TB): A contagious infection that usually affects the lungs in humans.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

How can I plan healthy meals during pregnancy?
Planning healthy meals during pregnancy is not hard. The United States Department of Agriculture has made it easier by creating www.choosemyplate.gov. This web site helps everyone from dieters and children to pregnant women learn how to make healthy food choices at each mealtime.

How does MyPlate work?
With MyPlate, you can get a personalized nutrition and physical activity plan by using the "SuperTracker" program. This program is based on five food groups and shows you the amounts that you need to eat each day from each group during each trimester of pregnancy. The amounts are calculated according to your height, prepregnancy weight, due date, and how much you exercise during the week. The amounts of food are given in standard sizes that most people are familiar with, such as cups and ounces.

What are the five food groups?
1. Grains—Bread, pasta, oatmeal, cereal, and tortillas are all grains.

2. Fruits—Fruits can be fresh, canned, frozen, or dried. Juice that is 100% fruit juice also counts.

3. Vegetables—Vegetables can be raw or cooked, frozen, canned, dried, or 100% vegetable juice.

4. Protein foods—Protein foods include meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds.

5. Dairy—Milk and products made from milk, such as cheese, yogurt, and ice cream, make up the dairy group.

Are oils and fats part of healthy eating?
Although they are not a food group, oils and fats do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.

Why are vitamins and minerals important in my diet?
Vitamins and minerals play important roles in all of your body functions. During pregnancy, you need more folic acid and iron than a woman who is not pregnant.

How can I get the extra amounts of vitamins and minerals I need during pregnancy?
Taking a prenatal vitamin supplement can ensure that you are getting these extra amounts. A well-rounded diet should supply all of the other vitamins and minerals you need during pregnancy.

What is folic acid and how much do I need daily?
Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Taking 400 micrograms of folic acid daily for at least 1 month before pregnancy and 600 micrograms of folic acid daily during pregnancy may help prevent major birth defects of the baby’s brain and spine called neural tube defects. It may be hard to get the recommended amount of folic acid from food alone. For this reason, all pregnant women and all women who may become pregnant should take a daily vitamin supplement that contains the right amount of folic acid.

Why is iron important during pregnancy and how much do I need daily?
Iron is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron—about double the amount that a nonpregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your baby. The daily recommended dose of iron during pregnancy is 27 milligrams, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.

Why is calcium important during pregnancy and how much do I need daily?
Calcium is used to build your baby’s bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 milligrams of calcium daily; those aged 14–18 years should get 1,300 milligrams daily. Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli; dark, leafy greens; sardines; or a calcium supplement.

Why is vitamin D important during pregnancy and how much do I need daily?
Vitamin D works with calcium to help the baby’s bones and teeth develop. It also is essential for healthy skin and eyesight. All women, including those who are pregnant, need 600 international units of vitamin D a day. Good sources are milk fortified with vitamin D and fatty fish such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D.

How much weight should I gain during pregnancy?
The amount of weight gain that is recommended depends on your health and your body mass index before you were pregnant. If you were a normal weight before pregnancy, you should gain between 25 pounds and 35 pounds during pregnancy. If you were underweight before pregnancy, you should gain more weight than a woman who was a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight.

Can being overweight or obese affect my pregnancy?
Overweight and obese women are at an increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, preterm birth, and cesarean delivery. Babies of overweight and obese mothers also are at greater risk of certain problems, such as birth defects, macrosomia with possible birth injury, and childhood obesity.

Can caffeine in my diet affect my pregnancy?
Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 milligrams of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe.

What are the benefits of including fish and shellfish in my diet during pregnancy?
Omega-3 fatty acids are a type of fat found naturally in many kinds of fish. They may be important factors in your baby’s brain development both before and after birth. To get the most benefits from omega-3 fatty acids, women should eat at least two servings of fish or shellfish (about 8–12 ounces) per week and while pregnant or breastfeeding.

What should I know about eating fish during pregnancy?
Some types of fish have higher levels of a metal called mercury than others. Mercury has been linked to birth defects. To limit your exposure to mercury, follow a few simple guidelines. Choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, or tilefish. Limit white (albacore) tuna to 6 ounces a week. You also should check advisories about fish caught in local waters.

How can food poisoning affect my pregnancy?
Food poisoning in a pregnant woman can cause serious problems for both her and her baby. Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. To prevent food poisoning, follow these general guidelines:
Wash food. Rinse all raw produce thoroughly under running tap water before eating, cutting, or cooking.
Keep your kitchen clean. Wash your hands, knives, countertops, and cutting boards after handling and preparing uncooked foods. Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw fish (cooked sushi is safe). Food such as beef, pork, or poultry should be cooked to a safe internal temperature.

What is listeriosis and how can it affect my pregnancy?
Listeriosis is a type of food-borne illness caused by bacteria. Pregnant women are 13 times more likely to get listeriosis than the general population. Listeriosis can cause mild, flu-like symptoms such as fever, muscle aches, and diarrhea, but it also may not cause any symptoms. Listeriosis can lead to miscarriage, stillbirth, and premature delivery. Antibiotics can be given to treat the infection and to protect your unborn baby. To help prevent listeriosis, avoid eating the following foods during pregnancy:
Unpasteurized milk and foods made with unpasteurized milk
Hot dogs, luncheon meats, and cold cuts unless they are heated until steaming hot just before serving
Refrigerated pate and meat spreads
Refrigerated smoked seafood
Raw and undercooked seafood, eggs, and meat

Glossary
Antibiotics: Drugs that treat certain types of infections.

Body Mass Index: A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Gestational Diabetes: Diabetes that arises during pregnancy.

Macrosomia: A condition in which a fetus grows very large.

Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Preterm: Born before 37 weeks of pregnancy.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

What is morning sickness?
Nausea and vomiting that happen during pregnancy, especially during the first part of pregnancy, often are called "morning sickness." Despite its name, morning sickness can occur at any time of the day.

What causes morning sickness?
Although no one is certain what causes morning sickness, increasing levels of hormones during pregnancy may play a role.

How long should I expect morning sickness to last?
In most women, symptoms of nausea and vomiting are mild and go away after the middle of pregnancy.

What are the effects of morning sickness on pregnancy?
Most mild cases of nausea and vomiting do not harm your health or your baby’s health. Morning sickness does not mean your baby is sick.

When is morning sickness considered severe?
Morning sickness is considered severe if you cannot keep any food or fluids down and begin to lose weight. This condition is called hyperemesis gravidarum.

Is there a cure for morning sickness?
There is no cure for morning sickness. Some research suggests that women who are taking a multivitamin supplement regularly at the time they become pregnant are less likely to have severe cases of morning sickness.

What can I do to ease my symptoms of morning sickness?
If you experience morning sickness, there are several things you can do that might help you feel better. You may need to try more than one of these remedies:
Get plenty of rest.
Avoid smells that bother you.
Eat five or six small meals each day instead of three large meals.
Eat a few crackers before you get out of bed in the morning to help settle your stomach.
Eat small snacks high in protein (such as a glass of milk or a cup of yogurt) throughout the day.
Avoid spicy foods and fatty foods.
Are there any herbal supplements that can help?
Ginger may be helpful for some women. Taking three 250-milligram capsules of ginger a day plus another capsule right before bed may help relieve nausea. Remember to talk with your health care provider before taking any herbal medication or supplement or trying any treatment. You also can try ginger ale or ginger tea made with real ginger.

How are severe symptoms of morning sickness treated?
Your health care provider will first find out whether your nausea and vomiting are due to morning sickness or if there is another medical cause. If other causes are ruled out, certain medications can be given. Vitamin B6 may be suggested first. Doxylamine, a medication found in over-the-counter sleep aids, may be added if vitamin B6 alone does not relieve symptoms. Drugs that combat nausea and vomiting may be prescribed. If you are dehydrated from loss of fluids, you may need to receive fluids through an intravenous (IV) line.

Glossary
Hormones: Substances produced by the body to control the functions of various organs.

Hyperemesis Gravidarum: Severe nausea and vomiting during pregnancy that can lead to loss of weight and body fluids.

What causes back pain during pregnancy?
The following changes during pregnancy can lead to back pain:
Strain on your back muscles
Abdominal muscle weakness
Pregnancy hormones

How do my back muscles become strained during pregnancy?
The main cause of back pain during pregnancy is strain on your back muscles. As your pregnancy progresses, your uterus becomes heavier. Because this increased weight is carried in the front of your body, you naturally bend forward. To keep your balance, your posture changes. You may find yourself leaning backward, which can make the back muscles work harder. This extra strain can lead to pain, soreness, and stiffness.

How can weakened abdominal muscles affect my back during pregnancy?
Your abdominal muscles support the spine and play an important role in the health of the back. During pregnancy, these muscles become stretched and may weaken. These changes also can increase your risk of hurting your back when you exercise.

How can pregnancy hormones contribute to back pain?
To prepare for the passage of the baby through the birth canal, a hormone relaxes the ligaments in the joints of your pelvis.
This loosening allows the joints to become more flexible, but it also can cause back pain if the joints become too mobile.

What can I do to prevent back pain during pregnancy?
To help prevent back pain, be aware of how you stand, sit, and move. Here are some tips that may help:
Wear shoes with good arch support. Flat shoes usually provide little support unless they have arch supports built in. High heels can further shift your balance forward and make you more likely to fall.

Consider investing in a firm mattress. A firm mattress may provide more support for your back during pregnancy.

Do not bend over from the waist to pick things up—squat down, bend your knees, and keep your back straight.

Sit in chairs with good back support, or use a small pillow behind the low part of your back. Special devices called lumbar supports are available at office- and medical-supply stores.

Try to sleep on your side with one or two pillows between your legs or under your abdomen for support.

What can I do to ease back pain?
Get regular exercise. Exercises for the back strengthen and stretch muscles that support your back and legs and promote good posture. They not only ease back pain but also help prepare you for labor and childbirth. You also can try applying heat or cold to the painful area.

When should I contact my health care provider about back pain during pregnancy?
If you have severe pain, or if pain persists for more than 2 weeks, you should contact your health care provider. Back pain is a symptom of preterm labor, and it also can be a sign of a urinary tract infection. Contact your health care provider right away if you have a fever, burning during urination, or vaginal bleeding in addition to back pain. These can be signs of other pregnancy complications.

Glossary
Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Ligaments: Bands of tissue that connect bones or support large internal organs.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What are some of the benefits of exercise during pregnancy?
Becoming active and exercising at least 30 minutes on most, if not all, days of the week can benefit your health during pregnancy in the following ways:
Helps reduce backaches, constipation, bloating, and swelling
May help prevent or treat gestational diabetes
Increases your energy
Improves your mood
Improves your posture
Promotes muscle tone, strength, and endurance
Helps you sleep better
Regular activity also helps keep you fit during pregnancy and may improve your ability to cope with labor. This will make it easier for you to get back in shape after the baby is born.

What changes occur in the body during pregnancy that can affect my exercise routine?
The hormones produced during pregnancy cause the ligaments that support your joints to become relaxed. This makes the joints more mobile and more at risk of injury. The extra weight in the front of your body during pregnancy shifts your center of gravity and places stress on joints and muscles, especially those in the pelvis and lower back. This can make you less stable, cause back pain, and make you more likely to lose your balance and fall, especially in later pregnancy. The extra weight you are carrying will make your body work harder than before you were pregnant.

What forms of exercise are safe during pregnancy?
Certain sports are safe during pregnancy, even for beginners:
Walking is a good exercise for anyone.
Swimming is great for your body because it works so many muscles.
Cycling provides a good aerobic workout.
Aerobics is a good way to keep your heart and lungs strong.
If you were a runner before you became pregnant, you often can keep running during pregnancy, although you may have to modify your routine.

What forms of exercise should be avoided?
In general, activities in which there is a high risk of falling, such as gymnastics, water skiing, and horseback riding, should be avoided. Some racquet sports also increase the risk of falling because of your changing balance. Other sports to avoid include the following:
Downhill snow skiing—Your change in balance may put you at greater risk of injuries and falls. Also, you may be at risk of altitude sickness, an illness caused by breathing air that contains less oxygen.
Contact sports, such as hockey, basketball, and soccer—These sports can result in harm to you and your baby.
Scuba diving—Scuba diving can put your baby at risk of decompression sickness, a serious illness that results from changes in the pressure surrounding the body.

What should I be aware of when exercising during pregnancy?
The changes in your body can make certain positions and activities risky for you and your baby. While exercising, try to avoid activities that call for jumping, jarring motions, or quick changes in direction that may strain your joints and cause injury. There are some risks from becoming overheated during pregnancy. This may cause loss of fluids and lead to dehydration and problems during pregnancy.

When you exercise, follow these general guidelines for a safe and healthy exercise program:
After the first trimester of pregnancy, avoid doing any exercises on your back.
If it has been some time since you have exercised, start slowly. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week until you can stay active for 30 minutes a day.
Avoid brisk exercise in hot, humid weather or when you have a fever.
Wear comfortable clothing that will help you to remain cool.
Wear a bra that fits well and gives lots of support to help protect your breasts.
Drink plenty of water to help keep you from overheating and dehydrating.
Make sure you consume the daily extra calories you need during pregnancy.

What are the warning signs that I should stop exercising?
Stop exercising and call your health care provider if you have any of these symptoms:
Vaginal bleeding
Dizziness or feeling faint
Increased shortness of breath
Chest pain
Headache
Muscle weakness
Calf pain or swelling
Uterine contractions
Decreased fetal movement
Fluid leaking from the vagina

How can I get back into exercising after the baby is born?
Walking is a good way to get back into exercising. Brisk walks several times a week will prepare you for more strenuous exercise when you feel up to it. Walking has the added advantage of getting both you and the baby out of the house for exercise and fresh air. As you feel stronger, consider more vigorous exercise.

Glossary
Gestational Diabetes: Diabetes that arises during pregnancy; it results from the effects of hormones and usually subsides after delivery

Why is there a concern about having a child later in life?
Becoming pregnant after age 35 years can present a challenge. Also, having a child later in life has certain risks. These risks may affect a woman’s health as well as her baby’s health.

How does age affect fertility?
Fertility in women starts to decrease at age 32 years and becomes more rapid after age 37 years. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. Problems that can affect fertility, such as endometriosis and uterine fibroids, become more common with increasing age as well.

What specific health concerns are there for later childbearing?
Older women are more likely to have pre-existing health problems than younger women. For example, high blood pressure is a condition that is more common in older women (see the FAQ Preeclampsia and High Blood Pressure During Pregnancy). If you are older than 35 years, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. The risk of developing diabetes or gestational diabetes increases with age as well.

How can high blood pressure affect pregnancy?
High blood pressure poses risks that include problems with the placenta and the growth of the fetus.

How can diabetes affect pregnancy?
If you have diabetes, you are at greater risk of having a child with birth defects. The risks of high blood pressure, miscarriage, and macrosomia, a condition in which the fetus grows too large, are increased as well.

Do older women have an increased risk of having a child with a birth defect?
The overall risk of having a child with a birth defect is small. However, the risk of having a child with a birth defect caused by missing, damaged, or extra chromosomes is increased in older women.

What kinds of testing can be done during pregnancy to detect birth defects in the fetus?
Screening tests assess the risk that a baby will be born with certain disorders. All pregnant women should be offered screening tests for birth defects. Diagnostic tests show whether the baby actually has a certain disorder. Diagnostic testsare available for some, but not all, inherited defects and many chromosomal disorders. They include a targeted ultrasound exam, amniocentesis, and chorionic villus sampling. Diagnostic tests can be done instead of screening if a couple is at increased risk of certain birth defects based on age or personal or family history.

Are older women at greater risk of having a multiple pregnancy?
Older women have a higher risk of multiple pregnancy than younger women. In addition, some fertility treatments carry an increased risk of multiple pregnancy.

What risks are associated with multiple pregnancy?
Multiple pregnancy can cause serious problems, including preterm birth, preeclampsia, fetal growth problems, and gestational diabetes. The risk and severity of these problems increase with the number of babies.

What are the possible complications during labor and delivery for older women?
Older women are at increased risk of preterm labor and preterm birth Labor and Birth and Early Preterm Birth). Babies born preterm can have serious short-term and long-term health problems. The risk of stillbirth also is greater in women who are older than 35 years.

Women who are in their 30s are more likely to need a cesarean delivery than women who are in their 20s. Like any major surgery, cesarean delivery involves risks. Risks include infection, injury to organs such as the bowel or bladder, and reactions to the anesthesia used. These problems occur in a small number of women and usually are easily treated.

What can I do before pregnancy to increase my chances of having a healthy baby?
See your health care provider for a preconception care checkup.
Eat a healthy diet.
Take 0.4 milligrams of folic acid daily to help reduce the risk of having a baby with a neural tube defect.
Exercise regularly.
Lose weight if you are overweight or obese.
Stop smoking, drinking alcohol, and taking illegal drugs.
Avoid contact with substances in your home or workplace that could be harmful during pregnancy.

What can I do during pregnancy to increase my chances of having a healthy baby?
Continue to take good care of yourself during pregnancy, and get early and regular prenatal care. At each prenatal care visit, your health care provider will monitor your health and your baby’s health and manage any problems should they arise.

Glossary
Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells
from the sac surrounding the fetus.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Fibroids: Benign growths that form in the muscle of the uterus.

Gestational Diabetes: Diabetes that arises during pregnancy.

Miscarriage: Early pregnancy loss.

Neural Tube Defect: A birth defect that results from incomplete development of the brain, spinal cord, or their coverings.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Born before 37 weeks of pregnancy.

Stillbirth: Delivery of a dead baby.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Why is smoking dangerous during pregnancy?
If you smoke during pregnancy, your baby is exposed to harmful chemicals such as tar, nicotine, and carbon monoxide. Nicotine causes blood vessels to constrict, so less oxygen and nutrients reach the fetus. Carbon monoxide decreases the amount of oxygen the baby receives.

How can smoking during pregnancy put my baby at risk?
The risks of preterm birth and problems with the way the placenta attaches to the uterus are increased in women who smoke during pregnancy. Also, infants born to women who smoke during pregnancy tend to be smaller than those born to nonsmokers. They are more likely to have asthma, colic, and childhood obesity. They also have an increased risk of dying from sudden infant death syndrome (SIDS).

How can secondhand smoke affect my baby during pregnancy?
Breathing secondhand smoke—smoke from cigarettes smoked by other people nearby—can increase the risk of having a low birth weight baby by as much as 20%. Infants who are exposed to secondhand smoke have an increased risk of SIDS and are more likely to have respiratory illnesses than those not exposed to secondhand smoke.

What help is available if I want to quit smoking?
If you are pregnant and you smoke, tell your health care provider. He or she can help you find support and quitting programs in your area. You also can call the national "quit line" at 1-800-Quit-Now.

Can I use nicotine gum or the patch to help me quit smoking when I am pregnant?
Nicotine replacement (such as nicotine gum or the patch) or prescription medications for quitting smoking need to be used with caution during pregnancy. Over-the-counter nicotine replacement products should be used only if other attempts to quit have not worked and you and your health care provider have weighed the known risks of continued smoking against the possible risks of these products. Smokeless tobacco, electronic cigarettes, and nicotine gel strips are not safe substitutes for cigarettes.

Why is drinking during pregnancy dangerous for my baby?
When a pregnant woman drinks alcohol, it quickly reaches the fetus through the placenta. In an adult, the liver breaks down the alcohol. A baby’s liver is not fully developed and is not able to break down alcohol.

What are fetal alcohol spectrum disorders?
"Fetal alcohol spectrum disorders" is a term that describes different effects that can occur in infants when a woman drinks during pregnancy. These effects may include physical, mental, behavioral, and learning disabilities that can last a lifetime.

What is fetal alcohol syndrome?
Fetal alcohol syndrome (FAS) is the most severe alcohol spectrum disorder. FAS can cause growth problems, mental or behavioral problems, and abnormal facial features.

What amounts of alcohol can cause FAS?
FAS is most likely to occur in infants whose mothers drank heavily (3 or more drinks per occasion or more than 7 drinks per week) and continued to drink heavily throughout pregnancy, but it also can occur with lesser amounts of alcohol use. Even moderate alcohol use during pregnancy (defined as one alcoholic drink per day) can cause lifelong learning and behavioral problems in the child.

Is there an amount of alcohol that is safe to drink during pregnancy?
There is no safe level of alcohol use during pregnancy. Alcohol can affect the fetus throughout pregnancy. It is best not to drink at all while you are pregnant. If you did drink alcohol before you knew you were pregnant, you can reduce the risk of further harm to the baby by stopping drinking.

What is illegal drug use?
Illegal drug use includes the use of heroin, cocaine, methamphetamines, and marijuana and use of prescription drugs for a nonmedical reason.

How can my drug use affect my baby during pregnancy?
A drug’s effects on the fetus depend on many things: how much, how often, and when during pregnancy it is used. The early stage of pregnancy is the time when main body parts of the fetus form. Using drugs during this time in pregnancy can cause birth defects and miscarriage. During the remaining weeks of pregnancy, drug use can interfere with the growth of the fetus and cause preterm birth and fetal death.

How can drug use affect my baby after he or she is born?
Drugs used after the baby is born can be passed to the baby through breast milk.

Why is it important to tell my health care provider if I have used drugs during pregnancy?
It is important to be honest so that you get the help you need for yourself and your unborn baby. Drug testing of your hair or urine during pregnancy or during labor may be done if your health care provider suspects that you have used certain substances and if you have a complication during pregnancy or delivery that suggests drug use. The baby also can be tested after birth.

Will the results of my drug tests be kept confidential?
Some states consider drug use during pregnancy to be a form of child abuse. In some states, if a drug test result shows that you have used certain substances, it must be reported to state authorities. You should be informed about this testing and consent to it before it is done. How your consent is obtained also varies from state to state.

What are some of the problems related to substance abuse?
These problems include work, relationship, and family issues; drunk-driving arrests and car crashes; or medical problems caused by the substance. Substance abuse can lead to dependence (addiction).

What is addiction?
Addiction is a disease with three or more of the following signs and symptoms:
Tolerance—Not having the same effect with continued use of the same amount and the need to use greater amounts of the substance to get "high"
Withdrawal symptoms after stopping use of the substance
Using larger amounts of the substance or using it over a longer period
Desire or unsuccessful attempts to cut down or control substance use
Spending a great deal of time using or obtaining the substance or recovering from its use
Reducing or giving up important social, work, or recreational activities because of substance use
Continuing to use the substance despite knowing that you have a problem
Making excuses to continue using the drug instead of meeting your home or work responsibilities

Why is it important for pregnant women who are addicted to certain drugs, including pain medications and narcotics, to seek treatment to quit rather than quit on their own?
Withdrawal from these drugs can cause miscarriage or other harm to the fetus.

Can I take my prescription medication during pregnancy?
Some prescription medications are safe to take during pregnancy. Others have known risks. If you are taking a prescription medication and become pregnant, tell your health care provider. Do not stop taking a medication prescribed for you without first talking to your health care provider.

Can I take over-the-counter medications during pregnancy?
Medicines sold over the counter, including herbal supplements and vitamins, can cause problems during pregnancy. Pain relievers such as aspirin and ibuprofen may be harmful to a fetus. Check with your health care provider before taking any over-the-counter drug.

Glossary
Fetal Alcohol Syndrome (FAS): A pattern of physical, mental, and behavioral problems in the baby that are thought to be due to alcohol abuse by the mother during pregnancy.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Preterm: Born before 37 weeks of pregnancy.

Sudden Infant Death Syndrome (SIDS): The unexpected death of an infant in which the cause is unknown.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What can cause bleeding during pregnancy?
Vaginal bleeding or spotting during pregnancy can have many causes. Some are serious and some are not. Bleeding may occur early or late in pregnancy. Many women have vaginal spotting or bleeding in the first 12 weeks of pregnancy. Bleeding of the cervix may occur during sex. An infection of the cervix also can cause bleeding. Slight bleeding often stops on its own.
However, bleeding during pregnancy may mean something more serious. You may have a higher chance of going into labor too early (preterm labor), having an infant who is born too small, or having a miscarriage.

How is bleeding during early pregnancy checked?
If you are bleeding in early pregnancy, your health care provider may do a pelvic exam. You will be asked how much blood you have passed and how often bleeding has occurred. Your health care provider also will ask whether you have had any pain, and if so, its location and severity.

A blood test may be done to measure human chorionic gonadotropin (hCG). This substance is made by your body during pregnancy. You may have more than one test because hCG levels increase throughout pregnancy. Your blood type also will be checked to see if you need treatment for Rh sensitization. Ultrasound may be used to find the cause of the bleeding. Sometimes the cause is not found.

When does miscarriage happen?
Miscarriage can occur any time in the first half of pregnancy. Most often it occurs in the first 13 weeks. It happens in about 15–20% of pregnancies.

What are the signs and symptoms of miscarriage?
The following signs and symptoms may indicate a miscarriage:
Vaginal bleeding
Cramping pain felt low in the abdomen (often stronger than menstrual cramps)
Tissue passing from the vagina
Many women who have vaginal bleeding have little or no cramping. Sometimes the bleeding stops and pregnancy goes on. Other times the bleeding and cramping may become stronger, leading to miscarriage.

Is treatment needed after a miscarriage?
If some tissue stays in the uterus, bleeding often continues. Your health care provider may then recommend one or more treatment options. Medication may be used to help you pass the tissue. The tissue may be removed by dilation and curettage (D&C). It also may be removed by a suctioning device. This is called suction curettage. Sometimes more than one option is needed.

What is an ectopic pregnancy?
An ectopic pregnancy occurs when the fertilized egg does not implant in the uterus. Instead, it implants somewhere else, often in one of the fallopian tubes. An ectopic pregnancy causes pain and bleeding early in pregnancy.

What risks are associated with ectopic pregnancy?
A major risk with this type of pregnancy occurs if the fallopian tube ruptures. A rupture needs prompt treatment. There may be internal bleeding. Blood loss may cause weakness, fainting, pain, shock, or death.

How common are ectopic pregnancies and who is at risk?
Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women are at a higher risk if they have had:
an infection in the fallopian tubes (such as pelvic inflammatory disease)
a previous ectopic pregnancy
tubal surgery

What causes bleeding late in pregnancy?
Common problems that cause light bleeding include an inflamed cervix or growths on the cervix. These may be treated with medication. Heavy bleeding usually involves a problem with the placenta. The two most common causes at this time are placental abruption and placenta previa. Preterm labor also can cause such bleeding.

What is placental abruption?
The placenta is attached to the uterine wall. It may detach from the wall before or during labor. This may cause vaginal bleeding. It often causes pain, even if bleeding is light or not seen. When the placenta becomes detached, the fetus may get less oxygen. Prompt care is needed.

What is placenta previa?
 When the placenta lies low in the uterus, it may cover the cervix. That means it partly or completely blocks the opening. This is called placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs without pain.

Can bleeding be a sign of labor?
Late in pregnancy, vaginal bleeding may be a sign of labor. A small amount of mucus and blood is passed from the cervix just before or at the start of labor. This is called "bloody show." It is common. It is not a problem if it happens within 3 weeks of your due date. If it happens earlier, you may be going into preterm labor. Other signs of preterm labor include the following:
Vaginal discharge
Change in type of discharge (watery, mucus, or bloody)
Increase in amount of discharge
Pressure in the pelvis or lower abdomen
Low, dull backache
Stomach cramps, with or without diarrhea
Regular contractions or uterine tightening
If you have any of these signs or symptoms, contact your health care provider right away.

Glossary
Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Dilation and Curettage (D&C): A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovaries to the uterus.

Human Chorionic Gonadotropin (hCG): A hormone produced during pregnancy; its detection is the basis for most pregnancy tests.

Miscarriage: Early pregnancy loss.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Rh Sensitization: A condition in which an Rh-negative mother makes antibodies that attack the Rh factor, a protein on red blood cells.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Why is it important to wear a seat belt when I travel during pregnancy?
Although the baby is protected inside your body, you should wear a lap and shoulder belt every time you travel while you are pregnant for the best protection—even in the final weeks of pregnancy. You and your baby are much more likely to survive a car crash if you are buckled in.

How should I wear a seat belt while I am pregnant?
When wearing a seat belt, follow these rules:
Buckle the lap belt below your belly so that it fits snugly across your hips and pelvic bone.
Place the shoulder belt across your chest (between your breasts) and over the mid-portion of your collar bone (away from your neck).
Never place the shoulder belt under your arm or behind your back.
Pull any slack (looseness) out of the belt.

What should I know about air bags when I travel in a car?
Follow these tips if your car has air bags:
Keep 10 inches between the steering wheel and your breastbone.
If the car has an air bag “on/off” switch, check to be sure it is turned to “on.”
As your belly grows, you may not be able to keep as much space between you and the steering wheel. If the car has a tilt steering wheel, make sure it is angled toward your breastbone, not your belly or head.
Are there laws regarding child safety seats while riding in a car?

All 50 states have laws requiring the use of child safety seats for infants and children at different ages. In 48 states, there are laws requiring the use of booster seats for children who have outgrown their safety seats. Go to http://www.ghsa.org/html/stateinfo/laws/childsafety_laws.html to find out the laws for your state. In most states, you can be stopped for a child seat violation as the only reason.

If I am pregnant, when should I buy a car seat for my baby?
You cannot take your newborn home from the hospital without a car seat. Plan to have the car seat at least 3 weeks before your due date so you will have time to install it correctly and learn how to buckle the baby in safely.

Where should child car seats be installed in the car?
All car seats for children should be used in the back seat of the car—never in the front seat. Air bags in the front seat can cause serious injury to children. Until they reach age 13 years, children should always ride in the back seat.

What types of car seats are available for infants, toddlers, and school-aged children?
Rear-facing car seat—In a rear-facing car seat, the baby is turned to face the back windshield of the car. Infants and toddlers should ride in a rear-facing car seat until they are 2 years of age or until they reach the highest weight and height allowed by their car seat’s maker.
Forward-facing car seat—A forward-facing car seat faces the front windshield of the car. Toddlers and preschoolers who have outgrown the height and weight limit of the rear-facing seat should use a forward-facing seat.
Booster seat—A booster seat raises and positions your child so that the vehicle’s lap and shoulder belts fit properly. Your child should use a booster seat until the car seat belts fit properly. This usually occurs when the child is between the ages of 8 years and 12 years and is at least 4 feet 9 inches in height.

What should I keep in mind when choosing a car seat?
Know whether your car has the LATCH system. LATCH stands for Lower Anchors and Tethers for Children. Instead of seat belts, special anchors hold the seat in place. If your car and car seat do not have the LATCH system, you will need to use seat belts to install the car seat. Try locking and unlocking the buckle while you are in the store. Try changing the lengths of the straps. Read the labels to find out the seat’s height and weight limits. The National Highway Traffic Safety Administration offers parents a five-star rating system on its web site (http://www.nhtsa.gov/Safety/Ease-of-Use) based on how easy certain car seats are to use.

What should I know if I am considering buying a used car seat?
Do not buy a used car seat if you know it has been in a car crash. Also, used car seats may be missing parts or instructions. Avoid a used car seat that looks old or worn or is missing labels with the model number and maker’s name. Keep in mind that car seats have expiration dates. You can check the expiration date for any car seat on the maker’s web site.

What do I need to do after I buy a car seat?
After you buy the seat, register it with the maker using the card that comes with the seat, or register it online with the National Highway Traffic Safety Administration at http://www-odi.nhtsa.dot.gov/recalls/register/childseat/index.cfm. Registering your car seat allows you to get updates and recall notices. You can take your car and the seat to a car seat inspection station. These stations can check whether your car seat is installed correctly after you have installed it yourself.

What is distracted driving?
Distracted driving means doing something else while driving that takes your hands off the steering wheel or your eyes or mind off the road:
Using a cell phone
Texting
Eating
Feeding a child or picking up a toy
Grooming
Using a navigation system or changing a DVD

Parents who are distracted while driving with children in the car are more likely to be in a crash. Wait to send a text or make a call until your car is parked.

How long does pregnancy last?
Pregnancy lasts about 40 weeks, which is equal to 9 months. The 9 months of pregnancy are divided into three 3-month periods called trimesters.

What is a “due date”?
The due date that you are given by your partner’s health care provider is only an estimate of when the baby will be born. To calculate a due date, try this simple formula: take the date of the first day of your partner’s last menstrual period and subtract 3 months. Then add 7 days to get the due date.

What happens during the first trimester?
During the first trimester, most women need more rest. Women in early pregnancy also may have symptoms of nausea and vomiting. Although commonly known as “morning sickness,” these symptoms can occur at any time during the day or night.

What happens during the second trimester?
For most women, the second trimester of pregnancy (weeks 14–28) is the time they feel the best. As the woman’s body adjusts to being pregnant, she usually begins to feel better physically. Her energy level improves, and morning sickness usually goes away.

What happens during the third trimester?
In the third trimester of pregnancy (weeks 28–40), your partner may feel some discomfort as the baby grows larger and her body gets ready for the birth. She may have trouble sleeping, walking quickly, and doing routine tasks.

Is sex OK during pregnancy?
Unless your partner’s health care provider has told her otherwise, you and your partner can have sex throughout the entire 9 months. Also, there are other ways to be intimate during her pregnancy. Cuddling, kissing, fondling, mutual masturbation, and oral sex can fill the void until you can have intercourse again.

What if I smoke?
Not smoking around your partner is important because the chemicals in secondhand cigarette smoke can harm your baby before and after it is born. Babies exposed to secondhand smoke have an increased risk of developing asthma and sudden infant death syndrome.

Should I attend my partner’s prenatal care visits?
It may be helpful for you to go to some of your partner’s prenatal visits. At one of the early visits, you and your partner will be asked about your personal and family health histories. If you have a strong family history of a certain disease, you may have a gene for the disease that can be passed to your baby. Be sure that your partner knows your history if you cannot be there.

What tests will my partner have at her first prenatal care visit?
Your partner may have these tests and exams at the first visit:
Complete physical exam with blood and urine tests
A pelvic exam
Blood pressure, height, and weight measurements
All pregnant women are tested for human immunodeficiency virus (HIV) and syphilis. Many women also receive routine tests for other sexually transmitted diseases.

When is an ultrasound exam done?
Most women receive an ultrasound examination at 18–20 weeks of pregnancy. This exam gives an estimate of the actual age of the fetus and checks the baby’s development. It also may be possible to find out the baby’s sex.

What other tests may be included in prenatal care visits?
Later prenatal care visits may include the following tests and exams:
Checking the baby’s heart rate
Measuring your partner’s blood pressure
Testing her urine for signs of gestational diabetes
Measuring her weight
Measuring the height of the uterus to gauge the baby’s growth
Checking the position of the fetus
Screening tests for birth defects
Blood test to screen for gestational diabetes
Screening test for group B streptococcus

What can I do to help prepare for labor and delivery?
You can help prepare for labor and delivery by taking the following steps:
Enroll in childbirth classes.
Take a tour of the hospital.
Install an infant car seat.
What should I expect during labor?
Labor happens in three stages. It may last between 10 hours and 20 hours. If an emergency occurs during labor or delivery, you may be asked to leave the room. Although there may not be time to explain why at that moment, someone will explain the reasons to you later.

How can I help my partner during labor and delivery?
Although your partner is the one giving birth, there is plenty you can do to help during labor and in the delivery room:
Help distract your partner during the first stage of labor.
Unless she has been told to stay in bed, take short walks with your partner.
Time her contractions.
Offer to massage her back and shoulders between contractions.
Help her with the relaxation techniques you learned in childbirth class.
Encourage her during the pushing stage.
What will my partner experience during the postpartum period?
The postpartum period is the first 6 weeks after birth. Most women will feel tired and sore for a few days to a few weeks after childbirth. Women who have had a cesarean delivery may take longer to heal. Also, having a new baby in the house can be stressful. You, your partner, and any other children you have need to adjust to a new lifestyle.

What is postpartum depression?
It is very common for new mothers to feel sad, upset, or anxious after childbirth. Many new mothers have mild feelings of sadness called postpartum blues or “baby blues.” When these feelings are more extreme or last longer than a week or two, it may be a sign of a more serious condition known as postpartum depression. Postpartum depression also can occur several weeks after the birth. Women with a history of depression are at greater risk of this condition.

What are symptoms of postpartum depression?
A new mother may be developing—or already have—postpartum depression if she has any of the following signs and symptoms:
The baby blues do not start to fade after about 1 week, or the feelings get worse.
She has feelings of sadness, doubt, guilt, or helplessness that seem to increase each week and get in the way of normal functions.
She is not able to care for herself or her baby.
She has trouble doing tasks at home or on the job.
Her appetite changes.
Things that used to bring her pleasure no longer do.
Concern and worry about the baby are too intense, or interest in the baby is lacking.
Anxiety or panic attacks occur. She may be afraid to be left alone with the baby.
She fears harming the baby.
She has thoughts of self-harm or suicide.

How can I bond with the baby during breastfeeding?
Some fathers feel left out when watching the closeness of breastfeeding. But if your partner has chosen to breastfeed, there are ways you can share in these moments:
Bring the baby to her for feedings.
Burp and change the baby afterward.
Cuddle and rock the baby to sleep.
Help feed your baby if your partner pumps her breast milk into a bottle.
When can I and my partner have sexual intercourse after the baby is born?
There is no set “waiting period” before a woman can have sex again after giving birth. Some health care providers recommend waiting 4–6 weeks. The chances of a problem occurring, like bleeding or infection, are small after about 2 weeks following birth. If your partner has had an episiotomy or a tear during birth, the site may be sore for more than a week and she may be told to not have intercourse for a while.

Glossary
Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) to widen the vaginal opening for delivery.

Gene: A DNA “blueprint” that codes for specific traits, such as hair and eye color.

Gestational Diabetes: Diabetes that arises during pregnancy.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydial infection, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Syphilis: A sexually transmitted disease that is caused by an organism called Treponema pallidum; it may cause major health problems or death in its later stages.

Trimesters: The three 3-month periods into which pregnancy is divided.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is high blood pressure?
Blood pressure is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body. High blood pressure also is called hypertension. Hypertension can lead to health problems. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your baby.

What is chronic hypertension?
Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. If you took blood pressure medication before you became pregnant—even if your blood pressure is normal—you have chronic hypertension.

What is gestational hypertension?
Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

What kinds of problems can hypertension cause during pregnancy?
High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:
Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.

How is chronic hypertension during pregnancy managed?
Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your baby. If growth problems are suspected, you may have additional tests that monitor the baby’s health. This testing usually begins in the third trimester of pregnancy.

If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.

What is preeclampsia?
Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.

When does preeclampsia occur?
It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

What causes preeclampsia?
It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who are pregnant for the first time have had preeclampsia in a previous pregnancy or have a family history of preeclampsia have a history of chronic hypertension, kidney disease, or both are 40 years or older are carrying more than one baby have certain medical conditions such as diabetes mellitus, thrombophilia, or lupus are obese, had in vitro fertilization

What are the risks for my baby if preeclampsia occurs?
If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early also may die.

What are the risks for me if preeclampsia occurs?
Women who have had preeclampsia—especially those whose babies were born preterm—have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome.

What is HELLP syndrome?
HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.

What are the signs and symptoms of preeclampsia?
Swelling of face or hands
A headache that will not go away
Seeing spots or changes in eyesight
Pain in the upper abdomen or shoulder
Nausea and vomiting (in the second half of pregnancy)
Sudden weight gain
Difficulty breathing

How is mild gestational hypertension or preeclampsia without severe features managed?
Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis (you can stay at home with close monitoring by your health care provider). You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. You will need to see your health care provider at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.

How is preeclampsia with severe features managed?
Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.

What steps can I take to help prevent preeclampsia?
Prevention involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care provider for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy. If you have a medical condition, such as diabetes, it usually is recommended that your condition be well controlled before you become pregnant.

Glossary
Cardiovascular Disease: Disease of the heart and blood vessels.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Chronic Hypertension: High blood pressure that was diagnosed before the current pregnancy.

Corticosteroids: Hormones given to help fetal lungs mature, for arthritis, or for other medical conditions.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Eclampsia: Seizures occurring in pregnancy and linked to high blood pressure.

Fetal Growth Restriction: A condition in which a fetus has an estimated weight that is less than that of 9 out of 10 other fetuses of the same gestational age.

Gestational Hypertension: New-onset high blood pressure that occurs after 20 weeks of pregnancy.

HELLP Syndrome: A severe type of preeclampsia; HELLP stands for hemolysis, elevated liver enzymes, and low platelet count.

Hemolysis: Destruction of red blood cells.

Hypertension: High blood pressure.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Kick Count: A record kept during late pregnancy of the number of times a fetus moves over a certain period.

Liver Enzymes: Chemicals made by liver cells; elevated levels may indicate liver damage.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.

Platelets: Small, disc-shaped structures found in the blood that help the blood to clot.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, a severe headache, or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Proteinuria: The presence of an abnormal amount of protein in the urine.

Thrombophilia: A condition in which the blood does not clot correctly.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

When is the best time to travel during pregnancy?
The best time to travel is probably the middle of your pregnancy—between weeks 14 and 28. Most common pregnancy emergencies usually happen in the first and third trimesters. After 28 weeks, it may be harder for you to move around or sit for a long time.

What should I know about planning long car trips during pregnancy?
During a car trip, make each day’s drive brief. Try to limit driving to no more than 5 or 6 hours each day. Be sure to wear your seat belt every time you ride in a motor vehicle, even if your car has an air bag (see the FAQ Car Safety for Pregnant Women, Babies, and Children). Plan to make frequent stops to move around and stretch your legs.

What should I know about airplane travel while pregnant?
Some domestic airlines restrict travel during the last month of pregnancy or require a medical certificate; others discourage travel after 36 weeks of pregnancy. If you are planning an international flight, the cutoff point for traveling with international airlines is often earlier.

When traveling by air, you can take the following steps to help make your trip as comfortable as possible:
If you can, book an aisle seat, so that it is easy to get up and stretch your legs during a long flight.
Avoid gas-producing foods and carbonated drinks before your flight.
Wear your seatbelt at all times. The seatbelt should be belted low on the hipbones, below your belly.
If you are prone to nausea, your health care provider may be able to prescribe anti-nausea medication.

What should I know when planning a trip on a ship during pregnancy?
It may be a good idea, just in case, to ask your health care provider about which medications are safe for you to carry along to calm seasickness. Seasickness bands are useful for some people, although there is little scientific evidence that they work. These bands use acupressure to help ward off an upset stomach.

Another concern for cruise ship passengers is norovirus infection. Noroviruses are a group of viruses that can cause severe nausea and vomiting for 1 or 2 days. They are very contagious and can spread rapidly throughout cruise ships. People can become infected by eating food, drinking liquids, or touching surfaces that are contaminated with the virus. Before you book a cruise, you may want to check whether your ship has passed a health and safety inspection conducted by the Centers for Disease Control and Prevention (CDC).

How can I prepare for a trip out of the country while pregnant?
If you are planning a trip out of the country, your health care provider can help you decide if travel outside the United States is safe for you and advise you about what steps to take before your trip. The CDC also is a good resource for travel alerts, safety tips, and up-to-date vaccination facts for many countries. While you are pregnant, you should not travel to areas where there is risk of malaria, including Africa, Central and South America, and Asia.

What should I be aware of when traveling out of the country?
When traveling out of the country, make sure to follow these tips:
The safest water to drink is tap water that has been boiled for 1 minute (3 minutes at altitudes higher than 6,000 feet). Bottled water is safer than unboiled tap water, but because there are no standards for bottled water, there is no guarantee that it is free of germs that can cause illness. Carbonated beverages and drinks made with boiled water are safe to drink.
Do not put ice made from unboiled water in your drinks. Do not drink out of glasses that may have been washed in unboiled water. Avoid fresh fruits and vegetables unless they have been cooked or if you have peeled them yourself. Do not eat raw or undercooked meat or fish.

What health care preparations should I make before traveling while pregnant?
If you are traveling in the United States, locate the nearest hospital or medical clinic in the place you are visiting. If you are traveling internationally, the International Association for Medical Assistance to Travelers (IAMAT) has a worldwide directory of doctors. The doctors in the country you are visiting may not speak English, so bring a dictionary of the language spoken with you. Another tip is to register with an American embassy or consulate after you arrive at your destination. These agencies may be helpful if you need to leave the country because of an emergency.

What is high blood pressure?
Blood pressure is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body. High blood pressure also is called hypertension. Hypertension can lead to health problems. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your baby.

What is chronic hypertension?
Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. If you took blood pressure medication before you became pregnant—even if your blood pressure is normal—you have chronic hypertension.

What is gestational hypertension?
Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

What kinds of problems can hypertension cause during pregnancy?
High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:
Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.

How is chronic hypertension during pregnancy managed?
Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your baby. If growth problems are suspected, you may have additional tests that monitor the baby’s health. This testing usually begins in the third trimester of pregnancy.

If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.

What is preeclampsia?
Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.

When does preeclampsia occur?
It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

What causes preeclampsia?
It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who are pregnant for the first time have had preeclampsia in a previous pregnancy or have a family history of preeclampsia have a history of chronic hypertension, kidney disease, or both are 40 years or older are carrying more than one baby have certain medical conditions such as diabetes mellitus, thrombophilia, or lupus are obese, had in vitro fertilization

What are the risks for my baby if preeclampsia occurs?
If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early also may die.

What are the risks for me if preeclampsia occurs?
Women who have had preeclampsia—especially those whose babies were born preterm—have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome.

What is HELLP syndrome?
HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.

What are the signs and symptoms of preeclampsia?
Swelling of face or hands
A headache that will not go away
Seeing spots or changes in eyesight
Pain in the upper abdomen or shoulder
Nausea and vomiting (in the second half of pregnancy)
Sudden weight gain
Difficulty breathing

How is mild gestational hypertension or preeclampsia without severe features managed?
Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis (you can stay at home with close monitoring by your health care provider). You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. You will need to see your health care provider at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.

How is preeclampsia with severe features managed?
Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.

What steps can I take to help prevent preeclampsia?
Prevention involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care provider for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy. If you have a medical condition, such as diabetes, it usually is recommended that your condition be well controlled before you become pregnant.

Glossary
Cardiovascular Disease: Disease of the heart and blood vessels.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Chronic Hypertension: High blood pressure that was diagnosed before the current pregnancy.

Corticosteroids: Hormones given to help fetal lungs mature, for arthritis, or for other medical conditions.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Eclampsia: Seizures occurring in pregnancy and linked to high blood pressure.

Fetal Growth Restriction: A condition in which a fetus has an estimated weight that is less than that of 9 out of 10 other fetuses of the same gestational age.

Gestational Hypertension: New-onset high blood pressure that occurs after 20 weeks of pregnancy.

HELLP Syndrome: A severe type of preeclampsia; HELLP stands for hemolysis, elevated liver enzymes, and low platelet count.

Hemolysis: Destruction of red blood cells.

Hypertension: High blood pressure.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Kick Count: A record kept during late pregnancy of the number of times a fetus moves over a certain period.

Liver Enzymes: Chemicals made by liver cells; elevated levels may indicate liver damage.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.

Platelets: Small, disc-shaped structures found in the blood that help the blood to clot.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, a severe headache, or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Proteinuria: The presence of an abnormal amount of protein in the urine.

Thrombophilia: A condition in which the blood does not clot correctly.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

What causes a twin pregnancy?
Having twins runs in some families. The most important factor, however, is age. Women older than 30 years are more likely to have twins than are younger women. One reason is that women in their 30s—especially those in their late 30s—often release more than one egg during a menstrual cycle.

Women who take fertility drugs or use in vitro fertilization have a greater chance of having fraternal twins. Fertility drugs can cause more than one egg to be released. During in vitro fertilization, the egg is fertilized by a sperm in a lab. A doctor then places the embryo inside the uterus. If more than one embryo is transferred, twins, triplets, or even more can result.

What causes fraternal twins?
Usually, a woman releases one egg during ovulation. Fertilization occurs when one sperm joins with one egg. Sometimes, a woman releases two eggs, both of which can be fertilized by different sperm. When this occurs, it produces fraternal twins. These twins are no more alike than siblings born at different times. These twins can be boys, girls, or one of each. Each baby has its own placenta and amniotic sac.

What causes identical twins?
Identical twins occur when one fertilized egg splits and develops into two embryos. Identical twins may share a placenta or have separate placentas, but each baby usually has its own amniotic sac. Identical twins are the same sex and have the same blood type, hair color, and eye color. They usually look very much alike.

When is a twin pregnancy usually diagnosed?
A twin pregnancy usually is diagnosed during a routine ultrasound exam performed in the first trimester of pregnancy.

Are there more complications with a twin pregnancy than with a single pregnancy?
The risk of certain complications is higher in a twin pregnancy. Complications associated with a twin pregnancy include preterm labor, preterm birth, preeclampsia, gestational diabetes, and growth problems. Some of these problems may be prevented with early detection and care.

What is the most common complication of twin pregnancy?
The most common complication is preterm labor and preterm birth. Preterm labor is labor that starts before the end of 37 weeks of pregnancy. It can result in preterm birth. More than one half of all twins are born preterm.

What problems can babies who are born preterm have?
Preterm babies often have problems breathing and eating. They often have to stay in the hospital nursery longer than usual. Very preterm babies can die or have severe mental or physical problems. Problems also can occur as the babies grow and develop.

How can preterm birth be prevented?
Preterm birth sometimes can be prevented if preterm labor is found early enough. If you have preterm labor, you may be given a corticosteroid. This drug can help the babies’ lungs mature. In some cases, a drug called a tocolytic may be given to slow down or stop your contractions.

What is preeclampsia?
Preeclampsia is a disorder that occurs only during pregnancy. It usually starts after the 20th week of pregnancy. With twins, preeclampsia can start earlier and be more severe. Preeclampsia can lead to serious problems for both the woman and babies. The only cure for preeclampsia is delivery of the babies, which may result in preterm birth.

What growth problems are more likely in twins?
Twins are more likely to be smaller than single babies. Ultrasound often is used throughout pregnancy to check the growth of each baby.

What are discordant twins?
Twins are called discordant if one twin is much smaller than the other. Discordant twins are more likely to have problems during pregnancy and after birth. Identical twins may be discordant because of problems with the placenta or twin–twin transfusion syndrome (TTTS).

What causes twin–twin transfusion syndrome (TTTS)?
TTTS can develop when identical twins share a placenta. It occurs when the blood flow between the twins becomes unbalanced. One twin will have too little blood. The other twin will have too much blood. This condition can pose serious problems for both babies. If the condition is not treated, both babies can die.

Can TTTS be treated?
TTTS can be treated during pregnancy by withdrawing some of the extra fluid with a needle or with surgery on the placenta. Sometimes, the twins may need to be delivered early.

How common are birth defects in twin pregnancies?
Birth defects occur twice as often in twin pregnancies because each baby is at risk of having a birth defect. The risk of birth defects also increases with the mother’s age.

How can I find out if my babies may have birth defects?
Your health care provider may do special tests to find out if your babies have certain birth defects. These tests include chorionic villus sampling (CVS) and amniocentesis.

What should I know before having chorionic villus sampling (CVS) or amniocentesis?
Before having one of these tests, you should know that a sample usually needs to be taken for each baby. The risks of the procedures are increased with more than one baby results may show that one baby is normal and the other baby has a defect. In addition, these tests are more technically difficult to perform in twins.

Is there a greater chance of cesarean delivery in a twin pregnancy?
The chance of needing a cesarean delivery is higher with twins. Twins usually can be born vaginally if they both are in the head-down position. A vaginal birth also may be possible when the lower twin is in the head-down position but the higher twin is not.

Can I breastfeed if I have twins?
It may be more difficult to breastfeed twins—especially if they were born preterm—but it can be done. Mother’s milk is the best food for any infant. It has the right amount of all the nutrients the babies need and adapts as your babies’ needs change. When you breastfeed, your milk supply will increase to meet the amount needed by your babies. If your babies are premature, you can pump and store your milk until they are strong enough to feed from the breast.

Glossary
Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Amniotic Sac: A fluid-filled sac in the woman’s uterus where the fetus develops.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Chorionic Villus Sampling (CVS): A procedure in which a small sample of cells is taken from the placenta and tested.

Corticosteroid: A hormone given to help fetal lungs mature, for arthritis, or for other medical conditions.

Discordant: A large difference in the size of fetuses in a multiple pregnancy.

Embryos: Developing fertilized eggs up to 8 completed weeks of pregnancy.

Fertilization: Joining of the egg and sperm.

Fraternal Twins: Twins that have developed from more than one fertilized egg; they are not genetically identical and each
has its own placenta and amniotic sac.

Gestational Diabetes: Diabetes that arises during pregnancy.

Identical Twins: Twins that have developed from a single fertilized egg; they are usually genetically identical and may or may not share the same placenta and amniotic sac.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a dish in a lab with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Preterm: Born before 37 weeks of pregnancy.

Tocolytic: A drug used to slow contractions of the uterus.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Twin–Twin Transfusion Syndrome (TTTS): A condition of identical twin fetuses when the blood passes from one twin to the other through a shared placenta.

Ultrasound Exam: A test that uses sound waves to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is human immunodeficiency virus (HIV)?
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS).

How do you get HIV?
HIV enters the bloodstream by way of body fluids, such as blood or semen. Once in the blood, the virus invades and kills CD4 cells. CD4 cells are key cells of the immune system. When these cells are destroyed, the body is less able to fight disease.

How do you get AIDS?
AIDS occurs when the number of CD4 cells decreases below a certain level and the person gets sick with diseases that the immune system would normally fight off. These diseases include pneumonia, certain types of cancer, and harmful infections.

How long does it take for HIV to develop into AIDS?
It can take months or years before HIV infection might develop into AIDS. Unless a woman gets tested, she may never know she is infected with HIV until she gets sick.

Can HIV be treated?
HIV infection can be treated, but not cured. Taking anti-HIV drugs can help people with HIV infection stay healthy for a long time and can decrease the chance of passing the virus to others. There is no vaccine to prevent HIV infection.

If I am infected with HIV and pregnant, can I pass HIV to my baby?
It is possible to pass HIV to your baby in the following ways:
During pregnancy, HIV can pass through the placenta and infect the baby.
During labor and delivery, the baby may be exposed to the virus in the mother’s blood and other fluids. When a woman goes into labor, the amniotic sac breaks (her water breaks). Once this occurs, the risk of transmitting HIV to the baby increases. Most babies who get HIV from their mothers become infected around the time of delivery.
Breastfeeding also can transmit the virus to the baby.

What can I do to reduce the risk of passing HIV on to my baby?
You and your health care provider will discuss things you can do to reduce the risk of passing HIV on to your baby. They include the following:
Take a combination of anti-HIV drugs during your pregnancy as prescribed.
Have your baby by cesarean delivery if lab tests show that your level of HIV is high.
Take anti-HIV drugs during labor and delivery as needed.
Give anti-HIV drugs to your baby after birth.
Do not breastfeed.
By following these guidelines, 99% of HIV-infected women will not pass HIV to their babies.

Why is HIV treatment recommended during pregnancy?
Treatment during pregnancy has two goals: 1) to protect your own health, and 2) to help prevent passing HIV to your baby. Many combinations of drugs are used to manage HIV infection. This is called a "drug regimen." Anti-HIV drugs decrease the amount of HIV in the body.

Are there any side effects of HIV drugs?
Drugs used to treat HIV infection may cause side effects. Common side effects include nausea, diarrhea, headaches, and muscle aches. Less common side effects include anemia, liver damage, and bone problems such as osteoporosis. While unusual, drugs used to treat HIV may affect the development of the fetus. However, not taking medication greatly increases the chances of passing the virus to your baby.

What is my viral load?
Your viral load is the amount of HIV that you have in your body.

Why is it important for my viral load and CD4 cell count to be monitored?
Both a high viral load and a low number of CD4 cells mean there is a greater risk of passing HIV to your baby and a greater risk of you becoming sick. However, even if you have a low viral load, it is still possible to pass HIV to the baby.

Should I still use condoms during sex even though I am pregnant?
If your partner also is infected with HIV, condoms help protect you and your partner from other infections. If your partner is not infected with HIV, in addition to using condoms, there are some drugs that partners can take that may decrease their risk of becoming infected.

Are there extra risks for me if I am HIV positive and I have a cesarean delivery?
Having a cesarean delivery may carry extra risks if you are HIV positive. Women with low CD4 cell counts have weak immune systems, so they are at greater risk of infection after surgery. The incision may heal more slowly. Drugs to prevent infection are given during cesarean delivery.

After I give birth, how will I know if my baby is infected with HIV?
Babies who are born to HIV-positive mothers are tested for HIV several times in the first few months. The test looks for the presence of the virus in the baby’s blood. The baby has HIV infection if two of these test results are positive. The baby does not have HIV infection if two of these test results are negative. Another type of HIV test is done when the baby is 12–18 months old.

Glossary
Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV).

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

What is the body mass index?
The body mass index (BMI) is a number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese. (See our BMI Calculator under "Weight Loss")

When is a person considered overweight?
A person is overweight if he or she has a BMI of 25–29.9.

When is a person considered obese?
Obesity is defined as having a BMI of 30 or higher.

What are the increased risks during pregnancy for my baby if I am obese?
Being obese during pregnancy increases the risk of the following problems for your baby:
Birth defects—Babies born to obese mothers have an increased risk of having birth defects, such as heart defects and neural tube defects.
Problems with tests—If you have too much body fat, it can make it more difficult to see certain problems with the baby’s anatomy on an ultrasound exam.
Macrosomia—In this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. Macrosomia also increases the risk of cesarean delivery.
Preterm birth—Problems associated with a mother’s obesity may mean that the baby will need to be delivered early. Preterm infants have an increased risk of health problems, including breathing problems, eating problems, and developmental and learning difficulties later in life.
Stillbirth—The risk of stillbirth increases the higher the mother’s BMI.

What are the increased risks for me during pregnancy if I am obese?
Obesity during pregnancy puts you at risk of serious health problems:
High blood pressure—High blood pressure that starts during the second half of pregnancy is called gestational hypertension. It can lead to serious complications.
Preeclampsia—Preeclampsia is a serious illness for both a woman and her baby. The kidneys and liver may fail. In rare cases, stroke can occur. In severe cases, the woman, baby, or both may die.
Gestational diabetes—High blood glucose (sugar) levels during pregnancy increase the risk of having a very large baby and a cesarean delivery. Women who have had gestational diabetes have a higher risk of having diabetes in the future, as do their children.

Can I still have a safe pregnancy if I am obese?
Despite the risks, you can have a safe pregnancy and a healthy baby if you are obese. You will need to work with your health care provider to monitor your weight, exercise regularly, get regular prenatal care, and take steps to be as healthy as you can during your pregnancy.

Should I try to lose weight during pregnancy?
Even for obese women, pregnancy is not the time to actively try to lose weight. However, if you are obese and are gaining less than what the guidelines suggest, and if your baby is growing well, gaining less than the recommended guidelines can have benefits, such as decreased risks of needing a cesarean delivery and of having a very large baby.

Will I be tested for gestational diabetes during pregnancy?
Because overweight and obese women have a higher risk of this complication than women who are a normal weight, your health care provider may test you for gestational diabetes during the first 3 months of your pregnancy. You also may be given the test again in the later months of your pregnancy.

If I have never exercised, how should I begin during pregnancy?
Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes each day. Walking is a good choice if you are new to exercise. Brisk walking gives a total body workout and is easy on the joints. Swimming is another good exercise for pregnant women.

Can I have a vaginal delivery if I am obese?
Vaginal delivery is the ideal way to have your baby. However, a vaginal delivery is not always possible, and being obese can make a vaginal delivery even less likely. It can be harder to monitor the baby during labor. If the baby is very large, difficulties during labor and delivery may arise. For these reasons, obesity during pregnancy increases the risk of having a cesarean delivery.

Is cesarean delivery riskier for obese women?
Cesarean delivery is riskier for obese women than for women of normal weight. In general, the time it takes to perform the operation may be longer. The longer the operation takes, the greater the risks of bleeding and other complications.

Additional risks of cesarean delivery include the following:
Infections
Problems with anesthesia
Deep vein thrombosis (DVT)
Poor wound healing

What do I need to do after pregnancy if I had gestational diabetes during pregnancy?
If you had gestational diabetes during your pregnancy, you will need to have a follow-up test of your glucose level between 6 weeks and 12 weeks after you give birth. If your test result is normal, you should be retested for diabetes every 3 years.

Why is it important to lose excess weight before getting pregnant again?
Losing weight before getting pregnant again can help you prevent many of the complications caused by obesity during pregnancy. It is especially important to lose weight before getting pregnant again if you had complications in your previous pregnancy.

How can I lose weight safely after pregnancy?
Once you are home with your new baby, continue your healthy eating and exercise habits. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight more quickly than women who do not breastfeed.

Most people who have lost weight and kept it off get 60–90 minutes of moderate intensity activity on most days of the week. Moderate intensity activities include biking, brisk walking, and yard work.

Are there medications available to help me lose weight?
If you have tried to lose weight through diet changes and exercise and you still have a BMI above 30 or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, your health care provider may suggest medications to help with weight loss. These medications should not be taken once you become pregnant.

When is surgery an option to help me lose weight?
If diet and exercise or medications do not work, a special type of surgery, bariatric surgery, may be an option for people who are very obese (a BMI of 40 or greater or a BMI between 35 and 39 with major health problems caused by obesity).

When can I get pregnant after having weight-loss surgery?
If you have weight-loss surgery, you should delay getting pregnant for 12–24 months after surgery, when you will have the most rapid weight loss. Some types of weight-loss surgery may affect how the body absorbs medications taken by mouth, including birth control pills. You may need to switch to another form of birth control.

Glossary
Bariatric Surgery: Surgical procedures that cause weight loss for the treatment of obesity.

Body Mass Index (BMI): A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Gestational Diabetes: Diabetes that arises during pregnancy.

Gestational Hypertension: High blood pressure that starts during the second half of pregnancy.

Macrosomia: A condition in which a fetus grows very large.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Obesity: A condition characterized by excessive body fat.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Preterm: Born before 37 weeks of pregnancy.

Stillbirth: Delivery of a dead baby.

Stroke: A sudden interruption of blood flow to all or part of the brain, caused by blockage or bursting of a blood vessel in the brain and often resulting in loss of consciousness and temporary or permanent paralysis.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

What is the due date and what does it mean?
Your due date is used as a guide for checking your pregnancy’s progress and the baby’s growth and age. Health care providers often use more than one method to set the due date. Ultrasound performed between 18 weeks and 20 weeks of pregnancy often is used to help confirm the age of a fetus.

What is postterm pregnancy?
A postterm pregnancy is one that lasts 42 weeks or longer. Women who are having a baby for the first time or who have had postterm pregnancies before may give birth later than expected. However, the most common cause of postterm pregnancy is an error in calculating the due date. When a postterm pregnancy truly exists, the cause usually is unknown.

What are the risks associated with postterm pregnancy?
After 42 weeks, the placenta may not work as well as it did earlier in pregnancy. Also, as the baby grows, the amount of amniotic fluid may begin to decrease. Less fluid may cause the umbilical cord to become pinched as the baby moves or as the uterus contracts.

If pregnancy goes past 42 weeks, a baby has an increased risk of certain problems, such as dysmaturity syndrome, macrosomia, or meconium aspiration. There also is an increased chance of cesarean delivery.

What tests can be performed in cases of postterm pregnancy?
When a baby is not born by the due date, tests can help the health care provider check on the baby’s health. Some tests, such as a kick count, can be done on your own at home. A kick count is a record of how often you feel your baby move. Others are done in the health care provider’s office or in the hospital. These tests involve electronic fetal monitoring and include the nonstress test, biophysical profile, and contraction stress test.

What is electronic fetal monitoring?
Electronic fetal monitoring uses two belts placed around the mother’s abdomen to hold instruments that measure fetal heart rate and the strength of uterine contractions. This method is used to perform the following tests for fetal well-being:

Nonstress test—The mother pushes a button each time she feels the baby move. This causes a mark to be made on a paper recording of the fetal heart rate.
Biophysical profile—This test combines the results of electronic fetal monitoring and an ultrasound exam. It checks the baby’s heart rate (using the nonstress test) and estimates the amount of amniotic fluid. The baby’s breathing, movement, and muscle tone also may be checked.
Contraction stress test—The baby’s heart rate is measured when the mother’s uterus contracts. The contractions are induced, and changes in the fetus’s heart rate are noted.
What is labor induction?
Labor induction is the use of medication or other methods to bring on labor. Labor is induced to cause a pregnant woman’s cervix to open and to prepare for vaginal birth. Most health care providers wait 1–2 weeks after a woman’s due date before considering inducing labor.

How is labor induced?
Methods used to induce labor include:
Ripening or dilating the cervix—Prostaglandins may be used to soften the cervix and to cause the uterus to contract. Special devices can be used to dilate the cervix.
Stripping or sweeping the amniotic membranes—Your health care provider sweeps a finger over the thin membranes that connect the amniotic sac to the wall of your uterus. Women who have this procedure are more likely to have contractions and may go into labor within 48 hours.
Rupturing the amniotic sac—Your health care provider makes a small hole in the amniotic sac to release the fluid ("breaking the water"). Most women go into labor within hours of their water breaking
Using oxytocin—This hormone, given through an intravenous (IV) tube in your arm, causes the uterus to contract.

Glossary
Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Dysmaturity Syndrome: A condition in which the fetus is malnourished. He or she is born with a long and lean body, an alert look on the face, lots of hair, long fingernails, and thin wrinkled skin.

Macrosomia: A condition in which a fetus grows very large.

Meconium Aspiration: A condition in which the baby inhales a greenish substance that builds up in the bowels of a growing fetus. This blocks the airways and causes the baby to gasp for air.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Prostaglandins: Chemicals that are made by the body that have many effects, including causing the muscle of the uterus to contract, usually causing cramps.

Ultrasound: A test in which sound waves are used to examine the fetus.

Umbilical cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is the Rh factor?
Just as there are different major blood groups, such as type A and type B, there also is an Rh factor. The Rh factor is a protein that can be present on the surface of red blood cells. Most people have the Rh factor—they are Rh positive. Others do not have the Rh factor—they are Rh negative.

How does a person get the Rh factor?
The Rh factor is inherited—passed down through parents’ genes to their children. If the mother is Rh negative and the father is Rh positive, the fetus can inherit the Rh gene from the father and could be either Rh positive or Rh negative. If the mother and father are both Rh negative, the baby also will be Rh negative.

Can the Rh factor cause problems during pregnancy?
The Rh factor can cause problems if you are Rh negative and your fetus is Rh positive. This is called Rh incompatibility. These problems usually do not occur in a first pregnancy, but they can occur in a later pregnancy.

What happens if there is Rh incompatibility during pregnancy?
When an Rh-negative mother’s blood comes into contact with blood from her Rh-positive fetus, it causes the Rh-negative mother to make antibodies against the Rh factor. These antibodies attack the Rh factor as if it were a harmful substance. A person with Rh-negative blood who makes Rh antibodies is called "Rh sensitized."

How does Rh sensitization occur during pregnancy?
During pregnancy, the woman and fetus do not share blood systems. However, a small amount of blood from the fetus can cross the placenta into the woman’s system. This sometimes may happen during pregnancy, labor, and birth. It also can occur if an Rh-negative woman has had any of the following during pregnancy:
Amniocentesis
Chorionic villus sampling (CVS)
Bleeding during pregnancy
Manual rotation of a baby in a breech presentation before labor
Blunt trauma to the abdomen during pregnancy
Do problems usually occur during the pregnancy that causes Rh sensitization?

During an Rh-negative woman’s first pregnancy with an Rh-positive fetus, serious problems usually do not occur because the baby often is born before the woman’s body develops many antibodies. If preventive treatment is not given during the first pregnancy and the woman later becomes pregnant with an Rh-positive fetus, the baby is at risk of Rh disease.

Can I still develop antibodies if my pregnancy is not carried to term?
It also is possible to develop antibodies after a miscarriage, an ectopic pregnancy, or an induced abortion. If an Rh-negative woman becomes pregnant after one of these events, she does not receive treatment, and the fetus is Rh positive, the fetus may be at risk of Rh-related problems.

How does Rh sensitization affect the fetus during pregnancy?
Problems during pregnancy can occur when Rh antibodies from an Rh-sensitized woman cross the placenta and attack the blood of an Rh-positive fetus. The Rh antibodies destroy some of the fetal red blood cells. This causes hemolytic anemia, where red blood cells are destroyed faster than the body can replace them.

Red blood cells carry oxygen to all parts of the body. Without enough red blood cells, the fetus will not get enough oxygen. Hemolytic anemia can lead to serious illness. Severe hemolytic anemia may even be fatal to the fetus.

How can I find out if I have become Rh sensitized?
A blood test, called an antibody screen, can show if you have developed antibodies to Rh-positive blood and how many antibodies have been made. If you are Rh negative and there is a possibility that your baby is Rh positive, your health care provider may request this test during your first trimester and again during week 28 of pregnancy.

Can Rh sensitization be prevented?
Yes. If you are Rh negative, you will be given a shot of Rh immunoglobulin (RhIg). RhIg is made from donated blood. When given to a nonsensitized Rh-negative person, it targets any Rh-positive cells in the bloodstream and prevents the production of Rh antibodies. When given to an Rh-negative woman who has not yet made antibodies against the Rh factor, RhIg can prevent fetal hemolytic anemia in a later pregnancy.

Can RhIg help me if I am already Rh sensitized?
RhIg is not helpful if you are already Rh sensitized.

When is RhIg given?
RhIg is given to Rh-negative women in the following situations:
At around the 28th week of pregnancy to prevent Rh sensitization for the rest of the pregnancy
Within 72 hours after the delivery of an Rh-positive infant
After a miscarriage, abortion, or ectopic pregnancy
After amniocentesis or chorionic villus sampling

What if I am Rh sensitized and my fetus is Rh positive?
If you are Rh sensitized, you will be monitored during pregnancy to check the condition of your fetus. If tests show that your baby has severe anemia, it may be necessary to deliver your baby early (before 37 weeks of pregnancy) or give a blood transfusion while your baby is still in your uterus (through the umbilical cord). If the anemia is mild, your baby may be delivered at the normal time. After delivery, your baby may need a transfusion to replace the blood cells.

Glossary
Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Breech Presentation: A position in which the feet or buttocks of the fetus would be born first.

Chorionic Villus Sampling (CVS): A procedure in which a small sample of cells is taken from the placenta and tested.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed down from parent to offspring.

Hemolytic Anemia: Anemia caused by destruction of red blood cells.

Induced Abortion: The planned termination of a pregnancy before the fetus can survive outside the uterus.

Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Rh Factor: A protein that can be present on the surface of red blood cells.

Rh Immunoglobulin (RhIg): A substance given to prevent an Rh-negative person’s antibody response to Rh-positive blood cells.

Transfusion: Direct injection of blood, plasma, or platelets into the bloodstream.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is early pregnancy loss?
The loss of a pregnancy before 20 weeks is called early pregnancy loss or miscarriage.

How common are miscarriages?
Miscarriages are surprisingly common. They occur in about 15% of known pregnancies.

What causes miscarriages?
Most miscarriages are caused by a random event in which the embryo receives an abnormal number of chromosomes. Sperm and egg cells each have 23 chromosomes. During fertilization, when the egg and sperm join, the two sets of chromosomes come together. An embryo with an abnormal number of chromosomes often cannot grow or survive.

What factors increase the risk of an embryo having an abnormal number of chromosomes?
The likelihood that an embryo will have an abnormal number of chromosomes increases as a woman gets older. After age 40 years, about one third of pregnancies end in miscarriage, most as a result of this type of chromosome abnormality.

What are the signs and symptoms of miscarriage?
Bleeding and passing clots are the most common symptoms of miscarriage. Mild cramping of the lower abdomen or a low backache also may occur.

If I have bleeding in early pregnancy, does it mean I am having a miscarriage?
A small amount of bleeding in early pregnancy is relatively common. Bleeding often stops on its own without treatment. However, if you have spotting or vaginal bleeding early in pregnancy, you should contact your health care provider. If your bleeding is heavy or occurs along with a pain like menstrual cramps, you should contact your health care provider right away.

What tests may be done if I have significant bleeding or cramping?
If you have significant bleeding or cramping, your health care provider may do an ultrasound exam. This exam can check whether the pregnancy is growing normally. If your pregnancy is advanced enough, the ultrasound exam can detect whether there is a heartbeat. Your health care provider also may do a pelvic exam to see if your cervix has begun to open (dilate).

If I have had a miscarriage, do I need medical treatment?
After a miscarriage, all of the pregnancy tissue may not be expelled. There are three options for removing this tissue:
If you do not have any signs of an infection, your health care provider may recommend waiting and letting the tissue pass naturally. This usually takes up to 2 weeks, but it may take longer in some cases. You can take medication that helps expel the tissue. You will have bleeding, some of which can be heavy. Cramping pain, diarrhea, and nausea also can occur. You may pass tissue in addition to bleeding. You can have a surgical procedure called vacuum aspiration. This procedure involves inserting an instrument or suction device into the uterus to remove the tissue. It often can be performed in your health care provider’s office. Risks of this procedure include bleeding, infection, and injury to internal organs. The option that is used depends on many factors, including how far along in the pregnancy you were.

What precautions do I need to take after having a miscarriage?
After a miscarriage, you may be advised not to put anything into your vagina (such as using tampons or having sexual intercourse), usually for 2 weeks. This is to help prevent infection.

When should I have a follow-up visit with my health care provider after I have a miscarriage?
You should see your health care provider a few weeks after your miscarriage for a follow-up visit. Call your health care provider right away if you have any of the following symptoms:
Heavy bleeding
Fever
Chills
Severe pain

What if my blood type is Rh negative and I have a miscarriage?
If your blood type is Rh negative, you may receive a shot of Rh immunoglobulin after a miscarriage. The Rh factor is a protein that can be present on the surface of red blood cells. Most people have the Rh factor—they are Rh positive. Others do not have the Rh factor—they are Rh negative. During a miscarriage, it is possible for the mother’s blood to come into contact with fetal blood cells. If a woman is Rh negative and the fetus is Rh positive, this contact causes her to make antibodies against the Rh factor. These antibodies react against the Rh factor as if it were a harmful substance and can cause serious problems in a later pregnancy with an Rh-positive baby. Rh immunoglobulin prevents these antibodies from forming.

What can I expect to feel emotionally after a miscarriage?
The loss of a pregnancy—no matter how early—can cause feelings of sadness and grief. After a miscarriage, you need to heal both physically and emotionally. For many parents, emotional healing takes a good deal longer than physical healing.
Grief can involve a wide range of feelings. You may feel sad and depressed one day, and angry the next. You may find yourself searching for a reason your pregnancy ended. You may wrongly blame yourself. You may have headaches, lose your appetite, feel tired, or have trouble concentrating or sleeping.

Will my partner have the same feelings as me?
Your feelings of grief may differ from those of your partner. Your partner also may grieve but may not express feelings in the same way you do. This may create tension between the two of you when you need each other the most. Partners also may feel that they need to be strong for you both and not show their grief.

How soon can I become pregnant after having a miscarriage?
You can ovulate and become pregnant as soon as 2 weeks after an early miscarriage. If you do not wish to become pregnant again right away, be sure to use birth control. If you do wish to become pregnant, you do not have to wait to begin trying again. You may want to wait until after you have had a menstrual period so that calculating the due date of your next pregnancy is easier.

Glossary
Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Embryo: The developing organism from the time it implants in the uterus up to 8 completed weeks of pregnancy.

Fertilization: Joining of the egg and sperm. Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Ovulate: To release an egg from one of the ovaries. Pelvic Exam: A physical examination of a woman’s reproductive organs.

Rh Factor: A protein that can be present on the surface of red blood cells.

Rh Immunoglobulin: A substance given to prevent an Rh-negative person’s antibody response to Rh-positive blood cells.

Sperm: A cell produced in the male testes that can fertilize a female egg.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Why may special tests be needed during pregnancy?
Special testing during pregnancy most often is done when the fetus is at increased risk of problems that could result in pregnancy complications or lead to stillbirth. This can occur in the following situations:
High-risk pregnancy (a woman has had complications in a previous pregnancy or has a preexisting health condition such as diabetes or heart disease)
Problems during pregnancy, such as fetal growth problems, Rh sensitization, or high blood pressure
Decreased movement of the fetus
Pregnancy that goes past 42 weeks (postterm pregnancy)
Multiple pregnancy with certain complications
When during pregnancy are special tests performed?
Special testing usually is started between week 32 and week 34 of pregnancy. Testing may be started earlier if problems are particularly serious or there are multiple risk factors.

How often are special tests done?
How often the tests are done depends on the condition that prompted the testing, whether the condition remains stable, and results of the testing. Some tests are repeated weekly. In certain situations, tests may be done twice weekly.

What are the types of special tests?
The tests used to monitor fetal health include fetal movement counts, the nonstress test, biophysical profile, modified biophysical profile, contraction stress test, and Doppler ultrasound of the umbilical artery.

What are fetal movement counts?
If you have felt fetal movement less often than what you think is normal, your health care provider may ask you to keep track of the fetus’s movements. Fetal movement counting (also called "kick counts") is a test that you can do at home. There are different ways kick counts can be done. Your health care provider will tell you how often to do it and when to notify him or her.

What is a nonstress test?
The nonstress test measures the fetal heart rate in response to fetal movement over time. The term "nonstress" means that during the test, nothing is done to place stress on the fetus.

How is the nonstress test performed?
This test may be done in the health care provider’s office or in a hospital. The test is done while you are reclining or lying down and usually takes at least 20 minutes. A belt with a sensor that measures the fetal heart rate is placed around your abdomen. The fetal heart rate is recorded by a machine.

What do the results of a nonstress test mean?
If two or more accelerations occur within a 20-minute period, the result is considered reactive or "reassuring." A reactive result means that for now, it does not appear that there are any problems. A nonreactive result is one in which not enough accelerations are detected in a 40-minute period. It can mean several things. It may mean that the baby was asleep during the test. If this happens, the test may last 40 more minutes, or the baby may be stimulated to move with sound projected over the mother’s abdomen. A nonreactive result can occur if the woman has taken certain medications. It also can mean that the fetus is not getting enough oxygen.

What is a biophysical profile?
A biophysical profile (BPP) may be done when results of other tests are nonreassuring. It uses a scoring system to evaluate fetal well-being in these five areas:
1. Fetal heart rate

2. Fetal breathing movements

3. Fetal body movements

4. Fetal muscle tone

5. Amount of amniotic fluid

Each of the five areas is given a score of 0 or 2 points, for a possible total of 10 points.

How is the BPP performed?
A BPP involves monitoring the fetal heart rate (the same way it is done in a nonstress test) as well as an ultrasound exam. During an ultrasound exam, a device called a transducer is rolled gently over your abdomen while you are reclining or lying down. The transducer creates sound waves that bounce off of the internal structures of the body. The transducer receives these echoes, which are converted into images displayed on a computer screen for the technician to view.

What do the results of a BPP mean?
A score of 8–10 is reassuring. A score of 6 is equivocal (neither reassuring nor nonreassuring). If you have an equivocal score, depending on how far along you are in your pregnancy, you may have another BPP within the next 12–24 hours, or it may be decided to deliver the baby. A score of 4 or less means that further testing is needed. Sometimes, it means that the baby should be delivered early or right away. No matter what the score is, not enough amniotic fluid means that more frequent testing should be done or delivery may need to be considered.

What is a modified BPP?
A modified BPP is done for the same reasons that a BPP is done. The modified BPP combines a nonstress test with an amniotic fluid assessment that is performed using ultrasound. It is less cumbersome but can be just as useful as the BPP in predicting fetal well-being.

How is the modified BPP performed?
The fetal heart rate is monitored in the same way it is done for the nonstress test. Ultrasound is used to measure how much amniotic fluid there is in four areas of your uterus.

What do the results of a modified BPP mean?
If test results are nonreactive, it could mean that the fetus is having trouble getting enough oxygen. Results of the amniotic fluid measurement give an idea of how well the placenta is working. If the amniotic fluid level is low, it could mean that there is a problem with blood flow in the placenta. A full BPP or contraction stress test may be needed to confirm results.

What is a contraction stress test?
The contraction stress test helps your health care provider see how the fetal heart rate reacts when the uterus contracts. The contraction stress test sometimes is used if other test results are positive or unclear.

How is the contraction stress test performed?
In this test, belts with sensors that detect the fetal heart rate and uterine contractions are placed across your abdomen. To make your uterus contract mildly, you may be asked to rub your nipples through your clothing or you may be given oxytocin.

What do the results of a contraction stress test mean?
If the fetal heart rate does not decrease after a contraction, the result is normal (negative). A decrease in heart rate after most contractions is a positive result (the results are concerning to the health care provider). Results also can be equivocal (the results are not clear) or unsatisfactory (there were not enough contractions to produce a meaningful result).

What is a Doppler ultrasound exam of the umbilical artery?
Doppler ultrasound is used to check the blood flow in the umbilical artery, a blood vessel located in the umbilical cord. Doppler ultrasound is used with other tests when the fetus shows signs of not growing well.

How is the Doppler ultrasound exam performed?
You will be reclining or lying down for this test. A transducer is rolled gently over your abdomen to project sound waves. An image of the artery that is being examined is shown on a computer screen.

What do the results of a Doppler ultrasound exam mean?
A normal test result is one that shows normal blood flow in the umbilical artery. If the test shows problems with the blood flow in the placenta, it can mean that there is a decrease in the amount of oxygen being delivered to the fetus.

Glossary
Accelerations: Increases in the fetal heart rate.

Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Doppler Ultrasound: A type of ultrasound in which sound waves are used to detect how fast an object is moving. Doppler ultrasound can be used to detect the heartbeat of a fetus or how fast blood is moving through a vein or artery.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Multiple Pregnancy: A pregnancy in which there are two or more fetuses.

Oxygen: A gas that is necessary to sustain life.

Oxytocin: A hormone used to help bring on contractions of the uterus.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Postterm Pregnancy: A pregnancy that extends beyond 42 weeks.

Rh Sensitization: A condition in which an Rh-negative mother makes antibodies against Rh proteins. These antibodies can react against the baby’s Rh factor if the baby is Rh positive, causing anemia, jaundice, and other problems.

Stillbirth: Delivery of a dead baby.

Transducer: A device that emits sound waves and translates the echoes into electrical signals.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is a birth defect?
A birth defect is a problem that is present at birth, although it may not be noticed until the child is older. Birth defects may affect any part of the body, including major organs such as the heart, lungs, or brain. The defect may affect the baby’s appearance, a body function, or both.

What causes birth defects?
Some birth defects are caused by problems with chromosomes. Others are caused by a gene that is passed from parent to child. Some birth defects result from exposure to harmful agents.

What are some examples of chromosome disorders?
Aneuploidy is a condition in which there are missing or extra chromosomes. The most common aneuploidy is called a trisomy, in which there is an extra chromosome. A common trisomy is trisomy 21 (Down syndrome). Other trisomies include trisomy 13 (Patau syndrome) and trisomy 18 (Edwards syndrome). A monosomy is a condition in which there is a missing chromosome. A common monosomy is Turner syndrome, in which a female has a missing or damaged X chromosome.

What are inherited disorders?
Inherited disorders are caused by defective genes. These disorders are passed down by parents to their children. Some inherited disorders are more common in certain races and ethnic groups, such as sickle cell disease (African American), cystic fibrosis (non-Hispanic white), and Tay–Sachs disease (Ashkenazi Jewish, Cajun, and French Canadian).

What other things can cause birth defects?
Birth defects also may be caused by exposure to harmful agents, such as medications, chemicals, and infections. Some birth defects may be caused by a combination of factors. For most birth defects, the cause is not known.

How can I find out if I am at increased risk of passing on a genetic disorder?
Your health care provider or a genetic counselor can help find out if you are at increased risk of passing on a genetic disorder by asking about your personal and family health history.

What factors may increase my risk of passing on a genetic disorder?
Most babies with birth defects are born to couples without risk factors. However, the risk of birth defects is higher when certain factors are present. You are at increased risk if you have a genetic disorder you already have a child who has a genetic disorder there is a family history of a genetic disorder you belong to an ethnic group that has a high risk of certain genetic disorders.

What types of prenatal tests are available to address concerns about birth defects?
The following prenatal tests are available:
Carrier tests—These screening tests can show if a person carries a gene for an inherited disorder. Carrier tests can be done before or during pregnancy. Cystic fibrosis carrier screening is offered to all women of reproductive age because it is one of the most common genetic disorders.
Screening tests—These tests assess the risk that a baby will have Down syndrome and other chromosome problems, as well as neural tube defects. These tests do not tell whether the fetus actually has these disorders.
Diagnostic tests—These tests can provide information about whether the fetus has a genetic condition and are done on cells obtained through amniocentesis, chorionic villus sampling, or, rarely, fetal blood sampling. The cells can be analyzed using different techniques.

Do I have a choice between having screening tests or having diagnostic tests?
If a screening test shows an increased risk of a birth defect, diagnostic tests may be done to determine if a specific birth defect is present. Diagnostic testing may be done instead of screening if a couple is at increased risk of certain birth defects. Diagnostic testing also is offered as a first choice to all pregnant women, even those who do not have risk factors. Your health care provider will discuss all of the testing options with you and recommend the tests that best fit your needs.

What are the advantages and disadvantages of diagnostic tests compared with screening tests?
The main benefit of having diagnostic testing instead of screening is that it tells you whether or not the baby will be born with a chromosome disorder or a specific inherited disorder. The main disadvantage is that diagnostic tests can pose some risks to the pregnancy.

Do I have to have these tests?
Although screening tests for birth defects are offered to all pregnant women, it is your choice whether to have them done. Knowing whether your baby is at risk of or has a birth defect beforehand allows you to prepare for having a child with a particular disorder and to organize the medical care that your child may need. You also may have the option of not continuing the pregnancy.

Glossary
Alpha-fetoprotein (AFP): A protein produced by a growing fetus; it is present in amniotic fluid and, in smaller amounts, in the mother’s blood.

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Aneuploidy: Having an abnormal number of chromosomes.

Carrier: A person who shows no signs of a particular disorder but could pass the gene on to his or her children.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Cystic Fibrosis: An inherited disorder that causes problems in digestion and breathing.

Diagnostic Tests: Tests that look for a disease or cause of a disease in people who are believed to have or who have an increased risk of a disease.

Estriol: A substance made by the placenta and the liver of the fetus.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Gene: A segment of DNA that contains instructions for the development of a physical trait or control of a process in the body. Genes are the basic units of heredity and can be passed down from parent to offspring.

Genetic Counselor: A health care professional with special training in genetics and counseling who can provide expert advice about genetic disorders and prenatal testing.

Human Chorionic Gonadotropin (hCG): A hormone produced during pregnancy; its detection is the basis for most pregnancy tests.

Inhibin-A: A substance made by the placenta during pregnancy.

Monosomy: A condition in which there is a missing chromosome.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Pregnancy-Associated Plasma Protein-A (PAPP-A): A protein made by the fetus and placenta during pregnancy.

Screening Tests: Tests that look for possible signs of disease in people who do not have symptoms.

Sickle Cell Disease: An inherited disorder in which red blood cells have a crescent shape, causing chronic anemia and episodes of pain. It occurs most often in African Americans.

Tay-Sachs Disease: An inherited birth defect that causes mental retardation, blindness, seizures, and death, usually by age 5 years. It occurs mostly in people of Eastern European Jewish (Ashkenazi Jews), Cajun, and French Canadian descent.

Trimesters: The three 3-month periods into which pregnancy is divided.

Trisomy: A condition in which there is an extra chromosome.

Trisomy 13 (Patau Syndrome): A genetic disorder that causes serious heart defects and other problems with development. Most infants with trisomy 13 die within the first year of life.

Trisomy 18 (Edwards Syndrome): A genetic disorder that causes serious mental and developmental problems. Most infants with trisomy 18 die within the first year of life.

Trisomy 21 (Down Syndrome): A genetic disorder in which abnormal features of the face and body, medical problems such as heart defects, and intellectual disability occur.

Turner Syndrome: A condition affecting females in which there is a missing or damaged X chromosome. It causes a webbed neck, short height, and heart problems.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

What is diabetes mellitus?
Diabetes mellitus (also called "diabetes") is caused by a problem with insulin. Insulin moves glucose out of the blood and into the body’s cells where it can be turned into energy (see the FAQ Diabetes and Women). Pregnancy health care providers often call diabetes that is present before pregnancy "pregestational diabetes."

When the body does not make enough insulin or does not respond to it, glucose cannot get into cells and instead stays in the blood. As a result, the level of glucose in the blood increases. Over time, high blood glucose levels can damage the body and cause serious health problems, such as heart disease, vision problems, and kidney disease.

How can pregestational diabetes affect my pregnancy?
If your diabetes is not managed well, you are at increased risk of several of the complications associated with diabetes. The following problems can occur in women with diabetes:
Birth defects
High blood pressure
Hydramnios—In this condition, there is an increased amount of amniotic fluid in the amniotic sac that surrounds the baby. It can lead to preterm labor and delivery.
Macrosomia (very large baby)—The baby receives too much glucose from the mother and can grow too large. A large baby can make delivery more difficult. A large baby also increases the risk of having a cesarean delivery.
How can pregestational diabetes affect my baby?
Babies born to mothers with pregestational diabetes may have problems with breathing, low glucose levels, and jaundice. Most babies do well after birth, although some may need to spend time in a special care nursery. The good news is that with proper planning and control of your diabetes, you can decrease the risk of these problems.

If I have diabetes and wish to become pregnant, is it important to tell my health care provider?
Yes, your health care provider will help you get your blood glucose level under control before you become pregnant (if it is not already). Controlling your glucose level is important because some of the birth defects caused by high glucose levels happen when the baby’s organs are developing in the first 8 weeks of pregnancy—before you may know you are pregnant. Getting your glucose level under control may require changing your medications, diet, and exercise program.

How can I control my diabetes during pregnancy?
You can control your glucose level with a combination of eating right, exercising, and taking medications as directed by your health care provider. You may need to see your health care provider more often. Your health care provider will schedule frequent prenatal visits to check your glucose level and for other tests.

How does my health care provider know if my blood glucose level has been well controlled?
A blood test called a hemoglobin A1C test may be used to track your progress. This test result gives an estimate of how well your blood glucose level has been controlled during the past 4–6 weeks.

Can pregnancy affect my glucose level?
Women with diabetes are more likely to have low blood glucose levels, known as hypoglycemia, when they are pregnant. Hypoglycemia can occur if you do not eat enough food, skip a meal, do not eat at the right time of day, or exercise too much. Make sure you and family members know what to do if you think you are having symptoms of hypoglycemia, such as dizziness, feeling shaky, sudden hunger, sweating, or weakness.

How can my diet affect my pregnancy?
Eating a well-balanced, healthy diet is a critical part of any pregnancy because your baby depends on the food you eat for its growth and nourishment (see the FAQ Nutrition During Pregnancy). In women with diabetes, diet is even more important. Not eating properly can cause your glucose level to go too high or too low.

How can exercise help during my pregnancy?
Exercise helps keep your glucose level in the normal range and has many other benefits, including controlling your weight; boosting your energy; aiding sleep; and reducing backaches, constipation, and bloating.

Will I take medications to control my diabetes during pregnancy?
If you took insulin before pregnancy to control your diabetes, your insulin dosage usually will increase while you are pregnant. Insulin is safe to use during pregnancy and does not cause birth defects. If you used an insulin pump before you became pregnant, you probably will be able to continue using the pump. Sometimes, however, you may need to switch to insulin shots.

If you normally manage your diabetes with oral medications, your health care provider may suggest a change in your dosage or that you take insulin while you are pregnant.

How will diabetes affect labor and delivery?
Labor may be induced (started by drugs or other means) earlier than the due date, especially if problems with the pregnancy arise. While you are in labor, your glucose level will be monitored closely—typically every hour. If needed, you may receive insulin through an intravenous (IV) line. If you use an insulin pump, you may use it during labor.

If I have diabetes, can I breastfeed my baby?
Experts highly recommend breastfeeding for women with diabetes. Breastfeeding gives the baby the best nutrition to stay healthy, and it is good for the mother as well. It helps new mothers shed the extra weight that they may have gained during pregnancy and causes the uterus to return more quickly to its prepregnancy size.

Glossary
Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Hydramnios: A condition in which there is an excess amount of amniotic fluid in the sac surrounding the fetus.

Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.

Preterm: Born before 37 weeks of pregnancy.

What happens when labor begins?
As labor begins, the cervix opens (dilates). The uterus, which contains muscle, contracts at regular intervals. When it contracts, the abdomen becomes hard. Between the contractions, the uterus relaxes and becomes soft. Up to the start of labor and during early labor, the baby will continue to move.

What is false labor?
Your uterus may contract off and on before "true" labor begins. These irregular contractions are called false labor or Braxton Hicks contractions. They are normal but can be painful at times. You might notice them more at the end of the day.

Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour.  Usually, false labor contractions are less regular and not as strong as true labor. Sometimes the only way to tell the difference is by having a vaginal exam to look for changes in your cervix that signal the onset of labor.

What are the types of pain-relieving medications that can be used during labor and delivery?
In general, there are two types of pain-relieving drugs: 1) analgesics and 2) anesthetics. Analgesics relieve pain without total loss of feeling or muscle movement. They are used to lessen pain but usually do not stop pain completely. Anesthetics block all feeling, including pain.

What are systemic analgesics?
Systemic analgesics act on the whole nervous system, rather than a specific area, to lessen pain. They will not cause you act on the whole nervous system, rather than a specific area, to lessen pain. They will not cause you to lose consciousness. These medications often are used during early labor to allow you to rest.

Systemic analgesics usually are given as a shot. Depending on the type of medication, the shot is given into either a muscle or a vein. In patient-controlled analgesia, you can control the amount of medication you receive through an intravenous (IV) line. This is a small tube that is placed into a vein through which medications or fluids are given.

What are the risks of systemic analgesia?
Systemic pain medicine can have side effects, such as nausea, feeling drowsy, or having trouble concentrating. Sometimes another drug is given along with a systemic analgesic to relieve nausea. Systemic analgesics can affect the baby’s heart rate temporarily. It can be more difficult to detect fetal heart rate problems when these drugs are used. High doses of these drugs can cause you to have breathing problems and also can slow down the baby’s respiratory system, especially right after delivery.

What is local anesthesia?
Local anesthesia is the use of drugs that affect only a small area of the body. Local anesthetics provide relief from pain in that area. Local anesthetics are injected into the area around the nerves that carry feeling to the vagina, vulva, and perineum. The drugs are given just before delivery. They also are used when an episiotomy needs to be done or when any vaginal tears that happened during birth are repaired.

What are regional analgesia and regional anesthesia?
Regional analgesia and regional anesthesia act on a specific region of the body. Depending on the types of drugs that are used, they can lessen or block pain below the waist. They include the epidural block, spinal block, and combined spinal–epidural (CSE) block.

What is an epidural block?
An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used during labor and delivery in the United States. In an epidural block, medication is given through a tube placed into the lower back.

An epidural block can be used during labor and for a vaginal delivery or cesarean delivery. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used. This combination of drugs causes some loss of feeling in the lower areas of your body, but you remain awake and alert. You should be able to bear down and push your baby through the birth canal. For a cesarean delivery, the dose of anesthetic may be increased. This causes loss of sensation in the lower half of your body. An epidural also can be used for postpartum sterilization.

How long does an epidural take to work?
Because the medication needs to be absorbed into several nerves, it may take a short time for it to take effect. Pain relief should begin within 10–20 minutes after the medication has been injected.

Will I be able to move or feel anything after receiving an epidural?
You can move with an epidural, but you may not be able to walk around. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel your health care provider’s exams as labor progresses.

What are the risks of an epidural?
Although it is rare, an epidural block can cause the following side effects:
Decrease in blood pressure—An epidural can cause your blood pressure to decrease. This, in turn, may slow the baby’s heartbeat.
Fever—Some women develop a low-grade fever as a normal reaction to an epidural.
Headache—If the covering of the spinal cord is pierced while the tube is being placed and spinal fluid leaks out, you can get a bad headache. This happens rarely.
Soreness—After delivery, your back may be sore for a few days.
Serious complications with epidurals are very rare:
There is a small risk that the anesthetic medication could be injected into one of the veins in the epidural space. This can cause dizziness, rapid heartbeat, a funny taste, or numbness around the mouth when the epidural is placed.
If anesthetic enters your spinal fluid, it can affect your breathing muscles and make it hard to breathe.

What is a spinal block?
A spinal block—like an epidural block—is a form of regional pain relief. A small amount of medication is injected into the spinal fluid. Depending on the drugs used, it can be used for regional analgesia or anesthesia. It starts to relieve pain quickly, but it lasts for only an hour or two.

Will I be able to move or feel anything after receiving a spinal block?
You may be numb after receiving a spinal block and will need assistance moving.

What are the risks of a spinal block?
A spinal block can cause the same side effects as an epidural block.

What is a combined spinal–epidural (CSE) block?
A CSE block is another form of regional pain relief. It has the benefits of both a spinal block and an epidural block. The spinal part acts quickly to relieve pain. The epidural part provides continuous pain relief. Lower doses of medication can be used with a CSE block than with an epidural block for the same level of pain relief.

Will I be able to move after receiving a CSE block?
The CSE block sometimes is called a “walking epidural.” Depending on your hospital’s policy, you may be able to walk for a short distance after the block is in place. For example, you may be able to walk a few feet to the bathroom with assistance. However, some hospitals and birthing centers require women who receive any type of pain relief to remain in bed.

What are the risks of a CSE block?
A CSE has the same risks as an epidural block.

What is general anesthesia?
General anesthesia causes you to lose consciousness so that you do not feel pain. It usually is used only for emergency situations during childbirth.

How is general anesthesia given?
It is given through an IV line or through a mask. After you are asleep, your anesthesiologist will place a breathing tube into your mouth and windpipe.

What are the risks of general anesthesia?
A rare but major risk is aspiration of food or liquids from a woman’s stomach into the lungs. Labor usually causes undigested food to stay in the stomach longer than usual. While you are unconscious, the contents of your stomach can come back into the mouth and go into the lungs. This can cause a lung infection (pneumonia) that can be serious. General anesthesia usually requires the placement of a breathing tube into the lungs to help you breathe while you are unconscious. Difficulty placing this tube is another risk. General anesthesia can cause the newborn baby’s breathing rate to decrease. It also can make the baby less alert. In rare cases, the baby may need help breathing after birth.

Glossary
Analgesics: Drugs that relieve pain without loss of muscle function.

Anesthetics: Drugs that relieve pain by loss of sensation.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Combined Spinal–Epidural (CSE) Block: A form of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid (spinal block) as well as through a thin tube into the epidural space (epidural block).

Epidural Block: A type of regional anesthesia or analgesia in which pain medications are given through a tube placed in the space at the base of the spine.

Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) to widen the vaginal opening for delivery.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Perineum: The area between the vagina and the anus.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.

Regional Analgesia: The use of drugs to relieve pain in a region of the body.

Regional Anesthesia: The use of drugs to block sensation in a region of the body.

Spinal Block: A type of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid.

Systemic Analgesics: Drugs that provide pain relief over the entire body without causing loss of consciousness.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.

What is cesarean birth?
Cesarean birth is the delivery of a baby through incisions made in the mother’s abdomen and uterus.

What are the reasons for cesarean birth?
The following situations are some of the reasons why a cesarean birth is performed:
Multiple pregnancy—If a woman is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other problems. The likelihood of having a cesarean birth increases with the number of babies a woman is carrying.
Failure of labor to progress—Contractions may not open the cervix enough for the baby to move into the vagina.
Concern for the baby—For instance, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.
Problems with the placenta
A large baby
Breech presentation
Maternal infections, such as human immunodeficiency virus or herpes
Maternal medical conditions, such as diabetes or high blood pressure

Is a cesarean birth necessary if I have had a previous cesarean birth?
Women who have had a cesarean birth before may be able to give birth vaginally. The decision depends on the type of incision used in the previous cesarean delivery, the number of previous cesarean deliveries, whether you have any conditions that make a vaginal delivery risky, and the type of hospital in which you have your baby, as well as other factors. Talk to your health care provider about your options.

Can I request cesarean birth?
Some women may request a cesarean birth even if a vaginal delivery is an option. This decision should be weighed carefully and discussed with your health care provider. As with any surgery, there are risks and complications to consider. Your hospital stay may be longer than with vaginal birth. Also, the more cesarean births a woman has, the greater her risk for some medical problems and problems with future pregnancies. This may not be a good option for women who want to have more children.

What are the preparations for cesarean birth?
Before you have a cesarean delivery, a nurse will prepare you for the operation. An intravenous line will be put in a vein in your arm or hand. This allows you to get fluids and medications during the surgery. Your abdomen will be washed, and your pubic hair may be clipped or trimmed. You will be given medication to prevent infection. A catheter (tube) is then placed in your urethra to drain your bladder. Keeping the bladder empty decreases the chance of injuring it during surgery. The incision made in the uterine wall for cesarean birth may be transverse (left) or vertical (right). The type of incision made in the skin may not be the same type of incision made in the uterus.

What type of anesthesia will be used during the procedure?
You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. An epidural block numbs the lower half of the body. An injection is made into a space in your spine in your lower back. A small tube may be inserted into this space so that more of the drug can be given through the tube later, if needed. A spinal block also numbs the lower half of your body. You receive it the same way as an epidural block, but the drug is injected directly into the spinal fluid.

How is the procedure performed?
An incision is made through your skin and the wall of the abdomen. The skin incision may be transverse (horizontal or "bikini") or vertical, near the pubic hairline. The muscles in your abdomen are separated and may not need to be cut. Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical.The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your abdominal skin.

What are the complications?
Some complications occur in a small number of women and usually are easily treated:
Infection
Blood loss
Blood clots in the legs, pelvic organs, or lungs
Injury to the bowel or bladder
Reaction to medications or to the anesthesia that is used

What should I expect after the procedure?
If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, amount of bleeding, and abdomen will be checked regularly. If you are planning on breastfeeding, be sure to let your health care provider know. Having a cesarean delivery does not mean you will not be able to breastfeed your baby. You should be able to begin breastfeeding right away. You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you.

Soon after surgery, the catheter is removed from the bladder. The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. A heating pad may be helpful. There are many different ways to control pain. Talk to your health care provider about your options.

A hospital stay after a cesarean birth usually is 2–4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself and limit your activities.

What should I expect during recovery?
While you recover, the following things may happen:
Mild cramping, especially if you are breastfeeding
Bleeding or discharge for about 4–6 weeks
Bleeding with clots and cramps
Pain in the incision

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your health care provider if you have a fever, heavy bleeding, or the pain gets worse.

Glossary
Breech Presentation: A situation in which a fetus’s buttocks or feet would be born first.

Cervix: The opening of the uterus at the top of the vagina.

Epidural Block: A type of anesthesia given through a tube placed in the space at the base of the spine.

Fetal Monitoring: A procedure in which instruments are used to record the heartbeat of the fetus and contractions of the mother’s uterus during labor.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is circumcision?
Circumcision is the surgical removal of the layer of skin, called the foreskin, that covers the glans (head) of the penis.

When is circumcision performed?
Circumcision on infants may be performed before or after the mother and baby leave the hospital. It only is performed if the baby is healthy. If the baby has a medical condition, circumcision may be postponed. Circumcision also can be performed on older children or adults. However, recovery may take longer when circumcision is done on an older child or adult. The risks of complications also are increased.

Is circumcision a required procedure?
Circumcision is an elective procedure. That means that it is the parents’ choice whether to have their infant sons circumcised. It is not required by law or by hospital policy. Because it is an elective procedure, circumcision may not be covered by your insurance policy. To find out, call your insurance provider or check your policy.

Is circumcision a common practice?
Although many newborn boys in the United States are circumcised, the number of circumcisions has decreased in recent years. It is less common in other parts of the world.

Why do some parents choose to have their sons circumcised?
There are hygienic reasons for circumcision. Smegma is a thick white discharge containing dead cells. It can build up under the foreskin of males who are not circumcised. This can lead to odor or infection. However, a boy who has not been circumcised can be taught to wash his penis to get rid of smegma as a part of his bathing routine. For some people, circumcision is a part of certain religious practices. Muslims and Jews, for example, have circumcised their male newborns for centuries. Others may choose circumcision so that the child does not look different from his father or other boys.

Why do some parents choose not to have their sons circumcised?
Some parents choose not to circumcise their sons because they are worried about the pain the baby may feel or the risks involved with the surgery. Others believe it is a decision a boy should make himself when he is older.

Are there any health benefits associated with circumcision?
Circumcised infants appear to have less risk of urinary tract infections than uncircumcised infants. The risk of urinary tract infection in both groups is low. It may help prevent cancer of the penis, a rare condition.

Some research suggests that circumcision may decrease the risk of a man getting human immunodeficiency virus (HIV) from an infected female partner. It is possible that circumcision may decrease the risk of passing HIV and other sexually transmitted diseases from an infected man to a female partner. At the present time, there is not enough information to recommend routine newborn circumcision for health reasons.

Are there any risks associated with circumcision?
Possible complications include bleeding, infection, and scarring. In rare cases, too much of the foreskin or not enough foreskin is removed. More surgery sometimes is needed to correct these problems.

How is circumcision performed?
Circumcision takes only a few minutes. During the procedure, the baby is placed on a special table. It is recommended that an anesthetic be used for pain relief. Various surgical techniques are used, but they follow the same steps:
The penis and foreskin are cleaned.
A special clamp is attached to the penis and the foreskin is removed.
After the procedure, a bandage and petroleum jelly are placed over the wound to protect it from rubbing against the diaper.

What should I expect after my baby boy has been circumcised?
If your baby boy has been circumcised, a bandage with petroleum jelly may be placed over the head of the penis after surgery. The bandage typically falls off the next time the baby urinates. Some heath care providers recommend keeping a clean bandage on until the penis is healed, while others recommend leaving it off. In most cases, the skin will heal in 7–10 days. You may notice that the tip of the penis is red and there may be a small amount of yellow fluid. This usually is normal.

How do I keep the circumcised area clean?
Use a mild soap and water to clean off any stool that gets on the penis. Change the diapers often so that urine and stool do not cause infection. Signs of infection include redness that does not go away, swelling, or fluid that looks cloudy and forms a crust.

If I decide not to have my son circumcised, how do I clean his penis and foreskin?
If your baby boy has not been circumcised, washing the baby’s penis and foreskin properly is important. The outside of the penis should be washed with a mild soap and water. Do not attempt to pull back the infant’s foreskin. The foreskin may not be able to pull back completely until the child is about 3–5 years old. This is normal. As your child gets older, teach your son how to wash his penis. He should pull back the foreskin and clean the area with soap and water. The foreskin then should be pushed back into place.

Glossary
Anesthetic: A drug used to relieve pain.

Foreskin: A layer of skin covering the end of the penis.

Glans: The head of the penis.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Smegma: A whitish, cheesy substance normally built up and shed from under the male foreskin.

How does breastfeeding benefit my baby?
Breastfeeding benefits your baby in the following ways:
Breast milk provides the perfect mix of vitamins, protein, and fat that your baby needs to grow.
The colostrum that your breasts make during the first few days after childbirth helps your newborn’s digestive system grow and function.
Breast milk has antibodies that help your baby’s immune system fight off viruses and bacteria.
Breast milk is easier to digest than formula.
Breastfeeding decreases the risk of sudden infant death syndrome (SIDS).
If your baby is born preterm, breast milk can help reduce the risk of many of the short-term and long-term health problems that preterm babies face.

How does breastfeeding my baby benefit me?
Breastfeeding is good for you for the following reasons:
During breastfeeding, the hormone oxytocin is released. Oxytocin causes the uterus to contract and return to its normal size more quickly.
Breastfeeding may help with postpartum weight loss.
Women who breastfeed have lower rates of breast cancer and ovarian cancer than women who do not breastfeed. It also has been shown to reduce the risk of heart disease and rheumatoid arthritis.
Breastfeeding saves time and money.

How long should I breastfeed my baby?
It is recommended that babies breastfeed exclusively at least for the first 6 months of life. Your baby can continue to breastfeed beyond his or her first birthday as long as you and your baby want to.

How can I help my baby to begin breastfeeding?
Babies are born with all the instincts they need to breastfeed. A healthy newborn usually is capable of breastfeeding without any specific help within the first hour of birth. Immediately after the birth, your baby should be placed in direct skin-to-skin contact with you if possible. A nurse or lactation consultant (a health care provider with special training in breastfeeding) can help you find a good position.

What can I do to help my baby latch on?
To begin breastfeeding, the baby needs to attach to or “latch on” to your breast. Cup your breast in your hand and stroke your baby’s lower lip with your nipple. This stimulates the baby’s rooting reflex. The rooting reflex is a baby’s natural instinct to turn toward the nipple, open his or her mouth, and suck. The baby will open his or her mouth wide (like a yawn). Pull the baby close to you, aiming the nipple toward the roof of the baby’s mouth. Remember to bring your baby to your breast—not your breast to your baby.

How do I know if the baby is latched on correctly?
The baby should have all of your nipple and a good deal of the areola in his or her mouth. The baby’s nose will be touching your breast. The baby’s lips also will be curled out on your breast. The baby’s sucking should be smooth and even. You should hear the baby swallow. You may feel a slight tugging. If the baby is not latched on well, start over. To break the suction, insert a clean finger between your breast and your baby’s gums. When you hear or feel a soft pop, pull your nipple out of the baby’s mouth.

When should I switch breasts during breastfeeding?
When your baby empties one breast, offer the other. Do not worry if your baby does not continue to breastfeed. The baby does not have to feed at both breasts in one feeding. At the next feeding, offer the other breast first.

How long should each breastfeeding session last?
Let your baby set his or her own schedule. Many newborns breastfeed for 10–15 minutes on each breast, but some may feed for longer periods. A baby who wants to breastfeed for a long time—such as 30 minutes on each side—may be having trouble getting enough milk or may be just taking his or her time to feed.

How can I tell when my baby is hungry?
When babies are hungry, they will nuzzle against your breast, make sucking motions, or put their hands to their mouths. Crying usually is a late sign of hunger.

How often should I breastfeed my baby?
It is recommended that you breastfeed at least 8–12 times in 24 hours, or about every 2–3 hours, in the baby’s first weeks of life.

How will I know when my baby is full?
When full, the baby will fall asleep or unlatch from your breast.

When is it okay to let my baby use a pacifier?
Until your baby gets the hang of breastfeeding, experts recommend limiting pacifier use to only a few instances. You may only want to give a pacifier to help with pain relief (while getting a shot, for instance). After about 4 weeks, when your baby is breastfeeding well, you can use the pacifier at any time. Pacifier use at nap or sleep times may help reduce the risk of SIDS.

What problems may I encounter while breastfeeding?
It is normal for minor problems to arise in the days and weeks when you first begin breastfeeding. If any of the following problems persist, call your health care provider or ask to see a lactation specialist:
Nipple pain—Some soreness or discomfort is normal when beginning breastfeeding. Nipple pain or soreness that continues past the first week or does not get better usually is not normal. Nipple pain may be caused by the baby not getting enough of the areola into his or her mouth and instead sucking mostly on the nipple. Make sure the baby’s mouth is open wide and has as much of the areola in the mouth as possible. Applying a small amount of breast milk to the nipple may speed up the healing process. Try different breastfeeding positions to avoid sore areas.
Engorgement—When your breasts are full of milk, they can feel full, hard, and tender. Once your body figures out just how much milk your baby needs, the problem should go away in a week or so. To ease engorgement, breastfeed more often to drain your breasts. Before breastfeeding, you can gently massage your breasts or express a little milk with your hand or a pump to soften them. Between feedings, apply warm compresses or take a warm shower to help ease the discomfort.
Blocked milk duct—If a duct gets clogged with unused milk, a hard knot will form in that breast. To clear the blockage and get the milk flowing again, try breastfeeding long and often on the breast that is blocked. Apply heat with a warm shower, heating pad, or hot water bottle.
Mastitis—If a blocked duct is not drained, it can lead to a breast infection called mastitis. Mastitis can cause flu-like symptoms, such as fever, aches, and fatigue. Your breast also will be swollen and painful and may be very warm to the touch. If you have these symptoms, call your health care provider. You may be prescribed an antibiotic to treat the infection. You may be able to continue to breastfeed while taking this medication.

What can I do to ensure that I provide the best nutrition for my baby and myself?
The following tips will help you meet the nutritional goals needed for breastfeeding:
You need an extra 450–500 calories a day while breastfeeding.
Your health care provider may recommend that you continue to take your prenatal multivitamin supplement while you are breastfeeding. The baby’s health care provider may recommend that you give your baby 400 international units of vitamin D daily in drop form. This vitamin is essential for strong bones and teeth.
Drink plenty of fluids and drink more if your urine is dark yellow. It is a good idea to drink a glass of water every time you breastfeed.
Avoid foods that may cause stomach upset in your baby. Common culprits are gassy foods, such as cabbage, and spicy foods.
Drinking caffeine in moderate amounts should not affect your baby. A moderate amount of caffeine is about 200 milligrams a day.
If you want to have an occasional alcoholic drink, wait at least 2 hours after you drink to breastfeed.
Always check with your health care provider before taking prescription or over-the-counter medications to be sure they are safe to take while breastfeeding.
Avoid smoking and using illegal drugs. Both can harm your baby. Taking prescription drugs (such as codeine, tranquilizers, or sleeping pills) for nonmedical reasons also can be harmful.

What are some birth control methods that I can use while breastfeeding?
Progestin-only methods, including pills, the implant, and the injection, can be started immediately after childbirth while you are still in the hospital. Methods that contain estrogen, such as combination birth control pills, the vaginal ring, and the skin patch, should not be used during the first month of breastfeeding. Estrogen may decrease your milk supply. Once breastfeeding is established, estrogen-containing methods can be used.

What should I know about returning to work if I am breastfeeding?
By law, your employer is required to provide a reasonable amount of break time and a place to express milk as frequently as needed for up to 1 year following the birth of a child. The space provided by the employer cannot be a bathroom, and it must be shielded from view and free from intrusion by coworkers or the public. You also will need a safe place to store the milk properly. During an 8-hour workday, you should be able to pump enough milk during your breaks.

Glossary
Antibiotic: A drug that treats infections.

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Areola: The darker skin around the nipple.

Colostrum: A fluid secreted in the breasts at the beginning of milk production.

Estrogen: A female hormone produced in the ovaries.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Oxytocin: A hormone used to help bring on contractions of the uterus.

Preterm: Born before 37 weeks of pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Sudden Infant Death Syndrome (SIDS): The unexpected death of an infant and in which the cause is unknown.

What are the postpartum blues?
About 2–3 days after childbirth, some women begin to feel depressed, anxious, and upset. They may feel angry with the new baby, their partners, or their other children. They also may cry for no clear reason have trouble sleeping, eating, and making choices question whether they can handle caring for a baby. These feelings, often called the postpartum blues, may come and go in the first few days after childbirth.

How long do the postpartum blues usually last?
The postpartum blues usually get better within a few days or 1–2 weeks without any treatment.

What is postpartum depression?
Women with postpartum depression have intense feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks.

When does postpartum depression occur?
Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth.

What causes postpartum depression?
Postpartum depression probably is caused by a combination of factors. These factors include the following:
Changes in hormone levels—Levels of estrogen and progesterone decrease sharply in the hours after childbirth. These changes may trigger depression in the same way that smaller changes in hormone levels trigger mood swings and tension before menstrual periods.
History of depression—Women who have had depression at any time—before, during, or after pregnancy—or who currently are being treated for depression have an increased risk of developing postpartum depression.
Emotional factors—Feelings of doubt about pregnancy are common. If the pregnancy is not planned or is not wanted, this can affect the way a woman feels about her pregnancy and her unborn baby. Even when a pregnancy is planned, it can take a long time to adjust to the idea of having a new baby. Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman’s self-esteem and how she deals with stress.
Fatigue—Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength and energy. For women who have had their babies by cesarean birth, it may take even longer.
Lifestyle factors—Lack of support from others and stressful life events, such as a recent death of a loved one, a family illness, or moving to a new city, can greatly increase the risk of postpartum depression.
If I think I have postpartum depression, when should I see my health care provider?
If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see your health care provider as soon as possible. Do not wait until your postpartum checkup.

How is postpartum depression treated?
Postpartum depression can be treated with medications called antidepressants. Talk therapy also is used to treat depression, often in combination with medications.

What are antidepressants?
Antidepressants are medications that work to balance the chemicals in the brain that control moods. There are many types of antidepressants. Drugs sometimes are combined when needed to get the best results. It may take 3–4 weeks of taking the medication before you start to feel better.

Can antidepressants cause side effects?
Antidepressants can cause side effects, but most are temporary and go away after a short time. If you have severe or unusual side effects that get in the way of your normal daily habits, notify your health care provider. You may need to try another type of antidepressant. If your depression worsens soon after starting medication or if you have thoughts of hurting yourself or others, contact your health care provider or emergency medical services right away.

Can antidepressants be passed to my baby through my breast milk?
If a woman takes antidepressants, they can be transferred to her baby during breastfeeding. The levels found in breast milk generally are very low. Breastfeeding has many benefits for both you and your baby. Deciding to take an antidepressant while breastfeeding involves weighing these benefits against the potential risks of your baby being exposed to the medication in your breast milk. It is best to discuss this decision with your health care provider.

What happens in talk therapy?
In talk therapy (also called psychotherapy), you and a mental health professional talk about your feelings and discuss how to manage them. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.

What are the types of talk therapy?
You may have one-on-one therapy with just you and the therapist or group therapy where you meet with a therapist and other people with problems similar to yours. Another option is family or couples therapy, in which you and your family members or your partner may work with a therapist.

What can be done to help prevent postpartum depression in women with a history of depression?
If you have a history of depression at any time in your life or if you are taking an antidepressant, tell your health care provider early in your prenatal care. Ideally, you should tell your health care provider before you become pregnant. Your health care provider may suggest that you begin treatment right after you give birth to prevent postpartum depression. If you were taking antidepressants before pregnancy, your health care provider can assess your situation and help you decide whether to continue taking medication during your pregnancy.

What support is available to help me cope with postpartum depression?
Support groups can be found at local hospitals, family planning clinics, or community centers. The hospital where you gave birth or your health care provider may be able to assist you in finding a support group. Useful information about postpartum depression can be found on the following web sites:
National Women’s Health Information Center: http://www.womenshealth.gov/mental-health/illnesses/postpartum-depression.html
Postpartum Support International: www.postpartumsupport.net
Medline Plus: http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

Glossary
Antidepressants: Medications that are used to treat depression.

Cesarean Birth: Birth of a baby through surgical incisions made in the mother’s abdomen and uterus.

Estrogen: A female hormone produced in the ovaries.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Postpartum Blues: Feelings of sadness, fear, anger, or anxiety occurring about 3 days after childbirth and usually ending within 1–2 weeks.

Postpartum Depression: Intense feelings of sadness, anxiety, or despair after childbirth that interfere with a new mother’s ability to function and that do not go away after 2 weeks.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

What is a vaginal birth after cesarean delivery (VBAC)?
If you have had a previous cesarean delivery, you have two choices about how to give birth again:
You can have a scheduled cesarean delivery
You can give birth vaginally. This is called a vaginal birth after cesarean delivery (VBAC).

What is a trial of labor after cesarean delivery (TOLAC)?
A trial of labor after cesarean delivery (TOLAC) is the attempt to have a vaginal birth after cesarean delivery.

What are the some of the benefits of a TOLAC?
Compared with a planned cesarean delivery, a successful TOLAC is associated with the following benefits:
No abdominal surgery
Shorter recovery period
Lower risk of infection
Less blood loss
If you want to have more children, VBAC may help you avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.

What are the risks of a TOLAC?
With TOLAC, the risk of most concern is the possible rupture of the cesarean scar on the uterus or the uterus itself. Although a rupture of the uterus is rare, it is very serious and may harm both you and your baby. If you are at high risk of rupture of the uterus, TOLAC should not be tried.

Why is the type of uterine incision used in my previous cesarean delivery important?
Some types of uterine incisions are more likely to cause rupture of the uterus than others. Low transverse (side to side) incisions carry the least chance of rupture. Women who have had one or two previous ceasean deliveries with this type of incision can try TOLAC. High vertical (up and down) incisions carry the most chance of rupture. Women who have this type of incision should not try TOLAC.

What other factors should be considered when deciding whether to have a TOLAC?
In deciding whether to have a TOLAC, you should consider several factors in addition to the type of incision. These factors include whether you want more children, whether you have certain complications, and the hospital where the birth will take place:
Future deliveries—Multiple cesarean deliveries are associated with additional potential risks.
Prior uterine rupture—If you had this complication in a previous pregnancy, TOLAC is not advised.
A pregnancy problem or a medical condition that makes vaginal delivery risky
Type of hospital—The hospital in which you have a TOLAC should be prepared to deal with emergencies that may arise.
Whatever I decide, are there things that can happen during pregnancy or labor that may change my delivery plan?
Be prepared for changes to your delivery plan. If you have chosen TOLAC, things can happen during pregnancy and labor that alter the balance of risks and benefits. For example, you may need to have your labor induced, which can reduce the chances of a successful vaginal delivery and perhaps increase the chance of complications during labor. In the event that circumstances change, you and your health care provider may want to reconsider your decision.

If you have chosen a repeat cesarean delivery, in some situations, TOLAC may be advised. For example, if you have planned a cesarean delivery but go into labor before your scheduled surgery, it may be best to consider TOLAC if you are far along in your labor and your baby is healthy.

Glossary
Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Hysterectomy: Removal of the uterus.

What is preterm labor?
Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal).

What is preterm birth?
When birth occurs between 20 weeks of pregnancy and 37 weeks of pregnancy, it is called preterm birth.

Why is preterm birth a concern?
Preterm birth is a concern because babies who are born too early may not be fully developed. They may be born with serious health problems. Some health problems, like cerebral palsy, can last a lifetime. Other problems, such as learning disabilities, may appear later in childhood or even in adulthood.

Which preterm babies are at greatest risk of health problems?
The risk of health problems is greatest for babies born before 34 weeks of pregnancy. But babies born between 34 weeks and 37 weeks also are at risk.

What are risk factors for preterm birth?
Factors that increase the risk of preterm birth include the following:
Having a previous preterm birth
Having a short cervix
Short interval between pregnancies
History of certain types of surgery on the uterus or cervix
Certain pregnancy complications, such as multiple pregnancy and vaginal bleeding
Lifestyle factors such as low prepregnancy weight, smoking during pregnancy, and substance abuse during pregnancy

Can anything be done to prevent preterm birth if I am at high risk?
If you have had a prior preterm birth and you are planning another pregnancy, a preconception care checkup can help you get in the best possible health before you become pregnant. When you become pregnant, be sure to start prenatal care early. You may be referred to a health care provider who has expertise in managing high-risk pregnancies. In addition, you may be given certain medications or other treatment to help prevent preterm birth if you have risk factors. Treatment is given based on your individual situation and your risk factors for preterm birth.

What are the signs and symptoms of preterm labor and what should I do if I have any of them?
Call your health care provider right away if you notice any of these signs or symptoms:
Change in type of vaginal discharge (watery, mucus, or bloody)
Increase in amount of discharge
Pelvic or lower abdominal pressure
Constant low, dull backache
Mild abdominal cramps, with or without diarrhea
Regular or frequent contractions or uterine tightening, often painless
Ruptured membranes (your water breaks with a gush or a trickle of fluid)

How is preterm labor diagnosed?
Preterm labor can be diagnosed only when changes in the cervix are found. Your health care provider may perform a pelvic exam to see if your cervix has started to change. You may need to be examined several times over a period of a few hours. Your contractions also may be monitored.

Your health care provider may do certain tests to determine whether you need to be hospitalized or if you need immediate specialized care. A transvaginal ultrasound exam may be done to measure the length of your cervix. The level of a protein called fetal fibronectin in the vaginal discharge may be measured. The presence of this protein is linked to preterm birth.

If I have preterm labor, will I have a preterm birth?
It is difficult for health care providers to predict which women with preterm labor will go on to have preterm birth. Only about 10% of women with preterm labor will give birth within the next 7 days. For about 30% of women, preterm labor stops on its own.

What happens if my preterm labor continues?
If your preterm labor continues, how it is managed is based on what is thought to be best for your health and your baby’s health. When there is a chance that the baby would benefit from a delay in delivery, certain medications may be given. These medications include corticosteroids, magnesium sulfate, and tocolytics.

What are corticosteroids?
Corticosteroids are drugs that cross the placenta and help speed up development of the baby’s lungs, brain, and digestive organs. Corticosteroids are most likely to help your baby when they are given between 24 weeks of pregnancy and 34 weeks of pregnancy.

What is magnesium sulfate?
Magnesium sulfate is a medication that may be given if you are less than 32 weeks pregnant, are in preterm labor, and are at risk of delivery within the next 24 hours. This medication may help reduce the risk of cerebral palsy that is associated with early preterm birth.

What are tocolytics?
Tocolytics are drugs used to delay delivery for a short time (up to 48 hours). They may allow time for corticosteroids or magnesium sulfate to be given or for you to be transferred to a hospital that offers specialized care for preterm infants. In addition to its role in protecting against cerebral palsy, magnesium sulfate also can be used as a tocolytic drug.

What happens if my labor does not stop?
If your labor does not stop and it looks like you will give birth to your baby early, you and the baby usually will be cared for by a team of health care providers. The team may include a neonatologist, a doctor who specializes in treating problems in newborns. The care your baby needs depends on how early he or she is born. High-level neonatal intensive care units (NICUs) provide this specialized care for preterm infants.

Glossary
Cerebral Palsy: A long-term disability of the nervous system that affects young children in which control of movement or posture is abnormal and is not the result of a recognized disease.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Corticosteroids: Hormones given to help fetal lungs mature, for arthritis, or for other medical conditions.

Fetal Fibronectin: A protein produced during pregnancy.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Magnesium Sulfate: A drug that may help prevent cerebral palsy when it is given to women in preterm labor who are at risk of delivery before 32 weeks of pregnancy.

Neonatologist: A doctor who specializes in the diagnosis and treatment of disorders that affect newborn infants.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Tocolytics: Medications used to stop or slow preterm labor.

Transvaginal Ultrasound: A type of ultrasound in which a device specially designed to be placed in the vagina is used.

Uterus: A muscular organ located in the female abdomen that contains and nourishes the developing embryo and fetus during pregnancy.

What are the benefits of exercising after having a baby?
Daily exercise can help restore muscle strength and firm up your body. Exercise can make you less tired because it raises your energy level and improves your sense of well-being. During pregnancy, the muscles in your abdomen stretch. It takes time for good muscle tone to return. Exercising helps tighten these muscles.

When can I start exercising after having a baby?
Check with your doctor before starting an exercise program. You should start when you feel up to it and know you will keep it up. Follow the same guidelines as you did when you were pregnant. If you had a cesarean birth, a difficult birth, or complications, it may take a little while longer to feel ready to start exercising.

If you did not exercise during pregnancy, start with easy exercises and slowly build up to harder ones. If you exercised regularly throughout pregnancy, you have a head start. You should not try to resume your former pace right away, though.

How do I get started with an exercise program?
Walking is a good way to get back in shape. Brisk walks will prepare you for more vigorous exercise when you feel up to it. Walking is a good choice for exercise because the only thing you need is a pair of comfortable shoes. It is free, and you can do it almost any place or time.

Walking also is good because your baby can come along. The two of you can get out of the house for exercise and fresh air without needing to find child care. Seeing other people and being outside can help relieve stress and tension.

When should I add exercises besides walking?
As you feel stronger, think about trying more vigorous exercise. You will want to decide on exercises that meet your needs. A good program will make your heart and lungs stronger and tone your muscles. There are special postpartum exercise classes that you can join. Your health care provider can help you find some good classes.

What resources are available?
Resources that may be helpful are local health and fitness clubs, community centers, local colleges, hospitals, and adult education programs. With any program you get involved in, make sure it is one you will keep doing. Exercise over time is more important than starting right away after birth.

What are some basic tips for staying cool and comfortable while exercising?
Wear comfortable clothing that will help keep you cool.
Wear a bra that fits well and gives plenty of support to help protect your breasts.
Drink plenty of water.

How can I warm up before exercising?
Before you begin each exercise session, always warm up for 5–10 minutes. This light activity, such as slow walking, prepares your muscles for exercise. As you warm up, stretch your muscles to avoid injury. Hold each stretch for 10–20 seconds—do not bounce.

What is my target heart rate?
You should exercise so that your heart beats at the level that gives you the best workout. This is called your target heart rate. Your target heart rate is 50–85% of the average maximum heart rate for your age. To check your heart rate, count the beats by feeling the pulse on the inside of your wrist. Count for 10 seconds. Multiply this count by 6 to get the number of beats per minute.

When you begin your exercise program, aim for the lower range of your target heart rate (50% of your maximum heart rate). As you get into better shape, slowly build up to the higher end of your target heart rate. After 6 months of exercise, you should be able to exercise at up to 85% of your maximum heart rate. But you do not need to exercise at 85% of your maximum heart rate to stay fit. You should aim to exercise about 20–30 minutes while in your target heart rate.

How can I cool down?
After exercising, cool down by slowing your activity. Cooling down allows your heart rate to return to normal levels. Cooling down for 5–10 minutes, followed by stretching, also helps prevent sore muscles.

What is labor induction?
Labor induction is the use of medications or other methods to bring on (induce) labor.

Why is labor induced?
Labor is induced to stimulate contractions of the uterus in an effort to have a vaginal birth. Labor induction may be recommended if the health of the mother or fetus is at risk. In special situations, labor is induced for nonmedical reasons, such as living far away from the hospital. This is called elective induction. Elective induction should not occur before 39 weeks of pregnancy.

What is the Bishop score?
To prepare for labor and delivery, the cervix begins to soften (ripen), thin out, and open. These changes usually start a few weeks before labor begins. Health care providers use the Bishop score to rate the readiness of the cervix for labor. With this scoring system, a number ranging from 0–13 is given to rate the condition of the cervix. A Bishop score of less than 6 means that your cervix may not be ready for labor.

What is "ripening the cervix"?
Ripening the cervix is a process that helps the cervix soften and thin out in preparation for labor. Medications or devices may be used to soften the cervix so it will stretch (dilate) for labor.

How is cervical ripening performed?
Ripening of the cervix can be done with prostaglandins or with special devices.

What are prostaglandins?
Prostaglandins are drugs that can be used to ripen the cervix. They are forms of chemicals produced naturally by the body. These drugs can be inserted into the vagina or taken by mouth. Some of these drugs are not used in women who have had a previous cesarean delivery or other uterine surgery to avoid increasing the possible risk of uterine rupture (tearing).

What devices are used to ripen and dilate the cervix?
Laminaria (a substance that absorbs water) can be inserted to expand the cervix. A catheter (small tube) with an inflatable balloon on the end also can be inserted to widen the cervix.

What is "stripping the membranes?"
Stripping the membranes is a way to induce labor. The health care provider sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. This action may cause your body to release prostaglandins, which soften the cervix and may cause contractions.

How can rupturing the amniotic sac bring on labor?
Rupturing the amniotic sac can start contractions. It also can make them stronger if they have already begun. The health care provider makes a small hole in the amniotic sac with a special tool. This procedure, called an amniotomy, may cause some discomfort.

When is amniotomy done?
Amniotomy is done to start labor when the cervix is dilated and thinned and the baby’s head has moved down into the pelvis. Most women go into labor within hours after the amniotic sac breaks (their "water breaks").

What is oxytocin?
Oxytocin is a hormone that causes contractions of the uterus. It can be used to start labor or to speed up labor that began on its own. Contractions usually start in about 30 minutes after oxytocin is given.

What are the risks associated with labor induction?
With some methods, the uterus can be overstimulated, causing it to contract too frequently. Too many contractions may lead to changes in the fetal heart rate, umbilical cord problems, and other problems. Other risks of cervical ripening and labor induction include the following:
Infection in the mother or baby
Uterine rupture
Increased risk of cesarean birth
Fetal death
Medical problems that were present before pregnancy or occurred during pregnancy may contribute to these complications.

Is labor induction always effective?
Sometimes labor induction does not work. A failed attempt at induction may mean that you will need to try another induction or have a cesarean delivery. The chance of having a cesarean delivery is greatly increased for first-time mothers who have labor induction, especially if the cervix is not ready for labor.

Glossary
Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Amniotomy: Artificial rupture of the amniotic sac.

Cervix: The opening of the uterus at the top of the vagina.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy.

Laminaria: A natural or artificial substance inserted in the cervix that expands when it absorbs water.

Oxytocin: A hormone used to help bring on contractions of the uterus.

Prostaglandins: Chemicals that are made by the body that have many effects, including causing the muscle of the uterus to contract, usually causing cramps.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is a “medically indicated” delivery?
A medically indicated delivery is done for a medical reason. These reasons may be the woman’s medical condition or a problem with the baby. Labor may be induced (started with the use of certain drugs or other means) or a cesarean delivery may be performed (in which the baby is born through incisions made in the abdomen and uterus).

What is an “elective” delivery?
An elective delivery is performed for a nonmedical reason. Some nonmedical reasons include wanting to schedule the birth of the baby on a specific date or living far away from the hospital. Some women request delivery because they are uncomfortable in the last weeks of pregnancy. Some women request a cesarean delivery because they fear vaginal birth.

How long does a normal pregnancy last?
A normal pregnancy lasts about 40 weeks. It was once thought that babies born a few weeks early—between 37 weeks and 39 weeks—were just as healthy as babies born after 39 weeks. Experts now know that babies grow throughout the entire 40 weeks of pregnancy.

How does the baby grow and develop during the last weeks of pregnancy?
The lungs, brain, and liver are among the last organs to fully develop during pregnancy. The brain develops at its fastest rate at the end of pregnancy—it grows by one third just between week 35 and week 39. Also during these last weeks, layers of fat are added underneath the baby’s skin. This fat helps keep the baby warm after birth.

What are the risks for babies born before 39 weeks?
Babies who are born before 39 weeks may not be as developed as those who are born after 39 weeks. Because they may be less developed, they may have an increased risk of short-term and long-term health problems. Some of these problems can have lasting effects.

What health problems are possible for babies born too early?
The following health problems are possible in babies who are born too early:
Breathing problems, including respiratory distress syndrome
Temperature problems—Babies born early may not be able to stay warm.
Feeding difficulties
High levels of bilirubin—Too much bilirubin can cause jaundice. In severe cases, brain damage can result if this condition is not treated.
Hearing and vision problems
Learning and behavior problems

Why is it not a good idea to have an elective labor induction or cesarean delivery before 39 weeks?
Health care professionals recommend that unless there is a valid health reason or labor starts on its own, delivery should not occur before at least 39 weeks. If you have a cesarean delivery or labor induction for a medical reason, it means that the benefits of having the baby early outweigh the potential risks. But when they are done for a nonmedical reason, the risks—both to you and to the baby—may outweigh the benefits. When your pregnancy is normal and healthy, it should continue for at least 39 weeks, and it is preferable for labor to start on its own.

What are the risks associated with induced labor?
When labor is induced, there is an increased chance of infection, uterine rupture, and hemorrhage (life-threatening bleeding) compared to when labor starts on its own. Labor induction also may increase the likelihood of having a cesarean delivery, especially if you are giving birth for the first time and if your cervix is not ready for labor.

What are the risks associated with cesarean delivery?
A cesarean delivery is major surgery. Like all surgical procedures, it has risks, including infection, hemorrhage, and problems related to the anesthesia used. An elective cesarean delivery may pose additional risks if you plan to have more children. With each cesarean delivery, the chance that you will have a serious complication—including uterine rupture and needing a hysterectomy at the time of delivery—increases.

What are my alternatives to having an elective delivery before 39 weeks?
If you are considering an elective delivery before 39 weeks, it is important to discuss the potential risks and benefits with your health care provider as well as your reasons for requesting this type of delivery. If discomfort is a reason, it may help to know that it is normal to feel uncomfortable at the end of pregnancy. Your health care provider may be able to suggest ways to help you feel better. If you live far away from the hospital, you might want to stay with someone who lives closer.

You also may be able to set out for the hospital when you are in early labor. Talk to your health care provider to get other suggestions and advice.

Glossary
Anesthesia: Relief of pain by loss of sensation.

Bilirubin: A substance produced when the body breaks down worn-out red blood cells. High levels of bilirubin can result in jaundice and lead to other problems in newborns.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Hysterectomy: Removal of the uterus.

Jaundice: A buildup of bilirubin that causes a yellowish appearance.

Respiratory Distress Syndrome: A condition of some babies in which the lungs are not mature and causes breathing difficulties.

Uterine Rupture: A rare but serious complication of childbirth in which the uterus tears during labor or delivery.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.