Pregnancy and Childbirth

Steps you can take to prepare your body for a healthy pregnancy include:

• Take folic acid. The U.S. Public Health Service recommends that women of childbearing age get at least 400 micrograms of folic acid daily. Folic acid is contained in certain foods and in supplements. Folic acid supplements are often recommended to women three months before getting pregnant and for at least the first three months of pregnancy.
• Get your immunizations. If you’re thinking about getting pregnant, get vaccinatedbefore you get pregnant for diseases that could harm the fetus. These include chicken pox and rubella.
• Make sure any medical conditions are under control.
• Be healthy! Maintain a healthy weight, eat a well-balanced diet, and get regular physical activity. These behaviors will help keep you and your fetus healthy during pregnancy. As well, avoid smoking, alcohol, and drugs.
• Avoid harmful exposures. Some prescription, over-the-counter medications, and herbs and supplements can be harmful to the fetus—ask your healthcare provider about these and also about environmental exposures (certain cleaning products, for example) that you should avoid.

If you’re in your thirties or forties…

Fertility declines with age, but many, if not most, women in their late thirties and early forties have healthy babies. At this stage in life, however, you may need to pay extra attention to how you prepare your body for pregnancy. See your doctor regularly before you start trying to conceive—he or she can help you prepare.

When Should I Stop Taking Birth Control?

It is usually recommended that women who want to get pregnant stop taking birth control pills three months before they start trying to conceive. Condoms can be used for birth control during these three months.

Fertility Problems

Women of childbearing age who cannot get pregnant after one year of trying and men who cannot impregnate a woman after one year of trying are considered infertile. As well, the term infertile is used to describe women who can get pregnant but cannot carry a pregnancy to term, or birth.

What causes infertility?

There is no single cause of infertility, but several factors may contribute. And because becoming pregnant requires that several steps—from release of a healthy egg from the ovaries to nurturing a growing fetus—are carried out successfully, a complication with any of these steps can lead to infertility.

Genetic conditions and other health problems—gynecological and general—can cause infertility, and environmental factors can also contribute. Gynecologic causes of infertility may include: blocked fallopian tubes due to endometriosis, pelvic inflammatory disease, or surgery; problems with the uterine wall; and uterine fibroids.

Problems with ovulation are often the cause of infertility. Ovulation can be affected when the ovaries stop functioning before natural menopause (premature ovarian failure), by polycystic ovarian syndrome (PCOS)—a condition where an egg is not released regularly or is not viable and healthy—and other conditions. Polycystic ovarian syndrome can also affect a woman’s uterus, making it impossible for the fertilized egg to be implanted.

Lifestyle and environmental factors that can raise a woman’s risk of infertility include:

• Age
• Stress
• Poor diet
• Being overweight or underweight
• Smoking, drugs, and alcohol
• Environmental toxins
• Genetic conditions
• Other health problems, such as sexually transmitted diseases

Infertility can be diagnosed by a healthcare provider. For some couples, infertility is treatable, often with both medical approaches and lifestyle changes.

Exams and Testing

Testing for Pregnancy

Testing for pregnancy can be performed at home or in your doctor’s office. In both settings, tests work by detecting a hormone in the urine or blood that is present only during pregnancy. This hormone is called human chorionic gonadotropin (hCG) and is made when a fertilized egg implants in the uterus—about six days after the sperm and egg merge. Blood tests are performed by your doctor, and urine tests can be done at home or at the doctor’s office.

Tests and Exams During Pregnancy

Regular visits to the doctor throughout pregnancy (prenatal care) will monitor your health and your baby’s. Early appointments will include checking blood pressure, taking urine samples, and measuring uterine size, as well as weighing the mother and checking the fetal heart rate.

Different tests and exams are performed as pregnancy evolves; for example, amniocentesis, a test to rule out certain defects including Down syndrome, can be performed during the second trimester, as can ultrasound, which determines the baby’s sex. As a mother’s due date approaches during the third trimester, exams will begin to focus on progress toward labor, with internal and external exams that check the baby’s size and determine if he or she has dropped into the correct position for birth.

Why is prenatal care important?

Early and regular prenatal care is very important to the health of your baby and to your own health during pregnancy. If problems do arise, regular visits to your doctor can allow him or her to identify and treat complications as soon as possible. Studies also show that compared with babies whose mothers get prenatal care, those whose mothers don’t have a greater risk of low birth weight and of death.

What Happens Throughout Each Trimester?

Each trimester, or three-month period, of pregnancy is marked by different phases of development for the fetus and changes to the mother’s body. Regular visits to the doctor remain important throughout each trimester. Appropriate exams and tests will be performed as pregnancy progresses.

First Trimester

During the first trimester (the first 12 weeks after the first day of the last menstrual period), an egg is released by the mother’s body and is fertilized by a sperm. The fertilized egg then travels down the fallopian tube toward the uterus, where it implants (attaches) to the lining of the uterus. The fertilized egg is now considered an embryo and will grow in size and develop throughout the first trimester. By the end of the third month, the embryo is called a fetus.

During this time, the mother’s breasts will start to change, but she is not likely to look pregnant. She may also begin to experience dizziness, frequent urination, heartburn, food aversions and cravings, and morning sickness. Hormonal changes may also cause irritability and mood swings.

Second Trimester

At the beginning of the fourth month of pregnancy, when the second trimester begins, the baby is about 4 inches long and weighs just over an ounce. Some mothers begin to feel the baby move at this time. As the second trimester continues, the baby begins to grow muscle and hair and becomes more active. Toward the end of this trimester, the baby’s skin is covered with fine hair, called lanugo, and a waxy substance that protects the skin, called vernix. Brain development continues. He or she will be around 11 to 14 inches long by the end of the sixth month and weigh about 1 to 1.5 pounds.

Pregnant women may find that some of the discomforts of the first semester will ease during the second and that other discomforts will increase. Second-trimester discomforts can include skin changes, forgetfulness, swelling, backaches, nosebleeds, heartburn, constipation, and hemorrhoids. Pregnancy starts to show as the baby grows, and many women start to wear maternity clothes.

Third Trimester

The third trimester begins with the seventh month of pregnancy. The baby can open and close his or her eyes, continues to move, and can suck his or her thumb and make grasping motions. The baby continues to grow and gain weight throughout the third trimester. By the ninth month, the baby drops into a head-down position to be ready for birth. He or she now weighs between 6 and 9 pounds and is about 20 inches long.

For the mother, symptoms of the second trimester are likely to increase during the third, and she may have swelling in the legs, leg cramps, backaches, and shortness of breath and develop varicose veins.

What Happens During Childbirth?

When you arrive at the hospital to have your baby, be prepared to give your healthcare providers the following information about your labor so far:

• The date and time contractions began and their average duration and frequency
• The date, time, color, and amount of vaginal discharge
• The date, time, and color of fluid if your water has broken
• When you last ate, had a bowel movement, and if you’ve had diarrhea

You’ll typically be given an exam that will include taking your temperature, pulse, breathing rate, blood pressure, and possible other tests.

Labor and Delivery

There are four stages of labor, which include: 1) from onset of progressive contractions until the cervix is completely dilated; 2) from complete dilation to birth of the baby; 3) from birth of the baby to delivery of the placenta; 4) from delivery of the placenta to when the mother’s medical condition is stable and safe. Labor is different for every mother and can vary in length and difficulty.

Labor can also be induced if your doctor determines that it’s time for your baby to born but true labor hasn’t started. Medication is used to induce labor.

What Is an Epidural?

An epidural is a type of anesthesia that’s used to relieve pain during labor. An anesthesiologist administers an epidural as follows: A local anesthetic is injected into a small area of the back to numb it. A catheter is then inserted into the numbed area. As needed during labor, anesthesia is injected through the catheter.

By relieving pain, an epidural allows the mother to rest and focus on the birth instead of the pain. Other advantages of an epidural include little exposure to the medicine for the baby and no drowsiness for the mother, as with some other pain relievers.

Although research has widely proven that use of an epidural during childbirth is generally safe, there are several risks:

• The risk for a sudden drop in blood pressure: A mother’s blood pressure is monitored for this event so that it can be addressed immediately.
• The risk for severe headache caused by leakage of spinal fluid: This occurs in less than 1 percent of women.
• Possible side effects: These including shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
• Difficulty pushing: Forceps may be needed to help pull the baby through the birth canal.
• Numbness in the lower half of your body: The mother may require assistance walking after the birth.

Having a Healthy Pregnancy

In addition to seeing your doctor regularly during pregnancy, these general tips will help keep you and your fetus healthy:

• Avoid X-rays. If you must have diagnostic tests, including dental X-rays, tell your doctor or dentist that you are pregnant. Precautions can be taken.
• Get a flu shot. Flu may be more severe in pregnant women and require hospitalization.
• Ask your doctor whether you should take a daily prenatal vitamin.
• Don’t smoke, drink alcohol, or use drugs.
• Gain a healthy amount of weight—your doctor will help you determine how much you should be gaining.
• Unless your doctor has told you to avoid physical activity, stay active. If you’ve always been active, talk with your doctor about what level of activity you can maintain. A minimum recommendation is two-and-a-half hours per week of moderate-intensity activity, spread out throughout the week.
• Avoid hot baths and hot tubs.
• Manage stress levels and get plenty of sleep.
• Learn about childbirth and caring for a newborn—books, classes, videos, your doctor, and other mothers can all be excellent resources.

Nutrition Tips

• Eat healthy foods, including plenty of fruits and vegetables and foods that are rich in calcium.
• Drink plenty of fluids—mostly water.
• Get adequate nutrients from a variety of healthy foods. Iron is particularly important—it prevents anemia, which puts your fetus at risk for preterm birth and low birth weight.
• Don’t eat fish that tend to be high in mercury. These include swordfish, king mackerel, shark, and tilefish.
• Protect yourself from food-borne illnesses: wash fruits and vegetables thoroughly and don’t eat undercooked meat or fish.

Complications

It’s important to be aware of potential complications of pregnancy. Understanding early warning signs will help you know when to seek care, and knowing risk factors can help you determine your level of risk. Here are some examples:

Preeclampsia

Preeclampsia occurs when a woman experiences a sudden increase in blood pressure after her twentieth week of pregnancy. The condition can affect the mother’s kidney, liver, and brain and if not treated, can lead to long-term health problems and death of the mother and/or baby. Symptoms include high blood pressure, too much protein in the urine, swelling of face and hands, and problems such as headache, blurred vision, and abdominal pain. Risk factors for preeclampsia include high blood pressure before pregnancy or during previous pregnancies, obesity, age younger than twenty or older than forty, and certain health conditions including diabetes and kidney disease. The only cure for preeclampsia is to deliver the baby, though in some cases doctors will try to prolong the pregnancy so that the fetus can grow and mature more.

Eclampsia

Eclampsia is more severe form of preeclampsia. Mothers suffering from eclampsia may be at risk for seizures and coma.

Gestational Diabetes

Diabetes that occurs during pregnancy in a woman who has not had diabetes before is called gestational diabetes. Women at average risk of gestational diabetes are tested during weeks 24 to 28 of their pregnancy, and women at higher risk (such as those with a family history of type 2 diabetes) may be tested very early in pregnancy. When a mother controls gestational diabetes by maintaining normal blood sugar levels, maintaining a healthy weight, eating a healthy diet, and staying physically active, she is likely to have a healthy baby. When uncontrolled, however, gestational diabetes can adversely affect the baby.

Preterm Labor

Preterm labor occurs when the mother’s body tries to deliver the baby too early—before the pregnancy is full-term at 36 weeks. Symptoms may feel like menstrual cramping or a mild backache. If preterm labor contractions increase in frequency, strength, and length, there is a risk of delivering the baby too early. Serious instances of preterm labor may be treated with bed rest and medication; the goal of treatment is to allow the pregnancy to reach full-term.

Miscarriage

A miscarriage is a loss of pregnancy from natural causes that occurs before the twentieth week of pregnancy. Miscarriages are usually not preventable, nor are they the mother’s fault. There are, however, several risk factors that may contribute to the loss of pregnancy; these include a chromosomal abnormality in the fetus, problems with the uterus or cervix, and PCOS. Symptoms include spotting or bleeding, cramping or abdominal pain, and fluid or tissue passing through the vagina. If you have any of these symptoms, you should contact your doctor immediately.

Resources

Eunice Kennedy Shriver National Institute of Child Health & Human Development

www.pregnancy.org

American Pregnancy Association

Womenshealth.gov

SOURCES

Eunice Kennedy Shriver National Institute of Child Health & Human Development Web site. Available at: www.nichd.nih.gov. Accessed September 2010.

Womenshealth.gov Web site. Available at: www.womenshealth.gov. Accessed September 2010.

Pregancy.org Web site. Available at: www.pregnancy.org. Accessed September 2010.