Your Journey Through
Pregnancy
© 2013 Alere. All rights reserved. The Alere Logo and Alere
are trademarks of the Alere group of companies.
GJTP-0413
Your Journey Through Pregnancy
The information contained in this guide is intended for
informational purposes only, and should not interfere with or
be used as a substitute for doctor recommendations. The
enclosed material is the property of Alere Health, LLC, and
may not be copied or distributed, in whole or in part, without
the express written permission of the Alere Legal Department
(770.767.4500). Disclosure of this information outside its
intended use is strictly prohibited.
Your Journey
Through Pregnancy
Congratulations! You’re expecting. It’s very important
Table of Contents
Participate in Your Health Care _______________________ 3
BabyLine®_________________________________________ 4
Quick Guide for New Parents_________________________ 5
to take care of yourself. And your developing baby.
Section 1: Mapping Your Journey
This book will help you do that. It doesn’t replace
Normal Pregnancy and Care _________________________ 7
your doctor. But it will help you understand what’s
How Your Baby Develops ___________________________ 10
happening to your body. And guide you from the
Comfort Tips _ ____________________________________ 16
beginning of your pregnancy through the first six
Nutrition During Pregnancy _________________________ 24
weeks of your baby’s life. Enjoy the journey!
Caring for Gums and Teeth__________________________ 35
Holding Steady: Prevent Falls________________________ 36
Expecting More Than One___________________________ 37
Picking a Pediatrician______________________________ 47
Choosing Child Care_ ______________________________ 48
Section 2: Getting in Gear
Genetic Counseling________________________________ 51
Screening ________________________________________ 56
HIV and Pregnancy ________________________________ 58
Smoking and Pregnancy_ ___________________________ 61
Domestic Violence and Abuse_ ______________________ 66
3
1
Section 3: Problems – and Solutions
Nausea and Vomiting______________________________ 69
Infections________________________________________ 72
Diabetes_________________________________________ 80
Preterm Labor_____________________________________ 95
High Blood Pressure ______________________________ 102
Preeclampsia ____________________________________ 105
Bed Rest________________________________________ 110
Section 4: Are We There Yet?
Labor _ _________________________________________ 112
Delivery ________________________________________ 119
Baby Tests, Meds and Shots ________________________ 125
Special Delivery: Preemies _________________________ 128
Section 5: Welcome Home, Baby!
Food for Thought ________________________________ 130
Sleep Safe and Sound_ ____________________________ 142
Home Safety ____________________________________ 147
Postpartum Care__________________________________ 148
Postpartum Depression____________________________ 154
Well-Baby Care __________________________________ 157
Section 6: Resources
Case Management _______________________________ 165
Women, Infants and Children (WIC) _ ________________ 167
Online Information _______________________________ 169
Glossary of Terms ________________________________ 172
References_ _____________________________________ 181
2
Participate in Your Health Care
It’s very important to take an active role in your care.
This will help you have a healthy pregnancy. And deliver
a healthy baby. Here are some ways to do this:
▪ Ask
questions.
▪ Ask
for written
materials to make
things clearer.
▪ Learn
all you
can. But only use
reliable sources of
information. Your
pregnancy program
Web site is a good
place to start.
Ask your doctor
for other reliable
sources.
▪ Pay
attention to
how you feel.
Report any health changes to your doctor.
▪ Give
your doctor a list of all medicines you take. Include
vitamins and supplements. Make sure it’s OK to take
them during pregnancy. Take medicine only as directed.
Learn possible side effects. And tell your doctor if you
experience any of them.
▪ Call
your doctor if you have questions or concerns.
3
BabyLine
Quick Guide for New Parents
As part of the Pregnancy Program, you have access to
BabyLine®. BabyLine® is a special phone support line. It’s
available 24 hours a day, seven days a week. So call any
time you have questions
about your pregnancy, birth
or newborn. An experienced
nurse will answer your
questions until your baby is
six weeks old.
It’s wonderful to have a baby. But the first six weeks can
be filled with ups and downs. No one expects you to go it
alone. BabyLine® is here for you. Call our nurses anytime
you have questions about breastfeeding, diapering... You
name it. Or if you just need someone to talk to after a long
day or sleepless night with baby.
®
Call BabyLine® if you have
questions about:
▪ Your
changing body
during pregnancy
▪ Foods you should – and shouldn’t – eat
▪ Tests
you may have during pregnancy
Call your doctor if:
Call your pediatrician (baby doctor) if:
▪ You
have questions about your baby’s health.
▪ There’s
a big change in the way your baby acts, eats,
sleeps and/or cries.
▪ Your
baby has
diarrhea or is
constipated.
▪ You have bleeding any time during your pregnancy.
▪ Your
baby isn’t
wetting diapers as
much as usual.
▪ You
feel a big change in the way your baby is moving.
▪ Your
baby has a
fever higher than
100.3°F (or 38.5°C).
▪ You’ve been vomiting for 24 hours. And can’t keep food
or drink down.
▪ You
feel symptoms of early labor. (See Preterm Labor,
page 95.)
▪ You
feel very sad or depressed.
Seek immediate medical care if you have serious
problems like severe pain or bleeding.
4
Just remember: BabyLine® is not for emergencies. And
does not take the place of your doctor or your baby’s doctor.
▪ Your
baby is not
eating.
Seek immediate medical care if your baby is sick and
needs to be seen right away.
5
Important Phone Numbers
Section 1
Doctor______________________________________________
Mapping
Your
Journey
Hospital_ ___________________________________________
BabyLine® __________________________________________
Primary Nurse_ ______________________________________
Home Care Nurse ____________________________________
Pharmacy___________________________________________
Ambulance or Paramedics_____________________________
Transportation (Taxi)__________________________________
Poison Control Center_ _______________________________
Police Station________________________________________
Fire Department______________________________________
Electric Company_ ___________________________________
Gas Company_______________________________________
Water Company______________________________________
Other_______________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Dial 911 for emergencies
6
Normal Pregnancy and Care
Make an appointment to see your doctor as soon as you
know or suspect you’re expecting. Begin regular care. Go
to all checkups.
Pregnancy lasts an average of
280 days or 40 weeks. A baby
born at or after 37 weeks is
considered to be full term. An
easy way to figure out your
estimated due date is to add
nine months and seven days to
the first day of your last period.
Not sure when your last period
started? Your doctor can get an
idea of your due date from an ultrasound. Or when he/she
first hears your developing baby’s heartbeat.
But remember: This is just an estimated date. Few babies
are actually born on their estimated day of arrival.
7
Take Good Care of Yourself
When to Call Your Doctor
Getting regular checkups is the first step toward a healthy
pregnancy. At your first exam, your doctor will give you a
pelvic exam and urine and blood tests. He/she will check
your weight, height,
blood pressure, heart,
lungs, eyes, breasts
and thyroid gland. Your
doctor will also ask
about your family and
sexual history. And if
you have any chronic
diseases or allergies. Or
take any medicine. He/she may suggest lifestyle changes
to make your pregnancy healthier. Things like giving up
smoking and alcohol, limiting caffeine, eating right and
exercising. In a normal pregnancy, a woman typically has
checkups every four weeks until the 28th week. From 28 to
36 weeks, she sees her doctor every two weeks. And after
36 weeks, she has weekly checkups until the baby is born.
Women with special needs see their doctor more often. It’s
very important to keep all scheduled appointments.
Call your doctor right away if you have any of these signs:
What to Expect at Doctor Appointments
Your first appointment will be very thorough. Follow-up
checkups typically take less time. During regular checkups,
your doctor will take a urine sample and:
▪ Check
weight and blood pressure
▪ Check developing baby’s heartbeat
▪ Measure
your uterus
8
▪ Contractions
10 or fewer minutes apart (if less than
37 weeks)
▪ Noticeable
changes in developing baby’s movements
▪ Blurry
vision or spots before your eyes
▪ Continuous
diarrhea or constipation
▪ Bladder
feels full, but you can’t urinate
▪ Bladder
still feels full after urinating
▪ Pain
or burning when urinating
change in urine output
▪A
▪ Dark
or cloudy urine
▪ Red
or swollen legs
▪ Swelling
in face, hands or feet
▪ Continuous
vomiting
▪ Sudden
weight gain
▪ Dizziness
or confusion
▪ Pressure
on vagina or pelvis
▪ Cramps
(like during your period)
▪ Change
in vaginal discharge
▪ Vaginal
bleeding
▪ Bad
headache that doesn’t let up
▪ Chills
or fever of 100.4°F or higher
9
How Your Baby Develops
0 to 12 Weeks
One of your eggs is fertilized. This makes a new cell. This
cell divides quickly into many more
cells. At about one week, this cluster of
cells attaches to the wall of your uterus.
This group of cells is called an embryo.
While the embryo is growing, the
placenta and amniotic sac begin to
form. The placenta is an organ that
connects the developing fetus to your uterine wall. It
permits nutrient uptake and waste elimination. The amniotic
sac is a bag of fluid that holds and protects it from outside
bumps. Organs and body parts, including fingers and toes,
start forming. By the 8th week, the embryo is called a fetus.
At 12 weeks, the fetus weighs about an ounce and
is around 21/2 inches long. By the end of the 12th
week, the fetus can make a fist, turn its head, squint
its eyes and frown.
Changes You May Notice
▪ Breasts
feel heavy and tender.
▪ Uterus
grows and presses
on bladder.
▪ You
urinate more frequently.
▪ You
tire more easily.
▪ You
feel nauseous.
13 to 16 Weeks
▪ Fetal
head is about 1/3 the
size it will be at birth.
▪ Face
is becoming more
defined.
▪ Your
doctor can pick up
a heartbeat.
Sonogram: Fetus at 14 weeks
At 16 weeks, the fetus weighs about 5 ounces
and is around 7 inches long. Sex organs are
developed enough for your doctor to tell if it’s
male or female.
▪ Nipples
and areola (circle around them) get darker.
10
11
17 to 20 Weeks
21 to 24 Weeks
▪ Fetus
head, arms, legs
and body are fully formed.
▪ Fetal
organs continue to grow.
▪ Fine
hairs cover body.
▪ Skin
is pink/red and wrinkled.
cream-cheesy coating
▪A
(vernix) covers body.
▪ Hair begins to grow.
▪ Developing
baby sleeps/
Sonogram: Fetus at 20 weeks
wakes at regular times.
Moves more. Swallows. And may suck thumb.
At 20 weeks, the fetus weighs about 1/2 to 1 pound
and is around 10 inches long.
Changes You May Notice
You may have leg cramps. This may be due to poor posture
and diet. Gums may swell. And bleed easily. This is because
of hormone changes.
▪ Fetus
opens and shuts eyes.
▪ Fingerprints
and footprints form.
Changes You May Notice
You may have heartburn. You may also have some contractions. Some women develop small dark patches on
their faces. Or a dark line down the middle of their bellies.
This is from hormone changes.
25 to 28 Weeks
▪ Fetus
grows fast now.
▪ Fat
forms under skin.
▪ Lungs
get stronger.
▪ Hair
continues to grow.
▪ Fetus
kicks and stretches.
Sonogram: Fetus at 28 weeks
At 28 weeks, the fetus weighs about 2 to 21/2 pounds
and is around 14 inches long.
Changes You May Notice
You may see red streaks (stretch marks) on your belly,
breasts and/or thighs. This is from hormone changes and
skin stretching. Your feet, ankles and legs may swell. You
may develop varicose (swollen) veins. You may also develop hemorrhoids. Hemorrhoids are painful, swollen veins
in the rectum.
12
13
33 to 36 Weeks
▪ Developing
baby gains
about 1/2 pound a week now.
▪ Sucks
and grasps harder.
▪ Skin
is pink/red and smooth.
▪ At
about 34 weeks, body
makes what lungs need
to work on their own.
29 to 32 Weeks
▪ Kicking
gets stronger. But growing baby is too big to
move around much.
▪ Fetal
bones get harder and more fat forms under skin.
▪ Developing
baby hears noises outside your body.
At 30 weeks, the fetus weighs about 3 pounds and is
about 15 inches long.
Changes You May Notice
You may have trouble sleeping. You may also have some
shortness of breath. This is because your uterus is pressing
on your diaphragm. (Your diaphragm is a thin, dome-shaped
muscle. It separates your lungs from your stomach and
intestines. And helps you breathe.) You may have little
aches and pains in your hips, belly and vagina. Hormone
changes may cause pressure on blood vessels. This
stretches tissue that holds the uterus in place.
14
At 36 weeks, baby is fully developed, typically
weighs about 5 pounds and is about 18 inches long.
You’re now carrying your growing baby farther out in front.
Some of your belly muscles are stretching to hold it. Your
pelvis and vagina are relaxing to prepare for birth.
37 to 40 Weeks
▪ Baby
gets heavier.
▪ Reacts
to more things.
▪ Fingernails
may grow
longer than fingertips.
▪ Bones
in head and body
continue to grow.
At 40 weeks, baby typically weighs about 6 to 9
pounds and is about 20 inches long.
You’re near the end of your pregnancy! You can now
breathe easier – literally. This is because your baby has
moved down. You’ll urinate more often. And may feel more
contractions now.
15
Comfort Tips
Pregnancy is a very exciting time. But that doesn’t mean
you always feel great. You may have some discomfort as
your body changes to make way for baby. Here are some
tips to help you feel better.
Frequent urination It’s normal to urinate more when
pregnant, especially at night. In fact, it’s one of the first
signs you’re expecting. Don’t drink too close to bedtime.
This will reduce middle-of-the-night bathroom trips. But
don’t cut back on fluids during the day. It’s very important
to drink a lot of water (and other non-alcoholic beverages)
when pregnant. Urinate whenever you feel the urge. This
will help prevent urinary tract infections.
Tender breasts Soon after conception, breasts may feel
sore, fuller and heavier. This is from hormone changes. It
helps to wear support bras.
Morning sickness Many pregnant women feel nauseous.
They may also vomit. This is called morning sickness. But it
can strike any time of the day or night.
First Trimester
Fatigue Most women tire more easily when they first
become pregnant. This is because levels of the hormone
progesterone soar. This can make you sleepy. At the same
time, blood sugar and blood pressure drop. And blood
production increases. This also saps energy. To fight
tiredness, rest as much as you can. Make sure you get
enough iron and protein. Include physical activity like a
brisk walk in your daily routine. (Ask your doctor the best
exercise for you.)
16
Nausea sometimes
begins as early as
three weeks after
conception. The
exact cause isn’t
known. But some
women feel sick
because of rapidly
rising hormone
levels. Pregnant
women also have a
heightened sense of smell. Some odors (like food cooking,
perfume and cigarette smoke) may cause nausea. Too
little rest and an empty stomach may also be culprits. (See
Nausea and Vomiting, page 69.)
17
Tips to Prevent Nausea
Second Trimester
▪ Eat
small, frequent meals throughout the day.
Constipation You may be constipated. This can happen
because of hormone changes.
To prevent or relieve constipation, drink plenty of fluids. Aim
for six to eight 8-ounce cups a
day. Stick mostly to water. Be
sure to eat a lot of fiber. Things
like fruit, veggies, whole-grain
breads and cereals, beans, nuts
and seeds. Regular physical
activity helps, too. Do not take
laxatives or stool softeners
during pregnancy unless ordered
by your doctor.
▪ Avoid
foods that trigger or worsen nausea.
▪ Avoid
coffee,
cola and other
caffeinated drinks.
▪ Keep
crackers by
your bed to eat as
soon as you wake.
▪ Drink
lots of fluids.
▪ Eat
low-fat foods.
▪ Avoid
spicy/fried
foods.
▪ Don’t
skip meals.
Call your doctor if:
▪ Nausea
is severe.
▪ You
can’t keep
down liquids.
▪ You
feel dizzy or
faint when standing.
▪ Heart
is racing.
▪ You
vomit blood.
▪ You’re
only passing a small amount of urine.
▪ Urine
is dark in color.
For more info and tips, see Nausea and Vomiting, page 69.
18
Heartburn Food moves into your stomach more slowly
during pregnancy. Your stomach also takes longer to
empty. This gives nutrients more time to be absorbed
into your bloodstream. And reach your developing baby.
Unfortunately, it can also lead to heartburn. To prevent
heartburn, eat small, frequent meals. Avoid spicy foods,
carbonated drinks and citrus fruit and juices.
Hemorrhoids If you’re constipated, you may develop
swollen veins in your rectal area. These are called
hemorrhoids. Hemorrhoids may feel itchy and sore. You
may also see blood when you go to the bathroom. To
prevent hemorrhoids, adopt a daily bathroom routine.
Don’t strain or push when moving bowels. And don’t
stand or sit for long periods.
19
Gas You may feel gassy or bloated. To prevent gas:
▪ Don’t
eat beans, corn, onions or cabbage.
▪ Don’t
drink through a straw. This causes you to take in
extra air, which may cause gas.
▪ Don’t
chew ice.
▪ Don’t
drink carbonated beverages.
Round ligament pain The bands of tissue that hold up
your uterus are called round ligaments. They stretch as
your uterus grows. You may have a tugging feeling on one
or both sides of your lower belly. This may happen if you
stand up quickly. Or turn sharply. This typically occurs
at about 20 weeks. It may happen earlier if you’ve been
pregnant before. Avoid abrupt movements. Call your doctor
if tugging feeling gets worse or doesn’t go away.
Leg cramps You may get leg cramps during pregnancy.
This is when leg muscles feel like they’re tightening into a
ball. This typically occurs
while lying in bed. Or early
in the morning as you get
out of bed. Leg cramps
are usually caused by too
little calcium or phosphorous. If you get a cramp,
straighten your leg. And
point toes toward your
knee. This will help relieve it. To prevent leg cramps, drink
milk and eat milk products like cheese and yogurt high in
calcium and phosphorus. It also helps to keep legs warm.
And take a warm bath before going to bed.
20
Backache You gain weight. And your breasts and belly get
bigger during pregnancy. These changes can lead to poor
posture and back strain.
To prevent and reduce back pain:
▪ Wear
a maternity bra for extra support.
▪ Wear
shoes that fit well and support arches.
▪ Sleep
on your side.
▪ Use
extra pillows and a firm mattress.
▪ Try
to maintain good posture.
Call your doctor right away if you have low back pain that
seems to wrap around your belly. Or doesn’t let up within
an hour of resting or changing position. This could be a
sign of preterm labor. (See Preterm Labor, page 95.)
21
Third Trimester
Tips to Prevent Swelling
Varicose veins Varicose veins are swollen or enlarged
veins in your legs. They are most likely to occur during the
last three months of pregnancy. They tend to get worse
with each pregnancy.
▪ Don’t
sit or stand in one place for a long time.
Varicose veins are caused by the uterus pressing on large
blood vessels that carry blood from your legs back to your
heart. This causes blood flow to slow. And veins in your
legs to overfill.
To ease pain:
▪ Wear support hose. Put them on before you get out of bed.
▪ Don’t
sit or stand in one place for long periods.
▪ Don’t
cross legs when sitting.
▪ Rest
often with legs up.
Swelling Feet, ankles and legs may swell. This is because
your uterus is pressing on blood vessels in your belly and
pelvis. This forces fluid out of them. And into tissue in your
legs. Extra fluid may also cause your fingers to swell. (Hint:
You may want to remove rings early in pregnancy just in
case this happens later on.)
▪ Lie
on your side, not your back.
▪ Rest
often with
legs up.
▪ Don’t
wear tight
clothes. Or
stockings with
elastic tops.
▪ Don’t
wear tight
shoes. (You may
need a larger
shoe size while
pregnant. This
is because feet
may flatten and
spread.)
▪ Wear
shoes with good support and wide heels.
▪ Don’t
wear heels higher than 1.5 inches.
Call your doctor if face, hands, fingers and/or ankles swell.
And swelling doesn’t go away after rest.
Stuffy nose Hormone changes can cause a stuffy nose. A
humidifier or cool-mist vaporizer
may make you feel better. Your
doctor can suggest other fixes.
Don’t use nose sprays or decongestants while pregnant. They
can raise blood pressure.
22
23
Nutrition During Pregnancy
It’s very important to eat right during pregnancy. Following
are nutrients you need. And ways to get them.
Carbohydrates Carbohydrates (sugars and
starches) give your body
energy. The best sources
are fresh fruits, vegetables
and whole grains.
Protein You need protein for tissue growth and
repair. Meat, eggs, milk
products, chicken, beans and nuts are protein-rich foods.
Vitamins and minerals You need vitamins and minerals
for your body to function well. And to help your baby grow
the right way. One very important vitamin is folic acid. Folic
acid is a B vitamin. It helps your baby make new blood
cells. It’s also important for forming nerve cells early in
pregnancy. The right amount of folic acid helps reduce
the risk of birth defects like spina bifida. (In this condition,
the spine doesn’t close or form the right way.) Your doctor will likely tell you to take a daily multivitamin that contains the recommended amounts of folic acid. Foods high
in folic acid include leafy greens (like spinach, asparagus,
turnip greens), egg yolks, sunflower seeds, fortified grain
products (breads, pastas, cereals), legumes (dried or fresh
beans, peas and lentils) and fruit (like raspberries, strawberries, grapefruit, cantaloupe and honeydew).
24
Calcium You need calcium to help your baby’s heart,
muscles, bones and teeth form and grow. Your doctor may
tell you to take a calcium supplement to make sure you get
enough. Foods high in calcium include milk, milk products
(like yogurt and cheese), calcium-fortified apple and orange
juice, dark leafy greens (spinach, kale), sardines and calcium-fortified soy and rice products.
Iron You need iron for your baby’s red blood cells to form.
Iron is also important for normal growth. And for your baby
to store for use after birth. Your doctor may tell you to take
a prenatal vitamin with iron to make sure you get enough
iron. Iron-rich foods include lean red meat, dark leafy
greens (spinach, collards, kale), whole grains and poultry
(chicken and turkey).
Vitamin Vitamin C helps fight
infection. And keep bones,
muscles and gums healthy. It also
helps you and your developing baby absorb iron. Vitamin C
is found in citrus fruit (oranges,
tangerines, grapefruit), tomatoes,
broccoli, bell peppers and cauliflower.
Vitamin D Your baby needs vitamin D to develop healthy bones
and teeth. Vitamin D is called the
sunshine vitamin. This is because
you can get it from the sun.
You can also get it from milk and
other foods fortified with it.
25
Vitamin A Vitamin A helps keep your skin, eyes and thyroid
gland healthy. Vitamin A is found in carrots, sweet potatoes
and dark, leafy greens.
Other vitamins and minerals The best way to get
vitamins is by eating healthy foods. Your doctor may also
recommend a prenatal vitamin.
This is because nutrition needs are
higher during pregnancy. Prenatal
vitamins are not a substitute for good
food choices. They are meant to
supplement a healthy diet. And help
you meet an increased need. Always
check with your doctor before taking
any vitamins, minerals or over-thecounter medicine.
Fluids It’s very important to drink plenty of water. And stay
hydrated when pregnant. Fluids help your body stay warm
or cool. They also help you have normal
bowel movements. Avoid urinary tract
infections. And keep lips and skin soft.
To stay hydrated, drink at least eight
8-ounce glasses of fluids a day. Water
is your best choice. You can add lemon
or lime for flavor. Low-fat milk, fruit or
vegetable juice and clear soup are also
good options.
Fiber You need fiber for normal bowel movements. Wholegrain breads and cereals, fruit, vegetables and bran are
all good sources. Hint: Leave skins and peels on fruit and
veggies to add fiber.
26
Healthy Snacks
It may help to supplement your diet
with healthy snacks. Fruit, nuts and
low-fat yogurt are good choices.
Some other healthy options:
bran muffin with low-fat milk
▪A
peanut butter and jelly sandwich
▪A
cheese sandwich and tomato juice
▪A
▪ Rice
pudding made with low-fat milk
▪ Peanut
butter and banana slices on toast
Food Safety
It’s very important to stay healthy during pregnancy. One
way to do this is to handle food safely. Wash hands before
and after handling food. Wash fruit before eating. Rinse
meat, chicken and fish under cold water before cooking.
Scrub countertops, cutting boards and utensils. Cook all
food thoroughly. And store it the right way.
Listeria is a type of bacteria found in food. It’s rare. But
it can cause serious problems if present. It is especially
dangerous in pregnant women. (And other vulnerable
populations like the elderly, infants and people with
chronic health conditions.)
To reduce your risk, the U.S. Department of Agriculture
(USDA) recommends you:
▪ Reheat
all ready-to-eat foods until steaming hot.
▪ Don’t
drink or eat raw, unpasteurized milk or milk products.
▪ Don’t
eat unpasteurized cheese (Brie, bleu, etc).
27
Fruit: 1½ cups
Half a cup of fruit is equal to:
▪ 1/2 cup 100 percent fruit juice
▪ 1/2
cup fresh, frozen or
canned fruit
▪ 1/2
a fruit (small orange, apple
or banana)
▪ 1/4
cup dried fruit
▪ 16
grapes
Daily Food Guide
Following are recommended daily amounts of foods during
pregnancy. And some ways to get them.
Grains: 6 ounces
One ounce of grain is equal to:
1 cup is equal to:
cup milk
▪1
cup yogurt
▪1
slice of bread
▪1
▪ 11/2
ounces natural
cheese (cheddar, parmesan)
▪ 1/2
cup cooked rice, pasta or cereal
ounces processed cheese
▪2
(like American)
cup ready-to-eat cereal
▪1
small pancake (4½” in diameter)
▪1
small tortilla (6” in diameter)
▪1
Vegetables: 2½ cups
One cup of vegetables is equal to:
cup of raw or cooked vegetables
▪1
cup vegetable juice
▪1
▪ 2 cups raw, leafy greens
medium baked potato ( 21/2 to 3” in diameter)
▪1
Hold the butter, bacon and sour cream!
28
Milk Products: 3 cups
Protein: 5 to 51/2 ounces
1 ounce protein is equal to:
tablespoon peanut butter
▪1
▪ 1/4
cup cooked dried beans
ounce lean meat,
▪1
poultry or fish
egg
▪1
▪ 1/2
cup nuts
29
Vegetarians
Herbal Tea
Are you a vegetarian?
No problem. You can
usually get the nutrients you need for a
healthy pregnancy if
you plan carefully. If you eat eggs and dairy products, add
more grains, beans, nuts, fruits and vegetables to get the
extra protein and energy you need. If you only eat plant
foods, you will need to work harder to get enough protein,
calcium and other nutrients. Tips:
Avoid herbal tea while pregnant. Ingredients in some herbal
teas may have bad side effects. Among them: lobelia, sassafras, coltsfoot, comfrey and pennyroyal.
▪ Eat
an extra serving of protein (like tofu) each day.
▪ Eat
more calcium-rich dark green leafy vegetables,
almonds and whole sesame seeds. And drink more
fortified soy, almond or rice milk.
▪ You
doctor may recommend vitamin B12, folic acid and
iron supplements.
Caffeine
Take it easy on foods and drinks that contain caffeine.
These include coffee, tea, cola and chocolate. Caffeine can
make your heart pump faster. And very large amounts may
block some nutrients from getting to your developing baby.
Caffeine has also been linked to low birth-weight. So only
eat small amounts of foods with caffeine. And don’t drink
more than a cup of coffee a day.
Healthy Lifestyle Choices
You should always make healthy lifestyle choices. This is
especially important during pregnancy when your baby is
developing organs and tissue. Topping the list of things to
avoid during pregnancy: smoking and alcohol.
Alcohol
Drinking alcohol (wine, beer, hard liquor) during pregnancy
is the No. 1 cause of birth defects in the United States.
No amount of alcohol is safe to drink when pregnant.
Alcohol can cause brain damage. And keep your baby from
developing the right way. Drinking while pregnant also puts
your baby at risk for fetal alcohol syndrome. Fetal alcohol
syndrome may cause mental retardation, abnormal facial
features, heart problems and learning issues. It can also
slow growth and development. So don’t drink alcohol during
pregnancy.
Artificial Sweeteners
Artificial sweeteners are usually safe to use during pregnancy in limited amounts. That means no more than two to
three servings a day.
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31
Smoking
Medicine
If you smoke, your baby can have problems before it’s
even born. Your developing baby needs oxygen just like
you do. When you breathe, you supply it with the oxygen
it needs to live and grow. If you smoke a cigarette, your
developing baby gets the same dangerous chemicals, nicotine and carbon monoxide you inhale.
Some drugs are not safe to use while
pregnant. They can hurt your developing baby. So only take medicines (including prescription, over-the-counter
and herbal remedies) that your doctor
says are OK. On your first office visit, give your doctor a
list of all medicines (over-the-counter and prescription),
vitamins and supplements you take. Ask him/her the safest medicine to take for a headache or heartburn if needed
during pregnancy.
Nicotine is a drug. It
causes the heart to beat
faster. Carbon monoxide
is a poisonous gas. It
takes the place of oxygen in blood. Both can
harm your developing
baby. Pregnant women
who smoke have a
greater chance of miscarriage, early labor,
premature birth and stillbirth. They’re also more
likely to have low-weight babies. Their babies are at greater
risk for breathing and heart problems, sudden infant death
syndrome (SIDS) and death in the first year of life.
Recreational Drugs
If you’re hooked on drugs, so is your baby. Your baby will
be born addicted. He/she will go through withdrawal after
birth. Withdrawal for a newborn can be very dangerous.
Any illegal drug use when pregnant is dangerous for your
developing baby. You may not think you have a drug problem. But even using drugs occasionally while pregnant may
be a problem. And cause withdrawal. If you use drugs –
quit now. Ask your doctor for treatment options.
So if you smoke – quit! Ask your doctor for help. And check
out online smoking cessation programs. Secondhand
smoke (from others’ smoking) can also hurt your developing baby. So steer clear of smokers. Only go to non-smoking establishments. And don’t allow smoking in your home.
(See Smoking and Pregnancy, page 61.)
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33
Weighing In
Weight Gain
It’s important to remember that pregnancy is not a free
pass to gain weight. Ask your doctor how much weight
gain is healthy for you. Do not diet or use weight-loss
products during pregnancy. Make sure you’re eating the
right amount of each food group.
The amount of weight you need to gain depends on several
factors. They include your weight before pregnancy. And
the number of babies you’re carrying. If you’re overweight
when you become pregnant, your doctor may tell you to
gain less than the typical weight range. If you’re underweight, your doctor may tell you to gain more. Your weight
gain will depend on the type and amount of food you eat. It
will also depend on how much physical activity you get. It’s
very important to stick to a healthy diet. And exercise as
recommended by your doctor.
Here are tips to help you meet
increased nutritional needs
without adding unnecessary
pounds.
▪ Trim
fat from meat.
▪ Avoid
fried foods. Bake,
broil or roast lean meat,
fish and poultry.
▪ Steer
clear of sweets,
sugary drinks and high-fat
snacks (like potato chips).
▪ Eat
complex carbohydrates
(whole-grain breads, cereals).
▪ Eat
fresh fruit and veggies.
These help fill you up. And
give you energy.
▪ Use
skim or 1 percent milk.
And other low-fat milk
products.
▪ Limit
use of artificial sweeteners and sugar substitutes.
▪ Eat meals at regular times.
▪ Don’t
skip meals.
34
Caring for Gums and Teeth
Dental problems are common during pregnancy. Your
gums may be tender. And bleed more easily. This is
because of hormone changes. So it’s important to take
special care of your
mouth. Some ways
to do this:
▪ Brush
teeth at
least twice a day.
Use an extrasoft toothbrush.
And fluoride
toothpaste.
▪ Floss
gently at least twice a day.
▪ See
your dentist throughout your pregnancy.
▪ Avoid
carbonated drinks.
35
Holding Steady: Prevent Falls
Expecting More Than One
As your pregnancy progresses, you may be more prone
to accidents. Among the reasons: Your growing belly may
upset your sense of balance. You may tire easily. You
may feel faint in warm, crowded places. And you may
feel dizzy or lightheaded if you stand for long periods or
change positions suddenly. If you feel faint, sit down. Put
your head between your legs. Have someone help you to
a place where you can lie down. And get fresh air.
If you’re carrying more than one baby, you’re having a
multiple pregnancy. This means you may be having twins
(2), triplets (3), quadruplets (4), quintuplets (5) or more.
Multiple pregnancies are more common in women who
have gone through fertility treatments. For example, the
chance of twins without
fertility treatment is one in
83. With fertility treatments,
the chance is one in 31.
Other tips to prevent falls:
▪ Wear
flats or low-heeled shoes with non-slip soles.
▪ Exercise
regularly. Ask your doctor the best workout
for you. (Check with your doctor before beginning a new
fitness plan.)
▪ Change
position slowly.
▪ Use
hand rails on stairs.
Twins may be identical or
fraternal. Identical twins
grow from a single egg.
The egg is fertilized by
a single sperm. And divides into two identical embryos.
Identical twins share the same placenta and amniotic sac.
They are the same sex, have the same blood type and
look exactly alike. About a third of all twins are identical.
Fraternal twins develop from two eggs fertilized by two
sperm. The two eggs develop in separate amniotic sacs.
Each has a placenta. Fraternal twins can be the same or
opposite sex. They do not look exactly alike.
Identical triplets form when one fertilized egg divides into
three eggs. Triplets can also form from two eggs, one of
which divides into two. This makes one set of identical
twins and another baby of the same or different gender.
Fraternal triplets form from three eggs. This is the most
common type. The same process goes for quadruplets (4),
quintuplets (5) and so on.
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37
Routine Exams
Eating Right
It’s important to take good care of yourself no matter how
many babies you’re expecting. Weight, blood pressure and
urine will be checked during regular doctor visits. So will
the heartbeat(s) of your developing baby/babies.
You need extra protein during pregnancy to help your
babies grow the right way. (See Nutrition During
Pregnancy, page 24.) So be sure to eat protein-rich foods.
These include lean meat, fish, poultry, eggs and dairy
products. You also need iron to prevent anemia (iron-poor
blood levels). Foods like lean beef, pork and liver are good
iron sources. Carbohydrates (rice, potatoes, wheat) give
you energy. And fiber (raw veggies, fruit and whole-grain
breads and cereals with bran) helps keep you regular.
Eating carbohydrates with proteins helps keep blood
sugar levels normal. Some ways to do this is to eat healthy
snacks like crackers with cheese, cereal with milk or whole
wheat bread with peanut butter.
Other routine procedures performed at different stages
of pregnancy: ultrasound, amniocentesis, Group B strep,
alpha-fetoprotein, triple or quad screening, and glucose
tolerance and non-stress tests. (See Screening, page 56.)
Ultrasound An ultrasound is an exam that uses sound
waves to make an image (called a sonogram). Your doctor
will do an ultrasound to see how many babies you’re carrying. And to check for any problems with placenta, uterus
and/or amniotic fluid. An ultrasound also helps your doctor
determine the size and position of developing babies. And
guide him/her during an amniocentesis.
Amniocentesis This is a test for prenatal chromosomal
abnormalities or infections. It is typically done between 15
and 20 weeks. For this test, your doctor will remove a small
sample of amniotic fluid with a long, thin needle.
Typically, you should eat three meals and four healthy
snacks each day. This will help you gain the healthy weight
you need. And your developing babies grow the right
way. Eat healthy snacks in the middle of the morning and
afternoon, after dinner and before bed.
Non-Stress Test (NST) This test is done during the last trimester. It monitors developing babies’ heart rates and placenta health. And checks to make sure developing babies
are getting enough oxygen.
Biophysical Profile (BPP) This test uses ultrasound and
an outside fetal monitor. It tells your doctor how well each
fetus is doing. It measures things like developing babies’
breathing, muscle tone, body movements and amniotic fluid.
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39
Weight Gain Guidelines
Comfort and Safety Tips
The weight you gain in the first
24 weeks of pregnancy will help
your developing babies grow the
right way. This is more important
than weight gain after 28 weeks.
It is harder to gain weight after 28
weeks. As your developing babies grow bigger, you may
feel full before getting the calories you need.
▪ Maintain
good posture. This will help avoid back strain.
Activity Restrictions
When you’re about halfway through your pregnancy
(around 20 weeks), your doctor may recommend you cut
down on daily activities.
This is because standing a lot puts pressure
on your cervix. This
can cause early contractions and dilation.
Lie down to ease this
pressure. This will also
improve blood flow to
kidneys. And help you
get rid of extra fluid. It’s important to take it easy. You need
to save energy for your developing babies. Ask your doctor
for a list of activities you should avoid or limit. Ask others to
do housework and other chores if possible.
Your doctor may tell you to go on bed rest if you’re carrying
three or more babies. He/she may suggest you rest a few
hours a day. Or longer depending on your particular needs.
40
▪ Try
not to make sudden movements. They can strain
abdomen and back.
▪ Try
not to stoop, bend or climb stairs too much.
▪ Squat
rather than bend at the waist.
▪ Use
a pillow to support lower back while seated.
▪ Sit
if you don’t have to stand.
▪ Put
feet up to reduce swelling.
▪ Try
not to lift, carry or push heavy objects. Don’t lift more
than 35 pounds at a time. Be careful lifting. And carrying
young children.
▪ Use
arms and legs to push up from a sitting position.
▪ Rest
and sleep on your side. This will help blood get to
your developing babies.
▪ While
lying in bed, it may help to bend knees. And put a
pillow between them.
▪ Use
more pillows to support belly
and shoulders.
you’re still working, rest during
▪ If
and after work.
▪ Always
wear a seat belt. Wear the
shoulder strap. And adjust the
lower belt to fit below your belly. A seat belt too high or
loose can injure you and your developing babies.
▪ Ask
your doctor about sexual activity. There may be times
when sex is not a good idea.
▪ Rest
if you feel tired. Ask family and friends for help when
you need it.
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Possible Complications
Preterm Labor Preterm or early
labor is labor that occurs before
37 weeks of pregnancy. The risk
of early labor is greater if you’re
having more than one baby.
About 60 percent of twins and
more than 90 percent of triplets
in the U.S. are delivered early.
You can lower your chance of
early labor by following your
doctor’s recommendations for
rest, activity and nutrition. The
closer to full term you can carry
your babies, the healthier they
will be. Preterm labor may be
stopped if caught early. (See
Preterm Labor, page 95.)
Symptoms include:
▪ Blood
pressure of 140/90 or higher
▪ Protein
in the urine
▪ Swelling
of face or
hands.
▪ Blurred
vision
▪ Severe
headache
▪ Sudden
weight gain
of over 1 pound a day
▪ Pain
in upper right belly
▪ Regular
contractions (10 or fewer minutes apart)
Call your doctor right
away if you experience
any of these symptoms.
▪ Pelvic
pressure even after changing position
Doctor Visits
▪ Change
in vaginal discharge
It’s very important to keep regular doctor appointments.
Your doctor monitors blood pressure and weight gain at
each visit. If you have any problems, he/she will determine
the best treatment plan.
Call your doctor right away if you have any of these signs:
▪ Stomach
cramps (with or without diarrhea)
▪ Dull
lower back pain that doesn’t let up with rest
▪ Vaginal
bleeding
▪ Thigh
pain or discomfort
▪ General
feeling something is not right
▪ Slow
leak or sudden gush of fluid from vagina
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Preeclampsia Preeclampsia is a condition that may
develop during pregnancy. It can lead to liver, kidney, brain
and eye damage, bleeding problems and seizures in the
mother. It may also cause poor blood flow through the
placenta. This can cause growth problems in developing
babies. (See Preeclampsia, page 105.)
You may be advised to take it easy. If symptoms are more
serious, your doctor may put you on full or partial bed rest.
Or give you medicine.
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Labor and Delivery
Talk to your doctor about delivery options. Your doctor will
decide if you can deliver vaginally. Or if it’s safer to do a
cesarean delivery or C-section. A C-section is a surgical
procedure. Babies are delivered through an incision
(or cut) made in the belly and uterus. Most triplets and
quadruplets – and about half of all twins – born in the U.S.
are delivered this way. Your doctor will decide the best
way for you to deliver. He/she will consider several factors.
Among them:
▪ Your
age
▪ The
position of your developing babies
Diabetes During Pregnancy
Diabetes that develops during pregnancy is known as
gestational diabetes. It typically develops during the last
half of pregnancy. And goes away after delivery. (See
Diabetes, page 80.)
Women carrying more than one baby have an increased
risk of developing diabetes. Your doctor will do urine tests
at regular visits. This is to make sure your blood glucose
(sugar) levels are normal. If not, your doctor will do more
screening.
Blood sugar levels must be kept in check. If they’re
not, your developing babies may grow bigger than they
should. If you have gestational diabetes, your doctor will
teach you how to monitor your blood sugar. Gestational
diabetes increases your risk for diabetes later on. So
the American Diabetes Association (ADA) recommends
lifelong diabetes screening.
44
▪ The
location of the placenta
you or the babies are having problems
▪ If
A C-section may be planned if you have complications. Or
had a previous C-section. And a VBAC (vaginal birth after
cesarean) isn’t possible. But many C-sections are done on
an emergency basis.
Caring for More
Than One Baby
There’s no question
you’ll need help. So
plan ahead. Perhaps
your partner will
help with feeding,
diapers, shopping and other chores. Ask friends and neighbors for help, too. Consider joining a support group. (For
more tips, see Online Information, page 169.)
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Breast – or Bottle?
Newborns have tiny tummies. So they eat small amounts
frequently. Your baby/babies will probably eat every two
to three hours in the first few months. Breastfeeding is the
best way for babies to develop, grow healthy and bond
with you. Breast milk is very healthy. It’s easy for babies to
digest. And it’s just the
right temperature. Studies also show breastfed
babies have fewer allergies. And infections.
Breastfeeding is also
healthy for moms. It
helps the uterus shrink.
And return to normal
faster. Most women can
breastfeed. Ask your
doctor for tips if you
have trouble.
If you plan to return to
work, you can pump
breast milk. You can
also supplement with
formula. The more you
nurse or pump, the
more milk you’ll produce. If breastfeeding
more than one baby,
your milk supply will increase to meet babies’ needs. (See
Food for Thought, on page 130.)
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Picking a Pediatrician
A pediatrician is a doctor who cares for babies and
children. Ask your doctor, friends and family to recommend
pediatricians. Visit your top choices. Ask these questions
to decide the best one for your baby:
▪ Does
he/she take your insurance?
▪ How
close is his/her office to your house?
▪ How
much does an office visit cost?
▪ Does
he/she take calls 24 hours a day, 7 days a week?
▪ Who
covers for him/
her during holidays/
vacations?
▪ Do
you feel comfortable
with this doctor?
▪ Will
he/she talk to you
during office hours if
necessary? Is there
a charge for phone
consults?
▪ Does
this doctor have
an after-hours answering service? Will he/she call back
after hours if necessary?
▪ Does
the office have separate waiting areas for well and
sick children?
▪ Will
the doctor give you time to ask questions?
Don’t hesitate to change pediatricians if you find you don’t
like your choice.
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Day Care
If you opt for a day care center, ask these questions:
the center licensed? (Ask to see the license.)
▪ Is
▪ Does
it take newborns?
▪ How
many people are on staff? What are their
qualifications and experience?
▪ What
is the child/caretaker ratio?
▪ How
many rooms are at the center? How many babies/
children are in each room at a time?
▪ Can
children attend when they’re sick?
▪ Are
there separate places for sick and well children?
▪ What
are the operating hours?
Choosing Child Care
If you’ll be using day care, try to find a provider before
your baby is born. You can choose a day care center or inhome care provider. Ask friends for suggestions. In-home
care providers are licensed to care for a certain number
of children at a time. Ask the limit. And how many kids are
enrolled. Ask for references. And check them out. If there
are other workers, ask for their qualifications.
▪ What
is the cost?
▪ Can
you visit during the day to feed your baby?
there a fee for late pick up?
▪ Is
Visit any facility you select. Make sure you feel comfortable
leaving your baby there. Talk to employees and other
parents. Ask for references. And check them all!
Other questions to ask:
▪ Can
children attend when sick? If so, are sick and well
children separated?
▪ What
hours is care available?
▪ What
programs and activities are available?
▪ What
is the cost?
there a fee for late pick up?
▪ Is
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49
Visit Home/Day Care Centers
Section 2
Tour any care facility you’re considering. During visits,
check the following:
Getting
in Gear
▪ Is the house or center clean and inviting?
▪ Are there any bad smells or odors?
▪ How many children are being watched?
▪ Is there a place for your baby/babies to nap?
▪ Does
the facility supply formula, food and/or diapers?
Or will you have to bring them?
▪ Can you bring breast milk for your baby/babies?
▪ Are there separate rooms for babies and older children?
▪ How often are diapers changed?
▪ Are
the rooms safe for children? For example: Are
electrical outlets covered, strings (on blinds, etc.) tied up
and out of the reach of children? Are there safety locks
on cabinets and toilets? Are stairways gated?
▪ Are there working smoke detectors and fire
extinguishers?
This is a very important decision. Take your time. And don’t
be afraid to ask questions.
Do not leave your children any place you don’t feel is
safe and secure. Find another place you trust.
50
Genetic Counseling
Genetic counselors are specially trained to help families
understand the risk of disease or birth defects. They can
provide emotional support. Refer you to support groups.
And help you understand:
▪ An
abnormal test result
▪ Family
history of genetic disorders
▪ Your
baby’s chances of having a genetic disorder
▪ What
it would mean to have a baby with a certain condition
51
Who Should Receive Genetic Counseling?
Dominant Gene Disorders
Your doctor will tell you if
your baby is at risk for a
genetic disorder. Certain
factors can increase the risk.
People who may want to see
a genetic counselor include:
If a parent has a dominant gene for a condition, there’s a
50 percent chance his/her child will have the condition.
These are some disorders caused by dominant genes.
▪ Anyone
with an inherited
disorder or birth defect
▪ Women
35 and over
▪ Women
with another child/
children with an inherited
disorder
▪ Women
who had two or
more miscarriages or babies who died in infancy.
▪ Couples
concerned about genetic disorders more
common in their ethnic group.
▪ Women
who fear their jobs may put pregnancy or fetus/
fetuses at risk. This may be because of exposure to
radiation, drugs, infections or dangerous chemicals.
▪ Women
told their developing baby/babies may be at risk.
▪ Couples
with a family history of genetic disorders
In the Genes
Each of us is born with about 100,000 genes. Genes are
responsible for hair and eye color, body type and other
traits. Each of us has a unique genetic map. Genes are in
chromosomes in our cells.
52
Achrondroplasia This is a bone growth disorder. People
with it have very short arms and legs.
Marfan syndrome This condition affects connective tissue.
Connective tissue supports and anchors organs and other
body structures. Marfan can disrupt development and
function in some parts of the body. Heart, eyes, blood vessels and bones are most commonly affected. People with
this condition are usually tall and thin. And have disproportionately long arms, legs, fingers and toes.
Huntington’s disease This condition causes a breakdown
(degeneration) of nerve cells in the brain. It affects functional
abilities. And usually results in movement, thinking (cognitive) and psychiatric
disorders. Most people with Huntington’s
develop symptoms in their 40s or 50s.
But onset may be earlier or later.
Neurofibromatosis This is a group of
disorders that disrupts cell growth in
the nervous system. It causes tumors
to form on nerve tissue. These tumors can occur anywhere
in the nervous system. This includes the brain, spinal cord,
and large and small nerves. It is typically diagnosed in
childhood or early adulthood. Tumors are usually benign
(not cancerous). And the disorder is usually mild. But it can
cause hearing loss, learning problems, heart complications
and, in rare cases, cancer.
53
Recessive Gene Disorders
Recessive genes can only be passed on to children if both
parents have the same ones. Each child has a 25 percent
(one in four) chance of inheriting the disorder. If only one
parent has a recessive gene, the condition won’t be passed
on to the child. But the child will be a carrier. That means
his/her child could get the disorder. But only if his/her
partner has the same recessive gene. Following are some
recessive gene disorders.
Sickle cell anemia This is a blood condition. It mainly affects African Americans. People with it don’t have enough
healthy red
blood cells to
carry oxygen
throughout the
body. Normally
red blood cells
are round and
flexible. And
move easily
through blood
vessels. In Sickle
cell, red blood
cells become rigid and sticky. And are shaped like sickles
or crescent moons. These irregularly shaped cells can get
stuck in small blood vessels. This can slow or block blood
flow and oxygen to parts of the body.
Tay-Sachs disease This is a deadly nervous system disease. It is most common among people with Ashkenazi
(Eastern European) Jewish roots.
54
Cystic fibrosis (CF) Cystic fibrosis causes severe
damage to the lungs and digestive system. It affects
cells that produce mucus, sweat and digestive juices.
These fluids are normally thin and slippery. But in CF, they
become thick and sticky. They plug up tubes, ducts and
passageways, especially in the lungs.
Cystic fibrosis is most common in white people of Northern
European ancestry. But it also occurs in Hispanics, African
Americans and some Native Americans. It’s rare in people
of Asian and Middle Eastern origin.
Chromosome Disorders
These conditions are caused by errors in the number or
structure of chromosomes. Chromosomes are tiny, stringlike structures in cells. They contain genes. Chromosomal
abnormalities usually result from an error that occurs
when an egg or sperm
cell develops. It is
not known why these
mistakes happen. An
egg or sperm may
divide incorrectly. This
results in an egg or
sperm with too many or
too few chromosomes.
Many children with a
chromosomal abnormalities have mental
and/or physical birth defects. Some chromosomal abnormalities result in miscarriage or stillbirth.
55
Screening
Following are tests you may have when pregnant or planning to become pregnant.
Maternal Serum Alpha-Fetoprotein (MSAFP)
MSAFP is a blood test that measures the amount of alphafetoprotein (AFP). AFP is a protein produced by a fetus.
It’s normal for a small amount of AFP
to cross the placenta and enter the
mother’s bloodstream. But abnormally
high levels of AFP suggest the fetus has
a neural tube defect. The most common
one is spina bifida or anencephaly.
This is a condition characterized by an
underdeveloped brain and incomplete skull. An abnormal
test may be a false alarm. If your results are abnormal, your
doctor may do a second test. He/she may also do other
tests like ultrasound and amniocentesis.
Amniocentesis
Amniotic fluid surrounds and protects a developing baby
during pregnancy. Amniocentesis is a procedure used to
test for Down syndrome, neural tube
defects and some
genetic conditions.
It is typically done
between15 and 18
weeks of pregnancy.
(It may be done later
to see if developing
lungs are mature.)
Amniocentesis is recommended for older mothers. Potential risks include cramping and vaginal bleeding or spotting.
There is also a slight risk of miscarriage. Your doctor will
tell you if he/she thinks you should have this test. If you
have amniocentesis, it will most likely be done in your doctor’s office. You will lie down. An ultrasound will be used to
locate the amniotic fluid. Your doctor will clean and numb
an area on your belly. He/she will insert a long, thin needle
there. And draw out amniotic fluid. You will need to rest and
follow your doctor’s other directions after the test. Results
are usually available in about two weeks.
Chorionic Villus Sampling
This test is done at or after the 10th week of pregnancy. A
sample of tissue is taken from outside the sac surrounding
your developing baby. This test is done earlier than amniocentesis. But it does not appear to be as accurate. And the
risk of miscarriage may be higher.
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57
HIV and Pregnancy
Human immunodeficiency virus (HIV) can lead to acquired
immunodeficiency syndrome (AIDS). HIV attacks the
immune (infection-fighting)
system. It is possible to have
HIV and not know it unless
tested. Sometimes HIV is not
diagnosed until the immune
system is so weak that a usually
minor condition (like a cold) can be
very dangerous. Early diagnosis is very
important for pregnant women. This
is because HIV can pass to a baby
during pregnancy and delivery. It
can also be spread to a baby
during breastfeeding. Test
results are usually available
in a few days. So get tested
for HIV if you’re pregnant
or planning to become
pregnant. If diagnosed with
HIV, get proper treatment. This
is the best way to have a safe
pregnancy and healthy baby.
To avoid and lower your HIV risk:
▪ Use
condoms.
▪ Do
not have more than one
sexual partner.
▪ Do
not use risky sexual practices.
▪ Don’t
use recreational drugs. If you do, get help to stop.
Early HIV symptoms may include:
▪ Low-grade
fevers
▪ Weight
loss
▪ Tiredness
▪ Diarrhea
▪ Infections
that don’t go away
▪ Joint
pain
▪ Night
sweats
▪ Swollen
glands
▪ Lack
of appetite
▪ Muscle
aches
▪ Frequent
feminine problems like yeast infections, severe
herpes simplex ulcers, genital ulcers, human papilloma
virus (HPV) and pelvic inflammatory disease (PID)
You don’t get HIV through casual contact. HIV is transmitted through contaminated blood products and bodily fluids.
You can get it if you have unprotected sex or share drug
needles with someone who has it. You can also get it from
a blood transfusion if tainted blood is used. (But protections are now in place. So that doesn’t often happen.)
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59
Smoking and Pregnancy
Your fetus needs oxygen just like you do. Every time you
take a breath, you give your developing baby the oxygen
it needs to live and grow. When you smoke, your baby will
not get enough oxygen. And will not develop as well. Plus,
both you and your baby will take in the bad chemicals in
tobacco. Smoking increases your risk of miscarriage and
early labor. It also raises the risk of low birth weight and
sudden infant death syndrome (SIDS). So if you smoke –
stop! Ask your doctor for help. And check out online and
community smoking cessation programs.
HIV Treatment
Medicine can significantly reduce a mother’s risk of passing HIV to her baby. If an expectant mom has HIV, medicine
to help the developing baby is usually started at 14 to 34
weeks of pregnancy. It is also given during labor. The baby
will be treated for about six weeks. The medicine does not
appear to have any serious side effects. Tell your doctor if
you are already taking HIV medicine. He/she will tell you if
you should continue or stop any meds during pregnancy.
Secondhand smoke – smoke from other people’s cigarettes
– can also hurt you and your baby. So don’t allow smoking
in your home. And avoid places that allow it.
It is important to try to arrive at the hospital early when
you’re in labor. You will need to receive your HIV medicine
intravenously (through a vein) during labor. Your doctor may
suggest a C-section. It reduces the risk your baby will get
HIV during delivery. Breastfeeding is not recommended if
you have HIV. This is because there’s a risk it will be passed
to your infant through breast milk. A baby’s blood will be
tested several times to see if he/she has HIV. Take your
baby to all his/her doctor appointments.
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61
Kicking the Habit
Smoking has been linked to just about every medical
condition in the book. Smoking is especially dangerous if
you’re pregnant. If you smoke, try to quit
as soon as possible. It’s best if you’re a
non-smoker. But quitting any time during
your pregnancy will benefit you and your
baby. It will increase the flow of
oxygen to your developing baby.
And reduce health risks for both
of you. According to the American Heart Association (AHA),
eight hours after quitting, carbon
monoxide (poisonous gas from
cigarette smoke) in your blood
drops to normal. Two weeks to
three months after quitting, blood
flow improves and lung function increases up to 30 percent. One year after quitting, your risk
of heart disease is half that of a current smoker.
Nicotine Replacement Therapy (NRT) NRT helps smokers quit slowly. It does this by giving them the nicotine but
not other poisonous chemicals in cigarettes. Nicotine is
the No. 1 reason it’s so hard for people to stop lighting up.
So NRT provides smokers with nicotine in gum, a nasal
spray or a patch (worn on the skin) to help ease them off
cigarettes. NRT should be used with smoking cessation
programs to increase success. Do not use any nicotine
replacement products without checking with your doctor.
Some may not be safe during pregnancy.
62
Smoking cessation classes These classes can be very
helpful. The key is to find the best one for you. The most
effective ones run for at least two weeks, offer at least four
to seven sessions (each about 20 minutes) and are lead
by someone certified to teach such classes. If you need
help finding a class, contact the American Cancer Society (ACS), American Lung Association (ALA) or your local
health department. They offer classes in most communities. But if they don’t have any, they can tell you who does.
You can also ask your health insurance provider if it offers
smoking cessation programs or covers the cost of other
stop smoking programs. (See More Help, page 65.)
Nicotine Anonymous Nicotine Anonymous is a group
like Alcoholics Anonymous. Only it’s for smokers trying
to quit. It is a 12-step program. And has local meetings you
can attend. To find a Nicotine
Anonymous program in your
area, check out the Web site
www.nicotine-anonymous.org.
Game plan for quitting It’s
not easy to stop smoking. The
first step is deciding to do it.
The next is to pick a quit day.
And mark it on your calendar. To get ready for your big day,
make a list of all the reasons you want to kick butts. Tell
friends and family about your plan. Sign up for a smoking
cessation class now. And buy some sugarless gum, carrot sticks and healthy snacks to put in your mouth instead
of cigarettes. Ask your doctor, friends and family to support
and help you.
63
Countdown to Quitting Time
5 Days Before Quitting
▪ Stop
buying cigarettes.
▪ Make
a dentist’s appointment
to have teeth cleaned the day
before quitting day.
4 Days Before Quitting
▪ Think
about why you smoke. And come up with substitute
activities. For example, if you light up to relax, think of
new, healthy ways to relax. Some good choices: reading,
exercising, listening to music and watching a movie.
▪ Think
of things you can hold (like a rubber band or pencil)
if you’ll miss holding a cigarette.
3 Days Before Quitting
▪ Make
a list of things you can do with the money you’ll
save on cigarettes.
▪ Buy
a see-through bank so you can see your savings
pile up!
▪ Make
a list of friends, family and/or a support group to
call if you need help staying on course.
2 Days Before Quitting
▪ Clean
house and clothes to get rid of smoke smell.
1 Day Before Quitting
▪ Think
of a reward to give yourself after you quit.
▪ Have
your teeth cleaned.
▪ Throw
away all cigarettes and matches. Get rid of
ashtrays and lighters.
64
Quitting Day – and After
▪ Feel
like smoking? Eat healthy snacks like carrots, low-fat
yogurt or cheese and/or chew sugarless gum instead.
▪ Call
a friend or family member to chat.
▪ Keep
busy all day.
▪ Think
positive thoughts.
▪ Get
plenty of rest.
▪ Brush
teeth frequently.
▪ Play
with a pencil or rubber band if
you miss holding a cigarette.
▪ Put
a toothpick or straw in your
mouth. Or nibble on carrots or other
healthy snacks if you want something
in your mouth.
▪ Put
a few dollars in your see-through bank every day.
▪ Drink
lots of water.
▪ Limit
coffee and alcoholic drinks.
▪ Take
deep breaths, take a warm bath, read, take a walk
and do other things to relax.
▪ Steer
clear of places that make you think of smoking.
More Help
For more info on kicking butts, contact the following groups:
American Heart Association: www.heart.org
American Cancer Society: www.cancer.org
American Lung Association: www.lung.org
Center for Disease Control and Prevention (CDC): www.cdc.gov
65
Domestic Violence and Abuse
Domestic violence and abuse is when someone physically
and/or emotionally harms another person to have control or
power over her/him. It’s important to know that you’re not
to blame. No one deserves to be abused or hurt. Yet anyone can be a victim of domestic abuse. Domestic violence
and abuse is not limited by education or economic level. It
affects everyone. There are many kinds of abuse.
Physical Grabbing, pushing, shoving,
pinching, biting, hair pulling, burning,
cutting.
Emotional This is when someone tries
to lower your self-esteem and confidence by constantly criticizing you,
calling you names, putting you down
and trying to hurt your relationships
with children, family and friends.
Psychological When someone tries
to make you feel guilty by saying
things like, “If you loved me you would
(wouldn’t)…”
Sexual Threatening or forcing sex on
you without your consent.
Abuse is not always easy to recognize. You may not think
this behavior is wrong. You may just think the person has a
strong personality. Or make excuses for such behavior. Or
think you need direction. But this type of behavior is wrong.
It is abusive. And you should not put up with it.
66
What Can You Do?
Get help. Do not be ashamed.
Talk to your doctor, a family
member, friend, coworker, the
police or someone in your
church or temple. You can call
the National Domestic Violence
Hotline at (800) 799-7233 or TTY (800) 787-3224. Or find
hotlines, crisis centers and shelters online or in your local
phone book. If you feel like you or your children are in
danger, call 911 right away.
Develop a Safety Plan
Nobody should stay in a violent relationship. Seek help. And
get out as soon as possible.
Take these steps to stay safe:
▪ Get
rid of any weapons in the house. Stay out of rooms
that may contain them.
▪ Practice
“safe” words that will not anger your partner if
you have a disagreement.
▪ Teach
your children how and when to dial 911.
▪ Make
a list of people to call for help. Memorize these
numbers.
▪ Make
up a code word so the person you call will know
you need help.
▪ Plan
excuses to get out of the house. Some examples:
You have to take out the trash, walk the dog or mail a letter.
▪ Pack
a bag for an emergency. It should include clothes,
money, important phone numbers. Hide the bag in a safe
place where you can get it easily.
67
Leaving an Abusive Relationship
▪ Call
a shelter for battered women if you need a safe place
to go.
▪ Change
your phone number and door locks.
▪ Screen
calls at home and at work.
▪ Make
and practice an escape route in case you need it.
▪ Change
the places where you shop and your route to
work.
Section 3
Problems –
and
Solutions
▪ Tell
people at school and/or work what’s going on. Give
them a photo of the person who abused you.
Important Things to Remember
▪ Abuse
is about control.
▪ You
are not alone.
is not your fault.
▪ It
▪ You
deserve better.
it feels wrong, it is wrong.
▪ If
▪ You
can get help.
Nausea and Vomiting
About 70 percent to 80 percent of all pregnant women
experience at least some morning sickness (nausea and
vomiting). It typically begins at around six weeks. And
eases or goes away after the first trimester (three months).
Despite its name, morning sickness can happen any time
of day or night. Tell your doctor if you continuously feel
nauseous and vomit. And are losing (or not gaining) weight.
It is not normal to feel sick and vomit
all the time. This can be dangerous for
you and your developing baby.
You may have a severe form of
morning sickness called hyperemesis
gravidarum. Some 2 percent of
pregnant women have this condition.
Tell your doctor if you can’t keep
anything down. He/she can help you
feel better.
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69
Treatment
Tips to Manage Morning Sickness
There are different treatments for severe morning sickness.
If you are severely dehydrated, your doctor may recommend you be hospitalized to get IV fluids. He/she may also
prescribe medicine to help prevent nausea and vomiting.
It may help to stick to bland foods (low-fat crackers, white
toast, rice noodles, baked or mashed potatoes, apple
sauce, hot or dry cereal, cottage cheese) until you feel
better. And drink between – not with – meals. Many women
feel better if they eat frequent small meals throughout the
day rather than three large meals.
But you can only take drugs that will not hurt your developing baby. So be sure to ask your doctor about the safety
of any medicine prescribed. If you cannot keep anything
down, your doctor may recommend medicine delivered
through a suppository.
Here are some more suggestions:
▪ Eat
lean protein like skinless chicken.
▪ Eat
a late-evening snack.
But don’t lie down right
after eating.
▪ Nibble
on dry crackers or
cereal when you wake up.
▪ Get
out of bed slowly after
your morning snack.
▪ Sip
small amounts of water, decaffeinated tea (especially
ginger), ginger ale and/or weak lemonade.
▪ Don’t
drink through straws. Extra air comes through
straws. This can upset your stomach.
▪ Don’t
eat spicy, fatty and fried foods.
▪ Avoid
fruits and veggies that cause gas (broccoli, onions,
cabbage and cantaloupe).
▪ Ask
your doctor if you should stop taking prenatal
vitamins while nauseous.
▪ Avoid
foods and drinks with caffeine.
▪ Get
plenty of rest.
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71
Infections
Any kind of infection may cause a problem during pregnancy. Don’t worry. Most infections can be treated. Tell
your doctor if you have signs of an infection. Don’t ignore
possible problems. And don’t try to treat them yourself.
The key is to catch any infections and treat them early.
Seasonal Flu
You should get a flu shot if you’re pregnant or planning to
become pregnant. The Centers for Disease Control and
Prevention (CDC) recommends nearly everyone get a yearly
flu shot. The only ones who should not get it are babies
under six months old and people who are severely allergic
to eggs. (The vaccine is made with eggs.) It is especially
important for pregnant women to get the flu shot.
According to the CDC,
women who are pregnant
are five times more likely to
have serious complications
if they come down with the
flu. Plus, studies show that
when moms-to-be get the
flu shot, it also provides
some protection to their newborns. Remember: You have
to get the flu shot every year. Flu strains change all the
time. A new vaccine is made each year to protect against
the newest crop. The flu vaccine is given by injection or a
mist sprayed up the nose. Pregnant women should not get
the nasal spray. They should only get the flu injection.
72
Urinary Tract Infections (UTIs)
Pregnant women tend to have more urinary tract infections
(UTIs) than other women. This is because the fetus presses
on the bladder as it grows. As a result, the bladder may
not empty all the urine in it when you go to the bathroom.
It’s important
to treat bladder
infections early so
they don’t spread
to the kidneys. A
kidney infection
can interfere with
your developing
baby’s growth.
It can cause an
early birth. If your
doctor thinks you
have a bladder
infection, he/she will give you a urine test. If it’s positive,
your doctor will give you medicine that’s safe to take during
pregnancy.
Following are possible symptoms of a bladder infection.
Tell your doctor if you have any or all of them.
▪ Fever
▪ Frequent
urination
▪ Burning/pain
during
urination
▪ Cloudy
or bloody urine
hard time starting
▪A
to urinate
feeling you still have
▪A
to go after urinating
▪ Pain
in lower belly
and/or back
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Group B Strep (GBS)
Group B streptococcus (GBS) is one of many bacteria that
live in the body but usually don’t cause serious illness. But
it can be very serious – and even deadly – in newborns. GBS
can pass from mother to baby during labor and delivery.
Newborns infected with GBS can develop lung or blood infections. And even meningitis within the first 24 to 48 hours
of life. (Meningitis is inflammation of the membranes or
meninges surrounding the brain and
spinal cord.) About
5 percent of those
infected with GBS
die. The good news
is women who have
it can be treated. So
it’s very important
to get tested for
GBS when pregnant.
Testing is done late
in pregnancy, typically between 35 and
37 weeks. The test
is very simple. Your
doctor swabs your
vagina and rectal
area. If the test is positive, you will be given antibiotics during labor. Testing must be done each pregnancy. Some
women are considered high risk for passing GBS to their
babies.
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Vaginal Infections
Monilia or yeast infections are the most common type of
vaginal infection. You’re more likely to get a yeast infection
during pregnancy. This is because pregnancy changes
the environment in the vagina. The changes make it easier
for germs to grow there. If you have a yeast infection and
deliver vaginally, there’s a risk your newborn will develop a
yeast infection in his/her mouth called thrush. Following are
symptoms of a yeast infection. Tell your doctor if you have
any or all of them.
▪ Vaginal
itching and burning
▪ Pain
when urinating
▪ Thick,
white, cheesy discharge
Bacterial vaginosis (BV) BV is another type of vaginal
infection. It occurs when the normal balance of bacteria
in the vagina is upset. Most of the time, there are no
symptoms. But tell your doctor if you notice a fishysmelling, watery, yellow-gray discharge. BV may cause
early labor. So if you have early contractions, your doctor
may check for it.
75
Sexually Transmitted Diseases (STDs)
You get sexually transmitted diseases (STDs) through
sexual activity. STDs can be treated. But untreated, they
can lead to serious problems. If you have an STD, both you
and your sexual partner(s) must be treated. Following are
some of the most common sexually transmitted diseases.
Call your doctor if you have any of the symptoms.
Trichomoniasis Typically occurs in women 16 to 35 years
of age. Symptoms include:
▪ Swollen
vagina and cervix
▪ Pain
during urination
▪ Pain
during sex
▪ Itching
▪ Yellow-green
discharge
that smells bad
Chlamydia This is the most common STD. Left untreated,
it can cause serious damage to the fallopian tubes, cervix
and urethra. Chlamydia can cause
pelvic inflammatory
disease, infertility and
tubal pregnancy. It
can also cause premature birth. And
even fetal death. It
may also cause eye
infections and pneumonia in newborns.
Symptoms include:
▪ Watery
discharge with pus
▪ Burning
76
▪ Low
belly pain
▪ Frequent urination
Syphilis Syphilis is a bacterial infection. It can lead to very
serious problems if not treated. Your doctor will typically
give you a blood test for
syphilis at your first visit.
And treat you if you test
positive. Syphilis is spread
through direct contact
with a syphilis sore or rash
during sex. All partners
must be treated. When you are pregnant, syphilis can be
passed to your developing baby. It can cause your baby to
be born with an infection. It can also cause your baby to be
stillborn or to die shortly
after birth.
It’s very important to be
tested for syphilis early
in pregnancy. And get
treated if you have it.
Gonorrhea Gonorrhea
is another bacterial
infection. All sexual
partners must be
treated. Gonorrhea can
cause blindness in newborns if moms are infected at time of delivery. Your doctor
will test you for gonorrhea at your first visit. Gonorrhea
is treated with antibiotics safe to take during pregnancy.
Most women have few or no symptoms. Possible signs:
▪ Greenish-yellow discharge
▪ Frequent urination
▪ Pain when you urinate
▪ Genital swelling
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Herpes Herpes is an infection caused by a virus. It can be
dangerous to a newborn. So women with vaginal herpes
may have a C-section. This is to keep the baby from coming in contact with the infection. Signs include:
▪ One
or more blister-like bumps in the genital area.
(Blisters may pop. And leave painful, open sores.)
▪ Swelling
and pain when you urinate
▪ Flu-like
symptoms
▪ Itching
or tingling in genital area
The first bout of herpes is usually the worst and the longest. Sores typically heal in about two to four weeks. But
you still may have the
virus (even if the sores go
away). And pass it to your
sexual partner(s). Some
women never get herpes
again. Others will have
regular breakouts. There is
no known cure. Tell your
doctor if you have herpes or any of the symptoms listed.
Some meds can reduce pain. And prevent other infections.
Human Papiloma Virus (HPV) This virus is passed during
sexual contact. Most people don’t know they have it. Some
types cause warts in the genital area and/or throat. Some
can cause cancer in the cervix (most common) and/or in
the vulva, vagina, anus or penis. A pregnant woman can
pass HPV to her baby during delivery. There’s no cure for
HPV. But it can be treated. And there is now a vaccine to
prevent HPV.
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Good Health Habits
It’s very important to have good hygiene to prevent urinary
tract and other infections. Following are some helpful
hygiene tips:
▪ Wipe
from front to back after you go to the bathroom.
This prevents the spread of germs from your rectal to
vaginal and urinary areas.
▪ Urinate
as soon as you have the urge. Don’t hold urine
too long. Doing so can increase the risk of infection.
▪ Go
to the bathroom before and after sex.
▪ Wear
cotton underwear and loose pants.
Keep an eye out for early signs of an infection or STD.
Call your doctor right away if you notice any. It’s very
important to get treated early. Ask your doctor to explain
test results and treatments. And tell you how to prevent
future infections.
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Diabetes
Diabetes is when the body can’t make or use insulin the
right way. Insulin is a hormone made in the pancreas. It
helps cells use blood glucose (sugar) to make fuel for the
body. When you don’t have
enough – or your body
can’t use it the right way
– glucose builds up in the
blood. This can be dangerous. Untreated diabetes
can cause serious eye,
kidney, nerve and circulation (blood flow) problems.
There are two types of diabetes. Type 1 is an autoimmune disease. That means the
body’s immune (defense) system becomes faulty. Type 1
is treated with insulin injections, diet and exercise. Type 2
diabetes is mainly caused by poor diet, excess weight and
lack of physical activity. Smoking, age and family history
increase risk. It is mostly treated with diet and exercise.
It’s always important to control blood sugar levels. It’s
especially important early in pregnancy. The reason:
High blood sugar levels in the first two to eight weeks of
pregnancy can cause problems in your developing baby.
To control blood sugar, your doctor will likely tell you to:
▪ Check
blood sugar more frequently.
▪ Eat
a healthy diet. (Read: Cut down on sugar and fat. Eat
more whole grains, fruit, veggies, fish...)
▪ Exercise
regularly.
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Gestational Diabetes
Gestational diabetes is diabetes that develops during
pregnancy. About 7 percent of pregnant women develop
it. It typically occurs during the second or third trimesters.
And goes away after the baby is born. Your doctor will
monitor you. A family history of diabetes ups risk. So does
being overweight before becoming pregnant.
Prenatal diabetes testing Your doctor will usually test for
gestational diabetes between the 24th and 28th weeks of
pregnancy. Women with gestational diabetes should have
blood sugar levels tested six to eight weeks after their baby
is born to make sure they’re normal. Studies show that
women who develop gestational diabetes may be at higher
risk for type 2 diabetes later on.
Your doctor will tell you the best
treatment for your diabetes.
Follow his/her directions.
Untreated diabetes can
cause preeclampsia.
And lead to early labor.
Preeclampsia is high
blood pressure and
protein in the urine
during pregnancy. Symptoms include swelling of the face,
hands and legs. Urinary tract infections (UTIs) are also
more common when blood sugar levels are high. Tell your
doctor if you have symptoms of a urinary tract infection.
(See Urinary Tract Infections, page 73/Preeclampsia,
page 105.)
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Sugar baby problems If your blood sugar is too high, the
extra sugar will go to your developing baby. This can cause
it to grow bigger than normal (over 9 pounds). If you give
birth to a very large baby, it can be hard for you both. High
blood sugar levels can hurt developing lungs. The placenta
may not be able to carry nutrients to your developing baby.
And your baby may keep making extra insulin after birth.
This can cause blood sugar levels to fall too low. And
cause serious problems. To fix this, your baby will be given
sugar water in the first hours after birth. It will be given in a
bottle. Or through an IV. Your baby may have to stay in the
hospital a little longer.
Weight gain What you eat affects your blood sugar levels.
And how well your baby grows. If you weigh too much, it
will be harder to control your
diabetes. This is because extra
pounds make it harder for
your body to use insulin. Extra
weight also increases the risk of
high blood pressure and other
problems. Pregnancy is a time
to eat right. And exercise as
recommended by your doctor.
It is not a time to diet. Discuss
your weight with your doctor.
Pregnancy is a time to look
closely at your eating habits.
And make good food choices. You must gain a reasonable
amount of weight from healthy foods to keep your baby
growing properly. (See Nutrition During Pregnancy,
page 24.)
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Healthy Weight Tips
Ask your doctor how much weight you should gain. And
what you should eat. He/she may refer you to a registered
dietician (RD). Or a certified diabetes educator (CDE) to
help you plan healthy meals and snacks.
Here are some suggestions:
▪ Eat
several small meals a day to control blood sugar levels.
▪ Keep
a record of meals and snacks you eat. You and your
doctor/dietician can then see if you need to eat more or
less. And if you should add or cut out certain foods.
▪ Exercise
regularly. (Always check with your doctor before
beginning a new fitness program.) Your doctor will tell you
the best physical activity for you.
▪ Do
you eat to deal with stress or upset? Find other ways
to feel better. Read. Talk to a friend. Take a walk. Watch a
movie. Take a warm bath...
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Hypoglycemia
Hypoglycemia is when blood sugar is too low. This can
happen very fast, usually within a few minutes. Blood sugar
is dangerously low if it’s 60 mg/dl or lower. Low blood
sugar can be caused by:
▪ Missing
meals
▪ Too
much exercise
▪ Physical
or emotional stress
▪ Too
much insulin (if you take insulin for diabetes)
Blood Sugar – the Highs and Lows
Hyperglycemia
Hyperglycemia is when blood sugar is too high. It can
happen over hours or days. Blood sugar is too high if it’s
over 130 mg/dl (or 90 mg/dl, fasting). Hyperglycemia may
be caused by:
▪ Too
little insulin in the body
▪ Physical
or emotional stress
▪ Lack
of physical activity
▪ Overeating
Tips to Avoid High Blood Sugar
▪ Eat
a healthy diet.
▪ Exercise
regularly (as recommended by your doctor).
▪ Drink
plenty of fluids.
▪ Take
insulin as directed. Check blood sugar regularly (and
if you suspect it may be high).
84
If you have low blood
sugar, you may feel
tired. Or dizzy. And have
a headache. If you’re
pregnant, a good way to
treat low blood sugar is
to drink a cup of skim or
low-fat milk.
Talk to your doctor if
you have diabetes. You
will have to take special
precautions to prevent
both low and high blood
sugar levels during pregnancy. Keep a record of
blood sugar levels. Take
it with you when you
visit your doctor. This will help you figure out what’s causing levels to spike or dip. Ask your doctor what you should
do to keep blood sugar in check.
85
A1c Testing
Morning Sickness and Diabetes
If you have diabetes, you will continue to get hemoglobin
A1c blood tests during pregnancy. This test shows your
average blood sugar levels over the past six to 12 weeks.
Hemoglobin is the
part of red blood cells
that carries oxygen
throughout your body.
The sugar in your
blood attaches to the
hemoglobin. It stays
there for the life of that
red blood cell. The
sugar-hemoglobin part
of the red blood cell is
called the A1c.
Low blood sugar before a meal may make you feel sick.
It helps to eat regular meals. And have a snack before
bedtime to keep sugar from dropping too low. But don’t
lie down right after eating. (For more info and tips on
managing morning sickness, see Nausea and Vomiting,
page 69.)
An A1c test measures
the percent of hemoglobin that has sugar
attached to it. The A1c
and the finger-stick test
you do at home help
you manage diabetes
during pregnancy.
During pregnancy, your doctor may check your A1c every
six weeks. A normal A1c reading ranges from 4 percent to
6 percent. It’s important to keep A1c lower than 6 percent
during pregnancy.
Good blood sugar control means fewer problems. Your
doctor will tell you what to do to improve your A1c.
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87
Snacks that might help you feel better:
Sick Day Guidelines
saltine crackers
▪6
You must take care of your diabetes even if you have
nausea, diarrhea, a cold or other infection. Your blood
sugar may rise even if you’re not eating. Or are vomiting.
Test your blood sugar at least every two to four hours or
as recommended by your doctor. Test urine for ketones
every time you test your blood sugar.
▪ 1 /3 cup of rice
▪ 3/4
ounce of pretzels
▪ 1/2
cup of pasta
small baked potato
▪1
cup of chicken soup
▪1
▪ 1/2
cup of mashed potatoes
▪ 12
ounces of tomato juice
▪ 1/2
cup of cooked cereal
▪ 3/4
cup of dry cereal
▪ 1/2
cup of lemonade
small sour apple
▪1
▪ 1/2
cup of unsweetened
applesauce
small banana
▪1
If you take insulin and vomit
after eating, your doctor may
recommend a small dose of
glucagon (0.15mg). You may
need to repeat it every one to two hours until the effect
from the short-acting insulin has gone down.
Call your doctor if your vomiting does not stop. Your doctor
may hospitalize you to hydrate you. And prevent other
problems.
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Record test results If you’re able to eat, follow your
normal meal plan. You should also drink at least 8 ounces
(1 cup) of water or another sugar-free liquid an hour. Sip
slowly. If you can’t eat your usual foods, try crackers,
gelatin, clear soup
and unsweetened
applesauce. If you
use insulin to manage
diabetes, continue to
use it even if you’re
vomiting or not eating.
Insulin pump If you
use an insulin pump,
change pump site,
needle, tubing and
syringe (reservoir) if
the reading is over 180
mg/dl twice in a row.
Check urine for ketones. Give your sliding scale (correction
factor) insulin by separate syringe. Retest your blood sugar
every hour after giving a correction factor dose. Drink more
fluids.
89
When to Call Your Doctor
Treatment
▪ Blood
sugar levels are less than 60 mg/dl or more than
180 mg/dl twice in a row.
Your doctor may recommend you take extra insulin to bring
down high blood sugar levels. If levels continue to rise or
you keep vomiting after taking extra insulin – go to the
emergency room. If you have trouble breathing, it can be
a sign of a serious condition called diabetic ketoacidosis.
Have someone take you to the ER or call 911. Tell the
doctors and nurses in the ER you have diabetes and take
insulin.
▪ Urine
ketones are moderate or large.
▪ You
don’t feel better in 24
hours.
▪ You
have a fever over 100° F.
▪ You
vomit more than once in
six hours.
▪ You
have diarrhea more than
five times a day or for over
12 hours.
▪ You
feel more tired than
usual.
▪ You
have trouble breathing.
▪ You
can’t keep any fluids
down.
▪ You’re
not sure you can take
care of yourself.
When you call your doctor, he/she will want to know the
following information:
▪ Your
temperature
▪ Your
symptoms (vomiting, diarrhea, pain, etc.)
▪ Blood
sugar levels while sick
▪ Food
and drinks you’ve had
▪ Medicine
you’ve taken
▪ How
long you’ve been sick
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Infections and Diabetes
Infections are more common and serious when diabetes
is not well controlled. High blood sugar levels help germs
grow. And weaken your body’s ability to fight off infections.
Urinary tract infections
(UTIs) are more common
when you’re pregnant.
They’re also more common
in women with diabetes.
The reason: When the
kidneys remove extra
sugar from the blood, they
dump it into the bladder
to be sent out of the body
in urine. Germs feed on this sugar. And can eventually
cause an infection. An untreated UTI can become a kidney
infection. This can be very serious. Your doctor will test
your urine for an infection. If you have one, he/she will
prescribe medicine safe to take when pregnant. (But it’s a
good idea to double check a medicine is OK to take when
pregnant.)
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Yeast infections
Stress and Diabetes
Pregnancy changes the environment in the vagina. These
changes make it easier for germs to grow there. This
makes you more prone to vaginal yeast infections. Women
with diabetes are at high risk for these infections if blood
sugar levels are high for long periods. These are signs of a
possible yeast infection:
Stress can make you doubt yourself and feel afraid, anxious
and/or very sad. Everyone is stressed from time to time.
Good (a new job, baby, marriage) and bad (death, loss of
job) things can cause stress. You may stress over a deadline, being stuck in traffic or going to the doctor. But chronic
or continuous stress can lead to serious problems. It can
increase the risk of just about any medical condition. It can
make diabetes and other disorders harder to control. This is
because when stressed, your body releases hormones that
can cause your heart to beat faster, your blood pressure to
rise, breathing to speed or slow – and blood sugar levels
to go up. In people who don’t have diabetes, the pancreas
pumps out insulin that prevents
blood sugar levels from going too
high. But in diabetics, the pancreas
may not make enough (if any) insulin to keep a lid on blood sugar.
▪ Vaginal
itching and/or burning
▪ Thick,
white, cheesy discharge
▪ Pain
when urinating
Do not ignore symptoms. Or try to treat them yourself.
Tell your doctor. And he/she will tell you how to treat it.
Preventive Tips
To prevent yeast or urinary tract infections, try to keep
blood levels within the range your doctor tells you. Urinate
as soon as you feel
the urge. Don’t hold
in urine. Doing so
increases risk of
infection. Go to the
bathroom before
and after sex. Wear
clean cotton underwear. Keep an eye
out for early signs of
infection. Tell your
doctor if you notice any signs of infection. It’s important to
treat infections early. Ask your doctor how to lower the risk
of infection. (See Infections, page 72.)
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Managing stress Everyone responds to stress in different ways.
It’s important to try to find healthy
ways to manage stress. Some people smoke, drink or eat
too much (or too little) when they’re nervous. This is not
a healthy way to cope with stress. It will just cause other
problems. Try doing healthy things to relax like yoga, exercise, take a warm bath, read or listen to soothing music.
Avoid as many stressful situations as you can. It helps to
try to stay positive. And keep your sense of humor. Support
groups may help. Tell your doctor if you feel overwhelmed.
And can’t get a handle on stress. He/she can refer you to a
licensed therapist.
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Labor and Delivery
Your doctor will monitor your pregnancy very closely. Most
women with diabetes go into labor by themselves. They
usually give birth vaginally. Some women may have labor
induced because their water has broken. Some diabetics
may need a small amount of insulin during labor.
Breastfeeding
There is usually no problem breastfeeding your baby.
Breast milk is full of nutrients your baby needs. And helps
protect your baby from infection. If you work, you can
pump milk into a bottle. If
you’re breastfeeding, it’s very
important to eat a healthy diet.
And drink plenty of non-alcoholic beverages. Remember:
You’re passing what you eat to
your baby. Your doctor will recommend a good diet for you.
He/she may also change the
amount of insulin you take after
your baby is born. Some medicines aren’t good for newborns.
So if you’re sick and a doctor
prescribes a medicine, ask if
it’s OK to take when nursing.
Breastfeeding is best for your
baby – and for you. But don’t feel bad if you can’t breastfeed. Not everyone can. Formulas available today have
nutrients to help your baby grow. (See Food for Thought,
page 130.)
94
A pregnancy with diabetes is considered to be high risk.
But you can prevent problems by keeping blood sugar
levels in check, exercising regularly, eating right and taking insulin and/or
other medicine as
directed. So check
blood sugar as recommended by your
doctor. And let him/
her know if something isn’t right.
This will help your
developing baby
grow properly. And help you both stay healthy throughout
your pregnancy!
Preterm Labor
A normal pregnancy lasts between 38 and 42 weeks.
If you go into labor before 37 weeks, it is called preterm
or early labor. When you go into labor, you begin to have
contractions. Contractions cause the cervix to thin and
open. Your baby will enter the birth canal. This is good
if the baby is full term, because he/she is ready to be
born. All of his/her organs, including the lungs, are fully
developed. And the baby can breathe on his/her own.
But it’s important to call your doctor right away if you
go into early labor. Sometimes your doctor will give you
medicine to stop labor so your baby has more time to
develop before being born.
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What Causes Early Labor?
When to Call Your Doctor
The exact cause of early labor is unknown. But certain
things can raise the risk. Among them:
Call your doctor right away if you have any of the following
symptoms:
▪ High
blood pressure
▪ Contractions
every 10 minutes or more often
▪ Kidney
and heart disease
▪ Cramps
(like your period)
▪ Placenta
problems
▪ Stomach
cramps (with or without diarrhea)
▪ Severe
anemia
▪ Pelvic
pressure
▪ Extra
fluid around the fetus
▪ Dull
lower back ache not relieved by rest
▪ Bladder
and kidney infections
▪ Change
in vaginal discharge
▪ Vaginal
and uterine infections
▪ Vaginal
bleeding
▪ Cervical
and uterine abnormalities
▪ Thigh
pain or discomfort
▪ Previous
cervical or uterine surgery
▪ General
feeling something isn’t right
▪ Stress,
smoking, drug use and poor nutrition
How can you tell if you’re having early labor? The most
common sign is a tightening feeling in your belly. You may
or may not have pain.
If frequent, this may be
early contractions. To
check, do the following:
▪ Lie
on you left side.
▪ Place
fingertips on
your belly.
▪ Time
contractions
from the start of one
to the start of the next.
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Steps to Prevent Early Labor
If you’re at risk for early labor, your doctor will likely
recommend the following measures.
Rest Lie on your side to relax your uterus. Raise the foot of
your bed so hips are a bit higher than your head. This will
keep the pressure of your developing baby off your cervix.
Drink up Drink at least six to eight 8-oz. glasses of water,
juice or milk every day.
Reduce activity Your doctor may tell you to skip all heavy
physical activity, including cleaning, heavy lifting and going
up and down stairs frequently.
Cut down on work Your doctor may recommend you
change or stop doing some duties at work.
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Bed rest Your doctor may tell you to rest twice a day for
two hours each time. Or he/she may recommend complete
or modified bed rest. (This is when you sit up for meals.
And only get up to use the bathroom.)
Limit sexual activity Your doctor may recommend you
stop or reduce sexual activity.
If your doctor suspects you’re having early labor, he/she
may tell you to come to his/her office. Or go to the hospital.
You will get a pelvic exam to see if your cervix is opening
or shortening or becoming softer. You may be sent home
to rest if contractions stop after three or four hours. And
there’s no change in your
cervix.
Call your doctor if contractions start up again.
If contractions don’t stop
(but there’s no change in
your cervix), your doctor
may give you IV fluids and
medicine to slow contractions and help you rest.
You may stay in the hospital until contractions stop.
If contractions stay regular
(10 or fewer minutes apart) and your cervix begins to show
changes, your doctor may give you medicine to stop the
contractions. If you’re not in labor, he/she may let you go
home. But may give you a monitor to check for signs of
early labor. Always follow your doctor’s directions. And call
right away if you have any concerns.
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What is Normal?
Some back pain is normal as your developing baby grows
and causes posture changes. It’s also normal to feel pressure as your growing baby presses on your pubic bones
and legs. Your muscles pull and stretch as the uterus
grows.
What is Not Normal?
▪ Regular
contractions every 10 or fewer minutes apart
▪ Regular
lower belly cramps
▪ Dull
lower back pain
that doesn’t let up
▪ Diarrhea
and/or
stomach cramps that
don’t go away
▪ Continuous
pelvic
pressure
▪ Large
amounts of
mucous or water
leaking from the
vagina
▪ Vaginal
bleeding
and/or a brown
or pink vaginal
discharge
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Early Labor Treatment
Even short-term postponement of preterm birth (before 37
weeks) can help improve outcomes for babies. If you’re
having early labor, your doctor may give you medicine to
slow or stop it. This is to give the baby more time to develop before birth. The doctor may first try giving you IV
fluids. This is because dehydration can cause contractions.
If contractions go
away, you may be
sent home to wait
for labor to start. But
you may have some
restrictions like bed
rest and limits on
physical activity.
Tocolytics are a
class of drugs used
to slow contractions.
Reducing contractions is considered an off label use for
many of these medicines. That means they were approved
by the Food and Drug Administration (FDA) to treat other
conditions. But doctors found they also delay early labor.
Magnesium sulfate This drug may be used when you
first come to the hospital. It is given through a vein
(intravenously or IV). Possible side effects include low
blood pressure, increased pulse rate, headache, nausea,
constipation and fatigue. You may also feel warm. Tell your
doctor if you have heart or kidney disease. Or have had
a bad reaction to magnesium, other medicine, foods, dyes
or preservatives.
100
Indomethacin This is nonsteroidal anti-inflammatory drug
(NSAID). It blocks production of substances called
prostaglandins. Prostaglandins contribute to
uterine contractions. Idomethacin can be
taken by mouth (as a capsule or liquid) or
given intravenously or by suppository. This drug is used
only for short-term treatment of preterm labor before 32
weeks of pregnancy. It is used if labor needs to be delayed
for 24 to 48 hours to give the mother time to take steroids
to help fetal lungs mature. You should not take this drug if
you have or ever had ulcers, kidney disease, liver disease or
blood problems. You also should not take this drug if you’re
sensitive (or have an allergy) to NSAIDs. Side effects may
include nausea, vomiting, stomach pain, water retention,
headache, heartburn, vaginal bleeding and dizziness.
Nfedipine This is a calcium blocker that may be used to
stop uterine contractions. It is given by mouth as a pill that
can be swallowed or placed under the tongue to dissolve.
Blood vessels may relax while taking this medicine. This can
cause blood pressure to drop. And your face to flush. You
may feel lightheaded or dizzy. And pulse rate may speed up.
17 Alpha-hydroxyprogesterone caproate (17p) You’re
more likely to have early labor again if you had it during
a previous pregnancy (and it wasn’t related to a medical
problem like high blood pressure, placental abruption or
premature rupture of membranes). So your doctor may
prescribe 17p to cut the odds of this happening again. If so,
you will get weekly shots of 17p starting between the 16th
and 20th weeks of pregnancy. And continue to get them
until you reach week 37.
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High Blood Pressure
High blood pressure or hypertension during pregnancy
can hurt both you and your developing baby. This is why
your doctor checks your blood pressure at each visit. If it’s
high, he/she will take steps to control it. Blood pressure is
considered to be normal if it’s lower than 120/80. It’s considered high if it’s 140/90 and over. The only way your
doctor can diagnose high blood pressure is by measuring it.
Blood pressure can vary. It’s normal for it to rise if you’re
excited or during vigorous workouts. Blood pressure
may go up when you
change position during
pregnancy. These
changes don’t last long.
And are normal. But you
may have high blood
pressure if it stays high
for a long time.
The only cure for high
blood pressure during
pregnancy is delivery
of your baby. It should
return to normal in a few
days if it was normal
before pregnancy.
The best thing to do is to monitor it. So don’t miss any
appointments. Your doctor will tell you how to control
blood pressure with diet and exercise. He/she may also
prescribe medicine to keep it in check.
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Risk Factors
You’re at greater risk of high blood pressure during
pregnancy if:
▪ You
have a history of
high blood pressure.
▪ You
had it during a
previous pregnancy.
▪ You’re
over age 35.
▪ You’re
carrying more
than one baby.
▪ You
have a family
history of hypertension.
▪ You
have diabetes, kidney disease or other conditions.
Call your doctor right away for any of these symptoms:
▪ Swelling
of face, hands or feet early in the morning that
gets worse or doesn’t go away.
▪ Shoes
and rings suddenly don’t fit.
▪ Severe
headache that doesn’t get better after taking a
recommended pain reliever. You see spots. Or vision
suddenly becomes blurry.
▪ Pain
in the upper right belly area. The liver is located here.
So this could be a liver problem. Severe, ongoing high
blood pressure may cause the liver to swell.
▪ Nausea,
vomiting or flu-like symptoms
▪ Belly
pain with or without vaginal bleeding. This could
signal a placenta problem.
▪ Severe
vaginal pain
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Effects of High Blood Pressure on Baby
Blood flows to your uterus and developing baby. The
placenta is an organ. It connects the fetus to the uterine
wall. The placenta brings blood to your developing baby.
The blood vessels in your uterus are bigger. Blood flow
to the placenta is greater. Blood carrying nutrients and
oxygen enters the placenta. It passes through the umbilical
cord to the developing baby.
If you have high blood pressure, blood vessels get smaller.
And blood flow is restricted. That means fewer nutrients get
to the developing baby. This can cause injury to developing
kidneys, liver, eyes and brain. If the placenta starts to tear
away from the uterus wall and leaks blood, there may be
no blood for the fetus. And mom may lose a dangerous
amount of blood. This is called placenta abruptio. This is a
very serious condition.
Preeclampsia
Preeclampsia is when a pregnant woman develops high
blood pressure and protein in the urine after the 20th
week (late second or third trimester) of pregnancy. The
exact cause is unknown. But risk factors include obesity,
a history of high blood pressure or kidney disease, first
pregnancy, multiple pregnancy (twins or more) and age
(risk is higher if over 35). Symptoms may include:
▪ Swelling
of the hands and face/eyes (edema)
▪ Sudden
weight gain
over one to two
days, more than 2
pounds a week
▪ Headache
that
doesn’t let up
▪ Belly
pain on the
right side, below
the ribs. Pain may
also be felt in the
right shoulder. It
may be confused
with heartburn,
gallbladder pain, a stomach virus or baby kicking.
▪ Vision
changes, including seeing flashing lights or spots,
sensitivity to light and blurry vision
▪ Irritability
▪ Decreased
urine output
▪ Nausea
and vomiting
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105
Treatment
The only way to cure preeclampsia is to deliver the baby.
If your baby is developed enough (usually 37 weeks or
later), your doctor may want to deliver immediately so the
preeclampsia doesn’t get worse. You may receive medicine
to help start labor. Or you may need a C-section.
If your baby is not fully developed and you have mild
preeclampsia, the disease can often be managed at home
until your baby has a good chance of surviving. In that
case, your doctor may recommend:
▪ Bed
rest, lying on
your left side most
or all of the time
If your doctor suspects preeclampsia, he/she will do a
physical exam. Your doctor will check your blood pressure
and for abnormal swelling. (Some swelling in the feet and
ankles is normal during pregnancy.) Blood and urine tests
will be done to check for protein in urine, higher-thannormal liver enzymes and a low platelet count. Tests will
also be done to see how well your blood clots. And to
monitor the health of your developing baby.
Your doctor will also give you an ultrasound, non-stress
test and other exams. These will help him/her decide if your
baby needs to be delivered right away.
Women who had low blood pressure at the start of
their pregnancy, followed by a significant rise in blood
pressure, need to be watched closely for other signs of
preeclampsia.
106
▪ Drinking
plenty
of water
▪ Eating
less salt
▪ Frequent
doctor
visits to make sure you’re OK
▪ Medicine
to lower your blood pressure
Sometimes, a pregnant woman with preeclampsia is
admitted to the hospital. Treatment in the hospital may
include:
▪ Close
monitoring of both mom and developing baby
▪ Medicine
to control blood pressure and prevent seizures
and other complications
▪ Steroid
injections (after 24 weeks) to help speed
development of baby’s lungs
107
Delivery
You and your doctor will discuss the safest time to deliver
your baby. Factors considered include how well the baby
is doing in the womb, severity of symptoms (preeclampsia
can be very dangerous for the mother) and how close you
are to your due date. (The
further along you are, the
better it is for your baby.)
The baby must be delivered
right away if there are signs
of severe preeclampsia.
These include:
▪ Tests
that show your baby
isn’t growing well or getting
enough blood and oxygen
▪ The
bottom number of your blood pressure is over 110
mmHg or consistently higher than 100 mmHg over a 24hour period
Complications Severe complications are rare but can
occur in preeclampsia. They include bleeding problems,
early separation of the placenta from the uterus (before
the baby is born), rupture of the liver and, in very rare
instances, death. So call your doctor right away if you
have any preeclampsia symptoms.
Preeclampsia Follow-up
You should continue to monitor blood pressure after
delivery. Preeclampsia symptoms usually go away within
six weeks of delivery. But sometimes the high blood
pressure gets worse in the first few days after delivery.
If you had preeclampsia in a previous pregnancy, you’re
more likely to develop it again in another pregnancy. But
it’s usually not as severe as the first time.
If you have high blood pressure during more than one
pregnancy, you’re also more likely to have it when you’re
older.
▪ Abnormal
liver function test results
▪ Seizures
or changes in mental function (eclampsia)
▪ Fluid
in your (mother’s) lungs (pulmonary edema)
▪ Severe
headaches
▪ Pain
in the belly area
▪ Low
platelet count or bleeding
▪ Low
urine output, a lot of protein in the urine and other
signs kidneys aren’t working right
108
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Bed Rest
Sometimes, your doctor may order bed rest for problems
during pregnancy. That can be hard to handle. It helps to
remember you won’t be in bed forever – even if it feels that
way. Here are some tips to make it easier.
Make bed comfortable Add extra pillows – one for under
your stomach and one for between your knees while lying
on your side. Use a wedge
or “pillow chair” to sit in
bed to eat/work.
Keep things handy Place
items you’ll need throughout the day close by like
computer, phone, reading lamp, cooler for lunch/
snacks, water bottle,
cleaning wipes, a washcloth, tissues, lotion, comb, hairbrush, mirror, makeup…
Put them on a nightstand or table within easy reach.
Ask for help Make a list of things people can do for you
like make meals, do laundry, shop and take care of the
kids.
Spend time with children Read, play games, do crafts,
schoolwork or color with them. Talk to them about their
day. And the new baby.
Do bed rest exercises This may help prevent muscle
weakness and fatigue. Ask your doctor for a list of exercises you can do.
Coordinate activities If you have a partner, figure out
together your roles while you’re on bed rest. For example,
you make the menu and grocery list – and your partner can
food shop. You can make play dates or appointments by
phone or email for the kids. And your partner can take them
and pick them up.
Plan activities Read, watch TV and movies (using your
remote control), pay bills, knit, sew, write letters, shop
online, chat with friends on the computer or phone, do
small crafts…
Make a routine Wake up. Eat meals. Get ready for sleep.
Shower and dress in comfy clothes even though you’ll be
spending the day in bed. (Using the bathroom may be the
only time you’re allowed up.) At the start of each day, plan
the best use of your sitting and standing time.
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111
Section 4
Preparing for Labor
Are We
There Yet?
Ask your doctor when your baby is due. Every delivery after
the 37th week of pregnancy is considered to be full term.
Ask your doctor at what point you should call when you’re
in labor. For example, how far apart – or close – should
contractions be when you call?
Labor
It can be both exciting and a bit scary when it’s time to
have your baby. Your baby grows inside your uterus. The
cervix is the neck or lower part of the uterus. It opens
into the vagina. When your baby
is ready to be born, your uterine
muscle begins to tighten and relax
in a regular pattern. This is known
as contractions. Contractions
make the cervix open. The baby
is pushed into the vagina or birth
canal. This is called labor. Labor
typically lasts about 14 hours in
first-time mothers. If this is your
second or third child, labor is more
likely to be shorter. Contractions
are very painful during this time and
are called labor pains.
112
You’ll have regular
vaginal exams during
your last month of
pregnancy. During
these visits, ask your
doctor if there have
been any changes in
your cervix. To prepare
for labor:
▪ Attend
childbirth
classes.
▪ Learn
the admissions
procedures for your
hospital. Pre-register
so you don’t have to
worry about that on
your delivery day.
▪ Make
a trial run to the
hospital. Try various
routes (so you have alternatives if there’s traffic).
▪ Have
a bag packed and ready to go. Bring your camera
and anything special you have planned for your baby’s
birth.
113
Signs Labor is Near
What’s Going On Inside You
There are signs labor will start soon. You will have a
“lightening” feeling two to three weeks before your baby
is born. You’re likely to have this feeling right before labor
if you’ve previously given birth. This happens because
your baby is now in the lower part of your pelvis. People
sometimes say “the baby dropped” when talking about
this.
A few days before labor starts, the cervix gets even softer.
It begins to open a little. It may also thin and shorten or
efface. This means your
cervix is getting ready for
labor. For example, your
doctor may say you’re 20
percent effaced. As your
cervix softens, shortens
and begins to open, you
may have a pinkish vaginal
discharge. This is normal.
This typically occurs 24 to
48 hours before labor starts.
Your water may break before
labor begins. This will cause
a sudden gush or slow trickle
of fluid from your vagina.
This fluid should be clear
and odorless. Labor usually
begins within 24 hours after
your water breaks. If labor
does not begin on its own –
and you are near your due
date – your doctor may help you go into labor.
You will now be able to breathe a little easier. But you may
have leg cramps or aches. This is because of pressure on
the nerves that pass through the pelvis. You may also feel
more pressure on your pelvis and bladder. This means you
may urinate or feel like urinating more frequently. When
labor is near, your feet and ankles may swell a bit if you’re
on your feet too long. And you may have more fluids leak
from your vagina.
When you’re in labor, contractions are regular. They occur
more frequently (are closer together), become stronger and
each one lasts longer. Usually you feel pain in your back
that travels to the front of your belly. Pain does not let up
when you walk around.
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115
False Labor
Pain Management
False labor is contractions that don’t cause the cervix to
open. These contractions are not regular. And don’t get
stronger or more frequent. Walking around or a change in
activity or position usually relieves the pain. But false labor
can feel like the real thing. Sometimes the only way to tell if
labor is true or false is for your doctor to do a vaginal exam
to check for cervix changes.
Ask your doctor about pain management during labor and
delivery. Pain management is used to help you relax and
be awake so you can help in the birth of your baby. There
are many ways to ease
and control labor pain.
Relaxation exercises,
breathing exercises
and frequent changes
of position often help,
especially in the early
stages of labor.
When to Call Your Doctor
Call your doctor if you have any vaginal bleeding. Seek
immediate medical help if you have a large gush or steady
stream of bright red blood.
This is an emergency. Lie
on your side. Put feet higher
than your head. You should
also call your doctor if your
water breaks. This is
a sign labor may be
starting. Sometimes
this happens too early.
The fluid should be
odorless. So tell your
doctor if it smells. You
should also alert your
doctor if you have severe
stomach pain (with or
without contractions) that
doesn’t let up when you
change position.
116
Other options may
include listening to music
or taking a shower or
bath. As labor progresses
– and contractions
become stronger and
more frequent – many
women opt for medicine
to relieve pain. Epidural
and spinal blocks, for instance, temporarily block pain
in the lower body. An epidural can be used continuously
throughout labor. A spinal block is typically used shortly
before delivery. The best approach depends on your
preferences. And how your labor progresses. Even if you
have a plan for managing labor pain, you might decide to
change it as labor progresses. Still, it’s a good idea to think
about your options for managing labor pain ahead of time.
And discuss your preferences with your doctor.
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Pain Relief Options
Ask your doctor about different pain relief options.
To determine which is best for you, ask the following
questions about each one:
▪ What’s
involved?
▪ How
will it affect me? Will I be able to walk? Will I be
confined to bed?
▪ How
will it affect my baby?
▪ What
are possible side effects?
▪ How
quickly will it work?
▪ How
long will the pain relief last?
▪ Can
I combine it with other methods of pain relief?
▪ What
if it doesn’t work?
Talk to your labor partner about your pain relief plan before
you go into labor. Review the plan with your doctor and
healthcare team when you arrive at the hospital (or birthing
center) to give birth. Remember, you can request pain relief
at any point during labor and delivery.
Delivery
Vaginal Delivery
A vaginal delivery is a normal delivery. The baby passes
from the uterus through the birth canal.
Preterm (Early) Delivery
Early delivery is when a baby is born before the 37th week of
pregnancy. If this happens, your baby is premature. His/her
lungs and other organs may not be fully developed. There
have been many advances in the care of premature babies.
But these babies are still at higher risk than full-term babies
of breathing and other problems. They need special care.
And may have to be monitored long term.
Postdate Delivery
Postdate delivery is when a baby is born after 42 weeks.
This is not a risk for the mother. The baby may be at risk,
because the placenta doesn’t work as well after 42 weeks.
That means the baby may not get enough oxygen or nutrition. This is why most doctors don’t allow a pregnancy to go
longer than about two weeks past the estimated due date.
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Inducing Labor
Episiotomy
Sometimes a doctor takes steps to start or restart labor
that has slowed or stopped. He/she will do this if there’s
a problem. And the baby has to be delivered right away.
In this case, you will likely be given a medicine called
oxytocin. This is a synthetic form of a hormone your body
makes that causes your uterus to contract. And breasts to
fill with milk after your baby is born. Your doctor may give
this to you if your labor is moving very slowly. Or your baby
is very past due. It will be given intravenously (through a
vein). It will make your contractions stronger. And speed up
labor. Your doctor may also decide to break your water by
hand. This helps start and/or speed labor.
Your doctor may do an episiotomy when you give birth.
An episiotomy is a small cut made in the skin between the
vagina and rectum. This is sometimes done to widen the
vaginal opening for delivery to prevent skin from tearing.
A ragged tear usually takes longer than a straight cut to
heal. An episiotomy is now done routinely in most firsttime moms. This is because the muscles near the vagina
are typically tight and more likely to tear. These muscles
stretch once you’ve had
a baby. Future babies
typically come through
more easily. Your doctor
will numb the area where
the episiotomy is to
be done. He/she may
recommend applying
ice packs to the area for
12 to 24 hours after delivery. This will help swelling go
down. Your doctor may also suggest taking a sitz bath to
help reduce swelling the first few days after delivery. In a
sitz bath, you sit in warm water up to the hips for a few
minutes.
Forceps and Vacuum Extraction
If a baby isn’t moving down the birth canal, a doctor may
use certain tools to help deliver it.
Forceps These look like a long pair of tongs or spoons.
One tong is gently placed on either side of the baby’s head.
Vacuum extraction This involves placing a small cup on
top of the baby’s head. And applying a gentle suction.
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Cesarean or C-section
After Delivery
A cesarean or C-section is when a baby is born through
an incision or cut in your belly and uterus. This is surgery.
That means it carries more risk than a vaginal delivery.
It’s best for babies
to be delivered
vaginally. But that’s
not always possible.
A C-section may
be done if a vaginal
delivery is too
risky for a woman.
Or her baby is in
distress and must
be delivered right
away. It may also be done if a baby is too big for a vaginal
delivery. A doctor may recommend another C-section if a
woman already had a baby delivered that way. Sometimes
an emergency C-section must be done because of a
problem. Your doctor will schedule a C-section if he/she
determines in advance that you need one.
Right after you deliver your baby, you will be carefully
watched for bleeding. Your doctor may add a drug called
oxytocin to your IV fluids. This drug makes your uterus
cramp and pinch off the blood vessels that held the
placenta to the inside of your uterus. Breastfeeding also
helps reduce bleeding.
The umbilical cord connects the baby to the placenta. The
cord is cut right after your baby is born. Your doctor may
ask your birth partner to cut the cord. Soon after delivery,
your doctors and nurses will clean your newborn, take his/
her temperature and measure his/her weight, length, head
size and heart and breathing rates. And you’ll get to hold
your baby for the first time!
Vaginal Birth After Cesarean (VBAC)
If your doctor recommends a C-section – ask why. Many
times he/she will cite an earlier C-section. In many cases,
you can have a second baby vaginally even if you already
had a C-section. This is called a VBAC (pronounced veeback). It will depend on the type of cut the doctor made
– and the reason for your previous C-section. Ask your
doctor if it’s OK to try a VBAC.
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Cord Blood Banking
Cord blood is rich in stem cells. The only time it can be
collected is right after birth when the cord is cut. This can
be a lifesaving resource for you, your baby or someone else
down the road. Collecting blood will not harm you or your
baby. And it only takes a few minutes. You must decide
early. And tell your doctor if you want to save this blood. If
you don’t tell your doctor, this blood will be discarded. Ask
questions about saving cord blood before you’re ready to
deliver. Following are some questions you may want to ask:
▪ What
problems can it help?
▪ What
are the chances my child will use this cord blood?
▪ How
and where is it stored?
▪ Who
helps me decide where to store it?
▪ What
are the costs of keeping the cord blood?
If you’re not interested in saving your baby’s cord blood,
you may want to donate it for research, donate it to a
public cord blood bank or donate it to someone who could
use it right away (like someone with leukemia or sickle cell
anemia). You may want to discuss options with your doctor
before delivery.
Baby Tests, Meds and Shots
Your baby will get a complete exam before leaving the
hospital. This
will help ensure
he/she has a
healthy start to
life. Following are
some tests, meds
and shots she/he
will receive before
going home.
Apgar The Apgar
test is a quick way for doctors to figure out if a baby is
healthy or needs extra medical care. This is usually done
twice: one minute after birth and, again, five minutes after
birth. Doctors and nurses measure and “grade” babies on
five signs of health:
▪ Heart
rate
▪ Breathing
▪ Skin
color
▪ Reflexes
▪ Activity
and muscle tone
Apgar scores range from zero to 10. A baby who scores
seven or higher is considered very healthy. But a lower
score doesn’t always mean there’s something wrong. Perfectly healthy babies often have low Apgar scores in the
first minutes of life.
In more than 98 percent of cases, the Apgar score reaches
seven after five minutes of life. When it does not, the baby
needs medical care and close monitoring.
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Vitamin K The American Academy of Pediatrics (AAP)
recommends all newborns receive a shot of vitamin K.
Newborns usually have low levels of vitamin K in their
bodies. This vitamin is needed for blood to clot. Low levels
of vitamin K can cause a rare but serious bleeding problem.
Research shows that vitamin K shots prevent dangerous
bleeding in newborns.
Heel stick test Your doctor or nurses will prick your baby’s
heel to take a tiny blood sample. They will test this blood
for many diseases. Among them: phenylketonuria (PKU),
hypothyroidism, galactosemia and sickle cell disease.
Hepatitis B All newborns should get a vaccine to protect
against the hepatitis B virus (HBV) before leaving the
hospital. HBV can cause a lifelong infection, serious liver
damage and even death. The hepatitis B vaccine (HepB)
is a series of three different shots. The AAP and Centers
for Disease Control and Prevention (CDC) recommend
all newborns get their first HepB shot before leaving the
hospital. The second HepB shot should be given one
to two months after birth. The third HepB shot should
be given no earlier than 24 weeks of age, but before 18
months of age.
Hearing test Most babies are given a hearing test before
they leave the hospital. Tiny earphones or microphones
are used to see how the baby reacts to sounds. Hearing
defects are not uncommon. And hearing loss can be hard
to detect in babies. When problems are found early, babies
can get the services they need as soon as possible. This
may prevent speech and language delays.
Eye drops Your baby may receive eye drops or ointment
to prevent eye infections he/she can get during delivery.
Sexually transmitted diseases (STDs), including gonorrhea
and chlamydia, are a main cause of newborn eye infections.
These infections can cause blindness if not treated.
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Special Delivery: Preemies
Babies are considered to be full term if they’re born at
or after 37 weeks of pregnancy. Those born earlier are
considered to be premature
babies or “preemies.”
Babies born between 34
and 36 weeks of pregnancy
are considered to be late
preterm. They’re usually
healthy. But some – like other
premature babies – may have
trouble eating, breathing
and staying warm. They may
tire more easily and need
to sleep more than full term
babies. And eat more often.
Baby born four weeks early
at 8 days old
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Preemie Care
Preemies are at higher risk than other babies for cerebral
palsy and developmental delays. And may get sick more
easily than full-term babies. The reason: Their immune
systems are not as developed. If you have a preemie, keep
an eye out for signs of illness. And call your baby’s doctor
right away if you spot any. You should also call your baby’s
doctor if you’re having trouble breastfeeding. Or your baby
isn’t eating well or looks yellowish (jaundiced).
Warm up Preterm babies may not have the body fat
needed to stay warm. So they need an extra layer of
clothing. Keep all babies – and especially preemies – away
from drafts. And keep your home at least 68° to 70° F!
If your baby is delivered
early or has problems, he/
she may be transferred to a
neonatal intensive care unit
(NICU). This is a special area
of the hospital that provides
extra care for preemies. Here
your baby will be tested
and watched very closely.
This may seem scary. But
just remember, care here
is specially designed for
premature babies.
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Section 5
Welcome
Home,
Baby!
Food for Thought
Breastfeeding
The American Academy of Pediatrics (AAP) recommends
breastfeeding as the sole source of nutrition for about six
months. And continuing to breastfeed until your baby is at
least 12 months
as you add solid
foods. ( Ask your
pediatrician if you
should also give
your baby vitamin
D and iron supplements during his/
her first year.) Tell
your doctor if you have trouble breastfeeding. Your hospital
may have a lactation nurse to help you. You can also call
La Leche League at 1-800-LA-LECHE (1-800-525-3243) for
more information.
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Breastfeeding Tips
▪ Relax
and make sure you’re comfortable.
▪ Use
pillows to support your arms and back.
▪ Position
baby with mouth and tummy facing nipple.
▪ Gently
touch your
nipple to baby’s
lips. (When baby
“latches on” to
your nipple, it
forces milk from
the duct.)
▪ Feed
baby
whenever he/she
is hungry.
▪ To
help keep
breasts healthy,
nurse baby from
both breasts at each feeding. Nurse about 5 to
15 minutes on each side.
▪ Make
sure you get plenty of rest during the day so
nighttime feedings are easier.
▪ To
remove baby from your breast, put your little finger
between his/her lips to gently break the suction.
How do you know that your baby is getting enough milk?
▪ He/she
will have at least 6 to 8 wet diapers a day.
▪ He/she
will gain weight.
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Growth Spurts
When your baby is having a growth spurt, he/she will nurse
longer and more frequently. This will increase your supply
of breast milk. Growth spurts typically occur:
to 5 days after birth
▪3
weeks after birth
▪6
▪ 10
to 14 days after birth
▪ 12
weeks after birth
▪ At
6 months of age
Lying down You can lie down on your side to breastfeed
your baby. This position is good when you need to rest.
Or need to stay in bed after a C-section. But don’t do this
when tired or at night. So you don’t unwittingly roll on baby.
▪ Lean on a pillow for support.
▪ Lay
baby on his/her side with mouth close to a nipple.
Baby’s feet should face toward the foot of the bed.
▪ Lift your breast toward baby’s mouth with fingers.
Breastfeeding Positions
There are various ways to hold your baby while nursing.
Following are the most common positions.
Cradle position This works well sitting in bed or on a chair.
▪ In
bed: Sit up and put
pillows behind your back.
▪ Make
sure chair is comfy
and has a high back. Put
legs up on a stool so you
don’t have to bend over to
feed or look at your baby.
▪ Cradle
baby’s body in
one arm and rest his/her
head in the bend of your
elbow. Your arm should be
under the baby’s back and
bottom.
▪ Place
a pillow across your lap. This will help support your
arm and the baby.
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Football hold This can be done sitting in bed or on a chair.
▪ Place
a pillow by your side under your arm.
▪ Put
your baby on the pillow with his/her legs toward your
back. And his/her head facing your chest.
▪ Hold
baby’s head in your hand. And bring it close to your
breast. Your arm should be under the top of your baby’s
back. Put your other hand under your breast with your
thumb above the nipple and your other fingers under it.
Warning: Be careful not to block your baby’s nose when
breastfeeding, because this is how he/she breathes while
nursing.
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Nipple and Breast Care
▪ Wash
breasts every day with plain water. Don’t use soap.
Soap can dry out nipples. And make skin on them crack.
▪ Always
let nipples air dry. Don’t rub dry with a towel.
Breast swelling Your breasts may swell while nursing. This
is a normal, temporary condition. You may have some pain.
It helps to:
▪ Breastfeed every two to three hours (even if you have to
wake your baby).
▪ Use
both breasts each time you feed.
▪ Gently
rub breasts while feeding to help milk flow. (This
will help empty breasts faster.)
▪ Use
warm compresses on breasts. Or take a warm
shower before feeding.
breasts are too full for the baby to latch on, squeeze
▪ If
a little milk out before feeding. This will get rid of any
built-up pressure. And help your baby start eating.
▪ Use
ice packs after feeding. This will help relieve soreness
and swelling.
If breasts are sore for more than two days, you may have
mastitis. Mastitis is an infection. Call your doctor right away
if you have the following symptoms:
▪ High
fever
▪ Tiredness
▪ Chills
▪ Sore,
warm red breasts
Sore nipples Nipples may become dry and cracked when
breastfeeding. Do not use any medicine or lotion on them
without your doctor’s OK.
Tips to Prevent and Treat Soreness
▪ Put
an ice pack on
nipples just before
baby starts to suck.
▪ Begin
breastfeeding
on the side that is the
least sore. Babies
typically suck harder at
the start of feeding.
▪ Only
nurse for about
10 minutes on each
breast. (In other words,
have baby feed for a
shorter time but more
often.) Limit feeding by
putting your little finger
between baby’s lips
and nipple to gently
break suction.
▪ Let
your nipples air dry after each feeding. Leave them
open to air as much as possible. This is especially helpful
if the skin on them is cracked.
▪ While
nursing, wear breastfeeding pads. Allow nipples
and the area around them to completely air dry before
replacing.
▪ Switch
breastfeeding positions.
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Nutrition and Breastfeeding
Your body has been storing fat throughout your pregnancy.
This is so you will have enough calories in your body to
nurse your baby. You must also eat extra calories and drink
extra fluids while nursing. It is recommended that you consume 500 extra calories a day while breastfeeding. Any two
of these will provide the extra 500 extra calories you need:
▪ Slice
of whole grain bread with 1 tablespoon of peanut
butter and 1 teaspoon of honey or jelly
▪ One
cup of low-fat
yogurt mixed with
1/8 cup granola and
1/8 cup of almonds
▪ Smoothie:
Blend
1 cup of low-fat
yogurt, 1 banana
and 1/2 cup
strawberries
Another quick way to
get extra calories is
to eat healthy snacks
like cheese or drink a
glass of milk.
Remember: Whatever you eat or drink you pass to your baby.
Weight Loss and Breastfeeding
After your baby is born, you should lose weight you gained
gradually. Do not cut back on calories to lose weight faster.
You need the calories to make milk for your baby while
breastfeeding.
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Bottle Feeding
Breastfeeding is the healthiest option for you and your
baby. But some women cannot – or choose not to –
breastfeed. If you opt for the bottle, your doctor can help
you find the best formula for your baby. Formula does not
contain substances in breast milk that protect infants from
certain diseases and allergies. But it is formulated to include nutrients babies need to grow during their first year.
Many mothers find bottle-feeding better meets their needs.
If you bottle feed, it’s easier for your partner and others to
feed your baby. (FYI: You can also pump breast milk. This
keeps milk production active. And allows you to go back to
work. Breast milk can be refrigerated. And others can then
also feed it to your baby.)
You can buy ready-to-use formula. Or formula that has to
be mixed with water. Follow directions exactly to make the
formula.
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Bottle Feeding Tips
Moving to Moo Milk
Babies fed formula typically finish a bottle in about 20 or
30 minutes. If your baby finishes in less than 15 minutes,
switch to a bottle with a smaller hole in the nipple. If he/she
is sucking well, but it takes a long time to finish a bottle,
check the nipple to
make sure the hole isn’t
clogged. If clear, use a
nipple with a larger hole.
Breast milk or formula should be
used for baby’s entire first year. Do
not give cow’s milk to your baby
until after his/her first birthday.
Regular cow’s milk is hard for
babies to digest. It contains too
much protein and salt. And does
not have enough vitamin C, iron or
copper to meet infants’ nutritional
needs. If your pediatrician gives the go-ahead for cow’s
milk, give your baby whole milk (unless your doctor tells
you otherwise). Skim and 2 percent milk do not have
enough fat and calories
for babies.
▪ When
bottle feeding,
hold baby in an upright
position.
▪ Burp
baby after every
2 ounces.
▪ Never
leave your baby
alone with a bottle.
There’s a danger he/
she could choke. Plus,
babies who go to bed
with a bottle are at
greater risk of tooth
decay.
Most babies who receive
eight or more feedings
a day – and sleep well
between feedings – are
well nourished. Tell your doctor if your baby does not have
at least six wet diapers a day and/or is not gaining weight.
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Heating up Milk and
formula do not heat
evenly. They can become
very hot. And burn your
baby’s mouth. Formula
and milk should be
heated until barely warm.
Test the temperature by
putting a drop of milk/
formula against your skin
before giving it to your
baby.
Do not microwave bottles. Milk can get very
hot. And hurt your baby.
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Tips for Adding New Foods
▪ Feed
with a spoon (not in a bottle or infant feeder).
▪ Introduce
new foods one at a time for about a week.
▪ Don’t
use mixed or combination foods right away.
▪ Baby
cereals with extra iron are a good first food.
▪ Don’t
give your baby drinks with sugar, tea or cola.
Burping
Burp your baby during and after each feeding. Your baby
will spit up if there’s too much air in his/her stomach.
Here are ways to burp your baby:
Introducing Solid Foods
People may tell you to feed your baby solid food early to
help him/her sleep through the night. But the American
Academy of Pediatrics (AAP) recommends holding off
solid foods until at least six months of age to be sure the
baby is developed enough to handle them. This is because
babies may have trouble swallowing food before 6 months
old. Feeding babies solid food before they’re ready could
hurt their digestive systems.
▪ Place
baby on your shoulder
and gently rub his/her back.
▪ Place
baby face down
across your lap and
gently rub his/her
back.
▪ Sit
baby on your lap,
support his/her chin
and gently rub
his/her back.
Infants are generally ready for solid foods when they double
their birth weight and weigh 13 or more pounds. One sign
they’re ready is if they watch you eat. Reach for your food.
And seem eager to be fed. But babies should not start on
solids until they can sit in a high chair or infant seat and
have good head control.
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Sleep Safe and Sound
One of the best ways to make
sure babies under a year sleep
tight – and safe – is to place
them on their backs to snooze.
This goes for nap and bedtime. Babies spend much of
their time sleeping. Therefore,
the nursery should be the safest room in the house. Yet
many infants die during sleep because of unsafe environments. Some die from suffocation and strangulation. Some
die from sudden
infant death syndrome (SIDS). SIDS
is the unexplained
death of a seemingly
healthy baby. It usually occurs during
sleep. Sudden infant
death syndrome is
sometimes called
crib death. The exact
cause is unknown.
But research shows
it may be linked to
abnormalities in
brain areas that control breathing and
waking from sleep.
142
Only use cribs that meet current safety standards Crib
slats should be no more than 2 3/8 inches apart. This will
prevent baby’s head from getting stuck between them.
Make sure there are no gaps larger than two fingers between crib sides and mattress. Follow directions exactly to
make sure crib is assembled the right way. Do not use broken or modified cribs. Or cribs that are older than 10 years.
Infants can strangle
to death if their bodies pass through gaps
(between loose components or broken slats)
and their heads remain
trapped. Check to see
if your crib (bassinet or
play yard) has been recalled for safety violations. You can find this info at:
www.safetybook.org/crib-recalls.aspx. For more information
about crib safety standards, visit: www.cpsc.gov.
Beware of all cords Never place a crib or bassinet near a
window with blind or curtain cords or a baby monitor with
cords and wires. Babies can strangle on cords, wires and
strings. Tie up or remove all curtain/blind cords. Put baby
monitors out of reach.
Babies should sleep close... but not in the same bed.
Keep your baby’s crib or bassinet within an arm’s reach of
your bed. But your infant should not sleep in the same bed.
The reason: Sleeping parents may accidentally roll onto
babies. Infants may also get tangled in sheets, pillows and/
or blankets and suffocate. They can also roll off the bed.
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Breastfeed as long as you can Studies show breastfeeding may reduce SIDS risk.
Schedule and keep all well-child visits Recent research
suggests baby immunizations significantly cut
SIDS risk.
Don’t let baby overheat
Keep baby’s sleep area
a comfortable temperature. Your baby may be
too hot if sweating. Or if
his/her chest feels hot.
Cut SIDS Risk
The best way to cut the risk of SIDS and other sleep-related injuries is to place your baby on his/her back to sleep*
on a firm crib mattress covered by a fitted sheet. Nothing
else should go in the crib. No thick quilts, pillows, bumper
pads or stuffed toys. The same goes for bassinets and
play yards. These can cause your baby to suffocate. Do
not put blankets or pillows between the mattress and the
fitted sheet. And never put your baby to sleep on a chair,
sofa, waterbed, cushion or sheepskin. Following are more
recommendations from the American Academy of Pediatrics (AAP) and U.S. Consumer Product Safety Commission
(CPSC) to help babies sleep safe and sound.
*A very small number of babies with certain medical
conditions may need to be placed on their stomachs to
sleep. Ask your baby’s doctor what’s best for your baby.
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If you’re worried your
baby is cold, dress in infant clothes designed to keep babies warm without covering their heads. Don’t dress him/her in more than one layer
more than you would wear.
Offer a pacifier at nap and bedtime This may help reduce
the risk of SIDS. If breastfeeding,
wait until breastfeeding is going
well before offering a pacifier. This
usually takes three to four weeks.
It’s OK if your baby doesn’t want a
pacifier. Some just don’t like them.
Don’t use products that claim to reduce SIDS risk
Products like wedges, positioners, special mattresses and
specialized sleep surfaces have not been shown to reduce
the risk of SIDS. And some infants have suffocated while
using them.
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Home Safety
Give baby plenty of “tummy time” This helps strengthen
neck muscles so he/she can lift head. Always stay with your
baby during tummy time. And make sure he/she is awake.
(See Playdate: Tummy Time!, page 162.)
Don’t smoke According to the AAP, you can cut SIDS risk
by not exposing your baby to smoking. So don’t smoke.
And if you do, don’t smoke around your baby. Or in your
home. And don’t let anyone else smoke in your
home or around your
baby. Expectant moms
can reduce SIDS risks by
going to all prenatal visits,
not smoking (and steering
clear of other smokers),
and not drinking alcohol
or using drugs.
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Your baby will spend a lot of time in a crib. The crib
mattress should be at least 5 inches deep and fit close to
the rails of the crib. Crib slats should be no more than 2 3/8
inches apart to prevent your baby’s head from slipping
through or getting stuck. Keep all cords, strings, straps and
wires out of the baby’s reach. That means cords on drapes,
curtains and window blinds. Babies can strangle on the
cords. And older children can pull themselves up and fall
through the window. So be sure to choose a spot away
from windows, window blinds and draperies when setting
up the crib. The cord on a baby monitor can also pose a
danger. So place monitor out of baby’s reach. (See page
143 for more information on crib and sleep safety.)
Other Safety Measures You Should Take
▪ Do
not put car seat or baby carrier near the edge of a
table, chair, counter or bed.
▪ Do
not leave baby alone on a high surface.
▪ Never
leave babies alone in the tub or unattended
near a pool or any water – even a bucket
with just a few inches of water in it.
These are drowning risks.
▪ Use
safety covers on all electrical outlets.
▪ Use
safety locks on cabinets, toilets, etc.
▪ Only
use meds with child-safe caps.
And keep out of the reach of
babies and children.
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Postpartum Care
The postpartum period typically refers to the first six weeks
after your baby is born. Your baby will go through many
changes. You will also have many different feelings during
this time.
Vaginal discharge You will have a red discharge from
your vagina the first few days after giving birth. It will
gradually get lighter in color and flow – and stop. Do not
use tampons during this time. Call your doctor if discharge
increases, turns bright red or smells bad.
After Birth Pains You may have some cramping after
giving birth. This is your uterus shrinking back to normal
size. Call your doctor if cramping is severe. Ask what you
can take for the pain.
Episiotomy As your episiotomy heals, the stitches may feel
sore and itchy. Keep the area around the stitches clean.
Ask your doctor what you can do to relieve discomfort.
Urination You will go to the bathroom a lot the first few
days after your baby is born. This is how your body gets rid
of extra fluid you needed while pregnant.
Breast Tenderness Your breasts may feel full and heavy.
Make sure you wear a bra with good support, even at night.
If you’re breastfeeding, put warm,
wet pads on your breasts before
nursing. If you bottle feed, apply
cold pads. If pain is bad, ask your
doctor for something to ease it.
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Constipation
You may be constipated right after your baby is born. Do
not take laxatives (unless your doctor tells you to take
them). Here are some tips to ease constipation:
▪ Try
to get a little exercise. Ask your doctor what activities
are OK.
▪ Drink
at least 8 eight-ounce glasses of water, prune and
other fruit juices, milk… a day.
▪ Eat
high-fiber foods like fresh fruits (including washed
peels), dried fruits (prunes, figs, apricots), vegetables,
whole grain breads and cereals, dried peas and beans…
149
The Baby Blues
Getting Enough Rest
Your life will be very different once you bring your new
baby home. You not only have to take care of yourself.
You have to adjust to being a new mom, too. Sure you’re
excited. But you may also feel tired and stressed. Many
women get the blues after childbirth. You may have sudden
mood swings. That is, feel
very happy one moment and
very sad the next. You may
cry for no reason, be irritable,
restless – and feel lonely.
The baby blues (postpartum
blues) usually start within
three days of birth. They may
last only a few hours or as
long as two weeks after delivery.
It’s very important to your emotional and physical health to
get enough sleep. Here are some tips to help you get the
rest you need:
The baby blues are very
common. An estimated 70
percent to 85 percent of new
mothers have them. It will
take time for you and your baby to adjust. Be patient. Ask
for – and accept – help from family and friends. It may help
to join a new moms’ support group. The baby blues usually
go away on their own. But call your doctor if you still have
them after two weeks. And you’re having a hard time taking
care of yourself and/or your baby. Do not be embarrassed.
You are not alone. It’s not your fault you feel blue. And you
will feel better. But you may need help getting there. So tell
your doctor. He/she can help you get the treatment you
need. (See Postpartum Depression, page 154).
150
▪ Take
naps when your
baby is napping.
▪ Go
to bed early and
sleep late whenever
you can. This will
help you make up for
sleep you lose during
nighttime feedings.
▪ Limit
visitors
during the first few
weeks after your baby
is born.
▪ Ask
friends and family
for help with cooking
and household chores.
▪ Try
to relax at least
twice during the day.
Nutrition
It’s important to eat healthy after you have your baby, too.
Don’t even think about
dieting until after your sixweek post-delivery checkup. And your doctor says
it’s OK — and tells you the
best diet for you.
151
Postpartum Checkup
Birth Control
It’s important to take care of yourself as well as your baby.
Call your doctor to make an appointment for your postpartum checkup four to six weeks
after you give birth. At this office
visit, your doctor will ask how
you’re doing. And make sure
you’re healing the right way.
He/she will check weight and
blood pressure. And do a pelvic
exam to make sure your uterus
is returning to pre-pregnancy size. (If you had a C-section,
stitches may be removed.) Your doctor will check to make
sure all bleeding has stopped. And your episiotomy or any
tearing is healing. Your doctor will also check for hemorrhoids. If you’re due for a Pap test, it can be done now.
Your doctor will check your breasts. If you’re nursing, he/
she will ask if you have sore nipples or any other problems.
If you’re bottle feeding, your doctor will check that your
breasts are no longer making milk.
Some people believe breastfeeding prevents pregnancy. It
doesn’t. You can get pregnant again even if you’re nursing.
So you need to use birth control to prevent an unplanned
pregnancy. You can buy some forms of birth control like
condoms at the drug store. Your doctor must prescribe
birth control pills, a diaphragm or an IUD. Ask your doctor
to help you choose the birth control method best for you.
Having Sex
Most doctors recommend a postpartum exam before
you start having sex again. You usually need to wait until
bleeding stops. And your uterus has healed. It is very
normal not to feel like having sex for at least several weeks
after giving birth. You will know when you’re ready. You
may be a little nervous. And it may be a bit uncomfortable.
Your vagina may need extra lubrication (due to hormonal
changes). Ask your doctor the best lubricant to use if you
need one. Try different positions for comfort.
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Baby Spacing
Baby spacing is planning pregnancies with the best amount of
time between births for mother
and baby. The recommended
time between pregnancies is
usually more than 18 months
but less than five years. If pregnancies are too close (less
than 18 months apart) or far apart (more than five years),
risk is higher for having a premature or low-weight baby.
Spacing babies 18 months to five years apart increases the
chance the next one will be born healthy. This also:
▪ Gives
your body time to replace nutrients used during
pregnancy.
▪ Gives
you time to bond with your first baby.
▪ Helps
keep you from feeling overwhelmed.
▪ Gives
you a chance to adjust to changes that occur when
you have a new baby.
▪ Helps
you plan your finances.
▪ Gives
you time to lose baby weight you gained so you’re
a healthy weight when you get pregnant again.
153
Postpartum Depression
Having a baby can be one of the happiest events of your
life. It is exciting and rewarding. But it can also be stressful.
You will go through many physical and emotional changes
when you’re pregnant. And after you give birth. These
changes can leave
you feeling sad,
anxious, afraid or
confused. These
feelings (called
the baby blues)
typically go away
quickly. If they
don’t, you may
have postpartum
depression (PPD).
PPD is a serious
problem. Call
your doctor if these feelings don’t go away. Or get worse.
At least 1 in 10 new mothers get PPD. It can happen a
few days or even months after childbirth. These feelings
are like the baby blues but much stronger. They may keep
you from doing the things you need to do every day. If this
happens, call your doctor right away. If you do not get help,
your symptoms can get worse.
PPD is a very serious problem. But it can be treated with
medicine and counseling. Do not feel ashamed or guilty.
You did nothing to cause this condition. And it does not
mean you do not want or love your baby.
154
Signs of Postpartum Depression
▪ Pulling
away from family and friends
▪ Feeling
sluggish and exhausted
▪ Feeling
overwhelmed
▪ Thoughts
of death, suicide or harming your baby or
yourself
▪ Overly
worried about your baby
▪ Appetite
and weight loss
▪ Feeling
hopeless
▪ Little
or no interest in
your baby
▪ Feeling
helpless
▪ Deep
sadness, crying
a lot
▪ Feeling
restless,
irritable
▪ Lack
of interest or
pleasure in activities
▪ Unable
to sleep
▪ Nervous
or jumpy
▪ Sleeping
too much
▪ Feeling
worthless
▪ Unable
to handle daily
tasks
▪ Trouble
breastfeeding
▪ Financial
problems
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Treatment for Postpartum Depression
PPD can be treated and will go away. But you have to tell
your doctor. Don’t be afraid to talk to her/him. Your doctor may not know you’re depressed unless you discuss
your symptoms. The type of treatment will depend on the
severity of depression. It may be treated with therapy, antidepressants or a combination of both. If you are breastfeeding, ask your doctor if it’s safe to take antidepressants.
Some may affect breast milk. And should not be taken.
If you have PPD, your doctor
may recommend you attend a
support group. Or talk to other
women with the same problem.
It helps to get enough rest. So always try to nap when your baby
naps. Ask for help with daily
chores. Do not try to do everything. Do only as much as you
can. Trying to be Super Mom will only add to your stress.
Well-Baby Care
Health Insurance for Baby
Call your insurance company about covering your baby as
soon as you arrive home from the hospital. Some health
plans ask you to sign up your baby within 30 days after his/
her birth. Make sure you find out what your plan covers for
your baby. Ask how wellness visits and emergencies are
covered.
Car Safety
You should have a car seat that meets federal safety
standards. Install the car seat in the back seat, facing the
rear of the car. Do not place your baby in the front seat.
This is especially dangerous if your car has a passengerside air bag. Babies can be seriously injured and even
killed if an airbag bursts open against a car seat.
Causes of Postpartum Depression
No one knows for sure what causes PPD. Changes in
hormones that occur after delivery may trigger it. Thyroid
levels may also drop sharply after giving birth. Low thyroid levels can cause symptoms that feel like depression.
Among them: mood swings, fatigue, irritability, insomnia
and anxiety. A blood test can show if this condition is causing your PPD. If it is, your doctor can prescribe medicine to
treat it. Other factors that may cause PPD include exhaustion (sleep deprivation from getting up in the middle of the
night to take care of baby). You may also feel less attractive and be struggling with a sense of identity.
156
157
Bath Time
Umbilical Cord Care Tips
At first, only give your baby sponge baths. When the
umbilical cord falls off, you can wash your baby in a clean
sink or baby tub. You only
need about two inches
of water. Use warm not
hot water. Test water by
putting your elbow in it.
The water should feel the
same as your skin.
▪ Give
your baby sponge baths until the cord falls off to
keep this area dry.
Warning: Never leave your
baby alone in or near the
tub! It is very easy for a
baby to drown even in
just a few inches of water.
Umbilical Cord Care
After your baby is born, the umbilical cord will be clamped
and cut off leaving a stump. The stump will dry and fall off.
This usually happens within two weeks.
After the stump falls off, there will be a small red spot. You
may notice a small amount of fluid (sometimes tinged with
blood) in the belly button or navel area. This is normal. The
navel should heal completely within two weeks if you take
care of it.
The most important thing to remember is to keep the area
clean, dry and uncovered. This will help it heal right. And
prevent infection. Ask your doctor what you can use to
clean it.
158
▪ Keep
the area open to air. This will help with drying and
healing.
▪ Fold
diaper down in front. This will expose cord area to
air. And keep dirty diaper contents away from tender
skin here.
▪ Clean
the base of
the stump every
time you change
baby’s diaper. Wet
a cotton ball. Or
swab with warm
water. And gently
clean around the
base. Gently pat
the area dry with a
soft cloth.
It’s normal to see small amounts of discharge or dried
blood while stump area is healing. But call your doctor right
away if:
▪ Your
baby suddenly spikes a fever.
▪ There’s
redness and/or swelling around the stump area.
▪ The
stump area continues to bleed.
▪ There’s
a yellow discharge (that smells bad) oozing from
the area.
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Circumcision and Penis Care
Getting to Know your New Baby
Circumcision is when the foreskin on the end of a baby
boy’s penis is removed.
Your new baby will love attention. Hold him/her close. And
cuddle often. Your baby will learn to know your face and
voice. Babies cry to let you know when they need a diaper
change or are hungry, tired, sick, hot or cold. Sometimes,
babies are just fussy. And cry even when you have met all
their needs. If nothing seems to help and your baby keeps
crying, take deep breaths until you relax. Try these tips to
calm your baby:
The American Academy of Pediatrics (AAP) found that
medical benefits of circumcision outweigh the risks. Research shows the procedure reduces the risk of urinary
tract and sexually transmitted infections. The AAP says
parents should decide whether
to circumcise after discussing the
procedure with their pediatrician.
And weighing the best interests
of the child, including medical,
religious, cultural and ethnic traditions and personal beliefs. Some
parents have religious, family or
personal reasons for circumcision.
The procedure is usually done
soon after birth. If your baby is not
circumcised, do not push foreskin
back until you check with his doctor. If your baby has been circumcised, gently clean the outside
skin of the penis by squeezing
warm water from a washcloth on it each time you change
a diaper. Don’t use baby wipes until area has healed.
▪ Put
baby on your chest so he/she can feel your heartbeat.
▪ Play
soft music.
▪ Talk
or sing to baby in a soothing voice.
▪ Give
baby a pacifier.
▪ Carry
baby and move slowly from room to room.
▪ Take
baby for a walk in a stroller or a drive in the car.
Call your pediatrician if:
▪ Your
baby develops a fever or doesn’t urinate.
▪ There’s
a smelly discharge from baby’s penis
▪ Baby’s
penis bleeds or becomes red and swollen.
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161
Play Date: Tummy Time!
Child Abuse
Play with your baby at least two to three times a day.
A good time to play is after a nap or diaper change. Give
your baby more tummy play time – little by little. You can
place baby on his/her tummy on the floor. Lie next to him/
her. You can lie on your back. And place baby on your
chest. Or you can sit and put baby on his/her tummy on
your lap. Some babies don’t like being on their tummies
at first. Try putting a rolled-up towel or small pillow under
baby’s chest. Place toys (and yourself) just out of baby’s
reach. This will make your baby try to stretch and move in
different directions. These exercises help your baby:
Taking care of a baby is hard work. Sometimes you may
feel like you’re losing control. Do not handle your baby
when you are angry. NEVER shake or hit your baby.
Hitting and shaking your baby can cause brain damage,
blindness, other injuries and death.
▪ Strengthen
neck, arms and back
▪ Develop
hand-eye coordination
▪ Look
at what is around
▪ Do
things needed to learn to scoot, crawl and walk
It is never okay to hit, shake or hurt your baby.
If you feel like you might
hurt your baby, take these
steps:
▪ Put
your baby down in
a safe place for a few
minutes. And try to relax.
Do not go so far away
that you cannot hear
your baby.
▪ Take
deep breaths. And
listen to soothing music.
▪ Call
a friend or family
member. Ask him/her to
come over immediately.
▪ Run
the vacuum.
The noise may calm your
baby.
▪ Call
your doctor if the crying continues for a long time.
And you can’t calm your baby.
▪ Don’t
pick up your baby until you’re calm. Ask your
doctor to refer you to a counselor for help.
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163
Section 6
Resources
Well Baby Checkups
You must take your baby to all regular scheduled
checkups. At each visit, your pediatrician will take baby’s
temperature, weight and measure his/her length and head
size. The doctor will tell you how your baby is growing.
And how to take care of your baby’s health and prevent
accidents. Ask questions. And tell the doctor if you have
any concerns. Your pediatrician will tell you vaccines your
baby needs. And give them to him/her as scheduled.
You must keep these shots up to date to keep your baby
healthy. These shots protect against many dangerous
childhood diseases. Among them:
▪ Hepatitis
B
▪ Diphtheria
▪ Measles
▪ Haemophilus
influenza
type B
▪ Polio
▪ Mumps
▪ Rubella
(German measles)
▪ Pertussis
(whooping cough)
164
Case Management
Case management is a service your health insurance company may offer at no extra cost. This service is designed to
help you understand your healthcare choices. It’s up to you
whether to take advantage of it. If you do, a case manager
will help coordinate your treatment team. And figure out
your individual needs. All of your personal information is
kept confidential.
▪ Tetanus
(lockjaw)
▪ Pneumococcal
infections
▪ Chickenpox
165
Goals of Case Management
▪ To
make sure all of your doctors are aware of everything
about your health care
▪ To
help you take
advantage of all
resources available
to you
▪ To
help you get good
health care
▪ To
improve your
quality of life
▪ To
help keep health
care costs down
Medical services
often cost a lot. Case
managers make sure
you get all the services
your plan covers.
And know community
resources available to
you. They help your
doctors and insurance
company understand
you and your family.
Case managers work as partners with your doctors. And
they make sure you and your family get the care you need
when you need it.
166
Women, Infants and Children (WIC)
The Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) provides federal grants to states
for supplemental foods, health care referrals, nutrition
counseling and education for low-income pregnant women,
women who recently had babies, and infants and children
up to age 5 at nutritional risk. WIC state agencies provide
checks or vouchers for foods with nutrients especially
important during pregnancy, breastfeeding and early
development. Among them:
▪ Iron-fortified
infant formula
and cereal
▪ Dried
beans and peas
▪ Iron-fortified
adult cereal
▪ Fruits
and vegetables
▪ Fruit
and vegetable juices
high in vitamin C
▪ Peanut
butter
▪ Tuna
fish
▪ Eggs
▪ Milk
▪ Cheese
167
Online Information
For more information, check out
the following organizations and
their Web sites.
Pregnancy.org
www.pregnancy.org
A Web site built “By Parents, For Parents.™” Connects parents and parents-to-be. Provides information and tools on
getting pregnant, being pregnant, birth, baby and beyond.
La Leche League International
www.lalecheleague.org
Provides support, education and information to help new
moms breastfeed. Explains the benefits of breastfeeding
for baby and mom.
March of Dimes
www.marchofdimes.com
Are you eligible? You’ll find a list of WIC state agencies at
www.fns.usda.gov/wic. Contact one in your area to see if
you qualify for WIC benefits. You must meet certain income
requirements. A healthcare worker will determine if you
need help with nutrition. WIC benefits may include:
▪ Checks
or vouchers for nutritious supplemental foods
▪ Nutrition
education and counseling
▪ Screening
and referrals for other services needed
168
Helps prevent birth defects and infant death through
research, community services, education and support.
Sidelines
www.sidelines.org
Provides support, education and encouragement to
women with high-risk pregnancies. All volunteers are
women who had difficult pregnancies. You can talk to
volunteers on the phone. Phone: (888) 447-4754
Email: [email protected]
169
The Triplet Connection
Centers for Disease Control and Prevention (CDC)
www.tripletconnection.org
www.cdc.gov
Connects expectant parents with experienced
“resource parents.” Phone: (435) 851-1105
Alcoholics Anonymous (AA)
American Cancer Society (ACS)
www.aa.org
www.cancer.org
AA is a group of men and women who share their
experiences to help themselves and others recover
from alcoholism.
Phone: (800) 227-2345
American Diabetes Association (ADA)
www.diabetes.org
Academy of Nutrition and Dietetics
The National Council on Alcoholism and Drug
Dependence (NCADD)
www.ncadd.org
www.eatright.org
Phone: (212) 269-7797
Phone: (800) 877-1600
National help and referral line: (800) 622-2255
American Heart Association (AHA)
www.heart.org
Nicotine Anonymous
Phone: (800) 242-8721
www.nicotine-anonymous.org
Juvenile Diabetes Research Foundation (JDRF)
Nicotine Anonymous helps people stop using tobacco and
nicotine products.
www.JDRF.org
The world’s leading nonprofit, nongovernmental funder of
diabetes research. Provides information on diabetes care
and treatment. Phone: (800) 533-2873
National Domestic Violence Hotline
American Lung Association (ALA)
This is a 24 hour hotline. It provides referrals to agencies
in all 50 states, Puerto Rico and the U.S. Virgin Islands.
Hotline: (800) 799-7233 or TTY (800) 787-3224
www.lung.org
170
www.thehotline.org
171
Glossary of Terms
Afterbirth — Placenta and membranes.
AIDS — A disease of the immune system characterized
by very low T cells. Makes patient vulnerable to lifethreatening conditions.
Amniocentesis — A test in which a sample of amniotic
fluid is removed and checked for possible birth defects.
Amniotic Fluid — Fluid inside the amniotic sac. Serves
as a cushion for developing baby.
Amniotic Sac — Soft thin sheet of tissue or membrane
that surrounds a developing baby.
Anemia — A condition in which hemoglobin (the redcolored material in your blood that carries oxygen) is low.
Biophysical Profile (BPP) — A test using ultrasound
and an external fetal heart rate monitor to check fetus
wellbeing.
Blood Pressure — The amount of pressure needed
to push blood through the arteries.
Bradycardia — Slowing of heart rate.
Braxton-Hicks Contractions — Mild, irregular, often
painless contractions of the uterus during pregnancy
that don’t cause the cervix to dilate.
Breech — When a baby is buttocks or feet (instead
of head) down in uterus.
Catheter — Thin, flexible, hollow tube inserted to give
fluids or medicine.
Cervical Incompetence — Unexplained weakening
of cervix that results in cervix opening before labor.
Antiemetic — A drug that relieves nausea and vomiting.
Apgar Score — Simple system for checking an infant’s
health one and 5 minutes after birth. Scores range from
0 to 10.
Cervix — Neck (lower part) of the uterus that opens into
the vagina.
Areola — Dark ring around each nipple.
Cesarean Delivery — Surgical procedure by which baby
is delivered through an incision in the mother’s belly and
uterus. Also called a C-section.
Autoimmune — A condition in which the immune system
becomes faulty and attacks healthy tissue.
Colostrum — Thick fluid secreted by breasts containing
protein and calories. Strengthens a baby’s immunity.
Bilirubin — Sticky fluid secreted by the liver to aid in
breakdown and absorption of fats.
Contraction — Tightening of uterine muscles.
172
173
Corpus Luteum — Yellowish mass of tissue that forms
in the cavity of a follicle in the ovary after the release of
an egg cell. Secretes the hormone progesterone.
Deep Vein Thrombosis (DVT) — Formation of a blood clot
in a large, deep vein. Clots tend to form when blood flow is
sluggish.
Dehydration — Severe loss of body fluid. Occurs when
water intake is too low and/or excess fluid is lost through
vomiting or diarrhea.
Dietician — Specialist in planning meals and diets.
Dilation — Opening of cervix during labor to allow delivery
of a baby.
Engorgement — When breasts are overfilled with milk.
Episiotomy — Small incision made in tissue between the
vagina and rectum to prevent tearing during delivery.
Estrogen — A female hormone.
Fetus — In humans, the stage of prenatal development from
the end of the embryonic phase until birth.
Fundal — Refers to the fundus or upper portion of the uterus.
Gestation — Number of weeks since conception.
Gestational Hypertension — High blood pressure during
pregnancy.
Diuretic — Substance that increases urine output.
Growth Restriction (Growth Retardation) — Slower than
expected rate of growth of developing baby.
Eclampsia — Severe pregnancy disorder characterized
by prolonged high blood pressure.
Heparin — Anticoagulant or “blood-thinning” drug used
to prevent blood clots.
Edema — Excessive fluid in body tissue causing swelling.
Herpes Simplex — Diseases caused by herpes viruses that
result in blisters on skin or membranes of lips, mouth, face
and/or genital region.
Effacement — Thinning and shortening of cervix as labor
progresses.
Embolism — Artery blockage that slows or stops blood
flow.
Embryo — In humans, stage of prenatal development from
about two weeks until the end of the 7th or 8th week.
174
HIV (human immunodeficiency virus) — Any of several
retroviruses (especially HIV-1) that infect and destroy helper
T cells of the immune system.
Human Papilloma Virus (HPV) — Virus (linked to cervical
cancer) that causes various types of warts (common warts
of the extremities, plantar warts and genital warts).
175
Hyaline Membrane Disease (HMD) — Common cause
of breathing difficulty in preterm or premature babies. Also
known as Respiratory Distress Syndrome.
Hyperemesis — Severe vomiting that leads to weight loss,
dehydration and poor nutrition.
Hypertension — High blood pressure (140/90 or greater).
Miscarriage — Spontaneous expulsion of a fetus before
it can live outside the uterus.
Neonatal — Relating to or affecting a newborn during the
first month after birth.
Neonatal Intensive Care Unit (NICU) — Hospital unit
specially equipped to care for newborns with special
medical needs.
Incompetent Cervix — Cervix too weak to stay closed
during pregnancy that can result in a preterm birth without
labor or contractions.
Neonatologist — Doctor specializing in care of newborn
babies with special needs.
Ketones — By-product of burning fat. Presence of ketones
in the urine indicates dehydration and poor food intake.
Non-Stress Test (NST) — Test that uses a fetal monitor
to assess health of developing baby.
Labor — Process of regular uterine contractions,
effacement and dilation of cervix that expels a baby,
placenta and membranes from the body.
NPO — Stands for “nothing by mouth.” Means patient may
not eat or drink anything.
Lanugo — Soft, downy hair that covers and protects
a fetus.
Lightening — Sense of decreased weight and abdominal
tension pregnant women feel as a fetus moves down into
the pelvic cavity.
Low Birth Weight — Baby 2,500 grams (51/2 pounds)
or less at birth.
Meconium — Green material passed from baby’s bowels
during first days after birth.
176
Obstetrician (OB) — Physician who treats women during
pregnancy and delivery.
Osteoporosis — Condition that causes bones to thin and
break easily.
Pediatrician — Physician who specializes in treating
babies and children.
Pelvic Inflammatory Disease (PID) — Infection of female
reproductive tract (often sexually transmitted) that is the
leading cause of infertility in women.
177
Perinatologist — Doctor specializing in care of women
with high-risk pregnancies. Also called a maternal-fetal
medicine specialist.
Prenatal — Relating to or affecting an infant before birth.
Perineal — Refers to the perineum, a mass of muscle and
connective tissue that separates the vagina and rectum in
women, and the urethra and rectum in the male.
Proteinuria — Protein in urine.
Placenta — Spongy organ in the uterus that establishes
and maintains contact (through blood vessels in the
umbilical cord) between a pregnant woman and her
developing baby.
Placenta Abruptio — A serious condition in which part
or the entire placenta detaches from the uterine wall.
Preterm — Infant born before 37 weeks of pregnancy.
Pulmonary Embolism — When a clot breaks loose
and moves into the lungs, where it can block blood flow
between heart and lungs.
Respiratory Distress Syndrome (RDS) — Breathing
difficulty common in preterm infants.
Stillbirth — Birth of a dead fetus.
Placenta Previa — Complication of pregnancy in which
placenta grows in the lowest part of the womb (uterus) and
covers all or part of the cervix.
Sudden Infant Death Syndrome (SIDS) — Death of an
apparently healthy infant, usually before one year of age.
The cause is unknown. Typically occurs during sleep.
Also known as crib death.
Platelets — Cells in the blood that stick together to form
a “plug” or clot.
Surfactant — Substance produced by growing fetus that
coats lungs to prevent their collapse.
Postnatal — Relating to or affecting an infant immediately
after birth.
Thrombocytopenia — A condition in which the blood does
not clot the right way because of very low platelet level.
Postpartum — Period after birth.
Thrombosis — Formation of a blood clot.
Postpartum Depression (PPD) — Depression that occurs
after childbirth.
Toxoplasmosis — Infection or disease caused by parasite
that may damage the central nervous system. Results
from handling cat liter or contaminated soil or eating raw/
undercooked meat.
Preeclampsia — Pregnancy disorder characterized by
high blood pressure and protein in urine.
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179
Umbilical Cord — Cord that connects fetus with placenta
that respiratory gases, nutrients, and wastes pass through.
Uterus — Hollow, muscular organ in women in which a
fetus grows and develops.
Vagina — Passageway connecting the uterus to the
outside genital area. Also called the birth canal.
Varicose Veins — Abnormal swelling of (superficial) veins,
especially in the legs.
Vernix Caseosa — Pasty covering (mostly made up of
dead cells and sebaceous secretions) that protects skin
of a fetus.
Viable — Mature enough to live outside the uterus.
Womb — Uterus.
References
1. C
onsumer Product Safety Commission: www.cpsc.gov
2. A
merican Academy of Pediatrics (AAP):
http://www.healthychildren.org/English/ages-stages/
baby/sleep/Pages/Preventing-SIDS.aspx
3. P
ediatrics, February 27, 2012: http://pediatrics.
aappublications.org/content/129/3/e827.full
4. P
ediatrics, August 27, 2012
http://pediatrics.aappublications.org/content/130/3/e756
5. C
enters for Disease Control and Prevention (CDC):
www.cdc.gov/flu/groups.htm
6. M
ayo Clinic: http://www.mayoclinic.com/health/
preeclampsia/DS00583
7. C
onsumer Product Safety Commission, crib safety
guidelines: www.cpsc.gov/info/cribs/cribenforce.html
8. A
merican Diabetes Association, Standards of Medical
Care in Diabetes, 2012; Diabetes Care, January 2012,
vol. 35 no. Supplement 1 S11-S63
9. Institute for Clinical Systems Improvement, 2012:
https://www.icsi.org/_asset/13n9y4/PrenatalInteractive0712.pdf
10. M
arch of Dimes: http://www.marchofdimes.com/
pregnancy/trying_multiples.html
11. N
ational Institutes of Health (NIH): http://ghr.nlm.nih.
gov/handbook/inheritance/riskassessment
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