Pregnancy is an exciting time of major change. From the very start, your baby-to-be alters your body and the way you live your daily life. The best way to approach pregnancy, labor, delivery, and the postpartum period is to be informed. If you are planning to become pregnant, see your doctor for a preconception care visit. As soon as you suspect you are pregnant, call your doctor, get regular prenatal care, make sure you are well-informed when making decisions, and follow a healthy lifestyle. You will be helping your baby to have a healthy start in life and helping yourself to feel your best.

 

Prenatal Care
Pregnancy and birth are a natural part of life, but problems can arise. That is why all pregnant women should receive prenatal care as early as possible. This can include regular health care visits and childbirth education.
Prenatal Visits
Prenatal visits allow your doctor to closely watch your health and your baby’s progress. During these visits, you will be examined and the growth of the baby will be checked.
An early prenatal checkup may be longer and more involved than later visits. This visit will include a detailed health history, a physical exam, lab tests, calculation of your due date, and a schedule for your prenatal care. Throughout your pregnancy you will see your doctor on a regular basis. These visits provide a good chance to discuss any questions or concerns and learn more about your pregnancy.
History- A review of your health history and any previous pregnancies can help your doctor provide any special care you may need during your pregnancy. Each pregnancy is different and problems may arise without warning. The more information you can provide, the better equipped your doctor will be to plan your care.
Physical Exam- After your health history is obtained, your height, weight, and blood pressure will be measured. You will then have a general physical exam. A pelvic exam and a Pap test also may be done.
Due Date
The day your baby is due is called the “estimated date of delivery,” or EDD (also known as estimated date of confinement or EDC). A typical pregnancy lasts 40 weeks from the first day of your last menstrual period. Although only about 1 in 20 women deliver on their exact due date, the EDD is useful for many reasons. It is used as a guide for checking the baby’s growth and the progress of your pregnancy. Your due date also affects the timing of prenatal tests. In some cases, the test results depend on the stage of pregnancy.
There are a number of ways to figure your due date. They often are used together to help predict when your baby will be born. Most women go into labor within 2 weeks of their due dates—either before or after.
Childbirth Education
Childbirth education classes are a good way to learn what happens during labor and birth and how to prepare for it. Your doctor may help direct you to a childbirth education class that is a good match for you and the kind of birth you expect. These classes often meet over the course of a few weeks or months. They will inform you about the labor and delivery process and teach you how to help it go smoothly.

 

Birth Plan
Some childbirth education classes may help you draft a birth plan—a written outline of what you would like to happen during labor and delivery. This plan may include the setting you want to give birth in, the people you want to have with you, and the pain medications you want, if any. It is a good idea to go over this plan with your doctor. He or she will help you keep the plan realistic in case there is any conflict with hospital policies. Your doctor also may suggest ways to keep the plan flexible so changes can be made to it based on events that arise during labor and delivery.

 

Tests
During pregnancy, certain routine lab tests are done on all women. Depending on your health history and the results of your routine tests, your doctor may recommend that you have other tests.
To confirm a pregnancy, your blood or urine may be tested for the hormone human chorionic gonadotropin (hCG). Also, the doctor can order lab tests to check for any diseases or infections.
These tests may include:
Urine tests– A urine sample is checked to look for sugar, protein, and bacteria, which can signal diabetes or a bladder or kidney problem.
Blood tests– Blood samples are checked for anemia and certain infections. Your blood type and Rh factor also are noted.
Pap test or cervical culture– The cells from the cervix collected during a pelvic exam may be checked for signs of infection, cancer, or conditions that could lead to cancer.

Glucose screening test– The sugar level in the woman’s blood is measured to test for gestational diabetes.

Group B streptococcus (GBS) testing– The cells from the woman’s vagina and rectum are tested for the presence of GBS, which can be passed to the baby during delivery and cause infection.

Human immunodeficiency virus (HIV) test- A blood sample is checked for HIV antibodies. If the test result is positive, another test is used to confirm the results. If you have HIV, you could pass it to your baby during pregnancy, labor, delivery, and breastfeeding. There are things you can do to help prevent this from happening.

You and your doctor will discuss your results and decide what treatment and other tests, if any, are best for you.

 

Fetal Monitoring
Based on the results of routine prenatal care, your doctor may suggest tests to check the health of the baby. Most of the time, these tests help assure you and your doctor that all is going well. If problems arise, these tests may pinpoint them early.
The following tests are used to monitor the well-being of the fetus:
Kick count- A record of how often you feel your baby move. A healthy baby tends to move the same amount each day. You may be asked to keep track of this movement in the latter part of pregnancy and to contact your doctor if the baby is not active.

Ultrasound exam- An exam that uses sound waves to create pictures of the baby. This allows the doctor to check its growth and development.

Electronic fetal monitoring- These tests, including the nonstress test and the contraction stress test, help your doctor detect signs of problems the fetus may be having late in pregnancy. For these tests, monitors are placed on the woman’s abdomen to continuously measure the heartbeat and activity of the baby, as well as contractions of the woman’s uterus.

Biophysical profile- A combination of electronic fetal monitoring and ultrasound results are used to assess the well-being of your baby.

 

Testing for Birth Defects and Genetic Disorders

Tests can be done to help detect certain birth defects. These tests are done at various times during pregnancy. Some may need to be done in a special center equipped to perform them.
Some tests are offered to all women to help assess the risk of certain birth defects. These screening tests do not diagnose birth defects, but they may tell if there is an increased risk for a problem.

Types of screening tests include:

First trimester screening- The results of special ultrasound tests and blood tests are combined to determine your baby’s risk for Down syndrome and trisomy 18. These tests are done between 10 and 14 weeks of pregnancy.

Maternal serum screening- A group of blood tests (also called “triple” or “quad” screen) that check for abnormal levels of substances linked with certain birth defects, such as Down syndrome and neural tube defects. These tests are done between 15 and 20 weeks of pregnancy.

Cystic fibrosis testing- A lab test done on a sample of blood or saliva to see if a couple is at an increased risk for giving birth to a child who will have cystic fibrosis. This test can be done before pregnancy or early in pregnancy.

Other tests are done if the results of a screening test or other factors raise concerns about your baby. The results of these tests often can show whether the fetus has certain birth defects.

Detailed ultrasound exam- A type of ultrasound exam that can help explain abnormal results and provide more detailed information.

Amniocentesis- A procedure in which a needle is used to withdraw a small amount of amniotic fluid and cells from the sac surrounding the fetus. This fluid and cells are then sent to a lab and tested. This procedure most often is done between 15 and 20 weeks of pregnancy.

Chorionic villus sampling (CVS)- A procedure in which a small sample of cells is taken from the placenta and tested. This is done between 10 and 12 weeks of pregnancy.

No test is perfect. A test may not find a birth defect that is present. Or, your baby may have a problem that the test was not meant to find. The tests cannot find all birth defects.
If the results show that there is a problem, a counselor can help explain how the baby will be affected. In some cases, it is not known how severe a birth defect will be. Sometimes surgery or treatment is possible. In other cases, there is no treatment for a defect. The counselor and doctor can explain the results and provide guidance in making choices and considering options.

 

Taking Care of Your Health
It is important to take good care of both your physical and mental health during pregnancy. Many choices you make in your daily life during pregnancy can affect your health as well as the health of your baby.

 

Nutrition
A good diet is even more important during pregnancy, when there are added demands on your body to meet the needs of the growing fetus. A variety of foods can be used to create a healthy diet for you and your baby.
The U.S. Department of Agriculture offers guidelines to help you get the nutrients both of you need. It stresses a diet that is low in fat, sugar, and cholesterol (a substance that carries fat through the bloodstream) and high in vegetables, fruits, and grains.
Your diet should include proteins, carbohydrates, vitamins, minerals, and fat. You often can get enough of these nutrients if you eat a healthy diet, but your doctor may suggest you take a supplement or prenatal vitamin to ensure you get the right amount.

During pregnancy, you need more of these nutrients: calories to help nourish your growing baby, Iron and folic acid to help make the extra blood needed in pregnancy, protein to help make blood and build your baby’s tissues and muscles and calcium to help build your baby’s bones and teeth.

 

Weight Gain
An average woman needs about 2,000 calories a day. When you are pregnant, you need about 300 calories more each day to stay healthy and help the fetus grow.
A woman whose weight is normal before she becomes pregnant should gain 25–35 pounds during pregnancy. Women who are underweight should gain about 28–40 pounds. Women who are overweight should gain 15–25 pounds. Women who are obese should gain about 15 pounds. Women carrying twins should gain as much as 45 pounds.
If you keep up the good eating habits you began in pregnancy, you’ll be close to your normal weight within a few months after giving birth. Combining healthy eating with exercise will help the process.

 

Exercise
Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. Most women should exercise 30 minutes or more each day. Talk with your doctor before starting an exercise program. Your center of gravity shifts and your balance changes while you are pregnant. This may put you at a greater risk for falls. You tire more easily. It also takes longer to recover.
Caution should be the rule: avoid getting overheated, limit outdoor exercise in hot weather, avoid exercise that makes you very tired, or with a high risk of falling or abdominal trauma, drink lots of water and wear good support shoes and bra.
The type of exercise you can do during pregnancy depends on your health and on how active you were before you became pregnant. This is not a good time to take up a new, hard sport. But if you were active before, you can continue to be, within reason. If, for example, you played tennis, you can likely still play unless you have special problems or feel very tired.
The following activities, in moderation, are especially good during pregnancy: swimming, brisk walking and prenatal exercise classes.

 

Work
Most of the time, a healthy woman with a problem-free pregnancy can keep working if her job poses no more risk than daily life. Discuss with your doctor the type of work you do both at your workplace and at home.
There could be hazards in your workplace:
Do you work around chemicals, gas, dust, fumes, or radiation?
Do you have to lift heavy loads, work at heights, or use high-speed machines?
Do you stand for most of your day?

The federal Family and Medical Leave Act (FMLA) guarantees some women up to 12 weeks of unpaid leave after giving birth.

 

Travel
Most women can travel safely until the month before their due date. Usually, the most comfortable time to travel is in the middle of pregnancy. During this time, you often have more energy, and morning sickness usually is no longer a problem.
Here are some hints that apply no matter what type of travel you choose: use safety and lap belts, walk around every hour and a half or so, take some crackers, juice, or other light snacks with you to help prevent nausea, drink plenty of fluids, do not take motion–sickness pills unless you check with your doctor and take a copy of your medical record with you if you will be far from home.

 

Medications
Do not stop taking a medication prescribed for you. Ask your doctor about it first. Some medications could cause birth defects or other problems in the baby. Others may be safe to take during pregnancy. Certain diseases are more harmful to a fetus than the drugs used to treat them.
Also check with your doctor before taking any supplements or other over-the-counter drugs. This includes pain relievers, laxatives, cold or allergy remedies, and skin treatments. Your doctor can give you advice about medicines that are safe for pregnant women.

 

Alcohol, Tobacco, and Other Drugs
Alcohol can harm the fetus. How much alcohol it takes to harm the fetus is not known. Therefore, it is best not to drink at all in pregnancy. Drinking alcohol can lead to fetal alcohol syndrome. Babies who have fetal alcohol syndrome may have many problems, including mental retardation, heart defects, and defects of their joints and limbs.
Women who smoke during pregnancy are more likely to have certain problems, such as vaginal bleeding, stillbirth, and small babies. Less oxygen and nutrients may reach the fetus. Babies born to women who smoke have an increased risk of asthma and sudden infant death syndrome (SIDS). If you smoke, now is a good time to quit. It is a good idea for other family members to quit, too. Secondhand smoke also is bad for the baby.
Illegal drugs—such as crack or cocaine, heroin, PCP; methamphetamines and marijuana; and tranquilizers—also can harm the fetus. Use of these drugs can cause problems with the placenta, preterm birth, and birth defects. The baby can have learning problems and be addicted to drugs.

 

Abuse
Many women are victims of physical, sexual, or emotional abuse. Abuse often begins or increases during pregnancy, putting both the woman and the fetus at risk. During pregnancy, the abuser is more likely to aim blows at the woman’s breasts and abdomen. Dangers to the fetus include miscarriage, low birth weight, and direct injury from the blows.
If you are being abused, tell your doctor. He or she can help you get in touch with support services, such as crisis hotlines, domestic violence programs, legal aid services, or counseling. Shelters exist for abused women and children. A close friend, counselor, or clergy member also may be able to help.

 

Changes During Pregnancy
As your fetus grows and changes, it is normal for you to have some discomforts. Some of these may occur only in the early weeks of pregnancy. Others may occur only at the end. Still others may appear early, then go away, and then return.

 

Physical Changes

Breast Changes. Early in pregnancy, your breasts begin to grow and change to prepare for breastfeeding your baby. They will feel firm and tender. As your breasts grow, wear a bra that fits well and provides support. Your nipples may stick out more and get darker. This will help your baby to breastfeed.

 

Frequent Urination. Throughout pregnancy, the kidneys work harder to flush waste products out of your body. Also, as your uterus grows, it puts pressure on the bladder. Your bladder may be nearly empty but still feel like it is full. The weight of your uterus on your bladder may even cause you to leak a little urine when you sneeze or cough.
Coffee, tea, and cola drinks contain caffeine, which makes you urinate more. If you consume less of these drinks, you will urinate less often. Do not cut back on other liquids. Drinking less will rob your body of vital fluids.
Mouth and Tooth Changes. Pregnancy hormones can make your gums swell and bleed. Switching to a softer toothbrush may help lessen irritation.
A dental checkup early in pregnancy will help ensure that your mouth stays healthy. Pregnant women are at an increased risk for cavities and gum disease. When you go to the dentist, be sure to let him or her know that you are pregnant.
Lower-Abdominal Pain. As the uterus grows, the muscles that support it are pulled and stretched. You may feel this stretching as either a dull ache or a sharp pain on one side of your belly. The pains are most common between 18 and 24 weeks of pregnancy. Resting or changing your position may help relieve the pain.
Numbness and Tingling. Some women have pain, numbness, or tingling in certain parts of their bodies during pregnancy. As your uterus grows, it presses on some of the nerves connecting your legs to your spinal cord. This may cause chronic pain in the hip or thigh (sciatica).
Nerves also can get pressed if your legs swell during pregnancy (see “Swelling”). This pressure can cause your legs or toes to tingle or feel numb. Most often, these symptoms are minor and go away after the baby is born.
Your arms or hands also may tingle as a result of tissue swelling. For instance, a condition called carpal tunnel syndrome is common in pregnant women. It causes a burning, tingling feeling in one or both hands. It also may make your fingers numb. Wearing a special wrist splint can help.

 

Shortness of Breath. Later in pregnancy your uterus takes up more room in your abdomen. By about 31–34 weeks of pregnancy, the uterus is so large that it presses the stomach and the diaphragm (a flat, strong muscle that aids in breathing) up toward the lungs. Slowing down and sitting or standing up straight can help you breathe easier.
Skin Changes. The hormones in your body often cause some changes on your skin. Some women have brownish, uneven marks around their eyes and over the nose and cheeks. This is called chloasma. These marks usually disappear or fade after delivery or breastfeeding, when hormone levels go back to normal. Being in the sun tends to make the marks darker.

In many women, a line running from the top to the bottom of the abdomen becomes dark. This is called the linea nigra. Also, streaks or stretch marks may appear on the abdomen and breasts as they grow. This is caused by the skin tissue stretching to support the growing fetus. There is no way to prevent stretch marks. They may slowly fade after pregnancy.

 

Easing Discomforts
Backache. One of a pregnant woman’s most common problems, especially in the later months, is backache. One cause is the strain on your back muscles from carrying extra weight. Another is the posture women often assume during pregnancy to offset the weight. Exercises to stretch and strengthen your back muscles can help relieve this pain.
Here are some other tips to help ease back pain: wear low-heeled (but not flat) shoes with good arch support, avoid lifting heavy objects, bend at the knees to pick things up, sit in chairs with good back support, or tuck a small pillow behind your lower back, sleep on your side rather than on your back and apply a heating pad using the lowest temperature setting, warm-water bottle, or cold compress to ease the pain.
Congestion and Nosebleeds. During pregnancy, your hormone levels increase, and your body makes extra blood. Both of these changes cause the mucous membranes inside your nose to swell, dry out, and bleed easily. As a result, you may have a stuffy or runny nose. Try using saline drops to relieve congestion. Using a humidifier to moisten the air in your home also may help.
Constipation. Most pregnant women get constipated at some point. When that happens, gas can build up and cause bloating and pain.
Pregnancy hormones may slow digestion and cause constipation. Toward the end of pregnancy, the weight of the uterus puts pressure on your rectum, adding to the problem.
Some things may help: drink plenty of liquids, drink eight glasses of liquid per day, prune or other fruit juice also can help relieve constipation, eat high-fiber foods, raw fruits, vegetables, beans, whole-grain bread, and bran cereal are good choices.

 

Exercise

Exercising every day aids your digestive system.
Pregnant women who are constipated often have hemorrhoids. These are painful and itchy enlarged veins in the rectal area. Constipation can make these swollen, itchy veins worse. Talk to your doctor about using creams and suppositories to provide relief.

Even if hemorrhoids improve during pregnancy, straining during delivery can bring them back. Products for treating pain from hemorrhoids and the tips on avoiding constipation should help.

 

Leg Cramps. During pregnancy, a sharp, painful cramp or “charley horse” in the calf may be a bother—especially at night. Stretching your legs before going to bed can help relieve cramps. Avoid pointing your toes when stretching or exercising.
Heartburn. Heartburn is a burning feeling in the throat and chest. This is often caused by pregnancy hormones, which relax the muscle valve between your stomach and esophagus (the tube leading from the throat to the stomach). As your uterus grows, it adds to the problem by pressing up against your stomach.
For relief: eat six small meals per day instead of three big ones, do not drink a lot of liquid with your meals. Drink fluids between meals instead, stay away from fried, greasy, and fatty foods, avoid fizzy drinks, citrus fruits or juices, and spicy or fatty foods, do not eat or drink within a few hours of bedtime and do not lie down right after meals.
Ask your doctor about using antacids or other medications.
Insomnia. After the first few months of pregnancy, you may find it hard to sleep at night. As your abdomen grows larger, it may be hard to find a comfortable position.
These suggestions may help you get the rest you need: take a shower or warm bath at bedtime, try using relaxation techniques, such as yoga, lie on your side with one pillow under your abdomen and another between your legs, limit naps during the day.
Nausea and Vomiting. Nausea and vomiting are common during the first 12–14 weeks of pregnancy. This often is called “morning sickness,” although it can occur at any time of the day. It often occurs when your stomach is empty. Until the nausea and vomiting go away.
There are some things you can do that might help you feel better: eat dry toast or crackers before you get out of bed in the morning, eat foods that are low-fat and easy to digest-the “BRATT” diet (bananas, rice, applesauce, toast, and tea) may help (this diet will provide vital nutrients that will replace those you have lost), get plenty of fresh air, take a short walk or try sleeping with a window open, drink fluids often during the day, cold drinks that are bubbly or sweet may help, eat five or six small meals each day (try not to let your stomach get empty), and sit upright after meals, avoid smells that bother you, vitamin B6, acupressure, ginger, motion sickness bands, or hypnosis also may help relieve symptoms.
Talk to your doctor before taking any medication or herbal products.
Swelling. Some swelling (called edema) in the hands, face, legs, ankles, and feet is normal during pregnancy. It is caused by the extra fluid in your body. It tends to be worse in late pregnancy and during the summer.
For relief, put your feet up often and sleep with your legs propped up on pillows. This keeps fluid from pooling in the lower half of your body.
Let your doctor know if you are badly swollen or if you have sudden swelling in your face or hands (hint: your rings will be too tight). This could signal a problem, such as high blood pressure.
Varicose Veins. The weight of your uterus pressing down on a major vein can slow blood flow from your lower body. The result may be sore, itchy, blue bulges on your legs and vulva called varicose veins. In most cases, varicose veins are not a problem.
You cannot prevent varicose veins. However, taking these steps will help relieve swelling and soreness and may stop varicose veins from getting worse: if you must sit or stand for long periods, be sure to move around from time to time; do not sit with your legs crossed; prop up your legs——on your desk, a couch, a chair, or a footstool—as often as you can; exercise—walk, swim, or ride an exercise bike; wear support hose.

 

Emotional Changes
Your body is going through many changes now, and so are your emotions. These emotions—good and bad—are normal. Ask loved ones or close friends to support you and be patient. Rest and relax as often as you can. You will feel better, emotionally and physically, if you do.
Pregnant women often have fears about pregnancy, labor and delivery, the effect a child will have on their lives, and whether they will be good parents. This is normal.
There are some things you can do to ease your mind: know what to expect during labor and delivery; take a childbirth class to learn relaxation methods, ways to ease labor pain, and the options you have for pain relief; get prepared by taking a newborn-care class before your due date (many hospitals offer these 1- or 2-day courses); also, read up on infant care before your baby arrives.
Women who have a history of depression may need special care during and after pregnancy. If you find that you have any of these symptoms, seek help: depressed mood most of the day, nearly every day; loss of interest in work or other activities; feeling guilty, hopeless, or worthless; thinking about death and suicide; sleeping more than normal or lying awake at night; loss of appetite or losing weight (or eating much more than normal and gaining weight); feeling very tired or without energy; having trouble paying attention or making decisions; having aches and pains that do not get better with treatment.

Your Partner. Pregnancy can be a special time for a couple. It also can strain your relationship. The old roles are shifting, and you need to adapt to new ones. You will both spend a lot of time thinking about the baby, but try to make time for your partner, too. You can give each other support or you can find support through other family members or close friends.

 

Some couples worry about having sex during pregnancy. They may be afraid it will cause a miscarriage. For a healthy woman with a normal pregnancy, sex is safe into the last weeks of pregnancy. The fetus is well cushioned by amniotic fluid. For your comfort, you and your partner may want to try different positions. Your doctor may advise you to limit or avoid sex if there are problems in your pregnancy.
Both you and your partner may find your sex drives change now. Some women find they have a lower sex drive, some greater. Some see no change at all. Your partner’s feelings change, too. Share your feelings with each other.

 

Your Children. Pregnancy often is a time of planning and excitement. Children become aware of the changes around them. Include them in plans for the new baby.
Children also need to be prepared for their mother’s absence. Sometimes extended family members can help. They can care for older children when you need rest or when you go to the hospital.

 

Labor
You cannot predict when labor will start. Still, there are some things you can do ahead of time to be ready.
For instance: pack your bag for the hospital. Leave jewelry and other valuables at home; plan your hospital route; know how long it will take to get there; consider distance, means of transportation, time of year, time of day, who will take you, and if you need a babysitter; ask whether to call your doctor first or go to the hospital first when you go into labor; get a car safety seat to bring your baby home.

 

True Labor Versus False Labor
In the last weeks of pregnancy, your uterus might start to cramp. These cramps may become uncomfortable or even painful as you get closer to your due date. These irregular cramps are called Braxton–Hicks contractions, or false labor. Many women have them.

One good way to tell true labor from false labor is to time the contractions. Time how long each lasts and how long it is from the start of one to the start of the next. It is hard to time labor pains if they are weak. Keep a record for an hour. Ask your doctor when you should call him or her.

 

Are You Really In Labor?

False Labor. Contractions often are irregular; they do not get closer together as time goes on; contractions may stop when you walk, rest, or change position; contractions often are weak, and they tend to stay that way; or strong contractions are followed by weaker ones; pain usually is felt only in the front.

True Labor. Contractions come at regular intervals and get closer together. They last 30–90 seconds; contractions steadily get stronger; pain usually starts in the back and moves to the front.

 

Usually, you do not need to go to the hospital as soon as your contractions begin. While you wait at home, rest if you can. Some women may find it more comfortable to walk around or to take a shower or a warm bath. Discuss eating during labor with your doctor. You may be told not to eat or drink anything once labor has begun.
It is time to go to the hospital if: your amniotic sac ruptures (your “water breaks”), even if you are not having any contractions, write down the time it happens; you are bleeding from the vagina, more than spotting; the contractions come 5 minutes apart or closer; you have constant, severe pain. Call your doctor right away.
If you are less than 37 weeks pregnant and having regular uterine contractions, you may be in preterm labor. Call your doctor right away.

 

Stages of Labor

 

First Stage
This stage is usually the longest. It begins when the cervix starts to open and ends when it is completely open (fully dilated). Blood-tinged mucus is passed from the vagina (“show”). Near the end of this stage, contractions become longer and stronger.

 

Second Stage
Once your cervix is fully dilated, the baby needs help to move down the vagina. You will be asked to push the baby out by bearing down during each contraction, until the baby is born.
This is a lot of work. The second stage may last up to 3 hours or longer, especially during a first birth. It ends with the birth of the baby.

 

Third Stage
After the baby is born, the uterus will continue to contract and the placenta will be delivered. These contractions are closer together than the contractions that push out the baby. They usually cause less pain. This last stage may last from just a few minutes to 15–20 minutes.
Preterm Labor

The following signs may suggest preterm labor: vaginal discharge; change in type of discharge (watery, mucous, or bloody); ncrease in amount of discharge; pelvic or lower abdominal pressure; low, dull backache; abdominal cramps, with or without diarrhea; regular contractions or uterine tightening.

What Happens During Labor
Knowing what happens in labor makes it easier for you to relax and do your part. On average, labor lasts about 12–14 hours for a first birth. In later births, labor may be shorter.
Labor is divided into three stages. During each stage, certain changes take place in your body. Labor begins when the uterus contracts and the cervix starts to open. The uterus tightens and relaxes at regular intervals, causing the abdomen to feel hard, then soft. These are contractions. They make the cervix thin out (efface) and open as wide as it can (dilate). Early labor is often felt as a low backache that moves around to the front. As labor continues, the contractions come closer together, last longer, and are usually felt in the lower abdomen.
Contractions help the baby come through the vagina. Throughout labor, the baby moves deeper into the pelvis and farther down in the vagina. The baby’s head and body move and turn for the easiest fit through your pelvis.
Monitoring During Labor
The heart rate of the fetus usually is monitored during labor to help alert your doctor to warning signs. The doctor and nurse can listen to the fetal heartbeat at certain intervals, often after a contraction. The heartbeat can be heard with a type of stethoscope or an ultrasound device.
Electronic fetal monitoring uses electronic equipment to measure the fetus’s heart rate and uterine contractions. This monitoring can be done with instruments attached to the woman’s abdomen (external). It also can be done by having a small device attached to the scalp of the fetus (internal). Sometimes both types of devices are used.
Pain Relief
For most women, having a baby involves some pain. There are several ways to help you deal with the pain.
Relaxation techniques give some women very good control of the discomfort of labor. These techniques include breathing in certain patterns and imagining you are elsewhere. They are often taught in prenatal classes. Your labor nurse also may be able to teach you.
Analgesics are drugs that ease pain. They can be injected into the muscle or vein. These may make you more comfortable and allow you to rest between contractions.
Anesthetics are drugs that remove pain. Local anesthesia numbs a small area. Regional anesthesia (spinal anesthesia or epidural anesthesia) takes away painful feeling in the uterus and pelvic area. You may still feel the baby move through the birth canal. This type of pain relief allows you to be awake and take part in the birth of your baby without feeling as much pain.

 

Delivery
The hospital is the safest place to give birth to your baby. Ask to tour the hospital in advance so that you know what to expect. That way, once you are in labor and arrive at the hospital, you will know wher
Vaginal Delivery
Most women give birth to their babies through the vagina. When your baby’s head appears at the opening of the vagina, the tissue of the vagina becomes very thin and tightly stretched. Sometimes it is not possible for the baby’s head to fit through without tearing the woman’s skin and muscles. Your doctor may make a small cut in the vaginal opening while it is numbed with an anesthetic. This is called an episiotomy.
Sometimes the doctor needs to help delivery along. In these cases, forceps or vacuum cups can be used.
Cesarean Delivery
In some cases, a cesarean birth may be needed. Cesarean birth is delivery of the baby through a cut made in the woman’s abdomen and uterus.
Sometimes the decision to have a cesarean birth can be made before labor begins. Other times a cesarean birth may be needed during labor. The baby may be too large for vaginal delivery. Sometimes, opening of the cervix may be slow or incomplete. The fetus’s heart rate may decrease or slow for a long time. Cesarean birth also may be needed because of a problem for the woman, such as heavy bleeding.
Some women who have had a cesarean birth can have a vaginal birth in a later pregnancy. This is called vaginal birth after cesarean delivery (VBAC). It is not the right choice for all women and there are some risks. Talk to your doctor to find out if VBAC is an option for you.

 

Postpartum
After delivery your temperature, pulse, breathing, and blood pressure will be checked often. During this time, you can begin getting to know your new baby.
Unless you or your baby have a medical problem, you will be able to hold the baby. If you had planned to breastfeed, you may be able to start now.
Most women spend about 1–2 days in the hospital after a vaginal birth. If you had a cesarean birth, or if problems occur, you will likely stay longer.
Check with your hospital about who is allowed to visit. You may choose not to have visitors for a while. This gives you more time to rest and to learn about your baby.
Help may be available to teach you some of the beginning skills of being a parent, such as feeding, bathing, and changing the baby’s diaper. This can help you to feel more comfortable in the way you handle your newborn.
Before you go home, your baby may begin to get vaccines. They protect against diseases like rubella and hepatitis. Ask your baby’s doctor what shots your baby should receive and when.

 

Breastfeeding
Breastfeeding is the best way to feed newborns. Mother’s milk best meets the baby’s nutritional needs and helps the baby resist disease and allergies. Breastfeeding also is cheaper than bottle feeding.
Do not be upset if nursing is not easy right away. Both you and the baby need to get comfortable. If the baby calms down after nursing, makes urine and stools regularly, and is growing, he or she is getting enough milk.
If you are breastfeeding, you will have special nutrition and calorie needs. Now is not the time to try to lose weight. You need food for your own body plus extra food to produce milk for your baby. It is easy to add the extra nutrients you need if you are already eating a healthy diet.
Breastfeeding may not be for all women. Many factors are involved in each woman’s decision, including lifestyle and medical issues. Breastfeeding for even a few weeks has health benefits for the baby.

 

Your Changing Body
While you were pregnant, your body worked round-the-clock for 40 weeks to help your baby grow. Now that your baby is here, there is more work to be done as your body recovers from pregnancy, labor, and delivery. It will take time for things to get back to normal.
Lochia. Once your baby is born, your body sheds the blood and tissue that lined your uterus. This vaginal discharge is called lochia.
For the first few days after delivery, lochia is heavy and bright red. It may have a few small clots. Use sanitary pads instead of tampons.
As time goes on, the flow gets lighter in volume and color. A week or so after birth, lochia often is pink or brown. By 2 weeks postpartum, lochia often is light brown or yellow. After that, it slowly goes away.
Return of Menstrual Periods. If you are not breastfeeding, your period may return about 6–8 weeks after giving birth. It could start even sooner.
If you are breastfeeding, your periods may not start again for months. Some nursing mothers do not have a period until their babies are fully weaned.
After birth, your ovaries may release an egg before you have your first period. This means you can get pregnant before you even know you are fertile again, even if you are breastfeeding. If you do not want another baby right way, start using birth control as soon as you resume having sex. Talk with your doctor about which method is best for you.
Your Abdomen. Right after delivery, your uterus is hard and round and can be felt behind your navel. You may still look like you are pregnant. During pregnancy, the abdominal muscles stretched out little by little. So give your body time to go back to normal. Exercise will help. Ask your doctor when it is safe to start exercising.
You also may have backaches after delivery. Your stretched abdominal muscles do not help your back muscles support your weight. To prevent a sore back, practice good posture, support your back when you breastfeed, and try not to lift anything heavier than your baby for a while.

 

Easing Discomforts
After your baby’s birth your body will feel sore but most aches will not last long. Following are some ways to relieve postpartum aches and pains.
Afterbirth Pains. Your uterus contracts and then relaxes as it shrinks back to its normal size. These cramps are sometimes called afterbirth pains. If you have given birth before or you are breastfeeding, they may be more painful. They will go away in just a few days. In the meantime, take an over-the-counter pain reliever.
Painful Perineum. The perineum, the area between your vagina and rectum, stretches during delivery. You may have had an episiotomy or your perineum may have torn. Any of these causes may make this area feel sore and look swollen and bruised.

To ease discomfort and speed healing: apply cold packs or chilled witch-hazel pads to the area; take sitz baths; soaking in a few inches of warm water will bring relief; use a water bottle you can squeeze to soothe the area with a stream of warm water after you urinate; always wipe from front to back after you use the toilet; this will help prevent a healing episiotomy or tear from getting infected with germs from your rectum.
Hemorrhoids and Varicose Veins. If you had varicose veins in your vulva or hemorrhoids during pregnancy, they may get worse after delivery. These sore, swollen veins also can show up for the first time now because of the intense straining you did during labor.
For relief, try medicated sprays or ointments, sitz baths, and cold witch hazel compresses. If hemorrhoids make bowel movements painful, be sure to eat a diet rich in fiber and drink plenty of fluids. A stool softener also may help. Ask your doctor before taking one. Although constipation is common after giving birth, try not to strain when you have a bowel movement. This can worsen hemorrhoids. In time, they will get smaller or go away.
Urinary Problems. In the first days after delivery, you may feel the urge to urinate but cannot pass any urine. You also may feel pain and burning after you urinate. This usually goes away within days of delivery.
To lessen swelling or pain, try a warm sitz bath. To help trigger the flow of urine, spray warm water over your genitals with a squeeze bottle. Running the tap while you are in the bathroom also may help. Be sure to drink plenty of fluids. If you still cannot pass urine regularly, contact your doctor.
Some women may have problems with leaking urine after delivery. With time, the tone of your pelvic muscles will return and the problem will go away in most cases. Kegel exercises also will help tighten these muscles. If urinary problems persist, let your doctor know. There are treatments he or she can offer.
Swollen Breasts. Your breasts fill with milk about 2–4 days after delivery. When this happens, they may feel very full, hard, and tender. The best relief for this engorgement is breastfeeding. If you are not breastfeeding, avoid rubbing your breasts. Wearing a good-fitting support bra or sports bra may help ease the pain. Severe engorgement should not last more than about 36 hours. If you develop fever and redness, call your doctor. You could have an infection.
Cesarean Incision. If you had a cesarean birth, your doctor will tell you how to take care of your incision after delivery. It will take a few weeks to heal. You should check your incision for numbness, soreness, and pain. If you have fever or heavy bleeding, or the pain gets worse, call you doctor and follow his or her advice. These may be signs of infection.

 

Emotional Changes
Women have many different emotions after childbirth. Having a baby can be an exciting time. For some women, this is a time of stress and, at times, sadness.
The Baby Blues. Nearly 70–80% of new mothers get the baby blues. About 2–3 days after birth, you may begin to feel anxious, sad, and upset. For no clear reason, you may feel angry with the new baby. These feelings are scary, but they fade quickly. The baby blues tend to last from a few hours to a week or so. Most often, they go away without treatment.
Until then, do the following to help you: talk to your partner or a good friend about how you feel; ask your partner, friends, and family for help; get out of the house each day, even if it is only for a short while; join a new mothers’ group and share your feelings with the women you meet there.
Postpartum Depression. For some women, new motherhood brings with it more intense feelings. About 10% of new mothers have postpartum depression. This is marked by feelings of despair, severe anxiety, or hopelessness that get in the way of daily life. It can occur after any birth, not just the first.

Postpartum depression is more likely to occur in women who have had one or more of the following: mood disorders before pregnancy; postpartum depression after a previous pregnancy; recent stress, such as losing a loved one, family illness, or moving to a new city.

If you are prone to depression, seek professional help and enlist support from your loved ones before your baby arrives. Treatment and counseling will help relieve postpartum depression.

Talk to your doctor right away if you have any of these signs of depression: baby blues that last for more than 2 weeks; strong feelings of depression or anger that come 1–2 months after birth; not finding pleasure in things that used to make you happy; intense concern and worry about the baby; lack of interest in or feelings for the baby or your family; panic attacks, such as being afraid to be left alone with the baby; thoughts of harming the baby or yourself.

 

Return to Daily Living
Having a baby will change the way you live your daily life. Your relationship with your partner will be affected. Your old routines may no longer work. If you know this in advance, you will be a lot more relaxed as you start your life with the new baby.
Your partner also is going through a lot of changes right now. The needs and concerns of partners can be overlooked, with the focus on you and the baby. It is important to spend time together as a family.

 

Going Back to Work
If you work outside of the home, there are many factors to take into account when thinking about going back to work, such as finances and child care. You also will want to decide about going on with breastfeeding when you go back to work.
No matter what you choose to do, try to discuss it with your partner before the baby is born. Be careful to build in some time for yourself. You cannot know how you will feel about work until after your baby is born.

 

Sex And Family Planning
Your doctor will suggest when you can resume having sex. It likely will be a month or so after delivery. Make sure your partner understands this, too.
When you and your partner are ready to start having sex again, it is vital to start thinking about birth control. Birth control can allow your body to heal before having another baby and allow you to plan your family. Talk with your doctor about which method is best for you and how long to plan between pregnancies.

 

Your Follow-up Visit
You will have a postpartum visit with your doctor to make sure that your body has recovered from pregnancy and birth and that you are not having any problems. This visit usually is done within 6 weeks of the birth of your baby. If you had a cesarean birth, your doctor may want to see you sooner to check the incision.
Use this time to bring up any questions or concerns you have about the healing process, breastfeeding, birth control, weight loss, sex, or your emotions. To help you remember everything you want to talk about, jot down any questions you have and bring them with you to this visit.
You can improve your chances of having a healthy baby by leading a healthy lifestyle during pregnancy and getting proper prenatal care. Learn as much as you can before the birth of your baby. Know your own body and what to expect during pregnancy, labor, and delivery