LifeCare Medical Center - Your Childbirth Experience

YOUR CHILDBIRTH EXPERIENCE A guide for pregnancy, birth and parenting

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YOUR CHILDBIRTH EXPERIENCE A guide for pregnancy, birth and parenting

Bring book to every appointment, class and hospital.

YOUR CHILDBIRTH EXPERIENCE A guide for pregnancy, birth and parenting

Introduction The purpose of this book is to help you understand pregnancy, the process of labor and birth, newborn care and breastfeeding. The more knowledge you have of the process of birth, the more likely you will approach your personal journey with confidence. Special thanks to the many people all over the country who helped with suggestions, advice and support. Without their expertise and guidance, this publication could not have been produced in an accurate and complete way.

© 2018 Customized Communications, Inc. Arlington, Texas • 1-800-476-2253 All Rights Reserved

Visit us at: customizedinc.com • Email us at: cci@customizedinc.com

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TABLE OF CONTENTS

CHAPTER ONE Prenatal Care 7 Prenatal Care Is Important Choosing a Provider  7 What Happens at Office Visits?  7 What Happens During the First Visit?  7 What is Checked at Follow-Up Office Visits?  8 When is My Due Date?  8 How Often Will I Visit My Health Care Provider?  8 8 What Changes Will I Have? Dizzy or Fainting  8 Headaches  9 Morning Sickness  9 Nose Bleeds  9 Sleep  9 Stuffy Nose  9 Urination  10 Weight Gain  10 10 Will My Baby Be Healthy? Genetic and Family History  10 Prenatal Testing  11 12 Diseases and Infections Chickenpox (Varicella)  12 CMV (Cytomegalovirus)  12 Flu  12 Genital Herpes  12 German Measles  12 Hepatitis B and Hepatitis C  13 HIV (Human Immunodeficiency Virus)  13 Listeriosis  13 Toxoplasmosis  13 Zika Virus  14 Tetanus Diphtheria Pertussis (TDAP)  14 High-Risk Pregnancy  15 Warning Signs  15 16 How Does My Baby Grow Each Month? 1st Trimester  16 2nd Trimester  17 3rd Trimester  17 18 How Do I Take Care of Myself? 14 Vaccines

31 Prenatal Education Benefits of Classes  31 Enrolling in Classes  31

Baths  18 Teeth  19 Rest  19

Childbirth Education Methods  31

Clothing  19 Tampons  19 Household Cleaners and Bug Sprays  19 Sex  19 Street Drugs  20 Alcohol  20 Domestic Violence  20 Smoking  21 Medications  21 Artificial Sweeteners  21 X-Ray Studies  21 Caffeine  21 Stress  21

32 Labor Support Communication  32 33 Doula 33 Comfort Measures During Labor Relaxation  33 Focus and Distraction  34

Cleansing Breath  34 Breathing Patterns  34 Changing Positions  35 Touch and Massage  35 Effleurage (Light Touch)  35 Pressure  35 WarmWater (Hydrotherapy)  35 20-Minute Rule  35 Heat and Cold  35 36 Understanding Labor and Birth What Your Body Is Doing  36 Braxton Hicks Contractions  36 Baby “Drops”  36

22 Why Do I Feel Like This? Backache  22 Bottom and Leg Pain (Sciatica)  22 Breast Changes  23 Constipation  23 Hemorrhoids  23 Heartburn  23 Loose and Aching Joints  23 Leg Cramps  24 Round Ligament Pain  24 Shortness of Breath  24 Skin Changes  25 Swelling  25 26 What Should I Eat? Eating Well for Your Baby  26 Foods to Avoid During Pregnancy  26 Vitamins  27 Omega-3 Fats Are Important  27 27 Exercise During Pregnancy The Pelvic Rock  28 The Squat  28 Kegel Exercises  28 CHAPTER TWO Labor and Birth 29 Choosing Care for Yourself and Your Baby

Diarrhea and Vomiting  36 Burst of Energy (Nesting)  36 Mucous Plug  36 Thinning (Effacement)  37 Opening (Dilation)  37 Station  37 Dilation Chart  38

39 The Pain of Labor

Where Does the Pain Come From?  39 Back Labor  39 Your Water Breaks  39 HowWill I know I am in Labor?  40 How to Time Contractions  40 When Should I Go to the Hospital/Birth Center?  40 Warning Signs  41

42 Labor Management Monitoring  42 Intravenous Fluids  42 Pelvic Exams  42 Induced Labor  43 Breaking Your Water  43

Choosing a Hospital or Birthing Center  29 Tours  29 Choosing a Health Care Provider for Your Baby  30 Well-Baby Care  30

Getting Your Cervix Ready  43 Medicine for Contractions  43

Work  18 Travel  18 Seat Belts  18

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TABLE OF CONTENTS

CHAPTER THREE Postpartum Care 65 Physical Changes After Birth Birth Canal  65 Bladder  65 Bowel Movements  65 Hemorrhoids  65 Hair Loss  66 Menstrual Cycle  66 Muscles and Joints  66 Uterus  66 Red Eyes  66 Skin  66 Vaginal Discharge  67 Varicose Veins  67 Weight Loss  67 67 Self-Care Managing Postpartum Pain  67 Baths and Showers  68 Episiotomy Care  68 Exercise  68 Having Sex  69 Perineal Care  69 Preeclampsia  69 Rest and Sleep  69 Warning Signs  70 70 Emotional Changes Be Realistic  70 Postpartum Blues  71 Postpartum Depression and Anxiety  71 Warning Signs  71 72 To the New Partner 73 Take Time for Yourselves

44 Pain Medicine During Labor Epidural Block  44 Nitrous Oxide  45 Spinal Block  45 General Anesthesia  45

Taking Your Baby’s Temperature  79 Warning Signs  79 Umbilical Cord Care  79 Skin Care  80 Cradle Cap  80 Fingernails  80 How to Bathe Your Baby  80 82 How to Diaper Your Baby Diaper Rash  83 83 Bladder and Bowels 84 Circumcision Caring for the Circumcised Area  84 85 Newborn Senses 86 Infant Behavior Sleep  86 Play  87 Tummy Time  87 88 Why Is My Baby Crying? Colic  89 Gas  89 90 Calming a Fussy Baby 91 Shaken Baby Syndrome 92 Developmental Milestones 93 Becoming A New Family Physically  93 Socially  93 Emotionally  93 94 Single Parents 94 Family and Your Newborn Grandparents  94 Big Brothers and Sisters  94 Pets  95 95 Baby Gear Clothes  95 Diapers  95 Other useful items  95 96 Baby Furniture Safety Tips Warning Signs  97 What Your Baby Sees  85 What Your Baby Hears  85 What Your Baby Smells  85 What Your Baby Tastes  85 Touch  85

Systemic Medication Chart  46 Regional Anesthetics Chart  46

47 Labor Guide

How Long is Labor?  47 Pre-Labor  47 Three Stages of Labor  47

48 First Stage Early Labor  48 Active Labor  50 Transition  52 54 Second Stage Pushing  54

Positions for Pushing  55 Birth  56

56 Third Stage

Birth of the Placenta 56

57 Assisted Birth Episiotomy  57

Forceps or Vacuum Extractors  57

58 Cesarean Birth

Positions of the Baby  58 Fetal Distress  58 Placenta Problems  59 Getting Ready for a Cesarean  60

Recovery After Surgery  60 Vaginal Birth After Cesarean (VBAC)  61 62 The Miracle of Birth Immediate Care  62 Skin-to-Skin Bonding  62 Apgar Score  62 63 What Will My Baby Look Like? Baby’s Head  63 Color  63

CHAPTER FOUR Newborn Care 75 Newborn Screenings Jaundice  76 77 Immunizations Birth to 6 Months Immunization Schedule  77 78 Basic Care Well Baby Visits  78 How to Use a Bulb Syringe  78 Warning Signs  78 Stuffy Nose  79

Lanugo  63 Genitals  63 Umbilical Cord  63

Eyes  63 Skin  63 Milia  63

Soft Spots  63 Vitamin K  63 ID for Your Baby  64 64 Goody Bag List for Hospital

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TABLE OF CONTENTS

115 Breast Care

98 Safe Sleeping and SIDS 99 What Does a Safe Sleep Area Look Like? 100 Car Seats Basic Guidelines  100 How to put your baby into a rear-facing seat  100

108 Kinds of Breast Milk Colostrum  108 Transitional Milk  108 Mature Milk  108

Sore Nipples  115 Engorgement  115 Blocked Ducts  116 Mastitis  116

109 Feeding Your Newborn 109 HowWill I Know My Baby is Ready to Breastfeed? 110 Breastfeeding Positions Biological Nursing or Baby-Led Latch  110 Cradle Hold  111 Cross-Cradle Hold  111 Side-Lying Hold  111 Clutch or Football Hold  111 112 Guidelines for proper latch Getting Started  112 Signs of a Good Latch  112 Taking Baby Off The Breast  112 Burping  112 113 How Do I Know My Baby Is Getting Enough to Eat? How Much Can My Baby’s Stomach Hold?  113 Growth Spurts  113 Cluster Feeding  113 114 Newborn Feeding Patterns

117 Breastfeeding Questions 118 Collecting and Storing Breast Milk Expressing Breast Milk  118

101 Hot Car Safety 102 Home Safety

Breast Massage  118 Breast Pumps  118 Hand Expression  119 How Often to Express  120 Storing Breast Milk  120 Freshly Expressed Breast Milk Storage Guidelines  120 Healthy Eating and Breastfeeding  121 Going Back to Work and Breastfeeding  121

Fire and Hot Surfaces  102 Keep Out of Reach  102 Water  102

Furniture  103 Smoking  103

Taking Baby Outdoors  103 Websites with Useful Parent Information  103 104 Infant CPR (under 1 year of age) 105 Infant Choking (under 1 year of age)

122 Feeding Log 125 My BirthWishes 126 Medical History Form 127 Resources 128 Glossary 131 Bibliography 132 Notes

CHAPTER FIVE Breastfeeding

Birthday Nap  114 Learning Day  114 All Day Buffet  114 Night Owl  114

107 Benefits of Breastfeeding 107 Exclusive Breastfeeding The Breast  107 Making Milk  107

Please Note: All words highlighted in PURPLE are clearly defined in the glossary.

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Prenatal Care Is Important Take care of yourself now so that you and your baby will stay healthy. During prenatal care visits (doctor or nurse visits while you are pregnant), your health care team will talk with you about what you can do to help your baby get a healthy start in life. Go to all appointments with your doctor or nurse. Choosing a Provider

Health care providers who care for pregnant patients include:

zz Obstetrician – a doctor who takes care of patients during pregnancy and birth. zz Family Medicine Doctor – a doctor for people of any age. They also take care of patients during pregnancy and birth. zz Nurse Practitioner – a nurse with extra training. They can do checkups and give medicine.

zz Certified Nurse Midwife – a nurse with training in pregnancy and childbirth. They can give prenatal care and attend the birth. zz Physician Assistant – has trained with doctors and can do checkups, give medicine and order lab tests.

What Happens at Office Visits? It is important to know how healthy you are to take the best care of you and your baby. The first office visit may take longer than all other visits. This is so your health care provider can do some exams and tests. Follow-up visits are shorter. Your health care provider will look to see if you and your baby are having any health problems. The growth of your baby will also be checked. Blood tests or ultrasounds will be done at some visits.

What Happens During the First Visit?

Your health care provider will:

zz Ask you many questions about your health history. zz Give you a physical exam and a pelvic exam .

zz Order the lab tests listed below. zz Do all the things listed under Follow-Up Visits on the next page.

Lab tests:

zz Hepatitis B and Hepatitis C check zz Urine culture (if needed) zz HIV testing (if you agree) zz Screening for cervical cancer (if needed) zz Cystic fibrosis carrier screening (if needed)

zz Complete blood count zz Urine test zz Syphilis (sexually transmitted infection) test zz Rubella (German Measles) check zz Blood type, Rh factor and antibody check zz Cervical and vaginal cultures (if needed)

Chapter 1 – Prenatal Care 7

What is Checked at Follow-Up Office Visits?

Baby:

You:

zz Baby’s heartbeat zz Baby’s movements zz Size and growth of baby zz Where the baby is in the womb

zz Weight zz Blood pressure zz Urine sample zz Size of uterus (womb) zz Repeat blood count and antibody check (late in pregnancy) zz Pelvic exam (late in pregnancy) zz Special blood testing (glucose screening, genetic screening tests, cystic fibrosis carrier screening) zz Group B strep (GBS) culture

zz Ultrasound ( sonogram ) to double-check due date. You may have another one to check baby’s growth. zz Special fetal testing (if needed) zz Amount of amniotic fluid (if needed)

When is My Due Date? At your first office visit your health care provider will tell you when your baby is due to be born. This due date is used as a guide to check your baby’s growth and age. Your health care provider may figure out your due date using blood work or an ultrasound. Only 1 in 20 babies are born on their due date. Most babies are born a few days before or after that date.

How OftenWill I Visit My Health Care Provider?

It is very important to schedule and go to all prenatal appointments, even if you feel good. As long as you are doing well, your visits will be:

zz Months 1 through 6 – about once a month. Some visits may be a phone call from an office nurse.

zz Month 7 (32 weeks) through about month 8 (37 weeks) – every 2 weeks. These visits will be shorter than your first appointment. There will not be as many tests done at each of these visits.

zz Months 9 (37 weeks) through birth – about every week.

What Changes Will I Have?

If you feel dizzy:

Dizzy or Fainting Changes in your blood flow might make you feel dizzy sometimes, or you might faint. You might also feel dizzy when you lie on your back. It usually goes away by the second half of pregnancy.

zz Lie on your left side. zz Take your time sitting up and standing. zz Do not move or change position too quickly. zz If you are exercising, stop. zz Drink lots of water and other liquids.

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Chapter 1 – Prenatal Care

Headaches

Your head may hurt sometimes in the first few months. The headaches are from changes in the blood flow of your body. They will usually go away after the first half of pregnancy.

Call your health care provider if your head hurts and:

zz Bright lights make it hurt more.

zz You are sick to your stomach or throwing up.

zz You have a fever.

zz You are very weak.

zz You have numbness, weakness or speech problems.

Morning Sickness Feeling sick to your stomach is not always in the morning. It can be during the day, too. It may last a few minutes or all day. Some people will also throw up. Not every person has morning sickness . Big meals, spicy foods, and an empty stomach may make you feel sick. Morning sickness mostly happens between month 1 and month 4. If your morning sickness is really bad or you are still sick to your stomach after month 4, call your health care provider.

To help morning sickness:

zz Eat bread or crackers before you get out of bed. zz Get out of bed slowly – do not jump up.

zz Try yogurt or milk before bedtime. zz Avoid greasy, fried, or spicy foods.

zz Eat 5 small meals instead of 3 big meals each day. zz If you feel sick, get fresh air, take deep breaths and sip water. HINT: Take your prenatal vitamins or iron when you are not feeling sick to your stomach.

Nose Bleeds

Many pregnant people get nose bleeds. If your nose is bleeding, press your finger against the side that is bleeding for a few minutes. Call your health care provider if the bleeding is heavy or you cannot make it stop.

Sleep Get as much sleep and rest as you can. Sometimes stress or worry can keep you awake. Talk with your health care provider if you are staying awake at night and not getting any rest. This is called insomnia .

You may have trouble sleeping because you cannot relax. Take a warm bath before bedtime to help you rest. Do not drink alcohol or take pills to help you sleep.

Stuffy Nose If you have nasal congestion (a dry or stuffy nose), it is okay to use saline nasal spray or drops. Do not use medicated nose drops unless your provider tells you to. Drinking more liquids may keep the inside of your nose from being so dry.

Chapter 1 – Prenatal Care 9

Urination As your uterus grows, it pushes on your bladder. You may need to go to the bathroom more often. Do not stop drinking fluids to try to avoid this. Your baby needs you to drink at least 8 cups of water or other liquids every day.

Bladder Before Pregnancy

Bladder During Pregnancy

Weight Gain Your health care provider will tell you how much weight you should gain for your growing baby to be healthy. The amount will be different if you are underweight (do not weigh enough) or overweight (weigh too much) when you get pregnant. You will be weighed at every appointment. If you are gaining too much weight, your health care provider can tell you what foods will make you feel full without adding too many pounds. Look at page 26 for healthy food suggestions.

Weight before pregnancy

Amount to gain

Where the weight comes from:

zz Amniotic fluid ( bagof waters )

2 pounds

zz Underweight

28 to 40 pounds

zz Baby's weight

6 to 8 pounds

zz Normal weight

25 to 30 pounds

zz Body fluid

4 pounds 2 pounds 4 pounds 7 pounds 1.5 pounds 2 pounds

zz Breasts

zz Overweight

11 to 20 pounds

zz Extra blood

zz Carrying twins

up to 45 pounds

zz Fat, protein, nutrients

zz Placenta and membranes

Most of the recommended weight gain will come off during the postpartum period.

zz Uterus (womb)

Will My Baby Be Healthy? Every parent asks this question. Knowing your family history will let your health care provider look for certain health problems. With proper care, these problems can be fewer. Today there are many tests that can check to see that your growing baby is healthy. Genetic and Family History Some family health problems are important to know about while your baby is growing. These genetic (passed down from family) problems may be passed to your baby in the womb. Talk to your health care provider to see if you should have special genetic testing or talk to a genetic counselor about what these problems can mean.

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Chapter 1 – Prenatal Care

Prenatal Testing

There are many tests that can help spot health problems with you or your baby. If they are found early, some of these problems can be treated before the baby is born.

Screening Tests

Screening tests are part of all prenatal care. They can show that you or your baby might have a disease or health problem. Some screening tests are given to all pregnant people. Other tests are only given to people who may be at high risk for a problem. Screening for genetic disorders (family birth defects) is a big part of this testing. Please speak to your health care provider about the recommended genetic screening tests.

Rh Immunoglobulin Test

The Rh Immunoglobulin test shows if your blood is Rh negative. If it is, your red blood cells may harm your baby’s red blood cells. Your health care provider can give you a shot to stop this problem.

Pregnancy Diabetes Test (Glucose Tolerance Test)

For the Glucose Tolerance Test you drink a sugary liquid, then have a blood test. If the blood test shows you have a high amount of sugar in your blood and your body cannot process it, you have gestational diabetes . This will need to be treated.

Group B Strep Testing

Group B Streptococcus (GBS) is a normal bacteria and can be in the birth canal. If you have it and your baby gets infected during birth, it can be serious. Your health care provider will check your vagina and rectum in month 9 to see if GBS is in the birth canal. If you have GBS, you will have antibiotics during labor to protect your baby.

Ultrasound (Sonogram) This test shows a video picture of your baby moving inside your uterus. It can spot a problem while your baby is still in your womb. An ultrasound does not take long and can be done in the office or in the hospital. You lie down and a liquid gel is put on your belly. A wand is moved over your belly to show what is in your uterus. This test does not hurt.

Some things an ultrasound can tell your health care provider:

zz If your baby is growing. zz If your baby is a boy or a girl.

zz Why you are bleeding. zz When your baby is due. zz If you are having twins or more than one baby.

scan me!

Chapter 1 – Prenatal Care 11

Diseases and Infections Some diseases and infections can harm you or your unborn baby. If you think you might have a disease or infection, tell your health care provider right away. Chickenpox (Varicella) (va-ri-sel-uh) If you have ever had chickenpox you cannot get it again. Tell your health care provider if you have never had chickenpox or the vaccine so blood tests can be done. If you get chickenpox while you are pregnant, you may get a shot to keep it from getting too bad. If you become infected near your due date, your baby will also get a special shot.

The first step to staying healthy in your pregnancy is washing your hands.

CMV (Cytomegalovirus) (sigh-toe-meg-uh-low-vy-rus) CMV is a virus that spreads through body fluids and breast milk. If you get CMV, you may not know you are sick, or you may have a sore throat, fever and swollen glands. A blood test can show if you have the virus. There are medicines to help babies if they get CMV in the womb. Always use good hand washing and hygiene habits to avoid CMV.

Flu You are more likely to get the flu when you are pregnant. It can also turn into life-threatening pneumonia. The flu shot can protect you and your baby from serious health problems. The flu shot in the arm is safe during pregnancy.

Flu symptoms include:

zz Fever zz Muscle aches zz Headaches zz Fatigue

zz Congestion zz Sore throat zz Runny nose

Genital Herpes Genital herpes is a viral disease that causes painful blisters and ulcers on the sex organs of both men and women. If you have herpes, tell your health care provider about every flare-up during your pregnancy. You may be given medicine during the last month of pregnancy to prevent an outbreak. A newborn can have brain damage or even die if infected during birth.

Tell your health care provider if you or your sexual partner has ever had herpes so that your baby can be protected before and during childbirth.

German Measles (Rubella) This disease can cause birth defects in your baby’s eyes, ears and heart. Most people have had the German measles vaccine so they are protected from the disease. If you think you have German measles because you have a skin rash with a fever, call your health care provider right away.

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Chapter 1 – Prenatal Care

Hepatitis B and Hepatitis C A person with this liver infection can give the virus to others without knowing it. If you have ever been infected with the Hepatitis B or Hepatitis C virus, your baby will need special care right after birth. Your health care provider can test your blood for these viruses.

HIV (Human Immunodeficiency Virus) (ih-mew-no-de-fish-en-see) This virus keeps your body from fighting sickness and infection. A pregnant person with HIV can pass it to their unborn baby. If you have HIV, your health care provider may give you special medicine during pregnancy to lower the chance of your baby being born with it. The HIV virus can sometimes lead to AIDS (Acquired Immunodeficiency Syndrome). Your health care provider can test your blood for HIV at your first appointment. You can choose not to be tested. If you have sex without a condom or share needles while using drugs, you should be tested before your due date. If you have HIV you should NOT breastfeed because the baby can get the virus from your breast milk.

The 3 most common ways to get HIV:

zz Sharing needles. zz Having unprotected sex with an infected person. zz Passing it to your unborn baby.

Listeriosis (li-steer-ee-oh-sis) Eating food that has the listeria bacteria causes a serious infection. You may feel like you have the flu with chills, fever and muscle aches. A listeriosis infection during pregnancy can cause miscarriage, stillbirth, early delivery or life-threatening infection in the newborn baby. If it is caught early, the problem can be treated with antibiotics. Toxoplasmosis (tok-so-plaz-moe-sis) This disease comes from eating infected meat that is raw or not cooked through. You can also get toxoplasmosis from cats. If they eat small birds or mice who have it, you can be infected when you change their cat litter. You might feel like you have the flu, or you may not even know you are sick. If you get this illness while you are pregnant, your unborn child can become infected. This can cause permanent eye damage and other serious problems.

Foods that may have the listeria bacteria:

Make sure the label on juice, milk or cheese says “pasteurized”. Fully cook raw meats and wash your hands, knives and cutting boards after touching uncooked foods.

zz Unpasteurized (raw) milk and cheeses zz Hot dogs zz Deli meats zz Smoked seafood zz Unwashed vegetables

Be careful around meat and cats:

zz Only eat meat that has been cooked all the way through. zz Wear gloves or ask someone else to empty your cat's litter box. zz Wash your hands carefully after you touch uncooked meats or your cat, or after you work outside in the yard.

Chapter 1 – Prenatal Care 13

Zika Virus

zz If you are bitten and get the virus when you are pregnant, you can pass it to your growing baby. Zika can cause a small head and other severe brain defects in the baby. zz You can get Zika by having sex with someone infected by Zika – even if you are not in an area that has a high risk for Zika.

In some areas of North and South America, there is a type of mosquito that carries the Zika virus. Find out where Zika risk areas are. Get more information about the Zika virus, the symptoms, and the effects, on the Center for Disease Control website: www.cdc.gov/ zika/pregnancy. The site is kept up to date with the latest Zika information. If you do not have internet access, please contact your health care providers office for help getting this information. Protect yourself and your baby. DO NOT travel to areas with Zika. If you have to go, avoid mosquito bites.

zz Infected people do not always show symptoms.

zz Use a condom if your partner has traveled to an area where zika virus exists.

Vaccines Vaccines work best if you get them before you get pregnant. If you need vaccinations to travel outside the U.S., wait until after the baby is born to take the trip, or discuss with your health care provider.

Vaccines to get before getting pregnant (not safe during pregnancy):

These vaccines are safe for pregnant women:

zz Mumps zz Rubella

zz Chickenpox zz Measles

zz Hepatitis B

zz Flu

zz TDAP

Tetanus Diphtheria Pertussis (TDAP) TDAP is the vaccine to prevent Teen and Adult Whooping Cough ( Pertussis ). This disease makes it hard for your baby to breathe. Family members who will be around the baby should also get the vaccine before the baby is born. Ask your health insurance company if they cover TDAP.

If you do not get a TDAP vaccine during pregnancy, get one right after the baby is born. The TDAP vaccine is safe for breastfeeding .

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Chapter 1 – Prenatal Care

High-Risk Pregnancy Sometimes a pregnancy is called high-risk. This means that there is a health problem that needs to be watched more closely. If your health care provider says your pregnancy is high-risk, you will see your provider more often. You may also have special tests to decide if your baby should be born before your due date. Your health care provider may send you to someone who has extra training in high-risk pregnancies .

These can make a pregnancy high-risk:

zz Viral illnesses like Hepatitis B, HIV, German measles, CMV, Chickenpox zz Bleeding late in pregnancy zz Nicotine, alcohol, or drug abuse zz Weak cervix zz Age 40 or older zz Obesity zz Have had miscarriages, stillbirths or other infants with birth defects

zz Rh disease zz Pregnant with twins or triplets zz Diabetes zz Heart disease zz High blood pressure zz Going into labor 3 weeks before your due date zz Placenta or umbilical cord is not healthy

WARNING SIGNS

Call your health care provider right away if any of these happen to you. It could mean something is not right and you need help right away:

zz Bleeding from nipples, rectum, bladder, or coughing up blood. zz Any bleeding from your vagina. zz Swelling of hands or face. zz Changes or blurring of vision.

zz Severe or continuous headaches that are not relieved by Tylenol®. zz Chills or fever over 100.4˚F zz Stomach pains that do not go away after heat and rest, or after a bowel movement.

zz Throwing up for 24 hours. zz Painful or burning urination. zz Your baby stops moving. zz Fluid coming out of your vagina.

MoreWarning Signs toWatch For:

zz Contractions : if you have stomach cramps more than 5 or 6 times in an hour and you are 3 weeks or more before your due date, call your health care provider. zz Pain, light cramping, and “stretching pains” in early pregnancy are normal. If this gets very painful, call your health care provider.

Chapter 1 – Prenatal Care 15

How Does My Baby Grow Each Month?

Pregnancy can be divided into weeks and sometimes days. A pregnancy lasts about 40 weeks. The weeks are also grouped into three trimesters . Each trimester lasts about 12 to 13 weeks (about 3 months):

zz First trimester – 0 weeks to 13 weeks and 6 days (months 1 to 3)

zz Second trimester – 14 weeks to 27 weeks and 6 days (months 4 to 7)

zz Third trimester – 28 weeks to 40 weeks and 6 days (months 7 to 9)

Conception through your first week.

1st Trimester

MONTH 1

MONTH 2 zz Your baby is starting to look like a human. zz Your baby is about 1 inch long and weighs almost 1 ounce. zz Arms and legs are forming. zz Elbows, fingers and toes are forming. zz Eyelids are formed but stay closed. zz Nostrils are formed. zz Head is larger than the body. zz Brain is growing very fast.

MONTH 3

zz Your baby is called an embryo and is ½ inch long. zz Heart, brain, lungs, eyes and ears are forming. zz The embryo is floating in a sac of amniotic fluid.

zz Your baby is now called a fetus . zz Your baby is about 4 inches long and weighs about 1 ounce. zz Fingernails and toenails are growing. zz A little bit of hair may grow. zz The eyes start to form. zz Heart is beating. zz Your baby is moving, but you don’t feel it yet.

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Chapter 1 – Prenatal Care

2nd Trimester

MONTH 6 zz Your baby is about 12 inches long and weighs just over 1 pound. zz Looks like a tiny infant covered in red, wrinkled skin. zz Your baby starts moving more. zz Eyes start to open, eyelids and eyebrows are fully formed. zz Hair starts to grow. zz Your baby may hiccup. zz Your baby can hear you talk, read out loud, and sing.

MONTH 4 zz You may start to look pregnant. zz Your baby is more than 6 inches long and weighs about 5 ounces. zz Teeth, eyelids, eyelashes, hands and feet are more detailed. zz Hands are working and the fist is being played with. zz Neck is longer and the chin is not resting on the chest. zz Your baby can hear and swallow.

MONTH 5 zz Your baby is 10 inches long and weighs almost 1 pound. zz You may feel the baby move, but not often. zz Bones start to form. zz Eyes are almost formed. zz Fingers and toes are short andwebbed. zz Your baby begins to suck on their thumb.

3rd Trimester

MONTH 7 zz Your baby is up to 14 inches long and weighs over 2 pounds. zz You feel the baby kicking and stretching. zz Babies born now are premature (born early) but can survive with special care. zz Your baby responds to sound. zz Eyelids and nostrils are open. zz Your baby can sense light, smell and taste. zz Lungs start to work. zz Skin gets thicker. zz Your baby is starting to know your voice.

MONTH 8 zz Your baby is about 17 inches long and weighs 4 to 5 pounds. zz Bones and nails are getting harder. zz Fat starts smoothing out wrinkles. zz Your baby is getting your immunity to fight infections. zz All vital organs are fully formed, except the lungs. zz Brain is still growing. zz Very good chance of living if born now. zz Starts to turn upside down for birth. zz Skull is soft.

MONTH 9 zz Your baby may be about 20 inches long and weigh around 7 ½ pounds. zz You may have trouble sleeping as baby moves around. zz You may need to urinate often as baby presses on your bladder. zz Lungs are fully formed and ready to work outside the womb. zz Your baby starts sleeping at regular times. zz Fat tissue is added to protect organs and keep baby warm. zz Liver starts to store iron. zz Vernix (white cream) coats the skin.

Chapter 1 – Prenatal Care 17

How Do I Take Care of Myself? You need to take special care of yourself to have a healthy pregnancy and grow a healthy baby. Work Depending on your job, you may be able to safely work for most of your pregnancy. You may need to make some changes as your due date gets closer. Talk to your health care provider about your job duties and any suggestions for adjusting them.

Travel

It is usually fine to travel while you are pregnant. After 8 months, it is usually better to stay close to home and your health care provider.

Talk with your health care provider about traveling if you:

zz Are expecting twins. zz Have pregnancy-related high blood pressure. zz Are having a high-risk pregnancy. zz Have only 4 to 6 weeks left until your due date, even if it is an emergency trip.

If you sit still too long on a plane or in a car you may get a blood clot. Walk around for a few minutes every hour to keep your blood moving and avoid a clot.

Seat Belts

Wearing your seat belt will keep you and your baby safer during travel.

zz Use both the shoulder belt and the lap belt if you can. zz Place the lap belt under your belly, across your hips and thighs. zz Do not turn off air bags, but do push your seat as far back as you can. If you are in a car accident, see your health care provider to make sure you and your baby are both okay.

Baths

Baths are safe while you are pregnant. You may want someone at home to help you get in and out of the tub so you do not fall. Do not take a bath if your water breaks. Call your health care provider right away. Saunas and Hot Tubs Very hot water and steam can hurt your growing baby. It is okay to soak your feet in a hot tub, but do not sit in one. Stay out of saunas while you are pregnant.

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Teeth

Clothing

As your body changes, you may need to change some of what you wear. zz Get a good support bra as your breasts get larger and heavier. zz Try wearing support hose if your legs are tired or you have varicose veins . zz Choose footwear for support and to help you stay steady on your feet. Tampons You will be having more discharge from your vagina. Use mini-pads instead of tampons. You can spread germs into your vagina if you use tampons.

Make sure to brush and floss your teeth every day to keep them healthy. Your gums may bleed or swell during your pregnancy. See your dentist for checkups and any problems with your teeth or gums. Remember to tell them you are pregnant before they take any x-rays or give you any medicines. If your dentist needs to numb you or give you local anesthesia , talk to your dentist and your health care provider first. Local anesthesia is safe to use during pregnancy. Rest Rest is very important now. Get 8 to 10 hours of sleep each night and take naps during the day if you need to. You will be more tired than usual during the first part of your pregnancy. Your body is telling you to rest so your baby can grow.

Household Cleaners and Bug Sprays

Chemicals in household cleaners get into your body through your skin. Use products with natural ingredients instead of chemicals when you can.

zz Wear gloves when cleaning. zz Open windows for fresh air if you must use household cleaners. zz Stay away from bug sprays and weed killers.

zz If you have your home sprayed for bugs, let it air out before you return. zz Do not use aerosol spray cans. Use bottles with pump sprayers instead. zz Use latex wall paint or paints that say “Low VOC” or “No VOC”. You do not want to breathe gases from VOCs (volatile organic compounds). zz Stay away from lead paint and strong fumes from oil-based paint and paint thinners.

Sex

Your health care provider may tell you not to have sex if:

You may continue to enjoy sex while you are pregnant.

zz You have had a miscarriage before. zz You have had bleeding from your vagina.

Sex may not be comfortable in the last 4 to 6 weeks, but it is still safe to have it. Orgasms will not start labor or cause bleeding or other problems in a normal pregnancy. You will not harm your baby with your movements.

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Street Drugs Drug abuse during pregnancy hurts your unborn baby. Your child can be born addicted to drugs and go through withdrawal. There is also a higher risk that your baby will die while sleeping. This is Sudden Infant Death Syndrome (SIDS). Drugs that you inject, snort or inhale (cocaine, crack, heroin and marijuana) reach your baby easier than drugs you swallow. Certain medicines can also harm your baby. It is very important to talk about drug abuse with your health care provider.

These drugs cause babies to be too small or born too early:

zz Amphetamines zz Marijuana zz Barbiturates zz Crack

zz Narcotics zz Cocaine zz Opioids (heroin)

It is very important to tell your health care provider if you have used street drugs. Your baby could have permanent damage or die if you are not treated early.

Alcohol To be safe, do not drink any alcohol while you are pregnant. Even drinking small amounts can cause Fetal Alcohol Syndrome (FAS). Fetal Alcohol Syndrome is the medical term that describes the many physical and mental problems that affect children born to people who drank alcohol during their pregnancy. Remember, whatever goes into your body will also affect your baby.

Drinking alcohol during pregnancy may cause your baby to have:

zz Birth defects

zz Behavior problems

zz Learning problems

zz Mental problems

One in ten people have some type of drinking problem. Protect your baby. Talk to your health care provider if you need help.

DOMESTIC VIOLENCE

Domestic violence is physical, sexual or emotional abuse. You may be a victim if someone:

zz Hits, slaps, punches or chokes you. zz Scares you with a weapon. zz Forces you to have sex. zz Threatens to take your children away.

zz Withholds love to punish you. zz Takes away your keys or money. zz Keeps you from getting medical help. zz Says that you deserve to be hit. zz Keeps you from your family or friends.

zz Blames you for the violence. zz Forces you to do something.

Seek help immediately through local agencies. For more information visit Turning Point at www.turningpointdv.org or call the Crisis/Helpline at 1-800-221-6311.

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Smoking Do not smoke or be around people who are smoking while you are pregnant. Smoking puts your baby at risk for being small at birth. It also puts your baby at risk for Sudden Infant Death Syndrome (SIDS). When people smoke around your baby there is a greater risk of allergies and ear infections.

Talk to your health care provider if you need help to quit smoking.

Medications Do not take any medicines unless your health care provider tells you it is all right. Be sure to read the safe medicines list, given to you by your health care provider, before taking anything. Call your health care provider if you are not sure if a medication is safe.

zz Splenda® (Sucralose) yellow packet—600 times sweeter than sugar zz Equal®, NutraSweet® (Aspartame) blue packet—200 times sweeter than sugar zz Sweet'N Low® (Saccharin) pink packet—300 times sweeter than sugar

X-Ray Studies Dental and some other x-rays are safe during pregnancy if you need them. Be sure to tell the x-ray person that you are pregnant so your baby can be protected. Artificial Sweeteners Artificial sweeteners seem to be safe for pregnant women to use in small amounts. Different brands add different amounts of sweetness, so you may not need to use as much of one brand as you do of another.

Caffeine Caffeine makes your heart beat faster and can cause headaches, trouble sleeping and nervousness. It can also give you heartburn and dehydrate you. Limit caffeine to less than 2 cups each day.

Stress

You may be moody and get tired easily. Let go of stress as much as you can.

zz Try to avoid people, places or activities that will stress you out.

zz Do not try to do too much each day.

zz Find quiet time to sit and breathe deeply for a few minutes.

zz Talk to your health care provider about any stresses you may have. Be open and honest so they can help you.

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Why Do I Feel Like This? More physical and emotional changes happen starting in month 7. Your hormones are getting your body ready to have your baby. Backache As your womb grows, the joints in the pelvis relax. This can cause pain in your lower back. Wear sturdy flat shoes and have good posture. Exercise may help your backache more than anything else. Start doing back exercises every day. Get on your hands and knees and let the baby’s weight fall toward the floor. This will take the pressure off your back as the baby shifts, and it may give you less backache. The pelvic rock exercise will also help (see page 28).

Lungs

Liver

Stomach

Intestines

Uterus

Cervix

Bladder

Vagina

Pregnancy

Pre-Pregnancy

Helpful tips:

zz Walk with your back straight.

zz Do not lift heavy things.

zz Take breaks and rest your back.

zz To get out of bed, roll on your side first, then push yourself up to sitting. zz Never sit straight up from lying on your back.

zz Wear low shoes with rubber soles.

zz Put a small pillow or rolled towel behind your lower back when sitting or driving. zz Do back exercises if your health care provider says you can.

Bottom and Leg Pain (Sciatica) Your bottom and leg might hurt or feel numb on one or both sides. Your growing baby is pushing on a nerve. Try changing positions to make it stop. If this pain is too much for you, talk to your health care provider.

The sciatic nerve branches out from the lower back, and runs down the buttocks and legs to the feet.

Sciatic Nerve

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Chapter 1 – Prenatal Care

Breast Changes Your breasts may be larger, firmer and tender. The areola (air-e-oh-la), the dark part around your nipples, may get larger and grow darker in color. Halfway through your pregnancy, your breasts may start to leak fluid called colostrum (ko-los-trum) in small amounts. This is normal. Be sure to keep your nipples clean and dry.

Take care of your breasts:

zz Wear a good support bra. zz Wear breast pads if you are leaking colostrum. zz Use only warm water to wash your areola and nipple.

zz Let your breasts air-dry a few times each day and after showers if you are leaking.

Constipation Some people will have trouble moving their bowels when they are pregnant. This is constipation . Drinking fluids is one way to keep from getting constipated. Exercise every day and eat fruits and raw vegetables. Try adding bran to your diet.

DO NOT GIVE YOURSELF AN ENEMA OR TAKE LAXATIVES. Talk to your health care provider if you are having a problem.

Hemorrhoids Many people get hemorrhoids when they are pregnant. These are large veins at the opening of the rectum that may itch or burn. Straining due to constipation may cause hemorrhoids. Sometimes they are due to slowed blood flow caused by your growing baby. If you have hemorrhoids, try lying on your side with your hips up on a pillow. Soaking in a warm tub can help, too. Before you use any medicine, refer to the safe medicines list given to you by your health care provider. Heartburn Heartburn does not mean your heart is burning. An increase in hormones weakens the closure around your stomach. This lets stomach acid out and gives you a burning feeling in your chest. Ask your health care provider what medicine is safe for you to take.

Help for heartburn:

zz Try eating 5 or 6 smaller meals each day instead of 3 bigger meals. zz Do not eat food or drink lots of liquid right before bedtime. zz Limit spicy, hot, fried or greasy foods. zz Prop yourself up at night if you taste acid in your mouth.

Loose and Aching Joints

Your joints may feel loose, pop or just ache. Hormones are helping your pelvis get larger so your baby can pass through. You may feel achy all over your body.

Hormones soften cartilage so your pelvis can expand 1 to 1½ centimeters to help with the birth.

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Leg Cramps You may get a cramp or “charlie horse” in your leg. Try to straighten your leg and pull your toes back toward your head. This works better than rubbing your leg or trying to walk it out. Do stretching exercises 2 to 3 times each day and before bedtime.

Have your partner help stop a leg cramp by straightening your leg and gently pushing your toes toward your head.

Round Ligament Pain These ligaments are the stretchy fibers that hold your uterus in place. As your baby grows, they stretch like rubber bands. A sudden move can cause a sudden sharp pain down low on your belly. Some people also feel pains like this in their vagina or rectum. Short pains like this are normal.

If you have belly pain that will not stop or is getting worse, call your health care provider or go to the hospital right away.

Round Ligament

Shortness of Breath

It may feel harder to breathe now that your baby is bigger. Slow down and practice taking deep breaths. When you get close to your due date the baby will feel like it drops lower in your belly, giving your lungs more room.

If you feel like you cannot breathe:

zz Sleep on your side, not flat on your back. zz Put pillows all around you, between your legs and behind your back. zz Sleep in a recliner with pillows around you. zz Slow down when you climb stairs.

When the baby drops, it may be easier for you to breathe. This happens in the last few weeks of pregnancy.

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Chapter 1 – Prenatal Care

Skin Changes

Hormones in your body may cause skin color changes. These may go away or fade after the baby is born. Acne may get worse or better. Do not take any acne medicines by mouth until you talk with your health care provider.

Pregnancy hormones can cause:

zz A dark line running up your abdomen (Linea nigra). zz Brown marks on your face if you have pale skin. zz Acne or skin breakouts. zz Stretch marks on your belly, breasts, thighs and upper arms.

Linea nigra

Swelling

Your feet and legs may start to swell. If your face or hands swell or your legs are very swollen, tell your health care provider. You could need medical help.

If your legs swell:

zz Put pillows under your legs when you lie down. zz Do not cross your legs when you sit. zz Lie on your side when you are sleeping or resting. zz If you have to stand at work, ask if you can sit down sometimes. zz Get up and move around as much as you can. zz Ask your health care provider how you can exercise.

Put your feet and legs up when you can.

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Chapter 1 – Prenatal Care 25

What Should I Eat?

EatingWell for Your Baby

Eating healthy foods is a big part of staying healthy. Make sure your meals have foods from the 5 groups.

zz Grains – choose whole-grain cereals, breads, crackers, rice and pasta.

zz Vegetables – eat more dark green veggies like broccoli and spinach, orange veggies like carrots and sweet potatoes, dry beans and peas like pinto beans, kidney beans and lentils.

zz Fruits – eat different kinds of fruit that are fresh, frozen, canned or dried; limit fruit juices that have a lot of sugar.

zz Dairy – eat foods with lots of calcium and choose low-fat or fat-free milk, yogurt and other milk products; you can also choose lactose-free products or other products with added calcium. zz Protein – choose low-fat or lean meats and poultry that can be baked, broiled or grilled; choose more fish, beans, peas, nuts and seeds.

Foods to avoid during pregnancy

zz Raw fish and raw shellfish (sushi containing raw fish and oysters), smoked fish.

zz Undercooked meat, hot dogs, deli meat, poultry.

zz Raw or lightly cooked eggs and foods containing them.

zz Unpasteurized milk, other milk products, juices (apple cider).

zz Unpasteurized and pasteurized soft cheeses (Camembert, feta, Brie, and blue-veined cheeses).

scan me!

Foods to limit:

zz Refrigerated patés and meat spreads.

zz Limit solid fats like butter, stick margarine, shortening and lard. zz Check the Nutrition Facts label to keep saturated fats, trans fats and sodium low. zz Choose food and drinks low in added sugars to avoid extra calories. zz Limit salty foods that can make your body hold on to fluids.

zz Raw sprouts (alfalfa sprouts).

zz Fish with a high mercury content: shark, tilefish, mackerel and swordfish.

Handy, healthy snacks:

zz String cheese zz Yogurt zz Turkey slices

zz Cottage cheese zz Hard-boiled eggs

Drink at least 6 to 8 glasses of water everyday.

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Chapter 1 – Prenatal Care

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