OB Packet - BRENHAM FAMILY PRACTICE AND OBSTETRICS

Transcription

BRENHAM FAMILY PRACTICE AND OBSTETRICS
605 Medical Court, Ste 203
Brenham, Texas 77833
979-836-2822
Dr. Jon F. Bode
Dr. Gregg Workman
Dr. Nathan Simons
Scott and White Hospital of Brenham
979-836-6173
Labor and Delivery
979-830-7415
Estimated date of delivery
_____________________
Morning Sickness
What is morning sickness?
Morning sickness refers to the nausea and vomiting that some women have when they become pregnant.
It is caused by the sudden increase in hormones during pregnancy. Although morning sickness is more
common in the morning, it can occur at anytime of the day or night.
How long will morning sickness last?
Morning sickness is very common early in a pregnancy. It tends to go away later in pregnancy, and it's
almost always gone by the second trimester (after 13 weeks, or the fourth month). But there isn't a set
time for it to stop because each woman is different, and each pregnancy is different.
Will morning sickness hurt my baby?
Morning sickness can only become a problem for your baby if you can't keep any foods or fluids down
and begin to lose a lot of weight. You should call your doctor if you:
Have lost more than 2 pounds
Vomit blood (which can appear bright red or black)
Have vomited more than 4 times in 1 day
Have not been able to keep fluids down for more than 1 day
Tips to relieve morning sickness
The tips below may help reduce morning sickness:
Eat small meals throughout the day so that you're never too full or too hungry.
Avoid rich, spicy, greasy or fatty foods.
Avoid foods with smells that bother you or make you nauseous.
Eat more carbohydrates (plain baked potato, white rice or dry toast).
Eat bland foods when you feel nauseous (such as saltine crackers, gelatin desserts such as JellO, popsicles, chicken broths, ginger ale and pretzels).
The iron in prenatal vitamins can bother some women. If you think your morning sickness is
related to your vitamins, talk with your doctor and he or she may change your vitamins.
Before getting out of bed in the morning, eat a few saltine crackers to calm your stomach.
Wearing "acupressure" wrist bands, which are sometimes used by passengers on boats to
prevent sea sickness, may help some women who have morning sickness. You can buy the
bands at drugstores, boating stores or travel agencies.
If these tips don't provide some relief from morning sickness, talk to your doctor. Keep in mind that
morning sickness does not mean your baby is sick.
Taking Care of You and Your Baby While You're
Pregnant
Is prenatal care important?
Prenatal care is very important. To help make sure that you and your baby will be as healthy as possible,
follow some simple guidelines and check in regularly with your doctor.
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What will happen during prenatal visits?
After you find out you are pregnant, you should make an appointment with your doctor. Your first prenatal
visit will likely be when you are 6 to 8 weeks pregnant. Your doctor will probably start by talking to you
about your medical history and how you've been feeling. You'll be weighed and have your blood pressure
taken. These measurements will most likely be taken during each doctor's visit.
On your first visit, you'll also have a pelvic exam to check the size and shape of your uterus (womb) and a
Pap smear to check for abnormalities of the cervix (the opening of the uterus).
Urine and blood tests samples will be taken on the first visit and again at later visits. Other tests are
performed, such as urine tests to check for bacteria in your urine, high sugar levels (which can be a sign
of diabetes) and high protein levels (which can put you at risk for preeclampsia, a type of high blood
pressure during pregnancy). Blood tests to check for low iron levels (anemia), blood cell count, infectious
diseases (such as syphilis and hepatitis) and blood type are also performed.
Sometimes, an ultrasound may be done to help figure out when your baby is due or to check on your
baby's growth and position in your uterus. An ultrasound uses sound waves to create an image of your
baby on a video screen.
Other tests may be needed if you or your baby are at risk for any problems.
How much weight should I gain during pregnancy?
Talk to your doctor about how much weight you should gain. It's different for everyone, but most women
gain about 25 to 30 pounds. If you don't weigh enough when you get pregnant, you may need to gain
more. If you're overweight when you get pregnant, you may need to gain less.
What should I eat?
Eating a balanced diet is one of the most important things you can do for yourself and your baby. There
are a few foods that you should be more careful about eating while you are pregnant. Meat, eggs and fish
that are not fully cooked could put you at risk for an infection. Do not eat more than 2 or 3 servings of fish
per week (including canned fish). Do not eat shark, swordfish, king mackerel or tilefish. These fish
sometimes have high levels of mercury, which could hurt your baby. If you eat tuna, make sure it is light
tuna and eat no more than 6 ounces per week of albacore tuna and tuna steaks. It is safe to have 12
ounces per week of canned light tuna.
Wash all fruit and vegetables. Keep cutting boards and dishes clean. Eat 4 or more servings of dairy
foods each day. This will give you enough calcium for you and your baby. Do not drink unpasteurized milk
or eat unpasteurized milk products. Soft cheeses such as Brie, feta, Camembert, blue cheese and
Mexican-style cheeses such as queso fresco may have bacteria that can cause infections.
If you drink coffee or other drinks with caffeine, do not have more than 1 or 2 cups each day.
It is okay to use artificial sweeteners such as aspartame (some brand names: Equal, NutraSweet) and
sucralose (brand name: Splenda) while you are pregnant, but you should use them in moderation. If you
have a genetic disease called phenylketonuria, or PKU, you shouldn't use aspartame at all.
Should I take vitamins?
You should take 1,000 mcg (1 mg) of folic acid every day during your pregnancy. Folic acid can help
prevent problems with your baby's brain and spinal cord. It is best to start taking folic acid before you get
pregnant.
Your doctor might want you to take a prenatal vitamin. If you do take a prenatal supplement, make sure
you're not taking any other vitamin or mineral supplement along with it unless your doctor recommends it.
Is it okay to take medicine?
Check with your doctor before taking any medicine, including pain relievers or other over-the-counter
medicines. Even medicine you can buy without a prescription may cause birth defects, especially if it's
taken during the first 3 months of pregnancy.
How long can I keep working?
This depends on whether you have any problems with your pregnancy, what kind of work you do and if
you're exposed to anything at work that could harm your baby. For instance, lifting heavy objects or
standing for long periods can be hard on your body. Radiation, lead and other heavy metals, such as
copper and mercury, could be damaging to the baby. However, working in front of a computer screen is
not thought to cause harm to an unborn baby. Talk with your doctor about your work environment.
What about exercise?
Unless you have problems in your pregnancy, you can probably do whatever exercise you did before you
got pregnant. Exercise can help ease discomfort during pregnancy. Try to get at least 30 minutes of
exercise each day. Talk to your doctor about any special conditions that you may have.
Some women say exercising during pregnancy makes labor and delivery easier. Walking and swimming
are great choices. If you didn't exercise before pregnancy, start slowly. Don't overdo exercise. Listen to
your body. Call your doctor if you have symptoms such as blurred vision, dizziness, chest pain or
abdominal pain while you are exercising. Don't get overheated. Be sure to drink plenty of water so that
you don't get dehydrated. It's best to avoid anything that could cause you to fall, such as water skiing or
rock climbing. It's also best to avoid contact sports such as basketball or soccer.
Is it okay to have sex?
Yes, unless your doctor believes you're at risk for problems. Don't be surprised if you're less or more
interested in sex while you are pregnant. As you get larger, you may find you need to try different
positions, such as lying on your side or being on top. If you have oral sex, tell your partner not to blow air
into your vagina. This could force air inside you, which could cause an air embolism. Air embolisms can
cause permanent brain damage and even death to a pregnant woman and her baby.
What can I do to feel better?
Here are the most common discomforts of pregnancy and some tips for handling them:
Morning sickness. Nausea or vomiting may strike anytime during the day (or night). Try eating frequent,
small meals and avoid greasy foods. Keep crackers by your bed to eat before getting up.
Talk to your doctor if morning sickness lasts past the first 3 months of pregnancy or causes you to lose
weight.
Tiredness. Sometimes tiredness in pregnancy is caused by anemia, so tell your doctor. Get enough rest.
Take a daytime nap if possible.
Leg cramps. Gently stretch the calf of your leg by curling your toes upward, toward your knee.
Constipation. Drink plenty of fluids. Eat foods with lots of fiber, such as fruits, vegetables and bran
cereal. Don't take laxatives without talking to your doctor first. Stool softeners may be safer than laxatives.
Hemorrhoids. Don't strain during bowel movements. Try to avoid becoming constipated. Clean yourself
well after a bowel movement (wet wipes may be less irritating than toilet paper). Take several warm soaks
(sitz baths) a day if necessary.
Urinating more often. You may need to urinate more often as your baby grows because he or she will
put pressure on your bladder. This can't be helped.
Varicose veins. Avoid clothing that fits tightly around your legs or waist. Rest and put your feet up as
much as you can. Move around if you must stand for long periods. Ask your doctor about support or
compression hose, which may help ease or prevent varicose veins.
Moodiness. Your hormones are on a roller coaster ride during pregnancy. Plus, your life is undergoing a
big change. Don't be too hard on yourself. If you feel very sad or think about suicide, talk to your doctor.
Heartburn. Eat frequent, small meals. Avoid spicy or greasy foods. Don't lie down right after eating. Ask
your doctor about taking antacids.
Yeast infections. The amount of discharge from the vagina increases during pregnancy. Yeast
infections, which can also cause discharge, are more common during pregnancy. It's a good idea to talk
with your doctor about any unusual discharge.
Bleeding gums. Brush and floss regularly, and see your dentist for cleanings. Don't put off dental visits
because you're pregnant, but be sure to tell your dentist you're pregnant.
Stuffy nose. This is related to changes in the levels of the female hormone estrogen. You may also have
nosebleeds.
Edema (retaining fluid). Rest with your legs up. Lie on your left side while sleeping so blood flows from
your legs back to your heart better. Don't use diuretics (water pills). If you're thinking about cutting down
on salt to reduce swelling, talk with your doctor first. Your body needs enough salt to maintain the balance
of fluid and cutting back on salt may not be the best way to manage your swelling.
Skin changes
Stretch marks appear as red marks on your skin. Lotion with shea butter can help keep your skin moist
and may help reduce the itchiness of dry skin. Stretch marks often can't be prevented, but they often fade
after pregnancy.
Other skin changes may include darkening of the skin on your face and around your nipples, and a dark
line below your belly button. Staying out of the sun or using a sunscreen may help lessen these marks.
Most marks will probably fade after pregnancy.
Call your doctor if you have:
Blood or fluid coming from your vagina
Sudden or extreme swelling of your face or fingers
Headaches that are severe or won't go away
Nausea and vomiting that won't go away
Dizziness
Dim or blurry vision
Pain or cramps in your lower abdomen
Chills or fever
A change in your baby's movements
Less urine or burning when you urinate
Any illness or infection
Anything that bothers you
Warnings
"Don't do this, don't do that." You've probably heard every old wives' tale. Here are some warnings worth
heeding:
Don't smoke. Smoking raises your risk for miscarriage, premature birth, low birth weight and
many other problems.
Don't use drugs. Cocaine, heroin, marijuana and other drugs increase your risk of miscarriage,
premature birth and birth defects. Your baby could also be born addicted to the drug you've been
abusing, which can cause serious health problems.
Don't drink alcohol. Drinking alcohol during pregnancy is the major cause of preventable birth
defects, including fetal alcohol syndrome.
Don't clean your cat's litter box or eat raw or undercooked red meat. You could get toxoplasmosis,
a disease that can cause birth defects.
Don't sit in a sauna or hot tub. The high heat raises your risk of miscarriage and birth defects.
Don't douche. Douching could force air into the vagina, which can cause an air embolism. The
vagina doesn't require cleansing in addition to normal bathing. Douching disrupts the helpful
bacteria that keep the vagina clean.
Exercise During Pregnancy: What You Can Do for a
Healthy Pregnancy
Is it safe for me to exercise during pregnancy?
Check with your doctor to make sure that it's safe for you to exercise during your pregnancy. You may
have a medical condition that would make exercise harmful to you or your baby.
Exercise might help you feel better and maintain your weight. Exercise can help ease or prevent
discomfort during pregnancy. It can also give you extra energy and prepares your body for labor by
increasing your stamina and muscle strength. If you have no serious medical problems and you have an
uncomplicated pregnancy, it's probably safe for you to do some exercising.
How should I start an exercise program?
It's best to check with your doctor before starting any exercise program. If your doctor approves, you can
start exercising at a level that does not cause pain, shortness of breath or excessive tiredness. You may
then slowly increase your activity. If you feel uncomfortable, short of breath or very tired, you should
reduce your exercise level. If you have already been exercising, it's easier to keep exercising during
pregnancy. If you haven't exercised before, you need to start very slowly. Many women find that they
need to slow down their level of exercise during pregnancy.
What types of exercise are best when I'm pregnant?
The most comfortable exercises are those that don't require your body to bear extra weight. Swimming
and stationary cycling are good options. Walking and low-impact aerobics are usually well tolerated. You
and your doctor will need to decide what's best for you and your baby.
What should I be careful about?
Avoid activities that increase your risk of falls or injury, such as contact sports or vigorous sports. Even
mild injuries to the stomach area can be serious when you're pregnant. After the first 3 months of
pregnancy, it's best to avoid exercising while lying on your back, since the weight of the baby may
interfere with blood circulation. Also avoid long periods of standing.
When the weather is hot, exercise in the early morning or late evening to help prevent you from getting
overheated. If you're exercising indoors, make sure the room has enough ventilation. Consider using a
fan to help keep you cool. Drink plenty of fluids, even if you don't feel thirsty.
Make sure that you're eating a well balanced diet. Normally, pregnancy increases your food requirements
by 300 calories a day, even without exercise.
What problems should I tell my doctor about?
Listen to your body. Talk to your doctor if you have any of the following symptoms:
Blood or fluid coming from your vagina
Sudden or severe abdominal or vaginal pain
Contractions that go on for 30 minutes after you stop exercising
Chest pain
Shortness of breath
Headache that is severe or won't go away
Dizziness and nausea
Dim or blurry vision
Pregnancy: Should I Use a Seat Belt?
Should I wear a seat belt while I'm pregnant?
Yes, you should always wear a seat belt. Wearing your seat belt protects you and your baby from injury
or death in the event of a car crash. You should wear a seat belt no matter where you sit in the car.
How should I wear my seat belt?
The seat belt should be a 3-point restraint. That means it should have a lap strap and a shoulder strap.
Lap and shoulder belts keep you from being thrown from the car during an accident. The shoulder strap
also keeps the pressure of your body off of the baby after a crash.
Be sure to wear your seat belt correctly. The lap strap should go under your belly, across your hips and
as high as possible on your thighs. The shoulder strap should go between your breasts and off to the side
of your belly. Seat belt straps should never go directly across your stomach. The seat belt should fit
snugly. If possible, adjust the height of the shoulder strap so that it fits you correctly.
What about air bags?
Most experts agree that air bags are safe and can protect pregnant women from head injury. The air bags
in your car should not be turned off when you are pregnant. To be safe, you should move the seat back
as far as possible and tilt the seat to get some distance between your belly and the steering wheel or
dashboard.
Air bags are not a substitute for a seat belt, so always wear your seat belt even if your car has air bags.
Where should I sit if I'm a passenger?
Where a mother sits has not been shown to affect the safety of an unborn baby in a crash. However, if
you are not driving, you should sit in the back seat. Injuries from car crashes tend to be less serious in
people who are sitting in the back seat. It is still important to wear a seat belt.
What should I do if I am in a car crash?
You should get treatment right away, even if you think you are not hurt. Most injuries to the baby happen
within a few hours after a crash. Your doctor needs to check you and your baby as soon as possible after
a crash, especially if you are more than 6 months pregnant.
What danger signs should I watch for after a car crash?
Call your doctor right away if you have pain in your stomach, blood or fluid leaking from your vagina or
you begin to experience contractions.
Your Baby's Development
This first week is actually your menstrual period. Because your expected delivery date (EDD) is
calculated from the first day of your last period, this week counts as part of your 40-week pregnancy
even though your baby hasn't been conceived yet.
Your Body
During pregnancy, your healthy habits and your baby's health go hand in hand. While planning to
conceive, take the time to prepare your body for motherhood. Before becoming pregnant, you should:
Avoid alcohol, drugs, and tobacco products. These substances can cause birth defects,
fetal alcohol syndrome, respiratory problems, low birth weight, and other health problems.
Talk to your doctor about any prescription and nonprescription (OTC) drugs you are
taking. You'll need to take special precautions with medications because many prescription
and over-the-counter medications can negatively affect the fetus. But don't stop taking
prescription drugs without consulting your health care provider, who will help you weigh the
potential benefits and risks of stopping your medications.
Maintain a diet that contains an adequate amount of vitamins, especially folic acid.
Women who are attempting to become pregnant should take 400 micrograms of folic acid a
day. Adequate folic acid intake reduces the risk of neural tube defects (birth defects caused by
incomplete development of the brain or spinal cord), such as spina bifida. Be sure to talk to
your health care provider about taking a folic acid supplement while you are trying to
conceive.
This may sound strange, but you're still not pregnant! Fertilization of your egg by the sperm will only
take place near the end of this week — read more about fertilization in the Your Body section below.
Although you'll have to wait to find out what color to paint the nursery, your baby's gender will be
determined at the moment of fertilization. Out of the 46 chromosomes that make up a baby's genetic
material, only two — one from the sperm and one from the egg — determine the baby's sex. These
are known as the sex chromosomes. Every egg has an X sex chromosome; a sperm can have either
an X or a Y sex chromosome. If the sperm that fertilizes your egg has an X chromosome, you'll have a
girl; if it has a Y chromosome, your baby will be a boy.
Your Body
Your uterine lining, which will nourish the baby, is developing, and your body secretes folliclestimulating hormone (FSH), which stimulates an egg to mature. At the end of this week, you will be at
the midpoint of your menstrual cycle (if you have a regular 28-day cycle), and ovulation will occur
(your ovary will release an egg into the fallopian tube).
This is when you're most likely to conceive. If you have sexual intercourse without protection around
the time that you ovulate, you can become pregnant. After your partner ejaculates, millions of sperm
travel through the vagina, and hundreds make it to the fallopian tube, where your egg is waiting. One
sperm generally succeeds in penetrating the egg, and fertilization takes place. When that happens,
you will be pregnant — although you will not be feeling any body changes just yet.
Even though you may not feel that you're pregnant yet, you have a baby growing and developing
inside of you! Although your baby was just conceived, he or she is working overtime. The fertilized
egg goes through a process of cell division. About 30 hours after fertilization, it divides into two cells,
then four cells, then eight, and continues to divide as it moves from the fallopian tube to the uterus.
By the time it gets to the uterus, this group of cells looks like a tiny ball and is called a morula.
The morula becomes hollow and fills with fluid — it is then known as a blastocyst. Near the end of this
week, the blastocyst will attach itself to the endometrium, the lining of the uterus. This is called
implantation. The implantation in the uterus creates an essential connection — the endometrium will
provide the developing embryo with nutrients and will remove wastes. Over time, this implantation
site will develop into the placenta.
Your Body
Adequate intake of certain nutrients, such as folic acid, protein, calcium, and iron, is essential for
nourishing your baby. A folic acid supplement — which, ideally, you've been taking since before you
conceived — is particularly important because folic acid helps prevent defects of the neural tube (the
structure that gives rise to the brain and spinal cord), which forms very early in pregnancy.
Your intake of protein, which is used to create new tissue, should increase during pregnancy. In
addition, calcium is necessary for the development of bones and teeth, so make sure you're getting a
good dose of dairy products, leafy green vegetables, and legumes. Iron is essential during pregnancy
as you support the continual increase of your baby's blood volume. Good sources of iron include red
meat, legumes, eggs, and leafy green vegetables.
Four weeks into your pregnancy, your baby (called an embryo) consists of two layers of cells — the
epiblast and the hypoblast — that will eventually develop into all of your baby's organs and body
parts. Two other structures that develop at this time are the amnion and the yolk sac. The amnion,
filled with amniotic fluid, will surround and protect the growing embryo. The yolk sac will produce
blood and help to nourish the embryo until the placenta takes over that role.
Your Body
This week your baby continues to implant in your uterus, burying itself deep within the endometrium.
Once implanted, your baby starts to produce a hormone called human chorionic gonadotropin (hCG),
which helps to maintain the lining of the uterus. It also sends a signal to the ovary to stop releasing
an egg each month, which stops your monthly periods. Some women experience slight cramping and
spotting of blood during this week while implantation is taking place, and they may mistake this for a
period, as it often occurs around the time their monthly period was due.
hCG is the hormone that is measured in pregnancy tests. This week a pregnancy test will probably be
able to detect your pregnancy! hCG also causes the symptoms of pregnancy, which can appear this
week. Fatigue, tingling or aching breasts, or nausea might lead you to believe your period will be
starting any day because the first pregnancy symptoms resemble premenstrual syndrome (PMS). But
by the end of this week, your expected period will not take place. Your pregnancy is well on its way!
Until now, the embryo has been a mass of cells, but by this point in your pregnancy a distinct shape
begins to form. The neural tube, which will eventually form into the spinal cord and brain, runs from
the top to the bottom of the embryo. A bulge in the center of the embryo will develop into your baby's
heart. At this time, the placenta develops. It is through the placenta and its fingerlike projections,
called chorionic villi, that an embryo receives nourishment from its mother
Your Body
Even if nausea hasn't hit you yet, you'll want to steer clear of certain foods when you're pregnant.
Foodborne illnesses, such as listeriosis and toxoplasmosis, may cause birth defects or even
miscarriage. Here are some foods you'll want to avoid:
soft cheeses such as feta, goat, brie, Camembert, and blue cheese
unpasteurized milk and juices
raw or undercooked meats, including hot dogs and deli meats
raw eggs or foods containing raw eggs, including mousse and tiramisu
raw shellfish
paté
Toxoplasmosis can also be spread from soiled cat litter boxes, so try to have someone else clean the
litter box during your pregnancy.
By week 6, your baby’s brain and nervous system are developing at a rapid pace. Optic vesicles,
which later form the eyes, begin to develop this week on the sides of the head, as do the passageways
that will make up the inner ear.
Your baby's heart will begin to beat around this time, and it may even be detected on ultrasound
examination. And the beginnings of the digestive and respiratory systems are forming, too. Small
buds that will grow into your baby's arms and legs also appear this week.
Because their legs are curled up against the torso for much of the pregnancy, making a full-length
measurement difficult, babies often are measured from the crown to rump rather than from head to
toe. This week, your baby only measures 0.08 to 0.2 inches (2 to 5 millimeters) from crown to rump!
Your Body
Common pregnancy complaints may hit in full force this week. You may feel extreme fatigue as your
body adjusts to the demands of pregnancy. And tender, aching breasts and nausea and vomiting
(morning sickness) may leave you feeling less than great. Despite its name, morning sickness can
occur at any hour or all day, so don't be surprised if your queasy stomach doesn't pass by noon.
Nausea isn't the only thing that has you running to the toilet, though — hormonal changes and other
factors, such as your kidneys working extra hard to flush wastes out of your body, cause you to
urinate more frequently, too.
Your baby is constantly adapting to life inside the uterus. By this week, the umbilical cord has
formed. It will be your baby’s connection to you throughout your pregnancy, providing oxygen and
nourishment for your baby and disposing of your baby's wastes. In addition, your baby's digestive
tract and lungs continue to form.
Are you waiting impatiently to see your baby's face on his or her birth day? You have a long way to
go until then, but in the meantime, your baby's face is taking shape. The mouth, nostrils, ears, and
eyes are some of the facial features that become more defined this week.
Dreaming of a son or daughter to play ball with? The arm bud that developed just last week has a
hand on the end of it, which looks like a tiny paddle.
Your Body
Pregnancy causes many changes in your cervix. By this week you'll have developed a mucous plug,
which forms in the opening of the cervical canal and seals off the uterus for protection. (Eventually
you'll lose this plug as your cervix dilates in preparation for labor.)
Marveling over a baby's tiny fingers and toes is one of the joys of the first day of life. Those fingers
and toes are just beginning to form this week, and the arms can even flex at the elbows and wrists.
The eyes are becoming more obvious because they’ve begun to develop pigment (color) in the retina
(back of the eye).
Also, the intestines are getting longer and there isn’t enough room for them in the baby’s abdomen,
so they protrude into the umbilical cord until week 12.
By now, the beginnings of the buds that will develop into your baby's genitals have made their
appearance, although they've not yet developed enough to reveal whether your baby is a boy or a girl.
Your Body
Pregnancy symptoms such as a missed period, nausea, extreme fatigue, or tight clothes due to the
swelling of your uterus have probably prompted you to wonder whether you're pregnant. Once you
have confirmation of your pregnancy from a home pregnancy test or blood or urine test at the doctor's
office, you should call and schedule your first prenatal visit. Your pregnancy may be monitored by one
of several health care professionals, including an obstetrician, nurse practitioner, midwife, or family
doctor. If your pregnancy is considered high risk (for example, if you have had multiple miscarriages,
are older than 35, or have a history of pregnancy complications), your doctor may want to see you as
early as possible and more often during the course of your pregnancy.
Good prenatal care is extremely important for the health and safe delivery of your baby, so be sure to
make prenatal appointments a top priority.
The tail at the bottom of your baby's spinal cord has shrunk and almost disappeared by this week. In
contrast, your baby's head has been growing — it's quite large compared with the rest of the body and
it curves onto the chest. By this week, your baby measures about 0.6 to 0.7 inches (16 to 18
millimeters) from crown to rump and weighs around 0.1 ounces (3 grams). The tip of the nose has
developed and can be seen in profile, and flaps of skin over the eyes have begun to shape into
eyelids, which will become more noticeable in the next few weeks.
The digestive system continues to develop. The anus is forming, and the intestines are growing
longer. In addition, internal reproductive features, such as testes and ovaries, start to form this week.
Your baby may make some first movements this week as muscles develop. If you had an ultrasound
now, those movements might even be visible, but you won't be able to feel them for several more
weeks.
Your Body
In preparation for your first prenatal visit, take the time to familiarize yourself with your family's
health history and to review your medical records. Have you had any chronic illnesses, allergies, or
surgeries? Are you currently taking any prescription medications? Do you know of any genetic
disorders that run in your family? Has your menstrual cycle been regular, and have you had any past
pregnancies? Do you smoke or drink alcohol? What are your exercise habits? These are the things
your health care provider will want to discuss with you, so it will help to have this information ready
when you go.
By week 10, all of your baby's vital organs have been formed and are starting to work together.
As external changes such as the separation of fingers and toes and the disappearance of the tail takes
place, internal developments are taking place too. Tooth buds form inside the mouth, and if you're
having a boy, his testes will begin producing the male hormone testosterone.
Congenital abnormalities are unlikely to develop after week 10. This also marks the end of the
embryonic period — in general, the embryo now has a distinctly human appearance and starting next
week your baby will officially be considered a fetus.
Your Body
Your first prenatal visit, which often takes place around this time, is a milestone. At the doctor's office,
you'll go through a series of tests and checks, including having your weight and blood pressure
checked. You might also have an external abdominal examination to check the size and position of
your baby and have your urine tested. During this first prenatal visit, your health care provider will
thoroughly examine you, including an internal examination and a breast exam. Your health care
provider will also ask you many questions about your medical history and any family health problems,
to determine if your baby is at risk for genetic diseases. Another thing your provider will check? Your
baby's heartbeat! Using a Doppler stethoscope, you should get to hear it for the first time.
As you leave your first appointment, your health care provider will probably send you for a blood test
to find out whether you are immunized against varicella, measles, mumps, and rubella (German
measles), as well as to determine your blood type and Rh factor.
From this week until week 20, your baby will be growing rapidly — increasing in size from about 2
inches (5 cm) to about 8 inches (20 cm) from crown to rump. To accommodate all this growth, the
blood vessels in the placenta are increasing in both size and number to provide the baby with more
nutrients.
Facial development continues as the ears move toward their final position on the sides of the head. If
you saw a picture of your baby now, you'd think you had a genius on your hands — the baby's head
accounts for about half of the body length!
Although your baby's reproductive organs are developing rapidly, the external genitals of boys and
girls appear somewhat similar until the end of week 11. They will be clearly differentiated by week 14.
Your Body
Nourishing your baby usually requires that you gain weight — and in most cases, the recommended
weight gain is 25 to 35 pounds (11.33 to 15.87 kg) over the course of the pregnancy. If you were
overweight or underweight before pregnancy, your health care provider may have different
recommendations for weight gain.
Your baby's brain continues to develop, and tiny fingernails and toenails start to form. Vocal cords are
formed this week, which is the last of your first trimester.
Your baby's kidneys are functioning! After swallowing amniotic fluid, your baby will now be able to
pass it out of the body as urine. And the intestines will make their way into the abdomen, since there
is room for them now.
Your Body
Has anyone told you that you have that "pregnant glow"? It's not just the joy you may feel because
you're having a baby — there's a physiological reason for smoother, more radiant skin during
pregnancy. Increased blood volume and pregnancy hormones work together to give you that glow.
The greater blood volume brings more blood to the blood vessels and hormones increase oil gland
secretion, resulting in a flushed, plumper, smoother skin appearance. Sometimes, though, the
increased oil gland secretion can cause temporary acne.
As you begin the second trimester of pregnancy, your placenta has developed and is providing your
baby with oxygen, nutrients, and waste disposal. The placenta also produces the hormones
progesterone and estrogen, which help to maintain the pregnancy.
By now, the baby's eyelids have fused together to protect the eyes as they develop. Once you take
your newborn home, you might be wishing for those eyes to close once in a while so you can get some
rest!
Your baby may also be able to put a thumb in his or her mouth this week, although the sucking
muscles aren't completely developed yet.
Your Body
At your first prenatal appointment, your health care provider probably gave you a prescription for
prenatal vitamins. Taking these supplements, in addition to eating a healthy diet, ensures your baby
gets additional vitamins and minerals, such as folic acid, zinc, iron, and calcium, which are necessary
for growth and development. Talk to your pharmacist about the best way to take your vitamins, such
as whether they should be taken with food or beverages.
By this week, some fine hairs have developed on your baby’s face. This soft colorless hair is called
lanugo, and it will eventually cover most of your baby’s body until it is shed just before delivery.
By now, your baby’s genitals have fully developed, though they may still be difficult to detect on an
ultrasound examination. In addition, your baby starts to produce thyroid hormones because the
thyroid gland has matured. Your baby now weighs about 1.6 ounces (45 grams) and is about 3.5
inches (9 cm) long from crown to rump.
Your Body
Under certain circumstances (for example, if you're older than 35), your health care provider may
discuss amniocentesis with you. Amniocentesis is a test usually done between 15 and 18 weeks that
can detect abnormalities in a fetus, such as Down syndrome. During this test, a very thin needle is
inserted into the amniotic fluid surrounding the baby in the uterus and a sample of the fluid is taken
and analyzed. Amniocentesis does carry a very slight risk of miscarriage, so talk to your health care
provider about your concerns and the risks and advantages of the test.
Parents are often amazed by the softness of their newborn's skin. Your baby’s skin has been
continuously developing, and it is so thin and translucent that you can see the blood vessels through
it. Hair growth continues on the eyebrows and the head. Your baby's ears are almost in position now,
although they are still set a bit low on the head.
Internally, your baby's skeletal system continues to develop. Muscle development continues too, and
your baby is probably making lots of movements with his or her head, mouth, arms, wrists, hands,
legs, and feet.
Your Body
Has it sunk in yet that you're pregnant? Many women say that it isn't until they trade in their jeans for
maternity clothes and others start noticing their swelling abdomens that the reality of pregnancy sets
in. For many, this realization is both joyful and scary. It's normal to feel as if you're on an emotional
roller coaster (you have your hormones to thank). Another thing you may be feeling? Scatterbrained.
Even the most organized women report that pregnancy somehow makes them forgetful, clumsy, and
unable to concentrate. Try to keep the stress in your life to a minimum and take your "mental lapses"
in stride — they're only temporary.
Your Baby's DevelopmentYour baby now weighs about 3.9 ounces (110 grams) and
measures about 4.7 inches (12 cm) in length from crown to rump. Your baby can hold his or her head
erect, and the development of facial muscles allows for a variety of expressions, such as squinting and
frowning.
Your Body
Between weeks 16 and 18 of pregnancy, your health care provider may offer you the maternal blood
screening test, also known as a "triple marker" test or "triple screen," which measures the levels of
alpha-fetoprotein (AFP), a protein produced by the fetus, and the pregnancy hormones hCG and
estriol in the mother's blood. The test is sometimes called a quadruple screen when the level of an
additional substance, called inhibin-A, is also measured. The results of these tests can tell moms
whether their babies are at risk for (not whether they have) neural tube defects such as spina bifida
or chromosomal abnormalities such as Down syndrome. Out of every 1,000 women who take these
tests, about 50 will have abnormal results, but only one or two women will actually have babies with a
problem. Talk to your health care provider about the risks and advantages of these tests.
At about 5.1 inches (13 cm) from crown to rump and weighing 4.9 ounces (140 grams), your baby is
still very tiny.
The placenta, which nourishes the fetus with nutrients and oxygen and removes wastes, is growing to
accommodate your baby. It now contains thousands of blood vessels that bring nutrients and oxygen
from your body to your baby's developing body.
Your Body
You may notice that your breasts have changed considerably since your pregnancy began. Hormones
are preparing your breasts for milk production — more blood is flowing to the breasts, and the glands
that produce milk are growing in preparation for breastfeeding. This can increase your breast size
(many women increase one to two cup sizes) and cause veins to become visible. Buy supportive bras
in a variety of sizes to accommodate your breast growth during pregnancy.
Ears move to their final position and they stand out from the head. And start brushing up on your
lullabies — in the coming weeks, your baby will probably be able to hear! The bones of the middle ear
and the nerve endings from the brain are developing so that your baby will hear sounds such as your
heartbeat and blood moving through the umbilical cord. He or she may even be startled by loud
noises! Your baby's eyes are also developing — they're now facing forward rather than to the sides,
and the retinas may be able to detect the beam of a flashlight if you hold it to your abdomen.
Until now, your baby's bones had been developing but were still soft. This week, they begin to harden,
or ossify. Some of the first bones to ossify are those in the clavicles and the legs.
Your Body
You're probably beginning to prepare for life with baby. Your preparations should extend beyond
gathering the layette and decorating the nursery, though. This is a good week to begin your search for
a pediatrician or other health care provider for your child. Schedule visits to meet with potential
doctors to discuss issues such as appointment availability, immunization scheduling, and when to call
in an emergency. You'll also want to learn as much as you can about their practices and procedures.
Some good questions to ask: How many health care providers are in the practice? Who covers nights
and weekends? What is their policy on phone calls? Which hospitals are they affiliated with? What
insurance do they accept? What specialists do they work with? How are emergencies handled?
It's important that you feel comfortable with your child's doctor, so do your homework and make your
decision carefully.
Your baby is now covered with a white, waxy substance called vernix caseosa, which helps prevent
delicate skin from becoming chapped or scratched. Premature babies may be covered in this cheesy
coating at delivery.
Your baby is still tiny, but this week brings the development of brown fat, which will help keep your
baby warm after birth. During the last trimester, your baby will add more layers of fat for warmth and
protection.
Your Body
Your constant concern for your baby's health may give way to reassurance if you feel your baby's first
movements, which often happens between weeks 18 and 20. These first movements are known as
quickening, and they may feel like butterflies in your stomach or a growling stomach. Later in your
pregnancy, you'll feel kicks, punches, and possibly hiccups! Each baby has different movement
patterns, but if you're concerned or if the movements have decreased in frequency or intensity, talk to
your doctor.
Many women wonder around this time whether having sex will hurt their developing baby, and the
answer is no. Sex is considered safe at all stages of pregnancy, as long as your pregnancy is normal.
But that doesn't necessarily mean you're going to want to have it. Many expectant women find that
their desire for sex fluctuates during the various stages of pregnancy, depending on their fatigue,
growing size, anxiousness over the birth, and a host of other body changes. Keep the lines of
communication with your partner open as these issues come up. Even though you may both be
preoccupied with the baby, it's also important to have some "together time."
You're halfway there! Twenty weeks into your pregnancy, your baby has grown significantly from that
first dividing cell and now weighs about 11 ounces (312 grams) and measures about 6.3 inches (16
cm) from crown to rump. The baby is taking up increasing room in your uterus, and continued growth
will put pressure on your lungs, stomach, bladder, and kidneys.
Under the vernix caseosa (a protective, waxy coating), your baby's skin is thickening and developing
layers. Hair and nail growth continue.
Your Body
If you haven’t already had one, your health care provider may recommend that you receive an
ultrasound, a diagnostic test that uses sound waves to create an image. An ultrasound can determine
the size and position of the fetus, and any structural abnormalities of bones and organs that are
visible by this time. Depending on the position of the fetus, the sex can usually be determined by now.
During an ultrasound, the umbilical cord, placenta, and amniotic fluid can also be examined. Talk to
your health care provider about the risks and advantages of this test.
The amniotic fluid that has cushioned and supported your baby in the uterus now serves another
purpose. The intestines have developed enough that small amounts of sugars can be absorbed from
the fluid that is swallowed and passed through the digestive system to the large bowel. Almost all of
your baby's nourishment, however, still comes from you through the placenta.
Until now your baby's liver and spleen have been responsible for the production of blood cells. But
now the bone marrow spaces are developed enough to contribute to blood cell formation as well, and
bone marrow will become the major site of blood cell production in the third trimester and after birth.
(The spleen will stop producing blood cells by week 30, and the liver will stop a few weeks before
birth.)
Your Body
Is exercise safe during pregnancy? Exercise can be a great way to stay in shape during pregnancy and
can even keep some symptoms — such as varicose veins, excessive weight gain, and backache — to a
minimum. But pregnancy is not the time to start training for a triathlon — going slowly is the name of
the game. Because ligaments become more relaxed during pregnancy, you're at higher risk for injury,
so low- or non-impact exercise such as yoga, swimming, and walking are your best bets. Talk to your
health care provider before beginning any exercise program while you're pregnant.
The senses your baby will use to learn about the world are developing daily. Taste buds have started
to form on the tongue, and the brain and nerve endings are formed enough so that the fetus can feel
touch. Your baby may experiment with this newfound sense of touch by stroking his or her face or
sucking on a thumb, as well as feeling other body parts and seeing how they move.
Your baby's reproductive system is continuing to develop, too. In boys, the testes have begun to
descend from the abdomen, and in girls, the uterus and ovaries are in place and the vagina is
developed.
Your Body
If you haven’t felt them already, you may soon notice your uterus practicing for delivery with
irregular, painless contractions called Braxton Hicks contractions. You may feel a squeezing sensation
in your abdomen. Don't worry, though: Your baby may be able to feel the contraction as it squeezes
the uterus, but Braxton Hicks contractions aren't dangerous or harmful. If, however, the contractions
become more intense, painful, or frequent, contact your health care provider immediately because
painful, regular contractions may be a sign of preterm labor.
Even though fat is beginning to accumulate on your baby's body, the skin still hangs loosely, giving
your baby a wrinkled appearance. Your baby's daily workout routine includes moving the muscles in
the fingers, toes, arms, and legs regularly. As a result, you may feel more forceful movements.
By now your baby weighs a little more than 1 pound (454 grams). If preterm labor and delivery were
to occur this week, a baby could survive with expert medical care, but might have mild to severe
disabilities. With increasing research and knowledge in the field of fetal medicine, the long-term
prognosis for premature babies (preemies) improves every year.
Your Body
The closer you get to your delivery date, the more trouble you may have sleeping. Anxiety, frequent
urination, heartburn, leg cramps, and general discomfort can translate into a short night's sleep for a
pregnant woman. But your baby's health and your own depend on you getting adequate rest. Try a
warm bath, soothing music, a relaxing book, or a cup of herbal tea to put you in the mood to snooze.
Many doctors recommend that pregnant women sleep on their sides, not their backs or stomachs, so
that blood flow to the placenta is not restricted. If you find this uncomfortable, try placing a pillow
between your knees to relieve the pressure of your weight while lying on your side.
Your baby is still receiving oxygen through the placenta. But once birth occurs, his or her lungs will
start taking in oxygen on their own. In preparation for that, your baby's lungs are developing the
ability to produce surfactant. Surfactant is a substance that keeps the air sacs in our lungs from
collapsing and sticking together when we exhale, allowing us to breathe properly.
Because the inner ear — which controls balance in the body — is now completely developed, your
baby may be able to tell when he or she is upside down or right side up while floating and making
movements in the amniotic fluid.
Your Body
An important prenatal test, glucose screening, is usually performed sometime during weeks 24 to 28.
The glucose screening test checks for gestational diabetes, a temporary type of diabetes that occurs
during pregnancy and can cause problems in the newborn, such as low blood sugar. Gestational
diabetes may also increase the chances that a woman would need a cesarean section because it can
lead to the growth of very large babies.
During the glucose screening test, you'll drink a sugary solution and then have your blood drawn. If
your blood sugar levels are too high, you'll have further tests, which your health care provider will
discuss with you. Gestational diabetes usually can be controlled by eating a well-planned diet and
getting regular exercise, but sometimes medication, such as daily insulin, will be needed during the
pregnancy.
You may notice that your baby has resting and alert periods. You'll notice fetal activity more readily
when you are more sedentary. Your baby's hearing has continued to develop, too — he or she may
now be able to hear your voice!
Your Body
Pregnancy can cause some unpleasant side effects when it comes to digestion. Not only does the
hormone progesterone slow the emptying of the stomach, but it also relaxes the valve at the entrance
to the stomach so that it doesn’t close properly. This allows acidic stomach contents to move upward
into the esophagus. The result: reflux (also known as heartburn) that can make eating your favorite
meals a nightmare. The expanding uterus puts additional pressure on the stomach in the last few
months of pregnancy. Try eating smaller, more frequent meals, and avoid spicy and fatty foods.
Although your baby's eyes have been sealed shut for the last few months, they will soon open and
begin to blink. Depending on ethnicity, some babies will be born with blue or gray-blue eyes (which
may change color in the first year of life) and some will be born with brown or dark eyes. Eyelashes
are growing in, as is more hair on the head.
Your baby, weighing a little less than 2 pounds (907 grams), still looks wrinkly but will continue to
gain weight steadily over the next 14 weeks until birth.
Your Body
Your uterus provides a safe haven for your baby before birth. But what about after delivery? Your
baby will be moving about your home in what seems like no time at all. Take the time now to
safeguard your home by babyproofing. Covering electrical outlets, removing choking hazards,
installing smoke alarms, and blocking off staircases are just some of the steps to ensuring your child's
safety. Take every precaution you can think of, but remember: No amount of babyproofing can
substitute for careful supervision of your child.
By this first week of the third trimester, your baby looks similar to what he or she will look like at
birth, except thinner and smaller. The lungs, liver, and immune system still need to fully mature, but
if born now, your baby would have a very good chance of surviving.
As hearing continues to develop, your baby may start to recognize your voice as well as your
partner's. Sounds may be muffled, though, because the ears are still covered with vernix, the thick
waxy coating that protects the skin from becoming chapped by the amniotic fluid.
Your Body
Your body instinctively nourishes and protects your baby during pregnancy, but caring for a newborn
is a learned skill. Consider signing up for childbirth classes through your local community center or
hospital to learn about topics such as labor, options for pain relief, what to expect after delivery,
common newborn problems, babyproofing, breastfeeding and formula feeding, and infant CPR.
Learning all you can about birth and babies will help you feel more confident, especially if you're a
first-time parent.
Your baby now weighs about 2 pounds, 2 ounces (1,000 grams) and measures about 10 inches (25
cm) from crown to rump. At your next prenatal appointment, your health care provider may tell you
whether your baby is headfirst or feet- or bottom-first (called breech position) in the womb. Babies
who are in the breech position may need to be delivered by cesarean section. Your baby still has 2
months to change position, though, so don't worry if your baby is in the breech position right now.
Most babies will switch positions on their own.
The folds and grooves of your baby's brain continue to develop and expand. In addition, your baby
continues to add layers of fat and has continued hair growth.
Your Body
Your health care provider probably sent you for some blood tests early in your pregnancy. One thing
blood tests measure is the Rh factor, a substance found in the red blood cells of most people. If you
don't have it (if you’re Rh negative) but your baby does (is Rh positive), there is potential for your
baby to have health problems, such as jaundice and anemia. Your doctor can prevent these problems
by giving you a vaccine called Rh immune globulin at 28 weeks and again after delivery.
Your baby continues to be active, and those first few flutters of movement have given way to hard
jabs and punches that may take your breath away. If you notice a decrease in movement, do a fetal
kick count: your baby should move at least 10 times in an hour. If your baby moves less, talk to your
health care provider.
Your Body
During pregnancy, iron is important for replenishing the red blood cell supply. You should be eating at
least 30 milligrams of iron each day. Because iron deficiency is common during pregnancy, your health
care provider may recommend that you receive a blood test to check your iron level. If it's low, you
may be prescribed an iron supplement.
Now weighing about 3 pounds (1,400 grams) and measuring about 10.8 inches (27 cm) from crown to
rump, your baby continues to gain weight and layers of fat. This fat makes the baby look less wrinkly
and will help provide warmth after birth.
In preparation for respiration after birth, your baby will mimic breathing movements by repeatedly
moving the diaphragm. Your baby can even get the hiccups, which you may feel as rhythmic twitches
in your uterus.
Your Body
Constipation is a common complaint of pregnancy. The pregnancy hormones that allow you to
maintain your pregnancy also slow the digestive process considerably. Exercising regularly and eating
foods high in fiber, such as vegetables and whole grains, are great ways to keep everything regular.
By now your baby is urinating approximately several cups of urine a day into the amniotic fluid. He or
she is also swallowing amniotic fluid, which is completely replaced several times a day. Excess fluid in
the amniotic sac (known as polyhydramnios) may mean that the baby isn't swallowing normally or
that there is a gastrointestinal obstruction. Inadequate fluid in the amniotic sac (oligohydramnios)
may mean that the baby isn't urinating properly and could indicate a problem with the kidneys or
urinary tract. Your health care provider will measure your levels of amniotic fluid as part of your
routine ultrasound.
Your Body
Have you decided whether to breastfeed or formula feed your baby? Although the American Academy
of Pediatrics (AAP) recommends breast milk as the best form of infant nutrition, the decision about
how to feed your child is a personal one. Talk to your health care provider or a lactation consultant if
you need more information before making your choice.
The milk glands in your breasts may have started to make colostrum by now. Colostrum is the premilk that provides your baby with calories and nutrients for the first few days before your milk comes
in if you plan to breastfeed. For some women, it is thin and watery. For others, it is thick and
yellowish. If you notice your breasts leaking colostrum, you can buy disposable or washable breast
pads to protect your clothing.
The final touches are being placed on your baby masterpiece. Eyelashes, eyebrows, and the hair on
your baby's head are evident. The lanugo hair that has covered your baby since the beginning of the
second trimester is falling off, although some may remain on the shoulders and back at birth.
At about 4 pounds (1,800 grams) and 11.4 inches (29 cm) from crown to rump, your baby would have
an excellent chance of survival outside the womb if you delivered now.
Your Body
During your prenatal visits, your health care provider will monitor your blood pressure, urine, and any
swelling that may develop, but symptoms such as sudden weight gain, swelling in the hands or face,
headaches, or changes in vision can be signs of preeclampsia. This condition causes high blood
pressure and protein in the urine. Be sure to tell your healthcare provider if you experience any of
these symptoms, since this condition can affect both the mother and fetus during the second half of
pregnancy.
In these last few weeks before delivery, the billions of developed neurons in your baby's brain are
helping him or her to learn about the in-utero environment — your baby can listen, feel, and even see
somewhat. Your baby’s eyes can detect light and the pupils can constrict and dilate in response to
light. Like a newborn, your baby sleeps much of the time and even experiences the rapid eye
movement (REM) stage, the sleep stage during which our most vivid dreams occur!
Your baby's lungs are almost completely matured. Fat will continue to be deposited on your baby's
body for protection and warmth. Babies gain a good deal of their weight in the final few weeks before
birth.
Your Body
With labor and delivery only 2 months away, you may be considering how you'll cope with pain during
childbirth. Among the things you'll want to learn about are the most commonly used techniques for
pain relief. These include breathing techniques such as those taught in Lamaze classes, pain-relief
medications given through injection, and epidurals, where doctors can give an anesthetic by means of
a soft, thin catheter that's placed in your lower back. Whatever your ultimate choice, the more you
know, the better informed your decision can be. Although you don't have to make a decision yet, talk
to your health care provider now about your choices.
Maternal calcium intake is extremely important during pregnancy because the baby will draw calcium
from the mother to make and harden bone. If a pregnant woman doesn't get enough calcium during
pregnancy, it can affect her own bones because the developing fetus will take minerals from the
mother's skeletal structure as needed.
The vernix coating on the baby's skin is becoming thicker, whereas lanugo hair is almost completely
gone.
By now most babies will be in position for delivery. Your health care provider can tell you if your baby
is positioned head- or bottom-first. Babies born at 34 weeks usually have fairly well-developed lungs,
and their average size of 5 pounds (2,250 grams) and 12.6 inches (32 cm) from crown to rump allows
them to survive outside the womb without extensive medical intervention.
Your Body
Fatigue is a common complaint of late pregnancy. Difficulty sleeping, aches and pains, weight gain,
and anxiety about labor, delivery, and taking care of a newborn may contribute to your exhaustion.
Rest as much as you can and take naps if possible.
Your baby already weighs about 5 pounds, 5 ounces (2,400 grams), but this week begins your baby's
most rapid period of weight gain — about 8 to 12 ounces (226 to 340 grams) each week! Fat is being
deposited all over your baby's body, especially around the shoulders.
Because of this increasing size, your baby is now cramped and restricted inside the uterus — so fetal
movements may decrease, but they may be stronger and more forceful. If your baby is in a headfirst
position, his or her head will rest on your pubic bone in preparation for labor.
Your Body
The bond you may already feel with the baby growing inside of you will only grow stronger once your
baby is born. Bonding — the intense attachment that develops between you and your baby — is not
something that only occurs within minutes or days after birth. It may happen later and it may develop
over time. Bonding not only makes you want to protect your baby and shower him or her with
affection, but it also fosters your baby's sense of security in the world outside your womb.
The wrinkly, tiny fetus you may have seen on earlier ultrasounds has given way to an almost plump
baby. There is fat on your baby’s cheeks, and powerful sucking muscles also contribute to your baby's
full face. Your baby now weighs a little under 6 pounds (2,721 grams).
The bones that make up your baby’s skull can move relative to one another and overlap each other
while your baby’s head is inside your pelvis. This phenomenon is called molding, and it helps the baby
pass through the birth canal. Don't be surprised if your baby arrives with a pointy or misshapen head!
After a few hours or days, your baby's head will be back to a rounded shape.
Your Body
Starting this week, you may begin to see your health care provider every week. Your doctor or
midwife may give you an internal exam to determine if cervical effacement (thinning of the cervix) or
dilation (opening of the cervix) has begun. You may experience engagement (also known as
lightening), which is when the baby drops into the mother's pelvis in preparation for labor. Your
appetite may return because the baby is no longer putting as much pressure on your stomach and
intestines, and if you've been experiencing heartburn, the baby's descent may somewhat alleviate it.
This week, your baby is considered full-term! But your baby hasn't stopped growing yet. He or she
continues to develop fat at the rate of half an ounce (14 grams) a day. In general, boys weigh more
than girls at birth.
Your baby has developed enough coordination to grasp with the fingers. If shown a bright light, your
baby may turn toward it in your uterus.
Your Body
After this week, you may lose the mucous plug that sealed off your uterus from infection. The mucous
plug can be lost a few weeks, days, or hours before labor and is thick, yellowish, and may be tinged
with blood (the mucous plug is also called bloody show). As the cervix dilates in preparation for the
labor, the plug is discharged from the body. Be sure to speak with your health care provider about any
discharge you may be having.
Your baby weighs about 6 pounds, 6 ounces (2,900 grams) by now and measures about 13.4 inches
(34 cm) in length from crown to rump. Fat is still accumulating, although growth is slower now. You
may notice that your weight gain has decreased or ceased.
Since your baby has had the muscles to suck and swallow amniotic fluid, waste material has been
accumulating in his or her intestines. Cells shed from the intestines, dead skin cells, and lanugo hair
are some of the waste products that contribute to meconium, a greenish-black substance that
constitutes your baby's first bowel movement.
If you're having a boy, his testicles have descended into the scrotum, unless he has a condition called
undescended testicle. If you're having a girl, the labia are now completely developed.
Your Body
Because your baby is engaged in your pelvis, your bladder is extremely compressed, making frequent
bathroom trips a necessity.
Have you and your partner made a decision about circumcision? Circumcision is a surgical procedure
to remove the foreskin of the penis in male babies. For some parents the decision to circumcise is a
religious one. For others, the choice is not as easily made. Talk to your health care provider about the
issues surrounding circumcision, including pain relief options for the baby.
Umbilical cords, which carry nutrients from the placenta to the baby, vary in size but average about
22 inches (55 cm) long and half an inch (1-2 cm) thick. Sometimes the umbilical cord can become
wrapped around a baby’s neck. Generally, this doesn’t cause problems, although a cesarean delivery
could be required if it causes pressure on the umbilical cord during labor or delivery. A true knot in the
umbilical cord is much less common, occurring in only about 1% of pregnancies.
Most of the vernix that covered your baby's skin has disappeared, as has the lanugo. Your body has
been supplying the baby with antibodies through the placenta that will help the baby's immune system
fight infection for the first 6-12 months of life.
Your Body
Braxton Hicks contractions may become more pronounced. Also called "false labor," these contractions
may be as painful and strong as true labor contractions but do not become regular and do not
increase in frequency as true contractions do.
Another sign of labor, the rupture of your amniotic sac, could happen any day now. When their water
breaks, some women experience a large gush of water and some feel a steady trickle. Many women
don’t experience their water breaking until they’re well into labor. Others need to have their water
broken by their health care providers to get their labor started or to speed it up. If you think your
water has broken or you are experiencing regular contractions, contact your health care provider.
You Baby's Development
After many weeks of anticipation and preparation, your baby is here! Or maybe not — only 5% of
women deliver on their estimated due dates, and many first-time mothers find themselves waiting up
to 2 weeks after their due date for their baby to arrive.
A baby born at 40 weeks weighs, on average, about 7 pounds, 4 ounces (3,300 grams) and measures
about 20 inches (51 cm). Don't expect your baby to look like the Gerber baby right off the bat —
newborns often have heads temporarily misshapen from the birth canal and may be covered with
vernix and blood. Your baby's skin may have skin discolorations, dry patches, and rashes — these
many variations are completely normal.
Because of the presence of your hormones in your baby's system, your baby's genitals (scrotum in
boys and labia in girls) may appear enlarged. Your baby, whether a boy or a girl, may even secrete
milk from the tiny nipples. This should disappear in a few days and is completely normal.
Right after birth, your health care provider will suction mucus out of your baby's mouth and nose, and
you'll hear that long-awaited first cry. Your baby may then be placed on your stomach, and the
umbilical cord will be cut — often by the baby's dad, if he chooses to do the honors! A series of quick
screening tests, such as the Apgar score, will be performed to assess your baby's responsiveness and
vital signs, and he or she will be weighed and measured. If your pregnancy was high risk, or if a
cesarean section was necessary, a neonatologist (a doctor who specializes in newborn intensive care)
will be present at your delivery to take care of your baby right away. If your baby needs any special
care to adjust to life outside the womb, it will be given — and then your newborn will be placed in
your waiting arms.
Your Body
This week you'll experience the moment you've been anticipating — your introduction to your baby!
Before you can meet your baby, though, you have to go through labor and delivery. You may have
learned about the three stages of birth in your prenatal classes. The first stage of labor works to thin
and stretch your cervix by contracting your uterus at regular intervals. The second stage of labor is
when you push your baby into the vaginal canal and out of your body. The third and final stage of
labor is when you deliver the placenta.
If you don't go into labor within a week of your due date, your health care provider may recommend
you receive a nonstress test, which monitors fetal heart rate and movement to be sure that the baby
is receiving adequate oxygen and that the nervous system is responding. Talk to your health care
provider to find out more about this test.
Sometimes mother nature may need a little coaxing. If your labor isn't progressing, or if your health
or your baby's health requires it, your health care provider may induce labor by artificially rupturing
the membranes or by administering the hormone oxytocin or other medications. If your pregnancy is
high risk, or if there are any other potential complications, you may require a cesarean section
delivery.
Some women know ahead of time that they will be delivering via cesarean section and are able to
schedule their baby's "birth day" well in advance. If you're one of them, you've probably been able to
prepare yourself emotionally and mentally for the birth — which can help to lessen the feelings of
disappointment that many mothers who are unable to deliver vaginally experience. But even if you
have to undergo a cesarean section that wasn't planned, rest assured that you'll still be able to bond
with your baby. It might not be the birth experience you imagined, but your beautiful newborn has
arrived nonetheless. The months of waiting are over!
Good luck with your baby!
Your baby's finally here, and you're thrilled — but you're also exhausted, uncomfortable, on an
emotional roller coaster, and wondering whether you'll ever fit into your jeans again. Childbirth classes
helped prepare you for giving birth, but your weren't prepared for all of this!
What to Expect Physically in the First Few Weeks
After your baby arrives, you'll notice some changes — both physical and emotional.
Physically, you might experience:
Sore breasts. Your breasts may be painfully engorged for several days when your milk comes
in and your nipples may be sore.
Constipation. The first postpartum bowel movement may be a few days after delivery, and
sensitive hemorrhoids, healing episiotomies, and sore muscles can make it painful.
Episiotomy. If your perineum (the area of skin between the vagina and the anus) was cut by
your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for
a little while during healing. It also can be painful when you cough or sneeze during the
healing time.
Hemorrhoids. Although common, hemorrhoids (swollen anal tissues) are frequently
unexpected.
Hot and cold flashes. Your body's adjustment to new hormone and blood flow levels can
wreak havoc on your internal thermostat.
Urinary or fecal incontinence. The stretching of your muscles during delivery can cause you
to inadvertently pass urine when you cough, laugh, or strain or may make it difficult to control
your bowel movements, especially if a lengthy labor preceded a vaginal delivery.
"After pains." After giving birth, your uterus will continue to have contractions for a few
days. These are most noticeable when your baby nurses or when you are given medication to
reduce bleeding.
Vaginal discharge (lochia). Initially heavier than your period and often containing clots,
vaginal discharge gradually fades to white or yellow and then stops within 2 months.
Weight. Your postpartum weight will probably be about 13 pounds (the weight of the baby,
placenta, and amniotic fluid) below your full-term weight, before additional water weight drops
off within the first week as your body regains its sodium balance.
What to Expect Emotionally in the First Few Weeks
Emotionally, you may be feeling:
"Baby blues." Up to 80% of new moms experience irritability, sadness, crying, or anxiety,
beginning within days or weeks postpartum. These baby blues are very common and may be
related to physical changes (including hormonal changes, exhaustion, and unexpected birth
experiences) and the emotional transition as you adjust to changing roles and your new baby.
Postpartum depression (PPD). More serious than the baby blues, this condition is evident
in 10%-25% of new moms and may cause mood swings, anxiety, guilt, and persistent
sadness. Your baby may be several months old before PPD is diagnosed, and it's more
common in women with a history of depression, multiple life stressors, and a family history of
depression.
In addition, when it comes to sexual relations, you and your partner may be on completely different
pages. He may be ready to pick up where you left off before baby's arrival, whereas you may not feel
comfortable enough — physically or emotionally — and may be craving nothing more than a good
night's sleep. Doctors often ask women to wait several weeks before having sex in order to allow
healing to occur.
The Healing Process
It took your body months to prepare to give birth, and it takes time to recover. If you've had a
cesarean section (C-section), it can take even longer because surgery requires a longer healing time.
If unexpected, it may have also raised emotional issues.
Pain is greatest the day (or two days) after the surgery and should gradually subside. Your doctor will
advise you on precautions to take after surgery, and give you directions for bathing and how to begin
gentle exercises to speed recovery and help avoid constipation.
Things to know:
Drink 8-10 glasses of water daily.
Expect vaginal discharge.
Avoid stairs and lifting until you've healed.
Don't drive until you can make sudden movements and wear a safety belt properly without
discomfort.
If the incision becomes red or swollen, call your doctor.
Some other things to consider during the healing process include:
Birth Control
You can become pregnant again before your first postpartum period. Even though this is less
likely if you are exclusively breastfeeding (day and night, no solids, at least 8 times a day,
never going more than 6 hours without feeding), have not had a period, and your baby is
younger than 6 months old, it is still possible. If you want to protect against pregnancy,
discuss your options with your doctor. This may include barrier methods (condoms,
diaphragms, spermicidal jellies, and foams), IUDs, pills, or shots.
Breastfeeding
You need adequate sleep, fluids, and nutrition. An easy way to stay on top of drinking enough
fluids is to have a glass of water whenever your baby nurses. Until your milk supply is well
established, try to avoid caffeine, which causes loss of fluid through urine and sometimes
makes babies wakeful and fussy. If you have any breastfeeding problems, talk to your doctor
or a lactation specialist. Your clinic or hospital lactation specialist can advise you on how to
deal with any breastfeeding problems. Relieve clogged milk ducts with breast massage,
frequent nursing, feeding after a warm shower, and warm moist packs applied throughout the
day. If you develop a fever or chills or your breast becomes tender or red, you may have an
infection (mastitis) and need antibiotics. Continue nursing or pumping from both breasts.
Drink plenty of fluids.
Engorged Breasts
They resolve as your breastfeeding pattern becomes established or, if you're not
breastfeeding, when your body stops producing milk — usually within a few days.
Episiotomy Care
Continue sitz baths (sitting in just a few inches of water and covering the buttocks, up to the
hips, in the bathtub) using cool water for the first few days, then warm water after that.
Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the
stitches. Use a squirt bottle to wash the area with water when you use the toilet; pat dry.
After a bowel movement, wipe from front to back to avoid infection. Reduce swelling with ice
packs or chilled witch hazel pads. Talk to your doctor about taking an anti-inflammatory drug
like ibuprofen to help with the pain and swelling.
Exercise
Resume as soon as you've been cleared by your doctor to help restore your strength and prepregnancy body, increase your energy and sense of well-being, and reduce constipation. Begin
slowly and increase gradually. Walking and swimming are excellent choices.
Hemorrhoids and Constipation
Alternating warm sitz baths and cold packs can help. Ask your doctor about a stool softener.
Don't use laxatives, suppositories, or enemas without your doctor's OK. Increase your intake
of fluids and fiber-rich fruits and vegetables.
Sexual Relations
Your body needs time to heal. Doctors usually recommend waiting 4-6 weeks to have sex to
reduce the risk of infection, increased bleeding, or re-opening healing tissue. Begin slowly,
with kissing, cuddling, and other intimate activities. You'll probably notice reduced vaginal
lubrication (this is due to hormones and usually is temporary), so a water-based lubricant
might be useful. Try to find positions that put less pressure on sore areas and are most
comfortable for you. Tell your partner if you're sore or frightened about pain during sexual
activity — talking it over can help both of you to feel less anxious and more secure about
resuming your sex life.
Incontinence
Urinary or fecal incontinence often resolves gradually as your body returns to its normal prepregnancy
state. Encourage the process with Kegel exercises, which help strengthen the pelvic floor muscles. To
find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few
seconds, then relax (your doctor can check to be sure you're doing them correctly). Wear a sanitary
pad for protection. Let the doctor know about any incontinence you experience.
What Else You Can Do to Help Yourself
You'll get greater enjoyment in your new role as mom — and it will be much easier — if you care for
both yourself and your new baby. For example:
When your baby sleeps, take a nap. Get some extra rest for yourself!
Set aside time each day to relax with a book or listen to music.
Shower daily.
Get plenty of exercise and fresh air — either with or without your baby, if you have someone
who can babysit.
Schedule regular time — even just 15 minutes a day — for you and your partner to be alone
and talk.
Make time each day to enjoy your baby, and encourage your partner to do so, too.
Lower your housekeeping and gourmet meal standards — there's time for that later. If visitors
stress you, restrict them temporarily.
Talk with other new moms (perhaps from your birthing class) and create your own informal
support group.
Getting Help From Others
Remember, Wonder Woman is fiction. Ask your partner, friends, and family for help. Jot down small,
helpful things people can do as they occur to you. When people offer to help, check the list. For
example:
Ask friends or relatives to pick things up for you at the market, stop by and hold your baby
while you take a walk or a bath, or just give you an extra hand.
Hire a neighborhood teen — or a cleaning service — to clean once a week, if possible.
Investigate hiring a doula, a supportive companion professionally trained to provide
postpartum care.
When to Call the Doctor
You should call your doctor about your postpartum health if you:
experience an unexplained fever of 100.4° Fahrenheit (38° Celsius) or above
soak more than one sanitary napkin an hour, pass large clots, or if the bleeding level increases
had a C-section or episiotomy and the incision becomes more red or swollen or drains pus
have new pain, swelling, or tenderness in your legs
have hot-to-the-touch, reddened, sore breasts or any cracking or bleeding from the nipple or
areola (the dark-colored area of the breast)
find your vaginal discharge has become foul-smelling
have painful urination or a sudden urge to urinate or inability to control urination
have increasing pain in the vaginal area
develop a cough or chest pain, nausea, or vomiting
become depressed or experience hallucinations, suicidal thoughts, or any thoughts of harming
your baby
Triple Screening in Pregnancy
What is a triple screen?
A triple screen is a blood test that measures three things called alpha-fetoprotein, human chorionic
gonadotropin and unconjugated estriol. The results of the blood test can help your doctor see if your baby
may be at higher risk for certain birth defects such as Down syndrome and neural tube defects.
Why is it called a "screen"?
These test results can only show that there may be a problem, but they cannot prove that there definitely
is one. An abnormal test result doesn't necessarily mean that your baby has a birth defect. Most often, the
blood test results are abnormal because the baby is younger or older than your doctor initially thought.
And some birth defects will not be detected by this test. Remember, this test does not screen for all birth
defects.
When should the test be done?
Triple screens are most accurate when done between the 16th and 18th weeks of pregnancy. They may
also be done between the 15th and 22nd weeks of pregnancy.
What happens if the test results of the triple screen are abnormal?
Your doctor will probably want you to have some other tests or see a doctor that specializes in high-risk
pregnancy. The first step is often to have an ultrasound exam. This test can check on the age of the baby
and look for problems in the baby's brain, spinal cord, kidneys and heart. Another test that you might have
is called amniocentesis (say: am-nee-oh-cen-tea-sis). This test checks the fluid around the baby. The
results of these tests will help your doctor decide if your baby might have a defect.
Group B Strep Infection in Pregnancy
What is group B strep?
Group B streptococcus, or group B strep for short, is a certain kind of bacteria (germ) that lives in the
vaginal or rectal areas in about 25% of healthy pregnant women. A woman who has group B strep is said
to be "colonized" with this germ. If you are colonized with group B strep, your baby can become infected
with these germs while being born and can get sick. There is less than a 1% chance that this will happen,
but because group B strep infection is so dangerous for babies, it's important to find out if you're
colonized while you're pregnant.
If I have group B strep, what could happen?
Carrying the bacteria in your body when you're pregnant doesn't usually make you sick. In some cases,
though, group B strep germs can multiply inside your body and can cause serious infection. When you
are pregnant and have group B strep, your baby could get the germs from you during delivery and get
sick. Infected babies need treatment. Your baby will be kept in the hospital some extra days for close
watching (observation) if your doctor thinks the baby is infected with strep. Blood tests will be done to see
if your baby has group B strep. If your baby has this germ, the doctor will give the baby antibiotics.
How will I know I have group B strep?
Your doctor can do a skin culture to see if you have group B strep on your skin. This is done by taking a
bit of your skin and sending it to a lab to see if the strep bacteria grow. Your doctor can also do a test on
your vagina and rectum to see if it is inside your body. The test is like a Pap smear.
If I'm infected, what can I do?
Your doctor may have you take antibiotic pills during pregnancy until you give birth. Then, when you're in
labor, you can also take antibiotics intravenously (through an IV) to kill the germs. If you take antibiotics
while you're in labor, the chances very high that your baby won't get this infection.
Breastfeeding: Hints to Help You Get Off to a Good
Start
What are the benefits of breastfeeding?
Breastfeeding has many benefits for your baby. Breast milk is rich in nutrients. It has antibodies, which
help protect your baby against infections. It also helps prevent your baby from having allergies.
Breastfeeding also has benefits for you. It's clean and simple--you don't have to wash bottles or mix
formula. It's cheaper than using formula. It helps your uterus contract back to normal size after having
been stretched during pregnancy. It delays the return of your periods (although you shouldn't count on it
to prevent pregnancy). And it helps make time for you to be close to your baby.
How do I begin breastfeeding?
Wash your hands before each feeding. With your free hand, put your thumb on top of your breast and
your other fingers below.
Touch your baby's lips with your nipple until your baby opens his or her mouth very wide. Put your nipple
all the way in your baby's mouth and pull your baby's body close to you. This lets your baby's jaw
squeeze the milk ducts under your areola.
When your baby is "latched on" the right way, both lips should pout out (not be pulled in over his or her
gums) and cover nearly all of the areola. Instead of smacking noises, your baby will make low-pitched
swallowing noises. Your baby's jaw may move back and forth. If you feel pain while your baby is nursing,
he or she is probably not latched on correctly.
Your baby's nose may touch your breast during nursing. Babies' noses are designed to allow air to get in
and out in just such a case. But if you're concerned that your baby can't breathe easily, you can gently
press down on your breast near your baby's nose to give him or her more room to breathe.
How should I hold my baby while breastfeeding?
You can hold your baby in a number of ways. Your baby shouldn't have to turn his or her head or strain
his or her neck to nurse.
In the cradle position, you put your baby's head in the crook of your arm. Support your baby's back and
bottom with your arm and hand. Your baby will be lying sideways facing you. Your breast should be right
in front of your baby's face.
The football position consists of tucking your baby under your arm like a football with his or her head
resting on your hand. Support your baby's body with your forearm. This may be a good position if you're
recovering from a cesarean section or if your baby is very small.
You can also lie on your side with your baby facing you. You can use pillows to prop up your head and
shoulders. This is also a good position if you're recovering from a cesarean section or an episiotomy.
What is the let-down reflex?
The let-down reflex makes breastfeeding easier for your baby and means your milk is ready to flow. A few
seconds to several minutes after you start breastfeeding, you may feel a tingle in your breast, and milk
may start to drip from the breast not being used. These are signs that your milk has "let-down." Let-down
may also occur if a feeding is overdue, if you hear your baby cry or even if you think about your baby.
Let-down can be forceful enough to cause your baby to cough. If this is a problem, you can express some
of your milk by hand before a feeding to bring on the let-down reflex before you start breastfeeding.
What can I do if my nipples get sore?
It's easier to prevent sore nipples than it is to treat them. The main thing that causes sore nipples is when
your baby doesn't latch on properly.
If your baby isn't latched on the right way, you'll need to start over. To take your baby off your breast,
release the suction by putting your finger in the corner of your baby's mouth between the gums.
Don't limit the time you let your baby nurse. Putting a limit on nursing time doesn't prevent sore nipples,
but it may keep the milk ducts from completely emptying. This can lead to swelling and pain. Applying
crushed ice compresses before nursing can ease discomfort.
Call your doctor if you have a red, sore or painful area on your breast, if you have painful engorgement
(overfull breasts), if you have a fever or if you feel achy. These may be signs of an infection.
Preventing/healing sore nipples
Make sure your baby is sucking the right way. If the sucking hurts, your baby's mouth may not be
positioned correctly.
Let your nipples air dry between feedings. Let the milk dry on your nipples.
Offer your baby the less sore of your two nipples first. Your baby's sucking may be less vigorous after
the first few minutes.
Change nursing positions.
If possible, position any cracked or tender part of your breast at the corner of your baby's mouth, so
that it gets less pressure during feeding.
Wash your nipples daily with warm water. Don't use soap or lotion that may contain alcohol, which can
dry the skin.
Some women find that rubbing lanolin on their nipples is soothing. If you use lanolin, wash it off before
feeding your baby.
Avoid bra pads lined with plastic. Change bra pads between feedings to keep your nipples dry.
Express milk until your let-down reflex occurs. This will help make your milk more available so your
baby sucks less hard.
Breastfeed often to prevent engorgement. Engorgement can make it hard for your baby to latch on.
How often should I feed my baby?
Feed your baby as often as he or she wants to be fed. This may be 8 to 12 times a day or more. How
often your baby wants to feed may change over time as he or she goes through growth spurts. Growth
spurts occur at about 2 weeks and 6 weeks of age and again at about 3 months and 6 months of age.
Let your baby nurse until he or she is satisfied. This may be for about 15 minutes to 20 minutes at each
breast. Try to have your baby nurse from both breasts at each feeding. The box below lists the signs to
watch for so you'll know your baby is getting enough milk. If you're nursing fewer than 8 times a day, be
especially aware of these signs.
Signs that your baby is getting enough milk
Acts satisfied after each feeding.
Gains weight constantly after the first 3 to 7 days after birth. Your baby may lose a little weight during
the first week after being born.
Has about 6 to 8 wet diapers a day.
Has about 2 to 5 or more stools a day at first and then may have 2 or less a day. Stools will be runny at
first.
How can I increase my milk supply?
If you think your baby needs more milk, increase the number of feedings a day. It's also important for you
to get plenty of rest and eat right. Give your body time to catch up to your baby's demands.
Don't start giving your baby formula or cereal. If you give formula or cereal to your baby, he or she may
not want as much breast milk. This will decrease your milk supply. Also, your baby doesn't need any solid
foods until he or she is 4 months to 6 months of age.
What should I eat?
The best diet for a breastfeeding woman is well balanced and has plenty of calcium. This means you
should eat fruits, vegetables, whole-grain cereals and breads, meats, beans and milk and dairy foods like
cheese. You'll need to get enough calories--about 500 more per day than usual--and you'll need to drink
more fluids.
A balanced diet that includes 5 servings of milk or dairy products each day will give you enough calcium.
If you don't eat meat or dairy products, you can get the calcium you need from broccoli, sesame seeds,
tofu and kale. Talk to your doctor about taking extra calcium if you don't think you're getting enough from
your diet.
What should I avoid eating?
If you think a food you're eating bothers your baby, quit eating it. Caffeine and alcohol can get into your
milk, so limit how much you drink. Medicines--even those you can buy without a prescription--can also get
into your milk. Don't take anything without talking to your doctor first. Also, if you smoke, nursing is
another good reason to try to quit. Smoking can cause you to make less milk and the chemicals in
cigarettes and smoke can get into your milk.
Breastfeeding: How to Pump and Store Your Breast
Milk
Learning how to pump and store breast milk can make returning to work easier and less stressful. It does
require some work and careful planning, but it can be done.
When should I start to pump my breasts?
If you will be pumping your breasts when you return to work, practice for 1 or 2 weeks before you actually
go back to get the hang of it. You can try pumping just after your baby eats or you can pump your breasts
between feedings.
Practicing at home will help you learn how your pump works. During this time, you also can start to collect
and store breast milk to be fed to your baby when you return to work.
How much milk will I get when I pump?
You may not get much milk when you first start pumping. After a few days of regular pumping, your
breasts will begin to make more milk. Also, the more milk you pump, the more milk your breasts produce.
You should drink lots of fluids to stay hydrated (which will help your milk supply).
How long should I pump each time?
Pumping your breasts takes about the same time as breastfeeding, but with practice and a good pump,
you can pump your breasts in as little as 10 to 15 minutes. While you are at work, try to pump as often as
your baby usually feeds or for about 15 minutes every few hours. To keep up your milk supply, give your
baby extra feedings when you are together. You can also pump right after your baby feeds, which will
help your breasts make more milk.
Will there be times that my baby will need more milk than I have ready?
Yes, your baby will probably want more milk during growth spurts. The best way to increase your milk
supply for a growth spurt is to breastfeed or pump more often.
How should I store my breast milk?
Breast milk can be stored in a plastic or glass bottle with a sealable top, or in a sterile, sealable bag.
Store your breast milk in amounts that you use every day to avoid wasting it. For example, if your baby
eats 4 ounces in a feeding, put 4 ounces of breast milk in the storage container.
Where should I store my breast milk?
Pumped breast milk should be cooled in a refrigerator or other cooler as soon as possible. The milk can
also be frozen if you aren't going to use it right away.
How long can I store my breast milk?
The following are some general breast milk storage guidelines:
At room temperature (less than 77°F) for 4 to 8 hours
At the back of a refrigerator for 3 to 8 days
At the back of a freezer for up to 3 months
The breast milk I have in my refrigerator looks funny. Is something wrong?
Breast milk can vary in color. It can be bluish, yellowish or brownish. It is also normal for breast milk to
separate (the fatty part of the milk goes to the top). Shake the bottle or sealed bag, and the fat will go
back into the milk.
How should I thaw frozen breast milk?
Thaw the milk slowly by swirling the container of milk in warm water or by putting the container in the
refrigerator the day before it is to be used. Don't use hot water to thaw breast milk. Never thaw frozen
breast milk in a microwave oven. The milk could get too hot and burn your baby's mouth. Microwaving
can also damage valuable proteins in breast milk.
Thawed breast milk can be refrigerated for up to 24 hours, but it should not be refrozen.
Colic
How do I know if my baby has colic?
Babies who have colic cry a lot more than most babies. They may clench their fists when crying, curl up
their legs or seem like they are in pain. They may even turn bright red from crying. When this crying lasts
for more than 3 hours a day and happens at least 3 days per week for more than 3 weeks, it's called colic.
Colicky babies usually get fussy toward the end of the day, but colic can happen at any time.
A baby who has colic may cry in bouts or may cry almost all of the time. When your baby cries, he or she
may swallow air. This may give your baby gas and make your baby's tummy look swollen and feel tight,
which may make him or her even more uncomfortable.
What causes colic?
No one is sure what causes colic. Babies who have colic are typically healthy, so it's not caused by a
medical problem. Colic isn't caused by the way the baby is handled or treated, and it is not the parents'
fault. It may be caused by stomach pain or the baby's temperament. Babies who have colic seem to need
more attention and are more sensitive to their environment than other babies.
How long will the colic last?
Colic usually starts a few weeks after birth. It usually goes away by age 3 months, although it can last
longer. If your baby is still colicky after 3 months of age, he or she may be experiencing a reflux disorder.
Things to remember about colic
You didn't cause the colic, so try not to feel guilty.
Colic almost always goes away by 3 months of age. It should go away by the time your baby is 6
months old.
You can try many things to soothe your baby.
Giving your baby extra attention won't "spoil" him or her.
Just because your baby has colic doesn't mean he or she is unhealthy.
What can I do to help my baby stop crying?
You can try a number of things to soothe your baby. These may include changing the way you feed or
hold your baby. The tips listed in the box below may help.
Tips on soothing your baby
Feed your baby in an upright position.
Burp your baby often.
If you are breastfeeding, try making small changes in your own diet. Try to limit spicy foods, citrus fruits
or caffeine.
Rock your baby in a rocking chair or cradle.
Put your baby in a wind-up swing (make sure your baby can support his or her head).
Give your baby a warm bath.
Give your baby a pacifier.
Gently rub your baby's stomach.
Wrap or swaddle your baby in a soft blanket.
Put your baby in a stroller and go for a walk.
Go for a drive with your baby in the car seat.
What changes in feeding may help my baby stop crying?
Try feeding your baby if more than 2 hours have passed since the last feeding. Feed your baby more
often and less at a time.
If you feed your baby formula, your family doctor might suggest trying a different brand. Warming the
formula to body temperature before a feeding may also help.
Try using a nipple with a smaller hole on the bottle if a bottle feeding takes less than 20 minutes. Avoid
feeding your baby too quickly.
Will holding my baby differently help?
Sometimes babies who have colic will respond to different ways of being held or rocked.
Hold your baby across your lap and massage his or her back.
Hold your baby on top of a running dishwasher, washing machine or dryer (don't leave your baby
alone).
Hold your baby upright. This will help if your baby has gas.
Hold your baby while walking.
What can I do when I feel frustrated with my baby?
Colic can be very frustrating for parents. Babies who don't stop crying can be hard to care for. Any time
you feel overwhelmed and frustrated, get someone else to watch your baby for a while.
If you can't find anyone to help you, try going into a nearby room and watching TV or listening to the
radio. Make sure your baby will be safe without immediate supervision. Crying will not hurt your baby. Be
sure you give yourself time away from your baby so you don't get too frustrated.
Call your family doctor if:
Your baby's cry changes from a fussy one to a painful one.
Your baby stops gaining weight.
Your baby has a fever.
You're afraid you might hurt your baby.

OB Packet - BRENHAM FAMILY PRACTICE AND OBSTETRICS

Transcription

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