Pregnancy

Topic Overview

Is this topic for you?

This topic covers prepregnancy and pregnancy information, including planning for labor and delivery. For more information, see the topic Labor, Delivery, and Postpartum Period.

How can you get ready for pregnancy?

If you're planning to get pregnant, you might already be thinking about which room to turn into the baby’s room and how to decorate it. And you might be thinking about all the baby clothes and gear like car seats that you'll need.

But you also can start to think about how to help yourself have a happy pregnancy and a healthy baby.

Even before you get pregnant, take these steps to make your pregnancy as healthy as possible:

• See a doctor or certified nurse-midwife for an exam. Talk about the medicines and dietary supplements you take. Ask if you need any immunizations. Talk about any health problems or other concerns you have.
• Do not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. These may raise your risk of miscarriage, especially around the time you conceive or if you use them for more than a week.¹
• Take a daily multivitamin or prenatal vitamin with 0.4 mg (400 mcg) of folic acid. This B vitamin lowers the chance of having a baby with a birth defect.
• See your dentist. Take care of any dental work you may need.
• Keep track of your menstrual cycle. This helps you know the best time to try to get pregnant. And after you are pregnant, you will be better able to help your doctor or midwife figure out when your baby is due and how it is growing.
• Make healthy lifestyle choices. Eat a healthy diet. Avoid caffeine, or don't have more than 1 cup of coffee or tea each day. Avoid alcoholic drinks, cigarettes, and illegal drugs. Take only the medicines your doctor or midwife says are okay.
• Exercise regularly. A strong body helps you handle the demands of pregnancy, childbirth, and recovery. Exercise also helps improve your mood.

If you are not sure when you are most likely to get pregnant (when you are fertile), use the Interactive Tool: When Are You Most Fertile?

You're pregnant! What can you do to have a healthy pregnancy?

Now that you're pregnant, you may be happy and excited. You may be a little nervous or worried. If this will be your first child, you may even feel overwhelmed by all of the things you need to know about having a baby. There is a lot to learn. But you don't have to know everything right away. You can read all about pregnancy now, or you can learn about each stage as your pregnancy goes on.

During your pregnancy, you'll have tests to watch for certain problems that could occur. With all the tests you'll have, you may worry that something will go wrong. But most women have healthy pregnancies. If there is a problem, these tests can find it early so that you and your doctor or midwife can treat it or watch it to help improve your chance of having a healthy baby.

Taking great care of yourself is the best thing you can do for yourself and your baby. Everything healthy that you do for your body helps your growing baby. Rest when you need it, eat well, drink plenty of water, and exercise regularly. Drink plenty of water before, during, and after you are active. This is very important when it’s hot out and when you do intense exercise.

You'll need to have regular checkups. At every visit, your doctor or midwife will weigh you and measure your belly to check your baby's growth. You'll also get blood and urine tests and have your blood pressure checked.

It’s important to avoid tobacco smoke, alcohol and drugs, chemicals, and radiation (like X-rays). These can harm you and the baby.

Try to keep your body temperature from getting too high [over 100.4°F (38°C)]. Treat a fever with acetaminophen (such as Tylenol). Don't get too hot when you exercise. And don't get in a high-temperature hot tub or sauna. Call your doctor to report any fever or illness that requires the use of medicine.

What kinds of exams and tests will you have?

Your first prenatal exam gives your doctor or midwife important information for planning your care. You'll have a pelvic exam and urine and blood tests. You'll also have your blood pressure and weight checked. The urine and blood tests are used for a pregnancy test and to tell whether you have low iron levels (are anemic) or have signs of infection.

At each prenatal visit you'll be weighed, have your belly measured, and have your blood pressure and urine checked. Go to all your appointments. Although these quick office visits may seem simple and routine, your doctor is watching for signs of possible problems like high blood pressure.

In some medical centers, you can have screening in your first trimester to see if your baby has a chance of having Down syndrome or another genetic problem. The test usually includes a blood test and an ultrasound.

During your second trimester, you can have a blood test (triple or quadruple screen test) to see if you have a higher-than-normal chance of having a baby with birth defects. Based on the results of the tests, you may be referred to a geneticist for further discussion. Or you may have other tests to find out for sure if your baby has a birth defect.

Late in your second trimester, your blood sugar will be checked for diabetes during pregnancy (gestational diabetes). Near the end of your pregnancy, you will have tests to look for infections that could harm your newborn.

What warning signs should you look for during your pregnancy?

Call your doctor or midwife right away if you have:

• Cramping.
• Blood or other fluid from your vagina.
• Belly pain.
• An ache in your low back that doesn't go away.
• Burning or pain when you urinate.
• A bad headache.
• Blurred vision.
• A fever.
• Sudden severe swelling of your feet, ankles, or hands.

Frequently Asked Questions

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Depression: Should I take antidepressants while I'm pregnant?
	Diabetes: Should I get pregnant?
	Pregnancy: Should I bank my baby's umbilical cord blood?
	Pregnancy: Should I have amniocentesis?
	Pregnancy: Should I have an early fetal ultrasound?
	Pregnancy: Should I have an epidural during childbirth?
	Pregnancy: Should I have CVS (chorionic villus sampling)?
	Pregnancy: Should I have the maternal serum triple or quadruple test?
	Actionsets are designed to help people take an active role in managing a health condition.
	Pregnancy and diabetes: Planning for pregnancy
	Pregnancy: Dealing with morning sickness
	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: From Embryo to Baby in 9 Months
	Interactive Tool: What Is Your Due Date?
	Interactive Tool: When Are You Most Fertile?

Planning for a Healthy Pregnancy

If you're planning to become pregnant, prepare for a healthy pregnancy by taking care of medical and dental concerns beforehand. If you've been using the Pill for birth control (oral contraception), try to wait till you've had one regular menstrual period before conceiving. Fertility after stopping birth control can sometimes be delayed but isn't permanently affected.²

Now more than ever, it's smart to get regular exercise, eat a healthy diet, and drink plenty of water, as well as to reduce or stop drinking caffeine. Avoid alcohol, tobacco, and illegal drugs. Also, avoid using medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin.

If you haven't yet chosen a health professional for pregnancy, childbirth, and after-birth (postpartum) care, give some thought to your many options. For more information, see choosing your health professional for pregnancy care.

Review your immunization history with your health professional. To prevent birth defects, miscarriage, or stillbirth that can be caused by such infections as rubella or measles, get any necessary immunizations and wait the recommended period of time before trying to get pregnant.

Talk to your doctor about whether to have screening tests for diseases that are passed down through your family (genetic disorders). You may want to have a screening test if you or your partner has a family history of genetic disorders or if certain genetic disorders are more common among people of your racial or ethnic background. Some screenings for genetic disorders include:³

• Sickle cell disease, which is most common in people of African descent.
• Tay-Sachs disease, which is most common in people with an Ashkenazi Jewish, Cajun, or French Canadian background.
• Cystic fibrosis, which is most common in people with a Caucasian, European, or Ashkenazi Jewish background.

Routine Checkups

If you think you might be pregnant, you can use a home pregnancy test as soon as the first day of your first missed menstrual period. Pregnancy is measured in weeks from the first day of your last menstrual period (LMP). There are several ways to calculate how long you have been pregnant. You can also use your LMP to calculate your due date.

As soon as you know you're pregnant, make an appointment with your doctor or certified nurse-midwife (CNM). Your first prenatal visit will provide information that can be used to check for any problems as your pregnancy progresses.

Good care during pregnancy includes regularly scheduled prenatal exams. At each prenatal visit, you'll be weighed, have your abdomen measured, and have your blood pressure and urine checked. Use this time to discuss your list of pregnancy concerns or problems with your health professional. At different times in your pregnancy, you will have additional exams and tests performed. Although some are routine, others are only done when a problem is suspected or if you have a risk factor for a problem.

First prenatal visit exams and tests include a health history, physical exam, and blood and urine tests.

First-trimester exams and tests may include fetal ultrasound, which uses reflected sound waves to provide an image of your fetus and placenta. The late first trimester is the earliest time when you can have a noninvasive Down syndrome screening using a blood test and an ultrasound measurement of fetal neck (nuchal fold) thickness. (Nuchal fold ultrasound is not yet widely available, because only a specially trained provider can do it.) This is also when you can have genetic testing of your placenta (chorionic villus sampling, or CVS). A CVS gives you earlier results than a second-trimester amniocentesis. Only a highly trained provider can do a CVS.

Second-trimester exams and tests may include fetal ultrasound and electronic fetal heart monitoring. In the early second trimester, you can have the triple or quadruple screen. This screen measures your blood levels of:

• Alpha-fetoprotein (AFP).
• Human chorionic gonadotropin (hCG).
• Estrogen (estriol).
• Inhibin A (quad screen only).

If you are at risk for genetic problems or your triple or quad screen says your fetus might have a problem, you may have testing of the fluid surrounding your baby (amniocentesis).

Later on in the second trimester, you will have an oral glucose screen for possible gestational diabetes.

If you have Rh-negative blood, you may have an antibody screen and will receive an injection of Rh immune globulin.

Third-trimester exams and tests may include fetal ultrasound, hepatitis B, and group B strep screening.

All pregnant women should be screened for human immunodeficiency virus (HIV) infection to help prevent newborn HIV infection.⁴ Some health professionals may not order this test unless you request it.

Deciding about birth defect testing

Talk to your doctor or nurse-midwife about screening for birth defects in your fetus. You can choose from different kinds of tests. If you are worried about birth defect risk, you might want test results as early as possible. If your risk for having a baby with a birth defect is very low, you may decide to have no testing. On the other hand, if knowing early would not change how you handle the pregnancy in any way, you might decide against earlier testing, or testing at all. It's your decision.

A screening test uses your blood sample and/or an ultrasound to look at the chance that your fetus might have a problem. In some medical centers, you can be screened in the late first trimester for possible Down syndrome using a nuchal ultrasound and blood tests. (Only a specially trained provider can do this type of ultrasound, and it is not widely available.) You can be screened in the earlier second trimester for possible birth defects such as Down syndrome or a neural tube defect with a blood test called the triple or quadruple screen. These tests are not risky for you or your fetus.

A diagnostic test detects actual problems. If your screening results suggest a higher-than-average chance of a fetal problem, you can then decide whether to have a chorionic villus sampling or an amniocentesis. Or if you already know you are higher-risk for a birth defect, because of your age or family history, you might decide not to have the screening and go straight to diagnostic testing. A key factor for you to know is that chorionic villus sampling and amniocentesis have slight risks of miscarriage.

For more information about how your fetus is changing this month, and about what tests you might think about having, see Interactive Tool: From Embryo to Baby in 9 Months.

What to Think About

Timing is an important consideration when deciding which type of genetic testing to have.

• CVS can be done earlier in pregnancy (usually at 10 to 12 weeks) than amniocentesis (usually at 15 to 20 weeks).³ This allows you to make an earlier decision about whether to continue or end the pregnancy. Results of CVS may be available more quickly (within several days) than amniocentesis results (2 weeks).
• CVS doesn't detect neural tube defects, so an alpha-fetoprotein test, part of the triple screen, is recommended along with it.³
• Both CVS and amniocentesis pose a slight chance of causing a miscarriage because they disturb the uterus, amniotic sac, and/or placenta. One study showed that the miscarriage risk for either test was about 1 in 400 when done by a highly trained provider.⁵ Some studies have shown higher miscarriage risks, between 2 and 4 in 400.⁶ This greater risk may be more likely in medical centers with less experienced providers, especially for CVS. (The risk of miscarriage with CVS may be smaller when the procedure is done through the abdomen than when it is done through the cervix.⁷)

For more information, see the following:

Birth Defects Testing

Should I have the maternal serum triple or quadruple test (triple or quad screen)?

Should I have an early fetal ultrasound?

Should I have an amniocentesis?

Should I have chorionic villus sampling?

Healthy Pregnancy Choices

Make healthy lifestyle choices before, during, and after your pregnancy.

• Prepare for pregnancy by eating well and taking a daily prenatal vitamin, exercising regularly, getting necessary dental work out of the way, charting your menstrual cycle, avoiding or limiting caffeine, and stopping use of any potentially harmful medicines or illegal drugs, alcohol, and tobacco.
• Maintain a healthy pregnancy by eating well, exercising regularly, getting plenty of rest, and avoiding high temperatures and activities that could lead to a fall or abdominal injury, including contact sports. Drink plenty of water before, during, and after you are active. This is very important when it’s hot out and when you do intense exercise.
• Do pelvic floor (Kegel) exercises during and after pregnancy. They strengthen your lower pelvic muscles. This may help prevent a long period of pushing during labor.⁸ They also may help prevent urine control problems (incontinence) after childbirth.
• Take childbirth education classes to learn what to expect and how to best handle labor and delivery.
• Plan ahead for breast-feeding by learning about breast-feeding and finding a good lactation consultant ahead of time, buying necessary supplies, and making advance arrangements for a private place to pump if you plan to work away from your baby after a maternity leave. For more information, see the topic Breast-Feeding.

Exercise tips

Exercise safely during pregnancy. Try to do at least 2½ hours a week of moderate exercise.^{9, 10} One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Moderate exercise means things like brisk walking or swimming. In addition to moderate exercise, the following stretching and strengthening exercises are well suited to pregnancy:

• Back press
• Backward stretch
• Diagonal curl
• Forward bend
• Leg lift crawl
• Pelvic rocking
• Pelvic tilt
• Tailor press
• Tailor sitting
• Tailor stretching
• Trunk twist
• Upper body bends

Nutrition tips

• Strive for proper nutrition and weight gain during pregnancy. Pay close attention to your folic acid, iron, and calcium intake and the need for slow, gradual weight gain.
• A vegetarian diet during pregnancy and breast-feeding requires special attention to getting enough protein, vitamin B12, vitamin D, and zinc, in addition to the extra folic acid, iron, and calcium that all expectant mothers need. These nutrients are vital to your fetus's cellular growth, brain and organ development, and weight gain.
• Calcium is an important nutrient, especially during pregnancy. If you can't or don't eat dairy products, you can get calcium in your diet from nonmilk sources such as tofu, broccoli, fortified orange juice or soy milk, greens, and almonds.
• Getting enough vitamin C may help protect against premature rupture of membranes, according to one study.¹¹ Vitamin C is important for keeping the membranes around the fetus strong and healthy. You can get enough vitamin C by taking your daily prenatal vitamin and eating fruits and vegetables. Common foods that have high vitamin C content include citrus fruits, peppers, tomatoes, berries, broccoli, cabbage, and brussels sprouts.

What to avoid

• Medicines that are not approved by your health professional (for example, NSAID use during conception and early pregnancy, which may increase the risk of miscarriage¹)
• Papaya, when at all unripe, because it can cause the muscles of the uterus to contract.¹² Contractions of the uterus can lead to a miscarriage.
• Caffeine. Or limit your intake to 1 cup of coffee or tea each day.
• Alcohol and drugs
• Tobacco smoke
• Hot tubs and saunas
• Sources of food poisoning that may cause listeriosis or toxoplasmosis infection. Some sources may be raw meat, poultry, or seafood; unwashed fruits or vegetables; and cat feces or outdoor soil that cats commonly use.
• Fish that may contain mercury, such as shark, swordfish, king mackerel, tilefish, more than 6 oz (0.2 kg) of white albacore tuna per week, or fish caught in local waters that haven't tested as safe
• Hazardous chemicals, radiation, and certain cosmetic products

Common Concerns

Pregnancy has an impact on most aspects of a woman's daily life.

Normal physical changes and symptoms

Although they can range from mild to severe, the following conditions are normal during pregnancy. For more information and tips on how to manage these problems, see:

• Fatigue.
• Morning sickness.
• Sleep problems.
• Breast changes.
• Heartburn (a symptom of gastroesophageal reflux disease, or GERD).
• Nosebleeds and bleeding gums.
• Hemorrhoids and constipation.
• Varicose veins.
• Hair changes.
• Stretch marks, itchiness, and other skin changes.
• Leg cramps.
• Back pain and sciatica.
• Pelvic ache and hip pain.
• Hand pain, numbness, or weakness (carpal tunnel syndrome).

Pregnancy: Dealing with morning sickness

Lifestyle issues

Pregnancy makes it necessary to make changes in your daily activities and relationships.

• Nutrition and weight gain may require more attention than usual, and dieting is never a healthy practice during pregnancy.
• Sex causes no problems during an uncomplicated pregnancy, and sexual interest often changes during different phases of a pregnancy. If you are concerned about exposure to a sexually transmitted disease, avoid sex or use a condom.
• Changes in the relationship with your partner are inevitable, as your focus shifts to your own and your future child's well-being.
• Emotional changes are normal throughout pregnancy.
• Handling pregnancy and parenting can be a challenge. Rest whenever you can. Preparing your other child or children ahead of time helps your family adjust to the demands of a newborn.
• Exercise helps your body best handle labor, delivery, and recovery. Moderate activity such as brisk walking is ideal during pregnancy. Drink plenty of water before, during, and after you are active. This is very important when it’s hot out and when you do intense exercise.
• Working or going to school, if it isn't too physically demanding, is usually fine during pregnancy. Scale back if you're becoming too worn down as your pregnancy progresses. Talk to your doctor or nurse-midwife if you are at risk for preterm labor.
• Travel is usually a safe choice until later pregnancy. Talk to your health professional if you have any concerns. During your third trimester, it's best to stay within a few hours of a hospital, in case of sudden changes that need medical attention.
• Wearing a seat belt is vital to protect yourself and your baby during pregnancy.
• Massage during pregnancy is safe when it is done by a specially trained massage therapist.

Health concerns

• Vaginal bleeding may or may not be a sign of trouble—report any bleeding to your health professional right away.
• Medicine use (including herbal remedies) during pregnancy should always be approved by your health professional, to prevent harm to the fetus.
• Urinary tract infection is common during pregnancy and must be treated with antibiotics to prevent a dangerous infection or preterm labor.
• Bacterial vaginosis (BV) that causes symptoms is usually treated with oral antibiotics.
• RhoGAM (Rh immune globulin) treatment is necessary if you have Rh-negative blood and your partner is Rh-positive, to prevent Rh sensitization.

The emotional experience of pregnancy is different for every woman. Mixed feelings and uncertainty—even if your pregnancy was planned—are not unusual. Because of the increasing hormones and the fatigue of early pregnancy, mood swings can be worse than before pregnancy. Many women worry that problems that affect the baby will develop during the pregnancy. These feelings are normal.

If you have health concerns or a separate health problem that needs special care, be sure to discuss this with your health professional.

• Pregnancy over age 35 poses some risks, but most older women have healthy pregnancies.
• Flu vaccine is safe and recommended for all pregnant women just before flu season.
• Depression during pregnancy requires treatment to reduce risks to you and your baby, before and after pregnancy.

  Should I take antidepressants during pregnancy?

• Managing asthma during pregnancy is important for making sure you and your baby are getting enough oxygen. Most, but not all, asthma medicines are safe to use during pregnancy.
• Human immunodeficiency virus (HIV) during pregnancy requires early detection and treatment to prevent newborn infection.
• Cancer treatment during pregnancy is delayed whenever possible to prevent harm to the baby. But chemotherapy is sometimes used, when necessary.

Your First Trimester

Pregnancy is measured in trimesters from the first day of your last menstrual period (LMP), totaling 40 weeks. The first trimester of pregnancy is week 1 through week 12, or about 3 months.

Early development

During the week after fertilization, the fertilized egg grows into a microscopic ball of cells (blastocyst), which implants on the wall of your uterus. This implantation triggers a series of hormonal and physical changes in your body.

The third through eighth weeks of growth are called the embryonic stage, during which the embryo develops most major body organs. During this process, the embryo is especially vulnerable to damaging substances, such as alcohol, radiation, and infectious diseases.

Having reached a little more than 1 in (2.54 cm) in length by the ninth week of growth, the embryo is called a fetus. By now, the uterus has grown from about the size of a fist to about the size of a grapefruit.

See pictures of the fetus at 9 and 12 weeks of development (11th and 14th weeks after last menstrual period).

Early signs of pregnancy

Your first sign of pregnancy may be a missed menstrual period. Other early signs of pregnancy, caused by hormonal changes, include:

• Fatigue.
• Breast tenderness.
• Increased urination.
• Fullness or mild aching in your lower abdomen.
• Nausea with or without vomiting, also known as morning sickness. For more information, see:

  Pregnancy: Dealing with morning sickness.

Additional changes related to pregnancy

Throughout your pregnancy, you may notice a number of mild to severe effects, including:

• Constipation, due to hormonal changes that slow down the normal function of your bowels. Iron in your prenatal vitamin can also cause constipation.
• Mood swings, which can be caused by hormonal changes, extreme fatigue, or the stress of expecting a new baby.
• Vaginal discharge changes. A thin, milky-white discharge (leukorrhea) is normal throughout pregnancy. Also, the tissues lining the vagina become thicker and less sensitive during pregnancy.
• Vaginal yeast infections, which are more common in pregnancy because of the increased levels of hormones. Call your health professional if you have symptoms of a vaginal yeast infection or bacterial vaginal infection (bacterial vaginosis).
• Vaginal bleeding. Spotting in early pregnancy may go away on its own, but it can be the start of a miscarriage. If you experience any vaginal bleeding during pregnancy, contact your health professional. For more information, see the topic Miscarriage.

Your Second Trimester

The second trimester of pregnancy spans from week 13 to week 27 of your pregnancy. This is the time when most women start to look pregnant and may begin to wear maternity clothes. By 16 weeks, the top of your uterus, called the fundus, will be about halfway between your pubic bone and your navel. By 27 weeks, the fundus will be about 2 in (5 cm) or more above your navel.

See pictures of the fetus at 16, 20, and 24 weeks of development. By the end of the second trimester, your fetus is about 10 in (25.4 cm) long and weighs about 1.5 lb (680 g).

You may find that the second trimester is the easiest part of pregnancy. For some women, the breast tenderness, morning sickness, and fatigue of the first trimester ease up or disappear during the second trimester, while the physical discomforts of late pregnancy have yet to start. Pressure on your bladder may be less as the uterus grows up out of the pelvis.

If this is your first pregnancy, you'll begin to feel your fetus move at about 18 to 22 weeks after your last menstrual period (LMP). Although your fetus has been moving for several weeks, the movements have not been strong enough for you to notice until now. At first, fetal movements can be so gentle that you may not be sure what you are feeling. If you've been pregnant before, you may notice movement earlier, sometime between weeks 16 and 18.

Normal symptoms you may experience during the second trimester of pregnancy include:

• Breast changes.
• Leg cramps.
• Back pain.
• Pelvic ache and hip pain.
• Stretch marks and other skin changes.
• Hemorrhoids and constipation.
• Heartburn (also a symptom of gastroesophageal reflux disease, or GERD).
• Nosebleeds and bleeding gums.
• Hand pain, numbness, or weakness (carpal tunnel syndrome).

Common infections that require treatment during pregnancy include:

• Vaginal yeast infections.
• Bacterial vaginal infections.
• Urinary tract infections.

Your Third Trimester

The third trimester of pregnancy spans from week 28 to the birth. Although your due date marks the end of your 40th week, a full-term pregnancy can deliver between the 37th and 42nd weeks of pregnancy. During this final trimester, your fetus grows larger and the body organs mature. The fetus moves frequently, especially between the 27th and 32nd weeks.

In the final 2 months of pregnancy, a fetus becomes too big to move around easily inside the uterus and may seem to move less. At the end of the third trimester, a fetus usually settles into a head-down position in the uterus. You will likely feel some discomfort as you get close to delivery.

See pictures of the fetus at 32 and 40 weeks of development.

Normal symptoms you may experience during the third trimester of pregnancy include:

• Braxton Hicks contractions, which are "warm-up" contractions that do not thin and open the cervix (do not lead to labor).
• Fatigue.
• Back pain.
• Pelvic ache and hip pain.
• Hemorrhoids and constipation.
• Heartburn (a symptom of gastroesophageal reflux disease, or GERD).
• Hand pain, numbness, or weakness (carpal tunnel syndrome).
• Breathing difficulty, since your uterus is now just below your rib cage, and your lungs have less room to expand.
• Mild swelling of your feet and ankles (edema). Pregnancy causes more fluid to build up in your body. This, plus the extra pressure that your uterus places on your legs, can lead to swelling in your feet and ankles.
• Difficulty sleeping and finding a comfortable position. Lying on your back interferes with blood circulation, and lying on your stomach isn't possible. Sleep on your side, using pillows to support your belly and between your knees. Later in your pregnancy, it is best to lie on your left side. When you lie on your right side or on your back, the increasing weight of your uterus can partly block the large blood vessel in front of your backbone.
• Frequent urination, caused by your enlarged uterus and the pressure of the fetus's head on your bladder.

Signs that labor is not far off include the following:

• The fetus settles into your pelvis. Although this is called dropping, or lightening, you may not feel it.
• Your cervix begins to thin and open (cervical effacement and dilatation). Your health professional checks for this during your prenatal exams.
• Braxton Hicks contractions become more frequent and stronger, perhaps a little painful. You may also feel cramping in the groin or rectum or a persistent ache low in your back.
• Your "water" may break (rupture of the membranes). In most cases, rupture of the membranes occurs after labor has already started. In some women, this happens before labor starts. Call your health professional immediately or go to the hospital if you think your membranes have ruptured.

Labor and Delivery: Your Birth Plan

During your prenatal visits, talk with your health professional about what you would like to happen during your labor. Consider writing up your labor and delivery preferences in a birthing plan, either in a childbirth education class or on your own. You can find various examples of birthing plans on parenting Web sites.

Because no labor or delivery can be fully anticipated or planned in advance, be flexible. Your experience after labor begins may be totally different from what you expected. If an emergency or an urgent situation arises, your plans may be changed for your own or your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When making plans for your baby's birth, consider the location of your delivery, who will deliver your baby, and whether you want continuous labor support from a designated health professional or a doula, a friend, or family members. If you haven't already, this is also a good time to decide whether you'll attend a childbirth education class, starting in your sixth or seventh month of pregnancy.

After you've set the stage, think through your preferences for comfort measures, pain relief, medical procedures and fetal monitoring, and how you want to handle your first hours with your newborn.

Comfort measures may include:

• Nonmedicine pain management ("natural" childbirth), such as focused breathing, distraction, massage, imagery, and continuous labor support, which can reduce pain and help you feel a sense of control during labor. Acupuncture and hypnosis are also low-risk ways to manage pain that work for some women.¹³
• Laboring in water, which helps with pain, stress, and may also help prevent slow, difficult labor.¹⁴
• Walking during labor, including whether you prefer continuous electronic fetal heart monitoring or occasional monitoring. Most women prefer the freedom to walk and move around, which helps reduce discomfort, but a high-risk delivery would require constant monitoring.
• Eating and drinking during labor. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted because the stomach digests food more slowly during labor. This may make you vomit or feel like vomiting. An empty stomach is also best in the rare event that you may need general anesthesia.
• Playing music during labor.
• Birthing positions during pushing, including sitting, squatting, or reclining or using a ball, whirlpool, or birthing chair, stool, or bed.

Pain medicine may include:

• Epidural anesthesia, which is an ongoing injection of pain medicine into the epidural space around the spinal cord, to partially or fully numb the lower body. A "light" epidural allows the mother to feel enough so that she can push, reducing risks of stalled labor and cesarean delivery.
• Pudendal and paracervical blocks, which are injections of pain medicine into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where the baby will come out. Paracervical has been generally replaced by epidural, which is more effective.
• Narcotics, typically Demerol, which are sometimes used to reduce anxiety and pain. Narcotics have limited pain-relief effectiveness and can have troubling side effects for mother and baby.

Should I use epidural anesthesia during childbirth?

Some pain relief medicines are not the type that you would request during labor. Rather, they are used as part of another procedure or emergency delivery. But it's a good idea to be familiar with them. They include:

• Local anesthesia, the injection of pain medicine into the skin, which numbs the area before episiotomy or before inserting an epidural.
• Spinal block, the injection of pain medicine into the spinal fluid, which rapidly and fully numbs the pelvic area for assisted births, such as for forceps or cesarean delivery. If you have a spinal block, no pushing is possible.
• General anesthesia, the use of inhaled or intravenous (IV) medicine, which renders you unconscious. It has more risks, yet takes effect much faster than epidural or spinal anesthesia. So general anesthesia is only used for some emergencies that require a rapid delivery, when an epidural catheter has not been installed in advance.

Medical procedures for aiding a safe delivery may include:

• Labor induction and augmentation, including rupturing of the membranes and medicines for softening the cervix and stimulating contractions. This can be a medically necessary decision, such as when a mother has high blood pressure or another health problem that may endanger the fetus.
• Electronic fetal heart monitoring, either continuous for a high-risk delivery, or periodic, to check for signs that the fetus might be in distress.
• Episiotomy, which widens the area between the vagina and anus (perineum) with an incision. Episiotomy is done to shorten the time until the baby is delivered. Perineal massage and controlled pushing may also prevent or reduce tearing.
• Forceps delivery or vacuum extraction to assist a vaginal delivery, such as when labor is stalled at the pushing stage or the baby has signs of distress and needs to be delivered quickly.
• Need for a cesarean birth during a labor in progress. For more information, see the topic Cesarean Section.

If you have had a cesarean delivery before, you may have a choice between a vaginal trial of labor and a planned cesarean birth. For more information, see the topic Vaginal Birth After Cesarean (VBAC).

Newborn care decisions

Newborn care decisions include:

• Whether you plan to bank your baby's umbilical cord blood after the birth for possible use as a stem cell treatment. (This requires advance planning early in your pregnancy.)
• Keeping your baby with you for at least 1 hour after birth, for bonding and introduction to breast-feeding. Some hospitals allow rooming-in, with no mother-baby separation during the entire hospital stay. (A rooming-in policy also allows you to request time alone for rest, if you need it.)
• Delaying vitamin K injection, heel prick for blood test, and eye medicine, to help calm your newborn after delivery.
• Whether and when you'd like visitors, including children in your family.
• Allowing no water or formula for a breast-fed baby, to decrease early breast-feeding problems.

Should I bank my baby's umbilical cord blood?

When to Call a Doctor

During the last trimester, call 911 or other emergency services immediately if you:

• Experience severe vaginal bleeding.
• Have severe abdominal pain.
• Have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). If this happens, immediately get down on your knees so your buttocks are higher than your head to decrease pressure on the cord until help arrives. Cord prolapse can cut off the fetus's blood supply. (These measures apply to you if you are as early as 24 weeks pregnant.)

At any time during your pregnancy, call your health professional immediately if you:

• Have signs of preeclampsia, a potentially life-threatening condition, such as:
  • Sudden swelling of your face, hands, or feet.
  • Visual problems (such as dimness or blurring).
  • Severe headache.
• Have pain, cramping, or fever with bleeding from the vagina.
• Pass some tissue from the uterus.
• If you think or know you have a fever.
• Vomit more than 3 times a day, or are too nauseated to eat or drink, especially if you also have fever or pain.
• Have an increase or gush of fluid from your vagina. It is possible to mistake a leak of amniotic fluid for a problem with bladder control.

At any time during your pregnancy, call your health professional today if you:

• Notice sudden swelling of your face, hands, or feet.
• Have any vaginal bleeding or an increase in your usual amount of vaginal discharge.
• Have pelvic pain that doesn't get better or go away.
• Have itching all over your body (usually in the evenings at first, then throughout the day as well) with or without dark urine, pale stools, or yellowing of skin or eyes.
• Have painful or frequent urination or urine that is cloudy, foul-smelling, or bloody.
• Feel unusually weak.

If you are between 20 and 37 weeks pregnant, call your health professional immediately or go to the hospital if you have signs of preterm labor, including:

• Mild or menstrual-like cramping with or without diarrhea.
• Regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more in 1 hour, even after you have had a glass of water and are resting.
• Unexplained low back pain or pelvic pressure.

For more information, see the topic Preterm Labor.

Between 20 and 37 weeks of pregnancy, call your health professional immediately or go to the hospital if you:

• Have noticed that your baby has stopped moving or is moving much less than normal. See fetal movement counting for information on how to check your baby's activity.
• Have uterine tenderness or unexplained fever (possible symptoms of infection).

After 37 weeks of pregnancy, call your health professional immediately or go the hospital if you:

• Have vaginal bleeding (for light spotting, you can call at any time on the same day).
• Have had regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more within 1 hour.
• Have a sudden release of fluid from the vagina.
• Notice that the baby has stopped moving or is moving much less than normal. See fetal movement counting for information on how to check your baby's activity.

At any time during pregnancy, call your health professional if you have steady or heavy discharge from the vagina unlike your normal secretions along with symptoms of itching, burning, or odor.

For more information about problems during pregnancy, see the topic Pregnancy-Related Problems.

Related Information

• Alcohol Effects on a Fetus
• Alcohol or Drug Use During Pregnancy
• Asthma During Pregnancy
• Bacterial Vaginosis
• Birth Control
• Breech Position and Breech Birth
• Cesarean Section
• Fertility Awareness
• Gestational Diabetes
• Growth and Development, Newborn
• Health and Safety, Birth to 2 Years
• Immunizations
• Medicines During Pregnancy
• Miscarriage
• Multiple Pregnancy: Twins or More
• Newborn Rashes and Skin Conditions
• Placenta Abruptio
• Placenta Previa
• Preeclampsia and High Blood Pressure During Pregnancy
• Premature Infant
• Preterm Labor
• Rh Sensitization During Pregnancy (medical update in progress. sj)
• Urinary Tract Infections in Teens and Adults
• Vaginal Birth After Cesarean (VBAC)
• Vaginal Yeast Infections

References

Citations

1. Li D, et al. (2003). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population-based cohort study. BMJ, 327(7411): 368–372.
2. Speroff L, Fritz MA (2005). Oral contraception. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 861–942. Philadelphia: Lippincott Williams and Wilkins.
3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists (2007). Antepartum care. In Guidelines for Perinatal Care, 6th ed., pp. 83–137. Elk Grove Village, IL: American Academy of Pediatrics.
4. American Academy of Pediatrics, American College of Obstetricians and Gynecologists (2007). Human immunodeficiency virus section of Perinatal infections. In Guidelines for Perinatal Care, 6th ed., pp. 316–320. Elk Grove Village, IL: American Academy of Pediatrics.
5. Caughey AB, et al. (2006). Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstetrics and Gynecology, 108(3): 612–616.
6. Seeds JW (2004). Diagnostic mid trimester amniocentesis: How safe? American Journal of Obstetrics and Gynecology, 191: 608–616.
7. Alfirevic Z, et al. (2003). Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database of Systematic Reviews (3).
8. Salvesen KÅ, Mørkved S (2004). Randomized controlled trial of pelvic floor muscle training during pregnancy. BMJ, 329(7462): 378–380.
9. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
10. American College of Obstetricians and Gynecologists (2002, reaffirmed 2007). Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstetrics and Gynecology, 99(1): 171–173.
11. Casanueva E, et al. (2005). Vitamin C supplementation to prevent premature rupture of the chorioamniotic membranes: A randomized trial. American Journal of Clinical Nutrition, 81(4): 859–863.
12. Papaya (2004). In A DerMarderosian, J Beutler, eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
13. Smith CA, et al. (2006). Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews, (1). Oxford: Update Software.
14. Cluett ER, et al. (2004). Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour. BMJ, 328(7435): 314–320.

Other Works Consulted

• American College of Obstetricians and Gynecologists (2005). Changes during pregnancy. In Your Pregnancy and Birth, 4th ed., pp. 79–101. Washington, DC: American College of Obstetricians and Gynecologists.
• American College of Obstetricians and Gynecologists (2003, reaffirmed 2005). Immunization during pregnancy. ACOG Committee Opinion No. 282. Obstetrics and Gynecology, 101(1): 207–212.
• Hyde LK, et al. (2003). Effect of motor vehicle crashes on adverse fetal outcomes. Obstetrics and Gynecology, 102(2): 279–286.
• U.S. Department of Health and Human Services, U.S. Environmental Protection Agency (2006). Mercury Levels in Commercial Fish and Shellfish. Available online: http://www.cfsan.fda.gov/~frf/sea-mehg.html.

Credits