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Why is choosing caregiver one of the most important maternity

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					Women’s Issue’s
    From
 Conception
     To
   Birth



Mrs. Hanock
                Why is choosing a caregiver one of the most important maternity decisions I will make?

    Early in your pregnancy, it is important to make thoughtful decisions about who will be your caregiver and
    where you plan to give birth. These major decisions can influence:
          the care that you receive and the effects of that care
          the quality of your relationship with your main and other caregivers
          the amount of information you receive
          the choices and options you will have, particularly during your labor
      and birth
          the degree to which you are involved with decisions about your care.
    If you are a well and healthy childbearing woman (as are most pregnant women in the U.S.), you can choose a
    midwife or a doctor as your maternity caregiver. Options: Caregiver will help you learn about the midwifery
    model of care and the medical model of care, as well as different kinds of midwives and doctors who provide
    maternity care. This and other pages in this section can help you find the right caregiver for you.

    It may take some time and energy to find the right caregiver and birth setting. These important decisions are
    well worth the effort.

    How will my choice of caregiver influence where I can give birth?

    Caregivers and birth settings usually go hand in hand. As you explore your different options, you will want to
    decide on a caregiver who practices in a birth setting that will meet your needs. For example, if you decide that
    you would like to work with a physician, you will probably be limited to giving birth at a hospital. If you
    choose to work with a midwife, you may have more options since midwives practice in hospitals, birth centers,
    and homes. Moreover, there may be important differences among hospitals and among birth centers. When
    choosing a caregiver, it is also important to think about choosing a birth setting that is right for you.

    What are important considerations when choosing a maternity caregiver?

    The following are signs of an excellent choice of maternity caregiver:
          caregiver's practices are consistent with the best available research about safe and effective care
          caregiver's practices work with the physiology of pregnancy and birth — your body is finely tuned to
      do this work; some actions support this work, while others interfere with it
          the two of you are able to develop a strong relationship with good communication and mutual trust
      and respect
          the caregiver's personal style is compatible with your needs, preferences, and values.

    What are some insufficient reasons for choosing a caregiver?

    It is not wise to select a caregiver solely because:
          that person practices near your home or workplace — convenience is nice, but you may need to
      travel further to find the right person
           you know someone who worked with that person — even if recommended by a friend or relative,
      you will want to be sure that a maternity caregiver's style will meet your needs and values and reflects the
      best available research
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            that person is a woman, or a man — if you have a preference for caregiver gender, you will want to
        be sure that that person's maternity philosophy and style of practice match well with your needs and
        values and with the best available research
             that person has been your provider for well-woman or primary care — you will want to learn about
        that person's maternity philosophy and style of practice before making your decision.

    How do types of caregivers differ from one another?

    In making your decision, keep in mind that caregivers vary in important ways:
             philosophy of birth and model of care
            style of practice — this includes the amount of time spent with you, interest in sharing information
        and involving you in decision-making, and preferences for use of interventions
            birth settings — most caregivers work at one or two sites, and few offer the full range of hospital,
        out-of-hospital birth center, and home birth.
             whether specific types of caregivers are available in your area
             whether your insurance will cover their services.

    What if I change my mind and want to switch to another caregiver?

    As time goes on, you will learn more about your needs and about the caregiver and birth setting that you have
    chosen. If you have concerns and have not been able to resolve them through open and respectful
    communication, you may begin to wonder if you have made the right choice(s). Do not hesitate to explore
    other options. Even if it is late in your pregnancy, you can switch if:
             you have enough time to explore options and find a situation that you believe will work better for
        you
            the new caregiver or setting has no policies that prevent you from making this change at that time in
        your pregnancy
             your insurance will cover the new arrangements, or you are willing and able to pay out of pocket.

             You may have to change your caregiver and/or birth setting to get what you want.

    Pregnancy: Things to Think about Before You're Pregnant
    Why is being ready for pregnancy so important?

    Conception occurs about 2 weeks before your period is due. That means you may not even know you're
    pregnant until you're more than 3 weeks pregnant. Yet your baby is most sensitive to harm 2 to 8 weeks after
    conception. This is when your baby's facial features and organs, such as the heart and kidneys, begin to form.
    Anything you eat, drink, smoke or are exposed to can affect your baby. That's why it's best to start acting as if
    you're pregnant before you are.

    When should I talk with my doctor about pregnancy?
    Any time, even before you're thinking about getting pregnant. You can talk about your diet, habits, lifestyle
    and any concerns you have. Plan on visiting your doctor within a year before you want to get pregnant. At
    that time, you may be given a physical check-up. You and the father-to-be will probably be asked about your
    medical history. You'll both also have the chance to ask your doctor questions.
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What should I eat?

What you eat will also feed your baby. Junk food like potato chips, soda and cookies won't have the right
nutrients for your baby. You might also need to make some changes if you follow a vegetarian or weight-loss
diet. Talk to your doctor before taking extra vitamins and minerals. Some of them may be harmful, like high
doses of vitamin A.



    Folic Acid Alert

    Women who don't get enough folic acid during pregnancy are more likely to have a baby with serious
    problems of the brain or spinal cord. It's important to take folic acid before becoming pregnant
    because these problems develop very early in pregnancy--only 3 to 4 weeks after conception. Women
    need about 0.4 mg of folic acid a day. You can take a multivitamin or eat plenty of green, leafy
    vegetables, oranges, cantaloupe, bananas, milk, grains and organ meats (such as chicken livers).


What about weight?

If you're overweight, your risk during pregnancy is higher for things such as high blood pressure and diabetes.
You may also be less comfortable during pregnancy, and your labor may be longer. You can use the time
before getting pregnant to lose weight if you need to.

Is exercise okay?

Yes. The more fit you are, the easier your pregnancy and delivery may be. But if you exercise too much, it can
make getting pregnant harder. And overdoing it once you're pregnant can be dangerous. If you haven't been
exercising, start before you get pregnant. While you are pregnant, you can probably keep up a light exercise
program. Walking every day is good exercise. Talk to your doctor about an exercise plan for you.

Do I need to change my habits?

Using tobacco, alcohol or drugs can cause serious harm to your baby and can even cause miscarriage. If you
use tobacco, alcohol or drugs, get help from your doctor to quit. He or she will want to help you find a way to
stop.

Smoking. Smoking can cause miscarriage, bleeding, premature birth and low birth weight. It's also linked to
sudden infant death syndrome (SIDS), in which infants suddenly die of no obvious cause. Children of smokers
may do less well on IQ tests, and their physical growth may be slower.

Alcohol. Drinking by a pregnant woman can cause fetal alcohol syndrome (FAS). FAS can lead to many
problems, including mental slowness, poor growth, defects of the face and a head that is too small. Drink no
alcohol or as little as possible before and during pregnancy.

Illegal drugs. Using marijuana, cocaine and other illegal drugs raises the chances of miscarriage, premature
birth and birth defects. With some drugs, the child will be born addicted to the drug that the mother used and
will go through withdrawal.




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Am I around things at work or home that could be harmful?

Maybe. Some dangers include radiation, heavy metals like lead, copper and mercury, carbon disulfide, acids,
and anesthetic gases. The radiation from computer screens doesn't seem to be harmful.

Talk with your doctor about your workplace and home to find out if there are any dangers. If anything could
harm your baby at work, you may be able to use special clothing or equipment to protect your baby, or you
may be able to get a short-term transfer before and during pregnancy.

What about medicines I take?

Both prescription and over-the-counter medicines can affect your baby. Ask your doctor before taking
prescription or nonprescription (like aspirin) medicines.

If you need to take medicine often because of health problems, such as asthma, epilepsy, thyroid problems or
migraine headaches, talk with your doctor about your treatment and any risks during pregnancy.

What tests may I need before I get pregnant?

You may need some tests to find out if you have problems that could harm you or your baby during
pregnancy. Many things can be handled before pregnancy to help prevent problems for your baby and for
you.

Rubella. If you don't know whether you've ever had rubella (German measles) or been vaccinated against it, a
blood test can give the answer. Catching rubella while you're pregnant can be very bad for your baby. You can
be vaccinated before you get pregnant.

Sexually transmitted diseases (STDs). STDs such as gonorrhea, syphilis, chlamydia and AIDS can make it
hard for you to get pregnant and can also harm you or your baby. It is best if these infections are diagnosed
and treated before pregnancy.

Other problems. Your doctor may also want to do some other tests depending on if you're at risk for other
problems, such as anemia or hepatitis.

What if I have health problems?

Diabetes, high blood pressure or problems with your circulation may need extra care during pregnancy. It's
often easier to treat problems or get them under control before you're pregnant.

Will my baby be at risk for genetic problems?

Your baby may be at risk for certain problems that run in your family. These are genetic diseases. Cystic
fibrosis and sickle cell anemia are some examples. These problems aren't caused by anything you do. Talk with
your doctor about your risk factors and whether screening tests are needed.




                                                                                                                5
Conception Basics - The Key To Falling Pregnant
To guarantee conception is almost, if not entirely, impossible. There is so much that relies on the timing being absolutely
correct, as the female egg will only be available for fertilization for a short period of time during the female cycle. There
are also many external factors which may prevent you from having a successful conception. In order to conceive, you will
need to know the basics of the female cycle, how to calculate the ovulation date and when to have sex in order to best
help ensure conception.

Ovulation and The Female Cycle

The key to falling pregnant is to know your own monthly cycle down to a tee. Not all monthly cycles are the same and
can vary anywhere from between 22-42 days, with the average being 28 days. Some woman's cycles even vary from
month to month. It is usually recommended you track your cycle for 3 to 4 months to be 100% sure that you will be
accurate.

Ovulation usually takes place at around 14 days from the first day of your monthly cycle (bearing in mind the average
cycle is 28 days). The first day of your cycle is taken as the first day on which you begin to have your discharge.

However, you will begin to become more fertile from about 4 days before you actually ovulate and will last for up to 48
hours after you ovulate. You will be at your most fertile on the day prior to and of course on the day you do actually
ovulate.

Ovulation itself is easiest to calculate by measuring your body temperature; this is because you will have a slight increase
in body temperature when you ovulate. If you are unable to calculate your ovulation date, then just work around the
average of 14 days from the first day of your monthly cycle. Let's take a look at the pie chart to make better sense of
ovulation and when you are at your most fertile.




The key to a successful conception is understanding just how the female cycle works, when you are at your most fertile
and when you would be wasting energy trying to fall pregnant.

NOTE: This example takes into account that your cycle is 28 days, with a 14 day ovulation phase, or the Luteal phase.

 Days 1-5:
Your first day of the cycle is when you first start to menstruate. So day one is the day you begin to have discharge. It is
very important to record this date as we will need it to calculate your estimated ovulation date.

 Days 6-11:
These days are called 'dry days', as you are not menstruating nor are you fertile. Your body at this stage is simply
preparing to release the egg.




                                                                                                                              6
  Days 12-18:
These are the days when you will be at your most fertile. Your body will release the egg during the course of these 6 days,
so this is the best time to be having sex if you are trying to conceive.

  Days 19-28:
If you are only having sex during this period, then I am afraid to say you have missed your chance and will have to wait
for the cycle to begin again. It is highly unlikely that you will have any success in falling pregnant during this time.

If you can master these basics and apply them to your own cycle, then you will be at a good starting point to ensuring
that your timing is right to try and maximize your chances of successfully falling pregnant.




Conception Site
Stephanie Cummings
BellaOnline's Conception Editor


Biology of Conception

You would think that with billions of people walking around the planet that it would be simple
enough, but it’s actually a fairly complicated system that happens almost unnoticed every month.
Understanding exactly what’s going on in your body is the best way to successfully get pregnant.
Plus, it’s good information to have if you are trying to avoid pregnancy.


Every single pregnancy started with an egg and a sperm and they had to meet in the most perfect of
circumstances and then all kinds of wild things started happening. But let’s start at the beginning.


A woman begins the process of creating life on the first day of her menstrual cycle or her period as
many call it. During this time her body naturally cleans itself, sloughing off her uterine lining to
prepare for a pregnancy in the upcoming month.


Meanwhile, upstairs in the pituitary gland, a small gland at the base of your brain, messages from the
hypothalamus, another gland in the brain, are received signaling that it’s time to start making a baby.
The pituitary gland then starts to release hormones called Follicle Stimulating Hormone (FSH) and
Luteinizing Hormone (LH.) These hormones then travel through the blood stream and eventually
make their way to your ovaries, small oval shaped organs measuring about 3cm and located on either
side of your uterus, where eggs begin to develop in fluid filled sacs called follicles.


These follicles begin to release large quantities of estrogen, another hormone, which then stimulates
the endometrium, or uterine lining, to begin to thicken. A nice thick uterus is key to a successful
pregnancy. This process is aptly called the Follicular or pre-ovulatory phase and lasts about 12 days
(**Please note that this is based on a typical 28 day cycle. Individual cycles can vary by several days.)

                                                                                                                           7
On approximately day 13, the pituitary gland releases a larger amount of LH. This is commonly
referred to as your “LH surge” and is what creates a positive home ovulation kit. When your ovary
recognizes the LH surge, it releases the egg (also called an ovum) that it has been busy growing, rich
with proteins and nutrients as well as half of the possible baby’s DNA. This is called ovulation. You
are now officially in the Fertile Phase.


If you are trying to have a baby, now would be when you should have intercourse. During
intercourse, the man releases a fluid called semen into your vagina. Inside this fluid are millions of
tiny cells that resemble tadpoles called sperm. The sperm carry the other half of the possible baby’s
DNA as well as their own proteins and nutrients necessary to create a healthy baby. These sperm
then begin a long and tiring journey in search of your egg. Many will die along the way, but it only
takes one to reach your egg in order to make a baby. Of course, if you do not want to become
pregnant, you should avoid intercourse for several days surrounding ovulation or use a reliable form
of birth control.


The egg, ready to be fertilized, is swept into the fallopian tubes; long skinny shoots that lead to the
uterus, after it burst from your ovary. If you have had intercourse at the right time, it is here in the
fallopian tubes that the sperm are anxiously waiting. When they meet, the sperm will swarm the egg,
each one trying to penetrate the eggs thick outer mucus membrane. Once one sperm achieves this, the
eggs chemistry changes, hardening its mucus membrane and making it impossible for any other
sperm to get in. Inside, the egg, the DNA from the egg and sperm mix to create your baby’s DNA and
your baby is made.


If no fertilization takes place, the egg disintegrates within 24 hours and no pregnancy will occur.


The fertilized egg, now called a zygote, quickly starts to divide and multiply cells. While it begins to
grow, it also travels through the fallopian tubes, toward the uterus, which should by now have a nice
thick lining just waiting for a baby to implant. This journey takes between 6 and 12 days.


Back at your ovary, the now empty follicle where the egg had been developing is called the corpus
luteum. The corpus luteum is now a fluid filled sac that is releasing Progesterone, a hormone
necessary to sustain pregnancy. It will continue to release progesterone for another 14 days. This is
called the luteal (or post-ovulatory) phase.


Now, the zygote, or fertilized egg, has traveled through the fallopian tubes and divided many times
over, making a multi-celled organism called a blastocyst. The blastocyst will find a nice, comfy spot
and attach itself to the uterine lining. This is called implantation. Some women experience light, pink
                                                                                                       8
spotting during this time often referred to as implantation bleeding. It is nothing to worry about.


Over the next few days it grows at a rapid rate forming an embryonic sac (the sac of fluid where your
baby will live and grow until birth), a yolk sac (a small ball of nourishment to help your baby survive
these first few days) and a placenta (this is how your baby will get its nourishment and oxygen from
you) and the embryo (the baby itself.)


You should now be reaching the time of the month when you are expecting your menstrual cycle. If
no pregnancy has taken place, then the corpus luteum will shrivel and stop producing progesterone.
This decrease in progesterone tells your uterus that there is no baby and it begins to shed its lining,
starting your period and the whole process begins again.


If you did conceive a baby during this cycle, the placenta will release progesterone, keeping your
uterus for beginning it’s shedding and you will not have a period. For many women, missing her
period is the first sign that she might be pregnant.


In addition, the embryo produces another hormone called Human chorionic gonadotropin (hCG).
This is the hormone that home pregnancy tests look for in a woman’s urine. If hCG is present in the
urine, it is almost certain that you are pregnant. These tests should be taken on the day that you
expect your period (usually about 28 days after your last period started), although there is new
technology that is creating ultra-sensitive home pregnancy tests that can detect hCG even earlier.


There are other early signs of pregnancy. Fatigue, nausea (especially in the morning), sore or tender
breasts, and extreme emotions are all caused by the hormonal overhaul that is taking place inside
your body.


For the next 36 weeks, your baby will continue to grow in your uterus and your body will experience
a magnitude of changes. You can learn more about these changes at the Bella Pregnancy site.




Understanding when you're most fertile

Learning how ovulation works is one thing. Determining when it's actually happening is something else. For
many women, it's like hitting a moving target.

Ovulation occurs when a mature egg is released from the ovary, pushed down the fallopian tube, and is
available to be fertilized. The lining of the uterus has thickened to prepare for a fertilized egg. If no conception

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occurs, the uterine lining as well as blood will be shed. The shedding of an unfertilized egg and the uterine
wall is the time of menstruation.


                                        Key Facts of Ovulation:
      An egg lives 12-24 hours after leaving the ovary
      Normally only one egg is released each time of ovulation
      Ovulation can be affected by stress, illness or disruption of normal routines
      Some women may experience some light blood spotting during ovulation
      Implantation of a fertilized egg normally takes place 6-12 days after ovulation
      Each woman is born with millions of immature eggs that are awaiting ovulation to begin
      A menstrual period can occur even if ovulation has not occurred
      Ovulation can occur even if a menstrual period has not occurred
     Some women can feel a bit of pain or aching near the ovaries during ovulation called mittelschmerz,
     which means "middle pain" in German
      If an egg is not fertilized, it disintegrates and is absorbed into the uterine lining

Keep an eye on the calendar
Use your day planner or another simple calendar to mark the day your period begins each month. Also track
the number of days each period lasts.

If you have a consistent 28-day cycle, ovulation is likely to begin about 14 days after the day your last period
began.

If your cycles are somewhat irregular, subtract 18 from the number of days in your shortest cycle. When your
next period begins, count ahead this many days. This is a reasonable guess for your most fertile days.

      Pros: Calendar calculations can be done simply on paper. And they're free!

      Cons: Many factors may affect the exact timing of ovulation, including illness, stress and exercise.
     Counting days is often inaccurate, especially for women who have irregular cycles.

                                        Your Ovulation Calendar
Click this site and insert your info.

http://www.4woman.gov/pregnancy/tools/ovulationcalc.cfm

www.americanpregnancy.org

                     Day 1      Day 2      Day 3       Day 4       Day 5       Day 6      Day 7
                       X


                     Day 8      Day 9      Day 10     Day 11      Day 12      Day 13      Day 14
                                                                     O           O             O


                                                                                                                   10
                    Day 15     Day 16      Day 17     Day 18      Day 19     Day 20      Day 21
                      O           O          O           O          O


                    Day 22     Day 23      Day 24     Day 25      Day 26     Day 27      Day 28




                    Day 29     Day 30      Day 31     Day 32




                  X = First day of bleeding, which is the first day of your cycle

                  O = Possible time of ovulation




Watch for changes in cervical mucus
Just before ovulation, you'll notice an increase in clear, slippery vaginal secretions — if you check for it. These
secretions typically resemble raw egg whites. After ovulation, when the odds of becoming pregnant are slim,
the discharge will become cloudy and sticky or disappear entirely.

     Pros: Changes in vaginal secretions are often an accurate sign of impending fertility. Simple
    observation is all that's needed, particularly inside the vagina.

      Cons: Judging the texture or appearance of vaginal secretions can be somewhat subjective.

What are signs of ovulation?
The signs of ovulation can be any of the following, although many women may only notice one or two of
these:
• Change in cervical fluid
• Change in cervical position and cervical firmness
• Brief twinge of pain or dull ache that is felt on one side of the abdomen
• Light spotting
• Increase in sex drive
• Elevated level of the luteinizing hormone which can be detected on a test
• Body temperature chart that shows a consistent change
• Breast tenderness
• Abdominal bloating
• Heightened sense of vision, smell or taste

Can a woman ovulate more than once during each cycle?
A woman cannot ovulate more than once during each cycle, therefore she cannot get pregnant more than once
during a cycle. Multiple ovulation can occur and is when two or more eggs are released in a single cycle. Both
eggs are released during one 24 hour period and are responsible for the birth of fraternal twins. It is believed
that this may occur in as many as 5-10% of all cycles but does not result in that many twins due to a type of
miscarriage referred to as the “vanishing twin phenomenon.”


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Can I ovulate without having a period?
Since a woman releases an egg 12-16 days before her expected period, it is possible for women to get pregnant
without having periods. Women who are not menstruating due to a certain condition (i.e.…low body weight,
breastfeeding, perimenopause) risk the chance of ovulating at any point. For those who want to conceive, the
lack of periods could make it more difficult to know the timing of ovulation if you are not charting
temperature and cervical fluid changes. But if you are not having periods and wanting to prevent pregnancy, a
form of contraception should be used since there is no way to know when ovulation will occur.

Can I have a period and still not have ovulated?
Having a period does not necessarily mean that ovulation has taken place. Some women may have what is
called an anovulatory cycle, (meaning no ovulation) and can experience some bleeding which is mistaken for a
period, but it is actually not a true period. This bleeding is caused by either a buildup in the uterine lining that
can no longer sustain itself or by an estrogen level drop. The main way to decipher if ovulation is in fact taking
place is by tracking the body temperature.

During my ovulation time, how many days am I really fertile?
During the time of ovulation, an egg is available to be fertilized for only about 12-24 hours. But since sperm
can live in the body for 3-5 days and then the egg is available for one day, your most fertile time is considered
to be about 5-7 days.

Can I ovulate during my period?
For women who have regular cycles, ovulating during your period is highly unlikely. Some women have very
irregular cycles, maybe coming once every 3 months or 2-3 times in one month, and these women can have the
odd occurrence of ovulating during a period or what is believed to be a period. Still, the chance of ovulating
during a period is unlikely. But because sperm can live in the body for 3-5 days, pregnancy could occur from
intercourse that takes place during a period.

Can I ovulate right after my period?
The answer to this is determined by how many days are in your cycle. For example, if you have a 21 day cycle
( from the beginning of one period to the beginning of another) and you bleed for 7 days, then yes, you could
ovulate right after your period. This is because we know ovulation can occur 12-16 days before your next
period begins, and this would put you ovulating at days 6-10 of your cycle.

Can I get pregnant during my period?
Pregnancy can occur from intercourse that takes place during a period. This is because sperm can live in the
body for up to five days, and if a woman ovulates soon after her period, then conception could take place from
intercourse that occurred during her period.

Can I ovulate without detecting the stretchy white cervical fluid?
Ovulation can take place even if you do not notice the “stretchy egg-white” fluid that we assume accompanies
ovulation. Every woman can experience her own type of cervical fluid, and not all are the same. Ovulation is
assumed to take place on the day a woman has the most amount of wet fluid.

What does it mean if I have the stretchy cervical fluid on more than one day?
Many women can experience ovulation fluid a few days before ovulation actually takes place and can even
have it after ovulation has finished. When women are studying their fluid to determine ovulation, they are
looking for the 12-24 hour period that they had the greatest amount of wet fluid as the time that an egg is
available for fertilization, although intercourse that happens on the few days before this can also result in
pregnancy.
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Track your basal body temperature
This is your body's temperature when you're at rest. Ovulation may cause a gradual rise in temperature or
even a sudden jump — typically between 0.5 and 1.6 degrees Fahrenheit.

You'll be most fertile during the two to three days before your temperature rises. You can assume ovulation
has occurred when the slightly higher temperature remains steady for three days or more.

Use an oral thermometer to monitor your basal body temperature. Try the digital variety or one specifically
designed to measure basal body temperature. Simply take your temperature every morning before you get out
of bed. Plot the readings on graph paper and look for a pattern to emerge.

       Pros: It's simple. The only cost is the thermometer. It's often most helpful to determine when you've
      ovulated and judge if the timing is consistent from month to month.

        Cons: The temperature change may be subtle, and the increase comes too late — after ovulation has
      already happened. It can be inconvenient to take your temperature at the same time every day,
      especially if you have irregular sleeping hours.

Try an ovulation monitoring kit
Over-the-counter ovulation kits test your urine for the surge in hormones that takes place before ovulation. For
the most accurate results, follow the instructions on the label to the letter.

        Pros: Ovulation kits can identify the most likely time of ovulation. They can even provide a signal
      before ovulation actually happens. They're available without a prescription in most pharmacies.

        Cons: Ovulation kits often lead to excessively targeted sex — and timing sex so precisely can invite
      being too lat

       e. The tests can also be expensive, often ranging from $20 to $50 each.


                 Maximizing fertility (When you are 50 HAHA)
When you're trying to conceive, consider these simple do's and don'ts.

Do:

        Have sex regularly. If you consistently have sex two or three times a week, you're almost certain to hit
      a fertile period at some point. For healthy couples who want to conceive, there's no such thing as too
      much sex. For many couples, this may be all it takes.

        Have sex once a day near the time of ovulation. Daily intercourse during the days leading up to
      ovulation may increase the odds of conception. Although your partner's sperm concentration will drop
      slightly each time you have sex, the reduction isn't an issue for healthy men.

       Make healthy lifestyle choices. Maintain a healthy weight, exercise regularly, eat healthfully and
      keep stress under control. The same good habits will serve you and your baby well during pregnancy.

         Consider preconception planning. Your doctor can assess your overall health and help you identify
      lifestyle changes that may improve your chances for a healthy pregnancy. Preconception planning is
      especially helpful if you or your partner have any health issues.



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      Take your vitamins. Folic acid (vitamin B-9) plays an essential role in a baby's development. Taking a
    prenatal vitamin or folic acid supplement beginning at least one month before conception through the
    first trimester of pregnancy can reduce the risk of spina bifida and other neural tube defects by up to 70
    percent.

Don't:

     Smoke. Tobacco changes the cervical mucus, which may keep sperm from reaching the egg. Smoking
    may also increase the risk of miscarriage and deprive your developing baby of oxygen and nutrients. If
    you smoke, ask your doctor to help you quit before conception. For your family's sake, vow to quit for
    good.

        Drink alcohol. Alcohol is off limits if you're pregnant — or hope to be.

     Take medication without your doctor's OK. Certain medications — even those available without a
    prescription — can make it difficult to conceive. Others may not be safe once you're pregnant.



How to have high-quality sperm

It takes only one sperm cell to fertilize an egg. With 500 million sperm vying for the opportunity, you'd think
each act of intercourse between you and your partner would have excellent odds of resulting in conception. In
fact, it's never a sure thing, even if you're both healthy and your timing is right — that is, you have sex within
three days (72 hours) of when the egg enters the fallopian tube (ovulation). Here's what you can do to increase
your chance of contributing enough hardy, energetic sperm to get the job done.

     Consider a multivitamin. If your eating habits are irregular, a daily multivitamin usually provides
    adequate intake of selenium, zinc and folic acid, trace nutrients that are important for optimal sperm
    production and function. Sperm are particularly susceptible to oxidants, unstable oxygen molecules that
    damage cell membranes. A multivitamin also usually contains antioxidant vitamins such as C and E,
    which may help protect sperm from this damage.

      Reduce stress. Excessive or prolonged stress may interfere with certain hormones needed to produce
    sperm. A long-term fertility problem may be a stressor in itself, directly or indirectly contributing to
    infertility by interfering with hormones or impairing sexual function.

      Exercise regularly. Physical activity is good for your general and reproductive health. Contrary to
    what you may have heard, even strenuous exercise such as marathon running probably won't adversely
    affect your fertility. Just don't overtrain.

     Watch your weight. Too much or too little body fat may disrupt production of reproductive
    hormones, which can reduce your sperm count and increase your percentage of abnormal sperm. You're
    most likely to produce lots of high-quality sperm if you achieve and maintain a normal body mass index
    (BMI) between 20 and 25.

Caution: Hazardous to sperm

Even under the best circumstances, only 50 percent to 70 percent of a man's sperm are viable enough to
fertilize an egg. This suggests that sperm may be especially vulnerable to environmental assaults, such as
exposure to excessive heat or toxic chemicals. To protect your fertility:



                                                                                                                14
      Watch out for toxins. Many workplace and household chemicals and substances may reduce sperm
    quantity and quality. These include hydrocarbons such as ethylbenzene, benzene, toluene and xylene,
    found in such products as asphalt, crude oil and roofing tar; heavy metals such as lead, cadmium and
    mercury, used in some batteries, pigments and plastics; and aromatic solvents used in paint, varnish,
    stain, glue and metal degreasers. Some pesticides and herbicides have estrogen-like effects that disrupt
    sperm production. Protective clothing, proper ventilation and face masks can reduce the risk of
    absorbing such toxins through your skin, mucous membranes and lungs.

      Avoid tobacco and limit alcohol. Smoking may increase the risk of infertility and erectile dysfunction
    in men. The sperm of men who smoke one to two packs of cigarettes a day may be misshapen and may
    move more slowly than those of nonsmokers. Smokeless tobacco also adversely affects sperm quantity
    and quality. Similarly, heavy drinking may lower testosterone levels and reduce the quality and quantity
    of sperm. Limit alcohol to no more than one or two drinks a day. The combination of tobacco and alcohol
    is particularly harmful to sperm. Men who drink and smoke have significantly lower sperm counts and
    motility than do men with either habit alone.

      Shun recreational drugs. Marijuana can decrease sperm density and motility and increase the number
    of abnormal sperm. Cocaine and opiates can contribute to erectile dysfunction, and amphetamines can
    decrease sex drive.

      Skip the sauna. To maximize the quality and quantity of your sperm, avoid saunas, steam rooms, hot
    tubs and whirlpools. Spending more than 30 minutes at a time in water heated to 102 degrees Fahrenheit
    (40 degrees Celsius) or more may lower your sperm count.

      Head for the shower. Long, hot baths reduce the number and vitality of sperm just as much as hot
    tubs and saunas do. Take showers instead.

      Get off your duff. Prolonged sitting at work, at home or in your car may raise scrotal temperature
    and impair sperm production. If you have a sedentary job, take frequent breaks at work and choose
    leisure-time activities that get you out of the driver's seat and off the couch.

      Avoid hormone havoc. Think testosterone supplements will work in your favor? No way. Excess
    testosterone actually decreases fertility. Anabolic steroids, usually taken illegally to increase muscle
    strength and growth, can shrink the testicles and drastically reduce fertility. Anti-androgens used to treat
    prostate enlargement and cancer also interfere with sperm production.

      Review your medications. Many prescription medications may temporarily reduce your fertility. If
    you take medication to control a chronic condition such as high blood pressure, inflammatory bowel
    disease or gout, or to suppress your immune reaction to a transplanted organ, ask your doctor how your
    treatment may affect sperm development. Also, avoid cimetidine (Tagamet, others), a stomach-acid-
    suppressing drug available without a prescription. Instead, use ranitidine (Zantac, others), famotidine
    (Pepcid, others) or nizatidine (Axid), which decrease stomach acid without affecting fertility. If any other
    medication you're taking may decrease your fertility, ask your doctor whether a substitute drug is
    available. A few medications, including several common chemotherapy agents, may cause permanent
    infertility. If you'll be undergoing chemotherapy, talk with your doctor about saving and freezing your
    sperm (semen cryopreservation).

Separating fact from fiction

A number of sperm-related urban legends have made the rounds in recent years, including groundless rumors
that menthol cigarettes and certain soft drinks can make men sterile. Here are a few others with no basis in fact
— and some that turn out to be true.



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       Tight shorts reduce sperm count. Not true. Despite anecdotal reports that boxer shorts are better than
     briefs, researchers have found no scientific proof that briefs, athletic supporters or tight trousers
     adversely affect fertility, even if worn daily.

        Coffee jangles more than nerves. Not true. Caffeine consumption has no effect on male fertility.

       Bicycling sabotages the system. True. Sitting on a hard, narrow bicycle saddle for more than 30
     minutes at a time — especially if you also wear tight-fitting bicycle shorts — may raise your scrotal
     temperature and affect sperm production. In addition, the associated bouncing and jarring may cause
     genital numbness and damage delicate nerves and arteries. To possibly reduce such risks, point the
     saddle slightly downward, use a wider saddle, wear padded bicycle shorts and take frequent rests while
     biking.

       The calendar also matters to men. True. Since cooler temperatures are associated with increased
     sperm production, sperm counts are higher in the winter and lower in the summer. They're also higher
     in the morning than at other times of day.

Adopting healthy lifestyle practices to preserve your fertility — and avoiding things that can damage it — may
improve your and your partner's chances of conceiving a child. But you still may not become a father on your
first — or even 51st — try. If you and your partner haven't achieved a pregnancy after a year of unprotected
intercourse, see your doctor and get a semen analysis. Forty percent of infertility can be traced to men alone, 40
percent to women alone and 20 percent to both. A fertility specialist can identify the cause of the problem and
provide treatments that may help place you and your partner on the road to parenthood.




                                            Dr.’s Appointments

If you're healthy and there are no complicating risk factors, you can expect to see your health care provider:


        every 4 weeks until the 28th week of pregnancy
        then every 2 weeks until 36 weeks
        then once a week until delivery

The first visit

As soon as you think you're pregnant, schedule your first prenatal appointment. Set aside ample time for the
visit. You and your health care provider have plenty to discuss! Here are the basics:

      Medical history. Your health care provider will ask many questions — including details about your
     menstrual cycle, use of contraceptives, past pregnancies, and allergies or other medical conditions. List
     any prescription or over-the-counter medications you're taking. Share any family history of congenital
     abnormalities or genetic diseases. The information you share will help your health care provider take the
     best care of you — and your baby.

      Due date. Establishing your due date early in pregnancy allows your health care provider to monitor
     your baby's growth as accurately as possible. To estimate your due date, your health care provider will
     count ahead 40 weeks from the start of your last period.

      Physical exam. Your health care provider will check your weight, height and blood pressure. He or
     she will listen to your heart and assess your overall health.
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           Pelvic exam. Your health care provider will examine your vagina and the opening to your uterus
         (cervix) for any infections or abnormalities. You may need a Pap test to screen for cervical cancer.
         Changes in the cervix and in the size of your uterus can help confirm the stage of your pregnancy.

           Blood tests. Your health care provider will do blood tests to determine your blood type, including Rh
         factor — a specific protein on the surface of red blood cells. Blood tests also can reveal whether you've
         been exposed to syphilis, measles, mumps, rubella or hepatitis B. You may be offered a test for HIV, the
         virus that causes AIDS. Tests for chickenpox and toxoplasmosis immunity may be done as well.

          Urine tests. Analysis of your urine can reveal a bladder or kidney infection. The presence of too much
         sugar or protein in your urine may suggest diabetes or kidney disease.

           Lifestyle issues. Healthy lifestyle choices can help give your baby the best start. Your health care
         provider will talk to you about nutrition, prenatal vitamins, exercise and other lifestyle issues. You'll also
         discuss your work environment. If you smoke, your health care provider will offer suggestions to help
         you quit.

          Prenatal tests. Prenatal tests can give you valuable information about your baby's health. Your health
     care provider may recommend ultrasound, blood tests or other screening tests to detect fetal normalities.

                                                     The First Trimester

    Week 1 & 2 - Gestational Age:
    The menstrual period has just ended and your body is getting ready for ovulation. For most women, ovulation
    takes place about 11 - 19 days from the first day of the last period. During intercourse, several hundred million
    sperm are released in the vagina. Sperm will travel through the cervix and into the fallopian tube. If
    conception takes place, the sperm will penetrate an egg and create a single set of 46 chromosomes called a
    zygote - the basis for a new human being. The fertilized egg spends a couple days traveling through the
    fallopian tube toward the uterus, dividing into cells and is called a morula. The morula becomes a blastocyst
    and will eventually end up in the uterus. Anywhere from day 6-10 since conception, the blastocyst will imbed
    into the uterine lining and begin the embryonic stage.

    Week 3 - Gestational Age (Fetal Age - Week 1):
    The embryo is going through lots of basic growth at this time, with the beginning development of the brain,
    spinal cord, heart and gastrointestinal tract.




    Week 4 & 5 - Gestational Age (Fetal Age - Weeks 2 & 3):
    Arm and leg buds are visible, but not clearly distinguishable. The heart is now beating at a steady rhythm. The
    placenta has begun to form and is producing some important hormones including hCG. There is movement of
    rudimentary blood through the main vessels. The early structures that will become the eyes and ears are
    forming. The embryo is ¼ inch long by the end of these weeks.

    Week 6 - Gestational Age (Fetal Age - Week 4):



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The formation of the lungs, jaw, nose and palate begin now. The hand and feet buds have webbed-like
structures that will become the fingers and toes. The brain is continuing to form into its complex parts. A
vaginal ultrasound could detect an audible heartbeat at this time. The embryo is about a ½ inch in length.

Week 7 - Gestational Age (Fetal Age - Week 5):
At 7 weeks gestation, every essential organ has begun to form in the embryo’s tiny body even though it still
weighs less than an aspirin. The hair and nipple follicles are forming, and the eyelids and tongue have begun
formation. The elbows and toes are more visible as the trunk begins to straighten out.

Week 8 - Gestational Age (Fetal Age - Week 6):
The ears are continuing to form externally and internally. Everything that is present in an adult human is now
present in the small embryo. The bones are beginning to form, and the muscles can contract. The facial features
continue to mature, and the eyelids are now more developed. The embryo is at the end of the embryonic
period and begins the fetal period. The embryo is about 1 inch long and is the size of a bean.

Weeks 9 thru 13 - Gestational Age (Fetal Age - Weeks 7 thru 11):
The fetus has grown to about 3 inches in length and weighs about an ounce. The genitalia have clearly formed
into male or female, but still could not be seen clearly on an ultrasound. The eyelids close and will not reopen
until the 28th week of pregnancy. The fetus can make a fist, and the buds for baby teeth appear. The head is
nearly half the size of the entire fetus.

Changes in Your Body

During the first three months of pregnancy, or the first trimester, your body undergoes many changes. As
your body adjusts to the growing baby, you may have nausea, fatigue, backaches, mood swings, and stress.
These things are all normal.

Most of these discomforts will go away as your pregnancy progresses. And some women might not feel any
discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each
woman is different, so is each pregnancy.

As your body changes, you might need to make changes to your normal, everyday routine. Here are some of
the most common changes or symptoms you might experience in the first trimester:

Tiredness

Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way
of telling you that you need more rest. After all, your body is working very hard to develop a whole new life.

Try these tips to ease exhaustion:

      Get at least eight hours of sleep every night, and a nap during the day when possible.
      When you are tired, rest or relax.
      Start sleeping on your left side. This will relieve pressure on major blood vessels that supply oxygen
       and nutrients to the fetus. If you have high blood pressure during pregnancy, it is even more important
       to be on your left side when you are lying down.
      If you feel stressed, try to find a way to relax.



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Nausea and Vomiting

Usually called "morning sickness," nausea and vomiting are common during early pregnancy. For many
women, though, it isn't limited to just the morning. Although it can seem like it will last forever, nausea and
vomiting usually go away after the first trimester.

Try these tips to help prevent and soothe nausea:

      Eat frequent, small meals (6 to 8 small meals a day) rather than 3 large meals. Avoid fatty, fried, or
       spicy foods.
      Try eating starchy snacks, like toast, saltines, cheerios, or other dry cereals when you feel nauseated.
       Keep some by your bed and eat something before you get out of bed in the morning. If you feel
       nauseous in the middle of the night, reach for these starchy foods. It's also a good idea to keep these
       snacks with you at all times, in case of nausea.
      Try drinking carbonated drinks like ginger ale or seltzer water in between meals.
      Ask your doctor if you should change prenatal vitamins if it seems to be making your nausea worse.
       Sometimes taking your prenatal vitamin at a different time (e.g. at night not in the morning) can also
       help.
      Ask your doctor about taking vitamin B6 for nausea and vomiting that doesn't get better with dietary
       changes.

If you think you might be vomiting excessively, call your doctor. If you lose too much fluid you might become
dehydrated. Dehydration can be dangerous for you and your baby.

For some women, the nausea of the first trimester is so severe that they become malnourished and dehydrated.
These women may have a condition called hyperemesis gravidarum (HG). HG refers to women who are
constantly nauseated and/or vomit several times everyday for the first 3 or 4 months of pregnant.

HG keeps pregnant women from drinking enough fluids and eating enough food to stay healthy. Many
women with HG lose more than 5 percent of their pre-pregnancy weight, have nutritional problems, and have
problems with the balance of electrolytes in their bodies. The persistent nausea and vomiting also makes going
to work or doing other daily tasks very difficult.

Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their
veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit
and feel nauseated throughout all three trimesters. Visit the Hyperemesis Education and Research (HER)
Foundation Web Site for more detailed information on HG.

Frequency of Urination

Running to the bathroom all the time? Early in pregnancy, the growing uterus presses on your bladder. This
causes frequent urination.

See your doctor right away if you notice pain, burning, pus or blood in your urine. You might have a urinary
tract infection that needs treatment.

Weight gain

During the first trimester, it is normal to gain only a small amount of weight, about one pound per month.

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Changes in Your Baby

By the end of the first trimester, your baby is about three inches long and weighs about half an ounce. The eyes
move closer together into their positions, and the ears also are in position. The liver is making bile, and the
kidneys are secreting urine into the bladder. Even though you can't feel your baby move yet, your baby will
move inside you in response to pushing on your abdomen.

Doctors Visits

During the early months of pregnancy, regular doctor visits (prenatal care) are especially important. Become a
partner with your doctor to manage your care. Keep all of your appointments — every one is important!

During the first prenatal visit, you can expect your doctor or nurse to do the following:

      ask about your health history including diseases, operations, or prior pregnancies
      ask about your family's health history
      do a complete physical exam
      do a pelvic exam with a Pap test
      order lab tests
      check your blood pressure, urine, and weight
      figure out your expected due date
      answer your questions

Get more details on prenatal care.

1st Trimester Tests and Procedures

For special genetic or medical reasons, you may need other lab tests, like blood or urine tests, cultures for
infections, or ultrasound exams in the first trimester. Your doctor will discuss them with you during your
visits.

The most common tests recommended in the first trimester include:

Nuchal translucency screening (NTS)

This new type of screening can be done between 11 and 14 weeks of pregnancy. It uses an ultrasound and
blood test to calculate the risk of some birth defects. Doctors use the ultrasound exam to check the thickness of
the back of the fetus' neck. They also test your blood for levels of a protein called pregnancy-associated plasma
protein and a hormone called human chorionic gonadotropin (hCG). Doctors use this information to tell if the
fetus has a normal or greater than normal chance of having some birth defects.

In an important recent study, NTS found 87% of cases of Down syndrome when done at 11 weeks of
pregnancy. When NTS was followed by another blood test done in the second trimester ( maternal serum
screening test), 95% of fetuses with Down syndrome were identified.

Like all screening tests, the results are sometimes misleading. In 5% of women who have NTS, results show
that their babies have a high risk of having a birth defect when they are actually healthy. This is called a false
positive. To find out for sure if the fetus has a birth defect, NTS must be followed by a diagnostic test like
chorionic villus sampling or amniocentesis .
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NTS is not yet widely used. If you are interested in NTS, talk to your doctor. If she is unable to do the test, she
can refer you to someone who can. You should also call your insurance company to find out if they cover the
cost of this procedure. NTS allows women to find out early if there are potential health problems with the
fetus. This may help them decide whether to have follow-up tests.

Chorionic villus sampling (CVS)

CVS is performed between 10 and 12 weeks of pregnancy. In CVS, the doctor inserts a needle through the
abdomen or inserts a catheter through the cervix to reach the placenta. The doctor then takes a sample of cells
from the placenta. Experts use this sample to look for problems with the baby's chromosomes. This test cannot
find out whether your baby has open neural tube defects. About 1 in 200 women have a miscarriage as a result
of this test.

The Second Trimester




Weeks 14 thru 16 - Gestational Age (Fetal age - Weeks 12 thru 14):
The fetus’s skin is transparent and a fine hair called lanugo begins to form on the head. The fetus begins
sucking and swallows bits of amniotic fluid. Fingerprints which individualize each human being have now
developed on the tiny fingers of the fetus. Meconium is made in the intestinal tract and will build up to be the
baby's first bowel movement. Flutters may be felt in the mom’s growing abdomen as the fetus begins to move
around more. Sweat glands have developed, and the liver and pancreas produce fluid secretions. The fetus has
reached 6 inches in length and weighs about 4 oz.




Weeks 17 thru 20 - Gestational Age (Fetal Age - Weeks 15 thru 18):
The baby has reached a point where movements are being felt more often by the mom. The eyebrows and
eyelashes grow in and tiny nails have begun to grow on the fingers and toes. The skin of the fetus is going
through many changes and begins to produce vernix at the twentieth week. Vernix is a white pasty substance
that covers the fetus’s skin to protect it from amniotic fluid. A fetal heartbeat could be heard by a stethoscope
now. The fetus has reached a length of 8 inches and weighs about 12 oz.

Weeks 21 thru 23 - Gestational Age (Fetal Age - Weeks 19 thru 21):
Lanugo now covers the fetus’s entire body. The fetus is beginning to have the look of a newborn infant as the
skin becomes less transparent while fat begins to develop. All the components of the eyes are developed. The
                                                                                                                 21
liver and pancreas are working hard to develop completely. The fetus has reached about 10-11 inches in length
and weighs about 1 - 1 ¼ lbs.




Weeks 24 thru 26 - Gestational Age (Fetal Age - Weeks 22 thru 24)- Beginning the third trimester:
If your baby was delivered now, it could survive with the assistance of medical technology. The fetus has
developed sleeping and waking cycles and mom will begin to notice when each of these takes place. The fetus
has a startle reflex, and the air sacs in the lungs have begun formation. The brain is developing rapidly over
the next few weeks. The nervous system has developed enough to control some functions. The fetus has
reached about 14 inches in length and weighs about 2 ¼ lbs.

Changes in Your Body

Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay
informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable
changes to your body are now happening. Your abdomen will expand as you gain weight and the baby
continues to grow. And before this trimester is over, you will feel your baby beginning to move!

Many of the aches and pains you had in the first trimester may continue. So remember to follow the tips from
Pregnancy Basics to help prevent and ease these discomforts.

Some of the following aches and pains may make their first appearance during the second trimester:

      Pain in the abdomen, groin, and thighs
      Backaches
      Shortness of breath
      Stretch Marks
      Skin Changes
      Tingling in hands and fingers
      Itching on the abdomen, palms, and soles of the feet — Call your doctor if you have nausea, loss of appetite,
       vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem
       called cholestasis of pregnancy.

Weight Gain

Everyone gains weight at different rates. On average, it is normal to gain about one pound per week, or about
three to four pounds per month during this trimester.

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Changes in Your Baby

By the end of the second trimester your baby will weigh about 1 3/4 pounds and be about 13 inches long. With
this growth comes the development of fingers, toes, eyelashes, and eyebrows. Around the fifth month, you
might feel your baby move! By the end of this trimester, all of your baby's essential organs like the heart,
lungs, and kidneys are formed.

2nd Trimester Tests and Procedures

During the second trimester, you should continue to see your doctor for
prenatal care. Most pregnant women have monthly office visits with their
doctor or midwife until the end of this trimester.

During the second trimester your doctor can use an ultrasound to see if
your baby is developing in a healthy way and to find out your baby's sex.
You will also be offered screening tests to look for genetic birth defects.

Birth defects result from problems with a baby's genes, inherited factors
that are passed down from the mother and the father at conception.
Genetic birth defects sometimes occur in people with no family history of that disorder. Women over the age
of 35 have the greatest chances of having a baby with birth defects.

Some of the diagnostic and screening tests your doctor might suggest in the second trimester include:

Amniocentesis

This test is performed in pregnancies of at least 16 weeks. It involves your doctor inserting a thin needle
through your abdomen, into your uterus, and into the amniotic sac to take out a small amount of amniotic
fluid for testing. The cells from the fluid are grown in a lab to look for problems with chromosomes. The fluid
also can be tested for AFP. About 1 in 200 women have a miscarriage as a result of this test.

Chorionic villus sampling (CVS)

This test is performed between 10 and 12 weeks of pregnancy. The doctor inserts a needle through your
abdomen or inserts a catheter through your cervix in order to reach the placenta. Your doctor then takes a
sample of cells from the placenta. These cells are used in a lab to look for problems with chromosomes. This
test cannot find out whether your baby has open neural tube defects. About 1 in 200 women have a
miscarriage as a result of this test.

Maternal serum screening test

This blood test can be called by many different names including multiple marker screening test, triple test,
quad screen, and others. This test is usually given between 15 and 20 weeks of pregnancy. It checks for birth
defects such as Down syndrome, trisomy 18, or open neural tube defects. Doctors take a sample of your blood.
They check the blood for 3 chemicals: alpha-fetoprotein (AFP) (made by the liver of the fetus), and two
pregnancy hormones: estriol and human chorionic gonadotropin (hCG). Sometimes, doctors test for a fourth
substance in the blood called inhibin-A. Testing for inhibin-A may improve the ability to detect fetuses with a
high risk of Down syndrome.

Higher levels of AFP are linked with open neural tube defects. In women age 35 and over, this test finds about
80% of fetuses with Down syndrome, trisomy 18, or an open neural tube defect. In this age group, there is a
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false positive rate (having a positive result without actually having a fetus with one of these health problems)
of 22%. In women under age 35, this test finds about 65% of fetuses with Down syndrome, and there is a false
positive rate of about 5%.

Targeted ultrasound

The best time to get a targeted ultrasound is between 18 and 20 weeks of pregnancy. Most major problems
with the way your baby is formed can be seen at this time. Some physical defects such as clubbed feet and
heart defects may not be seen.

Your doctor can also use ultrasound to see if your baby has any neural tube defects, such as spina bifida. In
most cases, if you want to find out the sex of your baby, you can ask your doctor during this test. This is not
the most accurate test for Down syndrome. Only 1 in 3 babies with Down syndrome have an abnormal second
trimester ultrasound.




The Third Trimester

Weeks 27 thru 32 - Gestational Age (Fetal Age - Weeks 25 thru 30):
The fetus really fills out over these next few weeks, storing fat on the body, reaching about 15-17 inches long
and weighing about 4-4 ½ lbs by the 32nd week. The lungs are not fully mature yet, but some rhythmic
breathing movements are occurring. The bones are fully developed but are still soft and pliable. The fetus is
storing its own calcium, iron and phosphorus. The eyelids open after being closed since the end of the first
trimester.

Weeks 33 thru 36 - Gestational Age (Fetal Age - Weeks 31 thru 34):
This is about the time that the fetus will descend into the head down position preparing for birth. The fetus is
beginning to gain weight more rapidly. The lanugo hair will disappear from the skin, and it is becoming less
red and wrinkled. The fetus is now 16-19 inches and weighs anywhere from 5 ¾ lbs to 6 ¾ lbs.

Weeks 37 thru 40 - Gestational Age (Fetal Age - Weeks 35 thru 38):
At 38 weeks the fetus is considered full term and will be ready to make its appearance at any time. Mom may
notice a decline in fetal movement as the fetus is now filling the uterus with little room to move. The
fingernails have grown long and will need to be cut soon after birth. Small breast buds are present on both
sexes. The mother is supplying the fetus with antibodies that will help protect against disease. All organs are
developed, with the lungs maturing all the way until the day of delivery. The fetus is about 19 - 21 inches in
length and weighs anywhere from 6 ¾ lbs to 10 lbs.

You're in the home stretch! Start thinking about breastfeeding, learn to spot the signs of labor and get the facts
on cesarean sections.

      Changes in Your Body
      Changes in Your Baby
      Sleeping in the 3rd Trimester
      Doctors Visits
      Inducing Labor
      Deciding to Breastfeed or Bottle-Feed
      When to Call Your Doctor
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      More Fact Sheets and Resources

Changes in Your Body

Some of the same discomforts you had in your second trimester will continue. Plus, many women find
breathing even more difficult and notice they have to go to the bathroom even more often. This is because the
baby is getting bigger and it is putting more pressure on your organs. Don't worry, your baby is fine and these
problems will lessen once you give birth.

The following aches and pains often appear for the first time during the third trimester:

      Heartburn
      Swelling of the ankles, fingers, and face. If you notice any sudden or extreme swelling or if you gain a lot of
       weight really quickly, call your doctor right away. This could be a sign of preeclampsia or toxemia.
      Hemorrhoids
      Tender Breasts
      Trouble Sleeping

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural
process that helps the birth canal (vagina) to open during the birthing process. Your doctor can check your
progress with a vaginal exam.

Weight Gain

Everyone gains weight at different rates. On average, it is normal to gain about one pound per week, or three
to four pounds per month, during the third trimester. By the end of your pregnancy you should have gained,
on average, about 25 to 30 pounds. About 7 1/2 pounds of that weight should be the baby.

Changes in Your Baby

Your baby is still growing and moving, but now it has less room in your uterus. Because of this, you might not
feel the kicks and movements as much as you did in the second trimester. During this final stage of your
pregnancy, your baby is continuing to grow. Even before your baby is born it will be able to open and close its
eyes and might even suck its thumb.

As your body prepares for birth, the baby will start to move into its birth position. You might notice the baby
"dropping," or moving down lower in your abdomen. This can reduce the pressure on your lungs and rib cage,
making it easier to breathe.

At birth, the average baby is 20 to 22 inches long and weighs 7 1/2 pounds. But newborns who weigh between
5 pounds, 11 1/2 ounces and 8 pounds, 5 3/4 ounces are considered healthy.

Sleeping in the 3rd Trimester

Your energy may lessen as you enter the ninth month. So you may begin to slow down. This is normal. It's
important to get enough rest now, even though it can be more difficult to sleep as you get larger. The baby's
movements, bathroom runs, and an increase in your body's metabolism can make sleeping difficult.

Try these tips for sleeping in the last three months of pregnancy:


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      avoid eating large meals three hours before going to bed
      do mild exercise like walking
      avoid taking long naps during the day
      talk with your partner, friends, doctor or midwife to relieve stress

When to Call Your Doctor



Before your due date, make sure to talk with your doctor about how to reach him or her if you go into labor.
It's also helpful to be familiar with the hospital or birthing center, where you should park, and where to
check in ahead of time. Know that sometimes you can think you're in labor, but really are not (called false
labor). This happens to many women, so don't feel embarrassed if you go to the hospital certain that you
are in labor, only to be sent home! It's always better to be seen by a doctor as soon as possible once labor
has begun. Here are the signs of true labor:Signs of Labor
      Contractions at regular and increasingly shorter intervals that also become stronger in intensity.
      Lower back pain that doesn't go away. You might also feel premenstrual and crampy.
      Your water breaks (can be a large gush or a continuous trickle) and you have contractions.
      A bloody (brownish or blood-tinged) mucous discharge. This is the mucous plug that blocks the cervix.
       Labor could be at any time, or days away.
      Your cervix is dilating (opening up) and becoming thinner and softer (also called effacement). During a
       pelvic exam, your doctor will be able to tell if these things are happening.



 Why Should You Attend Lamaze Childbirth Classes?

Women have always prepared for the birth of their babies. Until recent times, women learned about childbirth
from their own mothers and sisters. Birth took place at home, and family rituals and traditions ensured that
women were confident in their ability to give birth -- surrounded by family and wise women who provided
comfort and encouragement through labor. Lamaze attempts to recreate this experience.

 What Is Covered In Lamaze Classes?
True Lamaze classes today focus on much more than just the "breathing." Most Lamaze
teachers concentrate class time on normal labor, birth, and on the many choices that
expectant parents have today regarding their childbirth experience. Pregnant women and
their partners practice various positions, which will facilitate the normal progress of labor
and birth. Partners and other support persons learn massage techniques (fig. 1) to ease the
pain of labor and enhance relaxation.

Comfort measures such as hydrotherapy, the use of heat and cold, and pressure are
                                                                                                    figure 1
discussed. Much time is spent on relaxation skills, including breathing strategies and skills
(fig. 2), which can be used throughout life in times of stress. Communications skills are
practiced -- both for the pregnant woman with her partner or other support person, and for
the pregnant woman with the other members of the health care team. Class members
discuss what they would like for the childbirth experience and what they can do to help
make that experience happen.

 Are Common Problems That Arise During Labor Discussed?                                             figure 2

                                                                                                               26
Yes. Some time is spent on problems that occur during labor and birth and what the pregnant woman and her
partner might need to know. Information is provided about anesthesia and medical procedures so that women
can make informed choices about what is appropriate for their particular experience. Fear is reduced by
learning what happens during labor and birth, and confidence is increased by learning skills which help the
pregnant woman to manage the pain and stress of labor and birth. New innovations in maternity care are
discussed, such as the benefits of a doula or professional labor support. Most classes also spend time on
getting breast-feeding off to a good start, other aspects of the postpartum period, and making the most of
shortened stays in the birthplace.

                                   Common Pregnancy Myths
Pregnancy myths may vary from generation to generation and from region to region. Myths your
grandmother in Texas claims are true might be different from what your uncle in Alaska believes. Here are a
few of the most common pregnancy myths:


Myth: Standing on your head after sex can increase your chances of becoming pregnant.



Truth: Although some experts say that lying down after sex for 20 to 30 minutes can boost your chances of
conception because it keeps the sperm inside you, standing on your head has not been proven to aid in
conception (and you might hurt your neck while trying to do it!).


Myth: The shape and height of your belly can indicate your baby's sex.



Truth: The popular belief that women carrying boys carry low and that women carrying girls carry high just
isn't true. The shape and height of your belly is determined by your muscle tone, uterine tone, and the position
the baby is in. That's why someone may think you're having a boy because you're carrying low, when actually
the baby just dropped lower into the pelvis because you're closer to delivery. So, what's the most accurate way
to determine your baby's sex? Talk to your doctor about getting an ultrasound.


Myth: Fetal heart rate can indicate your baby's sex.



Truth: A normal fetal heart rate is between 110 and 160 beats per minute (bpm), although some people think if
it's faster (usually above the 140 bpm range) it's a girl and if it's slower it's a boy. But there have been no
studies that conclusively show that heart rate is a predictor for a baby's gender. Your baby's heart rate will
probably differ from prenatal visit to prenatal visit anyway - depending on the age of the fetus and activity
level at the time of the visit.


Myth: The shape and fullness of your face during pregnancy can indicate your baby's sex.



Truth: Every woman gains weight differently during pregnancy, and every woman experiences different skin
                                                                                                              27
changes. If people tell you that because your face is round and rosy you're having a girl, they might be right -
but it's just as likely that they're wrong!


Myth: If you experience heartburn during pregnancy, your baby will be born with lots of hair.



Truth: Because it's extremely common throughout pregnancy, heartburn isn't an accurate predictor of whether
your baby will be born with lots of hair.


Eating for Two: Weight Influences on Pregnancy

Weight gain during pregnancy helps your baby grow. Gaining weight at a steady rate within recommended
boundaries can also lower your chance of having hemorrhoids, varicose veins, stretch marks, backache,
fatigue, indigestion, and shortness of breath during pregnancy.

Why is weight gain important during pregnancy?
The extra weight you gain during pregnancy provides nourishment to your developing baby and is also stored
for breastfeeding your baby after delivery.

Where does all the extra weight go?
Here is an approximate breakdown of your weight gain:

        Baby = 7-8 pounds
        Placenta = 1-2 pounds
        Amniotic fluid = 2 pounds
        Uterus = 2 pounds
        Maternal breast tissue = 2 pounds
        Maternal blood = 4 pounds
        Fluids in maternal tissue = 4 pounds
        Maternal fat and nutrient stores = 7 pounds

How much total weight should I gain?
The amount of weight you should gain depends on your weight before pregnancy. You should gain:

        25-35 pounds: If you were a healthy weight before pregnancy.
        28-40 pounds: If you were underweight before pregnancy.
        15-25 pounds: If you were overweight before pregnancy.

At what rate should I gain weight during my pregnancy?
How much you should gain depends on your weight before you were pregnant and how far along you are in
your pregnancy.

        Healthy Weight Before Pregnancy:
               3-5 pounds during the first trimester

                                                                                                               28
               Approximately 1-2 pounds per week in the second trimester
               Approximately 1-2 pounds per week in the third trimester
        Underweight Before Pregnancy:
              5-6 pounds or more in your first trimester; this also can depend on how underweight you
         were before pregnancy & your health care provider's recommendations
               1-2 pounds per week in the second and third trimesters
        Overweight Before Pregnancy:
               Approximately 1-2 pounds in the first trimester
               Approximately 1 pound per week during the last six months
The goal is to keep weight gain as steady as possible because your baby requires a daily supply of nutrients
throughout your pregnancy that comes from what you eat. It is okay for your weight gain to fluctuate a little
from week to week. However, you should contact your health care provider if you suddenly gain or lose
weight, especially in your third trimester. This could be a sign of preeclampsia.

What if I am carrying twins?
If you are pregnant with twins, your appropriate weight gain should be monitored by your health care
provider. Weight gain should increase significantly (35-45 pounds) but will not double.

Does being underweight pose any risks to me or my baby?
Due to morning sickness, many women have trouble gaining weight in the first trimester and worry about
what effects this has on their baby's development. Some women loose a little weight in the beginning of their
pregnancy. Fortunately, at this time the baby does not need as many calories and nutrients as later in
pregnancy. It is important to gain weight at a steady pace throughout pregnancy. If a woman does not gain
weight throughout pregnancy, complications such as a low-birth weight infant or premature delivery could
occur. Babies who are born to mothers who do not gain more than 20 pounds are often considered small for
gestational age (SGA) meaning they may have been malnourished during pregnancy.

Healthy Eating During Pregnancy:
A sensible meal plan that is rich in vitamins and minerals are essential for a developing baby. You may want to
ask your health care provider for food recommendations or seek the help of a dietician in your area.

Women who are underweight during pregnancy tend to eat low-calorie foods and not enough protein. The
following are ways to get more calories:

        Eat breakfast every day. Peanut butter or a slice of cheese on toast can give you an extra protein boost.
        Snack between meals; yogurt and dried fruits can provide protein, calcium, and minerals.
      Try to eat a little more food each day that are high in good fats such as nuts, fatty fish, avocados, and
     olive oil.
     Drink juices that are high in vitamin C or beta carotene, such as grapefruit juice, orange juice, papaya
     nectar, apricot nectar, and carrot juice.
        Avoid junk food
        Consult your health care provider about taking prenatal vitamins

Can gaining too much weight be harmful?
The following are potential problems with gaining too much weight:

                                                                                                                   29
      Gestational diabetes
      Backaches
      Leg pain
      Increased fatigue
      Varicose veins
      Increased risk of Cesarean delivery
      Hight blood pressure

Do I really need to take a prenatal vitamin?
If you're very tuned in to nutrition and regularly eat a broad range of foods, including meat, dairy products,
fruits, vegetables, grains, and legumes, your diet will provide almost all the nutrients you and your baby need.
Realistically, though, most women — especially those in the throes of morning sickness — can benefit from
taking a prenatal vitamin and mineral supplement, preferably before they start trying to conceive. Think of it
as an insurance policy to make sure you're getting the right amount of certain important nutrients during
pregnancy.

And women with certain health issues, dietary restrictions, or pregnancy complications definitely need to take
a prenatal vitamin. This includes vegetarians and vegans, women who are lactose-intolerant or have certain
other food intolerances, smokers and women who abuse other substances, women who are having twins or
higher multiples, and women with certain blood disorders and certain chronic diseases.

What's in a vitamin supplement that I can't get from food?
If you're a stickler for nutrition, you may already be doing a pretty good job of getting what you need, but
there are two crucial nutrients that most pregnant women don't get enough of from food alone:

Folic acid
Taking a supplement is the only way to make sure you're getting the amount of folic acid you need each day.
All medical authorities recommend a daily dose of 400 micrograms (mcg) starting at least a month before you
begin trying to get pregnant and at least 600 mcg a day once you know you're pregnant. (And that's in
addition to the folic acid you get from food, which is actually not as easy for your body to absorb as the
synthetic kind in a supplement.) Research has shown that doing this can reduce the risk of neural tube defects
in your baby by up to 70 percent.

Most prenatal vitamins contain between 600 and 1,000 mcg of folic acid. If you don't take one, make sure you
still take a separate folic acid supplement. If you've previously had a baby with a neural tube defect, you'll
need to take 4,000 mcg, or 4 milligrams, of this vitamin every day, starting at least a month before conception.
See your practitioner about getting a prescription for pills that provide this larger dose.

Iron
A prenatal supplement can also help you get enough iron. Most women don't get enough of this mineral in
their diet to meet their body's increased needs during pregnancy. That's because your body makes a lot more
blood when you're pregnant to support your growing baby, and as a result, the iron stores in your blood can
get spread pretty thin. To avoid developing iron-deficiency anemia during pregnancy, most women need to
take a supplement.

The amount recommended when you're pregnant is 27 milligrams (mg) of iron per day, 50 percent more than
you need when you're not pregnant. The Centers for Disease Control recommends that all pregnant women
start taking a low-dose iron supplement of 30 mg at the first prenatal visit, either as an individual supplement
or in a prenatal vitamin. Most prenatal vitamins contain between 27 and 60 mg of iron. (Be sure to keep your

                                                                                                               30
pills out of reach of children; supplemental iron can be fatal to them.)

Some women need to take even more during pregnancy. After reviewing your prenatal blood work, your
caregiver will let you know if you need to boost your iron intake. Women with iron-deficiency anemia are
usually advised to take between 60 and 120 mg of iron each day in addition to a prenatal vitamin that contains
iron. If you're not yet pregnant but already know you're anemic, your caregiver may suggest that you start
taking an iron supplement now.

Is there anything that I won't get in a prenatal supplement?
Calcium is one of the nutrients that you won't find a full day's supply of in your prenatal vitamin and mineral
supplement. Most prenatal vitamins contain between 100 and 200 milligrams (mg) of calcium, but some don't
contain any. That's because calcium is a particularly bulky mineral, and the pills are already big enough!

The amount of calcium you need during pregnancy is about 1,000 mg per day — the same amount you need
when you're not pregnant. (If you're 18 or younger, you need 1,300 mg per day.) But it's even more crucial that
you get the recommended amount during pregnancy because you'll need to replace the calcium your growing
baby is getting from your own bones. Skimping on calcium now increases your risk for osteoporosis later in
life.

Luckily, there are many ways to get this mineral. For example, a cup of milk and a container of yogurt each
contain about 300 to 350 mg. If you can't stomach dairy products, you can get your calcium from separate
supplements. Some of the chewable ones taste pretty good. Look for them near the vitamins in your drugstore.

Prenatal vitamins don't contain any essential fatty acids either. DHA, an omega-3 fatty acid, is important for
the development of your baby's brain, nerve, and eye tissue. The recommended intake of DHA during
pregnancy is 300 mg a day — the amount you'd get if you ate about 5 to 10 ounces of cold water fish, such as
salmon or trout, every week — but few Americans get that much from their diet. Ask your healthcare provider
if she thinks you could benefit from a DHA or other omega-3 supplement.

WHAT IS FOLATE?

Folate is a B group vitamin found in leafy green vegetables, wholegrain breads, cereals and legumes (peas,
dried beans and lentils). It is also available in tablet form as folic acid.


WHO NEEDS FOLATE?

All women - especially those women planning a pregnancy.

As many pregnancies are unplanned, all women of reproductive age should make sure that they have a folate
rich diet or take a folic acid tablet each day. However, folate will only help in preventing spina bifida or other
neural tube defects in babies if it is being taken at the time of conception and for the first twenty-eight days of
pregnancy, or until the neural tube has completely formed.

A folate rich diet based on a wide variety of vegetables, fruit, legumes, wholegrain breads and cereals is a
healthy way of eating for everyone. This way of eating can help prevent heart disease, some cancers, diabetes
and other diseases.


HOW MUCH FOLATE IS NEEDED BEFORE AND EARLY IN PREGNANCY?


                                                                                                                 31
For most women as a rule, it is necessary to have about 0.4mg to 0.5mg (milligrams) of folate each day. This
can be obtained by eating a folate rich diet (consult your doctor, nutritionist or genetic counsellor), and/or
taking a low dose folic acid tablet (0.5mg) available from chemists, health food stores and supermarkets.

         The addition of folate to certain foods in Australia has been permitted since June 1995. This has been
          gradually introduced since that time and a number of cereals, breads and juices are supplemented with
          folate. Check labels to identify food sources of folate.


Stages of Labor

Going through the birth of your child is a wonderful and unique experience. No two deliveries are alike and
there is no way to tell how your delivery is going to be. What we can tell you is the stages you will go through
during this process and what you can generally expect. Childbirth can be broken into three stages:

First stage: Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.

Second stage: Continues after the cervix is dilated to 10 cm until the delivery of your baby.

Third stage: Delivery of your placenta.

First Stage:
The first stage of labor is the longest and is broken down into three phases:

Early labor phase: Starts from the onset of labor until the cervix is dilated to 3 cm.

Active labor phase: Continues until the cervix is dilated to 7 cm.

Transition phase: Continues until the cervix is fully dilated to 10 cm.

Each phase is full of different emotions and physical challenges. It is one big adventure you are about to take
and we would like to give you a guide for it.

Early Labor Phase:
What to do:

During this phase you should just relax. It is not necessary for you to rush to the hospital. It might be nicer for
you to spend this time at home, in familiar territory. If it is during the day you should do daily simple routines
around the house. Keep yourself occupied but still conserve some of your energy. Drink plenty of water and
eat small snacks. Keep track of the time of your contractions.

If it is during the night it is a good idea to try and get some sleep. If you can’t fall asleep, do things that will
distract you like cleaning out your closet, packing your bag, or making sack lunches for the next day.

What to expect:

         Duration will last about 8-12 hours
         Your cervix will efface and dilate to 3 cm
         Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest in between contractions

                                                                                                                       32
      Contractions are typically mild, somewhat irregular, but progressively stronger and closer together
      Contractions may feel like aching in your lower back, menstrual cramps, and pressure or tightening in
     the pelvis area
      Your water may break; also known as amniotic sac rupture (this can happen any time within the first
     stage)

Second Stage:
The second stage of childbirth is pushing and delivery of your baby. Up until this point your body has been
doing all the work for you. Now that your cervix has fully dilated to 10 cm it is time for your help. Time to
PUSH!

Pushing and what to expect:

      The entire process of the second stage lasts anywhere from 20 minutes to 2 hours
      Contractions will last about 45-90 seconds with a 3-5 minute rest in between
      You will have a strong natural urge to push
      You will feel strong pressure at your rectum
      Most likely you will have a slight bowel or urination accident but don't be embarrassed
      Your baby's head will eventually crown (become visible)
      You will feel a burning, stinging sensation during crowning
      During crowning you will be instructed by your healthcare provider not push
Pushing and what to do:

      Get into a pushing position (one that uses gravity to your advantage)
      Push when you feel the urge, unless told otherwise
      Relax your pelvic floor and anal area (Kegel exercises can help)
      Rest between contractions so you can regain your strength
      Use a mirror so you can see your progress (this can be very encouraging!)
      Use all your energy to push
      Do not feel discouraged if your baby's head poked out and then goes back in (this process can take
     two steps forward and then one step back)
Tips for the support person:

      Help her to be relaxed and comfortable (give her ice chips if you can and support her in her position)
      Encourage, encourage, encourage
      Be her guide through her contractions
      Affirm what a great job she has done and is doing
      Don't feel bad if she tells you to shut up or some other unexpected remark
What your baby is doing:

While you are in labor your baby is taking steps to enter this world.



                                                                                                                33
1. Your baby's head will turn to one side and the chin will automatically rest on the chest so the back of the
head can lead the way.

2. Once you are fully dilated, your baby's head leads the way and the head and torso begin to turn to face your
back as they enter your vagina.

3. Next you your baby's head will begin to emerge or "crown" through the vaginal opening.

4. Once your baby's head is out, the head and shoulders again turn to face your side. This position allows your
baby to easily slip out.

Delivery and what to expect:

When your baby is delivered, he/she is not going to come out looking like the Gerber Baby. Keep in mind
your baby has been soaking in a sac full of amniotic fluid for nine months. He/she has been through
contractions, and your very narrow birth canal. The results of this journey include:

      Cone-shaped head
      Vernix coating (cheesy substance that coats the fetus in the uterus)
      Puffy eyes
      Lanugo (fine downy hair that cover the shoulders, back, forehead, and temple that will shed by the
     end of the first week)
      Enlarged genitals
 Internal electronic fetal monitoring: An internal monitor can only be used once your "water has broken"
 and your cervix has dilated enough. A small clip is placed on the baby's scalp to directly monitor the fetal
 heart rate.




Episiotomy
An Episiotomy is a surgical incision occasionally necessary to enlarge the vaginal opening to help deliver your
baby.

What are some circumstances that would require an episiotomy?
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An episiotomy may be needed for any one or more of the following reasons:

      Birth is imminent and your perineum hasn't had time to stretch slowly
      Your baby's head is too large for your vaginal opening
      Your baby is in distress
      You need a forcep or vacuum assisted delivery
      Your baby is in a breech presentation and there is a complication during delivery
      You aren't able to control your pushing

How is an episiotomy performed?
If you have already had an epidural, you will probably not need any further anesthetic. Otherwise, a local
anesthetic in your perineum, known as a pudendal block, will be necessary.

The mediolateral cut is angled down, away from the vagina and the perineum, into the muscle. The midline cut
is performed by cutting straight down into the perineum, between the vagina and anus.

How can I prevent the need to have an episiotomy?
The following are preventive measures to lessen the chances of needing this surgical incision:

      Good nutrition (healthy skin stretches more easily!)
      Kegels (exercise for your pelvic floor muscles)
      A slowed second stage of labor where pushing is controlled
      Warm compresses and support during delivery.
      Use perineum massage techniques
      Avoid lying on your back while pushing

Can episiotomies be harmful?
The following are potential side effects of an episiotomy:

      Infection
      Bruising
      Swelling
      Bleeding
      Extended healing time
      Painful scar which may necessitate a period of abstinence from sexual intercourse.
      Future problems with incontinence

What are some pain relief options for episiotomies and tears?
If you have an Episiotomy, or tearing, you may want to try some of the following to help ease the pain.

      Cold packs on the perineum. Ask your health care provider about special maxi pads that have built in
     cold packs.
      Take a sitz bath. Portable baths that you place over a toilet to let warm water cover the wound.
      Use medication such as Tucks Medicated Pads.
                                                                                                             35
         Use a personal lubricant, such as KY Jelly when you resume sexual intercourse.
          Wash with a squirt bottle instead of wiping after using the bathroom. Pat dry, instead of wiping can
         also help.

What if I want to avoid having an episitomy?
Clearly state on your pre-admission paperwork at the hospital, that you wish an episiotomy not be done
unless absolutely necessary.

Assisted Vaginal Delivery

There are times when it is necessary to help the delivery along using forceps or a vacuum extractor. Forceps
resemble two large salad spoons, and the doctor uses them to guide the baby's head out of the birth canal.
Vacuum extraction uses a soft plastic cup that is applied to the baby's head and stays in place by suction. There
is a handle on the cup that allows the doctor to use this to assist with delivery through the birth canal. The
choice between using forceps or a vacuum extractor is usually made by the doctor.




These methods are sometimes used during:

         Signs of fetal distress
         Prolonged second stage labor
         A difficult delivery due to the baby's position
         The mother is too tired to push, or has a medical problem that makes it dangerous for her to push

The second stage of labor can take a long time, and it may be tempting to ask for a little help with a vacuum or
forceps. But studies suggest that the safest route, for your bottom and for your baby, is to deliver without a
vacuum or forceps. Assisted delivery is associated with more severe tears and more urinary and bowel
problems for mom. Moreover, babies delivered with vacuums or forceps may have bump or bruises from their
hasty exit through the birth canal. That's why your health care provider will not use forceps or vacuum unless
there's a compelling reason to help speed up delivery.

                                                                                                                  36
When applied properly, forceps or vacuum deliveries rarely cause any permanent injury to the baby. The
forceps' marks on the baby's cheeks usually disappear in a few days. Very rarely, the baby's facial nerves may
be temporarily injured. The resulting drooping of facial muscles almost always recovers completely in a matter
of weeks. Caput succedaneum is diffuse swelling of the scalp due to molding after prolonged labor. A vacuum
delivery may leave a more noticeable caput. Caput usually disappears in 2-3 days.




Third Stage:
The third stage is the delivery of the placenta and is the shortest stage. The time it takes to deliver your
placenta is anywhere from 5 to 30 minutes.

What to expect & what to do:

After the delivery of your baby, your healthcare provider will be waiting for small contractions to begin again.
This is the signal that your placenta is separating from the uterine wall and ready to be delivered. Pressure
may be applied by massage to your uterus; and the umbilical cord may be gently pulled on. The result will be
the delivery of your placenta, also known as afterbirth. You may experience some severe shaking and
shivering after your placenta is delivered. This is common and nothing to be alarmed about.

You have now completed all the stages of childbirth and will be monitored for the next few hours to make sure
that the uterus continues to contract and bleeding is not excessive.

Now you can relax and enjoy your little bundle of joy!

CONGRATULATIONS!!!!!

                                                      Facing downward
                                                      This baby is in the occiput anterior position, the most
                                                      preferable — and common — fetal position. With the face
                                                      down and turned slightly to the side, the smallest part of
                                                      the baby's head leads the way through the birth canal. The
                                                      back of the baby's head is ready to enter the pelvis.




                                                                                                               37
Facing upward
This baby is in the occiput posterior position, with the face
up toward the mother's abdomen. In this position, a baby
can't extend his or her head out from under the pubic bone
— which makes delivery more difficult. Intense back labor,
with the greatest discomfort in the lower back, is possible.
Most babies eventually turn on their own, if there's enough
room. Sometimes, changing positions can help rotate the
baby. Your health care provider may suggest getting on
your hands and knees with your buttocks in the air. If that
doesn't work, your health care provider may try to rotate
the baby manually by reaching through your vagina and
using his or her hand as a wedge. Sometimes, forceps can
be used to help the baby rotate.
Buttocks first
This baby is in the frank breech presentation — head
facing the top of the uterus and buttocks facing the birth
canal with both legs folded up over the body. Also known
as the pike position, it's the most common type of breech
presentation. Caesarean section is often the safest way to
deliver these babies.




Feet first
This baby is in a complete breech presentation — head
facing the top of the uterus, legs crossed and feet facing the
birth canal. It's also known as the cannonball position.
Babies in this presentation are delivered by Caesarean
section due to potential problems with the umbilical cord.




                                                           38
                                                     Dangling feet
                                                     This baby is in the least common breech position — a
                                                     footling presentation. One or both feet dangle below the
                                                     buttocks, leading into the birth canal. These babies are
                                                     delivered by Caesarean section as well.




                                                     Lying sideways
                                                     This baby is in a transverse lie — positioned horizontally
                                                     across the uterus, rather than vertically. If one of the baby's
                                                     shoulders is pointing toward the birth canal, it's known as
                                                     a shoulder presentation.
                                                     Less than 1 percent of babies begin labor in a sideways
                                                     position. If the position lasts, the baby must be delivered
                                                     through Caesarean section.




After pregnancy, signs of depression may also include being afraid of hurting the baby or oneself and not
having any interest in the baby.

What is the difference between “baby blues,”postpartum depression, and postpartum psychosis?

The baby blues can happen in the days right after childbirth and normally go away within a few days to a
week. A new mother can have sudden mood swings, sadness, crying spells, loss of appetite, sleeping
problems, and feel irritable, restless, anxious, and lonely. Symptoms are not severe and treatment isn’t needed.
But there are things you can do to feel better. Nap when the baby does. Ask for help from your spouse, family
members, and friends. Join a support group of new moms or talk with other moms.

Postpartum depression can happen anytime within the first year after childbirth. A woman may have a
number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and
worthlessness. The difference between postpartum depression and the baby blues is that postpartum
depression often affects a woman’s well-being and keeps her from functioning well for a longer period of time.
Postpartum depression needs to be treated by a doctor. Counseling, support groups, and medicines are things
that can help.

Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1000 births and usually begins in the first 6 weeks
postpartum. Women who have bipolar disorder or another psychiatric problem called schizoaffective disorder
have a higher risk for developing postpartum psychosis. Symptoms may include delusions, hallucinations,
sleep disturbances, and obsessive thoughts about the baby. A woman may have rapid mood swings, from
depression to irritability to euphoria.
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What steps can I take if I have symptoms of depression during pregnancy or after childbirth?

Some women don’t tell anyone about their symptoms because they feel embarrassed, ashamed, or guilty about
feeling depressed when they are supposed to be happy. They worry that they will be viewed as unfit parents.
Perinatal depression can happen to any woman. It does not mean you are a bad or “not together” mom. You
and your baby don’t have to suffer. There is help.

There are different types of individual and group “talk therapies” that can help a woman with perinatal
depression feel better and do better as a mom and as a person. Limited research suggests that many women
with perinatal depression improve when treated with anti-depressant medicine. Your doctor can help you
learn more about these options and decide which approach is best for you and your baby. The next section
contains more detailed information about available treatments.

Speak to your doctor or midwife if you are having symptoms of depression while you are pregnant or after
you deliver your baby. Your doctor or midwife can give you a questionnaire to test for depression and can also
refer you to a mental health professional who specializes in treating depression.

Here are some other helpful tips:

      Try to get as much rest as you can. Try to nap when the baby naps.

      Stop putting pressure on yourself to do everything. Do as much as you can and leave the rest!

      Ask for help with household chores and nighttime feedings. Ask your husband or partner to bring the
       baby to you so you can breastfeed. If you can, have a friend, family member, or professional support
       person help you in the home for part of the day.

      Talk to your husband, partner, family, and friends about how you are feeling.

      Do not spend a lot of time alone. Get dressed and leave the house. Run an errand or take a short walk.

      Spend time alone with your husband or partner.

      Talk with other mothers, so you can learn from their experiences.

      Join a support group for women with depression. Call a local hotline or look in your telephone book for
       information and services.

      Don’t make any major life changes during pregnancy. Major changes can cause unneeded stress.
       Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your
       new situation ahead of time.

How is depression treated?

There are two common types of treatment for depression.

      Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn to change how
       depression makes you think, feel, and act.

      Medicine. Your doctor can give you an antidepressant medicine to help you. These medicines can help
       relieve the symptoms of depression.


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Women who are pregnant or breastfeeding should talk with their doctors about the advantages and risks of
taking antidepressant medicines. Some women are concerned that taking these medicines may harm the baby.
A mother’s depression can affect her baby’s development, so getting treatment is important for both mother
and baby. The risks of taking medicine have to be weighed against the risks of depression. It is a decision that
women need to discuss carefully with their doctors. Women who decide to take antidepressant medicines
should talk to their doctors about which antidepressant medicines are safer to take while pregnant or
breastfeeding.

What effects can untreated depression have?

Depression not only hurts the mother, but also affects her family. Some researchers have found that depression
during pregnancy can raise the risk of delivering an underweight baby or a premature infant. Some women
with depression have difficulty caring for themselves during pregnancy. They may have trouble eating and
won’t gain enough weight during the pregnancy; have trouble sleeping; may miss prenatal visits; may not
follow medical instructions; have a poor diet; or may use harmful substances, like tobacco, alcohol, or illegal
drugs.

Postpartum depression can affect a mother’s ability to parent. She may lack energy, have trouble
concentrating, be irritable, and not be able to meet her child’s needs for love and affection. As a result, she may
feel guilty and lose confidence in herself as a mother, which can worsen the depression. Researchers believe
that postpartum depression can affect the infant by causing delays in language development, problems with
emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps
if the father or another caregiver can assist in meeting the needs of the baby and other children in the family
while mom is depressed.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and
their children. Don’t suffer alone. If you are experiencing symptoms of depression during pregnancy or after
having a baby, please tell a loved one and call you doctor or midwife right away.




Abruptio Placenta (Placental Abruption):
       The placenta has started to separate from the uterine wall before the baby is born.


Amniotic Fluid:
       This protective liquid, consisting mostly of fetal urine and water, fills the sac surrounding the fetus.


APGAR :
       A measurement of the newborn's response to birth and life outside the womb. The ratings, APGAR, are
       based on Appearance (color), Pulse (heartbeat), Grimace (reflex), Activity (muscle tone), and
       Respiration (breathing). The scores, which are taken at 1 & 5 minutes following birth, range from 10 to
       1, with 10 being the highest and 1 being the lowest.


Breech Presentation:
       When the fetus is positioned head up to be born buttocks first or with one or both feet first.


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Cephalopelvic Disproportion(CPD):
       The baby is too large to safely pass through the mother's pelvis.


Cervidil:
       A medication used to ripen the cervix before induction.


Cesarean:
       An incision through the abdominal and uterine walls for extraction of the fetus; it may be vertical or
       more commonly, horizontal. Also called abdominal delivery; commonly called C-Section.


Colostrum:
       This is a thin, white fluid discharged from the breasts in the early stage of milk production, and usually
       noticeable during the last couple weeks of pregnancy.


Complete Breech:
       The baby's buttocks are presenting at the cervix, but the legs are folded “Indian style,” making vaginal
       delivery difficult or impossible.


Contraction:
       The regular tightening of the uterus, working to push the baby down the birth canal.


Crowned/Crowning:
       When the baby's head has passed through the birth canal and the top or “crown” stays visible at the
       vaginal opening.


Dilation:
       The extent to which the cervix has opened in preparation for childbirth. It is measured in centimeters,
       with full dilation being 10 centimeters.


Effacement:
       This refers to the thinning of the cervix in preparation for birth, and is expressed in percentages. You
       will be 100% effaced when you begin pushing.


Engaged:
       The baby's presenting part (usually the head) has settled into the pelvic cavity, which usually happens
       during the last month of pregnancy.


Epidural:


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         A common method of anesthesia used during labor. It is inserted through a catheter which is threaded
         through a needle, into the dura space near the spinal cord.


Episiotomy:
         An incision made to the perineum to widen the vaginal opening for delivery.




Fetal Distress:
         Condition when the baby is not receiving enough oxygen or is experiencing some other complication.


Fontanelle:
         Soft spots between the unfused sections of the baby's skull. These allow the baby's head to compress
         slightly during passage through the birth canal.


Forceps:
         Tong shaped instrument that may be used to help guide the baby's head out of the birth canal during
         delivery.


Frank Breech:
         The baby's buttocks are presenting at the cervix and the baby's legs are extended straight up to the
         baby's head.


Incontinence:
         Inability to control excretions. Urinary incontinence can occur as the baby places heavy pressure on the
         bladder.


Induced Labor:
         Labor is started or accelerated through intervention, such as placing prostaglandin gel on the cervix,
         using an IV drip of the hormone oxytocin (Pitocin), or by rupturing the membranes.


Jaundice:
         Condition in newborn babies, reflected in yellowing of the skin, caused by the immature liver's
         inability to process excess red blood cells.


Labor:
         Regular contractions of the uterus that result in dilation and effacement of the cervix.


Lightening:
                                                                                                                  43
        When the baby drops in preparation for delivery (Engagement).


Meconium:
        This is the greenish substance that builds up in the bowels of a growing fetus and is normally
        discharged shortly after birth.


Neonatalogist:
        A specialist who cares for newborns.


NICU:
        Acronym standing for Neonatal Intensive Care Unit.


Nubain:
        Synthetic narcotic pain reliever commonly used in labor and delivery.


Oxytocin:
        Hormone secreted by the pituitary gland that stimulates contractions and the milk-eject reflex. Pitocin
        is the synthetic form of this hormone.


Perineum:
        The muscle and tissue between the vagina and the rectum.


Phenergan:
        A sedative administered that also controls nausea and vomiting.


Placenta:
        The tissue that connects the mother and fetus to transport nourishment and take away waste.


Placenta Previa:
        When the placenta partially or completely covers the cervix.


Posterior:
        The baby is in a face-up position during delivery. Normal presentation is anterior which is face down.


Post Partum:
        The period after childbirth.


Post-Term:
                                                                                                              44
       Pregnancy lasting more than 42 weeks.


Preterm:
       Babies born earlier than 37 weeks.


Prostaglandin Cream:
       Medication used to ripen the cervix before induction.


Ruptured Membranes:
       Usually refers to the breaking of the fluid filled sac surrounding the baby. The fluid may come as a
       gush of water or as a slow leak. Slow leaks are sometimes mistaken as incontinence.


Speculum:
       An instrument used to open the vagina slightly wider so that the cervix can be seen more easily.


Timing Contractions:
       Contractions are measured from the beginning of one contraction until the beginning of the next
       contraction.


Transverse:
       Baby's body length is horizontal in the uterus. If the baby cannot be moved, it will have to be delivered
       by cesarean .


Umbilical Cord:
       The cord that transports blood, oxygen and nutrients to the baby from the placenta.


Vacuum Extractor:
       Instrument that attaches to the baby's head and helps guide it out of the birth canal during delivery.

Labor Induction

What is labor induction?
Sometimes, if labor hasn't started on its own, doctors use medicines to make a woman's labor start so she can
deliver her baby vaginally. This is called "labor induction."

Why would my doctor recommend labor induction?

The most common reason for labor induction is that the pregnancy has gone 2 weeks or more past the due
date. The baby may get too big if you carry it this far past your due date. It may not be able to get enough food
from inside your body. Your doctor might also recommend labor induction if:

      Your water breaks before you go into labor.
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      You have high blood pressure.
      You have a serious infection.
      You have diabetes.

How will my doctor induce my labor?

There are several ways to induce labor. Toward the end of pregnancy, the cervix (the opening to the uterus, or
womb) gets soft. It may even open up a little. Your doctor will check to see if your cervix is getting soft and
opening up. If it isn't, your doctor may put a medicine in your vagina near the cervix. The medicine helps your
cervix get soft and open up.

Your doctor may also "break your water" or use a finger to separate your cervix from the membranes (tissues)
around your baby's head. This often makes labor start.

Your doctor will watch you closely. When you're ready, your doctor will start giving you a medicine called
oxytocin (one brand name: Pitocin). Oxytocin will start your contractions and help them to get strong and
regular.

Are there any risks to labor induction?
One risk is that the medicine might not work. If your labor won't start with medicine, you might need to have
a cesarean section (also called a "C" section). Or the medicine might make your contractions too strong. If this
happens, your doctor might stop the medicine and wait for a while, or do a cesarean section. If your labor is
induced because of medical problems, there might be other risks.

What can I expect during labor induction?

Sometimes it takes 2 or 3 days to induce labor, but it usually takes less time. It takes more time if you're being
induced really early or if it's your first baby. Don't eat very much before you come to the hospital. Remember
that the medicines for labor induction can give you very strong contractions and might upset your stomach.
Tell your doctor if you need help with the pain. In most cases, labor induction goes well and you can deliver
your baby vaginally.

What are the Reasons that Cesarean Deliveries are Performed?
There are many reasons why a health care provider may feel that you need to have a cesarean delivery. Some
cesareans occur in critical situations, some are used to prevent critical situations and some are elective.

Placenta previa: This occurs when the placenta lies low in the uterus and partially or completely covers the
cervix. 1 in every 200 pregnant women will experience placenta previa during their third trimester. The
treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been
diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal
delivery may be an option.

Placental abruption: This is the separation of the placenta from the uterine lining that usually occurs in the
third trimester. Approximately 1% of all pregnant women will experience placental abruption. The mother will
experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with
oxygen getting to the baby and depending on the severity, an emergency cesarean may be performed.

Uterine rupture: In approximately 1 in every 1,500 births the uterus tears during pregnancy or labor. This can
lead to hemorrhaging in the mother and interfere with the babies oxygen supply. This is a reason for
immediate cesarean.

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Breech position: When dealing with a breech baby, a cesarean delivery is often the only option, although a
vaginal delivery can be done under certain circumstances. However, if the baby is in distress or has cord
prolapse (which is more common in breech babies) a cesarean is necessary. A cesarean may also be done if the
baby is premature.

Cord prolapse: This situation does not occur often but when it does an emergency cesarean is done. A cord
prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is
born. When the uterus contracts it causes pressure on the umbilical cord which diminishes the blood flow to
the baby.

Fetal distress: The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects
a problem with the amount of oxygen that your baby is receiving, then an emergency cesarean may be
performed.

Failure to progress in labor: This can occur when the cervix has not dilated completely, labor has slowed
down or stopped, or the baby is not in an optimal delivery position. This can be diagnosed correctly once the
women is in the second phase (beyond 5 centimeters dilation), since the first phase of labor (0-4 centimeters
dilation) is almost always slow.

Repeat cesarean: You may be surprised to find out that 90% of women who have had a cesarean are
candidates for a vaginal birth after cesarean for their next birth (VBAC). The biggest risk involved in a VBAC is
uterine rupture, which happens in 0.2-1.5% of VBACs. However, there is a criteria you must meet in order to
have a VBAC. Consult with your health care provider about your current situation and your options.

Cephalopelvic Disproportion (CPD): A true diagnosis of CPD occurs when a baby's head is too large or a
mother pelvis is too small to allow the baby to pass through.

Active genital herpes: If the mother has an active outbreak of genital herpes (diagnosed by a positive culture
or actual lesions), a cesarean may be scheduled to prevent the baby from being exposed to the virus while
passing through the birth canal.

Diabetes: If you develop gestational diabetes during your pregnancy or are diabetic, you may have a large
baby or other complications. This increases your chance of having a cesarean.

Preeclampsia: Preeclampsia is a condition of high blood pressure during pregnancy. This condition could
prevent the placenta from getting the proper amount of blood needed and decrease oxygen flow to the baby.
Delivery is sometimes recommended as a treatment for this condition. Only with severe preeclampsia is a
cesarean needed.

Birth defects: If a baby has been diagnosed with a birth defect, a cesarean may be done to help reduce any
further complications during delivery.

Multiple births: Twins may be delivered vaginally depending on their positions, estimated weights and
gestational age. Multiples of three or more are less likely to be delivered vaginally.




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