All About Your Pregnancy - Free Handbook

Pregnancy Handbook Whether you are pregnant or thinking of becoming pregnant, it is important to know what changes you can expect for your body, your skin, your well-being, and your attitude and the attitudes of those around you. We have put together a comprehensive guidebook chock full of information to help you along through this very important time in your life. For more in-depth information on Pregnancy, check out our 50 page comprehensive and informative Pregnancy Handbook below , or download your free copy at: www.fairlightcosmetics.com This informative guide contains information on Pregnancy including: What to Expect Through Each Trimester First Days with your New Baby Working While Pregnant & Hazards in the Workplace 10 Tips for Working While Pregnant Traveling While Pregnant Bodily Changes While Pregnant Skin Care While Pregnant Skin Care Products Safe to Use While Pregnant Pregnancy Handbook What to Expect Through Each Trimester First Days with your New Baby Working While Pregnant - Tips & Hazards in the Workplace 10 Tips for Working While Pregnant Traveling While Pregnant Bodily Changes While Pregnant Skin Care While Pregnant Go to top of page What to Expect for Each Trimester The First Trimester (1-13 Weeks) Your first office visit will be to confirm your pregnancy, make sure the pregnancy is in the uterus, and that the baby's heart is beating. Your past medical history will be taken and reviewed by your Doctor. Your office visits will be less frequent during the first 28 weeks, then the interval will increase during the last 12 weeks of pregnancy. You may receive ultrasounds of the baby at your office visits to determine general parameters of the baby's growth. This is not to test for any birth defects or other genetic disorders. Go to top of page Medicines during pregnancy It is advised that you do not take medicines until you are 13 weeks pregnant, except prescribed Vitamins, Tums, Calcium, Iron or Surfac. If you are on any daily prescription medicines please discuss them with your Doctor. During your pregnancy you should not take aspirin or aspirin products, unless prescribed by your Doctor. In most cases you may take Tylenol or Extra Strength Tylenol. Avoid during entire pregnancy: Aspirin Aleve Nuprin Advil Motrin Safe medicines* : Cough Robitussin Pain Tylenol/Acetaminophen Antihistamine/Decongestant Afrin Nasal Spray (No longer than 2 days) Benadryl Sudafed/Actifed Antacids Maalox Mylanta Digel Gelusil Riopan Anit-Gas Mylicon 80 Milk of Magnesia Stool Softener Colace Metamucil or similar Surfac Diarrhea Kaopectate Hemorrhoids Preparation H Anusol Nausea Phenergan Emetrol *These medicines have been shown to be safe, and are approved for pregnancy by the FDA. If you take these for more than 2-3 days please notify your Doctor. If you take routine medicine routinely, please notify your Doctor. Your Doctor will review it on an individual basis. Vitamins are prescribed to supplement a balanced diet. Iron supplements are prescribed to be taken twice a day. You may usually use any over the counter Iron that is 50-65 meq. of Iron. Slow Fe has a stool softener in it. Surfac, Colace, or Metamucil will help mild constipation. Notify your Doctor if constipation persists for more than 2 days. Additional fluids and exercise will also help. If your prenatal vitamin makes you nauseated, stop taking them until you are finished with your first trimester. The nausea typically goes away at that time. Go to top of page Nausea and Vomiting in Pregnancy Mild symptoms do not have a negative effect on the fetus. Diet: small frequent meals complex carbohydrates before rising such as crackers, toast, or cereal have high protein snacks such as yogurt or nuts take fluids between meals rather than with meals sip carbonated beverages such as ginger ale or sprite in small amounts sip clear liquids such as: clear soups or broth, diluted Gatorade, jello water, ginger or any herbal tea with sugar, and popsicles. Helpful medications: Vitamin B6 50mg - one by mouth three or four times a day. Emetrol 15 ml - on arising, can repeat every three hours. Avoid: Coffee, alcohol, iron and vitamins, fried foods, high fat foods, spicy foods, dairy products. Additional rest periods during the day are encouraged. *Call your Doctor's office if you are unable to retain small amounts of liquids for 12 hours. Eat moderately! An additional apple a day - only. For a healthy pregnancy it is recommended that you gain no more than 35 pounds total. 3-4 pounds the first 12 weeks and 3-4 pounds the second 12 weeks, and 1/2 pound per week the last 12 weeks. pregnancy. You are encouraged to take the Calcium every day. Tums or Calcium supplements have been shown to lower and prevent BP problems in 5 to 10 regular Tums or 4 Tums 500. Please tell your Doctor if you have a house cat with a litter box. If you do it is recommended that you not change the litter box while you are pregnant. Do not dig in the garden during your pregnancy. When pregnant : Do not douche Do not drink alcohol Do not smoke Do not use drugs Go to top of page Bodily Changes What are the normal body changes that I feel while pregnant Your breasts will get larger and firmer. The areolae or dark areas around your nipples will get darker and may develop bumps in them. Veins in the breast may become more noticeable. At the 4th or 5th month your nipples may start giving off a clear or cloudy liquid. You may have to urinate (empty your bladder or pass water) more often. However, this may lessen during the middle months of pregnancy and then become more frequent toward the end of pregnancy. You may feel sick to your stomach during the first half of your pregnancy. Sometimes this is worse in the morning. Also, you may feel heartburn (a burning sensation in your chest). These discomforts can be helped by eating smaller meals and eating more often. For example, rather than eating three regular meals a day, try six small meals each day. Also try to snack on plain crackers (without butter) especially early in the morning before getting out of bed. Try getting more rest and drinking very hot or very cold liquids. For heartburn, try not to lie down for at least one hour after eating. Your moods may change. It is not unusual for a pregnant woman to feel happy one minute then sad soon after without an apparent reason. You may get tired more easily. You may notice pulling pains in your lower belly and hip areas. These are usually caused by the growth of your uterus. Your belly will get larger as your baby grows inside. You may notice skin changes such as stretch marks or striae (pinkish lines on your breasts or belly) later in the pregnancy and some brown blotches on your face. Creams, lotions or oils do not prevent these changes. However, after pregnancy the marks tend to fade and are less noticeable. We recommend TriReduction Basic Cream and Emu Oil for Stretch Marks You may get constipated and have to strain to have a bowel movement. Hemorrhoids (large blood vessels near the opening in your rectum) may develop. Constipation is best prevented or relieved by including more fiber in your diet. Foods such as fresh fruits, fresh vegetables and bran cereal are often helpful. Do not take laxatives unless this is first discussed with your physician. Surface is stool softener that is fine to take during pregnancy. You may experience changes in your legs such as cramps and possibly develop enlarged blood vessels (varicose veins). You may get acne and body hair increase. These are usually normal results of changes in the body's hormones during pregnancy. For acne, we recommend Pineapple Enzyme Scrub. What should I do if any of these changes happen? If they are bothering or worrying you, don't hesitate to let your Doctor know at your next visit. If you need it taken care of sooner, call your Doctor. Go to top of page Relationships with fathers Recently, there has been an increased interest on the part of fathers in the birth experience. There has also been a change in our society's attitude and now men are encouraged in their efforts to experience the pregnancy and childbirth. The pregnant woman experiences the physical changes taking place and is constantly reminded of impending parenthood. Often the man feels like an outsider and has difficulty relating to his changing role. The father needs to understand what is happening to the mother of his child, what effect this pregnancy will have on his relationship with her, and what the new baby will mean to both of them. Many men begin to worry about finances. There are the costs for the prenatal care and delivery at the hospital. He wonders if his salary is sufficient or will they also need hers. Sexual concerns often surface. The father may fear that sexual intercourse will somehow harm the developing child. Conflicting feelings regarding the pregnancy, physical difficulties, and a constant concern over how all this will effect their relationship contributes to much frustration. With others, there is a "fear of abandonment", that the child's birth will change his relationship with the mother and that perhaps she will no longer love him. It is very important that both parents openly discuss their feelings. They must come face to face with what is happening and how it is affecting them so they may make changes accordingly. Men who are well informed and attend childbirth classes to help with the birth of their child, often express their pride in their being there to "give birth". They often have tremendous feelings of importance. These men seem to be able to more readily accept the role of fathering and quickly become actively involved in all aspects of their child's care. When the father views pregnancy as a "growing" experience, he has the opportunity to gain a deep understanding of himself and the mother of his child. This can help make this period in their lives quite satisfying which may help smoothly pave the road into parenthood. Go to top of page A new baby and other children The arrival of a new baby is often the first real "crisis" in the life of a young child. There is no "right" time to tell the other children about another child coming. It all depends upon their ages, how long they may need to adjust to the news, and how comfortable you are discussing it with them at that time. It is important to tell them before you go to the hospital and before the baby is born. Each child will react in his own way depending upon how he views this "new addition" to the family. Children may feel threatened and react with behavior unlearned. They return to soiling their clothes, acting helpless, speaking baby talk, or acting hostile. It is best to help them view the situation positively. Encourage them to talk about some of the changes that may occur in the household with the arrival of the new baby. Encourage conversation from your children about their feelings. Allowing your children to help prepare for the new baby is often helpful. Perhaps taking them along on a shopping trip for baby items will help with their understanding and good feelings about the situation. Allow them to help around the house in new and different ways. They will usually appreciate the independence and enjoy their new feeling of importance. After the baby comes, be sure to set aside time especially for your older children, so they won't feel neglected. Young children need constant reassurance that they are loved. Several hospitals now allow young children to visit the new baby soon after birth. The existence of "sibling visitation" programs may be a consideration in deciding which medical facility you might like to utilize when your baby is born. Many parents feel that involving the other children early with a new baby promotes family closeness and helps to avoid other possible problems with insecurity, jealousy and rivalry. You may want to think about "what is right" for your family and what is available in your community for providing you with the type of birth experience you desire. Please feel free to discuss with your Doctor any questions or concerns you may have regarding the adjustments of your other children to your new baby. Go to top of page Warning signs & hazards in early pregnancy For what problems should I call your Doctor right away, even at night or weekends? Bleeding from the vagina. Bad pains that do not quickly go away. Chills and fever. Vomiting that doesn't get better and if you are unable to hold down fluids. Burning or any trouble passing urine. Go to top of page What are the dangers of cigarettes, alcohol, caffeine and drugs? These things can damage your unborn baby. If you already smoke cigarettes or drink any alcohol, you will be given more information. It is best not to smoke or drink alcoholic beverages while you are pregnant. Some new information suggests caffeine in coffee, tea, many cola's and other soft drinks may be a cause of miscarriage (loss of babies early in pregnancy) or harm the growth of the baby. It is best to try to avoid or limit caffeine-containing drinks while you are pregnant. Discuss the amount with your Doctor. It is wise to check with your Doctor about the safety of any medication before taking it. But, if you are taking a medication necessary to your health, do not stop the medication without discussing it with your Doctor. As for drug store medicines you can buy without a prescription, please discuss these with us before taking them. Go to top of page Is it true that cats may carry a disease that could affect my baby while I am pregnant? Cats may carry a disease that is called Toxoplasmosis. This problem is rare but important, as it is rather easy to prevent. Even though it is rare, it has been known to cause very serious problems in newborn babies including mental retardation, growth failure, blindness and deafness. To prevent it, avoid changing or cleaning the cats litter box as the disease is usually spread to humans by cat droppings. Ask someone else to do this for you. Raw or poorly cooked meat (especially beef) is another cause of this disease. Cook all meat until it is well done and avoid eating raw beef in any form, including raw hamburger meat while you are pregnant. It is also important to wash your hands after handling raw meat. Other ways of preventing this problem are to wash fruits and vegetables before eating them and wearing gloves while gardening. Let your doctor know if you have eaten raw meat or handled cat droppings (litter box). Your Doctor will decide whether or not this is important. Go to top of page Seat belt in pregnancy Should I use seat belts during pregnancy? Yes! Your Doctor strongly recommends you use them for your baby's safety, as well as your own. Why are seat belts so strongly recommended during pregnancy? I have heard that they can be dangerous? Studies of pregnant women in car accidents have shown that you and your baby are much less likely to have injuries if you are wearing a seat belt. What kind of seat belts are recommended? The best is the combination of a lap plus a shoulder belt. If no shoulder belt is available, a lap belt, worn correctly, is better than no belt at all. What is the correct way to wear a seat belt while I am pregnant? The lap belt should be worn low around the hip bones and be kept as tight as is comfortable. The shoulder belt should be kept above the high point of the abdomen (belly), but low enough to avoid having it cross over your neck. Be sure to use the head rest to support your neck. It is important to keep good posture while traveling. If I am in an accident, what should I do? In anything more than a simple fender-bender, you should get checked by your Doctor as soon as possible. This is true even if you are not hurting as your baby could be affected. Your Doctor may decide to do some simple tests to be sure your baby is doing well. If any vaginal bleeding or contractions occur, call your Doctor immediately. Are you saying I should buckle up whenever I get into a car? Yes. Most accidents happen close to home so please don't save your best safety measures for long trips. Buckle yourself and your baby up every time you travel, even on the way home from the hospital. By not using your seat belt, you are taking the risk of hurting yourself or your baby. By buckling up you are doing the very best you can to avoid injury. Go to top of page Exercise in pregnancy Why is my doctor concerned about the kind of exercise I do during my pregnancy? Exercise makes you feel good and look good. Your physician wants to be sure you set up a safe exercise program. It is important that you know of any risks that could affect both you and your growing baby. If you provide your Doctor with accurate information about the kind of exercise, frequency, and intensity you are used to or would like, a satisfactory exercise program can be set up to carry you through pregnancy. What actually happens to my body during pregnancy that changes the way exercise affects both the baby and me? Your ligaments become easier to stretch. That is why you may feel a little wobbly just walking. It is easier to sprain something, like an ankle, or to pull a muscle. As your baby grows, your weight distribution is different, your center of gravity changes which may make it easier for you to lose your balance. Your ability to catch your breath (get enough oxygen), is decreased during exercise. Because of these changes in your breathing and circulation systems you may occasionally experience dizziness or weakness. Now, when you exercise, you will notice you don't have the aerobic capacity you did before. With some adjustments you can continue to enjoy exercising and return slowly, to your desired program after your baby is born and your body is ready. Are there times when I should not exercise all? Yes! Your Doctor may tell you to avoid exercise if you : 1. Have problems with early labor 2. Are excessively overweight or underweight. 3. Have blood pressure, heart, lung, or thyroid problems. 4. Have experienced vaginal bleeding during the pregnancy. 5. Are having problems with your baby's growth. 6. Are severely anemic. 7. Have leaking from your bag of water. 8. Have experienced #1, 3, 5, or 7 on the above list during a different pregnancy. How about some guidelines for safe exercising that I can use during my pregnancy? 1. Drink enough before exercising, even in the winter. 2. Warm up slowly, at least 5 minutes before starting. 3. Stretch, but not to your limit so as not to injure your ligaments. Remember, they are looser now. 4. Avoid exercises with jerky or bouncing motions. 5. Use a stable floor. Avoid loose rugs that may slide. 6. Exercise regularly (every other day), not just once in a while. 7. No competitive exercises. 8. Do not exercise during hot humid weather or if you have a fever. 9. Your body temperature should not go above 38 degree C. (101 degrees F.). Avoid the use of hot tubs and saunas. 10. After the 4th month, do not exercise lying down on your back. 11. No weight lifting or anything where you hold your breath and strain. 12. During pregnancy caloric intake is to be over and above your usual need. Adjust it to your level of activity. 13. Avoid strenuous exercise at altitude. How about things other pregnant women have found helpful? Choose exercise shoes that feel secure and help your balance. Support hose can help your legs feel better during and after exercise. Watch how you put your feet down, especially if you are planning to walk and there is ice outside. If you need to increase your bra size you might go right into a nursing bra if you plan to nurse, or you may need an athletic bra for more support during your workouts. Put your feet up with pride, this allows any swelling of your ankles to go down. Your body is working hard helping your baby grow, 24 hours a day! I've always wanted to take up a new sport, like tennis, I don't even look pregnant yet, is this a good idea? It is NOT a good idea to take up a new sport while pregnant. But you can begin something that is on the "good for pregnancy" list, that will give you a head start in beginning tennis after your baby is born. Some good sports are, Yoga (without breath holding), swimming, pregnancy classes, stationary bicycling (gently), easy stretching (but not to your limit), and don't forget about daily walking in fresh air! Truthfully, I am worried about gaining weight during this pregnancy, I like to exercise,can overdoing it cause any problems? There are several things to remember. Being pregnant is not being fat. Exercise does release a chemical into the body called "endorphins" which gives you that feeling of well being. Even with adjustments, your body will have that feeling of "well being". Lastly, gaining 20 to 30 lbs. is healthy. Your baby's size and health depends on this increased nutrition (but we don't mean candy, cola, and chips). You must normally INCREASE calories during exercise for your pregnancy and INCREASE calories and fluid over and above that for exercise. If you do not have enough calories, your body can go into a chemical state called ketosis which can cause developmental problems for your baby. If you don't get enough calories regularly during pregnancy your baby may not grow as well. If I stopped exercising regularly a few months ago, and want to start back up, what should I do? Begin very slowly with low intensity. Remember, even if you are in great shape, you will not be able to do what you did. Pregnancy is a special time and requires not lower goals, but special ones to help you and your growing child feel happy and stay well. What are the rewards of a sensible program? Your baby will be growing safely. You will feel and look good. After the birth of the baby it will make it easier to return to the exercise program of your choice. When should I stop exercising immediately and call my doctor? If any of the following happen to you, stop what you are doing and call your Doctor immediately: 1. Regular contractions. 2. Vaginal bleeding or leaking of fluid. 3. Blacking out of fainting. 4. Shortness of breath. 5. Pain. 6. Unusually fast heart beating that doesn't seem to pass. 7. Anything else that concerns you. Is it safe for me to use a sauna, spa, or hot tub? During the first 12 weeks of pregnancy, the high heat to the body from these activities may have as harmful effect on your baby. There is a very small possibility that the brain and spine areas of your baby may not form the right way. Avoid these activities until after the first 12 weeks of pregnancy. If you have already been in a hot area such as a sauna or hot tub during these first 12 weeks of pregnancy, let your Doctor and staff know now. You will be offered a blood test for alpha-fetoprotein around the fourth month of pregnancy that can help find out if your baby might have the type of problem mentioned above. More information on this test will be given to you. Go to top of page Weight and diet How much weight should I gain during pregnancy? The best amount to gain depends on how much you weighed right before you became pregnant. The doctor or staff will let you know if this weight is considered overweight, normal or underweight. If you are overweight the best amount to gain is 15 or so pounds. If you are normal the best amount to gain is between 25 and 40 pounds. If you were underweight the best amount to gain is between 28 and 40 pounds. Important: do not try to lose weight while you're pregnant. what problems can be caused by not gaining enough weight? There is a slightly higher chance of your baby being smaller than normal. This might lead to being delivered early. Small babies, whether born premature or at the due date, can still have serious problems after birth. To help lower the chances of having a small baby, try to gain the amount of weight recommended by your Doctor or nurse. What problems can be caused by gaining too much weight? The extra pounds will put more strain on your back and legs. Also being overweight can lead to serious medical problems for you such as high blood pressure and diabetes. The extra weight may stay with you after you deliver your baby. Breast feeding may help you lose the extra pounds, but this is not true for everyone. Even if you are overweight, do not try to lose weight while you are pregnant. What is a good diet to follow during my pregnancy? Your body needs a good balance of foods to keep you healthy and build a healthy baby. Try to eat regularly and not skip meals. Important parts of your daily diet should include : Protein at each meal from meat, chicken, fish, eggs, beans, milk, or cheese. Calcium, Vitamins A and D from a few glasses of milk each day (low fat is best). B Vitamins from whole wheat cereals, breads or noodles. Vitamin C from the fruit or juice of oranges or grapefruits. Other healthy additions to your diet are fresh fruits and vegetables. Butter, margarine or vegetable oils should only be used in moderation (these are empty calories). It is best to avoid "junk food" (candy, sodas, desserts) as they are very high in calories and filling but have few nutrients or vitamins. To keep from becoming constipated, it might be helpful to have high fiber foods like bran, bran cereals, breads, as well as fresh fruits and vegetables including salads. What about taking vitamins and iron pills? If you eat a balanced diet, the only extra things you may need are some iron and multi-vitamins with folic acid. Later in your pregnancy we may suggest you take an iron pill up to 3 times each day. Taking additional vitamins and supplements available over the counter may be harmful to your developing baby. Please check with us before taking other vitamins or medications. How far along is my baby? By the end of the third month your baby has formed all of it's vital organs such as the heart, lungs, and kidneys. Also formed are the arms, legs, and the head. The baby weighs about one ounce and is three inches long. In addition the placenta has formed. This is attached to the inside wall of the uterus (womb) on one side and to the umbilical cord on the other. The umbilical cord then goes on to attach to what will be the baby's belly button. Food or nutrition from your blood stream travels through the placenta into the blood stream in the umbilical cord and feeds your baby. Go to top of page The Second Trimester (13-28 Weeks) You will begin to feel more like yourself now. The morning sickness should have passed and you will begin to feel good. Your prenatal blood work will be drawn around the 16th week. Please ask a nurse when you will be 16 weeks, if you do not know. These laboratory tests must be performed at this time. A Trisomy profile will be included in this laboratory work and will identify if you are at increased risk for certain conditions. This is only a screening test and is not diagnostic if it comes back abnormal additional tests will be ordered. Patients may be asked to have a Level 2 Ultrasound. This is a more sophisticated Ultrasound, which shows more details of the baby. Your bladder should be comfortably full for the Ultrasound. If you bring a VCR tape you may be able to have the procedure taped for you. If you will be 33 years old or older at your expected time of delivery you may be referred for an amniocentesis. This is the time to choose your baby's pediatrician. If you already have a family doctor or pediatrician that you wish to use then let us know this physician's name so he or she can be notified when your baby is born. You can then ask any questions about that doctor's management of breast feeding, bottle feeding, well child care, insurance, office hours, etc. This will give you a chance to see if you feel comfortable with the medical management that this doctor offers. Fetal kick counts At 28 weeks you have become accustomed to your baby movements. Be aware of fetal movement through the day. Sick babies do not move. Count and keep track of your baby's movements. You will begin to see a pattern. You will need to count the baby's movement on the daily basis after 28 weeks. If the baby does not kick 10 times before 12 noon please call your Doctor immediately. A full day should never go by without feeling the baby move! Go to top of page General health care If I have a job, when should I stop working? Generally, you can work right up until the end of your pregnancy if you feel up to it. The only types of jobs that might be a problem are those where you work around certain chemicals or x-rays. If you have any questions ask your Doctor. What about exercise? Avoid sports where you might get hit in the belly. Otherwise you can continue the same activities as before pregnancy. Try not to push yourself to the point of becoming overtired. You may find that you have less strength and energy than before you became pregnant, but exercise is still good for you. Skiing is generally not a problem unless your pregnancy is considered High Risk, and then the general recommendation would be to avoid skiing. What about high altitude stays - above 8-9,000 ft? In non High Risk Pregnancies short stays (several days) at high altitude are generally not felt to be a significant problem. In High Risk Pregnancies high altitude exposes the mother and developing fetus to less oxygen and should be avoided whenever possible. Your physician will be happy to discuss your special problem with you. Go to top of page Can I continue regular sexual relations? Yes, as long as it is not causing you to have pain or bleeding. For certain problems, you may be told to avoid sex. Some women find that sex is more comfortable during pregnancy if they are on top or lying side to side. Feel free to ask your Doctor any questions about sexual relations during any of your prenatal visits. Can I travel during pregnancy? Yes. There are generally no problems with riding in a plane or taking auto trips. In case you will be away for more than a week or way from home near your due date, it is a good idea to get the name of a doctor or hospital in the area where you will be. Go to top of page What about dental care? Keep getting your regular dental check ups. Take good care of your teeth. Let your dentist know that you are pregnant before any x-rays are taken or any medicines are given to you. How should I take care of colds or small aches and pains? You can take acetaminophen (Tylenol or Daatril) for mild aches and pains. This is safer than aspirin. Don't take any other medicines without checking with us first. Please take your temperature and notify our office of any fever 1004 or greater. Go to top of page What about clothing? Wear comfortable clothes that are not tight on your belly. Flat heeled or broad heeled shoes are recommended. Use a bra that gives good support to your breasts. How far along is my baby? Your baby, by the 4th month, weighs about four ounces and is close to seven inches long. The head is the longest part of the body which now has completely formed eyes, ears, nose, and mouth. Sometime over the next month you should begin to feel the baby moving. At first this may feel like a faint, gentle fluttering in your belly. This movement is called "quickening". By the fifth month of pregnancy your baby is 12 inches long and weighs about one pound. Hair may be starting to grow on the head. Even though many important inside parts of the baby such as the heart and kidneys are well developed, the baby cannot survive outside the mother at this time. Go to top of page Trisomy or alpha-fetoprotein test (AFP) Why should I consider having this test done? This test is used to identify babies with a spine defect. Spine defects occur when the baby is growing inside the womb and doesn't form a complete covering around the major parts of the nervous system (Brain and Spinal Cord). The defect is usually called spina bifida. It may lead to various physical problems ranging from needing braces to walk, to severe handicaps including the inability to walk, as well as mental problems and even death. The AFP test is used to screen for this. AFP testing is routinely offered to all women who are pregnant. The decision to have the test done is the patients. In this country, the overall chance of having a child born with this defect is about one in one thousand (1:1000). However, if you, the baby's father, or any relatives have had a child with spina bifida, the chance goes up to 10 to 20 out of 1000 babies. If you or the baby's father actually have spina bifida, then the chances go up to 50 out of 1000. You should notify your physician if anyone in your family, including yourself, the baby's father, or other children have had spine defects. Remember, if you have had a child with anencephaly (where the brain and scalp do not develop normally), this is considered a type of spinal defect and should be reported to your physician. Even though there is an increased risk of having a child with a spine defect because of a family history, most of the children with spine defects are born to couples without a family history of this. how is the test done? The test involves a simple blood test, with blood taken from an arm vein at 16-18 weeks of pregnancy. If there is a history (either in the family, a previous pregnancy, or the parents) of a spine defect, genetic amniocentesis is a more appropriate test than the blood test. More testing is needed when high levels of AFP are found in the blood or amniotic fluid. Low levels of AFP can also be a sign that the baby has a problem and should be tested further. Why is the test done so early in pregnancy? The test is most accurate early in pregnancy. Early testing also lets us give you counseling about the choices open to you if a problem is found. These may include planning which hospital and medical staff will be needed for the pregnancy and delivery, or giving you appropriate counseling and offering termination (an abortion) of the pregnancy, but it cannot predict if your child will have a spine defect once you are past 22 weeks. This is why the test is not done after 22 weeks. Does an abnormal test always mean that the baby has a spine defect? No, there are other conditions that can cause an abnormal test. There are some normal conditions which cause an abnormal test including twins, not being as far pregnant as you thought you were, or nothing actually wrong with the baby. There are other things which can cause an abnormal test (high or low). These include some birth defects that have a high value, of Down syndrome (which was called a Mongoloid child in the past) which can have a low value. In any case, an abnormal test will require further testing to see if your baby has a spine defect or any of these problems. If you need to have these extra tests done, you will have a lot of worry and extra expense. This is the main reason why the decision to have this test done is left up to the patient instead of just doing it on everyone. After you have read this material, you should discuss any questions with your doctor or medical staff. What will be done if the test is abnormal? Your Doctor will explain the possible meanings of the abnormal test and order some further tests which may include a repeat AFP, ultrasonography and/or an amniocentesis to help discover the cause of the abnormal alpha-fetoprotein test. The decision of having these other tests done will be left up to you. Your physician will do the further testing or refer you to a specialist. Does the test always detect babies with these abnormalities? No test is absolutely foolproof. Rarely, this test can be normal even though you may be carrying a baby with a spine defect. Fortunately, this test is very good. Just by itself, it will detect 80% of all spine defects. With the test and a complete ultrasound, it can detect 90-95% of all spine defects. But remember, a normal result on this test does not guarantee a normal baby or a baby free of this or other birth defects. When will the results of the test be ready? Usually the results of the test are back by 1 week. Go to top of page Breast or bottle feeding Even though your delivery is months away, this is a good time to think about how you're going to feed your baby during the early months. Will you use breast milk or formula? What are the advantages of breast feeding? Breast feeding or nursing is unquestionably an excellent way to feed your baby. It can give you much pleasure to have your child in close contact with you during feedings, and of course, this contact gives much pleasure to your little one. Breast milk is the most easily digestible food that a baby can consume. In other words, it is very agreeable and is unlikely to cause spitting-up or any stomach problems. No special preparation is needed such as measuring and sterilizing and it's definitely cheaper than formulas. If asthma or allergies run in the family, it seems that breast feeding can cut down the chances of these happening in the baby. Breast milk contains antibodies that protect young babies against infections. They are made in your body and passed to your child in the breast milk. Breast feeding helps your body get back to it's normal size and shape. The baby's sucking stimulates the muscles of your uterus (which got stretched out during pregnancy) to return to normal. Breast feeding can help prevent overfeeding. Breast fed infants usually get just what they need during each feeding. There is sometimes a problem of bottle fed babies getting too many calories and gaining too much weight. Overweight babies often grow up to have weight problems. What are the problems with breast feeding? Almost any mother can breast feed her baby. Women with certain diseases or those taking certain medicines, may be told that they should not nurse. Your Doctor will discuss this with you. One of the greatest problems of breast feeding is a mother's fear that she can't do it. This is common, but with a little help and instruction these fears can be removed. If you think you want to breast feed, your Doctor will help you and give you information on how to prepare for it and how to handle problems that can come up during nursing. Some mothers think their breast size is too small. The part of the breast that makes milk has little to do with the breast size. Women with any size breasts or nipples should be able to nurse their children. Some mothers fear that breast feeding limits their freedom. Many women have gone back to full time jobs after having a baby and continued to nurse when at home. There are ways to save breast milk so it can be put into a bottle for use when the mother is not home. La Leche League is available 24 hours a day for support and questions. You can find their phone number in your local directory. What about bottle feeding? Some women may choose not to nurse their baby and, instead, desire to give them formula. Formula is safe and healthy. It is easy to buy. Most supermarkets and drugstores sell it. Formulas are easy to prepare. In fact some are already premixed so no preparation is needed. If you choose to bottle feed, it is important to remember a few things: 1. Keep bottles and nipples clean so germs don't get into the baby's milk. 2. Try to hold the baby close to you while giving the formula. This can help you and the baby build a closer relationship. Propping a bottle on a blanket, so the baby lies alone and drinks, is not a good habit and can be dangerous. Babies need and like close contact. 3. Always use formula for the entire first year of your baby's life. Using regular or low fat homogenized milk before your baby is a year old is not recommended and can lead to anemia or a low blood count in the baby. 4. Later during your pregnancy, more information will be given to you regarding the feeding of your baby. Go to top of page Involving your family in the pregnancy How might the baby's father be affected by my being pregnant? Often when a woman becomes pregnant, she begins experiencing different moods and concentrates on these feelings and on how her body is changing. These changes can make the father feel neglected. He most likely wants to be an important part of your life. He is probably having many concerns about the new baby. All these things can put some strain on your relationship. It is often helpful to talk about the feelings both of you are having about the new baby. Several other helpful things you can do are : Bring him with you for some of your prenatal visits. Let him feel the baby as it kicks and moves. Have him take childbirth classes with you. If you have more questions, ask one of the staff here. Sometimes the father does not seem interested in the upcoming baby or even worse, may seem angry. If this is a problem for you, please let your Doctor know so that he or she can help you better deal with it. How might my other children react to my pregnancy? Children, except for very young infants, usually notice that their mom and dad are going through something new. It is important to tell them that a new baby will be coming and explain how they can help take care of the new child. Let little ones practice diaper changing on a doll and let the older ones know how they'll be able to help take care of their new brother or sister. Let them feel the baby moving and kicking. Hospitals offer classes and tours of your Doctorry for siblings. They may get jealous because they think your new baby will be more important than they are. It doesn't hurt to remind them how much you love them and that they are just as important as the new baby. Preparing for the hospital If you have not yet discussed at which hospital you will deliver your baby, you should do this today. The phone numbers are located in the front of this book. It is a good idea to make a practice trip to the hospital at some time before actually going into labor. This way you can make sure you know the correct roads and how long the drive takes. Many hospitals will give you a tour of their labor and delivery area and tell you where in the hospital you should go, when you arrive for your child's birth. Even if they don't give a tour, check with them about all their general policies for labor, delivery, and postpartum care. If you have other children, you might want to make arrangements ahead of time for someone to watch them when you go to the hospital for the delivery. Go to top of page What will I need to bring with me to the hospital? Sometime during the month before your due date you might want to pack a suitcase of things, to take with you to the hospital. Some of the things you might want to bring are: bathrobe, slippers cosmetics 2 or 3 nightgowns nursing bras (if you plan to breast feed or otherwise just 2 good support bras) toothbrush, toothpaste hairbrush loose fitting outfit to wear home About all you'll need for the baby is a baby blanket, a sleeper or nightshirt and two diapers. If you are expecting cold weather, then make sure these items are heavy enough to keep the baby warm on the way home. Go to top of page Prepared childbirth What is prepared childbirth? A satisfying childbirth experience requires a lot of work from both your mind and your body. The best way to make each birth experience the best possible is to be prepared. You can become prepared by learning what to expect during labor and delivery, including the medications and anesthesia used. Also, it is important to know about caring for the new baby. By knowing what to expect and how to respond, the prepared woman can overcome fear and frustration. The woman and her partner, usually the baby's father, can then take an active part in the birth process. Fear is thought to be a factor in causing significant pain during childbirth. Reducing fear makes labor and delivery easier and the whole experience more enjoyable. Are there special classes? We feel the best way to prepare for childbirth is to take a series of classes. Unfortunately, there are many classes with different names that make for some confusion. Besides the term "prepared childbirth" you may come across the terms "natural childbirth", "childbirth without fear", "childbirth without pain", "conditioning for childbirth", "the Lamaze method", "childbirth and family life", and many more. All of these classes are directed toward education about and overcoming fear of childbirth. Almost always, hospitals that permit the father or "coaches" in the delivery room, require that the couple attend that hospital's parent classes. These may be given along with other prepared childbirth classes such as "Lamaze", or you may have to find classes through another organization. The phone numbers for these classes are located in the front of this book. Fetal monitoring What is fetal monitoring? This is a technique used to watch the pattern of your uterine contractions and the pattern of the baby's heartbeat. It is usually done during labor. Fetal monitoring allows us to detect certain problems. If such problems develop, the baby can usually be delivered by Cesarean Section to prevent birth complications. Will I be monitored? This depends on whether or not you have certain problems during your pregnancy (such as high blood pressure) or other problems during labor. Your Doctor will decide if it is needed. If you have an epidural your blood pressure will be monitored regularly until delivery of the baby. If you are monitored, don't get scared. It doesn't mean anything is going wrong. It's usually just a precaution to make sure you have a healthy baby. What is a nonstress test and an oxytocin challenge test? Sometime before you go into labor, you may be asked to have fetal monitoring done just to see if the baby is doing well. This special monitoring, called a nonstress test, is done while you are resting. An oxytocin challenge test is done with the administration of a medication called oxytocin which is given to you through an IV needle into a blood vessel in your arm. This medicine causes your uterus to contract. If these tests are normal, it usually means your unborn baby will do well for at least a week. Once you have a test done, it is usually repeated weekly until the baby is born. What if the monitoring is not normal? Your Doctor will probably want to get your baby delivered quickly. This may sometimes mean having a cesarean section. How is the monitoring done? It is done in the hospital. It can be done with external or internal monitors. The external ones are on two belts fastened around your waist. The internal monitors are the ones placed gently into the vagina and into the uterus next to the baby and onto the skin of the baby's scalp. Generally, monitoring is very safe. Go to top of page Signs of labor When should I expect to go to labor? Labor normally starts when your baby is full grown or as it is called "term". This can be as early as two weeks before your due date to as late as two weeks after your due date. If labor begins before the two weeks ahead of your due date, your baby can be born too early or premature. If it doesn't happen until after the two weeks following your due date, your baby can be born overdue or postmaturely. How will I know that I am in labor? Labor occurs when your uterus begins to tighten over and over again in an effort to push the baby out. This tightness or contractions are felt from the back which spread over the whole belly area. They last from about 45 to 60 seconds and occur about every 10 to 20 minutes. After an hour or two, these contractions usually become stronger and closer together. Sometimes a small amount of thick blood streaked mucous may come from the cervix, through the vagina during labor. This mucous plug is normal. Some women experience a sudden gush or slow leaking of clear fluid (amniotic fluid) from their vagina. This is the liquid that has surrounded and cushioned the baby so far. Usually this fluid is forced out toward the end of labor, but sometimes it occurs earlier. You should call your Doctor if this happens to you. What is false labor? These are pains, that are often felt in the low belly which don't follow a regular time pattern. They usually go away in a few hours. What should I do if i'm really in labor? First, use a clock to check how far apart the contractions are and how long they last. When they are strong and occurring about 10 minutes apart, call us and we will tell you the best time to go to the hospital. If you think you are in labor, don't eat or drink anything since it is possible that you may get sick to your stomach during labor. What if I'm supposed to have a cesarean section? Let your Doctor know as soon as your labor begins, since you will need to get to the hospital very soon and the Doctor will want to be ready for surgery when you arrive. What are the warning signs in labor that tell me I need to call the doctor or go to the hospital as soon as possible? Decreased fetal movement Vaginal bleeding Rupture of membranes (bag of water) Pain is not associated with uterine contractions Labor and delivery What happens when I get to the hospital? If you have visited and toured the hospital already, you will know where to go and you may have already pre-registered. If you do not already know the hospital's procedures, go directly to the labor and delivery section of the hospital. You will be admitted to the hospital and then taken to the room where you will spend the rest of your labor. This room may be a labor room or a birthing room. If it is a labor room, you will be moved to a delivery room shortly before the baby is born. If it is a birthing room, you will stay in this room when you deliver the baby. After you get to your room you will be asked to put on a hospital gown. Your temperature and blood pressure will probably be taken and your Doctor will listen to your baby's heartbeat. An internal exam may be done at this time to check the progress of your labor. This will be done several times while you are in labor. If needed, an IV may be started in order to give you fluids and medicine through a needle in the veins in your arm. If your Doctor has requested that your labor be monitored electronically, a monitoring device will be set up that checks the baby's heartbeat and your contractions. You can then rest while your contractions get stronger and your cervix begins to open up, or dilate. If the bag of water that surrounds the baby has not broken and the fluid has not leaked out, your Doctor may painlessly break the bag and allow the fluid to leak out so your labor can move faster. When your cervix has dilated all the way and the baby's head is beginning to push at the vaginal opening, you will be taken to the delivery room if you are not in a birthing room. You may be placed on a special table or bed almost like the one used for a pelvic exam at our office. Prior to the delivery your Doctor will usually prepare you for delivery by washing your pubic area. If an episiotomy is needed (a surgical cut to make the vaginal opening larger), it will be done at this time. Now you will help push the baby out. When the baby is out, the cord is cut and the baby is wiped off and wrapped in a blanket. The baby may then be placed on your belly, placed next to you, or may be put into a warmer. Finally the placenta comes out. Often a little pushing by you will help get it out. If an episiotomy was made, it will be sewn at this time. If your baby is delivered in a delivery room, you will be taken to a recovery room to rest and be watched for several hours. If your baby is delivered in a birthing room, you will remain in that room and be closely watched. At the same time, your baby will be taken to your Doctorry for observation. How long should labor last? It can take as long as a total of 20 hours. Most of the time is spent waiting for the gradual opening and enlargement of the cervix. Your first baby usually takes the longest, and the total time often gets shorter with each later pregnancy. Go to top of page The Third Trimester (28 Weeks - Delivery) During this time your baby will be gaining weight very fast. Car Seats The Hospitals will require you to take your baby home in a car seat. If you do not have one, you may rent one from the hospital . How to know when you are in labor 1. If you bleed more than a tsp. of blood. 2. When your contractions are five minutes apart for at lest one hour. 3. If your membranes rupture; you feel a gush of fluid. The vast majority of pregnancies are uncomplicated and end with the birth of a normal, healthy baby. Even when complications do occur, early diagnosis and treatment will often prevent serious problems. Go to top of page It is important that you notify your Doctor immediately of these early warning signs : Bleeding from the vagina, rectum, nipple, or from coughing Swelling or puffiness of the face or hands A sudden large weight gain Persistent severe swelling of the legs Severe or repeated headaches Dimness, blurred vision, flashes of light, or spots before you eyes Sharp or prolonged pain in your abdomen Severe or continued vomiting Chills and/or fever Sudden escape of fluid from the vagina A significant decrease in fetal movement Go to top of page How far along is my baby? By the eighth month your baby probably weighs between two to four pounds and is somewhere between 15 to 17 inches long. Most important, is that your baby is now able to survive outside of you, if you were to deliver. He or she would be very premature but could be helped to develop normally. Fetal development at term At the end of nine months (or at term) the average sized baby weighs about seven or seven and a half pounds. Your baby's length is approximately 20 inches. The skin is coated with a creamy coating and hair and fingernails are developed. By this time your baby should do well living outside the uterus, whenever that specific day comes. Go to top of page Patient instructions for induction of labor If Your Doctor has scheduled an induction of labor for you. The following is a list of directions that you should follow. As always any questions may be addressed to the Nursing Staff in Your Doctor's office. 1. Nothing to eat or drink after midnight the night before your induction day. You may brush your teeth in the a.m. but do not swallow any water. 2. Call the hospital Labor and Delivery Unit by 6:00 a.m. to see if you can come on in. 3. An induction of labor, unless an emergency is an elective procedure. This means that if the hospital can work you in they will. If for some reason all of the labor rooms are full they will cancel you and place you on the next available day. In most instances inductions are not done on the weekends. Sometimes the babies don't come on the first day of induction. 4. Sometimes the staff nurses in Labor and Delivery will ask that you wait a few hours and they will call you in when a room becomes available. If this should happen continue fasting and wait for their call. The hospital will notify your Doctor if they are unable to call you in. 5. As always, be watchful for fetal movement, bleeding, leaking of fluid, signs of labor, and if something "doesn't feel right". If these should occur while waiting, or at any other time, please call your Doctor immediately. Go to top of page For what problems should I call as soon as possible What are the problems for which I should call the doctor right away? Any bleeding from the vagina Chills and fever Sudden gush of water from the vagina or slow leak or fluid that is not urine Any unusual pains: in the head, chest, belly, or in any part of your body The baby is moving less A lot of swelling or puffiness in your legs, hands or face that doesn't go away after lying down. Go to top of page Episiotomy What is an episiotomy? An episiotomy is a surgical cut, which is made just before the baby is born, to make the vaginal opening larger. Why is an episiotomy done? As the baby is being born, the tissue and muscles in and near the mother's birth canal are often stretched, bruised, and torn. These tears may extend many different ways at once and even go down into the rectum. Tears usually have ragged edges which are very difficult to sew back together. An episiotomy is a straight cut and is easily sewn back together. Having an episiotomy is thought not only to prevent ragged-edged tears, but also is thought to prevent problems in later life. Is an episiotomy always done? The decision, as to whether or not an episiotomy is necessary, is made by your Doctor at the time of delivery. Episiotomies are nearly always done on mothers delivering for the first or second time as the tissue tends to be rather tight. Your Doctor's decision is also based on the size of your baby, it's position, and how your labor is moving along. Does it hurt? An episiotomy is usually done under some type of anesthesia. With some anesthesias the woman may still feel pressure from the baby. But she usually does not feel pain when the episiotomy cut is made. Several stitches, that do not need to be removed, are used to repair the cut. This incision may be tender and uncomfortable for the first few days after delivery, but it usually heals quickly and without any problems. What can be done to lessen the discomfort from the episiotomy? To decrease the discomfort, placing ice packs to the painful area of sitting in a tub of warm water several times a day may be helpful. Sprays that numb the skin are available. Bowel movements may be painful due to the incision. It is helpful to keep the bowel movements soft. This can be done by drinking lots of fluids, eating bulky foods such as raw fruits, raw vegetables, and bran cereal. Are there any risks? Occasionally an episiotomy may become infected, and antibiotics, pain medication, and sometimes removal of some of the stitches may be necessary. However, episiotomy infections are unusual. For what reason should I call my doctor? Be sure to call your Doctor if you are experiencing fever, having extreme pain, or notice foul smelling yellowish-white drainage from the area around the stitches. Be sure to call your Doctor if there is anything else about which you are concerned. Go to top of page Complications of labor and delivery What are some of the problems that can happen during labor and delivery? Most pregnancies will go well without any problems. However, it is good to be aware of some of the common problems that do occur. One thing that sometimes happens, is that the labor does not move along at a steady pace. It may even just stop. To help your contractions, your Doctor may give you a medicine called oxytocin. Oxytocin is the same chemical that your own body makes to cause labor. This medicine is adjusted to strengthen your contractions so your labor will move along. Another problem is that the baby's head may stop from moving out, before it reaches the opening of the vagina. Often, the baby can be helped out with forceps. These are metal instruments that carefully fit over the baby's head. The easiest way for babies to come out is head first. Sometimes the baby may be turned around with the rump (breech), legs, or arms coming first. Your Doctor will carefully decide in these situations whether to perform a cesarean section or try to deliver the baby through the vagina. Your safety and the baby's safety will be the most important factors in making such a decision. Go to top of page Cesarean section What is a Cesarean Section? This is an operation where the baby is delivered through an opening made in the lower belly area. Why it is done? Many of these operations are done because the woman has had a previous cesarean section. If you had one done for your last pregnancy, most doctors prefer to have all your other babies delivered by cesarean section. This is especially true if the first section was done because the baby couldn't fit through your pelvic area. Other cesarean sections are done when you and your baby may be in some danger. The cesarean section allows the baby to be delivered in minutes to prevent damage to you or the baby. How it is done? You usually will have an IV started to allow fluids and medicines to be given to you through a needle in your arm. Anesthesia will be used to prevent pain. You may be put to sleep (general anesthesia) or you may get medicine in the lower part of your spine (spinal or epidural anesthesia) which numbs your body from slightly above the waist and downward. The doctor will discuss these options with you. Your belly will be cleaned off and then a cut is made in the lower part of your belly and then through your uterus. The baby and placenta are removed. The cuts are sewn. When the baby is out, the cord is cut and the baby is cleaned up. The baby will be placed next to you for you to see and hold or may be put into a warmer. You will then be taken to a recovery room to rest and be watched for several hours. At the same time the baby will be taken to the nursery to be watched. What is general anesthesia? Many women do not want to be awake or know what is going on. General anesthesia consists of gases which are inhaled and circulated throughout the mother's body which make her go to sleep. She, then, wakes up when everything is all over. This type of anesthesia takes a short time to administer and has almost immediate effects. It may also be used if there is an emergency and not a moment to waste. what is epidural anesthesia? The anesthetic provides numbing of the body from the waist to the toes, while the mother remains awake. This is the type most frequently given for cesarean sections. A numbing medication, something similar to novacaine, is injected into the lower portion of the back which gradually causes the mother's lower part of her body to feel tingly, heavy, and eventually without any feeling or ability to move her legs. She feels no pain during delivery, but the feeling gradually returns in an hour or so. Are there any complications to a cesarean section? Since there is a cut made into the abdomen there is a chance that a bleeding problem may occur or an infection could develop. There are also certain problems that may occur because of the anesthesia used. Anesthesia will be discussed with you in greater detail later. However, should a problem develop, prompt treatment usually corrects the difficulty. Complications following cesarean sections are not common. Go to top of page Circumcision What is circumcision? Circumcision is a minor surgical procedure in which the foreskin is removed from the top of the penis. It is usually performed in the first few days of life by Special Pediatric Surgeons. This procedure has been performed for various reasons for quite some time. If you have a boy child, you will be asked before you deliver to make a decision on whether you want him circumcised. In order to make a decision, you may want to consider reasons for and against circumcision. What are the reasons for doing a circumcision? You should know that there is no absolute medical reason for removing the foreskin on a newborn baby. Males are born with a normally tight foreskin which cannot be pulled back. However, if the foreskin opening is too small to allow urine to flow easily, your sugeon may feel it necessary to have the foreskin removed. There are several other reasons for which circumcision is thought to be necessary. These include : 1. It is thought that it is easier to clean the penis when the foreskin is removed. With better hygiene, fewer infections occur. 2. Cancer of the penis may be less likely to develop in adults who are circumcised. 3. If the baby's brothers or father have been circumcised, you may want your new son to look the same as they do. What are some of the reasons for remaining uncircumcised? Many experts feel that good cleaning beneath the foreskin is very possible without circumcision. In that case, proper hygiene would prevent build up of secretions from which infections, ulcers, and ultimately cancer could occur. Since cancer of the penis is so rare, many physicians feel it is not worthwhile to do a circumcision for this reason alone. Are there any risk to the operation? There are some rare complications with circumcisions. These include bleeding, infection, and very rarely a deformity. Your Doctor will answer any questions you may have. When is circumcision performed? Most often it is performed in the first few days after birth, if the baby is healthy. Will the baby feel pain? Usually no anesthesia or painkiller is given for this short operation. The baby generally will become quite irritable and cry, but is quickly comforted afterwards, being held and offered something to drink. Aafter the operation, for what reasons should I notify my doctor? Some swelling is natural; as long as your baby continues to wet diapers there is no reason for alarm over this. Should there be any abnormal bleeding, signs of infection, or if there is anything about which you are concerned, do not hesitate to call your baby's doctor. Go to top of page Preparing to breast feed How can I prepare my breasts for nursing? Keep the skin around your nipples healthy. Avoid excess rubbing or stimulation since this might damage the skin. Your body will prepare your breasts for breast-feeding. Rubbing or stimulating your nipple can cause your uterus to contract, leading to a possibility of preterm labor if you are early in your pregnancy, or undue stress on the baby if you are near delivering. It's best to avoid using lotions or alcohol on your breasts. You can do normal cleaning of the breasts when bathing or showering. If you have inverted nipples (nipples that are turned inward) ask about what you may need to do when breast-feeding. Ask your Doctor or nurse for more information. Should my diet be any different? You will need to take in about 500 extra calories each day to help you produce good breast milk. Otherwise your diet should be like the diet recommended during pregnancy. To be sure you are not getting too many calories, watch your weight. You should not gain weight at this time. What about medicines, drugs, and alcohol? These can get into your breast milk. Don't use anything, even nonprescription medicine from the drug store unless you first check with your Doctor. It's best to avoid alcohol and smoking while you are pregnant and even later, when breast-feeding. How do I nurse the baby? The first time to breast feed should be as soon as possible after the delivery since the baby is more awake and willing to nurse at this time. Nursing about every one and a half to three hours helps bring in milk, gives the baby fluid that it needs, and helps the baby's digestive system start cleaning itself out. Nursing can usually begin when the baby is first brought to you. The baby's body should be turned toward you with the baby's tummy turned to your tummy and the baby's knee against your stomach. This position prevents the baby's mouth from slipping and helps keep your nipples from getting sore. Touching the baby's lower lip will usually make it's mouth open wide, then bring the baby to your breast. As much as possible of the areola (the dark circle around your nipple) should be in the baby's mouth. After about ten to fifteen minutes, gently put your little finger in the corner of the baby's mouth and push the mouth open. This breaks the suction and lets you easily remove the nipple. Switch to the other breast and let the baby nurse for another ten to fifteen minutes. By the time you get home, the feeding time should approach about ten minutes on each breast. Babies don't follow set schedules and may not nurse the same amount of time at each feeding. Most babies need and want about 10-12 feedings every 24 hours. It is okay to nurse about every one and a half hours. The feedings don't have to be timed exactly. The first few feedings are usually a "get acquainted time. Your baby may not be very hungry at first, and your milk will not yet have started flowing fully. Try to nurse anyway, but don't get discouraged if the baby does not seem to get much. The baby will be getting colostrum (the very early milk that the breast makes) which is very healthy. How can I tell if baby is getting enough milk? Watch that the baby is swallowing while nursing. The baby should be content for one or more hours after feeding. The baby has 6-8 wet cloth diapers a day, or 5-6 wet disposable diapers a day (the baby may have less the first few days after birth). The baby is having stools (bowel movements) at least every day or two. What can I do if I have problems nursing? If you have any problems at all, don't get discouraged and think it would be easier to switch to a bottle. First, talk to your Doctor or the nursing staff and let them help you. You can also call the hospital nursery (anytime day and night). There are support groups and breast-feeding centers in many states. Ask the doctor, the hospital nursery or check your phone book. One suggestion would be to call the La Leche League. What if I have to stop nursing for some reason? If breast-feeding is delayed after birth, stopped for a while, or if you and baby are separated, you will want to use a breast pump or hand expression to keep up your milk supply and empty your breasts. Ideally, if the baby is not nursing 6 hours after birth, you should begin to stimulate your milk supply by stimulating your breasts. Ask the hospital personnel for assistance with this. To use a breast pump, follow these steps: There are many types of breast pumps you can buy. Your hospital can recommend a breast pump to use (some may even sell or rent them). Whichever type you choose, always: 1. Read the instructions carefully. 2. Wash your hands and cleanse your breast with clean water and dry. 3. Get comfortable and relax. Think about the baby. 4. Massage your breast from the chest wall to the nipple with the flat of the hand. Use your fingertips to massage in circles from the full area toward the nipple. 5. Begin pumping (it should NOT hurt). 6. Alternate breasts as the flow decreases, or every 5-10 minutes if pumping to stimulate supply. 7. Save the milk in a sterilized baby bottle or throw away bottle liner. Cover it and place it in the refrigerator. It can stay for a few days and given to your baby through a bottle. It can also be frozen for longer periods. To hand express, follow these steps: 1. Wash your hands and cleanse your breasts with clean water and dry. 2. Get comfortable and relax. Think about the baby. 3. Massage your breast from the chest wall to the nipple with the flat of the hand. Use fingertips to massage in circles from the full area toward the nipple. 4. Place thumb and fingers one and a half inches from the nipple. 5. Push back towards the chest wall. 6. Roll your fingers around the breast to empty all ducts. 7. Work your fingers around the breast to empty all ducts. 8. Switch from the right to the left breast to increase the amount expressed. 9. Save the milk in a sterilized baby bottle to throw away bottle liner. Cover it and place it in the refrigerator. It can stay for a few days and be given to your baby through a bottle. It can also be frozen for longer periods. Avoid sliding your fingers over skin or pulling on the nipple itself. Fingers should remain away from nipple so milk doesn't run over the fingers. milk that runs over your fingers might get germs in it and should be thrown away. Whatever method you choose, pump or hand, it will take time and practice to master this. Consider your first few attempts as practice and don't expect any milk on your first few tries. If you do get milk the first few times, consider it a bonus. Go to top of page The First Days With Your Baby What is bonding? This is what happens between you and your baby during your earliest contact together. This is a very important time for both of you. Babies who have a good bonding experience seem to do well. Even though you may be tired from your labor and delivery, try to give your baby much love during these early hours. Sometimes the baby is kept separate for the first 4 to 6 hours of life then brought to you. No matter how soon it is before you first see the baby, it is good to begin to cuddle and show your love to the child. What is rooming-in? This means the hospital will allow you to keep your baby in your room with you. It allows you to spend more time and have more contact with your baby. Not all hospitals have this policy. If you would like to have rooming-in, check with your hospital and see if you can make arrangements. What are some important things to know in caring for my baby? During the first few days most of the time your baby will be feeding, sleeping, and needing diaper changes. More information about feeding will be given to you later. The hospital staff will help you learn anything you need to know about taking care of your new baby. Ask someone whenever you have questions. Remember that there are many different opinions about child care. You may get different answers to the same question from nurses, family and friends. When in doubt, call your Doctor. Neonatal problems Most babies will have no problems and only need to stay in the hospital along with you for as little as one day. For cesarean sections, the stay is usually around 3-4 days. Sometimes a baby will have a complication. Some of the more common ones are discussed below. What is jaundice? This is when the baby's skin and whites of the eyes develop a yellowish color. It can be caused by several things. Usually it is a normal occurrence caused by a chemical from the breakdown of the extra blood the baby is born with. It starts at about the second to third day and usually is gone by the end of the first week, without treatment. Jaundice can also be caused by infection (rarely) or by a difference between your blood type and that of the baby. The jaundice is measured by a blood test for bilirubin. The blood is usually taken from the baby's heel. If the bilirubin gets high, the baby may need to be treated for jaundice by being put under special lights. Usually these cases of jaundice are easily treated. Rarely is there any harm to the baby from jaundice. What kind of feeding problems might the baby have? During the first day the baby's appetite might be small. This is normal. By the second or third day the baby should be drinking well. A small amount of spitting up is not unusual and is not a cause for worry unless most of the food is coming back up. It is not unusual for your baby to lose a small amount of weight in the first few days. This also is normal and is usually regained in the following few days. Sneezing, burping, passing gas and occasional shivering are also normal for the baby. What about crying? Crying is the normal way the baby communicates with you. Usually the problem is hunger, a wet diaper, or wanting to change positions. Your baby may just want to be picked up, held, talked to, or patted. Your baby may be tired and need help in falling asleep. Then there always seems to be some crying for no reason at all. It seems as if the baby "just wants to cry". Usually this is perfectly all right. Many mothers, fathers, grandparents and doctors feel it is all right to pick up baby whenever he/she cries. On the other hand, many other such persons feel quite differently, and they suggest that the baby be allowed to fuss for a period of time. It seems that no one has the "right" answer. We suggest that you first do whatever needs to be done to make baby comfortable. You and the baby's father will then want to decide how much "extra" crying is reasonable and just how much you want to let baby cry before picking him/her up again. Always let your pediatrician know if the crying is excessive. Taking the baby home Before both you and the baby leave the hospital it's a good idea to make sure things are ready at home. What should I have ready for the baby? Diapers - about 3 dozen cloth or disposable Diaper pins for cloth diapers - 2 sets Rubber pants - about 3 or 4, if you use cloth diapers A few nightgowns Blankets Crib sheets Mattress pads - waterproof For bathing the baby : soft towels, washcloths, baby soap, baby lotion, vaseline or diaper ointment, thermometer, and shampoo If you are using formula, you will need bottles, nipples, and a supply of formula. You may find the type with disposable liners easy to use. If not, it is important to have thorough cleansing; using a bottle brush and soapy water, followed by hot water rinse or cycling in a dishwasher. Before you leave the hospital you will be told which formulas are recommended. Do not use regular homogenized milk. Will I need any help at home? You may want to have some extra help for the first week or more when you're home. Your baby's father may be able to be home with you, or you may have a relative stay with you. This would give you more of a chance to rest and relax with your baby. Or you may want this special time just for you, the father and baby. Relatives may always come at a later date. However, if you have other young children at home, you may really appreciate having someone else around who can take care of them and give them that extra attention they need while your attention is on the new baby. How might the new baby affect my family? The baby's father and other children may feel neglected and a little jealous of your attentions for the new baby. It helps to get them involved in taking care of the baby. Ask them to talk and sing to the baby and bring things like bottles, diapers, and tissues. The baby's father and the older children can also carry the baby around. Postpartum care What are the early changes I might feel after the baby is born? Your uterus will begin to shrink during the next six weeks following delivery until it is about the same size as before pregnancy. Some vaginal bleeding will occur during this period (six weeks). This fluid is red at the beginning and slowly changes to brown then pinkish, then white before it stops. Sometimes cramping may also be felt during this time. If you are not planning to nurse, it is advisable to wear a good-fitting support bra day and night. Even so, your breasts might fill up and feel sore. Ice packs might help. If you are nursing, more information will be given to you by your nurse. Sometimes constipation is a problem for the first few days. If so, your Doctor can prescribe or recommend some safe medicine for this. Make sure you let the doctor know if you have this problem. What about mood changes after I deliver? It is not unusual for you and also the baby's father to feel very emotional or even blue or depressed for the first few weeks after the baby is born. Many things might be getting to you. Your new baby is keeping you busy, waking you up at night. You may feel tired and may hurt in different places. You may feel uncomfortable taking care of the new baby. Your hormones are returning to normal levels as all these other changes are happening. Don't worry. These "postpartum blues" should pass. Soon you can expect to feel much better. If you find things unbearable or not improving, please let us know. Postpartum depression is a real condition that can have long term consequences to you and your baby. What activities can I start to do? This depends on how you feel. Your energy may be low over the first few weeks after the baby's birth but you can begin to exercise or work a little at a time,. If you build up your activities slowly you should have your full energy within a couple of months. Sexual relations can be resumed in a few weeks if it feels comfortable. When will my period start again? If you are nursing, your periods may not occur as long as you keep nursing. Don't worry if your periods do start; you can continue nursing a usual. If you don't nurse, periods usually start in one to two months. The first period may be a heavy one. When should I return for a check up? Sometime between three to six weeks after the baby's birth, you'll need to come in for a general check up which includes a breast and pelvic exam. This may be a good time to choose a method of birth control. If you had a cesarean section, you will need to come in for a visit by the second week after you leave the hospital to have your stitches and surgery scar checked. However, if you notice redness, pain, or pus around the surgery scar, you need to let us know right away. Best wishes to you and your family! Go to top of page Working While Pregnant - Tips & Hazards in the Workplace More women are working outside the home than ever before. In most cases, you can plan to continue working through most of your pregnancy. That's not to say pregnancy won't affect your ability to work. You may feel extremely fatigued, especially in the early weeks, and you'll no doubt have to use the bathroom more frequently than usual. Morning sickness can certainly get in the way of a pleasant day at work. Your need to snack during the day may be against job policy. Increase in body size, back problems, swelling, and fatigue can make some jobs more difficult as pregnancy progresses. Arranging to get away for your regular checkups may conflict with your job schedule. And if complications occur, you may have no choice but to discontinue work altogether. Although some women actually manage to work safely until the day before delivery, most will take off the last month or so. A nurse patient of mine was actually working on the day she went into labor. She walked downstairs and had her baby -- but no, she didn't finish her shift. A female colleague of mine performed a cesarean section on the morning of her own delivery. Two days later she was back at work. I don't necessarily think this approach is best for everyone, but it can be done. A job requiring long hours is by itself not a risk factor in pregnancy. A study of physicians-in-training found that professional women who work long hours during pregnancy are just as likely to have healthy babies as other women who work more moderate hours. Researchers emphasize that these findings only apply to healthy women with no pregnancy complications, and that those women in the study who worked as long as 100 or more hours a week were more likely to have a pre-term delivery. Even before you become pregnant, try to assess yourself and your job realistically; that way, you'll know what to expect and how to plan ahead. As your pregnancy continues, you might have to reduce the number of hours you work each day. In fact, this is often better than reducing the number of days you work, since it's less fatiguing. Lifting, prolonged sitting, or standing may be difficult as you get further along, so that a modification of your job may be in order. If your health insurance is related to your job, be sure it will continue for the duration of your pregnancy. Although most employers are understanding, I have seen a few terminate their pregnant employees and leave them not only without a job but also without insurance when these women need it the most. Hazards of the Workplace The possible effect of your work on your pregnancy is probably more important than the effect of your pregnancy on your work. The U.S. Supreme Court has recently ruled that women can't be barred from hazardous jobs just because they are women and capable of bearing children. The responsibility falls on employers to document potential reproductive hazards and obtain individual women's informed consent to continued employment. As a female employee considering pregnancy, you must share this responsibility. In the final analysis, you need to make yourself aware of workplace risks, evaluate them, and avoid them whenever possible. Here are some of the most common hazards you might encounter: Lead. Lead, which is often used in manufacturing processes, has been linked to miscarriages, deformities, and premature births. Radiation. Certain radioactive drugs and X rays emit radiation, which is linked to miscarriages and birth defects. Chemicals. At least 26 substances have been linked to problems for pregnant women, including lead, alcohol, mercury, carbon monoxide, benzene, and toluene. Some of these substances also affect male fertility. Viruses. Nurses and day-care workers are often exposed to the rubella virus and cytomegalovirus (CMV), both of which are hazardous during pregnancy. Rubella during the first three months of pregnancy may cause severe birth defects in the fetus; CMV can be passed along to a fetus, causing handicaps such as blindness, hearing loss, and cerebral palsy. Quite a few jobs expose workers to teratogens, or chemical or physical agents that are harmful to a developing fetus. Health-care and laboratory jobs, hairdressing and cosmetology, housecleaning, laundry and dry cleaning, and factory work (including electronics, photography, textiles, and printing) may all expose you to potentially harmful chemicals or infectious agents. These substances can be inhaled, absorbed through the skin, or taken in by mouth. For most substances, there is an exposure level that will produce no detectable effect and a dose above which problems can occur. In some instances this "no effect" level of exposure is known; in others, it is not. In some cases, your exposure can be measured, such as when X-ray technicians wear exposure badges. Often, it can't be. It would be wise to evaluate the potential reproductive effect of any workplace exposures prior to trying to conceive. If you're a doctor, nurse, laboratory technician, or other health-care worker, you may find yourself exposed to several hazards. These include infectious diseases such as herpes, CMV, and AIDS. Other risky exposures are to anesthetic gases and some cancer drugs, as well as chemicals used for sterilization and radiation. Most of these exposures are minor and usually cause no demonstrable problems, but minimizing exposure before and during pregnancy is certainly recommended. Lead exposure of the kind that occurs when you work with certain paints, batteries, and ceramics can cause infertility, miscarriages, and mental retardation in your offspring. Other toxic agents to avoid include solvents such as benzene and toluene, since they can cause birth defects. They are used in dry cleaning, paint removers, and electronics manufacturing. This article is not meant to give you the final word on how these exposures may affect your pregnancy, but rather to make you aware of the many issues involved. Information is changing rapidly and the list of potential risks seems never-ending. Many manufacturers and companies may not only be unaware of the latest studies, but they may be unwilling to take the responsibility of warning employees when they do know the risks. Therefore, you need to make it a point to obtain the best current information regarding your particular exposures, either from your Doctor or in consultation with experts or agencies that have access to current data bases regarding reproductive risk. Here are some resources for further information: March of Dimes: Call your local chapter for the number of a teratogen information center in your state. 9 to 5, National Association of Working Women: 1-800-522-0925. Hotline: 1-800-522-0925 (10 A.M. to 3:50 P.M. ET) National Institute for Occupational Safety and Health: 1-800-356-4674. Dads Matter, Too Let's not forget the father-to-be. His work exposure can also affect your pregnancy. If he is exposed to reproductive toxins, his ability to produce sperm may be reduced, and studies have implicated defective sperm in birth defects and childhood disease. Toxicologists recently discovered that men who work in certain fields -- glass, clay, stone, textile, and mining industries -- have twice the average risk of fathering premature infants. Other very preliminary studies found that the offspring of nuclear power plant workers, firefighters, aerospace workers, and men who work with hydrocarbons, solvents, spray paints, and toxic metal fumes have higher rates of birth defects. There is some suspicion that substances such as lead can be found in semen, and exposure during pregnancy may expose the fetus to harmful chemicals by this route. A man may also bring toxins home on his clothes or skin, so prospective dads need to consider the hazards of their jobs, too. When we talk about a man's exposure to chemical or physical agents, however, the majority of evidence suggests that either it interferes with his ability to produce effective sperm and father a child, or it has no impact. Once you're both informed, you can decide whether you or your spouse needs to request a transfer from a potentially toxic workplace, change jobs, or possibly delay the pregnancy. "1997 by Barry Herman, M.D., and Susan K. Perry, Ph.D. From The Twelve-Month Pregnancy Go to top of page 10 TIPS TO WORKING WHILE PREGNANT Many women find themselves juggling the inside "job" of growing a baby and the outside job of working for pay. For some, especially those who do not suffer from pregnancy sickness and whose jobs are important to them, work is a welcome way to wait out the nine months. These mothers want to work right up until the first contraction. Other women may need a month or more to prepare their nest and focus on the life inside; they may plan to leave their jobs at a particular time, often in the last trimester. Some mothers, due to pregnancy complications, need to quit even in the early months. Whatever your pregnancy situation and your job, here are 10 Tips to Working while Pregnant: Tip #1: Inform your employer. If you intend to stop working after your baby comes, give your employer plenty of time to find a replacement, and yourself enough time to finish up important projects. Tell them when you plan to quit and ask how they would like you to help make the transition a smooth one. You will act responsibly, but your stated intention to quit makes it clear that your pregnancy and family come first. Tip #2: Keep your options open. If you want to return to your job after the baby is born, use caution. You want to keep your options open for a satisfactory maternity leave and at the same time protect your position. While it is illegal to discriminate against someone who is pregnant, the corporate world is often confused by a worker becoming a mother. A promotion you are in line for may be jeopardized by the fact of your pregnancy. You may risk being given less challenging assignments because of your "condition." You may be uncertain how your coworkers will take the news. Some may be sympathetic to your occasional memory lapses and your first trimester miseries. Others, you fear, will be worried about having to "cover" for you on days when you aren't at your best. Tip #3: Use good timing. The best time to tell is just after people begin to suspect you might be pregnant and before they are sure. Although you are excited about your news, most women recommend against revealing a pregnancy in the early months. Be careful not to wait too long to tell, either. You don't want to give your employer any reason to think you are untrustworthy; any suggestion that you concealed your pregnancy for your own gain may make you look as though you are not a "team player." Tip #4: Do some homework. Don't expect to function every day on your job at the same level as you did before you were pregnant. If you want to stay employed yet find your current position too strenuous, ask for a temporary transfer to a less demanding job. Better to be honest with your supervisor than be disgruntled and inefficient. If you don't want to change jobs, ask if you could work part-time, do some of your work at home, or have flexible hours where you could work harder or longer on more comfortable days. Tip #5: Explore your options. Interview yourself. If you truly know what you want, you are more likely to get it. Determine what you ideally want, what you can afford and what's best for your pregnancy and your family. Can you grow a baby and do your job? Do you want to? Bear in mind that complications or situations during your pregnancy (or after delivery) may make some of these decisions for you. Unless your Doctor or your baby determines otherwise, could you work through most of your pregnancy? Would you rather start maternity leave early? Continue your job on a part-time basis from home? After the baby is born, do you want to come back to your present job, or one that is more compatible with family life? Do you want full-time work or part-time? Tip #6: Enjoy the best of both worlds. Working while pregnant should not mean being torn between protecting your job and mothering your baby, you can do both. Whether you want to take off and return as soon as possible or work as long as possible and return as late as possible, you should be able to work out the best plan for you, your baby, and your family. That plan may be very specific or quite general. One mother we know was certain that she was more committed to her baby than her job, so she had nothing to lose. Not knowing how she'd feel about working, she asked her employer if they could negotiate after the baby came. In the meantime, she offered to keep up with projects from home on an hourly pay basis. After the baby was born, she worked a few hours a week from home, came in for meetings at four and six weeks (with the baby) and at eight weeks knew enough to negotiate a continuation of work from home for an hourly wage -- that way she felt neither party would be short-changed. She worked 10 to 20 hours a week from home for the company for four years. Tip #7: Know your rights. Know what your company's maternity leave policies are (you should have been given a copy of them when you were hired) and what the laws allow. If you know and trust a coworker who previously negotiated a leave package with this company, ask what she did, what she got, and what she'd advise you to do. If you do not have a copy of the maternity leave policy, you can get one from the personnel director. (However, he or she may also inform your boss.) If the company does not already have a maternity leave policy and is small enough not to be legally required to have one, you may have to be a pioneer, negotiating the policy for the benefit of your future pregnant coworkers. If you can, check out the maternity leave policies of other companies before you talk to your supervisor. Tip #8: Review your company's policy. When reviewing your company's policy, be sure you understand: Whether maternity leave is paid, unpaid, or partially paid Whether you are eligible for disability insurance benefits, complete or partial. Whether the company has a medical disability insurance policy that pays a portion of your salary while on leave. Pregnancy is legally considered a medical disability. Find out which forms you have to complete, and where to send them. Follow up: has the appropriate office received, processed, and finalized your application? Be sure your Doctor has signed and completed the appropriate forms stating when you are able to return to work. Whether the company's policy guarantees you can return to your same job or one that is equivalent in pay and advancement possibilities. How much time off you are allowed. Whether you may use your present benefit days (sick leave, personal leave, vacation time) to extend your paid maternity leave. What the company's provisions are for extended maternity leave -- paid, unpaid, partially paid, working from home? What the possibilities are of continuing your present job during and after your pregnancy by working part-time at home and being tied into your Doctor by phone, fax, or computer. What options are available should medical complications or maternal desires necessitate a change in plans. Whether your health plan is still in effect while you are on extended leave, and whether it is partial or full coverage. How long will they keep you on the medical insurance policy at full or partial benefits? Do you share the cost? Tip #9: Select the right way to tell. After selecting the time and person to tell (and preferably when that person is having a good day), present your case. How to tell depends upon your pregnancy, your job, your wishes, and the reception you imagine you will get from your supervisor and coworkers. As in any negotiations, consider where the other person is coming from. Your supervisor wants to know when you are leaving, when you are coming back, and how best to fill in the gap while you're gone. Be ready with those answers. Realistically, your supervisor is more concerned about the company's operations than your personal needs. Your employer must consider the possibility that you may later decide not to return to work (although studies show that attractive maternity leave policies and a family-friendly workplace make it more likely that women will return). Tip #10: Work out the right maternity leave package for you. Only you can guess how much maternity leave time you need; only your company can guess how much time they can afford to be without you. Remember, your bargaining power depends not only on how you present your case, but also on your value to the company. If you have a unique skill required for a special job, you have more clout than if there are many others within the company who can do your job just as well. Be realistic about your needs, your negotiating power, and the needs of the company, but remember, too, that companies want to be seen as family-friendly in their maternity leave policies. Go to top of page TRAVELING WHILE PREGNANT If your work (or pleasure) requires travel, you may have concerns about traveling during pregnancy. Most routine travel, even air travel, should pose no problem, but check with your healthcare provider just in case. Treat yourselves to a fling before baby arrives. After baby comes, candlelight dinners intended for two, even your bed, may have to accommodate an added guest. Best odds for a safe and satisfying vacation are during the fourth through the sixth month of your pregnancy. In the first trimester, you are likely to be too tired or too nauseated to enjoy your vacation; in the last trimester you may be too uncomfortable. In the last month of your pregnancy, keep your feet on the ground. Domestic airline regulations prohibit air travel in the last four weeks of your pregnancy (36 weeks pregnant). Foreign airlines prohibit air travel after 35 weeks. Don't count on flight attendants being trained midwives. If you look obviously pregnant, airlines require a note from your healthcare provider stating your estimated date of delivery. If you are at risk of delivering your baby prematurely after you are 25 weeks along, it's safest not to travel to any place that is not equipped with newborn intensive care facilities. Position yourself for comfort. Request a seat as far forward on the aircraft as possible. Not only is the air circulation better in front, it's easier to get on and off the aircraft. Some women find a window seat helpful for minimizing early-pregnancy queasiness; others prefer an aisle seat, which makes it easier to walk and go to the bathroom. Many mothers-to-be ask for the bulkhead seats, which have the most legroom. (However, their armrests are stationary, which can restrict your sideways mobility and prevent you from stretching out should the adjacent seat be vacant.) Pregnant women are not allowed to sit in exit rows because the occupants of those seats are expected to assist with opening a heavy door in an emergency. If you want to be near an emergency exit, choose a seat in the row behind the exit row; seats in the row in front of the emergency exit don't recline. If you are traveling with a companion, request the aisle and window seat, and ask that the middle seat be left vacant to give you some extra space for maneuvering unless the space is needed. If you can upgrade to a more comfortable class, now is the time to pamper yourself. Air circulation is usually better in the first-class cabin, too. Cushion your growing body with extra pillows. Elevate your feet as much as possible and walk frequently during the flight to lessen leg swelling. On long flights, expect your feet to expand a size no matter what you do. Once you remove your shoes, you may not be able to get them back on, so be sure to take along a roomier pair, or even a pair of slippers. Sit in clean air. Absolutely avoid flights where smoking is allowed. (While smoking is not permitted on domestic flights, some foreign carriers still permit smoking). Even though aircrafts are divided into smoking and non-smoking sections, trying to keep the air in one section smoke-free is like trying to chlorinate half a swimming pool. Drink to your thirst's content -- and more. Airline air dries the mucous membranes of mouth and nose and can contribute to dehydration. Drink plenty of caffeine-free, non-alcoholic fluids before, during, and after the flight. Humidify the air. The humidity of cabin air is only around seven percent. Besides being uncomfortable to your nasal passages, dry air can contribute to dehydration. In addition to drinking extra fluids, prevent your nasal passages from drying by breathing the steam from a hot cup of water. You can also take along a bottle of saline nasal spray (available at any pharmacy without a prescription), and spray some of the salt water into your nose every hour or so. Eat comfortably. If you're planning to travel during your first trimester or are still experiencing morning sickness, calling ahead to request a special meal can increase your chance of getting the airline food most friendly to your queasy stomach. Better yet, pack your own already tested munchies. Alert the flight attendant of any special needs. Avoid non-pressurized, high-altitude flights. As you probably know, most airline cabins are pressurized to compensate for the lower levels of oxygen available at high altitudes. Once you get to 7,000 feet above sea level, oxygen levels decrease as altitude increases. When you make your reservations, be sure you're getting a plane with a pressurized cabin. Be especially careful with commuter flights, as they are not pressurized, since they usually fly at low altitudes. While a short time spent in an unpressurized cabin above 7,000 feet is unlikely to harm your baby (baby's oxygen level in the womb is already lower than mother's), it can reduce the oxygen in your blood, causing you to feel lightheaded and impair your thinking and ability to move. (Pregnant women should avoid vacationing at altitudes greater than 7,000 feet. Some studies show a statistical correlation between living in high altitudes and having lower birth weight babies.) Seek assistance. Pregnant women, like senior citizens, should always be given a seat on a bus or assistance with luggage. It would appear, however, that many people are afraid of insulting a woman's independence by offering aid. Don't be afraid to ask! Be especially careful to avoid stretching and reaching into overhead compartments for heavy luggage. You don't want to overtax any muscles unnecessarily; pregnancy is not the time to strain a muscle. Consult your healthcare provider before you travel. Check with your doctor to be sure you do not have any complications of pregnancy that would put you at risk of a preterm delivery or other dangers: preeclampsia, high blood pressure, diabetes that is poorly controlled, multiple pregnancies, incompetent cervix, repeated miscarriages, previous multiple premature births, or a baby who is not growing optimally in the womb. Many obstetricians encourage women with these complications to avoid airline travel or any long trips in the last three months of their pregnancy. Go to top of page SOME OF THE THINGS TO EXPECT WHEN YOU ARE PREGNANT You're pregnant! You have been waiting and planning for this. But, if you're so happy, why do you feel so lousy? It isn't just the Morning Sickness, it's everything else. Right now your body is the playground for the hormone express. Find out what's causing it all. "Morning Sickness" Headaches Constipation Cramps Fatigue Skin Changes Frequent Urination Hair Changes Heartburn Nail Changes Breast Changes Changes in Vision Faintness Dizziness Vaginal Discharge Mood Swings and Apprehension Sleep Disturbances MORNING SICKNESS "MORNING SICKNESS" can occur at any time of the day. It may occur by the fourth week and usually lasts until the twelfth or thirteen week. Occasionally, it extends beyond the thirteenth week. Because everything you eat is rapidly turned to glucose to feed the developing fetus, you can develop low blood sugar. Some women are more sensitive to low blood sugar than others and this can cause nausea. Sensitivity to pregnancy hormones also plays a role in 'morning sickness'. Unlike the nausea associated with an illness, the nausea of pregnancy increases when the stomach is empty. Some things that may help include: Eat frequent small meals. Eat dry crackers or dry toast before getting out of bed in the morning. Drink peppermint or rose hip tea during the day, between meals. Avoid fatty, fried or spicy foods. Keep your area well ventilated both at home and at work. Get out of bed slowly in the morning. Avoid long periods of time without food. Keep five to six anise seeds in your mouth between meals. Go to top of list CONSTIPATION Constipation occurs because food goes through the digestive system at a slower pace due to the effect of progesterone. Progesterone relaxes smooth muscle, therefore, food is propelled more slowly by the smooth muscle of the intestines. As food slows down, more water is absorbed from the contents of the colon, creating a harder stool. Iron, in your prenatal vitamins, can also contribute to constipation. Drinking more water and eating more fiber may help. You should NOT take laxatives. If constipation becomes a problem, ask your Doctor to recommend a natural stool softener, if this becomes a problem. Go to top of list FATIGUE Fatigue is caused in part by the sedative effect of progesterone. Your body will tell you how much sleep you need. Learn to listen. I have never been disappointed with a patient knowing when to rest, once she learns to understand her own body. Go to top of list FREQUENT URINATION Frequent Urination at this stage of pregnancy is the result of increased kidney function to rid the body of waste products and toxins. Your kidneys are now working for two - you and your baby. You may want to avoid regular hot and iced teas. Tea has a natural mild diuretic effect. A better choice would be herbal teas. Drink plenty of fluids, especially water, to replace what you lose. Go to top of list HEARTBURN Heartburn is caused by progesterone's relaxation of the smooth muscle at the entrance of the stomach. This allows 'back flow' of the contents of the stomach into the esophagus. The esophagus reacts to the stomach acid with a burning sensation. Antacids may relieve this, but please get your Doctor's advice on the one to use. Go to top of list BREAST CHANGES Breast changes in early pregnancy are the result of vessel engorgement. Vessels in the breasts become engorged because of smooth muscle relaxation. The smooth muscles in the veins relax which in turn causes the valves located in the veins to work less efficiently. This results in the vessels becoming engorged with blood. Wearing a good support bra, properly fitted, will help. If your breasts are large, wearing a bra while sleeping may be beneficial. If you have breast implants, check with your Doctor concerning the advisability of breastfeeding. Go to top of list FAINTNESS/DIZZINESS Faintness/Dizziness is caused by a decrease of blood flow to your brain. This happens because more blood is going to the uterus and because the smooth muscles of your veins are relaxed, causing pooling of blood in your legs. Low blood sugar can also contribute to faintness/dizziness. You can avoid this by changing your body position slowly (lying to sitting, sitting to standing) and by not standing in one position for long periods. Eating frequent, small meals may also help. If you do feel faint, sit down immediately. If sitting does not help, lie down or put your head between your legs. Go to top of list MOOD SWINGS AND APPREHENSION Mood swings and apprehension are the result of both pregnancy hormones and your own variable and changing feelings about being pregnant. Talking with your partner or a friend, a gentle massage, reassurance that this is normal, and meditation may all help. Meditation should calm and relax. To meditate, go to a quiet place, if possible. Close your eyes and relax all your muscles slowly, start with your toes and work your way up your body. Take deep, slow breaths as you relax the muscles of your body. Imagine yourself floating on a white cloud. Slowly allow this cloud to envelop you, so that you are surrounded by calm, white light. As the white light surrounds you, visualize your baby growing within you, healthy and happy. In your thoughts, talk to your baby. Continue the slow, deep, calming breaths as you open your eyes, refreshed and relaxed. Go to top of list HEADACHES Headaches can be common throughout pregnancy. They may be caused by tension, low blood sugar, mild dehydration or vascular effects of hormone changes. Eating frequent small meals, drinking plenty of fluids, or meditation and relaxation techniques may help. You should ALWAYS inform your Doctor about headaches. Go to top of list CRAMPS Cramps are not uncommon in early pregnancy. Mild, menstrual-like cramps happen to some women. If they become severe or persist for long periods of time, notify your doctor immediately. Go to top of list SKIN CHANGES Skin changes can occur during pregnancy. Although most changes occur later in pregnancy, some can be very early. These include: acne, dryness, pigmentation changes, spider veins, blotchy skin and increased sensitivity to cosmetics. Estrogen levels increase in pregnancy and cause the spider veins and blotchiness. Along with estrogen, increased levels of progesterone and melanocyte-stimulating hormone (MSH), a hormone which is responsible for skin pigmentation, cause an increase in skin pigmentation. This is more pronounced in women with dark hair. The increased levels of hormones can also cause increased oiliness or dryness of the skin. Every woman is different and there is no way to predict how the hormone changes will affect you. Using natural moisturizers, natural facial cleansers, or changing to natural cosmetics may help. Go to top of list HAIR CHANGES Hair becomes thicker and grows faster due to the hormone changes. Normally, you lose 15-20% of your hair at any one time. During pregnancy, this rate of hair loss decreases to ten percent. Because every woman is different, you may also react to hair color or dyes differently. You should avoid the fumes and unpredictability of metallic dyes. Ask your hairdresser to use natural vegetable hair products. Permanents are also unpredictable in pregnancy. Go to top of list NAIL CHANGES Nails also grow faster during pregnancy. Splitting and breaking can occur. Keep nails short and use hand creams liberally. Go to top of list CHANGES IN VISION Your vision may also be affected. The cornea of the eye thickens due to water retention. If you wear contact lenses, you may not be able to tolerate them as your pregnancy progresses. Some women experience vision changes very early in their pregnancy. Go to top of list VAGINAL DISCHARGE Vaginal discharge increases normally in pregnancy due to the rapid turnover of cells. This should be white, odorless and non-irritating. You may be more comfortable wearing a panty liner if your discharge is copious. If the discharge becomes very thick, cottage cheese-like, odorous or itchy, call your Doctor. Yeast infections are very common during pregnancy and should be treated by a doctor. Remember, even simple things should be handled differently during pregnancy. Go to top of list SLEEP DISTURBANCES Sleep disturbances can occur even in early pregnancy. The increased metabolism you are now having as well as the thermogenic effects of progesterone will cause an increase in body heat. Frequent urination may cause you to get out of bed several times a night. Heartburn happens throughout pregnancy and can be more intense at night, when you are lying down. As the pregnancy progresses, the increase in abdominal pressure may increase the general discomfort you feel. Disturbing dreams also can occur throughout pregnancy. These are common and normal. You may have dreams that you will miscarry, that something will be the matter with your baby or that you will have problems with labor and delivery. These dreams mean nothing and are not portents of things to come. Some of the things that you can do is meditate, have a gentle massage before bedtime, drink chamomile tea at bedtime, do not drink caffeine after three in the afternoon, use an antacid one hour before bedtime and use 'white' noise (sounds of oceans, winds, rain) in you bedroom and sleep with your head and shoulders elevated on extra pillows or a pregnancy pillow. Skin Care while Pregnant: Scroll down for a list of products safe to use while pregnant and nursing, including products to treat or prevent stretch marks. Can I use the Acid Peels and products while pregnant? What products are best to use while pregnant or trying to become pregnant? While Lactating? Do not use Glycolic Acid in strengths above 8%. Do not use Salicylic Acid products at all. Lower strength Glycolic Acid (8% or lower) does not go deep enough into the skin to actually penetrate into the bloodstream, so is supposedly poses no risk to a fetus. However, since the stronger glycolic acids (stronger than 8%) do penetrate deeper into the skin, I advise against using while pregnant, trying to become pregnant, or while lactating. Although it has not been proven, theoretically I think it could be possible for some glycolic acid to penetrate into the bloodstream and reach the baby. Some Doctors say it is OK to use, but some say not to use it while pregnant. We advise not to use while pregnant. Although Glycolic Acid is simply a fruit acid, and theoretically should do no harm even if it does reach the blood stream, we would rather play it safe and not use at all while pregnant or nursing. I have not heard one report of a problem with using Glycolic Acid while pregnant though. Products you can use while pregnant, trying to become pregnant, or while lactating: You can use the Fruit Enzyme Peels or any of the Fruit Enzyme products, such as the Enzyme Peeling Cream. The enzyme products work entirely on the surface of the skin to exfoliate, and do not penetrate a couple of layers of skin like the Glycolic Acid does. The Enzyme products work with all natural fruit enzymes including Papaya enzyme and Pineapple enzyme. They do a beautiful job on the skin! You can use any of the mud masks and other mild exfoliation products such as the Almond Honey scrub. Use of the glycolic products with a low strength glycolic acid, at 8% or less is OK as well. We also have an acid-free Skin Refining Concentrate which is an advanced and powerful complex of Vitamins (A,C,E), natural Algae, Yeast Extract, Herbal Extracts, and exclusive acid-free marine technology gently enhances skin's own shedding cycle to help visibly improve texture, reduce pore size, calm irritation, and soften fine lines. Great to use while pregnant are the Copper Peptide products. These will keep your skin looking good while pregnant and will keep the collagen and elastin regenerating deep in the skin without the use of Acids. It does the job of the stronger acids without irritating the skin. The Copper Peptide Protect & Restore Classic is a good one to start with. Yes, the Copper Peptide products are safe during pregnancy. The Copper Peptide does not enter the bloodstream, nor does it accumulate in the body. When creams containing copper-peptides are applied to the skin, only very small amounts of the copper-peptides penetrate into the skin. Copper-peptides have passed numerous safety tests. Scientific studies of copper-peptides have found that the amount of copper taken into the body from such copper-peptide creams is insignificant and does not raise total blood copper levels. What is NOT safe to use: Don’t use anything containing Hydroquinone (such as skin bleaches) or any Glycolic Acid in strengths over 8% (glycolic acid at higher strengths could penetrate the skin enough to get into the bloodstream). Do not use Salicylic Acid products stronger than 2%

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