This edition of “Pregnancy and Childbirth” is based on the VA/DoD Management of 

Pregnancy Clinical Practice Guideline, revised in 2009. Compared to the previous 

Guideline, the scope of this version of the Guideline has expanded to include evidence 

based research recommendations for prenatal care for all pregnant women receiving 

care in the DoD and VA healthcare systems. The Guideline also addresses several 

minor or common complications of pregnancy. The full text of this Guideline can be 

found at https://www.qmo.amedd.army.mil or http://www.healthquality.va.gov.

This book has become known as “The Purple Book” for an obvious reason. It is 

designed primarily as a resource for pregnant women but is also a useful tool 

for obstetric care providers. It provides quality information that can serve as a 

reference, guide, journal, and springboard for further discussion and education. 

It can be used in either one-on-one traditional or group based prenatal care.

The Pregnancy Guideline itself and the recommendations and information 

contained in this book serve as a basis for world-class prenatal care. However, 

the very best recommendations can quickly become outdated as new information 

becomes available. As individual circumstances are unique, the Guideline 

and this book are no substitute for the personal care and recommendations 

given by a qualified obstetric provider. Indeed, the very best prenatal care 

mandates occasional, well-reasoned deviation from these recommendations.

As a final word, we wish to thank the many individuals who have voluntarily 

given thousands of hours developing the Guideline and this edition of “The 

Purple Book”. This work represents the efforts of individuals from the Air Force, 

Army, Navy, and VA communities. Obstetric and non-obstetric personnel from 

various healthcare professions contributed. Talented pregnant volunteers read the 

drafts and provided fantastic editorial support. We all hope this book will be of 

great use to our Nation’s Heroes and their families as they welcome an infant.

Pregnancy

and Childbirth

A Goal Oriented Guide

to Prenatal Care

VA/DoD Management of Pregnancy Clinical Practice Guideline – 2009 

Version 3.2

February 2016

The Editors
Congratulations on Your Pregnancy

The Department of Defense and the Department of Veterans 

Affairs are proud to welcome you to our Obstetrical 

Services. We will do everything possible to help you 

receive the best prenatal care for you and your baby. That’s 

why we have implemented Goal-Oriented Prenatal Care. 

If you have any complications in your pregnancy, you 

may need additional visits and testing. Visits and testing 

outlined here form the basis of care for all pregnant women.

With goal-oriented care, we design each visit to cover 

precise goals that are most appropriate to that specific time 

in your pregnancy. So no matter where you are located 

you will receive all critical aspects of prenatal care at the 

appropriate time. We have eliminated practices that do not 

have sound scientific backing (such as taking urine at each 

visit and early pregnancy cervical checks) and have added 

practices that have been shown to help promote a healthy 

pregnancy. With this approach, you will know what to expect 

and when to expect it. When possible, we encourage you 

to involve your baby’s father or support person in your care.

This book will guide you each step of the way through 

your pregnancy. Please bring it to every visit. We have 

divided the contents by visits with additional material in 

the Resource Section. Each visit section will include what 

to expect at your visit, signs to report, patient education, 

and a space to record related information. We encourage 

you to read each visit section carefully prior to each 

appointment. Please ask your healthcare provider if you 

have any questions or concerns. In this way, you will be 

well prepared for each step in this very special journey! 

Thank you for allowing us to take this journey with you!
ii Prenatal Information Sheet: Introduction

Important Information

Hospital Name

Healthcare Provider

Important Telephone Numbers

OB Clinic

Labor & Delivery (L&D)

Labor & Delivery Triage Line

Emergency Department

My Childcare Provider

Appointment List

DATE TIME PROVIDER LOCATION
Prenatal Information Sheet: Introduction iii

Table of Contents

Visit Information

This section provides detailed information for each visit. Each visit section includes what to 

expect in your pregnancy, what to expect at your visit, and general pregnancy education. 

We suggest you be cautious about information and advice you may receive from family 

members, friends, the Internet or other outside sources. While most of these sources are 

well-meaning and may provide important support, bad advice and inaccurate information

are common. Please make sure to discuss your specific concerns with your provider.

Week 6 - 8 . . . . . 1 Week 24 . . . . . .33 Week 36 . . . . . .63

Week 10 - 12 . . 13 Week 28 . . . . . .43 Week 38 - 41 . . 73

Week 16 - 20 . . 23 Week 32 . . . . . .53 After Delivery . . 87

Resource Section:

• Pregnancy Information

• Common Terms ......................................................................................... 209

• Types of Providers ..................................................................................... 216

• EPDS - Postpartum .................................................................................... 219

- Active Duty Information ...................................................................... 95

- Veteran’s Information........................................................................ 101

- Father’s Information ......................................................................... 103

- Anatomy (front & side views) ........................................................... 105

- Common Discomforts and Annoyances of Pregnancy ......................... 107

- Exercise .......................................................................................... 115

- Travel During Pregnancy .................................................................. 116

- Having Twins, Triplets or More ......................................................... 117

- Fetal Movement Count Charts .......................................................... 118

- Immunizations ................................................................................ 123

- Nutrition in Pregnancy ..................................................................... 125

- Weight Gain Chart ......................................................................... 135

- Dental Care .................................................................................... 136

- Tobacco, Alcohol, and Drug Use in Pregnancy .................................. 137

- Sexually Transmitted and Other Infections in Pregnancy ..................... 139

- Genetic Screening ........................................................................... 142

- Specific Genetic Testing ................................................................... 149

- EPDS - 28 Week ............................................................................. 151

- Testing and Monitoring During Pregnancy ......................................... 153

- True versus False Labor .................................................................... 155

- Preterm Labor ................................................................................. 156

- Labor and Delivery Procedures ......................................................... 157

- Labor and Delivery Basics ................................................................ 159

- Cesarean Delivery ........................................................................... 176

- Birth Plan ........................................................................................ 181

- Baby Supplies ................................................................................. 183

- Family Planning .............................................................................. 185

- Breastfeeding .................................................................................. 195

- Bottle Feeding ................................................................................. 205

- Safety Tips for Baby ........................................................................ 207

The Birth of a Mother ..................................................................................v

Visit Summary Pages ................................................................................ vii

This section provides a quick overview of goals and expectations for each visit.

Keeping You and Your Baby Safe ............................................................x
iv Prenatal Information Sheet: Introduction

Suggested Additional Reading (available in your clinic): 

- Prenatal Fitness and Exercise

WEB SITE INFORMATION: Links to non-federal organizations in this book are 

provided solely as a service to our users and are not an all inclusive list of nonfederal organizations. Links do not constitute an endorsement of any organization 

by the Department of Defense or the Department of Veterans Affairs and none 

should be inferred. The Department of Defense and the Department of Veterans 

Affairs are not responsible for the content of the individual organizations web 

pages found via these links.

General Pregnancy and Childbirth

http://www.nlm.nih.gov/medlineplus 

http://www.healthfinder.gov 

http://familydoctor.org

http://marchofdimes.com

http://www.childbirth.org

http://www.text4baby.org (text messages about baby)

http://www.midwife.org/consumer_information

http://www.plannedparenthood.org 

http://www.mypyramid.gov/mypyramidmoms 

http://www.dodparenting.org (Parent Review)

Baby/Child Care

http://www.aap.org

http://www.dodparenting.org (Parent Review)

Breastfeeding

http://www.lalecheleague.org 

http://www.ilea.org 

http://www.4women.gov

http://www.womanshealth.gov/breastfeeding/learning

General

http://www.militaryonesource.com
Prenatal Information Sheet: Introduction v

The Birth of a Mother

In this book, you are asked questions focused on how you feel about your 

pregnancy and your relationship with your mother and the father of your baby. 

There is space provided to record your thoughts. As you go through your 

pregnancy and adapt to being the mother of a new baby, it is important that you 

realize you are being “born” or reborn into your role as a mother to this baby. 

Even if this is not your first baby, the transition to being a mother is a process 

that involves feelings, behaviors, attitudes, and character developed from life 

experiences and expectations.

While responses to being a mother may come from life experiences, maternal 

attitudes and behaviors change in relation to the age, condition, and situation of 

one’s child. Each mother-child relationship, each pregnancy, each delivery, and 

each childbirth experience are different for each woman. This is true even if you 

already have children. Each pregnancy, labor, and delivery is unique.

Supportive sharing from significant persons, especially your family, balances the 

process of becoming a mother. The support you receive from your mother and 

the father of your baby assists you in the changes you go through to become 

a mother. If your mother and/or the father of the baby are not involved, other 

supportive relationships have to fill this gap. For you and the father of the baby, 

mutual sharing provides the best foundation for adapting to your roles as mother 

and father. The ability to see yourself as a mother and expand on the idea that the 

new child will impact your dreams and fantasies is a building process that occurs 

throughout pregnancy. It happens best with the support and help of your partner. 

Some of the questions raised in this book are to help include the father in this 

important process. 

The ability to imagine and think about being a mother depends on your life 

experiences. Good “mothering” role models, whether your own mother or another 

woman you respect, will help you be confident and identify with being a mother. 

Many women feel a tremendous sense of relief in having a female friend or 

mentor with whom they can share feelings about their pregnancies. Regardless 

of the relationship you have with the father of your baby, you may feel unable to 

express certain feelings or fears with him. This is normal. Women often say that 

they recognize their husband or partner “kind of understands”, but worry about 

discussing their fears, thoughts, hopes and dreams with him. It is important to try 

to talk about some of these things with him but very important to identify a woman 

who can help you as well.

Keep in mind that it is natural to have doubts and conflicts about this immense 

role change. This usually happens every time you have a baby. Becoming a 

mother affects your sense of self. If you are expecting your first child, you are truly 

between roles. Often there is fear of the impact the baby will have on marriage, 

family, and career. Generally, a vision of your image as a mother becomes 

clearer as pregnancy continues. The questions throughout this book are to help 

you define your idea of motherhood. Being able to picture or express your idea 

of motherhood takes place by rehearsing or imagining yourself in the role of a 

mother. It is normal to dream of yourself as a mother. 
vi Prenatal Information Sheet: Introduction

This process helps you identify the characteristics of a good mother. The ongoing 

process of the “birth of a mother” requires you to accept the loss of a former part 

of yourself. It is important to recognize your new role, with all its responsibilities, 

has many rewards. In other words, any losses you might have are balanced by 

rewards you will receive.

Preparing for any role change requires a desire to learn. During the process of 

becoming a mother, you will seek out information or models of your new role. Various confidants, whether your mother, a close friend, or the father of the baby can 

all help provide information and act as role models. Watching other mothers with 

their children and attending birthing and prenatal classes are sources of information to help you through this process.

At many military installations, the DoD provides assistance through the New 

Parent Support Program. This program employs nurses, social workers and other 

individuals who can provide you access to many education programs. They can 

provide you written or video educational information and sometimes they can even 

come to your home to help you adapt to your role of becoming a new mother. For 

women veterans receiving services through the Department of Veterans Affairs, 

each facility has a Women Veterans Program Manager who can assist you with 

finding the resources you need during your pregnancy and after delivery. 

This book will provide you with a lot of valuable information and should help 

answer many of your questions but it is no substitute for a wise and supportive 

mentor. Some places have support groups for women whose spouses are 

deployed. Other places have groups where experienced women volunteer to 

provide guidance to new mothers. We encourage you to take advantage of these 

kinds of opportunities. We wish you the very best in your own birth as a mother!
Prenatal Information Sheet: Introduction vii

Visit Summary Information

Goal-oriented visits: 

6–8 Week Visit Goal: Exchange information and identify existing risk factors 

 that may impact your pregnancy

 To Do: 

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions you may have.

2. Ask your family about any medical problems that exist in your 

family members such as diabetes, cancer, hypertension, and genetic 

problems. 

3. Fill out questionnaire, if provided prior to your appointment, in 

preparation for this visit.

4. Suggested reading in Resource Section: Common Discomforts

and Annoyances of Pregnancy, Travel and Pregnancy, Tobacco, 

Alcohol and Drug Use in Pregnancy, Specific Genetic Testing, Nutrition, 

Dental Care, and Genetic Screening. Think about whether you wish to 

have blood tests to screen for birth defects.

10–12 Week Visit Goal: Determine current health status and work toward a 

 healthy pregnancy

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions you may have.

2. Wear clothing easy to change out of for physical exam.

3. Suggested reading in Resource Section: Common Discomforts

and Annoyances of Pregnancy, Genetic Screening, Breastfeeding, 

Exercise, Immunizations, and Sexually Transmitted and Other Infections.

4. Review Prenatal Fitness and Exercise brochure.
viii Prenatal Information Sheet: Introduction

16–20 Week Visit Goal: Work toward a comfortable and safe pregnancy 

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions you may have.

2. After visit, schedule your appointment for an ultrasound if not already 

scheduled.

3. Suggested reading in Resource Section: Breastfeeding and Testing and 

Monitoring during Pregnancy.

24-Week Visit Goal: Prevent preterm labor for a safe and healthy baby 

 To Do:

1. Read the visit information and any additional related information prior 

to your visit. Write down any questions or concerns you may have.

2. Suggested reading in Resource Section: Preterm Labor and Fetal 

Movement Counting Chart. Check out available prenatal classes at 

your hospital.

28-Week Visit Goal: Monitor your baby and your progress and learn to 

 count fetal movements

To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions or concerns you may have.

2. Follow instructions given to you for your one hour glucola test. 

3. Suggested reading in Resource Section: Fetal Movement Count Chart, 

Testing and Monitoring during Pregnancy, and True versus False Labor. 

32-Week Visit Goal: Prepare for your baby’s arrival

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions or concerns you may have.

2. Fill out Fetal Movement Chart and bring with you to visit. 

3. Suggested reading in Resource Section: Labor and Delivery Basics, 

Labor and Delivery Procedures, Family Planning, Birth Planning, 

Breastfeeding, and Bottle Feeding.
Prenatal Information Sheet: Introduction ix

36-Week Visit Goal: Begin preparations for your hospital experience

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions or concerns you may have. 

2. Fill out Fetal Movement Chart and bring with you to visit. 

3. Suggested reading in Resource Section: Labor and Delivery Basics, 

Labor and Delivery Procedures, Birth Plan, Promoting Safety in 

Childbirth, Baby Supplies for First Week, and Safety Tips for Babies.

38–41 Week Visit Goal: Preparing for birth and baby’s arrival at home

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions or concerns you may have.

2. Fill out Fetal Movement Chart and bring with you to visit. 

3. Suggested reading in Resource Section: Labor and Delivery Basics, 

Labor and Delivery Procedures, Birth Plan, Promoting Safety in 

Childbirth, Baby Supplies for First Week, Safety Tips for Babies, 

Breastfeeding, and Bottle Feeding.

Post Delivery Visit 6-8 Weeks after Delivery: Determine health status 

 and promote adjustment to being a mother

 To Do:

1. Read the visit information and any additional related topics prior to 

your visit. Write down any questions or concerns you may have.

2. Think about family planning needs if that has not already been decided.

3. Call the clinic to confirm whether or not you may bring baby with you

for this appointment.
x Prenatal Information Sheet: Introduction

Keeping You and Your Baby Safe 

The VA and DoD have created Guidelines for Pregnancy that form the basis for the 

care outlined in this book. We have created the Resource Section to provide you 

further information that will help in your pregnancy. It is important that you be a 

partner with the providers in your pregnancy care. To help with this we have a few 

tips and recommendations for you. 

The information in this book is helpful but it is not a substitute for your obstetric 

care provider. He or she will have specific information about you and will be 

able to help tailor your prenatal care for your personal circumstances. These are 

guidelines and the best care will sometimes mean doing things different than or in 

addition to what is outlined here. 

Help keep track of your key pregnancy information. The VA/DoD Pregnancy 

Passport contains most of the information that is essential for good prenatal care.

Take it to your visits and keep it with you at all times. This will help if your records 

are misplaced or computer systems are down. It will also be useful if you have an 

emergency and need to get care away from your hospital or clinic.

Help us assure your due date is well established by 20 weeks of pregnancy. It is 

very hard to establish a firm due date after mid-pregnancy. Firm due dates are 

always estimates but the due date affects many of the decisions that could need to 

be made for your care. If there is any uncertainty in your due date your provider 

will usually order an ultrasound to help establish the due date.

Remember, your due date is an estimate. Normal pregnancies usually end 

between 37 and 42 weeks by you going into labor all on your own. In a normal 

pregnancy, the baby and placenta help prevent you from going into labor too 

soon. Usually, when the baby is mature, the baby will stop preventing labor and 

allow it to happen. 

Try not to be too anxious to deliver before it happens on its own. There are many 

reasons why your provider might recommend causing you to give birth before 

your due date. Sometimes it is critical for you or the baby’s health to be delivered 

early. There should always be a good reason to cause birth before 39 weeks (the 

week before your due date). If your cervix is not ripe, labor induction can be long 

and hard and can increase your chances of a cesarean delivery especially if this 

is your first baby. Even babies born at 37 to 38 weeks can have problems from 

prematurity such as difficulty breathing and eating or jaundice.

If you have questions or concerns, ask or arrange to go to the hospital to be seen. 

This book can give you answers to many questions. Your provider will also answer 

your questions and address your concerns. It is important that you help us take 

care of you by making sure we understand your needs.
6–8 Week Visit 

Prenatal Information 

Sheet

Goal: Exchange information and identify existing 

risk factors that may impact the pregnancy 

6-8 Week Visit

Prenatal Information Sheet: 6–8 Week Visit 3

Prenatal Information Sheet: 6–8 Week Visit 

Goal: Exchange information and identify existing 

risk factors that may impact the pregnancy 

Your baby’s growth

•	Your baby (embryo) is probably an inch long and likely weighs	

1/30 of an ounce.

•	Your baby’s face and body are fairly well formed.

•	Your baby’s bones have appeared. Internal organs are beginning	

to work and the baby’s heart has been beating since the third

week.

•	The placenta is attached to the uterine (womb) wall on the mother’s	

side and the umbilical cord going to the baby on the other. The placenta

acts as an “almost” perfect filtering system between mother’s blood and

baby’s blood. The placenta has a fetal (baby) circulation side and a maternal

circulation side. A membrane barrier separates these sides. The placenta and

umbilical cord provide the way for nutrients (food and oxygen) to get to your

baby and for waste products to be removed. Unfortunately, it also allows some

harmful substances, such as alcohol and drugs, if in the mother’s blood, to get

to the baby.

Your body’s changes

•	Your uterus has grown from the size of a pear to the size of a

large orange.

•	You are probably beginning to notice changes in your body as a

result of your pregnancy.

•	Your breasts may become larger and tender.

•	The area around your nipples may darken.

•	You may have to go to the bathroom more frequently to urinate.

•	You may have morning sickness that lasts beyond morning.

•	Your bowel habits may change. You may be more constipated.

Your family’s changes

•	The hormone changes that affect your body may also affect

your emotions, causing mood swings.

•	Your partner may have concerns about your health, the baby,	

and your family’s financial state.

•	Coping with the discomforts of pregnancy may change

household and work routines.

•	You and your partner both need time to adjust and accept your	

upcoming role as new or repeat parents.

•	It is important to share these feelings with someone you trust.

•	Talk with your spouse/partner regarding any feelings about the pregnancy.

Your baby’s

growth

Your body’s

changes

Your family’s

changes
4 Prenatal Information Sheet: 6–8 Week Visit

Your thoughts and feelings

• You may have some new feelings - maybe you stopped doing

things you enjoy or felt sad some days in the past couple weeks.

•	Accept how you are feeling, even if it is that you are very tired,

and remember that these changes are temporary.

•	Discuss your feelings with someone you trust and your healthcare

provider, especially if you have been very sad or depressed.

•	If you have experienced depression at another point in your life,

you are at much higher risk for pregnancy-related depression.

In fact, one in three mothers with a history of Major Depressive

Disorder will experience depression during or after pregnancy.

Please discuss any history of depression or any mental health

concerns with your provider as soon as possible.

•	In early pregnancy you may find that your desire for sexual

intercourse changes especially if you have nausea, vomiting,

fatigue and/or breast tenderness. Since the amniotic sac protects

and cushions the fetus, intercourse normally does not hurt the

developing baby or cause a miscarriage. Ask your healthcare

provider if you have concerns.

•	Hormone changes and weight gain can make it easy to become

frustrated with yourself and others. Physical discomforts, like not

sleeping well, nausea and fatigue, can make it hard to deal with

the demands of life even when you are not pregnant! If you are

already a parent, your challenge may be even greater.

•	Pregnancy is both exciting and scary. Pregnancy is different

for a military spouse in that military life is demanding for the

active duty member, as well as for the family. Adapting to a new

pregnancy as a Veteran transitioning to civilian life, as an Active

Duty member or as a military spouse can be challenging. For

pregnant spouses of deployed military members there may be

anxiety about the timing of the pregnancy and birth. Planning an

upcoming PCS/move can be especially challenging when you

are pregnant. A strong support system helps decrease anxiety

that may come with pregnancy and military/veteran transitions.

Signs to report 

immediately

Signs to report immediately

•	When in doubt, call the clinic or your healthcare provider or go

to the Emergency Department!

•	Bright red vaginal bleeding or painful cramping

•	Persistent severe headaches, severe nausea, and vomiting

•	Fever at or over 100.4° F or 38° C

•	Inability to keep liquids down (due to nausea and/or vomiting)

resulting in a reduced amount of urine

Thoughts

&

feelings

Thoughts

&

Feelings
Prenatal Information Sheet: 6–8 Week Visit 5

Today’s visit

Normal is same

as pre-pregnant

BP or slightly

less than prepregnant BP

My BP:

My weight:	

Today’s visit

• Fill out the questionnaire, if received prior to this visit, about any

history that is relevant to this pregnancy.

• The nurse will screen for potential risk factors such as:

– Social risks: alcohol/drug/tobacco/domestic abuse

– Medical risks: immunization status, exposure to sexually	

transmitted infections, current health status, and family history

of specific diseases

– Nutritional risks: weight and dietary intake

– Obstetrical risks: problems in previous pregnancies and risks for preterm

labor

• If you are struggling with nausea and vomiting, refer to Common Discomforts &

Annoyances of Pregnancy in the Resource Section for things you can do. Now

is the time to think about avoiding too much weight gain. For tips about weight

gain, refer to Nutrition in Pregnancy in the Resource Section.

• Receive and discuss information on exercise, benefits of breastfeeding, and

other health related behaviors.

• Discuss initial information regarding options for screening for birth defects

including chromosomal abnormalities. More detailed counseling will be

arranged at later visits. See Genetic Screening in Resource Section.

• Receive needed immunizations and information on ways to decrease chance

of getting various diseases.

• Have recommended blood work and urine screen completed.

• Discuss your anticipated due date which may change when more information

is known and further testing is done. Knowing your last menstrual cycle date

will help determine your due date.

Your blood pressure

•	We will measure blood pressure (BP) at every

prenatal visit. Rapidly increasing or abnormally

high blood pressure can be a sign of Gestational

Hypertension.

•	High blood pressure can cause serious

complications such as a decrease in the

blood and oxygen supply to the baby and mother.

Your weight

•	You are likely to gain two to four pounds in the	

first three months. Record any weight gain

in the space provided in the Resource Section.

•	Total weight gain should be about 25 pounds

unless you are over or underweight. Your weight

gain is not all fat. It is mostly water in your body

and the weight of the growing baby.

Your blood

pressure

Your weight
6 Prenatal Information Sheet: 6–8 Week Visit

Your exercise

routine

Consider 

breastfeeding

Your weight

Your weight

•	Normal pregnancy weight gain:

(if pre-pregnant BMI is normal)

breast . . . . . . . . . . . . . . . . . . . . . 1.0 - 1.5 lbs.

	 blood. . . . . . . . . . . . . . . . . . . . . 3.0 - 4.5 lbs.

	 extra water. . . . . . . . . . . . . . . . . 4.0 - 6.0 lbs.

	 uterus. . . . . . . . . . . . . . . . . . . . . 2.5 - 3.0 lbs.

	 placenta/amniotic fluid . . . . . . . . . . . . 3.5 lbs.

	 baby . . . . . . . . . . . . . . . . . . . . . . 7.0 - 8.0 lbs.

	 fat stores . . . . . . . . . . . . . . . . . . 4.0 - 6.5 lbs.	

TOTAL . . . . . . . . . . . . . . . . . . . 25 - 35 lbs.

•	Gaining the right amount of weight by eating the right

type of food is an extremely important part of a healthy

pregnancy.

Your exercise routine

•	Regular exercise helps you to keep fit

during your pregnancy and to feel better	

during a time when your body is changing.

•	Before beginning a new type of exercise,	

check with your healthcare provider.

Breastfeeding - a great start

•	Now is the time to think about how you want to feed your

baby.

•	The American Academy of Pediatrics, the American College

of Nurse-Midwives, the American College of OB/GYN, and

the American Dietetic Association all strongly recommend

breastfeeding for at least your baby’s first 12 months of life.

•	Breastfeeding is not only best for the baby, it is also best

for your health. Breastfeeding can improve your health by

helping you lose pregnancy weight and lower the level of

bad cholesterol. On average, women who breastfeed live

longer and healthier lives compared to women who do not

breastfeed.

•	See Breastfeeding in Resource Section for further information.

Reference:

Prenatal

Fitness and

Exercise
Prenatal Information Sheet: 6–8 Week Visit 7

Take only medications approved by your 

healthcare provider

•	Discuss any prescription medication with your

provider.

•	Over-the-counter drugs considered safe for

common discomforts include:

–	Headaches: Tylenol®, Tylenol PM®, Datril®

–	Cold: Tylenol®, saline nose spray/rinses,

Robitussin® (no alcohol), Benadryl®

– Allergies: Claritin®, Zyrtec®, Allegra®

–	Constipation: Metamucil®, Fiber-All®,

Miralax®, Milk of Magnesia®

–	Indigestion: Tums®, Rolaids®, Maalox®,

Mylanta II®, Simethicone

– Heartburn: Zantac®, Pepcid®, Prilosec®

–	Hemorrhoids: Preparation H®, Anusol®

–	Nausea/Vomiting: Vitamin B6, Emetrol®,

Unisom®, ginger, sea sickness bands

Drugs to avoid

•	Aspirin®, Motrin®/Ibuprofen, Tetracycline,

Accutane®

•	Caffeine - see Nutrition in Resource Section.

•	Alcohol, tobacco, and any illicit drugs are

harmful to your baby, avoidance helps decrease

risks.

NOTE: If you are using any drugs or substances

that may be harmful to your baby, ask about

strategies to quit and approaches to lifestyle

behavior changes.

Work and household activities

•	AVOID:

–	Cat litter

–	X-rays (may be necessary after discussion	

with your OB healthcare provider)	

NOTE: Dental x-rays with proper shielding

are safe.

–	Use of dry cleaning solutions

–	Children’s sandboxes (cats may use as a litter box)

–	Working around radiation or radioisotopes

–	Working with lead or mercury

–	Gardening without gloves

•	If in doubt about your potential exposures, ask your health

care provider.

Take only 

medications 

approved by 

your provider

Drugs 

to avoid 

Work and 

household

activities
8 Prenatal Information Sheet: 6–8 Week Visit

Avoiding infections

•	Practice behaviors that prevent infection: Wash your hands often,

especially after using the toilet or changing a diaper, before food

preparation, and before and after you eat.

•	Cover your cough and encourage your family members to do the

same.

•	Avoid contact with people who have known infectious

conditions, such as a cold, the flu or a childhood disease such as

chicken pox.

• It is important that you be open with your healthcare provider

regarding exposure to any Sexually Transmitted Infections (STIs).

Sexually Transmitted Infections (STIs) are viruses, bacteria, or

parasites that pose risks of injury or death to your baby.	

These STIs include:

–	HIV(AIDS)

–	Gonorrhea

–	Syphilis

–	Chlamydia

–	Genital Herpes

–	Genital warts

Immunization status

•	Your immunizations should be up-to-date. We will review your

immunization and/or past exposure history for the following:

– Varicella (Chicken Pox)

– Rubella (German Measles)

– Hepatitis B

– Tetanus (Lockjaw)

– Pertussis (Whooping Cough)

– Diphtheria

– Influenza (Flu) (seasonal-related)

•	No live virus vaccines are recommended during pregnancy.

•	Please make sure your flu vaccines are up-to-date during your

pregnancy and after delivery.

•	Receive immunizations as needed.

•	If you are pregnant during the flu season, influenza vaccinations

are recommended (but not the flu mist because it is a live

vaccine).

•	You can avoid many infections by following good hand washing

practices.

Contact with 

certain diseases

or

infections

Immunization 

status
Prenatal Information Sheet: 6–8 Week Visit 9

Domestic abuse

screen

Summary of visit

Your next visit

Domestic abuse

•	Domestic abuse often increases during

pregnancy. Please do not hesitate to seek help

from your healthcare provider, counselor, or a

close friend if you are experiencing physical,

sexual, or emotional abuse from anyone.

•	Let your healthcare provider know if within the

last year, or since you have been pregnant,

you have been hit, slapped, kicked, otherwise

physically hurt, forced to have sexual activities

or verbally abused by anyone.

•	National Domestic Abuse Hotline:

1-800-799-7233

Summary of visit

Due date:_________ Date of next visit: __________

Date for lab work/other medical tests:___________

Date for any other scheduled appointments:______

____________________________________________

Your next visit

At your 10-12 week visit we will:

•	Measure your uterine growth, blood pressure,

and weight, and listen to the fetal heart tone

(may not be heard this early in pregnancy) and

discuss any concerns/questions you may have.

•	Complete a head-to-toe physical and pelvic

exam, Sexually Transmitted Infection (STI)

screening and possibly a Pap smear.

•	Discuss lab test results from first visit and have

additional labs, if needed.

•	Discuss lifestyle changes if needed.

•	Provide further education on Cystic Fibrosis

Carrier risk and discuss your options to be

screened with a blood test if not done at first

visit.

•	You should plan on at least 30 minutes for this

visit.

•	You should bring: any copies of your outpatient

medical record and your immunization record

for your provider to review and complete your

medical history.

ALWAYS BRING

YOUR

PURPLE BOOK

AND

PREGNANCY 

PASSPORT

TO

EVERY VISIT
10 Prenatal Information Sheet: 6–8 Week Visit

My reaction when I learned I was pregnant:

Goals for my pregnancy:

Questions for my next visit:

My partners reaction to my pregnancy:
Notes:

10–12 Week Visit 

Prenatal Information 

Sheet

Goal: Determine your current health status 

and work toward a healthy pregnancy

10-12 Week Visit

Prenatal Information Sheet: 10–12 Week Visit 15

Prenatal Information Sheet: 10–12 Week Visit 

Goal: Determine your current health status and 

work toward a healthy pregnancy

Your baby’s growth

•	Your baby is now about 2.5 to 3.0 inches long and likely weighs

about 0.5 ounces. The head is about twice the size of the body.

•	During this time, your baby’s body and organ tissues grow

rapidly.

•	The eyes and ears are moving into normal positions.

•	Intestines move from the umbilical cord into the stomach area.

•	We may be able to hear your baby’s heartbeat with a Doppler.

Your baby’s

growth

Your body’s changes

•	Your uterus is now the size of a grapefruit.

•	We may be able to feel the upper edge of your uterus (the

fundus) a little bit above your pubic bone.

•	Wear comfortable clothing that provides room to grow.

•	Morning sickness often diminishes by the end of this month.

•	If you haven’t already started, slowly add healthier food choices

and change unhealthy eating habits.

• Your teeth and gums are affected by pregnancy, just as other

tissues in your body. Routine dental care is important to

maintaining your dental health. Check when your last dental

cleaning was and schedule an appointment with your dental

provider if it has been more than six months. Dental x-rays with

the proper precautions are not harmful during pregnancy.

Your body’s 

changes

Your family’s changes

•	You may be moody, irritable, tearful, disorganized, have trouble

concentrating, or have irrational thoughts. These feelings are

normal. It may be helpful to talk about them with your family.

•	Your sexual desire may increase or decrease - both are normal.

Your family’s 

changes

Your thoughts and feelings

• You may find you are more moody or “stressed out” than you	

have been in the past. This is in part due to hormonal changes	

as your body adjusts to pregnancy. Just planning for your	

baby’s arrival can be challenging.

•	Most expectant mothers have concerns, whether it is body	

changes/discomforts, their health or the baby’s, fear of labor	

or changes to their personal or work situation.

 Thoughts

&

feelings

Thoughts

&

Feelings
16 Prenatal Information Sheet: 10–12 Week Visit

Today’s visit

Your blood

pressure

Signs to report 

immediately

Thoughts

&

feelings

Thoughts

&

Feelings

My BP:

Your thoughts and feelings

• Discuss your feelings with someone you trust and your 

healthcare provider, especially if you have been very sad or	

depressed.

• Discuss any concerns about past traumatic events with your

provider. There are options to help you cope with this if it

becomes a problem.

Signs to report immediately

•	When in doubt, call the clinic or your healthcare provider or

the Emergency Department!

•	Bright red vaginal bleeding, or painful cramping

•	Persistent severe headaches, severe nausea, and vomiting

•	Fever at or over 100.4° F or 38° C

•	Inability to keep liquids down (due to nausea and/or

vomiting) resulting in a reduced amount of urine

Today’s visit

• Review your medical and mental health history with your

healthcare provider.

• Receive a complete head-to-toe physical and pelvic exam that

may include a Pap smear and STI screening.

• Obtain height and weight to determine amount of fat in your

body - called the Body Mass Index (BMI).

• Review and discuss initial lab results.

• Identify and discuss with your healthcare provider any

additional visits, labs, or tests you may need.

• Discuss with your provider information regarding options

for screening for birth defects including chromosomal

abnormalities. See Genetic Screening in Resource Section.

- If you have chosen to undergo first trimester screening for

birth defects, with a first trimester result, your provider will

review any tests completed.

- If you have chosen a testing strategy with results in the first

trimester but have not yet had testing, and you are still 

within the appropriate gestational age, testing will be	

arranged.

Your blood pressure

•	Blood pressure is measured at every

prenatal visit because high blood	

pressure can cause serious complications	

for baby and mother if not controlled.
Prenatal Information Sheet: 10–12 Week Visit 17

My weight:

___________

Total weight

change:

____________

My optimal

weight gain:

	 	

Your weight and nutrition

•	Weight gain now is usually two to four pounds.	

Monitor/review your weight gain regularly.

•	Your baby is likely to be healthier if you eat

nutritious foods.

•	Try small, frequent meals to provide needed

nutrition and to decrease nausea and vomiting.

•	Choose your calories wisely—make sure each one is good for

both the baby and you.

•	If you are currently taking a multivitamin, you may continue

taking it. Discuss your decision with your provider.

• If you are taking specific nutritional supplements (such as

vitamins) or if you are on a special diet, you should discuss

with your provider the need for ongoing supplementation or

additional nutritional consultation.

•	Whether you are underweight (BMI <18.5), overweight (BMI

>30), or normal weight, you should discuss your optimal

weight gain with your healthcare provider.

•	Track your weight gain in the Resource Section of this book.

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	You may find it more difficult to “catch your

breath” even when walking up stairs. Take it

slowly. If you have a concern, discuss it with

your provider.

•	It is best to never exercise to the point of

exhaustion or breathlessness. This is a sign that your

body cannot get the oxygen supply it needs, which

affects the oxygen supply to the baby as well.

•	Certain activities should be avoided. For further information,

see Exercise in the Resource Section.

Breastfeeding - a great start

•	Get to know other breastfeeding moms and get involved in

community breastfeeding groups, such as La Leche League.

•	Human breast milk contains more than 100 protective ingredients

not found in a cow’s milk-based formula. Breast milk can’t be

duplicated.

•	Learn as much about breastfeeding as you can ahead of time.

•	I plan to _______________ feed my baby. I want to do this

for ___________ weeks.

Consider

breastfeeding

Your exercise

Your weight
18 Prenatal Information Sheet: 10–12 Week Visit

Fetal heart rate

•	You may be able to hear your baby’s heartbeat

at this visit with a Doppler.

Fetal heart

rate:

Uterine size

•	At 10 - 12 weeks your uterus is at the top of

your pubic bone.

Uterine size:

	 	

Initial lab results

Initial lab results

•	If any of your test results are abnormal,

your provider will discuss life-style changes,

treatments, and possible outcomes.

Blood type

testing

Blood type testing

•	Blood typing and antibody testing will be done

to tell if you are Rh (D) negative or positive.

•	If you are found to be Rh (D) negative:

–	You will receive a D-immunoglobulin

(RhoGAM®) injection at 28 weeks to prevent

your blood from building up antibodies that

can harm your baby.

–	Additional RhoGAM® injections are usually

given if you have certain procedures, such

as amniocentesis, or if you are experiencing

vaginal bleeding during the pregnancy.

–	The RhoGAM® injection is repeated after

delivery if baby’s blood is Rh positive.

Rubella and 

Varicella results

Rubella and Varicella results

•	If screening shows no immunity (tests negative),

we will discuss precautions to protect against

these infections.

+

Uterine size

Fetal heart rate
Prenatal Information Sheet: 10–12 Week Visit 19

Asymptomatic Bacteruria (ASB) Screen

•	ASB is an increased growth of bacteria in the

urine that can only be found through laboratory

analysis of a urine sample. There are no

symptoms, but ASB can result in a serious

kidney infection if left untreated.

•	Antibiotic treatment may be prescribed. It is

important to take as directed and finish the

whole prescription or the bacteria can return.

•	To reduce the chance of getting ASB, wear

cotton panties and wipe from front to back.

Asymptomatic 

Bacteruria (ASB) 

screen

Cystic Fibrosis (CF) Carrier Screen

•	This test is optional. The chances of having CF

vary with ethnic groups. See Specific Genetic

Testing in the Resource Section for further

information.

•	We offer this test to determine if you are a

carrier for CF and your baby’s chances of

having the disease. If you test positive, then the

next step is to test the baby’s father.

•	If you and your partner are carriers, your

unborn baby will have a 1 out of 4 (25%)

chance of having CF.

•	You will be given additional information and the

option for further counseling.

•	This information allows couples to decide on

their options.

Summary of visit

Due date:_________ Date of next visit: __________

Date for lab work/other medical tests:___________

Date for dental cleaning if needed: _____________

Date for any other scheduled appointments:______

____________________________________________

Summary of

visit

Cystic Fibrosis

(CF)

carrier screen
20 Prenatal Information Sheet: 10–12 Week Visit

Your next visit 

Your next visit 

At your 16 - 20 week visit we will:

•	Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, and

discuss concerns/questions you may have.

•	Follow-up on results from birth defect and fetal

abnormality screening tests if you elected to do

any.

•	Discuss the potential benefit, limitation and

safety of prenatal obstetric ultrasound.

ALWAYS BRING

YOUR

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT

Differences I have noticed recently in my body:

How pregnancy has impacted my relationship with my partner:

Questions for my next visit:
Notes:

16–20 Week Visit 

Prenatal Information 

Sheet

Goal: Work toward a more comfortable 

and safer pregnancy

16-20 Week Visit

Prenatal Information Sheet: 16–20 Week Visit 25

Prenatal Information Sheet: 16–20 Week Visit 

Goal: Work toward a more comfortable and safer pregnancy

Your baby’s growth 

•	Your baby (fetus) is now about 4.4 to 5.5 inches long and may

weigh about 4 ounces.

•	Fine hair, called “lanugo,” is growing on your baby’s head and

is starting to cover the body. Fingernails are well-formed.

•	The arms and legs are moving and you may start feeling this

movement. This movement is called “quickening.” You may

not feel movement everyday at this point, but the movements

will become stronger and more frequent as your pregnancy

progresses.

Your body’s changes

•	Your uterus is about the size of a cantaloupe.

•	Your center of gravity changes as your uterus grows. This change

may affect your balance and your ability to move.

•	There is an increase in the mobility of your joints that can affect

your posture and cause discomfort in your lower back. As your

uterus grows, the round ligaments supporting the uterus can

stretch and pull. This ligament pain feels like a sharp pulling

sensation on either or both sides of the lower abdomen.

•	You may have difficulty sleeping.

•	You may have some head stuffiness or frequent nose bleeds.

These symptoms may occur because of changes in your

circulatory system due to hormonal changes.

•	Constipation may be a problem. Refer to Common Discomforts &

Annoyances of Pregnancy in the Resource Section for things you

can do.

•	You may notice a whitish vaginal discharge.

•	You may feel Braxton-Hicks contractions that are usually

painless, irregular uterine contractions or tightening of the uterus

beginning as early as your sixth week of pregnancy.

•	Most women, especially in their first pregnancy, will not feel

Braxton-Hicks contractions until after 20 weeks.

Your body’s 

changes

Your baby’s 

growth
26 Prenatal Information Sheet: 16–20 Week Visit

Your family’s changes

• Open communication is important to developing a strong

relationship that will be the foundation for your family. This is

especially important if military operations or transitions require

family separation.

• Now is the time to begin discussing birth control with your

partner and healthcare provider. There are many effective birth

control options available for you after baby’s birth.

• Keep in mind that breastfeeding alone may not prevent a

pregnancy. Many birth control methods can be used safely while

breastfeeding if you want to prevent/delay another pregnancy.

Your thoughts and feelings

• You may still feel somewhat emotional at times. This will likely

continue through your pregnancy as you and your partner

prepare for changes now and after baby arrives. You will likely

feel more rested which will help you be more positive. As much

as you are excited about planning for your baby’s birth, you

may be worried about how you will adjust to motherhood, labor

and delivery, expenses, work and the changes that are coming.

• Pregnant women deal with many changes. Hormone changes

and weight gain may make you more likely to become frustrated	

with yourself and others. Physical discomforts such as not

sleeping well, pain, nausea or heartburn may add to your

frustration.

• Discuss your feelings with someone you trust and your

healthcare provider especially if you have been sad or

depressed.

• Consider taking time to talk to your mother or mothers who you

admire to help you identify important characteristics of a mother.

Signs to report immediately

•	When in doubt, call the clinic, your

healthcare provider or Labor and Delivery!

•	Bright red vaginal bleeding

•	Gush of fluid from the vagina

•	Severe nausea and vomiting

	 - Inability to keep fluids down

	 - You are producing only a small amount of dark urine or no

urine at all.

•	Fever at or over 100.4° F or 38° C

Signs to report 

immediately

Your family’s

changes

Thoughts

&

feelings

Thoughts

&

Feelings
Prenatal Information Sheet: 16–20 Week Visit 27

Today’s visit

• We will measure your uterine growth, blood

pressure, weight, listen to baby’s heart rate, and

discuss any concerns/questions you may have.

• If you have chosen to undergo screening for

birth defects, your provider will review any test	

results. Your chosen strategy may necessitate

that additional blood be drawn or an

ultrasound be arranged after this visit.

• Your provider will discuss with you the risks,

benefits, and indications for an obstetrical

ultrasound. If an ultrasound is indicated, it will

be ordered but not usually done during this visit.

• Discuss how to identify differences in preterm

labor versus false labor.

My weight:	

Total weight

change:

Your weight

•	The usual weight gain is approximately one

pound a week during the rest of the pregnancy.

•	Water contributes to 62% of the weight gain, fat

is about 30% and protein is about 8%.

•	Slow and steady weight gain is best.

•	Use your chart to monitor your rate of weight

gain. Follow the recommendations your provider

made at your first visit.

•	No amount of alcohol is safe for your baby.

Your weight 

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	Stay off your back while exercising from now

on.

• Mental, emotional and social benefits of

exercise include:

–	Helping to prevent depression

–	Promoting relaxation and restful sleep

–	Encouraging concentration and improving	

problem solving

–	Helping prepare for childbirth and parenting

–	Helping prevent excess weight gain

–	Improving self-esteem and well being

Your exercise

Today’s visit
28 Prenatal Information Sheet: 16–20 Week Visit

Breastfeeding - a great start 

• Some advantages to baby include:

–	Easier digestion of breast milk

–	No allergy problems to breast milk

–	Less likely to cause overweight babies

–	Less constipation for baby

–	Easier on baby’s kidneys

–	Fewer illnesses in the first year of life

–	Less SIDS (Sudden Infant Death Syndrome)

–	Close infant contact with mom

Fetal heart rate

•	Usually your baby’s heartbeat is easier to locate

and hear at this time in your pregnancy.

Fetal heart

rate:

Uterine size/Fundal height

•	At 16 weeks, your uterus is usually midway

between the belly button and the pubic bone or

16 cm above the pubic bone.

•	The fundal height is the distance between the

pubic bone and the top of the uterus.

•	Beginning at 20 weeks, the fundal height in

centimeters will be about equal to the number of

weeks you are pregnant.

Fundal height:

Screening for birth defects

•	After counseling with your provider you will

make the decision about which other test, if any,

should be scheduled to assess for risk of birth

defects. See Genetic Screening in Resource

Section.

Your blood pressure

•	Blood pressure is measured at every prenatal

visit. High blood pressure can cause serious

complications for baby and mother if left

unchecked.

Consider 

breastfeeding

Fetal heart rate

Fundal height

Maternal Serum

Analyte Screen

Your blood

pressure

My BP:	

_____________
Prenatal Information Sheet: 16–20 Week Visit 29

Ultrasound

Ultrasound

•	If an ultrasound is indicated, it will be ordered but not usually	

performed at this visit.

•	An obstetrical ultrasound exam uses sound waves to “see” your

baby in the womb. This exam provides information about your	

baby’s health and well being.

•	Indications for ultrasound evaluation include the following: known or

suspected complications of pregnancy, screening for possible fetal birth

defects, pregnancy dating, or evaluation of fetal growth and well being.

•	The result of an ultrasound can be exciting and reassuring, or it can detect

abnormalities in your pregnancy that are not anticipated. Ultrasound exams

provide much information about your pregnancy, but cannot detect all birth

defects. An ultrasound provides information about your baby’s health and well

being inside the womb such as:	

– Gestational age and size

– The number of babies

– Rate of growth

– Placenta position

– Baby’s heart rate

– Amount of amniotic fluid

– Some birth defects

– Gender, if readily visible

NOTE: Gender identification is not 100% accurate nor is it usually medically

necessary. It is not routinely noted in the ultrasound report. Lengthy or repeated

ultrasound exams, just to assess gender, are not indicated.	

• We receive many questions about 3D/4D ultrasounds for entertainment

or curiosity. The American College of OB/GYN and the Food and Drug

Administration do not support this technology for these purposes. Ultrasound

use, when medically indicated, has not been shown to produce any harm.

If there is a medical indication for 3D/4D ultrasound, your provider will

perform or order the procedure.

• Typically a trained technician will perform the ultrasound exams. The

technician is not authorized to discuss the findings with you at the time of

your exam. Your provider will discuss the result of this exam with you after

this visit.

• On the day of your ultrasound, wear clothes that allow your abdomen to be

exposed easily.
30 Prenatal Information Sheet: 16–20 Week Visit

Summary of visit

Due date:_________ Date of next visit: _________

Date for lab work/other medical tests:__________

Date for any other scheduled appointments:_____

___________________________________________

Your next visit

At your 24 week visit we will:

•	Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, and

discuss any concerns/questions you may have.

•	Discuss signs and symptoms of preterm labor.

•	Discuss the importance of the test for gestational

diabetes and how this test is done at your 28

week visit.

ALWAYS BRING

YOUR

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT

What do you feel is the role of a mother?

What concerns do you have about becoming a mother?

Things I will need to know to breastfeed:

Questions for my next visit:

Summary 

of visit

Your next visit
Prenatal Information Sheet: 16–20 Week Visit 31

Notes:

24 Week Visit 

Prenatal Information 

Sheet

Goal: Prevent preterm labor for a safe 

and healthy baby

24 Week Visit

Prenatal Information Sheet: 24 Week Visit 35

Prenatal Information Sheet: 24 Week Visit 

Goal: Prevent preterm labor for a safe and healthy baby

Your baby’s growth

•	Your baby is now about 8.4 inches long and weighs about 1.2

pounds.

•	Your baby is resting and growing inside your uterus, inside of

a sac filled with amniotic fluid. This sac provides the perfect

environment for your baby. Movement is easy and the fluid

serves as a cushion for the fetus against injury. The fluid in the

sac also regulates the temperature. The fluid level should now

begin to increase steadily.

Your baby’s 

growth

Your body’s changes

•	Your uterus is now an inch or two above the belly button and is

about the size of a small soccer ball.

•	You may feel occasional tightening of your abdomen (BraxtonHicks), which is normal.

•	You may develop varicose veins, increased heartburn, and skin

changes due to the fluctuation in hormones.

•	If you have any of the signs of preterm labor, such as cramping

or contractions that do not go away within an hour of rest, call

your provider immediately.

Your body’s 

changes

Your family’s changes

•	Talk to your family about ways to help each other adjust to the

many changes you are all facing. Encourage their involvement

by inviting them to your clinic visits. Jointly plan for the future

and share the many emotions, fears, and joys you are all going

through. The more your family is involved now, the easier they

will bond with the new baby and participate in his/her care.

•	If the father of the baby is not available, find someone you trust

and who is willing to be your support person.	

Who will be my support person?____________________________

Your family’s 

changes

Your thoughts and feelings

•	You may still feel somewhat emotional at times. This will likely

continue through your pregnancy as you and your partner

prepare for changes now and after baby arrives. As much as

you are excited about planning for your baby’s birth, you may

be worried about how you will adjust to motherhood, labor and

delivery, expenses, work and the changes that are coming.

•	Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been very sad or

depressed.

Thoughts

&

feelings

Thoughts

&

Feelings
36 Prenatal Information Sheet: 24 Week Visit

Signs to report 

immediately

Signs to report immediately

•	When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

•	Bright red vaginal bleeding

•	Gush of fluid from the vagina

•	Four or more painful cramping contractions within an hour (after

resting and emptying bladder)

•	Severe nausea and vomiting

	 - Inability to keep fluids down

	 - Producing small amount of dark urine or no urine at all.

•	Persistent headache (unrelieved by taking Tylenol®)

•	Loss of vision

•	Sudden weight gain

•	Rapid swelling of hands and face

•	Constant right upper belly pain

•	Fever at or over 100.4° F or 38° C

Today’s visit

•	We will measure your uterine growth, blood pressure, weight,

listen to your baby’s heart rate, and discuss any concerns or

questions you may have.

•	Schedule lab tests.

•	Sign up for breastfeeding and other prenatal classes.

•	Check to see if you are having any preterm contractions.

• Learn the signs of preterm labor and what to do if it occurs.

•	If you had a cesarean delivery for a prior birth, discuss your

birth options for this pregnancy. See Cesarean Delivery in

Resource Section for further information.

• If you are considering surgical sterilization (“tying your tubes“)

you should discuss this with your provider now. Some states

require several weeks between a signed consent and surgery.

Your weight

•	Your weight gain will average close to one pound per week.

•	Many common discomforts of pregnancy (constipation, nausea,

heartburn) can be reduced through a change in diet.

•	Record your weight on the Weight Chart in the Resource Section.

•	How am I doing with my weight gain?	

________________________________________________________

•	What can I do to improve my diet and exercise?	

________________________________________________________

Today’s visit

Your

weight:

_________

Your total

weight

change:

_________
Prenatal Information Sheet: 24 Week Visit 37

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	We recommend you drink a full glass of water

for every 30 minutes of exercise you do.

•	The American College of OB/GYN advises

women to avoid bouncing, jumping, jarring or

high-impact motions.

•	Always check with your healthcare provider

before beginning a new exercise.

Your exercise

Breastfeeding - a great start

•	Some advantages of breastfeeding to you

include:

– Burns about the same number of calories as

one hour of exercise and allows you to use

some of the extra fat you have stored during

your pregnancy.

– Helps your uterus get back to its normal size

faster.

– Saves time, money and extra trips to the

store for formula and supplies.

– There are no special foods you have to eat;

however, you should eat a well-balanced

diet,and limit alcohol and caffeine.

•	For further information see Breastfeeding in

Resource Section.

Consider breastfeeding

Fetal heart rate

•	Baby’s heartbeat is getting much easier to

hear.

Fundal height

•	Fundal height is about 24 cm or two inches

above the belly button.

Your blood pressure

•	Blood pressure is measured at every prenatal

visit. High blood pressure can cause serious

complications for baby and mother if left

unchecked.

Fetal heart rate

Fundal height

Fundal height:

Fetal heart

rate:

Your blood

pressure

My BP:	

_____________
38 Prenatal Information Sheet: 24 Week Visit

Preterm labor 

guidelines

Preterm labor 

•	Your baby needs to continue to grow inside you for the full

term of your pregnancy. Labor earlier than three weeks before

your due date can lead to a premature (preemie) baby with

many associated risks. Even 37 to 38 week babies can have

difficulties.

•	As always, when in doubt call your healthcare provider or Labor

and Delivery.

•	Report any of the following symptoms to your health 

care provider: 

–	Low, dull backache

–	Four or more uterine contractions per hour. Uterine

contractions may feel like:

 Menstrual cramps

 Sensation of “baby rolling up in a ball”

 Abdominal cramping (may also have diarrhea)

 Increased uterine activity compared to previous patterns

–	Increased pelvic pressure (may be with thigh cramps)

–	Sensation that “something feels different” (e.g., agitation, flulike syndrome, and sensation that baby has “dropped”)

• If you experience any of the above symptoms you 

should: 

–	Stop what you are doing and empty your bladder.

–	Drink three to four glasses of water.

–	Lie down on your side for one hour and place your hands on

your abdomen and feel for tightening/hardening and relaxing

of your uterus.

–	Count how many contractions you have in an hour.

–	If you have more than four contractions for more than one hour

call either the clinic or Labor & Delivery immediately.

• You should report immediately:

–	Change in vaginal discharge such as change in color of

mucus, leaking of clear fluid, spotting or bleeding, or a

vaginal discharge with a fish-like odor (may be more notable

after sex).
Prenatal Information Sheet: 24 Week Visit 39

Gestational Diabetes (GD) testing

•	Gestational diabetes is high sugar levels in your blood during

your pregnancy. It usually goes away after delivery. If your

results are high, this does not mean you have diabetes, it just

means further testing is needed.

•	You will have a blood test for gestational diabetes. This blood

test will tell how your body is responding to your sugar levels.

•	To prepare for the test at your next visit, eat your usual dinner

the night before the test and your normal breakfast the day of

the test.

•	At the lab, you will be given a very sweet drink (glucola) that

has a specific amount of sugar in it.

•	During the hour between drinking the glucola and having your

blood drawn, do not eat or drink anything, including gum or

candy, because it may affect the test results. You may drink

plain water during this time while you are waiting.

Summary of visit

Due date:_________ Date of next visit: ______________________

Date for lab work/other medical tests:_______________________

Date for any other scheduled appointments:__________________

________________________________________________________

Your next visit

At your 28 week visit we will:

•	Measure your uterine growth, blood pressure, weight, listen to

your baby’s heart rate, and discuss any concerns or questions

you may have.

•	Provide instructions on counting fetal movement.

•	Provide RhoGAM® if your blood is Rh negative (D-) and you

are not sensitized.

•	Have blood work for gestational diabetes and other labs if

needed. You will have to wait one hour between drinking

the glucola and having your blood drawn.

•	Sign up for breastfeeding and other available classes.

ALWAYS

BRING YOUR	

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT

Summary

of visit

Gestational

Diabetes

(GD) testing

Your next visit 
40 Prenatal Information Sheet: 24 Week Visit

Activities or traditions you remember from your childhood that you 

would like to continue in your family:

Think about what your baby will look like. Write your thoughts 

here:

Questions for my next visit:
Notes:

28 Week Visit 

Prenatal Information 

Sheet

Goal: Monitor baby and your progress and 

learn to count fetal movements

28 Week Visit

Prenatal Information Sheet: 28 Week Visit 45

Prenatal Information Sheet: 28 Week Visit 

Goal: Monitor baby and your progress and 

learn to count fetal movements

Your baby’s growth

•	Your baby’s weight has probably doubled since your last visit!

Your baby weighs about 2.5 lbs and is about 10 inches long.

•	The baby starts to lose the lanugo (fine hair), especially from

the face. The baby has a large amount of cheesy-like substance

(vernix) covering the body that protects the skin while the baby is

living in the amniotic fluid. This vernix decreases on the skin as

the baby grows.

•	Your baby’s eyebrows and eyelashes may be present now.

•	The brain tissue also increases during this time.

•	Now that you are 28 weeks, you should be feeling your baby

move (kicks, rolls, twists, turns, and jabs) on a regular basis.

Your body’s changes

•	You’ve probably gained about 18 pounds.

•	You may also start experiencing some swelling, and/or

numbness or pain in your hands and wrists (Carpal Tunnel

Syndrome). Avoid sleeping on your hands or bending your wrists

for long periods of time. Discuss persistent pain, numbness or

weakness with your provider.

Your body’s 

changes

Your family’s changes

•	Everyone needs help with child care whether on a full, part-time,

or occasional basis. Consider your needs.

•	Active duty moms should be prepared to list their child care

providers upon return to work/duty.

•	If you will be returning to work after baby’s birth, now is the time

to explore the various child care options in your community.

Your family’s 

changes

Your thoughts and feelings

• Stress may begin to surface. If it seems uncontrollable, talk to

your provider about this.

•	Remember to give yourself a break! You may need to adjust the	

expectations you have for yourself at this time. Focus on what is

important to you and your family. Sometimes going for a walk	

or doing something you enjoy will help you prioritize what is	

important or help you relax.

•	About 15% of women experience depression during pregnancy or after

delivery. Discuss any concerns with your provider.

•	Discuss your feelings with someone you trust, and your healthcare provider,

especially if you have been very sad or depressed.

Your baby’s

growth

Thoughts

&

feelings

Thoughts

&

Feelings

Your body’s

changes
46 Prenatal Information Sheet: 28 Week Visit

Signs to report 

immediately

Today’s visit

• We will measure your uterine growth, blood pressure, and

weight, listen to your baby’s heart rate, and discuss any

concerns or questions you may have.

• Check for preterm labor.

• Review signs of preterm and what to do if they occur.

• You will receive blood test for gestational diabetes.

• You will learn how to do Fetal Movement Counts.

• Discuss Domestic Abuse.

• Discuss and be screened for depression in pregnancy.

• If you are Rh negative, you will have an additional blood test

before receiving RhoGAM® injection.

•	Register for Breastfeeding class, Childbirth classes and Labor &

Delivery tour.

• Fill out the EPDS form in the Resource Section for this visit.

Your weight and nutrition

•	Try to eat a variety of foods.

•	If needed, extra nutrients such as iron, vitamins

B-6 and B-12, and calcium may be prescribed.

• Record your weight on the weight chart in the

Resource Section.

• For further information see Nutrition in Resource	

section.

Today’s visit

Your weight

Your

weight:

_________

Your total

weight

change:	

_________

Signs to report immediately

•	When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

•	Bright red bleeding or gush of fluid from the vagina

•	The baby is not moving as much as you expect

•	Four or more painful cramping contractions within an hour (after

resting and emptying bladder)

•	Severe nausea and vomiting

	 - Inability to keep fluids down

	 - Producing small amount of dark urine or no urine at all

•	Persistent headache (unrelieved by taking Tylenol®)

•	Loss of vision

•	Sudden weight gain

•	Rapid swelling of hands and face

•	Constant right upper belly pain (not related to baby movement)

•	Fever at or over 100.4° F or 38° C
Prenatal Information Sheet: 28 Week Visit 47

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	Now that your uterus is getting larger, you need

to avoid exercises that require a lot of balance,

to prevent a fall.

•	Make sure the calories you eat are nutritious for

both you and your baby and that you stay well

hydrated.

Breastfeeding - a great start

•	Classes on breastfeeding will:

–	Help answer many questions

–	Give you confidence in your ability to breastfeed

–	Introduce you to other breastfeeding moms

–	Reassure you that what you are doing is best

for both you, your baby and your family

Domestic abuse

• Domestic abuse often increases during

pregnancy. Please do not hesitate to

seek help from your healthcare provider,

counselor or a close friend if you are

experiencing physical, sexual, emotional, or

verbal abuse from anyone.

• Let your provider know if within the last year, or since you

have been pregnant, you have been hit, slapped, kicked,

otherwise physically hurt, or forced to have sexual activities

by anyone.

• National Domestic Abuse Hotline: 1-800-799-7233

Fetal heart

rate:

Fetal heart rate

•	This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart rate

Fundal height

•	The top of your uterus measures about 28 cm

from your pubic bone.

Your exercise

Consider

breastfeeding

Domestic abuse

screen

Fundal height 

Fundal height:
48 Prenatal Information Sheet: 28 Week Visit

My BP:	

_____________

Your blood

pressure

Fetal movement count

•	One very reassuring way to determine the baby’s	

overall health and wellness is to record your

baby’s movements daily.

•	By now, you probably know when your baby is	

most active. This may be before or after a meal,	

early in the morning, or at night when you go to bed.

Each baby is unique.

•	You should count your baby’s movements whenever he or she is

most active. This count should occur about the same time each

day. After 10 times, you can stop counting for the day. You will

need to record the time it takes for your baby to move 10 times.

See Fetal Movement Counting Chart in Resource Section.

•	You should be able to feel at least 10 movements within two

hours.

•	If you do not get 10 movements within two hours, you should

call or go to Labor & Delivery immediately with your baby’s

movement chart. Don’t wait until the next day or next 

appointment.

Your blood pressure

•	Blood pressure is measured at every	

prenatal visit. High blood pressure can	

cause serious complications for baby	

and mother if left unchecked.

Fetal

movement

count

Fetal

Movement

Count

Preterm labor 

•	Your baby needs to continue to grow inside you for the full term

of your pregnancy. Labor earlier than three weeks before your

due date can lead to a premature (preemie) baby with many

associated risks.

•	As always, when in doubt call your healthcare provider or

Labor and Delivery.

•	Report any of the following symptoms to your 

healthcare provider: 

–	Low, dull backache

–	Four or more uterine contractions per hour. Uterine

contractions may feel like:

 Menstrual cramps

 Sensation of the “baby rolling up in a ball”

 Abdominal cramping (may also have diarrhea)

 Increased uterine activity compared to previous patterns

Preterm labor

guidelines
49 Prenatal Information Sheet: 28 Weeks Visit

Preterm labor

guidelines

Preterm labor

–	Increased pelvic pressure (may be with thigh cramps)

–	Sensation that “something feels different” (e.g., agitation, flulike syndrome, and sensation that baby has “dropped”)

• If you experience any of the above symptoms you 

should: 

–	Stop what you are doing and empty your bladder.

–	Drink three to four glasses of water.

–	Lie down on your side for one hour and place your hands on

your abdomen and feel for tightening/hardening and relaxing

of your uterus.

–	Count how many contractions you have in an hour.

–	If you have more than four contractions for more than one hour

call either the clinic or Labor & Delivery immediately.

•You should report immediately:

–	Change in vaginal discharge such as change in color of

mucus, leaking of clear fluid, spotting or bleeding, or a

vaginal discharge with a fish-like odor (may be more notable

after intercourse).

Gestational Diabetes (GD) testing

High blood sugar puts your baby at risk for complications.

•	High blood sugar usually develops towards the middle of your

pregnancy.

•	Risk factors include: being over age 25, overweight, family

history of diabetes, ethnic background (Hispanic, African

American, Native American, Asian), previous delivery of a baby

weighing over nine pounds.

•	This test will determine if you have a normal response to a sugar

load (glucola).

•	If your blood sugar levels are high, further testing will be

ordered.

•	Often this condition can be controlled through special diet.

Rh (D) negative (Anti-D) prophylaxis

•	Earlier in your pregnancy, you had a test to identify your Rh (D)

status.

•	Rh (D) negative women will have an additional blood test

(antibody screen) and will usually receive a RhoGAM®

injection at this appointment.

•	This injection will be repeated after delivery if baby is Rh

positive.

Gestational

Diabetes

(GD) testing

+

Rh prophylaxis
50 Prenatal Information Sheet: 28 Week Visit

Summary of visit

Date of next visit: ____________________________

Date for lab work/other medical tests:__________

Date of Breastfeeding Class: __________________

Date of Childbirth Class: _____________________

Date of Other Classes: _______________________

Your next visit

At your 32 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, review

fetal movement record, and discuss any

concerns/questions you may have.

• You will sign up for classes (if not done

already).

• You will review preterm labor signs.

ALWAYS BRING

YOUR

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT

Your next visit

Review the goals you noted for yourself early in your pregnancy. Is 

there something you need to do to meet your goals? What?

Differences I have noticed recently:

How has the pregnancy effected your family/relationships?

Other things I need to do/get ready in the next four weeks:

Questions for my next visit:

Summary of visit
Notes:

32 Week Visit 

Prenatal Information 

Sheet

Goal: Prepare for your baby’s arrival

32 Week Visit

Prenatal Information Sheet: 32 Week Visit 55

Prenatal Information Sheet: 32 Week Visit 

Goal: Prepare for your baby’s arrival

Your baby’s growth

•	Your baby weighs almost four pounds, and the length is

18-19 inches!

•	Organ systems are now adequately developed.

•	Most likely, your baby is in the “head down” position so

you may feel most of his/her kicks and jabs under your ribs.

•	If your baby is in the breech or “butt down” or transverse	

(sideways) position you may feel the movements in different areas.

Your body’s changes

•	The top of your uterus is about four to five inches above your

belly button by now.

•	You may also notice that your back and pelvic area may feel

different. The bones in your pelvis are moving and shifting to

make room for the baby’s head to pass through.

•	As this happens, the ligaments around the pelvis also stretch,

which can cause some discomfort in the hip joints, back, and

front of the pelvis.

Your body’s 

changes

Your family’s changes

•	You and your partner may become more anxious as the “big

day” approaches.

•	You may become more irritable and find that this can put a strain

on your relationship.

•	You’ll probably find that it is harder to do all the things that you

are used to doing, such as sleeping and moving quickly. When

possible, schedule rest periods and avoid quick movements.

•	Make sure you have a plan for getting to the hospital no matter

when you need to go! This plan needs to include transportation,

child and pet care options, and phone numbers.

Your family’s 

changes

Your thoughts and feelings

• You may still feel somewhat emotional at times. You may feel

increasingly fatigued which will impact how you respond to the

people around you.

• Signs of pregnancy-related depression may include: loss of

interest in activities you enjoy, feelings of guilt or hopelessness,	

changes in appetite or sleep patterns, or thoughts of harming	

yourself or others. If you experience any of these symptoms,	

please contact your provider immediately.

• Discuss your feelings with someone you trust, and your healthcare provider,

especially if you have been very sad or depressed.

Thoughts

&

feelings

Thoughts

&

Feelings

Your

baby’s

growth
56 Prenatal Information Sheet: 32 Week Visit

Signs to report 

immediately

Signs to report immediately

•	When in doubt, call the clinic, your provider or Labor and

Delivery!

•	Bright red bleeding or gush of fluid from the vagina

•	The baby is not moving as much as you expect

•	Four or more painful cramping contractions within an hour (after

resting and emptying bladder)

•	Severe nausea and vomiting

	 - Inability to keep fluids down

	 - Producing a small amount of dark urine or no urine at all

•	Persistent headache (unrelieved by taking Tylenol®)

•	Loss of vision

•	Sudden weight gain

•	Rapid swelling of hands and face

•	Constant right upper belly pain (not related to baby movement)

•	Fever at or over 100.4° F or 38° C

Today’s visit

•	We will measure your uterine growth, blood pressure, and

weight, listen to your baby’s heart rate, check your baby’s

position, review the fetal movement record, and discuss any

concerns/questions you may have.

•	Check for preterm labor.

•	Discuss birth control options for after you deliver.

•	Receive a domestic abuse screening.

•	Sign up for classes such as Breastfeeding, Childbirth, Labor and

Delivery, Postpartum and Newborn tour if not done yet.

Your weight and nutrition

•	Continue to monitor/record your weight gain.

•	Pregnancy increases your requirements for iron,

calcium, folate, protein, and water.

•	Make sure to read food labels carefully.

•	Try to limit simple sugars (honey, maple

syrup, white, and brown sugars).

Your exercise routine

•	You can continue to exercise right up to delivery and this may

even help the delivery go more easily. Discuss your exercise

routine with your provider.

•	Don’t exercise on an empty stomach and make sure you replace

any fluids lost during exercise.

•	Avoid exercising in very hot and/or humid weather.

•	You may need to modify the intensity of your exercise routine

according to your symptoms. Now is not the time to exercise to

exhaustion or fatigue.

Today’s visit

Your weight 

Your exercise

Reference:

Prenatal

Fitness and

Exercise

My weight:

___________

Total weight

change:

____________
Prenatal Information Sheet: 32 Week Visit 57

Breastfeeding - a great start

•	The American Academy of Pediatrics, the

American Academy of Family Practice and

many other professional organizations

recommend breastfeeding for the first 12

months, but any amount of breastfeeding is

beneficial to your baby.

•	If you have any doubts or concerns about

breastfeeding, let your provider know. We have

many excellent resources to help you feel more

comfortable and confident with breastfeeding.

 Consider 

breastfeeding

Fetal heart rate

•	This measurement will be done at each

visit to monitor your baby’s well-being.

Fundal height

•	The top of your uterus is 32 cm above your

pubic bone or four to five inches above your

belly button.

Your blood pressure

•	Blood pressure is measured at every prenatal

visit because high blood pressure can cause

serious complications for baby and mother if	

not controlled. It can also be a sign of preeclampsia.

Fetal movement count

•	Review fetal movement count record.

Fetal heart rate

Fundal height 

Fundal	

height:

Fetal heart	

rate:

Fetal movement

count

Fetal	

Movement	

Count:

My BP:

Your blood

pressure
58 Prenatal Information Sheet: 32 Week Visit

Family planning

• Even though it may seem early to discuss birth control when you

are still pregnant, now is an excellent time to plan for what you

and your partner will use for birth control after baby arrives.

• You can get pregnant the first time you have sexual intercourse

following delivery. Prior to discharge from the hospital, your

provider will discuss birth control with you. See Family Planning

in Resource Section.

•Talk with your provider about plans for your next pregnancy.

Preparing for baby’s arrival

•	Most women go through the “nesting” phase a week or two

before delivery. You’ll probably clean everything in sight, so take

it as a blessing in disguise.

•	Plan, cook, and freeze some meals ahead of time. Keep a stock

of basic staples, so you won’t have to go to the store for basic

food items.

•	If friends offer to help, suggest that they cook a meal or two for

you and your family.

•	Baby’s living area: Whether baby has his or her own room, or

is sharing a room with a sibling or with you, be sure the area

is clean and safe. Wash your baby’s new sheets, blankets, and

clothes in a mild detergent (or, if your machine has this feature,

run them through an extra rinse) before you bring baby home.

•	After the baby comes home, you will have many new duties, a

lot less sleep, and a lot less energy. So plan ahead.

Preterm labor

•	Your baby needs to continue to grow inside you for the full term

of your pregnancy. Labor earlier than three weeks before your

due date can lead to a premature (preemie) baby with many

associated risks.

•	As always, when in doubt call your healthcare provider or

Labor and Delivery.

•	Report any of the following symptoms to your health 

care provider:

–	Low, dull backache

–	Four or more uterine contractions per hour. Uterine

contractions may feel like:

 Menstrual cramps

 Sensation of the “baby rolling up in a ball”

 Abdominal cramping (may have diarrhea)

 Increased uterine activity compared to previous patterns

–	Increased pelvic pressure (may be with thigh cramps)

–	Sensation that “something feels different” (e.g., agitation, flulike syndrome, and sensation that baby has “dropped”)

Preparing for

baby’s arrival

Preterm labor

guidelines

Family

planning
Prenatal Information Sheet: 32 Week Visit 59

Preterm labor

• If you experience any of the above symptoms you should:

– Stop what you are doing and empty your bladder.

– Drink three to four glasses of water.

– Lie down on your side for one hour and place your hands on your abdomen

and feel for tightening/hardening and relaxing of your uterus.

– Count how many contractions you have in an hour.

– If you have more than four contractions for more than one hour call either

the clinic or Labor & Delivery immediately.

• You should report immediately:

– Change in vaginal discharge such as change in color of mucus, leaking of

clear fluid, spotting or bleeding, or a vaginal discharge with a fish-like odor

(may be more notable after intercourse).

Weight

today:

________

Summary of visit

Date of next visit:____________________________	

Date for lab work/other medical tests:	

ALWAYS

BRING YOUR	

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY

VISIT

Your next visit

At your 36 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to the baby’s heart rate, check

your baby’s position, review the fetal movement

record, and discuss concerns/questions you may

have.

• Discuss any specific desires you have for your labor and

delivery. See Birth Plan in Resource Section.

• Do a Group B Streptococcus (GBS) test.

Summary of visit

Your next visit

____________________________________________

Right now, I am concerned/worried about:
60 Prenatal Information Sheet: 32 Week Visit

Preparation for labor: 

Who will be in the labor/birth room with you?

Questions/concerns since taking classes:

Plan for pain relief during labor:

I am planning to use _____________________ method of family 

planning to prevent/delay another pregnancy.

Questions for my next visit:

My spouse/partner is concerned/worried about:
Notes:

36 Week Visit 

Prenatal Information 

Sheet

Goal: Begin preparations for your hospital 

experience

36 Week Visit

Prenatal Information Sheet: 36 Week Visit 65

Prenatal Information Sheet: 36 Week Visit 

Goal: Begin preparations for your hospital experience

Your baby’s growth

•	Your baby probably weighs around 6 pounds now and is about

20 inches in length.

•	Most likely, your baby is in the “head down” position. However,

some babies settle into the head down position only a few days

before delivery. If baby is in the breech (or butt down) position,

your provider will discuss options to turn the baby to head down

position.

Your body’s changes

•	Easier breathing after the baby “drops” or moves down into

pelvis. Some babies don’t “drop” until after labor begins.

• More frequent urination after the baby “drops” down.

• Increased backache and heaviness.

• Pelvic and buttock discomfort.

• Increased swelling of the ankles and feet and occasionally the

hands.

• More frequent and more intense Braxton-Hicks (non-painful)

contractions.

Your body’s 

changes

Your family’s changes

•	More excitement and anxiety but also more impatience and

restlessness as the delivery date nears are common – for both

you and the baby’s father. Many parents feel a renewed desire

this month to tie up loose ends at work or home, organize the

home, or catch up on social obligations. While you may think

you have more energy now than in the last two months, don’t

overdo it. Involve your partner in carrying out needed tasks.

• Apprehension about the baby’s health and labor and delivery is

common.

• Share your concerns about the changes you anticipate with your

partner and those around you.

Your family’s 

changes

Your

baby’s

growth
66 Prenatal Information Sheet: 36 Week Visit

Your thoughts and feelings

• Some women find that as the due date approaches they become

very anxious about labor and delivery or their ability to care for

a newborn. You may experience mood swings, anxiety, or be

very short-tempered and emotional in these last few weeks of

your pregnancy. These feelings are common.

• If at any time you believe you are close to hurting yourself or

someone else, due to anger, contact your provider immediately.

If you cannot reach your provider, seek help at the hospital

Emergency Department.

• Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been very sad or

depressed in the last couple of weeks.

Signs to report 

immediately

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

•	Bright red bleeding or gush of fluid from the vagina

• The baby is not moving as much as you expect

• Four or more painful cramping contractions within an hour (after

resting and emptying bladder)

• Severe nausea and vomiting:

	 - Inability to keep fluids down

	 - Producing a small amount of dark urine or no urine at all

• Persistent headache (unrelieved by taking Tylenol®)

• Loss of vision

• Sudden weight gain

• Rapid swelling of hands and face

• Constant right upper belly pain (not related to baby movement)

• Fever at or over 100.4° F or 38° C

Today’s visit

• We will measure your uterine growth, blood pressure, weight,

listen to baby’s heart rate, review the fetal movement record,

check baby’s position, do a test for Group B Streptococcus

(GBS) and discuss any concerns/questions you may have.

• Discuss any specific plans you have for your birth experience.

• You will complete necessary forms from your healthcare

provider and take them to the Admissions Office.

• Homework - Prior to going into labor and being admitted to	

the hospital, make sure you have made arrangements for	

childcare and pet care.

Thoughts

&

feelings

Thoughts

&

Feelings

Today’s visit
Prenatal Information Sheet: 36 Week Visit 67

My weight:

___________

Total weight

change:

____________

Your weight and nutrition

•	When making your choices from each food

group, pick those that are low in fat and high in

fiber and iron.

•	With your enlarging uterus, you may need to

eat smaller, more frequent meals.

• Track your weight gain in the Resource Section

of this book.

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	Regular exercise helps you keep fit during your

pregnancy and feeling better during a time

when your body is changing.

•	Avoid overheating by drinking adequate

amounts of fluids and wearing appropriate

clothing.

Your exercise

Breastfeeding - a great start

•	Breast milk is the ideal food for a baby and is

easily digested.

Consider 

breastfeeding

Fetal heart

rate:

Fetal heart rate

•	This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart rate

Fundal height: Fundal height

•	This measurement will be done at each visit to

monitor the progress of your pregnancy.

Fundal height 

My BP: Your blood pressure

•	Blood pressure is measured at every prenatal

visit because high blood pressure can cause

serious complications for baby and mother if	

not controlled. It can also be a sign of preeclampsia.

Your weight

Your blood

pressure
68 Prenatal Information Sheet: 36 Week Visit

Fetal movement 

count

Fetal movement count

•	Review fetal movement count record.

Fetal

Movement

Count:

Fetal 

presentation

Fetal presentation

•	The location of the baby’s heartbeat in the lower

half of your abdomen is a clue to your baby

being in the head down position.

•	If the baby’s position is not head-down, your

healthcare provider will discuss with you what

may need to occur.

Group B 

Streptococcus 

Group B Streptococcus (GBS)

•	GBS, bacteria commonly found in the vagina

or rectum, can sometimes be passed on to the

baby during labor and delivery.

•	Testing will determine if you have GBS.

•	Your provider will swab the vaginal and rectal

area and send the specimen to the lab.

•	Once completed, test results will be discussed

with you at your next visit.

•	If the test is positive, you will receive antibiotics

during labor. See GBS in Resource Section for

further information.

Birth plan

Birth plan

•	It is anticipated that most women will have spontaneous onset

of labor and deliver vaginally. However, induction of labor with

medications may be required if you have premature rupture

of membranes and labor did not start spontaneously, or if you

developed medical problems that required delivery.

• At times, operative delivery is required (forceps, vacuum, or

cesarean section) to assist in the delivery of your baby. Your

provider will discuss with you if operative delivery is required.

• If you have a birth plan or any special requests, please let your

nurse or healthcare provider know and we will do whatever we

can to accommodate you and your family while also providing

an optimal and healthy outcome.
Prenatal Information Sheet: 36 Week Visit 69

Preparing for baby’s arrival

•	Pack two bags, one for you and one for the baby. The baby’s

bag can stay in the car until after the baby is born. This way

your partner will have less to carry while helping you to Labor &

Delivery.

• Bring things to make you comfortable: washcloths, extra socks,

lip balm, hair items, basic toiletries. If you wear contact lenses,

be sure to bring your case and a pair of glasses.

• Bring phone numbers of those you want to call immediately after

the baby is born.

• Don’t forget the camera! Bring extra film and batteries as backup. You don’t want to miss this once-in-a-lifetime opportunity!

• Bring several pair of your oldest panties as you’ll be bleeding

quite a bit for a few days after you give birth.

• If breastfeeding, be sure to bring a nursing bra or two.

• Feel free to bring your own nightgowns or pajamas, slippers,

and robe, but we can also provide these items for your use while

in the hospital.

• You will need your own clothes to go home. Make sure they are

comfortable, and, yes, you may still be wearing maternity clothes

for awhile.

• For baby: bring an outfit to go home in, a blanket, and a car

seat. You won’t need these until the day of discharge. Now

is a good time to install the car seat in your car and have the

installation inspected by a certified car seat technician.

• Feel free to bring a tape/CD player. Your tastes/preferences

may change as you move through the different stages of labor,

so you may want a variety of music options.

Preterm/Labor signs

•	Technically, this is the last week your need to report

preterm labor symptoms. Most providers will not attempt to stop

labor at this time in your pregnancy. If your baby is born prior to

39 weeks, it may require an extended stay in a special nursery

for monitoring of temperature, heart rate, and respiratory status.

• Go to Labor & Delivery if you’re having:

–	More than six contractions per hour that do not	

ease up with drinking three to four glasses of water, emptying

your bladder, and lying on your side for an hour

–	Leaking of clear fluid, spotting or bleeding

–	Or other preterm labor symptoms previously discussed

– For further information, see Labor and Deliver Basics in

Resource Section.

Preterm

labor guidelines

Preparing

for

baby’s arrival
70 Prenatal Information Sheet: 36 Week Visit

Summary of visit

Summary of visit

Date of next visit:_____________________________

Date for lab work/other medical tests:

____________________________________________

Your next visit

Your next visit

At your 38-41 week visit we will:

• Measure your uterine growth, blood pressure,

and weight, listen to your baby’s heart rate,

review the fetal movement record, assess baby’s

position, and discuss any concerns/questions

you may have.

• Discuss results of Group B Streptococcus (GBS)

culture.

• Offer to complete a vaginal exam to check for

any changes in the cervix.

ALWAYS BRING

YOUR

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT

Questions to ask at next visit:

Things to do before baby arrives:
Notes:

38–41 Week Visit 

Prenatal Information 

Sheet

Goal: Preparing for the delivery and 

baby’s arrival at home

38-41 Week Visit

Prenatal Information Sheet: 38-41 Week Visit 75

Prenatal Information Sheet: 38–41 Week Visit 

Goal: Preparing for the delivery and baby’s arrival at home

Your baby’s growth

•	Your baby probably weighs around 7 pounds now and is about

21 inches in total length.

•	Most likely, your baby is in the “head down into the pelvis”

position, but some babies won’t drop into position until a few

days before delivery or until labor begins.

•	We know babies are usually mature enough to do very well on

the outside beginning at 39 weeks. Many are ready at 37 to 38

weeks. We also know babies continue to grow well within mom

up to 42 weeks. If you have not delivered by 41 weeks, we will

begin testing to ensure the placenta is functioning well.

•	If you are still pregnant, labor will be induced between 410/7

and 420/7weeks. Keep in mind that a majority of pregnancies are

anywhere from 37 to 42 weeks long.

Your body’s changes

•	While baby’s type of movement may change as he or she takes

up more room in the uterus, it is still important to count and

report any decrease in the number of movements.

•	Baby is getting big and you are getting tired. Avoid over-	

exhaustion; take frequent breaks and prop your feet up.

•	If you have trouble sleeping, try a warm bath before bed, a soothing

massage, pillows between your legs, or sleeping on your side.

•	You will be seen by your provider more frequently as your due date

nears to promote a safe delivery for both you and your baby.

Your family’s changes

•	Keep in mind that you can deliver anytime from today until 42

weeks of pregnancy. Few babies are born on their due date.

•	You and your family may become more frightened and/or

frustrated if you have not delivered. Tips on conquering these

fears and frustrations include:

–	Talking them over with your partner, friends, or provider

–	Using relaxation techniques such as deep breathing, music,

quiet walks, afternoon naps, and quiet time alone

•	Enjoy this time with your family and try to rest up for the big

event.

•	Review your labor and delivery plans/wishes and coping

techniques with your support person and provider.

Your family’s

changes

Your baby’s 

growth

Your body’s

changes
76 Prenatal Information Sheet: 38-41 Week Visit

Your thoughts and feelings

•	Some women find that as the due date approaches they become

very anxious about labor and delivery or their ability to care for

a newborn. You may experience mood swings, anxiety, or be

very short-tempered and emotional in these last few weeks of

your pregnancy. These feelings are common.

• It is important to notice how you are feeling and coping. Do not

hesitate to ask loved ones or professionals for assistance.

• Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been very sad or

depressed in the last couple weeks.

Signs to report 

immediately

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

•	Bright red bleeding or gush of fluid from the vagina

• The baby is not moving as much as you expect

• Four or more painful cramping contractions within an hour (after

resting and emptying bladder)

• Any nausea and vomiting:

• Producing a small amount of dark urine or no urine at all

• Persistent headache (unrelieved by taking Tylenol®)

• Loss of vision

• Sudden weight gain

• Rapid swelling of hands and face

• Constant right upper belly pain (not related to baby movement)

• Fever at or over 100.4° F or 38° C

Today’s visit

• We will measure your uterine growth, blood pressure, weight,	

listen to your baby’s heart rate, review the fetal movement

record, assess baby’s position, and discuss any concerns/

questions you may have.

• With a vaginal exam, your provider may check for any cervical

opening or thinning.

• Discuss Group B Streptococcus (GBS) results.

You will:

• Sign up for any missed classes or tours.

• Make sure all necessary forms are completed and are at the	

Admissions Office.

Thoughts

&

feelings

Thoughts

&

Feelings

Today’s visit
Prenatal Information Sheet: 38-41 Week Visit 77

My BP/date: Your blood pressure

•	It is still important to report to your healthcare

provider any severe headache, loss of vision,

sudden weight gain, or rapid swelling of hands

and face.

Your blood 

pressure 

My weight/

date:

Your weight and nutrition

•	Total weight gain should be about 25 pounds

unless you are over or underweight. Your weight

gain is not all fat. It is mostly water in your body

and the weight of the growing baby.

•	Weight gain generally slows down or ceases

towards the end of your pregnancy.

Your weight 

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

•	Continue your exercises but modify intensity to

avoid fatigue.

•	Don’t forget to finish your exercise with an

adequate cool down and relaxation period.

• See Exercise in Resource Section for further

information.

Your exercise

Breastfeeding - a great start

•	Breastfeeding for even a few weeks has long

term health benefits for the baby and mom.

•	Drinking plenty of water will help maintain your

milk supply.

•	Breastfeeding is not for every mother. Your

decision will depend on lifestyle, desire, time

and support.

Consider 

breastfeeding

Fetal heart

rate/date:

Fetal heart rate

•	This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart rate

Fundal height

•	Measure uterine growth, and check to see

if baby is dropping into the pelvis. You may

feel this “drop” as an increase in frequency of

urination and easier breathing. Fundal height 
78 Prenatal Information Sheet: 38-41 Week Visit

Fetal movement 

count

Fetal movement count

•	See Fetal Movement Count record. Complete

Fetal Movement Count daily.

Weekly cervical 

sweeping

Cervical sweeping

•	Towards the end of pregnancy, the cervix will

start to prepare itself for going into labor. This

preparation or “ripening” results in cervical

softening (effacement) and opening (dilatation).

The part of the membranes that was over the

cervical opening can now usually be felt by a

vaginal exam.

•	If indicated, your provider may examine your

cervix at this visit. Some providers may offer

you cervical sweeping. This is done by your

provider inserting a gloved finger between the

membranes and the inner wall of the cervix. The

finger is then swept in a circular motion around

the inner cervix to separate the membranes from

the cervical wall.

•	Most women will find this process

uncomfortable. Some women, but not many,

will get some contractions and some vaginal

spotting as a result of this procedure. Some (but

not many) will actually go into labor!

Postdate 

pregnancy plan

Postdate pregnancy plan

•	If you have not delivered by the end of your

40th week, you will begin a postdate pregnancy

plan.

•	This plan may include:

–	Non-stress tests twice a week

–	Weekly ultrasound measurement of amniotic

fluid levels

–	Continued daily fetal movement recording

–	Continued weekly clinic visits

Cervical Exam	

Date: ________

__________cm

__________%

______station

Cervical Exam	

Date: ________

__________cm

__________%

______station
Prenatal Information Sheet: 38-41 Week Visit 79

Labor and Delivery

•	Hopefully, by now, you have toured the Labor

& Delivery area, are pre-admitted, have

transportation and child/pet care arranged,

and have camera and film in your bag.

•	Expect to be a little nervous. The big event is

about to happen!

•	Prior to admission, you will probably be given

a vaginal exam to determine where you are

in labor. Your vital signs will be taken and the

baby will be monitored.

•	If you are in active labor or your bag of water

broke or you need close observation, you will

be admitted and taken to a labor room where

your baby’s heart rate and your contractions

will be monitored by an external fetal monitor

(same monitor as used for the non-stress test you

may have had). You will have your blood drawn

and possibly an IV started at this time.

•	Now you and your partner get to put all that

practice to work! Remember each contraction

puts you one contraction closer to holding your

baby.

•	If you have any special requests, such as having

the father cut the cord, or you want to breast

feed immediately after delivery, let the staff

know now. Don’t forget the camera for your

baby’s very first pictures.

•	Righ atfter the baby is born is a good time to

put your baby to breast. Getting your baby and

you skin-to-skin is great for both of you. This

serves two functions: helps you bond with your

new baby and decreases your blood loss by

contracting your uterus.

•	Your placenta usually delivers within 30 minutes

after the baby is born. You may be too occupied

with baby to take much notice.

When you are 

admitted
80 Prenatal Information Sheet: 38-41 Week Visit

Postpartum 

(after the 

delivery)

Postpartum (after the delivery)

•	Even though you have worked hard and long to bring about

this birth, most mothers are too excited to sleep. Enjoy this time

but sleep when you can. Getting enough rest will decrease your

irritability, help you feel better, and help in your recovery.

•	The staff will be checking on both you and your baby frequently

during this postpartum period. These checks are done to ensure

both of you are doing well.

•	If your baby is a male, you will need to decide on whether or

not to have him circumcised. This procedure is usually done

prior to hospital discharge. While there may be health benefits,

at present, there is not enough medical evidence to recommend

routine circumcision. Circumcision is a personal decision based

on cultural, health, and religious beliefs.

•	If you are having any problems caring for your newborn, let the

staff know immediately. They are there to help you feel more

comfortable and secure in your new role.

•	The nursing staff will go over the basics of self and infant care.

Ask questions and make sure you understand the information you

are given.

Going home

Going home

•	Appointments: At the time of discharge, you will be given

information regarding follow-up appointments to be made for

you and your baby.

• Car seat: Before leaving the hospital, your car seat will be

evaluated and instructions given. The safest place for a newborn

car seat is in the middle of the back seat facing the rear.

• Family Planning: If you need a prescription for birth control, get

it before leaving the hospital.

• Immunizations:

- If your chicken pox and rubella titers indicate you have not had	

these diseases you will be given the vaccines to prevent these	

diseases in the future.

- If you have not received the flu vaccine, you may receive it	

prior to hospital discharge.

- If you are less than 26 years old, we recommend that you	

receive the series of three immunizations of the Human	

Papilloma Virus (HPV) vaccine. If you have not had it, the first	

dose is after your delivery before discharge from the hospital,	

with follow-up repeat immunizations at two months and at six	

months after the first immunization.

• DEERS: Soon after discharge, you must stop by the Military

Personnel Office or the nearest DEERS office to enroll your baby

in DEERS. At this time you should receive the forms to enroll your

baby in TRICARE. Complete these forms and forward them to

your local TRICARE office.
Prenatal Information Sheet: 38-41 Week Visit 81

• Shaken Baby Syndrome: Going home with a newborn is an

exciting but challenging time. Babies cry for many reasons:

when they are hungry, feel uncomfortable, have pain, or

when they just want to be held. At times, no matter what you

do, the baby will not stop crying. This can be very frustrating

for parents and caregivers. It is important that no one taking

care of your baby shakes your infant out of frustration due to

your baby’s behavior. If you or your partner are having trouble calming your

infant, put your baby in the crib, take a deep breath and call for help from

a friend or contact your baby’s provider as soon as possible to receive help

with this. Additional help may be obtained from the local New Parent Support

Program, telephone number:______________________________

• Domestic Abuse: Domestic abuse may increase during the postpartum period

as the family adjusts to the changes of adding a baby. Please do not hesitate

to seek help from your healthcare provider, counselor or a close friend if you

are experiencing physical, sexual, or emotional abuse. The National Domestic

Abuse Hotline: 1-800-799-7233

• Postpartum: Many new mothers experience the “baby blues”. This is a very

common reaction during the first few days after delivery. The “baby blues”

may include crying, worrying, sadness, anxiety, mood swings, difficulty

sleeping and not feeling like yourself.	

“Baby blues” is not the same as postpartum depression and does not require

medical attention. With time, patience, and the support of family and friends,

“baby blues” will usually disappear within a few days. If “baby blues” persist

or worsen it may be a sign of a bigger problem. You should contact your

provider prior to your scheduled postpartum visit.

Going home
82 Prenatal Information Sheet: 38-41 Week Visit

Post delivery appointment for newborn

• At the baby’s first appointments, your baby will

be measured, weighed, and receive a complete

physical exam.

• Parenting concerns such as feeding, bowel

movements, sleep, and number of wet diapers

will be discussed.

• Be sure to write down questions you have and

bring them with you to this visit.

• If you, your baby, or your family are having

problems adjusting, be sure to let your health

care provider know.

 Additional signs to report

•	 Prior to your six week check-up, call your 

 healthcare provider if you experience:

– Fever greater than 100.4° F or 38° C

– Burning on urination

– Increased pain near your vagina or surgical site

– Foul smelling vaginal discharge

– Swollen, painful, hot, red area on your leg or

breast

– Extended periods of hopelessness or depression

(more than two to three days a week)

Your post delivery appointment

Prior to when you leave the hospital, you will be

instructed to schedule a post-delivery appointment

for 6-8 weeks after you gave birth.

• You will receive a complete physical exam,

possibly including a Pap smear.

• During this visit, your healthcare provider will

review the following with you:

-	 Family planning

-	 Your adjustment to parenthood

-	 Signs of postpartum depression

• You may receive an HPV immunization.

Post delivery

appointments

Additional signs

to report

Your next visit
Prenatal Information Sheet: 38-41 Week Visit 83

Your post delivery appointment

• If you are especially sad or “blue” in the weeks after the

birth of your baby, contact your provider to discuss this

prior to this visit. Many new mothers get the baby “blues”

for a few days after delivery but it usually doesn’t last very

long. Postpartum depression is more intense and lasts longer.

With postpartum depression, signs and symptoms such as	

overwhelming fatigue, insomnia, loss of appetite, lack of

joy in life or thoughts of harming yourself or your baby

may actually interfere with your ability for care for yourself

and your baby.

Your next visit

If you have another visit prior to delivery, we will:

•	Measure your uterine growth, blood pressure, and weight,	

listen to fetal heart tone, review fetal movement record,	

assess baby’s position, and discuss any concerns/questions	

you may have.

•	Discuss Postdate Pregnancy Plan if you have not delivered by	

41 weeks.

•	Schedule you for twice a week Non-Stress Tests and weekly,	

ultrasound-amniotic fluid measurements beginning at your

41st week.

•	Schedule weekly prenatal visits.

Your next visit

ALWAYS

BRING YOUR	

PURPLE BOOK

AND 

PREGNANCY 

PASSPORT

TO EVERY VISIT
84 Prenatal Information Sheet: 38-41 Week Visit

Do you think you will be like your mother or different when you 

consider what kind of parent you will be?

How do you visualize yourself as a mother (warm, caring, strict, 

etc.)?

Write a few words to describe how you feel as a new mother:
Notes:

87

Prenatal Information Sheet: 38-41 Week Visit

Post Delivery Visit

Prenatal Information Sheet: 6-8 Weeks After Delivery 89

Post Delivery Information Sheet: 6-8 Weeks after Delivery

Goal: Determine health status and promote adjustment to being a 

mother and parent 

Your body’s changes

•	As soon as the baby is born your uterus starts to get smaller. By

the time of your postpartum check it should be almost back to the

size it was when you became pregnant.

• You should gradually return to your pre-delivery weight.

Combining a healthy diet with exercise will help you lose weight

and get safely back in shape after delivery.

• It is difficult to predict when you will ovulate after delivery. (This

is why it is very important that you always use birth control

whenever you have sex if you do not plan to become pregnant.)

Your body’s 

changes

Your family’s changes

•	Your baby is here! What an exciting and challenging time for

everyone as you each adjust to the changes of a growing family.

• You and the baby’s father may both have moments when you

feel anxious or sad. You may both worry about money, your

relationship or the future – not to mention being good parents.

Make time to talk with one another about your concerns. Let

your partner know he is still very important to you. Involve him in

your activities. And set aside time for the two of you to be alone

together.

• Your baby’s father may feel “left out” because of all the attention

you are giving to the baby. Involve him in activities to care for

the baby. Make time for the two of you to be alone together.

Your thoughts and feelings

• You may find you have less interest than you expected in having

sexual intercourse with your partner. There are several reasons

for this. One is that the demands of a baby leave you

exhausted. Additionally, your body is still adjusting to changing

hormone levels and the birthing process.

• Discuss your feelings with someone you trust and your	

healthcare provider, especially if you have been very sad or	

depressed.

• Remember to make time for yourself. If you are feeling especially

tired or stressed leave your baby with someone you trust and

take time to do something relaxing such as going for a walk,

going for a pedicure or just taking a long bath.

Thoughts

&

feelings

Thoughts

&

Feelings

Your family’s

changes
90 Prenatal Information Sheet: 6-8 Weeks After Delivery

Breastfeeding - a great start

•The American Academy of Pediatrics, the American College

of Nurse-Midwives, the American College of OB/GYN, and

the American Dietetic Association all strongly recommend

breastfeeding for at least your baby’s first 12 months of life.

•	Consider exploring community breastfeeding groups such La

Leche League. This is an excellent opportunity to get to know

other breastfeeding mothers.

•	Discuss any breastfeeding concerns with your provider at this

visit.

•	See Breastfeeding in Resource Section for further information.

At this visit

• A complete physical exam with a pelvic and breast examination

will be done to see if your body has returned to normal.

• Pre-existing medical conditions will be reviewed to help you

determine a follow-up plan.

• If you had gestational diabetes in your pregnancy, additional lab

work will be ordered.

• Your birth control method will be reviewed and revised as

needed.

• A post delivery depression screening and a domestic violence

screening will be completed.

• If you have not already completed the HPV vaccination series,

and you want to be vaccinated, your next immunization will be

given.

• If you are going back to work or need a release from your

healthcare provider to return to duty, be sure to let them know

during this visit.

• This is likely the last time you will see your healthcare provider

for a year or so. Do not hesitate to ask any questions you have

about your recovery or concerns you have.

• Your newborn is usually welcomed to accompany you to this

visit. Check with your clinic. If you are bringing your newborn,

bring a carriage or car seat for him/her to use during the exam.

Today’s visit

Consider 

breastfeeding
Prenatal Information Sheet: 6-8 Weeks After Delivery 91

My baby’s name:

Date/Time of birth:

Weight/Length:

My labor was - as expected / different than expected:

My support person/coach was:

Others present at delivery:

Things I want to remember:

Prenatal 

Information 

Resources

Resources

Prenatal Information Sheet: Resources 95

YOUR PREGNANCY IN THE ARMY

Information for Active Duty Service Members

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, and 

whether your pregnancy was expected or a bit of a surprise, we want your 

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone 

women on active duty in the military, can be a challenging experience. The Army 

has joined our sister services to create a plan of care, based on the best available 

current medical evidence, that will maximize your chances of a successful 

pregnancy. Our goal is to provide you with the care and education you need 

to take home a healthy baby and be optimally prepared to care for your new 

addition. After all, your baby will be a new member to our Army family. 

The plan of care and educational materials that are associated with these 

pregnancy guidelines as well as the requirements/limitations listed on your 

pregnancy profile will serve as a framework for your care during your pregnancy. 

There may be occasion to deviate from these guidelines due to your specific 

circumstances, potential pregnancy complications, local practices, and new 

medical information. Please remember these are guidelines and are not a substitute 

for specific recommendations made by a qualified provider.

Maternity uniforms

You will be provided two sets of maternity uniforms. At most posts, you will need 

to take a memorandum from your Commander requesting the issue and a copy of 

your pregnancy profile showing your due date to the Central Issuing Facility (CIF) 

or the unit supply room. These uniforms will be turned in upon your return from 

convalescent leave. Check with your command to inquire about specifics.

Pregnancy profile

Upon confirmation of your pregnancy (by examination or a lab test), you will be 

provided a physical profile which lasts until the end of your pregnancy. Activities 

that are acceptable during pregnancy are specifically noted in the profile and 

include: specific stretching, aerobic conditioning at own pace, and lifting up to 20 

pounds. Limitations specific to your duty will be indicated in your profile. 

You are exempt from regular physical training (PT) and Army Physical Fitness 

Testing (APFT) / weight standards for the remainder of your pregnancy and for 

180 days past delivery. After receiving medical clearance from your provider, 

Commanders will enroll Soldiers in the Army Pregnancy/Post-Partum physical 

training (PPPT) program. This will help you maintain health and fitness and prepare 

you for your APFT. 

It is critical that you maintain a copy of your current profile with you at all 

times. When you receive your profile, make an appointment to meet with your 

Commander to complete your pregnancy counseling. This is also a good time to 

start thinking about your family care plan.
96 Prenatal Information Sheet: Resources

Postpartum profile

Prior to leaving the hospital, your doctor will provide you with a postpartum 

profile. This temporary profile will be for 45 days beginning on the day of 

delivery and allows for PT at your own pace. Participation in a postpartum PT 

program is encouraged to assist you in returning to required fitness standards and 

transitioning back to unit PT.

Army Physical Fitness Test (APFT)

You are exempt from the APFT during pregnancy and for 180 days following 

delivery. At the end of 180 days, you will take a record APFT. Your unit may have 

you take diagnostic APFTs in preparation for the record test.

Both parents active duty

Both parents will need to update their Servicemembers’ Group Life Insurance and 

DD93, Record of Emergency Data. Also, both parents will need to let their unit 

command know of the new family member. Only the sponsor needs to enroll the 

baby in DEERS and TRICARE. Notify PAC of new family member.

Convalescent leave

Convalescent leave will be determined by your provider following delivery. The 

usual time allotted is 42 days following a normal pregnancy and delivery. The 

provider also determines the amount of convalescent leave following anything 

other than a normal pregnancy and delivery. 

Congratulations again on the exciting road ahead of you!

References 

Office of the Surgeon General Memorandum, dated 23 May 2001, Pregnancy 

and Postpartum Physical Profiles

http://phc.amedd.army.mil/home

Comment: Search on Pregnancy Postpartum Physical Training

Site provides a succinct summary of the information contained in the specific 

references listed below. 

AR 40-501 Standards of Medical Fitness, Pregnancy and Postpartum Profiles

AR 614-30 Assignments, Details, and Transfers, Overseas Service in 

Pregnancy

AR 600-8-10 Leaves and Passes, Postpartum Convalescent Leave

http://www.apd.army.mil

Comment: Navigate through Official Documents, Army Administrative 

Publications

Site details considerations in pregnancy.

DoD Directive 1308.1 DoD Physical Fitness and Body Fat Program
Prenatal Information Sheet: Resources 97

YOUR PREGNANCY IN THE NAVY/MARINE CORPS

Information for Active Duty Service Members

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, and 

whether your pregnancy was expected or a bit of a surprise, we want your 

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone 

women on active duty in the military, can be a challenging experience. The Navy 

has joined our sister services to create a plan of care, based on the best available 

current medical evidence, that will maximize your chances of a successful 

pregnancy. Our goal is to provide you with the care and education you need 

to take home a healthy baby and be optimally prepared to care for your new 

addition. After all, your baby will be a new member to our Navy/Marine Corps 

family.

The plan of care and educational materials that are associated with these 

pregnancy guidelines as well as the requirements/limitations listed on your 

pregnancy profile will serve as a framework for your care during your pregnancy. 

There may be occasion to deviate from these guidelines due to your specific 

circumstances, potential pregnancy complications, local practices, and new 

medical information. Please remember that these are guidelines and are not a 

substitute for specific recommendations made by a qualified obstetrical health care 

provider.

Maternity Uniforms

The certified maternity uniform is mandatory for all pregnant servicewomen in 

the Navy when the regular uniforms no longer fit. The outer garments (sweater, 

raincoat, overcoat, peacoat and reefer) may be worn unbuttoned when it no 

longer fits properly. You are expected to wear regular uniforms upon returning 

from convalescent leave; however, your Commanding Officer (CO) may approve 

the maternity uniforms for up to six months from the date of delivery. Enlisted 

servicewomen will be given a clothing allowance upon presenting the pregnancy 

notification to Personnel Support Detachment (PSD). 

Statement of Pregnancy

You will be provided with a Pregnancy Notification Form for use in notifying 

your CO. This form will identify your Estimated Due Date (EDD), the 20th week 

of pregnancy, and the 28th week of pregnancy. These dates are used by your 

command for planning purposes. The OPNAVINST 600.1 and MCORDER 

5000.12 Series provide guidance and detailed information regarding assignments 

and rest periods in relation to a servicewoman’s pregnancy time line.

Limitations

Few restrictions are required in an uncomplicated pregnancy of a physically fit 

servicewoman working in a safe environment. You are exempt from standing at 

parade rest or attention for longer than 15 minutes; lying in a prone position for a 

prolonged period; working in one position for prolonged periods; and performing 

prolonged work at heights.
98 Prenatal Information Sheet: Resources

You are also exempt from participating in weapons training; swimming 

qualifications; drown proofing; diving; lifting greater than 25 pounds; exposure to 

excessive heat or vibration; and any other physical training requirements that may 

adversely affect the health of the servicewoman/fetus.

During the last three months of pregnancy (weeks 28 and beyond) you will be 

allowed to rest 20 minutes every four hours and limited to a 40 hour work week 

(pregnancy does not preclude watch standing but all hours will count as part of the 

40 hour work week). You may request a waiver to extend your hours beyond 40 

hours if your health care provider concurs.

Physical Readiness Program (PRP)

You are exempt from the PRP during pregnancy and for six months following 

delivery. However, if you have an uncomplicated pregnancy you are encouraged 

to perform an individualized exercise program that incorporates regular to 

moderate exercise for 30 - 45 minutes, three or more times a week. An exercise 

program should be gradually resumed six weeks after an uncomplicated vaginal 

delivery or cesarean delivery.

Convalescent Leave

You will be given 42 days of convalescent leave after discharge from the hospital 

following an uncomplicated delivery or cesarean section. The attending physician 

may recommend extension beyond the standard 42 days based on medical or 

surgical complications. 

Congratulations again on the exciting road ahead of you! 

Useful policy references

OPNAVINST 6000.1 Series: Guidelines Concerning Pregnant Servicewomen

MARINE CORPS ORDER 5000.12 Series: Marine Corps Policy on Pregnancy and 

Parenthood

MARINE CORPS ORDER P6100.12 Series: Marine Corps Physical Fitness Test and 

Body Composition Program Manual

OPNAVINST 6110.1 Series: Physical Readiness Program

OPNAVINST 1740.4 Series: U.S. Navy Family Care Policy

MARINE CORPS ORDER 1730.13 Series: Family Care Plans

NAVMEDCOMINST 6320.3 Series: Medical and Dental Care for Eligible Persons 

at Navy Medical Department Facilities 

References

http://navymedicine.med.navy.mil/

http://www.hqmc.usmc.mil/hqmcmain.nsf/frontpage

http://www.bupers.navy.mil/
Prenatal Information Sheet: Resources 99

YOUR PREGNANCY IN THE AIR FORCE

Information for Active Duty Service Members

Congratulations! 

Whether you are pregnant for the first time or are an experienced mother, and 

whether your pregnancy was expected or a bit of a surprise, we want your 

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone 

women on active duty in the military, can be a challenging experience. The 

Air Force has joined our sister services to create a plan of care, based on the 

best available current medical evidence, that will maximize your chances of a 

successful pregnancy. Our goal is to provide you with the care and education you 

need to take home a healthy baby and be optimally prepared to care for your new 

addition. After all, your baby will be a new member to our Air Force family.

The plan of care and educational materials that are associated with these 

pregnancy guidelines as well as the requirements/limitations listed on your 

pregnancy profile will serve as a framework for your care during your pregnancy. 

There may be occasion to deviate from these guidelines due to your specific 

circumstances, potential pregnancy complications, local practices, and new 

medical information. Please remember that these are guidelines and are not a 

substitute for specific recommendations made by a qualified obstetrical health care 

provider.

Maternity Uniforms

Enlisted personnel will receive a lump sum maternity uniforms allowance. You must 

take your profile, signed by your Commander to the orderly room. The staff will 

forward this to Finance and you should receive your payment within one month. 

We advise you do this early in your pregnancy so that you receive your payment 

and purchase uniforms before you grow out of your regular uniforms. This payment 

is enough to purchase one maternity blues set, ABU set and dress blues set. Visit 

your Airman’s Attic on base for spare sets of maternity uniforms.

Profile

Within 24 hours of notification of your positive pregnancy test, you are required 

to go to Force Health Management (FHM) for initiation of your pregnancy profile 

and Occupational Health Assessment. The pregnancy profile outlines some 

requirements and limitations regarding your activity during your pregnancy. You 

will receive a memorandum from FHM that will serve as a temporary profile 

until the Profile Reviewing Officer has validated your profile. As an Air Force 

service member, it is your responsibility to notify your supervisor regarding your 

pregnancy soon after pregnancy is diagnosed (AFI 48-123). Your supervisor, 

commander and Unit Deployment Manager will receive a copy of your profile via 

e-mail immediately upon validation.
100 Prenatal Information Sheet: Resources

Limitations

The pregnancy profile limits requirements for physical training, body weight 

requirements and environmental exposures. During your pregnancy and for six 

months following delivery, you are not worldwide qualified and must be removed 

from mobility status.

Physical Training (PT)

Although you are not required to perform formal physical training or weigh-ins, 

we strongly encourage you to eat a healthy diet and perform moderate exercise 

during your pregnancy. Most facilities offer programs on appropriate exercise, 

health diet, tobacco cessation, labor and delivery, new mom classes and other 

programs, specifically for pregnant women. We encourage you to take advantage 

of these programs as well as some of the many other activities and resources that 

are available to you during your pregnancy.

Convalescent Leave

You will be given 42 days of convalescent leave after discharge from the hospital 

following an uncomplicated delivery or cesarean section. The attending physician 

may recommend extension beyond the standard 42 days based on medical or 

surgical complications.

Congratulations again on the exciting road ahead of you!

References

AFI 44-102 Community Health Management 

 (Section 2F - Medical Care Related To Pregnancy) 

AFI 40-502 The Weight Management Program

http://www.operationalmedicine.org/ed2/Instructions/Instructions.htm
Prenatal Information Sheet: Resources 101

DEPARTMENT OF VETERANS AFFAIRS (VA)

Maternity Care Benefits for Eligible Veterans

Congratulations! 

Whether you are pregnant for the first time or are an experienced mother, we 

want your pregnancy to be healthy, happy and successful. Many people are 

unaware the Veterans Health Administration (VHA) is authorized to provide 

comprehensive pregnancy and postpartum care to eligible women Veterans. If 

eligible, maternity benefits begin with the confirmation of pregnancy and continue 

through the final post-partum visit, usually at six to eight weeks after the delivery or 

when you are medically released from obstetric care.

Most VA Medical Centers do not have obstetrical services “in-house”. Obstetrical 

(OB) care is paid by the VA through the “fee basis” or “contract” program. Fee 

basis care is routinely used to provide maternity care within a reasonable distance 

of your home. The VA pays the hospital bill and the licensed OB provider. This 

includes coverage for required laboratory and ultrasound tests in pregnancy. You 

will need to present the “VA Authorization for Care” (Form # 7078, also known 

as a voucher) at every visit. This will help to avoid errors in billing. If an error does 

occur and you receive a bill, contact your Fee Basis office.

Once your pregnancy is confirmed, your VA provider and Women Veterans 

Program Manager (WVPM) or designee will discuss with you all aspects of 

maternity care that will be covered. Every facility has a Fee Basis office. Personnel 

at your local Fee Basis office can help explain the process to the OB provider you 

choose. They will also be able to determine if the OB provider of your choice will 

accept VA payment terms. In some cases you may be asked to choose another OB 

provider. It is important for you to make your OB appointment as soon as possible. 

The earlier you start prenatal care, the better for you and your baby.

Please discuss coverage for newborn services with your facility Women Veterans 

Program Manager or designee. These individuals and the Fee Basis office can 

assist you with information regarding current newborn health coverage.

SPECIALTY CARE WHILE PREGNANT: During the pregnancy, if medical concerns 

come up and your OB provider thinks you need to see another specialist or need 

additional procedures, the OB provider can refer you to a non-VA specialist 

doctor. The OB provider's office must telephone the VA Fee Basis office to receive 

pre-approval. Depending on the urgency of the procedure, the request should 

be telephoned, faxed or mailed to the Fee Basis Office. This will allow the OB 

doctor and hospital to be paid for the services performed. An additional “VA 

authorization for care” (Form #7078, also known as a voucher) is necessary. It is 

important to present this VA authorization to all of your specialty care visits.
102 Prenatal Information Sheet: Resources

Make sure that when you see your OB provider you get their emergency contact 

information and you know where to go for emergencies. Since most VA Medical 

Centers do not have obstetrical services “in-house”, you should go to the hospital 

your OB provider recommends if you have a pregnancy related emergency.

FOLLOWING UP DURING AND AFTER YOUR PREGNANCY: Keep in contact 

with your local Women Veterans Program Manager or designee during your 

pregnancy. Make sure you have a follow-up appointment with your VA provider 

after the birth of your baby (within three to six months). Request a copy of your 

Obstetric records from your OB provider to be sent to your local VA facility.

My Women Veterans Program Manager or designee is 

_______________________________________________________

Women Veterans Program Manager or designee Telephone Number

_______________________________________________________

Fee Basis Office Contact Person 

_______________________________________________________

Fee Office Telephone Number 

_______________________________________________________
Prenatal Information Sheet: Resources 103

Fathers and Pregnancy

Most expectant fathers feel both excited and anxious about the upcoming changes 

in their lives. You can help your partner by being understanding of the changes a 

pregnant woman may experience and by being a prepared and supportive fatherto-be. Your support contributes to a healthy pregnancy and often helps make labor 

and delivery easier.

Emotional Aspects of Pregnancy

Pregnancy can be an emotional journey for both you and your partner. You may 

feel isolated as she focuses on her changing body and emotions. It will be helpful 

if you attend prenatal visits together. Also, read materials about pregnancy and 

parenthood with her. 

Pregnancy and Sex

Sexual intercourse is permitted during the entire pregnancy unless your partner’s 

provider has told her otherwise. The baby is cushioned within the “womb” and 

there is no way to harm the baby during normal sexual relations. Of course there 

may be times when your partner may not feel comfortable having intercourse. 

Remember to be patient and supportive of her feelings. 

Dad’s Checklist before Delivery

• Did you take a tour of the hospital?

• Did you and your partner attend prenatal classes?

• Is the hospital pre-admission paperwork completed? 

• Do you know your partner’s wishes regarding pain relief during labor?

• Do you want to cut the umbilical cord? 

• Do you have a car seat for baby? Do you know how to install it in your 

 vehicle?

• Do you have cash/change ready for late night vending machine trips? 

• Do you have a dad’s bag packed? (Things you may want to help you 

 and her through labor.) Be sure to add your camera.

• Do you have a list of phone numbers or people to call/e-mail after the 

 birth? 

How to Help During Labor and Delivery

Remember, you are the “coach” during labor and delivery. Being supportive and 

staying calm is important for the father-to-be.

• During early labor, you can help your partner by going for a walk, listening to music, or watching a movie with her.

• The “coach” can time contractions from the beginning of one 

 contraction to the beginning of the next contraction.

• Offer a massage or apply pressure to her back if that relaxes her.

• Help her to focus on something when she is having a contraction and

 remind her to breathe. Slow deep breathing can be very relaxing. Breathe with her.

• Stay calm with a relaxing tone in your voice.

• Encourage her during the pushing stage. 
104 Prenatal Information Sheet: Resources

Paternity Leave

If you are active duty, discuss paternity leave with your supervisor. You may be 

allowed up to 10 days of paternity leave for the birth of your child.

The Postpartum Period

Typically, women will stay in the hospital for one to two days. Have the car seat 

installed so you are ready to take your new baby home when your partner is 

discharged from the hospital.

If mother is breastfeeding, some fathers may feel left out of the bonding process. 

You can help her by changing the diaper before bringing the baby to her to 

nurse. After the feeding, you can burp the baby and rock the baby to sleep. 

Breastfeeding does allow an active role for both the woman and her partner. Some 

fathers may enjoy bathing or showering with the baby.

Sexual Intercourse after Delivery

There is no set time frame before a woman can have sex again after giving 

birth. Some health care providers recommend waiting four to six weeks. You and 

your partner should discuss with her healthcare provider when to resume normal 

sexual relations.

When your partner does feel ready to have sex again, remember to go slow and 

listen to her. Even if a woman is not having a period or is breast-feeding, she can 

become pregnant. You should use some type of birth control when you start having 

sex again if you and your partner do not want her to get pregnant right away.

References

2009 National Defense Authorization Act
Prenatal Information Sheet: Resources 105

fallopian tube

ovary

uterus

bladder

pubic bone

sacrum

cervix

vagina

rectum

perineum

Pre-pregnant anatomy

(lateral view)

fetus

amniotic sac

uterus

bladder

pubic bone

sacrum

cervix

mucus plug

vagina

rectum

perineum

fundus

placenta

umbilical cord

(bag of waters)

Pregnant anatomy

(lateral view)
106 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 107

Common Discomforts & Annoyances of 

Pregnancy

All these discomforts/annoyances are a common part of pregnancy and usually 

end eventually. Try the hints given below. If you don’t get relief, talk to your 

provider or nurse about other possible measures to try.

Discomfort When What you can do to help Notify provider if:

Ankle/foot 

swelling

Second 

trimester 

until 

delivery

• While sitting, prop your feet up 

(even a few inches up helps) 

and do not cross your legs.

• Continue drinking lots of fluids 

(at least 8 glasses daily).

• Wear comfortable shoes or 

sandals and avoid high heels.

• Consider support hosiery.

• Redness in legs

• Increasing pain/

redness in calves

Breast 

tenderness

Begins 

early and 

continues

• Wear well fitted, good support 

or athletic bra day and night.

• Soak in a warm bath.

• Redness in breast

• Fever

Breast 

leakage

May begin 

second 

trimester

• Wear pads in bra.

• Avoid harsh soaps or creams.

• Red/pinkish discharge 

from breasts

• Fever

Bleeding 

gums

Entire 

pregnancy 

• Use a very soft tooth brush.

• Get routine dental care.

• Gently brush teeth at least 

twice daily.

• Floss daily.

• Use good dental hygiene.

• More than slight 

bleeding from gums

• Pain in teeth

• Pus from gums

Constipation Entire

pregnancy

• Eat foods high in fiber (bran, 

green leafy vegetables, whole 

grain cereals/breads, fruits) 

daily. 

• Drink at least 8 - 10 glasses of 

fluids daily.

• If approved by your provider, 

exercise daily (this will help 

move food through the bowel).

• Walk after meals.

• Do not take stool softeners, 

laxatives, or enemas unless you 

talk with your provider.

• Blood in stool

• Abdominal pain

• No bowel movements 

over extended period 

of time
108 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Contractions 

(Braxton 

Hicks)

After 20th 

week

• Know this is part of your uterus 

getting “ready” for labor.

• Empty bladder and drink 2 - 3 

glasses of water.

• Lie down on your side with 

hands on belly.

• Keep track of how often these 

occur.

• Regular contractions 

that do not go away

• Painful contractions

• No improvement in 

symptoms

• History of preterm 

labor

Dizziness

As your 

uterus 

enlarges

• Move slowly when getting up 

from lying down or sitting.

• Eat small, frequent meals and 

healthy snacks with protein to 

avoid low blood sugar.

• Drink lots of fluids especially if 

exercising or in hot weather.

• If dizzy, lie down on your side.

• Persistent dizziness

• Feeling faint

• You have diabetes

• Shortness of breath/

chest pain

• Vaginal bleeding or 

abdominal pain

Enlarging 

belly and 

breasts

Second 

half of 

pregnancy

• Sleep on your side with a 

pillow between your legs.

• Wear loose, comfortable 

clothes.

• Wear support bra even to bed.

• Use maternity support belt.

Fatigue or 

tiredness

Early in 

pregnancy 

and again 

in the last 

month

• Take extra naps during the day 

if possible.

• Avoid fluids before bedtime.

• Continue mild exercise but not 

to the point of exhaustion.

• Try to get at least 8 hours sleep 

at the same time each night.

Flatulence 

(gas)

Anytime, 

especially 

after 20 

weeks

• Eat foods high in fiber daily.

• Drink at least 8 glasses of 

water daily.

• Avoid gas-forming foods such 

as beans, cabbage and sodas.

• If approved by your provider, 

exercise daily.

• Walk after meals.

Food 

cravings

First half of 

pregnancy

• OK to indulge if food choice is 

not harmful.

• Craving excessive ice

• Craving non-food 

items (dirt/paint)
Prenatal Information Sheet: Resources 109

Discomfort When What you can do to help Notify provider if:

Frequent 

urination

Begins 

early, gets 

better midpregnancy, 

then 

increases 

towards 

the end of 

pregnancy 

when baby 

drops. 

• Don’t cut back on fluids.

• Know bathroom locations.

• Expect to make many trips to 

the bathroom, day and night.

• Avoid drinking lots of fluids 

before bedtime.

• Pain or burning with 

urination

• History of urinary tract 

or kidney infection

• Fever/chills/sweats

• Pelvic, back, stomach, 

or side pain

Headaches First half 

• Use mild pain relievers such as 

Tylenol® as directed

• Avoid aspirin, ibuprofen and 

other pain medications, unless 

you have discussed their use 

with your healthcare provider.

• Avoid eyestrain.

• Rest eyes frequently and take 

frequent computer breaks.

• Get gentle massages and do 

mild stretching exercises.

• Drink plenty of water.

• Persistent headache 

not relieved by overthe-counter (OTC) 

medication

• Worse headache of 

your life

• Associated with vision 

changes

Heartburn

Second 

trimester 

until 

delivery

• Eat 6 - 8 small meals daily.

• Eat slowly, chew food well.

• Avoid deep fried, greasy, and 

spicy foods.

• Drink fluids between your 

meals.

• Avoid citrus fruits or juices.

• Go for a walk after meals.

• Avoid lying down right after 

eating.

• Antacids can help.

• Persistent heartburn 

not relieved by 

antacids

• Associated with 

persistent nausea and 

vomiting

Hemorrhoids Anytime

• Prevent constipation - try not to 

strain with bowel movement.

• Apply hemorrhoid ointment as 

needed (discuss with provider).

• Apply witch hazel pads.

• Take sitz baths.

• Do your Kegel exercises 

(see prenatal fitness brochure).

• Bleeding hemorrhoids

• Persistent pain from 

hemorrhoids
110 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Increased 

perspiration Anytime

• Increase fluids intake.

• Wear easily washable, 

comfortable, loose fitting 

clothing.

• Practice good hygiene.

Increased 

saliva

First 

trimester

• Gum and hard candy - watch 

excess calories.

• Use mouthwash.

• Avoid starches.

Increased 

vaginal 

discharge

Entire 

pregnancy

• Wear cotton underwear.

• Avoid nylon underwear/panty 

hose, feminine hygiene soaps 

or sprays.

•	Do not douche.

• Yellow or greenish, 

thick and cheesy, or 

has a strong fish-like 

odor

• Soreness, itching or 

burning

Leg cramps 

Second 

half of 

pregnancy

• Extra potassium or calcium 

may help. Try eating a banana 

every day or drinking a glass 

of milk.

• Gently stretch by - sitting down, 

extending legs and flexing toes 

towards body (grab toes if you 

can and pull towards yourself). 

Your partner can help with this.

• Mild exercise may help. 

• Worsening cramps/

pain especially in the 

back of calves/legs

• Redness/swelling in 

calves

Ligament 

pain (sharp 

pulling 

sensation on 

either side 

of the lower 

abdomen)

Increases 

with 

increasing 

uterine size 

• Support your weight with 

your hands when changing 

positions.

• Move slower.

• A mild analgesic may help.

• Apply ice to affected side.

• Use maternity girdle/belt for 

support.

• Lean back in a slant position 

supporting your back with your 

knees bent.

• Worsening pain
Prenatal Information Sheet: Resources 111

Discomfort When What you can do to help Notify provider if:

Light headed 

& dizzy

Begins 

early and 

continues

• Stop what you are doing and 

lie on your left side with your 

legs up for short period of 

time. 

• If unable to lie down, sit 

immediately and tell someone 

you are dizzy.

• If dizziness resolves, get up 

slowing from lying to sitting, 

then up to standing position if 

possible.

• Ensure adequate hydration by 

drinking plenty of water.

• Repeated episodes

• Associated with other 

symptoms such as 

chest pain/shortness 

of breath

• Loss of consciousness

Low 

backache

Second 

half of 

pregnancy

• See page 114. • See page 114.

Nasal 

stuffiness & 

bleeding

First 

trimester 

and again 

at term

• Use a saline nasal spray.

• Use cool mist humidifier/

vaporizer if air is dry.

• Talk with your provider about 

OTC medications.

• Avoid using nasal 

decongestant sprays.

• Blow your nose gently.

•	Ensure adequate hydration by 

drinking plenty of fluids.

•	Stop bleed by squeezing nose 

between thumb and forefinger 

for a few minutes.

• If nasal bleeding is 

frequent

Nausea 

(Morning 

Sickness)

Occurs 

in early 

pregnancy 

and usually 

improves 

after first 

trimester. 

• See page 113. • See page 113.

Numbness/

tingling 

fingers/

hands 

(Carpel 

Tunnel 

Syndrome)

Second 

and third 

trimester

• Elevate hands and wrists as 

much as possible.

• Rest hands with frequent 

breaks.

• Talk with your provider about 

wrist splints.

• Your hands are weak 

and not just numb
112 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Sleeplessness

Anytime 

but 

especially 

last 

trimester

• Try a warm bath before 

bedtime.

• Avoid stimulating activity 

before bedtime

• Avoid drinks containing 

caffeine.

• Use relaxation techniques.

• Get in a comfortable position 

to sleep; place pillows 

between legs.

• Try a glass of milk before 

going to bed.

• Talk with your 

provider If you are 

feeling very stressed, 

depressed or nervous 

about your pregnancy

Varicose 

veins

Increases 

as 

pregnancy 

progresses

• Avoid tight clothing and 

stockings.

• Avoid crossing legs.

• Practice good posture.

• Put support hose, ace wraps 

or elastic stockings on in bed 

before lowering feet - wear all 

day.

• Painful bulging veins

• Redness in area of 

veins

• Leg cramps

Vision 

changes

Entire 

pregnancy

• Don’t buy a new prescription 

for your glasses as you will 

probably return to pre-pregnant 

vision after delivery.

• Take frequent eye breaks.

• May not be able to wear 

contact lenses during 

pregnancy.

• Wear glasses as prescribed for 

reading/distance vision and 

for driving.

• Blurry (fuzzy) vision

• Seeing black spots or 

shadows

• Headache

• Loss of vision
Prenatal Information Sheet: Resources 113

Nausea and Vomiting in Pregnancy 

(aka “morning sickness”)

Nausea can occur during early pregnancy. It usually gets better after the first 

trimester.

What can you do?

 • Nibble some plain crackers, dry toast, dry cereals before getting out of 

 bed in the morning and when you are feeling queasy

 • Eat six to eight small meals throughout the day instead of big meals

 • Try eating protein snacks

 • Get plenty of rest

 • Avoid odors or foods that set off the nausea

 • You may have to avoid prenatal vitamins during the first trimester if they seem 

 to worsen the nausea

 • Drink liquids between meals not with meals

 - Avoid dehydration by drinking water and nutritious smoothies 

 and eating ice chips

 - Sip on ginger ale, water, weak tea, or mild fruit juices

 - Try diluting a sports drink with half water and sip on this liquid all day 

• Avoid greasy or spicy foods

 • Chew gum or suck on hard candy (mints/ginger) or ice chips

 • Sit and put your head down between your legs

 • Motion/Sea sickness bands may help

 • Acupuncture may be helpful

Notify your provider if you

 • Cannot keep down any liquids or food

 • Have nausea that does not go away

 • Have more than three to five pounds of weight loss since becoming pregnant

 • Have vomiting that is blood tinged

 • Have flu-like symptoms or fever

 • Feel faint
114 Prenatal Information Sheet: Resources

Low Back Pain 

Low back pain in pregnancy is the most common discomfort of pregnancy. 

Why does it happen? 

 • Strain of back muscles

• Uterus gets bigger and center of gravity changes - thus posture changes.

• Hormones cause ligaments to relax and joints to loosen. 

What can you do? 

• Use good body mechanics.

• Keep your back straight and your head up.

• Avoid lifting heavy objects by yourself.

• Avoid flat or high heeled shoes (low heel with arch support is best).

 • Sleep on a firm mattress (or place a board between mattress and box spring).

• When bending to pick something up, bend from your knees (not waist).

• Gently massage lower back or apply hot/cold compress.

• Take a warm soak in a bathtub - no bubbles. (Make sure to have good grip on 

 hand rail when exiting tub to prevent a fall.)

• Take a warm shower with pulsating/heavy stream aimed at lower back area.

• When sitting, place a small pillow behind your lower back for support.

• Avoid standing for long periods of time.

• If standing for an extended period, prop one foot up on a stepstool or stair, 

 this helps straighten the small of your back.

• Sleep on your side and place a pillow between your legs.

 • Stretch and stay active in pregnancy (talk with your provider before starting a 

 new exercise program).

- Forward bend - Sit in a chair, feet flat on ground bend head/shoulders 

 forward to the knees.

- Pelvic rock exercises - When on hands and knees, stretch your lower 

 back – arch so back is rounded, then relax it back to original position. 

 Use your stomach muscles to keep your back straight when relaxing.

• Talk with your provider about over the counter pain medication if needed.

• Consider a maternity girdle for support. 

Contact provider if any of the following occur 

• Severe pain

• Intermittent pain (comes and goes) 

• Burning with urination

• Vaginal bleeding

• Pain lasting more than two weeks

• Tingling/numbness in lower legs
Prenatal Information Sheet: Resources 115

Exercise

Exercise is encouraged during pregnancy as it has many benefits including 

preparing you for labor and childbirth. Exercise should occur at least 30 minutes 

a day on most if not all days. Exercise will help with some of the common 

discomforts of pregnancy including reducing backaches, constipation, bloating 

and swelling. It also improves sleep, your mood and posture. Exercise can help 

prevent or treat gestational diabetes. If you have any medical conditions or 

complications with the pregnancy, it is important to talk to your healthcare provider 

before exercising.

The following activities are safe during pregnancy: walking, swimming, cycling, 

and aerobics. Running is also safe for women who were runners prior to 

pregnancy. Activities that should be avoided during pregnancy include downhill 

skiing, contact sports, and scuba diving. Activities that increase your risk of falling 

should also be avoided such as gymnastics, water skiing, and horseback riding. 

You should avoid exercises that involve jumping, jarring motions or quick changes 

in direction.

You should be able to talk normally while exercising and it is important to drink lots 

of fluids. You should stop exercising if you have any of the following symptoms: 

vaginal bleeding, dizziness or feeling faint, increased shortness of breath, chest 

pain, headache, muscle weakness, calf pain or swelling, contractions, decreased 

fetal movement, or leakage of fluid from the vagina.

Exercise can be resumed postpartum when you feel ready. If you had a 

complicated pregnancy or delivery, you need time to recover and should check 

with your healthcare provider prior to resuming exercise.

Most women think of physical exertion when they think of exercise. In addition to 

the exercises mentioned already, women should regularly do pelvic floor exercises, 

known as kegels. These should be done during and after your pregnancy. 

Doing kegels during pregnancy has been shown to facilitate quicker recovery 

of postpartum muscle strength. This decreases your risk of urinary and bowel 

incontinence caused by stretched or injured pelvic floor muscles. Pelvic muscle 

strength also helps maximize effective pushing during labor. After pregnancy, 

doing kegels will help recover strength in the pelvic floor muscles. Strong pelvic 

floor muscles may also enhance sexual pleasure for you and your partner.

For further information regarding pregnancy and exercise, please see the brochure 

Prenatal Fitness: Exercise During Pregnancy.
116 Prenatal Information Sheet: Resources

Travel During Pregnancy

Questions regarding travel may arise from time to time during your pregnancy. You 

may ask “Is it safe for me to travel?” Whether or not it is safe to travel depends on 

how far along you are, whether or not you have complications in your pregnancy, 

and your overall comfort level. For most women, traveling is safe during most of 

the pregnancy.

The best time to travel is during the second trimester between weeks 18 and 28. 

By this time you are usually over morning sickness yet your belly is not so big that 

you are very uncomfortable. You do not always have to limit yourself to this time 

period. If you feel up to traveling, discuss your travel plans with your provider. If 

she or he does not object to your travel plans enjoy your trip! Make sure you keep 

your Pregnancy Passport with you during the trip.

If you have an option, what mode of travel should you choose? The best mode of 

travel should be the one that will get you to your destination in the least amount 

of time. For long distances, such as across the United States, that may be by air. 

Be sure that during long plane or car rides you get up, stretch, and move about 

periodically. This will help minimize the amount of swelling that can occur in your 

legs during such long trips. This also decreases the risk of developing a blood clot. 

Blood clots are uncommon but happen more often to pregnant women, especially 

if they are lying or sitting still for a long time. Typically, airlines restrict women 

beyond 34 weeks from traveling over the ocean and beyond 36 weeks from 

flying at all. Make sure you contact the airline and notify your provider if you are 

thinking of traveling late in your pregnancy. You may need to bring a statement 

from your healthcare provider approving your travel and stating your due date. If 

you decide to take a road trip, try to limit your riding or driving to five to six hours 

a day. During this time, take breaks to stretch your legs as you would with an 

airplane trip.

Being prepared before you go will ease your mind when you travel and likely 

make your trip much more enjoyable.

If you are traveling internationally, check the Centers for Disease Control and 

Prevention (CDC) web site at http://www.cdc.gov/travel/. The CDC is a good 

resource for travel alerts, safety tips, and up-to-date vaccination facts for many 

countries. The CDC web site has a travel page called “Traveler’s Health” that may 

be useful to you. The CDC can be reached by phone at 1-800-232-4636.

Another source for help is the US Embassy or Consulate in the country where you 

are traveling.
Prenatal Information Sheet: Resources 117

Having Twins, Triplets or More! 

Having twins or even triplets seems to be on the rise in the United States. This is 

due in large part to the use of fertility drugs and in vitro fertilization. While having 

multiples can bring great joy, there are definitely more challenges and often 

greater risks involved. These risks include preterm delivery and other complications 

that can affect the mother and the babies. 

If you learn you are carrying more than one baby, you and your partner will likely 

feel both elated and scared. Having one baby brings joy and challenges. Having 

more than one can definitely add stress. As always, discuss your concerns with 

your provider. The most important aspect of your care will be for you to understand 

how to care for yourself while you are pregnant and then how to be prepared for 

when you and the babies go home from the hospital. 

Your prenatal care will likely require more provider visits than a pregnancy 

with one baby. Your weight gain and uterine growth will be monitored closely. 

Pregnancy with multiple babies requires greater nutritional intake and often 

requires you to rest more than you would with one baby. You will be monitored 

closely for complications such as hypertension, preterm labor, and premature 

rupture of membranes. 

TAKE CARE OF YOURSELF! If you feel tired, rest. Carrying more than one baby 

can be very taxing on the body. Listen to your body and rest when you need to – 

both while you are pregnant and after your babies are born. 

New parents often benefit from having assistance at home when discharged from 

the hospital. This is especially helpful with multiple births. Plan ahead for your 

homecoming and explore arrangements that will allow you to get as much rest as 

possible in the first few weeks home. While you are pregnant you might also check 

out community support groups for parents of multiples so that you can be better 

prepared for the birth of your babies. 

Most women who have multiple births are able to successfully breast feed their 

babies. Sometimes this involves pumping or hand-expressing milk. Since most 

multiple births are preterm, the babies may have some trouble breastfeeding. 

However, most benefit from breast milk regardless of how they get it. They can get 

it in many ways. The nursery staff will help you know how and when to feed your 

babies. Amazingly, your body will automatically adjust the content of your milk to 

best support premature or term babies.
118 Prenatal Information Sheet: Resources Fetal Movement Counting Chart Date Go to Labor and Delivery if less than 10 movements in 2 hours (120 minutes) 120 min. 110 min. 100 min. 90 min. 80 min. 70 min. 60 min. 50 min. 40 min. 30 min.

20 min.

10 min.

Start time

Weeks 

pregnant

Counting your baby’s movements is an excellent way of knowing that your baby is doing well. It is also a great excuse for you to get off your feet, relax and get in touch with your baby. You should begin counting your baby’s movements when he or she is usually most active and you have time to concentrate. Begin your count around the same time each day and start by lying down on your left side with hands over your uterus. Write the time you begin your counts on the chart in the “start time” row. Also write down the date in the top row marked “date” and the number of weeks you are pregnant in the bottom row. Count 10 distinct movements and note how long it took, i.e. 15 minutes, two hours, whatever time it took. Put an “X” in the time box closest to the total time it took for your baby to move 10 times. If you have not felt 10 movements in two hours you will need to be monitored in Labor & Delivery to make sure your baby is OK. You may want to call Labor & Delivery to tell them you are on your way (but don’t let the phone call delay you from going in). In most cases your baby is just fine, but it is always better to be safe than sorry. Bring this chart with you to your next visit and any time you go to Labor & Delivery.
Prenatal Information Sheet: Resources 119Fetal Movement Counting Chart Date Go to Labor and Delivery if less than 10 movements in 2 hours (120 minutes)

pregnant

Weeks 

Start time

10 min.

20 min.

30 min.

40 min.

50 min.

60 min.

70 min.

80 min.

90 min.

100 min.

110 min.

120 min.

Bring this chart with you to your next visit and any time you go to Labor & Delivery.but it is always better to be safe than sorry. call Labor & Delivery to tell them you are on your way (but don’t let the phone call delay you from going in). In most cases your baby is just fine, If you have not felt 10 movements in two hours you will need to be monitored in Labor & Delivery to make sure your baby is OK. You may want to an “X” in the time box closest to the total time it took for your baby to move 10 times. you are pregnant in the bottom row. Count 10 distinct movements and note how long it took, i.e. 15 minutes, two hours, whatever time it took. Put time you begin your counts on the chart in the “start time” row. Also write down the date in the top row marked “date” and the number of weeks to concentrate. Begin your count around the same time each day and start by lying down on your left side with hands over your uterus. Write the relax and get in touch with your baby. You should begin counting your baby’s movements when he or she is usually most active and you have time Counting your baby’s movements is an excellent way of knowing that your baby is doing well. It is also a great excuse for you to get off your feet, 
120 Prenatal Information Sheet: Resources Fetal Movement Counting Chart Date Go to Labor and Delivery if less than 10 movements in 2 hours (120 minutes) 120 min. 110 min. 100 min. 90 min. 80 min. 70 min. 60 min. 50 min. 40 min. 30 min.

20 min.

10 min.

Start time

Weeks 

pregnant

Counting your baby’s movements is an excellent way of knowing that your baby is doing well. It is also a great excuse for you to get off your feet, relax and get in touch with your baby. You should begin counting your baby’s movements when he or she is usually most active and you have time to concentrate. Begin your count around the same time each day and start by lying down on your left side with hands over your uterus. Write the time you begin your counts on the chart in the “start time” row. Also write down the date in the top row marked “date” and the number of weeks you are pregnant in the bottom row. Count 10 distinct movements and note how long it took, i.e. 15 minutes, two hours, whatever time it took. Put an “X” in the time box closest to the total time it took for your baby to move 10 times. If you have not felt 10 movements in two hours you will need to be monitored in Labor & Delivery to make sure your baby is OK. You may want to call Labor & Delivery to tell them you are on your way (but don’t let the phone call delay you from going in). In most cases your baby is just fine, but it is always better to be safe than sorry. Bring this chart with you to your next visit and any time you go to Labor & Delivery.
Prenatal Information Sheet: Resources 121Fetal Movement Counting Chart Date Go to Labor and Delivery if less than 10 movements in 2 hours (120 minutes)

pregnant

Weeks 

Start time

10 min.

20 min.

30 min.

40 min.

50 min.

60 min.

70 min.

80 min.

90 min.

100 min.

110 min.

120 min.

Bring this chart with you to your next visit and any time you go to Labor & Delivery.but it is always better to be safe than sorry. call Labor & Delivery to tell them you are on your way (but don’t let the phone call delay you from going in). In most cases your baby is just fine, If you have not felt 10 movements in two hours you will need to be monitored in Labor & Delivery to make sure your baby is OK. You may want to an “X” in the time box closest to the total time it took for your baby to move 10 times. you are pregnant in the bottom row. Count 10 distinct movements and note how long it took, i.e. 15 minutes, two hours, whatever time it took. Put time you begin your counts on the chart in the “start time” row. Also write down the date in the top row marked “date” and the number of weeks to concentrate. Begin your count around the same time each day and start by lying down on your left side with hands over your uterus. Write the relax and get in touch with your baby. You should begin counting your baby’s movements when he or she is usually most active and you have time Counting your baby’s movements is an excellent way of knowing that your baby is doing well. It is also a great excuse for you to get off your feet, 
122 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 123

Immunizations

Immunizations

Immunizations offer protection against certain diseases and are usually given 

during our childhood. Some immunizations can be given during pregnancy while 

others cannot. You will be screened for several of the diseases that you (and your 

unborn baby) might be at risk for having or getting. This screening is through 

blood tests (Rubella, Hepatitis B) or through your childhood disease history 

(measles, mumps, chickenpox) or immunization history (tetanus). It is important to 

know if you are protected against these diseases, and, if not, what can be done 

to decrease your risk of getting a disease. If you are at risk for any of the diseases 

screened for, immunization will be offered during your pregnancy (if safe) or 

immediately after the baby is born. If you cannot avoid travel to foreign countries 

during your pregnancy, talk to your health care provider to see what can be done 

to lessen your risk from other diseases such as yellow fever and malaria.

Vaccine/

Disease 

Screening 

for 

Immunity

Disease Affect on 

Pregnancy/Baby Use in Pregnancy

MMR: 

Measles, 

Mumps and 

Rubella- 

(German 

Measles) 

Childhood 

disease history 

obtained at first 

visit. 

Rubella 

screened 

through a blood 

test at initial 

visit.

Measles: increased 

risk of miscarriage, birth 

defects, and low birth 

weight 

Mumps: possible 

increased risk of first 

trimester miscarriage

Rubella: Severe 

congenital defects 

especially when disease 

occurs early in pregnancy

Immunization is not safe 

during pregnancy. 

Avoid gatherings of young 

children and people with 

disease while pregnant. 

Receive immunization 

after delivery and use 

birth control for three 

months after delivery. 

Influenza: 

Seasonal Flu 

&

H1N1 Flu

None

Possible increase in 

miscarriages 

Increased risk of serious 

illness and/or death

Single dose injection safe 

to use in pregnancy. 

Mist not safe in 

pregnancy.

Hepatitis B

Screened with 

a blood test at 

first visit 

Possible increase in 

miscarriage, pre-term, 

birth, and neonatal 

hepatitis 

Safe to use in pregnancy 

for women at high risk 

of exposure such as 

laboratory personnel, etc. 

Tetanusdiphtheria 

(Td)

Tetanus 

shot/booster 

required every 

10 years. 

Increased risk of fetal 

death

Safe in pregnancy. If more 

than 2 years since last Td, 

Tdap should be received 

after delivery, ideally prior 

to hospital discharge.
124 Prenatal Information Sheet: Resources

Vaccine/

Disease

Screening 

for 

Immunity

Disease Affect on 

Pregnancy/Baby Use in Pregnancy

TetanusDiptheriaPertussis 

(Tdap)

None

Infants in the first several 

months of life are at the 

greatest risk of severe 

illness from pertussis 

but are too young to 

be directly immunized, 

thus vaccination during 

pregnancy is critical

Optimal timing for Tdap 

administration is between 

27 and 36 weeks of 

gestation although Tdap 

may be given at any time 

during pregnancy

Varicella 

(chicken pox)

Childhood 

disease history 

obtained at first 

visit.

Severe infection in adults 

Risk for congenital 

varicella syndrome (limb 

deformaties, skin scarring, 

eye defects) and death

Safe for women exposed 

to varicella during 

pregnancy 

For non-immune women 

given after delivery, 

prior to discharge with 

recommendation to use 

birth control for at least 

three months

Smallpox None See 

www.vaccines.army.mil

Immunization is not 

considered safe for 

pregnant women and 

pregnancy should be 

avoided 4 weeks after 

getting the smallpox 

vaccine

Anthrax None See 

www.vaccines.army.mil

As a precaution, pregnant 

women should not be 

routinely vaccinated with 

anthrax vaccine

HPV None Low risk for warts in the 

larynx of the baby.

Not considered safe in 

pregnancy.

Vaccine series can be 

started immediately 

postpartum in women up 

to age 26
Prenatal Information Sheet: Resources 125

Nutrition in Pregnancy

When you are pregnant, you have special nutritional needs. What you eat affects 

your baby’s development and can affect your baby throughout his or her entire 

life. Making good food choices during pregnancy will help you and your baby 

stay healthy

Nutritional needs 

Mypyramid.gov is a good source of nutrition information. There is a special 

section devoted to pregnancy and breastfeeding. You can get a personalized plan 

by logging into MyPyramid Plan for Moms. Your nutritional needs will change as 

the pregnancy progresses. 

Weight Gain

The total amount of weight you should gain depends on your body mass index 

(BMI) when you became pregnant. Your BMI is calculated based on your height 

and weight. You can calculate your BMI by using the chart on page 134.

Women who were at a healthy weight before becoming pregnant should gain 

between 25 and 35 pounds while pregnant. The recommended weight gain 

is different for those who were overweight or underweight before becoming 

pregnant and for women carrying more than one baby. If you are pregnant with 

one baby, the table below will help you determine your recommended weight gain 

based on your BMI.

Calculated BMI BMI Categories Weight Gain Guidelines

<18.5 Underweight Gain 28 - 40 pounds

18.5 - 24.9 Normal weight Gain 25 - 35 pounds

25 - 29.9 Overweight Gain 15 - 25 pounds

30 or greater Obesity Gain 11 - 15 pounds

At each visit you will be weighed. You can keep track of your weight gain on the 

table on page 135. If you are gaining weight too fast, you may need to cut back 

on the calories you are currently eating. If you are not gaining weight, or gaining 

too slowly, you may need to eat more calories. However, normal women do gain 

weight in different patterns and don’t always follow the average pattern.

If you are gaining weight too slow, the best way you can take in more calories is 

to eat a little more from each food group. 

If you seem to be gaining weight too fast, the best way to eat fewer calories is to 

decrease the amount of “extras” you are eating. Another good way is to increase 

the amount of vegetables you are eating. Vegetables are full of good nutrients and 

can help you feel full but have fewer calories than many foods.
126 Prenatal Information Sheet: Resources

Ways to avoid excessive weight gain

• Limit juice to two, four ounce servings per day.

• You’re not “eating for two.” At four months, add an extra 300 calories per 

day. Examples of 300 calories include a sandwich with two ounces of meat or 

a small peanut butter and jelly sandwich or two, eight ounce glasses of milk.

• Make healthy choices when dining out. A typical fast food meal has about 

1,500 calories, which is almost a full day’s worth of calories!

• Limit fried foods and high fat meats such as ribs and sausage. Choose lean 

cuts of meat such as “loin” cuts and trim visible fat.

• Use mayonnaise, salad dressings, and oils sparingly.

• Portion control is one of the easiest ways to reduce unnecessary calories.

• Remember to exercise. Walking and being active in your daily routine counts!

• Make an appointment with a dietitian to address your individual needs. 

What are “extras”?

 Extras are added sugars and solid fats in foods. Some examples of foods with 

“extras” are the following:

Soft drinks Candies Desserts Sweetened cereals 

Fried foods Cheese Whole milk Sweetened yogurt 

Sausages Fatty meats Biscuits

Look for choices that are low-fat, fat-free, unsweetened, or with no 

added sugars such as

Whole fruits Skim milk Low-fat yogurt Unsweetened cereal 

Eggs Vegetables Wheat crackers 

Intentional Weight loss

Losing weight intentionally (on purpose) is not recommended during pregnancy. 

Weight loss can cause low birth weight and other abnormalities. A small amount 

of weight loss is okay if you began your pregnancy overweight or obese and 

are now eating a healthy more balanced diet. Some women do lose weight in 

the beginning of their pregnancies due to nausea and vomiting. Usually this is 

temporary and not harmful to the woman or her baby. If you are losing weight, 

please talk with your healthcare provider.

Dietary Supplements

During pregnancy, your needs increase for several vitamins and minerals. You 

need enough for your growing baby’s needs as well as your own needs. This 

makes it difficult to get all that you need from food. This is especially true for folic 

acid and iron. During pregnancy, mothers need to consume enough nutrients to 

meet their increased needs as well as those of their growing baby.
Prenatal Information Sheet: Resources 127

Food Guide Pyramid: A Guide to Healthier Eating

When you are pregnant, you have special nutritional needs. Follow the MyPyramid Plan 

below to help you and your baby stay healthy. The plan shows different amounts of food for 

different trimesters, to meet your changing nutritional needs.

Food 

Group

1st 

Trimester

2nd & 3rd 

Trimester

What counts as 

1 cup or 1 ounce?

Remember to. . .

Fruits 2 cups 2 cups 1 cup fruit or juice 

1/2 cup dried fruit

Focus on fruits

Eat a variety of fruits

Vegetables 2 1/2 cups 3 cups 1 cup raw or cooked 

vegetables or juice 

2 cups raw leafy 

vegetables

Vary your veggies

Eat more dark-green 

and orange vegetables 

and cooked dry beans

Grains 6 ounces 8 ounces 1 slice bread 

1 ounce ready-to-eat 

cereal 

1/2 cup cooked pasta, 

rice or cereal

Make half your grains 

whole

Chose whole instead of 

refined grains

Meats & 

Beans

5 1/2

ounces

6 1/2 

ounces

1 ounce lean meat, 

poultry or fish 

1/4 cup cooked dry 

beans 

1/2 ounce nuts or 1 egg 

1 tablespoon peanut 

butter

Go lean with protein

Choose low-fat or lean 

meats and poultry

Milk 3 cups 3 cups 1 cup milk 

8 ounces yogurt 

1 1/2 ounces cheese 

2 ounces processed 

cheese

Get your calcium-rich foods

Go low-fat or fat-free 

when choosing milk, 

yogurt and cheese

* These amounts are for an average pregnant woman. You may need more or 

 less than the average. Check with your doctor to make sure you are gaining 

 weight as you should.

Eat the amount indicated 

below from each 

group daily *
128 Prenatal Information Sheet: Resources

Folic Acid: Folic acid is a B vitamin that helps prevent serious birth defects of a 

baby’s brain or spine. These are called neural tube defects. Getting enough folic 

acid can also help prevent birth defects like cleft lip and congenital heart disease. 

These birth defects often happen before most women know they are pregnant. 

Most prenatal supplements contain 600 micrograms per day of folic acid or more. 

This is the amount recommended for pregnant women.

Iron: Pregnant women need extra iron for the increasing amount of blood in their 

bodies. Iron helps keep your blood healthy and able to carry oxygen to your cells. 

Plus, your baby needs to store iron in his or her body to last through the first few 

months of life. Too little iron can cause a condition called anemia. If you have 

anemia, you might look pale or notice paleness under your nails, and feel very 

tired. Your health care provider checks for anemia with blood tests during your 

pregnancy. Most prenatal supplements contain 27 milligrams per day of iron. This 

is the amount recommended for pregnant women. 

Omega-3 Fatty Acids: For pregnant and nursing women, omega-3 fatty acids, 

particularly DHA, are important for the health of mom and baby. DHA is the most 

common omega-3 in the brain and eyes. Getting plenty will help to support a 

baby’s brain and eye development and function. Women should get at least 200 

milligrams of DHA every day.

DHA and other omega-3 fatty acids can be found in fatty fish, algae oil and fish 

oil. Pregnant moms need to be careful about the kinds of fish they eat (see section 

on page 131 on eating fish during pregnancy). 

Flaxseed is a source of omega-3 fatty acids. Some animal studies have shown 

that flaxseed can be harmful during pregnancy. Little research has been done 

in humans. But because we know so little, it’s wise to avoid flaxseed if you are 

pregnant or breastfeeding. 

If you are not getting enough DHA from food, another option is to take a 

supplement containing at least 200 milligrams of DHA. Several prenatal 

supplements include DHA, either from fish oil or other sources. As with all 

supplements, talk to your healthcare provider beforehand to make sure this choice 

is right for you.

Take a prenatal vitamin instead of individual vitamins or minerals: 

This ensures that you and your baby get balanced amounts of the vitamins and 

minerals you need. A high dose of some nutrients, in particular vitamin A, can be 

harmful to your baby. Too much vitamin A can cause birth defects.
Prenatal Information Sheet: Resources 129

Do not take dietary supplements or herbal products on your own: 

Scientists have not determined the risks to your baby from taking most herbal 

or botanical supplements. For this reason, avoid them when you are pregnant 

or breastfeeding. Not all “natural” products are safe. In fact many poisons are 

natural. These supplements are not tested or regulated like other drugs and 

medicines. You should avoid taking these substances without first talking with your 

healthcare provider.

Taking too much of a dietary supplement can have harmful effects: 

Take supplements or herbal products only if approved by your healthcare provider. 

Some dietary supplements can interact with prescribed medications or may not 

be safe for your baby. To avoid the possibility of harmful effects, discuss any 

supplement or medication you are taking or considering with your provider.

Food Safety

When you are pregnant, your ability to fight off infections you can get from food is 

decreased. In addition, your unborn baby’s immune system is not fully developed. 

This means both you and your baby have a greater chance of getting sick from 

eating unsafe food. Eating unsafe food can cause foodborne illness. 

If you get a foodborne illness, the effects may be worse than if you were not 

pregnant. Some foodborne illnesses can cause a woman to have a miscarriage or 

premature delivery, or cause the baby to die. They may also result in serious health 

problems for the baby after birth.

To protect your health and your baby’s health, you need to be especially careful 

about food safety while you are pregnant.

Food safety advice for everyone: Keep food safe to eat by following 

these general guidelines to avoid food borne illness. Practice the following when 

preparing food:

	 • Clean: Wash hands and surfaces often 

	 • Separate: Don’t cross-contaminate 

	 • Cook: Cook to proper temperature 

	 • Chill: Refrigerate promptly 
130 Prenatal Information Sheet: Resources

Keeping food safe from toxoplasmosis: Toxoplasmosis is an infection 

caused by a parasite. For most people, the body’s immune system usually keeps 

the parasite from causing illness. However, if you become infected while pregnant, 

you can pass an infection to your unborn child, even if you are not ill. The best 

way to protect your unborn child is by protecting yourself against toxoplasmosis.

Follow this advice to prevent toxoplasmosis:

• Wash your hands with soap and water after touching soil, sand, raw meat, 

 or unwashed vegetables.

• Cook your meat completely. The internal temperature of the meat should 

 reach 160°F. Chicken and turkey need to be cooked to a higher 

 temperature. Do not sample meat until it is cooked.

• Freeze meat for several days before cooking to greatly reduce the chance of 

 infection.

• Wash all cutting boards and knives with hot soapy water after each use.

• Wash and/or peel all fruits and vegetables before eating them.

• Cats can spread this parasite. Have someone else change the litter box if 

 possible. If you have to change it, wear disposable gloves and wash your 

 hands thoroughly with soap and water afterwards.

• Wear gloves when gardening or handling sandbox material. Cats may 

 use gardens or sandboxes as litter boxes. Wash hands afterward. 

• Avoid drinking untreated water, particularly when traveling in less 

 developed countries. 

Keeping food safe from listeriosis: Listeriosis is an infection caused by a 

bacteria. In pregnancy, it can cause miscarriage, serious illness, preterm delivery, 

or serious illness or death of a newborn baby. To decrease your risk of listeriosis, 

do the following:

• Keep your refrigerator at 40°F or slightly lower. Keep your freezer at 

 0°F or lower.

• Clean up all spills in your refrigerator right away - especially juices from 

 uncooked meat.

• Wash your hands after handling raw meat or seafood or its juices.

• Do not eat hot dogs, lunch meats, or meats from a deli unless they are 

 reheated to steaming hot.

• Do not eat meat spreads, pate, or smoked seafood from a store deli or meat 

 counter. Canned foods such as tuna, salmon, or packaged pasteurized deli-

 type meats are all right to eat. Refrigerate contents after opening.

• Do not drink raw milk or eat foods made of unpasteurized milk.

• Do not eat salads made in a store

• Do not eat soft cheeses such as feta, queso blanco, queso fresco, 

 brie, camembert, blue-veined cheeses, or panela unless it’s labeled MADE

 WITH PASTEURIZED MILK.
Prenatal Information Sheet: Resources 131

Eating Fish While Pregnant or Breastfeeding

Fish provide important nutrients, including omega-3 fatty acids, which are good for 

your health. Omega-3 fatty acids are critical for the development of the baby. Fish 

can be part of a healthy diet for pregnant and breastfeeding women. However, 

some types of fish may contain chemicals that can be health risks.

One of these chemicals is mercury. Some types of fish have high levels of 

mercury. It can harm the developing nervous system in an unborn child or baby. 

See information below about which fish are safe versus not safe to eat. Choose 

fish carefully to prevent any harm to your baby while still enjoying the health 

benefits of eating seafood. Do not eat shark, swordfish, king mackerel, or tilefish 

because they contain high levels of mercury.

The Food and Drug Administration (FDA) suggests you may eat up to 12 ounces a 

week (two average meals) of a variety of fish and shellfish that are low in mercury. 

However, many experts strongly believe the FDA limits are too restrictive. The FDA 

limitations did not take into account all of the benefits of fish to pregnant women 

and their babies. Eat plenty of fish but choose those lowest in mercury. As a rule, 

the benefits of eating fish outweigh the risks, especially during pregnancy. Eat 

smaller fish and cook and handle fish carefully.

• Shrimp, canned light tuna, salmon, pollock, and catfish are some 

 commonly eaten fish that are low in mercury. To check on mercury 

 in other types of fish, go to mypyramid.gov or the EPA web site 

• “White” tuna (albacore) has more mercury than canned light tuna. 

 When choosing fish and shellfish, include only up to 6 ounces 

 per week of white tuna. 

Other chemicals in fish: In addition to mercury, fish may contain other harmful 

chemicals, especially fish caught in local waters. Check local advisories to learn 

about the safety of fish caught in your local lakes, rivers, and coastal areas. 

Advisories may recommend that people limit or avoid eating some types of fish 

caught in certain places. If no advice is available, you may eat up to six ounces 

per week of fish from local waters, but don’t eat any other fish during that week.

Alcohol

Drinking alcohol while you are pregnant can cause your baby to be born with 

both physical and mental birth defects. The most serious concern is a condition 

called fetal alcohol syndrome (FAS). FAS is one of the most common causes of 

mental retardation.
132 Prenatal Information Sheet: Resources

No one knows exactly how much alcohol a woman has to drink to cause birth 

defects in her baby. That level may differ from woman to woman. So experts agree 

that the best thing to do is not to drink alcohol at all while you are pregnant - that 

includes beer, wine, wine coolers and liquor.

If a woman takes an occasional drink before she knows she is pregnant, it 

probably won’t harm her baby. But she should stop drinking alcohol as soon as 

she thinks she may be pregnant. 

No amount of alcohol is safe when you are pregnant. If you find it hard to say no, 

avoid parties, bars, and other places where people are drinking alcohol. If you 

have a problem stopping alcohol use, get help. Start by talking with your provider 

or someone you trust. There is no more important time to stop than when you are 

pregnant. 

Food Items to Limit

Caffeine: Among experts there is no strong agreement regarding how much 

caffeine is safe during pregnancy. Most sources recommend that pregnant women 

limit their caffeine intake to less than 200 milligrams per day. This is the amount of 

caffeine in one cup of coffee. Of course, the amount of caffeine in a cup of coffee 

will vary depending on how it was made. Also, pregnant women should be aware 

that there is some caffeine in tea, chocolate, and soft drinks. Even energy drinks 

and non-prescription medications may have some caffeine in them. 

Compared to drinking beverages high in caffeine, it is better for you and baby 

if you drink water, milk, and small amounts of fruit juice during pregnancy. You 

may drink decaffeinated soft drinks, coffee and tea but be aware that these may 

contain a small amount of caffeine. Caffeine does damage the DNA so its use 

should be limited whether or not you are pregnant.

Juice: Fruit juices are high in calories. Limit juice intake to four ounces per day. A 

better choice would be to eat the whole, fresh fruit.

Fats: Be mindful about the amount of fat you eat. Fried foods and fast foods are 

high in fat (and calories). Some forms of fat are worse for your health. “Trans fats” 

found in many processed foods are particularly harmful. When choosing cooking 

oils, olive and canola oils are much better for you and the baby than regular 

vegetable oil (soy), margarine, or shortening. Limit the amount of fast food you 

consume to no more than one meal per week.

Sugar: Excess sugar is not good for you or your baby. It can lead to problems 

with your teeth and excessive weight gain. Sugar substitutes may be used in 

moderation.

Herbs: Overall, scientific evidence is lacking about the safety of various herbs in 

pregnancy. Some “safe” herbal teas include: blackberry, citrus peel, ginger, lemon 

balm, and rose hip.
Prenatal Information Sheet: Resources 133

Notes:
134

Prenatal Information Sheet: Resources

Directions:

To find BMI category (e.g., obese), find the point where the woman’s height and weight intersect.

To estimate BMI, read the bold number on the dashed line that is closest to this point.

Reprinted with permission from Nutrition During Pregnancy and Lactation, An Implementation Guide. Copyright 1992 by the National Academy of Sciences, Courtesy of the National Academy Press, Washington, D.C.
Prenatal Information Sheet: Resources 135

Weight Record

Date Weeks of 

Gestation

Weight Notes

Key:

Prepregnancy BMI < 19.8 ( )

Pre-pregnancy BMI < 19.8–26.0 (normal body weight) ( )

Pre-pregnancy BMI > 26.0 ( )

Reprinted with permission from Nutrition During Pregnancy and Lactation, An Implementation Guide. Copyright 1992 

by the National Academy of Sciences, Courtesy of the National Academy Press, Washington, D.C.
136 Prenatal Information Sheet: Resources

Dental Care

Proper care of your teeth and gums is especially important now that you are pregnant. If you have not had a professional dental cleaning within the past six months, 

we recommend that you do so early in your pregnancy. If you have recently had a 

dental check-up, we recommend that you continue your preventive visits to the 

dentist every six months. Dental cleanings and needed dental care are both safe 

and encouraged before, during and after pregnancy. It is important to floss daily 

and to brush your teeth in the morning after breakfast and before bed at night. Try 

to replace juices with water and avoid concentrated sugary foods/drinks. Chewing xylitol-containing gum after meals or sweets may help decrease the likelihood 

of cavities during your pregnancy.

If your dentist thinks you need dental care beyond cleanings during pregnancy, 

the following guidance may help you and your dentist make good decisions about 

your care:

• The x-rays normally taken during routine dental care may be taken during 

 pregnancy. Dental x-rays are considered very safe in pregnancy if you 

shield your abdomen and pelvis with a lead gown or drape during the 

x-rays. All dentists who take x-rays have these kinds of gowns as they use 

them routinely.

	 • Unless you have an allergy to them, many antibiotics are safe for you and 

 the baby during pregnancy. Common antibiotics that are considered safe 

include penicillins and cephalosporins. Sulfa antibiotics are safe 

although when given just before delivery babies have an increased risk of 

 jaundice. Quinolones and tetracycline type antibiotics should be avoided 

 if possible as they can have an impact on the baby’s growth and develop-

 ment of bones and teeth.

•If you need pain medication, Tylenol® (acetaminophen) and narcotics are 

safe as long as they are taken in typical doses. You should avoid Motrin®

or Advil® (ibuprofen) and other related medications called non-steroidal 

anti-inflammatory drugs (NSAIDs) unless you specifically talk to your 

provider. These drugs can affect the baby’s kidneys, heart and lungs if 

 they are taken too long or too late in the pregnancy.
Prenatal Information Sheet: Resources 137

Tobacco, Alcohol, and Drug Use in Pregnancy

Most people know that tobacco and alcohol are not good for you. Tobacco causes 

cancer, heart disease, and other major health problems. Alcohol use has immediate effects that can increase the risk of many harmful health conditions including 

illness and accidents.

Women who smoke during pregnancy put themselves and their unborn babies at 

risk for other health problems. The dangers of smoking during pregnancy include 

premature birth, low birth weight, and pregnancy complications. Even being 

around cigarette smoke puts a woman and her baby at risk for problems.

Pregnant women who smoke expose their babies to all of the harmful effects of the 

cigarette smoked. Nicotine in the cigarette causes blood vessels to constrict, so less 

oxygen and nutrients reach the baby. Carbon monoxide from the cigarette lowers 

the amount of oxygen the baby receives. Also, women who smoke during pregnancy are more likely to have certain problems such as tubal pregnancies, vaginal 

bleeding, problems with the way the placenta attaches to the uterus, low birth 

weight babies, and even stillbirths. Babies that are smaller than they are meant to 

be have increased long-term health risks, including diabetes and heart disease as 

adults.

Breathing in the smoke from the cigarettes of others is also a concern. Pregnant 

women who are exposed to secondhand smoke have a higher risk of giving birth 

to a low birth weight baby than women who are not exposed to secondhand 

smoke during pregnancy. Infants who are exposed to secondhand smoke are more 

likely to die of Sudden Infant Death Syndrome (SIDS) than infants not exposed. 

Children who are exposed to secondhand smoke are at increased risk for bronchitis, pneumonia, ear infections, severe asthma, respiratory symptoms, and slowed 

lung growth. Exposure to secondhand smoke causes premature death and disease 

in children and adults who do not smoke.

Drinking alcohol during pregnancy can cause a baby to be born with birth defects 

and have disabilities. These conditions, called fetal alcohol spectrum disorders, are 

among the top preventable birth defects and developmental disabilities. The effects 

of the alcohol can cause problems in how a person grows, learns, looks, and acts. 

Alcohol during pregnancy can also cause birth defects of the heart, brain, and 

other major organs. These problems last a lifetime. 

There is no known amount of alcohol that is safe to drink while pregnant. All drinks 

with alcohol can hurt an unborn baby. A 12-ounce can of beer has as much alcohol as a five ounce glass of wine or a one ounce shot of liquor. Also, there is no 

safe time to drink during pregnancy. Alcohol can harm a baby at any time during 

pregnancy. It can cause problems in the early weeks of pregnancy, even before a 

woman even knows she is pregnant.
138 Prenatal Information Sheet: Resources

If you are pregnant and smoking or drinking, it is very important that you speak 

openly with your provider at your next visit about how to stop. We are here to 

work with you to help you cut down and quit. Our goal for you is a healthy pregnancy and a healthy baby.

The less a woman uses tobacco or drinks alcohol the less harm it will do. Cutting 

down or stopping any time during pregnancy is better than not stopping at all. If 

you kick the habit while you are pregnant, the chances of you quitting for a lifetime go up dramatically. Let us work with you for a healthier outcome that will last 

a lifetime for you and baby! 

The dangers from the use of illegal drugs are magnified during pregnancy. 

Cocaine is particularly bad. Cocaine use increases the chances of damage to the 

placenta and the developing baby. It can cause brain damage by causing fetal 

strokes. If you have used illegal drugs in the past or are using them in your pregnancy, please talk to your provider and a trusted friend. Get any help necessary to 

quit. 

Prescription narcotics are generally safe in pregnancy when taken as prescribed. 

However, long-term use of narcotics is addicting to both mother and baby. If the 

mother is taking narcotics near delivery, the baby may need to stay in the hospital 

for several days to be monitored and treated for narcotic withdrawal. Sudden withdrawal from narcotics can cause seizures or other potentially harmful problems. 

Women who take prescription narcotics need to make sure they are not taking 

more than prescribed. These medications are often given with Tylenol®. While 

Tylenol® is safe in normal doses, it is very toxic to the liver if taken in even small 

amounts over the recommended dose. As with any drug, always discuss what you 

are taking with your provider. To avoid taking too many narcotics during pregnancy, you should get all your medication from one provider.
Prenatal Information Sheet: Resources 139

Sexually Transmitted and Other Infections 

in Pregnancy

Sexually transmitted infections (STIs) affect one in four Americans at some time. 

During your pregnancy you will be tested for several STIs and treated if needed. 

Many STIs require that you and your partner be treated to avoid reinfection.

STIs can cause serious harm to your baby if not untreated. Most STIs can be 

treated during pregnancy, but treatment does not prevent you from becoming 

infected again or being infected with a new STI during this pregnancy. Using 

condoms and avoiding sexual contact with an infected person can help protect 

you against STIs. If at anytime you think you have been exposed to an STI or have 

any symptoms of an STI (vaginal itching, odor, or abnormal discharge), let your 

health care provider know. You will be tested and treated if you have an infection. 

This list includes some of the more common and more potentially harmful STIs and 

other common non-sexually transmitted vaginal infections. This does not cover all 

of them, as there are more than 20 known STIs.

Bacterial Vaginosis (BV, Gardnerella): This is the most common type of 

vaginal infection in women. It happens when the normal bacteria in the vagina get 

out of balance. It is not considered an STI.

•	 Signs and symptoms of infection: Sometimes causes no symptoms. Some 

women have an increase in white or grey vaginal discharge, itching in or 

around the vagina and burning or pain when urinating. The discharge is 

commonly thin and can have a “fishy” odor especially after having sex.

•	 Possible effects on baby: Does not cause baby direct harm but can cause 

preterm labor and delivery. Preterm birth can cause the baby serious problems 

such as blindness, lung problems, mental problems or even death. 

•	 Testing: A vaginal secretion sample will be examined under a microscope (wet 

prep).

•	 Treatment: For you the best treatment is antibiotic pills taken by mouth—

usually Flagyl (metronidazole). Eating yogurt containing live “good” bacteria 

(lactobacilli) can sometimes help prevent this infection. 

Chlamydia

•	 Signs and symptoms of infection: More than 50% of all infections are without 

symptoms. You can experience burning on urination or unusual vaginal 

discharge.

•	 Possible effects on baby: Baby has a 20-50% chance of becoming infected 

while passing through the birth canal resulting in pneumonia or an eye 

infection.

•	 Testing: Cervical culture at the time of your initial pap smear

•	 Treatment: Antibiotic pills for you. Antibiotic ointment to baby’s eyes at birth. In 

some states, these antibiotics are given to all babies by law.
140 Prenatal Information Sheet: Resources

Gonorrhea (Drip, clap, dose)

•	 Signs and symptoms of infection: Burning on urination, unusual vaginal 

discharge or no symptoms at all.

•	 Possible effects on baby: Baby can become infected as it passes through 

the birth canal. This infection can result in conjunctivitis (redness of the eye), 

blindness and/or a serious generalized infection.

•	 Testing: Cervical culture at the time of your initial pap smear

•	 Treatment: Antibiotic pills for you and an antibiotic ointment for the baby’s eyes 

at birth. In some states, antibiotic eye medications are given to all babies by 

law.

Genital warts (caused by Human Papilloma Virus) 

•	 Signs and symptoms of infection: Skin tags or warts that can be small or large, 

soft or hard, raised or flat, single, or in clusters like cauliflower.

•	 Possible effects on baby: Baby can get laryngeal papillomas (benign tumors on 

the vocal cords) from passing through an infected birth canal.

•	 Testing: Let your health care provider know if you think you have warts.

•	 Treatment: Usually delay treatment until after delivery but may be removed in 

pregnancy. If large enough to block the birth canal, you may need a cesarean 

section.

Hepatitis B 

•	 Signs and symptoms of infection: You often have no symptoms. You can have 

yellowing of the skin and eyes, loss of appetite, nausea, vomiting, stomach and 

joint pain, or feel extremely tired.

•	 Possible effects on baby: Can pass to your baby during the pregnancy resulting 

in liver damage and risk of death.

•	 Testing: Blood test at initial visit

•	 Treatment: Vaccine, immune globulin, and a baby bath after delivery can help 

protect baby from becoming infected. 

Herpes Simplex Virus (Herpes) 

•	 Signs and symptoms of infection: Fluid-filled sores in the genital area that may 

itch, burn, tingle or cause pain.

•	 Possible effects on baby: Can be transmitted to baby during delivery if mother 

has blisters near term. Can cause severe disease and death of newborn but 

transmission is extremely rare, even with vaginal deliveries. 
Prenatal Information Sheet: Resources 141

•	 Testing: Tell your health care provider immediately if you think you have an 

outbreak. Cultures of the blisters can be done.

•	 Treatment: If active infection occurs at or near your delivery date, you may 

need cesarean delivery within four to six hours of your bag of water breaking.

HIV (AIDS)

•	 Signs and symptoms of infection: Often times there are no symptoms of HIV.

•	 Possible effects on baby: Can pass infection to baby while pregnant, during 

birth or through breastfeeding. Can cause serious complications and death to 

baby.

•	 Testing: Blood test at initial visit

•	 Treatment: Medication called AZT® can decrease transmission to baby.

Syphilis (Syph, pox, bad blood) 

•	 Signs and symptoms of infection: Painless sores in genital area

•	 Possible effects on baby: Miscarriage, stillbirth or damage to baby’s bones, 

teeth and brain

•	 Testing: Blood test at first visit

•	 Treatment: Antibiotics for the mother

Trichomonas (Trich) 

•	 Signs and symptoms of infection: Common in pregnancy. You may have an 

increase in bad smelling, thin or thick, white, yellow-green/gray vaginal 

discharge with itching.

•	 Possible effects on baby: May increase chance of pre-term labor

•	 Testing: Tell your health care provider. Your vaginal discharge will be examined 

under a microscope.

•	 Treatment: Flagyl® pills can be given safely after the first trimester.

Yeast (Candidiasis)

•	 Signs and symptoms of infection: Vaginal itching or burning pain, which 

increases with urination and sex. Can also occur without sexual transmission. 

More common in pregnancy.

•	 Possible effects on baby: Baby can get a mouth infection (thrush) while passing 

through an infected birth canal 

•	 Testing: Let your health care provider know if you are experiencing any 

symptoms. A vaginal secretion sample will be looked at under the microscope.

•	 Treatment: Vaginal creams or suppositories. Nystatin® for baby. 

Listing of medications/drugs does not represent endorsement by VA/DoD 
142 Prenatal Information Sheet: Resources

Genetic Screening

As a new mother-to-be you might be wondering, “How do I know my baby is 

OK?” It seems as soon as a pregnancy is confirmed we begin to wonder and hope 

that the baby is developing and growing normally. Many of the routine processes 

and testing that are done during pregnancy are outlined in the visit sections 

of this book. Your test results can be recorded in this book as well as in your 

Pregnancy Passport. While healthcare providers can detect many problems and 

help correct them, pregnancy is an amazingly complicated process and things do 

not always go well. There are some problems that begin at conception that are not 

correctable. Approximately three to five percent of babies born to women in the 

United States have birth defects.

Birth defects can be caused by many factors including genetic problems. While 

most birth defects are minor, with little or no significance, others can cause 

major short and long-term problems. Most of the tests that we do in pregnancy 

help your providers to help you and the baby do well. There are other tests that 

primarily provide information to you. These tests have the potential of giving you 

helpful information but do not necessarily help providers take better care of you 

or improve the chances of a good outcome for the baby. Such information could 

either help give you some peace of mind that things are going well or help you 

prepare for problems if they are not. In some cases, women use this information 

to help decide whether or not to continue a pregnancy. While we all hope this 

information would provide peace of mind, this information also has the potential 

to make you worry, usually unnecessarily. As it turns out, there are several such 

optional tests that you may or may not find helpful depending upon what you 

would do with the information from the test results. 

The following information will help you understand some of the optional tests and 

help you make a decision about the tests that may be useful for you. 

Background

Genetic information is contained in chromosomes. As human beings, we have 23 

pairs of chromosomes. Normally, we get 23 chromosomes from our father and 23 

chromosomes from our mother for a total of 46. One pair of the chromosomes (sex 

chromosomes X and Y) is responsible for our gender and the other chromosomes 

(numbered 1-22) are responsible for a multitude of different structures and 

functions in our bodies. At the time of egg or sperm formation, or conception, 

mistakes can occur that result in too many or too few chromosomes. Having more 

or less than the normal 46 chromosomes is called aneuploidy. Aneuploidy causes 

major problems because each chromosome contains thousands of genes. Because 

so many genes are involved, aneuploidy usually causes a miscarriage. Half of 

all human pregnancies end in miscarriage because of aneuploidy. Most of these 

pregnancy losses occur before women even recognize they are pregnant. It is rare 

for pregnancies with aneuploidy to go on and result in a live born baby. However, 

when certain chromosomes are involved in aneuploidy, such as number 13, 18 

or 21, survival is possible, although the majority of these pregnancies also end in 

miscarriage. 
Prenatal Information Sheet: Resources 143

Having an extra copy of chromosome number 21 is called Trisomy 21, which is 

also called Down Syndrome. People who have this syndrome share a common 

group of characteristics. The chance that a baby will be born with any aneuploidy 

increases as the mother gets older. At the age of 20, the chances of having a baby 

with Down Syndrome is less than 1 out of 1500 but at the age of 43, it is 1 out of 

50. Down Syndrome is usually not related to family history or the age of the father.

When considering all pregnant women together, the overall chances of having 

a live born baby with Down Syndrome are about 1 out of 800 and the chances 

for a live born baby with Trisomy 18 are 1 out of 6000. Because pregnancies 

affected by Trisomy 13, 18, or 21 do not always end in miscarriage, testing has 

been developed to evaluate the possibility of aneuploidy before the baby is born. 

This type of testing is usually offered during the first half of the pregnancy and is 

completely optional. This testing does not change baby’s chances for being healthy 

at birth nor does it improve the chances for good long-term health of the child. 

The primary benefit of this testing is to give parents information. This information 

can be reassuring when the results show that your risk is decreased, or can 

provide parents an opportunity to emotionally and mentally prepare for the birth 

of the baby that may have problems. This information would also allow parents 

the possibility of deciding not to continue the pregnancy by having an abortion. 

Please read this information carefully and discuss your wishes regarding prenatal 

diagnosis with your provider early in your pregnancy. If you should decide to 

terminate (abort) the pregnancy due to this information, the procedure cannot be 

performed at a DoD or VA facility and is not covered by TRICARE.

There are two main categories of tests for aneuploidy: screening tests and 

diagnostic tests. Tests that adjust your risk of aneuploidy compared to what the risk 

is based on your age alone are called screening tests. These include: ultrasound 

evaluation of the baby, blood tests on the mother, or a combination of age, blood 

tests and ultrasound findings. Because these tests are do not provide definite 

answers, they can give inaccurate results.

There are two types of inaccurate results. They are called false positive and false 

negative. A false positive test occurs when the test result suggests an increased risk 

of aneuploidy when in fact the baby has a normal number of chromosomes. False 

negative tests occur when the test suggest that there is low risk for aneuploidy, 

when in fact the baby actually has an abnormal number of chromosomes. False 

negative tests are not common. Most of the time, when the test results say there is 

a lower risk of a problem, the test is right. One example of a false negative test 

is when the baby looks normal on ultrasound but actually has Down Syndrome. 

Babies with Down Syndrome can look normal on ultrasound 20-50% of the time. 

False positive results are relatively common. For example, 5-15% of babies have 

minor ultrasound abnormalities that suggest the possibility of aneuploidy. In these 

cases, when there are no other major findings on the ultrasound, more than 99% 

of these babies have normal chromosomes. 

False positive tests can cause a lot of unnecessary worry and anxiety. Depending 

on what a mother chooses to do when she has an abnormal test, she can end up 

worrying the rest of the pregnancy.
144 Prenatal Information Sheet: Resources

Diagnostic tests can give definite answers regarding the baby’s health including 

the baby’s chromosome numbers. Diagnostic testing involves some risk to the 

mother and some risk of causing a pregnancy loss. A normal result on a diagnostic 

test for chromosomes does not guarantee that other problems do not exist. In 

addition, small “mistakes” in the chromosomes cannot be detected this way at all. 

These small mistakes are referred to as microdeletions or copy number variants. 

There are no tests that prove the baby will be completely normal, just as there are 

no tests that can tell us what kind of personality your baby will have. These tests 

always involve getting a sample of tissue from the baby. This sample comes from 

either the amniotic fluid or the placenta. After cells from the baby are obtained, 

they can be prepared in a special way and a picture is taken of the baby’s 

chromosomes. A picture of chromosomes is called a karyotype. 

Possibilities for Testing

Since there are several possibilities of tests and combinations of tests for prenatal 

diagnosis, you have several options. There is a steady increase in the risk of 

delivering a child with aneuploidy as women age. This is illustrated in the chart on 

page 148 labeled Age Related Risk of Aneuploidy. The age of 35 was previously 

considered the cut off for being “high risk” of having a baby with aneuploidy. 

However, less than 5% of pregnant women are over 35 years of age, and they 

deliver 30% of children with Down Syndrome. That means that 70% of babies with 

Down Syndrome are born to women younger than 35.

In January 2007, the American College of Obstetricians and Gynecologists 

(ACOG) recommended that all prenatal testing options be available to all 

pregnant women, regardless of age. As a result of the recommendation, the 

availability of varied types of testing and reimbursement for these tests for all 

woman is changing and becoming more widespread. At present, there are still 

limitations on the availability of such testing in both the military and civilian 

communities, primarily because there are not enough qualified ultrasound 

technicians and obstetricians to do the testing. Further, many insurance companies 

(including TRICARE) may not currently pay for these tests.

Specific Options for Prenatal Testing at Your Hospital/Clinic

The VA/DoD guidelines recommend that certain kinds of screening and diagnostic 

tests be available to you either in your hospital/clinic or by referral elsewhere. In 

addition, ACOG has encouraged individual practices to come up with screening 

and diagnostic testing strategies that fit their patient population and available 

resources. While we are going to review all the options that are theoretically 

available, not all options are offered in all areas.

Check with your local obstetrical provider to find options are available in your 

area. Depending upon which lab your facility uses, these tests may have slightly 

different names.
Prenatal Information Sheet: Resources 145

Strategies/Options for Testing

The following section outlines the types of testing and screening strategies that 

are available in most VA and DoD facilities. If the specific test is not available 

in your VA or DoD medical facility, it can usually be obtained by referral. You 

should understand that you have the option of having blood tests and ultrasound 

examinations in the first trimester and/or second trimester. In addition, these tests 

can occur separate from each other (so you get results in the first trimester separate 

from those you get in the second trimester), or can be done together, giving you 

one result in the second trimester only. (Again, some of these tests may not be 

covered by TRICARE. Talk to your provider or healthcare benefits advisor for 

further information.)

Strategy 1: No optional screening. No ultrasound or blood tests for screening. 

If during your routine care an abnormality is identified, you would probably be 

offered an ultrasound and additional testing. For example, if when measuring 

your abdomen in your clinic visit the baby seemed to not be growing well, an 

ultrasound would be encouraged. If the baby were too small or the amniotic fluid 

too low, you would be offered additional testing.

Strategy 2: Start with a second trimester screening ultrasound. This usually takes 

place at 18-20 weeks. You would be notified if an abnormality were detected and 

be offered additional counseling and testing.

Strategy 3: Start with a second trimester Quad Screen (15-21 weeks) then have 

a second trimester screening ultrasound (18-20 weeks). You would be notified if 

the Quad Screen result is considered high risk and be offered a comprehensive 

ultrasound, Maternal-Fetal Medicine consultation, and amniocentesis.

If the Quad Screen result were considered low risk, you would be scheduled for a 

screening ultrasound. You would be notified if a major abnormality was detected 

by the screening ultrasound and be offered additional counseling and testing.

Strategy 4: Start with a first trimester screen (11-13 weeks). This test involves 

drawing your blood. Most first trimester tests also involve ultrasound measurements 

of certain baby structures such as a space on the back of the baby’s neck called 

the nuchal lucency. If the screening test result is considered high risk, you would be 

notified and counseled and given options for a Chorionic Villus Sampling (CVS) 

test (this may need to be done at another hospital or clinic), an amniocentesis 

after 15 weeks, or a comprehensive ultrasound at 16-18 weeks followed by an 

amniocentesis if desired.

If the screening test result were considered low risk, you would be scheduled for 

a screening ultrasound at 18-20 weeks. You would also be notified if a major 

abnormality was detected by the ultrasound examination and you would be 

offered additional counseling and testing.

Strategy 5: Start with an amniocentesis after 15 weeks. If the amniocentesis were 

abnormal, you would be given further counseling regarding your options. If the 

amniocentesis were normal, you would be scheduled for a screening ultrasound 

at 18-20 weeks if the ultrasound were not already completed at the time of the 

amniocentesis. 
146 Prenatal Information Sheet: Resources

You would be notified if a major abnormality were detected by the ultrasound 

examination and you would be offered additional counseling and testing.

Strategy 6: Start with Chorionic Villus Sampling (CVS). In most cases, this would 

need to be done at a hospital/clinic that specializes in this procedure. If the CVS 

were abnormal, you would be given further counseling. If the CVS were normal 

you would be scheduled for a screening ultrasound at 18-20 weeks. If a major 

abnormality were detected by the ultrasound, additional counseling and testing 

would be offered. 

Your Specific Risks

You may be interested to know your specific risk of having a baby with 

aneuploidy. You can use the tables below to estimate your specific risk.

Based on your age of _____ at your due date, your risk for delivering a live-born 

child with Down Syndrome is ______ and the total risk for delivering a live-born 

child with any aneuploidy is ______ (see chart on page 148).

If an Abnormality is Found

If the screening or diagnostic testing outlined above finds that the baby has a 

birth defect or genetic problem, your providers will present you with more specific 

information about that problem. If necessary, they can refer you to another 

provider who can better help you understand the significance of the problem 

and your options. They can help you plan the rest of the pregnancy. Your family, 

friends, military unit, social worker, chaplain or other spiritual leader may be able 

to provide you support.

Be careful about the medical advice you might receive from well meaning 

individuals who are not your medical care providers. Even individuals who have 

medical training, but don’t take care of pregnant women, can give you bad 

information. The Internet has a lot of information. Some of that information is 

good and accurate but there is also a lot of misinformation. The bottom line is that 

your provider will be able to give you the best information or refer you to another 

provider who can.

Usually, if there are problems, you will be referred to a Maternal-Fetal Medicine 

specialist. These doctors have special training to take care of women with 

complicated pregnancies.

If your baby does have a serious birth defect and you are early in the pregnancy, 

the two basic options are to continue the pregnancy for as long as it is safe for 

you or end the pregnancy early. Government facilities and funds cannot be used 

to perform abortions no matter what is wrong with the baby. This is true even if 

there is such a serious problem that the baby would certainly die before or after 

birth. The only times that government funds (e.g. TRICARE) or facilities can be used 

to perform an abortion is when the pregnancy is the result of rape or incest or if 

continuing a pregnancy were life threatening to the mother. 
Prenatal Information Sheet: Resources 147

As long as you have not passed the gestational age limits, whether you are active 

duty, retired, or a dependent, you can have an abortion if you choose. Each state 

has laws that limit how far along you can be and still have an abortion. If you 

choose to end the pregnancy, you will be responsible for finding the physician 

who would do the procedure. It would be your responsibility to pay for the 

procedure. Remember to involve people you trust in helping you to make decisions 

about what to do. Whether you continue the pregnancy or not, there are far 

reaching challenges to your emotional health when dealing with a complicated 

pregnancy.

Summary

While most babies are born healthy, three to five percent have birth defects. Most 

of these birth defects are minor. Some more serious birth defects are caused by 

chromosome number problems (aneuploidy) while other birth defects happen even 

when the baby’s chromosomes are normal. There are several optional tests that 

can be performed prior to the birth of the baby that can be used to screen for or 

diagnose aneuploidy.

Screening tests can be performed by ultrasound and maternal blood 

measurements. These tests modify (raise or lower) the age related risk of 

aneuploidy but do not give definite answers. They can have false negative 

and false positive results. Thus, there are potential benefits and hazards of the 

screening tests. At most VA and DoD facilities, a basic screening ultrasound is 

offered to everyone and a comprehensive ultrasound is offered to women at 

increased risk based on previous testing. 

The Quad Screen is the second trimester screening blood test offered at most 

facilities in the VA/DoD. There are several new screening tests that are becoming 

available for first trimester testing. Some VA and DoD facilities offer first trimester 

screening and it is usually available via referral at other VA and DoD facilities.

Tests, such as the first trimester screen and the Quad Screen, are likely to be most 

useful to women who would benefit from the reassurance of a normal (low risk) 

test or who would consider diagnostic testing if the screening test is abnormal 

(elevated risk). Screening tests may not be useful for women who would not 

consider pregnancy termination even if the baby had Down Syndrome or other 

abnormalities. 

In such circumstances, screening tests may be harmful by causing significant 

anxiety for women who undergo the testing but would choose not to undergo 

diagnostic testing even if the result returned abnormal (elevated risk).
148 Prenatal Information Sheet: Resources

Diagnostic (yes or no) tests are invasive and include amniocentesis and chorionic 

villus sampling (CVS). The CVS can be performed as early as 11 weeks but is not 

available at most DoD or VA facilities. It can usually be obtained through referral. 

Amniocentesis is available at most VA and DoD facilities that provide obstetric 

services.

Maternal 

Age

Risk of Down 

Syndrome

Total Risk 

for All 

Chromosomal 

Abnormalities

20 1/1667 1/526

21 1/1667 1/526

22 1/1429 1/500

23 1/1429 1/500

24 1/1250 1/476

25 1/1250 1/476

26 1/1176 1/476

27 1/1111 1/455

28 1/1053 1/435

29 1/1000 1/417

30 1/952 1/385

31 1/909 1/384

32 1/769 1/322

33 1/625 1/317

34 1/500 1/260

35 1/385 1/207

36 1/294 1/164

37 1/227 1/130

38 1/175 1/103

39 1/137 1/82

40 1/106 1/65

41 1/82 1/51

42 1/64 1/40

43 1/50 1/32

44 1/38 1/25

45 1/30 1/20

46 1/23 1/15

47 1/18 1/12

48 1/14 1/10

49 1/11 1/7

References:

JAMA.1983 Apr 15; 249 (15): 2034-8.

Obstet Gynecol. 1981 Sep; 58 (3): 282-5.

Table 1. 

Risk of having a live-born child

with Down Syndrome or other 

chromosome abnormality.

TEST Detection rate at 5%

False Positive

First Trimester Screens 83 - 88%

Quad Screen 81 - 85%

Screening Ultrasound 50 - 70%

Genetic Ultrasound 70 - 90%

Table 2. Down Syndrome Detection Rates

TEST Timing 

(weeks)

Risk of Loss Comment

CVS 11 - 14 1/10 to 

1/1000

Referral 

usually 

required

Amnio >14 1/1500

Available at 

most DoD 

facilities

Table 3. Diagnostic Testing
Prenatal Information Sheet: Resources 149

Specific Genetic Testing

Cystic fibrosis (CF) is a genetic disorder that occurs more often in certain races 

and ethnic groups. Caucasians, Northern Europeans, and those of Ashkenazi 

Jewish descent are much more likely than others to be carriers of CF. The risk of 

being a carrier is also increased in those who have a family history of CF. 

All genetic disorders are caused by abnormal genes that are passed from parent 

to child. Some disorders can be caused by the transmission of only one abnormal 

gene but that is not the case with CF. CF is called a recessive disorder, which 

means that both parents must carry a copy of the abnormal gene in order to 

make a child who has the disease of cystic fibrosis. People who carry copies of 

abnormal recessive genes generally do not have any type of illness themselves. 

Cystic fibrosis is a life-shortening illness that causes problems with breathing and 

digestion. It does not affect a child’s appearance or mental ability. The symptoms 

of CF vary from very mild to quite severe. Most people with CF produce very 

thick, sticky mucus that can clog up the lungs and make it hard to breathe. It also 

increases the chance for lung infections like pneumonia. Many people with CF 

also have problems with digestive organs which makes it hard to break down and 

absorb food. Most males with CF are sterile and unable to father children. 

New treatments and drugs have significantly improved the outlook of people with 

CF. Most people born today with CF will likely live to be more than 50 years old. 

Most children with the disease need to have physical therapy for about 30 minutes 

per day in order to help clear the thick mucus from their lungs. This physical 

therapy is easy to do and can be performed by family members. 

Carrier testing for CF can be done to find out if a person carries a copy of the CF 

gene. Although testing is available to all women, it may be less useful to women 

in the lower risk ethnic groups. If a pregnant woman tests positive for being a CF 

carrier, the next step is to test the baby’s father. 

If only the woman is a carrier for CF, the chance is very small that the child will be 

affected. (There are some rare CF gene defects that our best testing is unable to 

detect, which would mean you and/or the baby’s father would be told your test 

result was normal but still be a carrier. The risk of this occurring is low.) If both the 

woman and father of the baby test positive for being CF carriers, then every time 

they make a baby together they have a 25% chance that the child will have CF. 

There is a 50% chance the child will simply be a carrier, like they are, and will not 

have the disease, and another 25% chance that the child will not have the disease 

and will not be a carrier. 

If both partners are carriers, there are additional tests that may be performed 

to see if the baby will have CF. Diagnostic prenatal tests such as chorionic 

villi sampling and amniocentesis are available that will give results during the 

pregnancy. Alternately, the cord blood of the baby can be sent for testing at birth. 

Depending on the state where you live, your baby may be tested for CF after 

delivery. Ask your health care provider about this testing. Even if it is determined 

that your baby has the genes that cause cystic fibrosis, we cannot tell you how 

severe your baby’s disease might be. 
150 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 151

EPDS - Complete at 28 Week Visit

Name: ________________________________________________ Date _______________ 

As you will soon have a baby, we would like to know how you are feeling. Please CIRCLE 

the answer which comes closest to how you have felt IN THE PAST 7 DAYS, not just how 

you feel today. 

 1. I have been able to laugh and see the funny side of things.

 0 As much as I always could 2 Definitely not so much now 

 1 Not quite so much now 3 Not at all 

 2. I have looked forward with enjoyment to things.

 0 As much as I ever did 2 Definitely less than I used to

 1 Rather less than I used to 3 Hardly at all 

 3. I have blamed myself unnecessarily when things went wrong.

 3 Yes, most of the time 1 Not very often

 2 Yes, some of the time 0 No, never 

 4. I have been anxious or worried for no good reason. 

 0 No, not at all 2 Yes, sometimes

 1 Hardly ever 3 Yes, very often 

 5. I have felt scared or panicky for no very good reason. 

 3 Yes, quite a lot 1 No, not much 

 2 Yes, sometimes 0 No, not at all 

 6. Things have been getting on top of me. 

 3 Yes, most of the time I haven’t been able to cope at all 

 2 Yes, sometimes I haven’t been coping as well as usual 

 1 No, most of the time I have coped quite well 

 0 No, I have been coping as well as ever 

 7. I have been so unhappy that I have had difficulty sleeping. 

 3 Yes, most of the time 1 Not very often

 2 Yes, sometimes 0 No, not at all 

 8. I have felt sad or miserable. 

 3 Yes, most of the time 1 Not very often

 2 Yes, quite often 0 No, not at all 

 9. I have been so unhappy that I have been crying.

 3 Yes, most of the time 1 Only occasionally

 2 Yes, quite often 0 No, never 

10. The thought of harming myself has occurred to me. 

 3 Yes, quite often 1 Hardly ever

 2 Sometimes 0 Never 

Adapted from: Cox JL, Holden JM & Sagovsky R (1987). Detection of postnatal depression: 

Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. 

Prenatal Information Sheet: Resources 153

Testing & Monitoring During Pregnancy

At each of your goal-centered visits, your health care provider will be monitoring 

your health and that of your baby through a variety of techniques. These 

techniques include blood pressure checks, uterine growth measurements, your 

weight and detailed questioning of your activities, feelings and eating patterns. 

Another means of checking your baby’s health is through a variety of fetal tests. 

One such test is the Fetal Movement Count. Beginning at 28 weeks, your health 

care provider will instruct you on how to count the baby’s activity through fetal 

movement counts. As long as your baby’s activity stays above the minimum ten 

movements in two hours or doesn’t drastically decrease, you can be assured that 

the baby is doing fine. Other tests such as Non-Stress Testing and measuring the 

amount of your amniotic fluid (bag of water) by ultrasound are routinely begun at 

41 weeks. By 42 weeks, the placenta is starting to age and may not be able to 

meet all the baby’s needs. If more information is needed to evaluate your baby’s 

health, your healthcare provider may recommend the use of tests such as the 

Biophysical Profile or the Contraction Stress Test.

Fetal testing includes 

• Fetal Ultrasound exams (sonograms)

•	 Fetal Movement Counts

• Non-Stress Tests (NST)

• Amniotic fluid measurement

• Biophysical Profile

• Contraction Stress Tests

Fetal Ultrasound Exams (Sonograms)

Fetal ultrasounds give a picture of your baby through the use of high-frequency 

sound waves that bounce off solid structures to create black and white images. 

Fetal ultrasounds are most commonly used to determine the baby’s due date, check 

for twins, measure amniotic fluid volume, determine the baby’s size, check the 

condition of the placenta, and screen for some major birth defects in the baby. 

A fetal sonogram is typically performed between 18 to 20 weeks of pregnancy 

to evaluate your baby’s development. If there is any uncertainty regarding 

your due date, a dating sonogram in the first trimester is the best way to clarify 

your estimated delivery date (EDD). In the third trimester, if your uterine growth 

measurement (fundal height) is measured to be too big or too small, or if you have 

health conditions that can affect your baby’s growth, your provider may want 

to order a sonogram to see how your baby is growing. In the majority of cases, 

if your pregnancy is moving along normally, and you are in good health, there 

will be no additional fetal sonogram needed after the 18 to 20 weeks ultrasound 

exam. Sometimes, when doing an ultrasound exam, the sex of your baby is 

obvious - but this is not always the case. Don’t paint the baby’s room blue or pink 

based on ultrasound results alone. If you don’t wish to know your baby’s sex, let 

your ultrasonographer know before the exam starts. Although sonogram is a very 

good test to look for major birth defect(s) in your baby before birth, do keep in 

mind that this test is not perfect, and that unexpected birth defect(s) may be found 

in your baby at birth, during childhood, or in adult life. 
154 Prenatal Information Sheet: Resources

Most women have at least one ultrasound exam during pregnancy. We, at the 

Department of Defense and at the Veteran Administration, believe that ultrasounds 

provide more accurate due date information and thus may be able to decrease the 

incidence of labor inductions and increase the detection of serious fetal problems, 

multiple gestations, and women at risk for placenta problems. The decision to 

undergo a fetal sonogram is entirely up to you. Sonograms have been used safely 

in pregnancy for over three decades but there is always the remote possibility that 

some risk may be found in the future. If you do decide to have an ultrasound, you 

may want your partner to join you for your baby’s first pictures. 

Fetal Movement Counts

Fetal Movement Counts are a quick and easy way for you to know your baby is 

doing well. Studies show that by recording baby’s movement on a daily basis and 

reporting decreased movement, fetal death rates can be significantly reduced. 

Most authorities recommend starting fetal movement counting at 28 weeks of 

pregnancy. Remember to call your provider or Labor and Delivery if your baby has 

had less than 10 movements in two consecutive hours or any noticeable decrease. 

This counting is especially important as your pregnancy progresses. 

Non-Stress Test (NST)

Non-Stress Tests look at your baby’s heart rate in response to its movement. Just as 

your heart rate increases with exercise, so should your baby’s. An external fetal 

monitor will be placed across your uterus to measure your baby’s heart rate. This is 

the same type of monitor used in the labor and delivery room. If your baby’s heart 

rate or movement is not adequate, further testing, such as Biophysical Profile or a 

Contraction Stress Test will be done. 

Amniotic Fluid Measurement

Amniotic fluid is measured through use of a limited (focusing in on just one 

thing) ultrasound. Adequate fluid levels tell us that your placenta is functioning 

adequately and that the baby is doing fine in your uterus.

Biophysical Profile (BPP)

Biophysical Profiling uses ultrasound to look at your baby’s heart rate, breathing, 

body movements, muscle tone and amount of amniotic fluid. Each aspect of the test 

is scored and these scores are added together. The total score helps determine if 

the baby well. 

Contraction Stress Test (CST)

The Contraction Stress Test uses the same fetal monitor that a Non-Stress test uses 

except that now you will be given some contractions and your baby’s response to 

these contractions will be observed. If the baby reacts poorly to these very mild 

contractions, he or she may not tolerate real labor well. If the baby tolerates these 

contractions without difficulty, then we are reassured that the baby will tolerate 

labor. An abnormal CST requires further observation and evaluation in the Labor 

and Delivery suite. If there is any concern about your baby’s health, your provider 

may recommend delivery by inducing labor or by cesarean delivery. 
Prenatal Information Sheet: Resources 155

True vs. False Labor

Listed below are some of the differences between true and false labor. If you are 

not sure what you are feeling try timing your contractions with walking and with 

rest. If the contractions increase in intensity with walking and do not go away with 

rest, you are probably having true labor contractions.

Action True Labor False Labor (Braxton-Hicks)

Walking 

• Increases the strength 

 of the contraction

• Decreases the rest time 

 between contractions

• Decreases strength of contraction

• Increases rest time between 

 contractions

Strength • Contractions become 

 more painful with time • Contraction pain doesn’t increase

Timing: 

Frequency & 

Duration

• Occur at regular time 

 periods 

• The time from 

 beginning to end of 

 the contraction 

 increases with time.

• Contractions occur irregularly and 

 the duration does not increase 

 over time.

Location of 

pain

• Begins in lower back 

 and spreads to the 

 lower abdomen and 

 sometimes to the legs 

• Stays in lower abdomen

Cervix

• Dilates (opens) & 

 effaces (thins out, 

 shortens) 

• The cervix will change positions to 

 be in line with the vagina (from its 

 previous posterior position) and 

 start a small amount of dilatation 

 and effacement to get you ready 

 for the real thing. 

Other signs 

• Bloody show or 

 mucous tinged with 

 blood occurs as cervix 

 dilates and effaces.

• No bloody show unless vaginal 

 exam was recently performed

“Bag of 

water” 

• Rupture (break) or leak 

 occurs in only 15% of 

 labors

• Does not break or leak

Drinking fluids

• Does not affect the 

 frequency or duration 

 of contractions

• Will slow down your 

 contractions 

Rest • Contractions continue • Contractions lessen or stop
156 Prenatal Information Sheet: Resources

Preterm Labor

Preterm labor occurs when contractions cause your cervix to dilate and thin out 

before 37 weeks of gestation (preterm). 

Delivery of a baby prior to full maturity is the most common cause of infant death 

or illness. Babies who survive being born too early may have problems gaining 

weight or growing tall. They may have problems with vision, hearing, breathing, 

and coordination. There may also be behavioral or learning problems in these 

babies as they get older.

Most of the time, we do not know why preterm labor starts. Your chances of 

having preterm labor are higher if you smoke, use illegal drugs, don’t eat properly, 

or get certain types of infections. If you have already had a preterm delivery, 

if you are carrying more than one baby or if you have had early rupture of 

membranes you are at very high risk for preterm labor and delivery. Things you 

can do to decrease your chances of a preterm delivery include: 

- Get regular prenatal care

- Do not use illegal drugs 

- Do not smoke 

- Be alert to signs of preterm labor

- Eat healthy foods/do not skip meals

- Always follow your providers advice 

The best way to prevent preterm delivery is to detect preterm labor early. If you 

experience any of the following symptoms, contact your provider or Labor and 

Delivery immediately: 

- Change in vaginal discharge such as change in color of mucus

- Leaking or gushing clear fluid or bright red blood

Below is a list of early signs of preterm labor:

- Persistent low, dull backache or low back or pelvic pressure

- Four or more uterine contractions per hour. Contractions may feel like:

 - Menstrual cramps

 - Sensation of the “baby rolling up in a ball”

 - Increased uterine activity (more that you are used to)

 - Abdominal cramping with or without diarrhea

 - Increased pelvic pressure with or without thigh cramps

If you experience any of these symptoms, lie down on your side, place a hand on 

your lower abdomen and feel for contractions. If after one hour, these symptoms 

continue, contact your provider or Labor and Delivery immediately. 

All pregnant women are at risk for preterm labor, some are at higher risk than 

others. Ask your provider if you are at high risk for preterm labor. 
Prenatal Information Sheet: Resources 157

Labor and Delivery Procedures

AMNIOINFUSION: A procedure where fluid is inserted into the uterus by using 

an internal pressure catheter (see below) to replace some of the amniotic fluid 

lost when your water broke. This is sometimes helpful if the fetal monitoring strip 

indicates that the baby’s umbilical cord is being compressed too much during your 

contractions due to the lack of fluid.

AMNIOTOMY: A procedure that involves “breaking the bag of water” that surrounds the baby in the uterus. A small plastic rod with a hook at the end is inserted 

through the cervix and used to place a small hole in the “bag” to allow the baby’s 

head to put more direct pressure on the cervix. This procedure is sometimes used 

to help labor proceed more quickly than it might otherwise, or when internal monitoring is needed to more accurately evaluate contractions or the baby’s heartbeat. 

ELECTRONIC FETAL MONITORING (EFM): A method of examining the condition 

of the baby while still in the womb by noting any unusual changes in the baby’s 

heart rate. EFM is usually performed continuously during labor to ensure the that 

the baby is in good health. EFM can be used externally or internally in the womb. 

External EFM involves the use of belts that wrap around your abdomen to monitor 

both your contractions and the baby’s heartbeat. The belts are not painful to wear 

but they do somewhat limit your ability to move around during labor. The external 

monitors do not measure contraction strength, only frequency. Internal EFM uses a 

Fetal Scalp Electrode (see below) to monitor the baby’s heart rate. 

EPIDURAL ANESTHESIA: A procedure performed by anesthesia personnel to 

provide pain relief to laboring women and people who need certain types of surgical procedures. The goal of epidural anesthesia in laboring women is to provide 

significant pain relief rather than complete loss of feeling, though some women 

do experience this as well. The epidural blocks the nerve sensation in the lower 

spine which then decreases sensation in the lower half of the body. This is done by 

inserting a small catheter into the space in the lower back that surrounds the spine, 

and injecting medication into that space through the catheter. The catheter remains 

taped in place until after the baby is delivered and then it is easily removed.

EXTERNAL CEPHALIC VERSION (ECV): A procedure that involves turning the 

baby from an undesirable position to a position more favorable for a vaginal 

delivery. Generally, this option is available to women whose babies are not in 

the head-down position by the 36 week visit. The provider will feel the position 

of the baby through the abdomen. If it feels like the baby is in the breech position 

(bottom down) or transverse position (sideways), an ultrasound can be performed 

to confirm the position of the baby. If the baby is not head-down, you may be offered an ECV to help turn the baby into the proper position. This procedure is only 

performed in the hospital under close ultrasound surveillance and is rarely associated with serious complications. If the baby cannot be turned, your provider will 

continue to monitor the baby’s position at each subsequent visit. If the baby does 

not turn on its own (which sometimes they do), your provider will usually schedule 

you for a cesarean section in the week before your due date.
158 Prenatal Information Sheet: Resources

FETAL SCALP ELECTRODE: A device used to directly monitor the baby’s heartbeat 

while you are in labor. A small electrode is placed just under the skin of the baby’s 

scalp during a cervical exam. Sometimes it is difficult to accurately monitor the 

baby’s heartbeat with the external monitor. If there is a concern about your baby’s 

well being, your provider may suggest direct monitoring with the fetal scalp electrode. 

FOLEY CATHETER: A procedure that involves placing a soft plastic tube through 

the urethral opening into the bladder where it drains urine continuously during 

labor or surgery. It is often used with epidural anesthesia as women frequently are 

unable to feel the sensation of having to urinate once the epidural is fully functioning. If not already in place, it will be inserted prior a cesarean delivery.

FORCEPS ASSISTED DELIVERY: The use of smooth metal tongs applied gently 

around both sides of the baby’s head to guide the baby out of the birth canal. 

Forceps have been used to safely deliver babies for a long time. If they are needed, your provider will discuss the potential risks and benefits of a forceps delivery 

with you.

INTRATHECAL ANALGESIA: Similar to spinal anesthesia. The anesthesia provider 

places a small needle between the bones of the spine into the spinal fluid. A small 

amount of numbing or pain medication (usually narcotics) is injected into the fluid. 

The needle is then taken out and no catheter is left in place. The medicine helps relieve the pain of labor or childbirth. The medicine will usually lose its effect within 

an hour or two but some types of medicine can last for a whole day.

INTRAUTERINE PRESSURE CATHETER (IUPC): A device used to measure the exact 

strength of your contractions during labor. This can only be used after your bag of 

water breaks. A soft plastic tube is inserted through your cervix past your baby’s 

head into the uterus next to the baby. The tip of the tube has a pressure sensing 

device within it which measures the actual strength of contractions. Information 

from the IUPC helps your healthcare team evaluate if your contractions are strong 

enough to dilate your cervix and how the contractions are affecting the baby.

VACUUM ASSISTED DELIVERY: The use of a soft plastic suction cup that is placed 

on the baby’s head to guide the baby out of the birth canal. If a vacuum assisted 

delivery is needed, your provider will discuss the potential risks and benefits of this 

type of delivery with you.
Prenatal Information Sheet: Resources 159

Labor & Delivery Basics 

What exactly is labor and what does it do?

Labor is the term given to the entire process of bringing your baby into the 

world. It is certainly well named, for may be the hardest work you will ever do. 

By understanding the process, knowing how to respond in a positive manner, 

and having a good support person, you will be ready to face your labor with 

confidence and knowledge.

The uterus is a muscular organ marvelously designed to house the growing fetus, 

and, at the appropriate time, to send him or her forth into your arms. During labor, 

the uterus works as a muscle by contracting and relaxing. Each uterine contraction 

first softens and shortens your cervix, which is the lower part of your uterus, and 

then opens it to allow birth to occur.

The softening and shortening of your cervix, called effacement, usually begins 

early in labor or even during the latter part of your pregnancy. The opening of 

your cervix, known as dilatation, commonly starts when the cervix is already soft 

and partially shortened or thinned out (effaced). This is especially true if this is your 

first baby. Women who have had prior babies may dilate a bit first, then efface 

and continue dilatation until delivery.

Contractions are measured from the beginning of one, to the beginning of the 

next, to determine the frequency and from start to finish of one contraction to 

measure length (duration). If you have contractions at 12:00, 12:07, 12:15 and 

12:21, then your contractions are six to eight minutes apart. If your contraction 

begins at 12:00 and ends at 12:01 then your contraction is one minute long. They 

will start out as irregular, short-lasting contractions and progress to regular, intense 

tightening lasting from 1 to 11⁄2 minutes.

The hardest part of the contraction is at its peak and lasts less than 15 seconds. 

Remember, no matter how hard or painful they feel, they will end, usually in less 

than 90 seconds. Remember also, that each contraction you have puts you that 

much closer to holding your baby. There are many ways to cope with the pain of 

labor contractions and all will be explained in the labor pain section of this book.

Before labor begins

Anytime after your 20th week of pregnancy, you may feel an irregular tightening 

of your uterus or Braxton-Hicks contractions. As you get closer to actual labor, this 

“tightening” will become harder, more regular, and last longer. As this happens 

you may experience several other sensations. These include:

• Lightening Your baby has dropped down into your pelvis. First time mothers 

 experience this more. Lightening can occur two to three weeks before actual 

 labor begins. You will notice that breathing is a lot easier but you will need to 

 urinate even more frequently. You also may feel an increase in leg cramps and 

 aching in your thighs, pelvis and lower back.
160 Prenatal Information Sheet: Resources

•	 Engagement Your baby’s head has passed through the upper pelvis into the 

lower true pelvis. This feels similar to lightening and is a sign baby is preparing 

for delivery. Pressure from the baby’s head on the cervix will help prepare it for 

labor.

Preparing for Labor

Preparation for labor should begin early in pregnancy and needs to include both 

physical and emotional preparation. Classes, reading, and practice will help 

greatly when actual labor begins. 

Physical preparation includes staying physically fit and continuing to exercise 

throughout your pregnancy unless told to stop by your health care provider. 

Pregnancy specific exercises on a daily basis are also beneficial. 

Relaxation exercises must be practiced with your labor coach so you both will 

be ready when your true contractions begin. Your coach calls the commands and 

checks your muscles for tension or tightness. This exercise is designed to help you 

remain relaxed in labor when your uterus is hard at work.

• Begin by lying on a firm surface with one or two pillows under your head and 

shoulders and one pillow under your knees. 

• Raise arms about two feet from the floor or bed, stretch them slightly and hold 

for a few seconds, then slowly bring them down. When they are about six 

inches from the floor release your arms and let them fall limply to the floor. Legs 

should be fully relaxed. 

• Repeat with left arm and right leg, keeping the other arm and leg totally 

relaxed.

• Repeat with right arm and left leg, keeping the other arm and leg totally 

relaxed.

• Repeat with right arm and leg, keeping the other arm and leg totally relaxed.

• Repeat with left arm and leg keeping the other arm and leg totally relaxed.

• Repeat with three limbs and keep the remaining one fully relaxed. 

• Learn to respond on commands such as “tighten” or “relax.”

• Coach checks for tightness and relaxation.

Breathing exercises

There is no absolute correct way to breath throughout your labor. Focused 

breathing is a tool to help you concentrate on your breathing and away from the 

pain of labor. It helps you stay relaxed and maintain control. There are many 

different breathing patterns to choose from. The exact breathing pattern that you 

use is less important than your ability to use it when the time comes. Your ability 

to use it will depend on how much you practiced! Listed below are some basic 

focused breathing techniques that you can use to help you through your labor and 

delivery experience. It is never too early to practice these techniques.
Prenatal Information Sheet: Resources 161

For early labor (First Phase)

Take a deep cleansing breath at the start of the contraction, then breathe slowly in 

through your nose and out through your mouth. End the contraction with another 

deep cleansing breath. Continue to breathe in this way until you feel like you need 

more concentrated breathing. At the point where you feel this early breathing 

is not helping enough, you should switch to active breathing techniques and be 

thinking about coming to the hospital. 

For active labor (Second phase)

Take a deep cleansing breath at the start of the contraction, relax and stare at 

your focal point. Then breathe in through your mouth. “Hee” is the sound you will 

make as you breathe in. Follow this breath with two breaths out making the “HaHa” sound. Continue the “Hee Ha-Ha” pattern until the contraction ends. At the 

end of the contraction take another deep cleansing breath and relax – you finished 

another one!
162 Prenatal Information Sheet: Resources

Transition breathing

If you feel like you have to push down but are instructed not to do so, you will 

need to pant like a puppy or breathe quickly in and out through your mouth. This 

should only be to stop you from pushing (at the peak of your contraction) and for 

only a short period of time. If you begin to feel dizzy, let your nurse know. 

Breathing for coached pushing

Once you are dilated and ready to push, you can either push like a bowel 

movement as your body tells you to or do coached pushing. The choice is usually 

up to you. 

Coached pushing consists of starting each contraction with two or three deep 

cleansing breaths and holding the last one in. At the same time of your last 

breath, put your chin on your chest, grab your knees up and out and begin to 

push down (just like you are having a bowel movement). You may find it more 

comfortable to exhale slowly as you are pushing instead of holding your breath. 

End the contraction with another deep cleansing breath and relax until the next 

contraction. 
Prenatal Information Sheet: Resources 163

Packing for the hospital 

Around your 36th week of pregnancy you need to begin getting things packed that 

you wish to bring to the hospital with you. Your hospital will have gowns, slippers 

and robes for you to wear but if you would like to have your own make sure to 

pack them. It’s a good idea to pack one bag for you and one for your baby. 

Baby’s bag will not be needed for several hours or maybe not until the day after 

delivery. Do not bring anything too fancy or valuable.

Mom’s bag 

2 or more well fitting bras: Nursing bras may make it easier to breastfeed.

2-3 pairs of cotton underwear: Bring your oldest pairs, as you will bleed 

quite a lot and they will probably get stained. 

2 or more comfortable nightgowns: If you plan to breastfeed, it will be 

easier if your gowns open in the front. Don’t bring anything you don’t want 

to get dirty. 

Slippers or slip-on shoes with non-slick soles

Personal care items (shampoo, toothpaste, toothbrush, etc.)

Loose fitting/maternity clothing to wear home: You usually wear your 

maternity clothes for several days to weeks after delivery.

Camera with plenty of film: Don’t forget to check the battery!

Baby’s bag 

One going-home/picture outfit

Car seat

Baby bag with diapers, burp cloth, wipes for the trip home

Blanket, hat and warm outfit if cold out

Labor tools

Lotion or talcum powder - for your coach to give you massages.

Snack bag: Lollipops, hard candy to suck on in labor, snack foods for 

coach (since you don’t know when the food will be needed), and a treat for 

both of you after delivery 

Lip balm or lipstick to prevent dry lips

Something for you to concentrate on (focal point) such as a favorite picture, 

stuffed animal, flower, etc. 

To pass the time: A deck of cards or books for you and coach

Favorite pillow(s) with distinctive pillow cases to identify them as yours

Music: portable tape or CD player with a good variety of music selections

Tennis balls in a sock for back rubs 
164 Prenatal Information Sheet: Resources

What to do when you have false or early labor pains

	 • Keep busy and distract yourself. You can go to a movie, shopping, or find 

another activity that keeps your mind off these contractions. 

	 • Walking may help you get your labor going but if it does not, do NOT 

continue to walk until you are exhausted. Save your energy as you will need 

it soon.

• Rest is important. If you are over-tired, your uterine muscles will be over-tired 

as well and your contractions will not be as effective as they would be if well 

rested. You will have the pain, but not the cervical changes.

	 • Try to relax by:

 - Sipping a cup of warm milk

 - Taking a warm (not hot) tub bath or shower

 - Having your coach give you a back rub or body massage. 

 - Listening to some soothing music

• Make sure you continue to drink fluids. If you become dehydrated (low in 

fluids), your contractions will not be as effective. You will have the pain, but 

not the cervical changes.

• Don’t starve yourself! Eat small amounts of easily digestible foods frequently. 

You have no way of knowing when your real labor will begin.

• Stay calm. When you tense up, everything you feel will be twice as 

uncomfortable and labor will not progress as quickly as it should.

When to come to Labor and Delivery

	 • Rupture of Membranes: Small trickle or big gush. Note color, consistency, 

and time of membrane rupture. We will want to test the fluid on arrival.

	 • Bright red vaginal bleeding, more than just a very small amount. 

	 • Loosing the mucous plug prior to 36 weeks (see Common Terms in Resource 

 Section)

	 • Decreased fetal movement: Less than ten movements in two hours after lying 

down and concentrating on counting 

	 • Severe headache

	 • Difficulty seeing, blurring of vision, sparkles, or flashing lights

	 • Severe swelling of your hands and face along with a sudden weight gain

	 • Vomiting that continues for 24 hours

NOTE: Bloody show, losing your mucous plug or spotting, especially if you have 

 had your membranes stripped recently, is normal.
Prenatal Information Sheet: Resources 165

	 • If you are a first time mom, you will want your contractions to occur every five 

minutes for at least an hour and get stronger with walking before you go to 

the hospital. Strong contractions will usually take your breath away and 

require you to focus on your breathing patterns as described earlier in this 

section. If you have had prior babies, you should come when your 

contractions are regular. You may need to come in earlier based on your 

individual situation which should be discussed with your health care provider.

	 • If unsure, come in and be checked! It’s better to know than exhaust yourself 

with worry or come in too late.

How to tell if you are in real labor

The first thing to remember is that every woman’s labor is different. Sometimes 

the only way to tell if you are in labor is to go to the hospital for an exam and 

observation. Never feel embarrassed to call or go into the clinic or to Labor and 

Delivery. We are here to help you through all aspects of your pregnancy, labor, 

deliver and postpartum care. Please use our expertise! 

What to expect when coming to Labor and Delivery

While each medical treatment facility has a slightly different way of doing things, 

you can usually expect to:

	 • Have a vaginal exam (if membranes are intact) to check for dilatation 

(opening), effacement (thinning), and station (location of baby’s head).

	 • Be examined for questionable rupture of membranes with a sterile speculum 

to avoid contamination. A small amount of fluid will be collected and put 

on a microscope slide to determine if it is amniotic fluid (from your bag of 

water) or normal vaginal secretions. Amniotic fluid will dry on the slide in 

about five minutes forming a very distinctive fern-like pattern. 

	 • Have your and your baby’s heartbeat timed. 

	 • Have your temperature, blood pressure and pulse taken. 

	 • Decide whether you need to be admitted now. You are usually admitted if:

 - Your bag of water is broken or leaking

 - You are four centimeters dilated.

 - Have any potential or current problems that need close observation such 

as high blood pressure, fever, infection, low or high fetal heart rate, or 

decreased fetal movements, etc. 

	 • When admitted, your coach may be asked to assist in completing admission 

paperwork while you are put in a labor room.

	 • Once in the labor bed you will:

 - Be asked many personal questions. 
166 Prenatal Information Sheet: Resources

 - Have the external fetal monitor applied to your abdomen to measure 

baby’s heart rate and your contractions. 

 - Possibly have an IV or saline lock inserted into a vein in your arm for a 

fluid access line. 

 - Have lab work taken (blood and possibly urine). 

	 • You can ask for an enema if you are feeling uncomfortable about having a 

bowel movement during delivery. Many women like to avoid this and will 

request an enema. A small enema is an option if baby’s head is engaged 

and/or your bag of waters is not broken.

	 • Now you and your coach need to work together to have a safe and 

meaningful labor and birth experience.

Labor phases and how to cope

To deliver your baby you must pass through several phases of labor. These 

phases include: pre-Labor (often called false labor), early labor, active labor, and 

transition. At the end of these phases you will be completely dilated (10 cm) and 

effaced (100%) and will be ready to push your baby out into the world. 

The following is a guide to each of the phases of labor, what you may feel, what 

you can do to help yourself, what your labor coach can do and some simple 

breathing techniques to help you cope with the process. The more practice time 

you devote to preparing yourself, the better off you, your coach and baby will 

be. You may want to bring your notebook with you to Labor and Delivery as a 

reference during labor.
Prenatal Information Sheet: Resources 167

Pre-Labor

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Duration: hours 

to several days; 

may start and 

stop; change of 

activity affects 

contractions. Not 

everyone feels this 

phase.

Birthing 

Progress: 

Effacement, slight 

dilatation, cervical 

positioning

Contractions:

Increased BraxtonHicks, some 

uncomfortable, 

may begin a 

pattern, then fade.

Abdominal or 

pelvic pressure, 

crampiness, low 

backache

Burst of energy 

or its opposite– 

laziness

Nesting instinct

Relax with 

contractions. 

Breathe normally 

or try slow early 

labor breathing.

Don’t overdo. 

This energy is 

for labor. Finish 

packing for 

hospital.

Eat small amounts 

of easily digested 

foods.

Don’t forget to 

drink fluids.

Pelvic rock for 

backache, side 

lying position for 

resting.

Be sure to sleep 

and eat well.

Help with meals 

and chores, 

last minute 

preparations for 

baby.

Stay in close 

touch. Be 

available for 

transportation.

Encourage 

daily practice 

of breathing 

and relaxation 

techniques.

Provide: 

– Moral support 

– Entertainment 

– Back massage 

– Loving words

The real thing may begin with any of the traditional labor signs. It may begin 

slowly (the onset of labor may not be clear to you) or it may surprise you by 

beginning with contractions that are strong and as close as those described under 

active labor in the following pages. With the guidance of your provider, you will 

decide at some point in early or active labor to make the trip to the hospital. 

Once there, progress will be measured by:

Effacement: thinning and softening of the cervix, measured as a percentage.

Dilation: opening of the cervix, measured in centimeters (1 to 10).

Station: the dropping down of the baby (-5 to +5 station), in relation to the pelvis

Also of interest will be what part of the baby is “presenting” (coming first through 

the birth canal), condition of membranes, your blood pressure, fetal heart tones, 

pattern of contractions, and how you are feeling.

The First Stage, the longest part of labor, has three phases which progress from 

the first “real” labor contraction until the cervix is fully dilated and you start your 

pushing.
168 Prenatal Information Sheet: Resources

First Stage Labor – Phase 1: Early Labor

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Duration: 

ranges from 2 

hours to days. 

Birthing 

Progress: Cervix 

dilates to 4 cm.

Contractions: 

Last 30-60 

seconds; are 

5-15 minutes 

apart, and are 

mild but definite; 

progressively 

longer, stronger, 

closer together.

Bubbly, excited. A 

little stage fright.

Wish to tell the 

world

Gradually less 

sociable, more 

serious, beginning 

to realize it’s 

work.

Wavelike 

pressure/

crampiness in 

back or frontall over tummy 

or very low in 

the tummy with 

contractions.

Hungry, thirsty, 

“time to get 

going”

Enjoy this! You 

know your cues. 

Normal, light 

activity, plenty of 

rest.

Relax and breathe 

thru contraction; 

use good 

positioning.

Call the L&D unit.

Pelvic rock for 

backache, slow 

breathing for each 

contraction. Warm 

shower.

Clear liquids, if 

allowed. Light, 

small snacks.

This phase is 

usually spent at 

home and you 

will need to be in 

close contact in 

case she needs 

you.

Stay in touch 

hourly. 

Support, 

entertainment.

Extra rest for you 

too.

Call sitter for older 

children.

Encourage 

relaxation.

Start coaching 

breathing 

exercises just for 

practice. 

Hand on tummy 

to get acquainted 

with contractions. 

Back massage if 

needed.

When she needs 

to concentrate on 

breathing, begin 

to time each 

contraction.

Watch for change 

of attitude. 

Offer fluids often.

Carefully drive to 

hospital when she 

is ready.

For early labor 

(1st Phase Breathing):
Prenatal Information Sheet: Resources 169

First Stage Labor – Phase 2: Active Labor

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Duration: 4-8 

hours.

Birthing 

Progress: Cervix 

dilates from 4 to 

8 cm.

Contractions: 

Last 45 - 75 

seconds and are 

3-5 minutes apart 

and are quite 

strong, peak more 

quickly.

Serious, need to 

concentrate

Intense pressure 

with contractions 

Vaginal bleeding. 

Backache may 

intensify or vanish

Trembling legs

Flushed warm, dry 

mouth

Nausea

Discouraged if no 

progress 

Very self-centered

Focal point away 

from traffic pattern 

in room. 

Switch to focused 

breathing. 

Urinate often. 

Change position. 

May want to suck 

on lollipop.

Tell others of 

needs! 

Turn on 

background 

music.

Walk or shower if 

possible.

Try squatting or 

sitting on exercise 

ball.

Be prepared with 

information for 

admissions if not 

pre-admitted. 

Return quickly 

to labor and 

delivery.

Time contractions. 

Talk her thru them. 

Check for 

relaxation and 

help get her to 

relax. 

Anticipate needs 

for comfort 

and handle 

distractions.

Walk with her if 

able.

Help her to 

bathroom often 

(tell nurses).

Help her change 

positions often.

Tell nurses if she 

has urge to push.

Massage 

Praise! 

Encourage often! For active labor

(2nd Phase Breathing):
170 Prenatal Information Sheet: Resources

First Stage Labor – Phase 3: Transition

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Duration: 15 

minutes to 11⁄2 

hours.

Birthing 

Progress: Cervix 

dilates from 7-8 to 

10 cm.

Contractions: 

60-90 seconds 

long, 2-3 minutes 

apart. Very strong, 

tremendous 

pressure, may 

have more than 

one peak.

Confused, 

irritable, not 

wanting to be 

touched, afraid of 

losing control.

Increased rectal 

pressure. 

Urge to bear 

down, very tired 

and sleepy.

Nausea, vomiting, 

burps, shaky legs, 

or trembling all 

over, leg cramps.

Hiccups, 

dizziness, tingling 

hands and face 

(hyperventilation).

More vaginal 

discharge caused 

by descent of 

baby.

Hot and 

perspiring, or cold 

and shivering.

Increased 

backache as baby 

descends.

Switch to 

transition 

breathing pattern; 

take each 

contraction one at 

a time.

DON’T push! Pant 

or blow till urge 

has passed. 

Concentrate 

on relaxing, 

especially 

between 

contractions.

Try to keep 

breathing 

slow - don’t 

hyperventilate. 

Ask to change 

bed pads if 

needed.

Change positions 

often.

Urinate often.

Stay in bed.

Rest between 

contractions-many 

women fall asleep 

between them. 

Be firm in 

coaching, never 

mind her mood. 

She’ll thank you 

later for coaching 

breathing. 

Put your face 

about 10 inches 

in front of her 

face and do 

the breathing 

exercise if she is 

having difficulty 

in maintaining 

control and 

breathing. 

If she doesn’t want 

to be touched, 

back off—this is 

only temporary—

but keep on 

coaching her 

breathing though 

the contractions.

Coach her to pant 

or blow if she 

starts to push and 

call your nurse. 

Let her sleep 

between 

contractions-keep 

distractions down, 

dim the lights, 

lower the sound.

At onset of each 

contraction 

coach her to start 

breathing.

Have cool cloth 

ready for face, 

lips and mouth.
Prenatal Information Sheet: Resources 171

Transition breathing:

First Stage Labor – Phase 3: Transition (cont.)

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Stroke legs, back, 

and shoulders if it 

helps her relax.

Straighten limb 

and flex foot 

to relieve leg 

cramps.

Remind her she is 

getting closer to 

holding her baby!

Help her get into 

different positions 

often.

Make sure she is 

urinating often.

Ask staff about 

getting ready for 

delivery.

PRAISE!
172 Prenatal Information Sheet: Resources

The Second Stage includes the time from full dilation of the cervix until the baby 

is born. Setup for delivery will begin now if it is not your first baby.

Second Stage Labor – Pushing

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help

Duration: Varies 

greatly - 2 pushes 

to 2 hours.

Birthing 

Progress:

Pushing the baby 

down the birth 

canal and out into 

the world.

Urge to push 

varies, usually 

strong

Great relief to 

push

May feel uncertain 

at first but you will 

soon get into it

Take two 

cleansing breaths, 

and rest between 

contractions.

Listen closely to 

coaching from 

team.

Check her position 

and help her 

to change it 

frequently.

Remind her of 

cleansing breaths 

at beginning 

and end of each 

contraction.

Encourage long 

pushes. 

Let her rest/

sleep between 

contractions.

Keep distractions 

to a minimum.

Wet her forehead, 

lips and mouth 

with cool wet 

cloth.

Give ice chips 

between pushes.

Ask for mirror 

to increase 

motivation.

Respect her mood. 

She may be quiet, 

bubbly or crabby. 

Remember she 

is working really 

hard.

Coach firmly.

Coached breathing:
Prenatal Information Sheet: Resources 173

Contraction: 

Last 60 - 90 

seconds and are 

2-5 minutes apart, 

peak more slowly 

than transition 

contractions, 

and may have 

more rest breaks 

between.

Alertness returns, 

new burst of 

energy

Back pain may 

vanish or return.

Great pressure in 

rectum. Stretching, 

stinging sensation 

around vagina 

as crowning 

approaches; 

numb for birth of 

baby.

Actual feel of 

baby emerging 

is warm and 

pleasant relief!

Enjoy the 

excitement.

Pushing harder 

may help you to 

cope with pain.

Release perineum 

as completely as 

you can and think 

“Open, baby 

out!”

Lie back and pant 

or blow for birth 

of baby’s head.

Push as directed 

for baby’s 

shoulders.

Get ready to hold 

your new baby.

Support her 

during pushes. 

Limit movement. 

Stay next to or 

behind her head 

now unless told 

otherwise.

Remind her 

to “Relax her 

bottom.”

Support her head 

and shoulders so 

she may watch 

baby emerge.

Look to see 

WHO’S HERE!

If this has been 

discussed and 

planned: Get 

ready to cut cord.

Get the camera 

out and ready for 

first shot of new 

baby.

Welcome your 

baby into the 

world!

Second Stage Labor – Pushing (cont.)

Characteristics What You May 

Feel

Helping 

Yourself

Coach’s Help
174 Prenatal Information Sheet: Resources

The Third Stage includes the time from baby’s birth to expulsion of the afterbirth.

Third Stage Labor

What is 

Happening

What You May 

Feel

Helping 

Yourself

Coach

Duration: up to 

30 minutes.

Birthing 

Progress:

Afterbirth comes 

out (placenta, 

membrane, cord).

Contractions:

Few, mild ones.

May or may 

not notice 

contractions.

Chilled, shivery, 

impatient

Overwhelmed and 

overjoyed! 

Ask to push 

placenta out 

yourself.

Respond to 

coaching.

Nursing baby 

stimulates your 

uterus to contract.

Concentrate on 

your baby.

Reinforce 

instructions.

Remind her to 

relax.

Enjoy watching 

or holding your 

baby. 

Stay near until she 

is ready to rest.

Pain management in labor

Each woman will respond differently to her contractions. This response depends on 

many factors to include:

• Time spent in labor

• Level of pain tolerance

• Quality of coaching

• Emotional and physical state

• Preparation for labor

• Size and position of baby

• Stage of labor

Coping techniques 

Since it is impossible to predict how your labor will go and how well you will 

cope with your labor, it is very important for you to know all your options. The 

absolute safest option for you and your baby is to not rely on any medications 

while in labor. Unfortunately, this is not always possible. If you require medications 

after trying the various non-medication techniques listed below, your health care 

provider will determine the safest route, amount, and timing of the medication. 

•	 Breathing with the contractions: Various breathing techniques are taught 

in childbirth preparation classes and it doesn’t matter which one you choose to 

use. By using these breathing techniques you will be focusing on breathing and 

not on the pain of your contractions. Simple but effective breathing techniques 

are outlined in the Phases of Labor section (see charts for each phase of labor). 
Prenatal Information Sheet: Resources 175

•	 Medications: Several medications can be given in labor to help you cope 

with contraction pain. How much, when to give the medication and what to 

give depends on many factors. Your provider will work with you to minimize the 

pain as much as is safe for you and your baby. There is no labor medication 

that is guaranteed to be 100% free of side effects, although with proper 

monitoring, dosing and timing of medications, side effects can be kept to a 

minimum. 

Narcotics and synthetic narcotics - these can be given through an injection 

in your muscle or into your IV to dull the pain and help you to relax. IV 

medications act quickly but don’t last as long as an injection into a muscle. We 

try not to give these medications within an hour of delivery to prevent the baby 

from being born with effects from the medication. If baby comes quicker than 

expected then a narcotic blocking medication can be given to your baby to 

block its effects. Other side effects include slowing of your labor or stopping it if 

given too soon.

•	 Regional Anesthetics: Epidural and spinal analgesia are popular methods 

of pain control because they provide excellent pain relief with little side effects 

to either mom or baby. Both are called regional anesthetics because they 

provide anesthesia (loss of sensation/pain) to one specific region of the body 

while leaving you awake and your baby unaffected by the pain control.

– Spinal Block: A spinal anesthetic may be used for create pain control in 

both labor and delivery. It is most commonly used to provide anesthesia 

during a cesarean delivery. Common sensations during a spinal anesthetic 

include the absence of sensation from the toes up to the breast bone. 

– Epidural: An epidural anesthetic may be used to create pain control for 

labor. An epidural may be placed any time during your labor. The decision 

is based on maternal request and a discussion between your obstetric and 

anesthesia providers. An epidural is a small catheter that is placed under 

sterile conditions into the epidural space (a small space located outside of 

the thick membranes that protect the spinal cord and hold in cerebral spinal 

fluid). The epidural catheter is placed well below the bottom of your actual 

spinal cord so that there is little risk of injury. Once the epidural catheter is in 

place, medication is infused though this catheter to provide you pain control 

during your labor. Usually epidural catheters may be used in the event of an 

emergency cesarean delivery. In this situation the epidural can provide you 

and your baby with the necessary medication to enable a quick and safe 

surgery. The epidural will also permit you to be awake during this surgery so 

that you will not miss the birth of your child.

There are risks associated with any medical procedure, including spinal 

and epidural anesthetics. Those risks include but are not limited to bleeding, 

infection, headache, decreased blood pressure, epidural hematoma, 

paralysis and total cardiovascular collapse. Fortunately, major complications 

are extremely rare events. 
176 Prenatal Information Sheet: Resources

Cesarean Delivery: Questions & Answers 

There are several reasons to perform a cesarean delivery. Often it is a combination 

of factors that help make the final decision. It is not performed strictly to avoid 

labor contractions as this is a major surgical procedure. Unless it is an emergency 

situation in which a delay could harm either you or your baby, the provider 

performing the surgery will explain to you why a cesarean delivery is needed.

Reasons for cesarean delivery include: 

•	 Cephalic-pelvic disproportion (CPD): Baby is too big or your pelvis is too 

small to allow for your baby to be born through your birth canal.

•	 Fetal distress: Baby’s heartbeat is slowing down to a dangerous level and 

won’t come back to normal levels despite usual interventions such as increased 

fluids, oxygen and position change.

• Excessive vaginal bleeding

• Active Herpes or infections that could affect your baby

•	 Malposition or malpresentation: Baby is in an unsafe position such as 

breech, or unsafe presentation such as neck fully extended that will not allow 

him/ her to be born safely through the birth canal. 

•	 Failure to progress: The cervix is not dilating (opening) properly even with 

adequate period of time with strong contractions. 

•	 Placenta previa: Placenta is covering all or part of the cervical opening 

leading to severe vaginal bleeding. 

•	 Placenta abruption: Placenta separates from the uterine wall and blocks 

oxygen exchange to your baby.

•	 Previous cesarean section: Especially if you had a previous classical 

incision (runs up and down your uterus). Often even if you had a cesarean 

previously, you can still attempt to deliver vaginally this time. 

What usually happens with a Cesarean Delivery? 

• You will be counseled as to why a cesarean delivery is needed and you will 

sign a consent form allowing the cesarean delivery to occur.

• You will have an IV (tube into vein) and Foley catheter (tube in bladder) 

inserted. 

• You will be counseled on what type of anesthetic is best for you and baby. 

– General anesthesia (you go to sleep)

– Regional anesthesia (you are numb from chest down)

• The operating room can be quite crowded with nurses, doctors and assistants.
Prenatal Information Sheet: Resources 177

Depending on the situation, your partner may be allowed to accompany you. In 

the operating room, you will be placed on the operating table. Once on the table, 

your abdomen and pubic area will be washed, shaved and drapes or covers 

will be placed over your abdomen. The anesthetist will administer anesthesia 

after taking several blood pressure readings and monitoring your other vital signs 

(respiration rate, temperature). After the anesthesia begins to work, a cut will be 

made below your belly button to get the baby out.

You will not be able to see this incision, even if awake, because a drape will 

be between your head and your abdomen to block your view. After the baby is 

born, the pediatrician will make sure baby is OK and then let you hold/ see baby 

depending on your baby’s condition. After your abdomen is sutured, you will be 

taken to a recovery area. You may be very sleepy at this time. When sufficiently 

recovered you will be taken to the Postpartum area. 

After a cesarean delivery can I deliver vaginally?

In many cases you can deliver vaginally after having a cesarean delivery. If you 

had a prior cesarean delivery with a side-to-side incision in the lower part of 

your uterus (the non-contracting portion of your womb), you may choose either 

to attempt to have a vaginal delivery (trial of labor) or have an elective repeat 

cesarean delivery. The chance of a successful vaginal birth is around 74% (ranged 

60 to 80%). Your provider will review with you the conditions of your current 

pregnancy, as well as the records from your previous cesarean deliveries in order 

to help you to decide if a trial of labor or an elective repeat cesarean delivery is 

best for you.

What are the benefits of an elective repeat cesarean delivery?

The benefits of an elective repeat cesarean delivery are:

• The delivery date is scheduled and you and your provider can both plan on 

the birth of your baby accordingly

• There is a very low risk of uterine rupture (tearing of the uterine scar)

What are the drawbacks of an elective repeat cesarean delivery?

Infants delivered by cesarean delivery may have some problem taking their first 

breaths, or having to breathe too fast. They can be slow to start breastfeeding, 

and it may take a little longer time for mother-infant bonding. Possible drawbacks 

of an elective repeat cesarean delivery are:

• Complications from surgery such as infections, and injuries to the bladder 

and intestines

• Higher risk of complications with the next pregnancy

• Longer healing time after giving birth

What are the advantages of a successful vaginal delivery after a 

previous cesarean delivery?

The advantages include the following:

• Less blood loss compared to the average cesarean delivery
178 Prenatal Information Sheet: Resources

• Less risk of blood clots forming in the legs

• A shorter stay in the hospital

• Faster healing after giving birth

• Decreased need for future cesarean deliveries and related complications

What are the risks of trying to have a vaginal delivery after 

previous cesarean delivery?

Whenever a woman is in labor, emergency complications can occur. These 

complications can occur not only in women who have had a previous cesarean 

delivery, but also in vaginal deliveries. The most serious risk of a trial of labor is 

tearing of the uterine scar during labor (uterine rupture). In general, a trial is quite 

safe with a very low risk of uterine rupture (less than one percent of the time). 

Uterine rupture can cause serious injury and harm to you and your baby when 

it occurs. If uterine rupture is suspected during labor, an emergency cesarean 

delivery will be performed. Most of the time, there will be no ill effects to you or 

to your infant from an emergency cesarean delivery. However, from time to time, 

emergency surgery may have increased blood loss; a need for blood transfusion; 

and in some situations, there is a need to remove your uterus (hysterectomy) if 

hemorrhage cannot be controlled by other means. 

What factors may increase the risks of uterine rupture?

The risk of uterine rupture is almost three times higher if you have had two or more 

prior cesarean deliveries. Using medications to start labor can also double the 

risks of uterine rupture. If your labor is induced, other factors that may increase 

your risk of uterine rupture are:

• Unfavorable cervix at time of labor induction (cervix not effaced, not 

dilated, and the baby’s head is not down in your pelvis)

• If your BMI is more than 30 (BMI or body mass index is a measure of your 

weight in relationship to your height)

• Time from your most recent pregnancy was less than 18 months

• Your baby is heavier than 4,000 grams (8 pounds 13 ounces)

• Your prior cesarean delivery uterine incision was closed with only one-layer 

of stitches

What factors may decrease the risks of uterine rupture?

Having had a prior vaginal birth reduces the chance of uterine rupture during a 

trial of labor. 

Is there a difference in the chance of needing a blood transfusion or 

hysterectomy between trial of labor and repeat cesarean delivery?

The overall chance of needing blood transfusion or hysterectomy is not different 

between those women who attempted a vaginal delivery and those women who 

chose to have a repeat cesarean delivery. Factors that can increase the risk of 

transfusion and hysterectomy are:
Prenatal Information Sheet: Resources 179

• Induction of labor, especially without prior vaginal delivery

• High-risk pregnancies

• Increased number of prior cesarean deliveries 

What factors are related to a successful vaginal delivery after a 

previous cesarean delivery?

You may have a better chance for a successful vaginal delivery if you have the 

following condition(s):

• Your prior cesarean delivery was due to your baby’s position (i.e., breech -

when the baby enters the birth canal with buttocks or feet first)

• Your prior cesarean delivery was due to abnormal fetal heart rate during

labor (i.e., heart rate going down)

• You have had at least one vaginal delivery in the past

• Your labor has started on its own

• Your BMI is less than 30

• Your baby’s estimated weight is less than 4,000 grams (8 pounds13 ounces)

• Your cervix is already effaced (thinned out) to at least 75 to 90%

• Your cervix is already dilated

• Your baby’s head is already engaged (down into your pelvis) 

What factors are related to an unsuccessful or “failed” trial of 

labor?

Race and ethnicity effect the risk. Hispanic women have a lower rate of successful 

vaginal delivery after cesarean delivery than non-Hispanic white women. African 

American women have a lower rate than Caucasian women. You may have a 

higher chance for a failed attempt at a vaginal delivery if you have the following 

condition(s):

• Medical problems such as high blood pressure, diabetes, asthma, seizures, 

 renal disease, thyroid disease, or heart disease

• A previous cesarean delivery was due to labor not progressing normally

• The birth weight of your baby from a prior cesarean delivery was more than 

4,000 grams (8 pounds 13 ounces)

• You’ve had two or more cesarean deliveries and never gave birth vaginally

• You are more than 40 weeks pregnant

• Your labor was induced

• Your labor needed to be sped up by medications such as Pitocin

What are the complications of a failed attempt at vaginal delivery?

If you attempt a trial of labor, but a cesarean delivery becomes necessary, you will 

have a higher chance of complications than if you had a planned elective repeat 

cesarean delivery. Some of the complications from a failed attempt at vaginal 

delivery are: 
180 Prenatal Information Sheet: Resources

• Injuries to your bladder, ureter, and intestines during the cesarean delivery

• Higher risk of infection of your uterus

• Higher risk of infection of your abdominal incision

What are the risks of multiple cesarean deliveries?

The more cesarean deliveries you have had, the higher the risks to you from 

pregnancy. The risks of multiple cesarean surgeries are:

• Placenta previa (abnormal placenta position blocking the cervix) causing

 bleeding during pregnancy or bleeding around the time of birth

• Abnormal placenta growth with placenta growing into your uterus leading

 to bleeding that can be difficult to control

• Scars that make the repeat cesarean surgery more difficult causing injuries

 to your intestines, bladder and ureter (the tube connecting your kidney and

 your bladder)

• Higher chance of an emergent hysterectomy

• Higher risk of infection for you

What medications are safe to use for labor induction or 

augmentation (speeding up labor progress) for trial of labor?

Medications such as oxytocin (i.e., Pitocin) can be used safely during a trial of 

labor. Medications such as the prostaglandin type of drugs (i.e. Cytotec) carry 

high risks for uterine rupture and are not recommended for labor induction in 

women who desire a trial of labor.

Can I choose to try to deliver vaginally if I want my tubes to be tied 

(tubal ligation or tubal sterilization procedure) after delivery?

Yes, you can choose to attempt vaginal delivery if you have decided to have 

your tubes tied after giving birth. Please make sure you inform your provider of 

your decision for a tubal ligation well in advance of your labor. Prior to deciding 

to have a tubal ligation, which is a procedure that makes you sterile (prevents 

pregnancy) you should have discussed other birth control options with your partner 

and provider.

How can I prepare for an attempt at a vaginal delivery?

The preparation requirements to attempt a vaginal deliver after a cesarean 

delivery vary from hospital to hospital. Please discuss these requirement with your 

provider. In general, prepare the way you would for any planned vaginal delivery. 

See Labor and Delivery Basics in Resource Section.

What happens if I become overdue?

In the event you become overdue, you should be prepared to discuss with your 

provider, the need to schedule a date for labor induction or a date for a repeat 

cesarean delivery.
Prenatal Information Sheet: Resources 181

Birth Plan

Many of our patients have specific requests for management during labor and 

delivery. Our goal for managing your labor and delivery is to help you bring your 

baby into this world in a safe and friendly environment. We hope this will be a 

wonderful experience for you. 

Most published “birth plans” provide a menu of options with check boxes for 

things that you want during labor and delivery. These forms suggest that having a 

baby is like having a meal at a smorgasbord, pick what you want for each course 

the price is the same. However, when it comes to labor, some of these “menu 

items” are more expensive (have more risk) than others. Below we provide you 

some information about our common practices and reasons for them. If you have 

any special requests or would like to discuss any of these issues further, please 

make a note of them below and we will discuss them with you.

Environment—If you would like to have the lights down, or bring/play your own 

music, that is usually acceptable. Let the Labor and Delivery staff know of your 

wishes. During the actual delivery or after the delivery if stitching is required, some 

lighting is necessary.

Visitors—Your partner is welcome throughout your labor and delivery unless 

an emergency cesarean section is necessary and you have to have general 

anesthesia. In addition, depending upon your wishes, their maturity, the room size 

and your condition, other family members/friends are usually allowed to attend 

the birthday party.

Pain management—Except in specific circumstances, we usually leave the type of 

pain management up to you. Available options include Lamaze-type techniques 

(no medications), IV narcotics and regional anesthetics (such as an epidural). All 

options for pain relief have their own risks and benefits. We base the type and 

timing of pain relief methods on your wishes and individual situation.

IV—We strongly recommend that you have an IV in place during labor. This allows 

you to be quickly cared for in the event of an emergency. It is common to attach 

the IV to tubing and give some IV fluids but this can usually be limited if you desire. 

IV fluids may actually help your body labor more effectively.

Food and drink—We recommend limiting intake to clear liquids and hard 

candy so that your stomach can be relatively empty. If an emergency delivery is 

necessary and you have to have general anesthesia, it is much safer for you if your 

stomach is empty. 

Monitors—We usually do continuous fetal monitoring once you are admitted 

to labor and delivery. If your pregnancy is uncomplicated and the initial fetal 

monitoring is reassuring and there is adequate nursing staff available, it may 

be appropriate to go for periods of time without fetal monitors in place. Usually 

the fetal monitors are placed on your abdomen over your uterus. If additional 

information is necessary we sometime put monitors directly on the baby or inside 

your uterus.
182 Prenatal Information Sheet: Resources

Labor positions—As long as we can monitor the baby often enough to be sure that 

the baby is OK (varies with the situation), you can move around the room if you 

would like.

Delivery positions—Most women deliver while lying on their back or side and most 

providers have the most experience delivering babies from this position. If you 

would like to deliver in an alternative fashion, please let us know.

Episiotomy—We do not routinely cut episiotomies. If they are performed it is 

usually because we need to get the baby out quickly.

Forceps and vacuums—We do not use forceps or vacuums without a reason. 

Vacuum or forceps assisted delivery is recommended when your cervix is 

completely dilated but the baby needs to be delivered more quickly than you are 

able to push the baby out or because you have been unable to make enough 

progress on your own. If forceps or vacuum is recommended it is because the 

provider believes that the potential benefits of the procedure outweigh the risks. 

The umbilical cord – If you desire, your partner can cut the cord unless, the baby 

needs extra help transitioning to life outside of the womb and we have to move 

quickly.

Bonding—You can let us know at the time if you prefer to have the baby placed on 

your abdomen right after birth or have the baby cleaned off first and then given 

to you. Unless there is a medical reason to do otherwise, we keep the mom and 

baby together after the delivery. Getting you and the baby skin-to-skin right away 

is usually the plan.

Feeding—Usually the best time to begin breastfeeding is shortly after birth. We 

support and encourage this practice.

Medications for baby—We typically give the baby a shot of vitamin K in the thigh 

and put some antibiotic ointment on the eyes within the first half an hour after 

birth. These medications help the baby’s blood to clot properly and decrease the 

risk of eye infections that the baby may acquire during the birth. If you would 

rather the medications be given later or not at all, please let us know.

Please share with us any of your concerns or special requests. 

Remember in the event of an emergency regarding your health or the health of 

your unborn baby, we will do our best to keep you informed but we may need to 

modify your birth plan. 
Prenatal Information Sheet: Resources 183

Baby Supplies for the First Week

The following is a list of baby items that will be very helpful to have prior to 

bringing baby home. Give the list to friends and family when they ask what you 

need. 

Infant car seat

• You will need a rear facing car seat to bring your baby home from the hospital. 

Make sure you know how to install it safely into your car’s backseat. Your baby 

will not be discharged without the staff first checking the car seat with your 

baby in it. 

Clothing

• 4-6 shirts, sleepers and gowns. Plan on at least a few change of clothes a day. 

• Warm clothes such as hats, blankets, booties, etc. as needed. Dress baby as 

you would dress yourself, but add one layer. 

Bedding

• A crib or bassinet: Make sure the slats are no farther than 2 inches apart.

• 4-5 snug fitting sheets

•	 6-8 receiving blankets

Bathing/diaper supplies

• 2-3 towels, 4 wash cloths

• 3-4 dozen diapers (disposable or cloth). Plan on your baby using about a 

dozen per day

• Baby shampoo and soap

• Saline nose drops

• Baby bathtub or pad for sink to prevent slipping

• Baby hairbrush or comb

• Baby fingernail clippers or scissors

• Mild laundry soap

• Cotton swabs or cotton balls

• Soft cloths or disposable wipes for cleaning after diaper change

Baby first aid

• Digital or rectal thermometer

• Baby acetaminophen

• Rubbing alcohol if you are told to use it for cord care

• Petroleum jelly or other lubricating jelly
184 Prenatal Information Sheet: Resources

Breastfeeding supplies

• Clean soft cloth or disposable breast pads for leaking breasts

• 2-3 nursing bras

• Nursing tops and nightgowns for added convenience

Bottle-feeding supplies

• 8 (4 ounce) baby bottles, caps and nipples

• Bottle and nipple brush for cleaning

• A one quart measuring cup 

Extras you might want

• Diaper bag to carry baby items

• Pacifiers

• Burp cloths

• Unscented alcohol-free wipes to carry in diaper bag

• Changing mat
Prenatal Information Sheet: Resources 185

Family Planning

Sex after delivery

It is best to avoid sex for at least three to six weeks following the delivery of your 

baby in order to give yourself time to recover from the changes associated with 

childbirth. Your stitches (if you had any) should be dissolved and your vaginal 

discharge greatly reduced by this time showing that you are well on your way to 

complete recovery. The perineal area (or area between the vagina and the rectum) 

may be slightly tender suggesting some healing is still taking place. In order to 

help make your first sexual experience after the delivery an enjoyable one, there 

are a few helpful hints that we suggest you follow:

• Have your partner or yourself apply gentle pressure at the entrance of your 

vagina towards your rectum. If this is very painful, it is better to wait until it 

does not cause discomfort before having sex. Discuss this with your provider.

• Use a lubricant such as K-Y Jelly® around the entrance of your vagina as you 

may be drier for a period of time following your delivery. This is especially true 

if you are breastfeeding. 

• The side position may be more comfortable if you had a midline episiotomy. 

This position places less pressure on the suture area. 

• Make sure baby is asleep so you will be less likely to be disturbed. 

• If you are breastfeeding, you may wish to keep your bra on in order to absorb 

the milk that can be released during your orgasm. 

• Be sure to use some form of birth control. You can become pregnant at any time 

after delivery. You release the egg two weeks before your period. You usually 

will not know when your egg is being released. 

• Be sure to spend time together as a couple even if you are not quite ready to 

have intercourse.

Masters and Johnson, experts on sexuality, have found that women in the first two 

months after delivery were slower to respond to sexual stimulation and responded 

less strongly. In spite of this, women usually found sex enjoyable. Just remember, 

you must be ready both physically and mentally before resuming sex. Do not rush 

it. There are many other ways to express your love. 

Birth control methods after delivery 

Before resuming sexual intercourse, we recommend waiting until your bleeding 

has stopped, or at least greatly decreased, your stitches (if you had any) have 

healed and you are on a reliable form of birth control. Ideally it would be best to 

wait until your six to eight week postpartum appointment to make sure everything 

is healing without problems and that your birth control method is adequate. If 

you feel well enough to enjoy sex prior to that time, there are many birth control 

options. 

If you are not breastfeeding, you can expect to have your first period anywhere 

from four to six weeks after the delivery. With full breastfeeding (no supplements of 

any kind) your periods may be delayed up to six months. 
186 Prenatal Information Sheet: Resources

You will release an egg (and therefore be fertile) before your first period whenever 

it occurs. This is why women should consider a reliable type of birth control prior 

to resuming intercourse, no matter when the intercourse occurs. Luckily, there 

are several good choices of reliable birth control methods available for both 

breastfeeding and non-breastfeeding women. 

Non-hormonal methods

Condoms and foam are excellent methods for women after delivery. These 

methods avoid the very small possibility of hormones effecting breastfeeding. The 

small risk of blood clots right after delivery is avoided. Barrier methods include:

•	 Withdrawal The man pulls his penis out of the vagina before he “comes” to 

keep the sperm from getting to the egg. This takes great self control, experience 

and trust. Effectiveness is only around 81% but increases greatly when a 

condom is used as well. 

•	 Spermicides (foam, cream, tablets, suppositories and film)

Chemicals that are applied in the vagina less than one hour before sex. Much 

more effective if used with a barrier method.

•	 Male condoms Offers protection against infection. This is especially 

important in the post-partum period when your uterine wall is healing. To be 

effective, your partner needs to use these each and every time. 

•	 Female condoms Plastic tube that lines the vagina to prevent sperm from 

reaching the cervix. This method also protects against Sexually Transmitted 

Diseases (STIs). These are not intended for use with a male condom. You will 

need to choose one or the other.

•	 Diaphragm and spermicidal jelly or cream A soft rubber cup that 

covers the cervix and thereby blocks sperm from entering the uterus. Should be 

used with a spermicidal jelly or cream. Must be used prior to each and every 

time you have sex. You must be fitted for this device (even if you have one from 

before this pregnancy) at your postpartum visit. A diaphragm is left in place 

no shorter than six hours after sex and no longer than 24 hours. For each 

additional act of intercourse you must apply new spermicide. Do NOT remove 

the diaphragm when adding new spermicide. 

•	 Cervical cap and spermicidal jelly or cream A soft rubber cup similar 

to the diaphragm but smaller. Should be used with a spermicidal jelly or cream. 

Must be used prior to each and every time you have sex. You must be fitted for 

this device (even if you have an old one) at your postpartum visit. You leave this 

in place no shorter than six hours after sex and no longer than 48 hours. You 

can use the cervical cap for up to 48 hours of protection. 

•	 Intrauterine device (IUD) Small, flexible plastic frame inserted into the 

uterus through the vagina. These are effective up to 10 years depending on 

type. If you would like this method, discuss it with your health care provider 

prior to your postpartum visit so arrangements can be made for its insertion 

postpartum. 
Prenatal Information Sheet: Resources 187

•	 Permanent sterilization A woman can obtain a tubal ligation or a man 

can have a vasectomy; if you are absolutely sure you do not ever want future 

children. These methods are more than 99% effective. Institutions will vary 

on requirements (usually age and number of children) to have this procedure 

performed. If this interests you, talk to your health care provider early on in 

your pregnancy. Tubal ligation can often be done prior to leaving the hospital, 

if arranged for in advance. 

Lactational Amenorrhea Method (LAM) for breastfeeding women

This method provides some protection against pregnancy for up to six months 

postpartum if no supplements are added to the baby’s diet and intervals between 

breastfeeding do not exceed four hours during the day and six hours at night. The 

use of a condom with foam and/or withdrawal increases effectiveness. 

Options for women who are breastfeeding

It is recommended that breastfeeding women avoid using combined oral 

contraceptives (those that have both estrogen and progesterone) since they may 

decrease the milk supply and alter the milk composition. Studies have shown 

varied results but most report a decline in the mineral content of the breast 

milk with use of combined oral contraceptives. Even though existing evidence 

(scant that it is) suggests that the combined oral contraceptives do not directly 

harm infants, most providers feel safer using the progesterone-only birth control 

methods if hormonal contraception is desired. Studies have shown no ill effects of 

progesterone-only methods on lactation and some studies have suggested there 

may even be a slight increase in milk volume. Progesterone-only methods include:

•	 Progesterone only pills (POPs or minipills) It may be best to wait 

until six weeks after delivery since there is a theoretical (unproven) risk that 

POPs may pose a problem to your baby. This theoretical risk is based on your 

newborn’s liver and kidneys not being fully developed and therefore unable to 

break down and excrete drugs. If the need is great and you are willing to take 

this theoretical risk, then ask your health care provider for a supply prior to 

leaving the hospital. You should wait until your milk supply is well established 

before to starting. The amount of progesterone is even lower than the amount 

found in low dose combination pills. 

•	 Progesterone injection This method is a liquid form of progesterone and is 

very effective in preventing pregnancy for 12 weeks. Several medical treatment 

facilities will give this injection prior to discharge from the hospital.

•	 Implanon A single rod implantable device that is placed in your upper arm 

and is effective three years. The most common side effect is irregular bleeding. 

This method is greater than 99% effective.
188 Prenatal Information Sheet: Resources

Options for women who are bottle-feeding Combined oral contraceptives 

can be started two weeks after delivery. Waiting the two weeks allows for the 

recommended vaginal rest and avoids the period of peak risk for postpartum 

blood clots. 

•	 Oral Contraceptive Pills/NuvaRing/Ortho Evra Patch All of these 

contain estrogen and progesterone. They are easy to use and effective. Your 

provider can give you a prescription for these prior to your discharge from the 

hospital after you deliver.

•	 Progesterone injection A progesterone injection given prior to discharge 

from the hospital is effective immediately and lasts for 12 weeks from date of 

injection. 

•	 Progesterone only pills (POPs) Prescribed for women who wish to avoid 

the estrogen found in combined oral contraceptives. 

•	 Implanon A single rod implantable device that is placed in your upper arm 

and is effective three years. The most common side effect is irregular bleeding. 

This method is greater than 99% effective.

•	 Combined hormonal injection such as Lunelle® an injection given 

every four weeks containing both estrogen and progesterone. 

Methods that do not work well enough to depend on:

• Breastfeeding: if you miss any feedings, are ill, baby gone etc. you could 

ovulate and become pregnant. 

• Feminine hygiene products

• Douching

• Urinating after sex

• Withdrawal of the penis

• Fertility awareness immediately after delivery

• When in doubt, check with your healthcare provider.
Prenatal Information Sheet: Resources 189

Method % Pregnant within 

First Year Advantages Side Effects

No Birth Control 

Used 85 out of 100 

Pregnancy and no 

protection against 

STIs. 

Pill: (Oral 

Contraceptive Pill)

 Progestin only 

or

 Estrogen & 

Progesterone 

combined pills

5 out of 100

1 out of 100

1 out of 100

Easy to use and 

very effective. 

Periods are 

usually lighter, 

regular with less 

pain. Studies have 

shown women 

using the Pill 

have less ovarian 

and uterine 

cancer in later 

life, less acne, 

less Premenstrual 

Symptoms, less 

anemia (iron poor 

blood). 

POPs (mini 

pills): Irregular 

bleeding, weight 

gain, breast 

tenderness, 

less protection 

against ectopic 

pregnancy.

Combined: 

Dizziness, 

nausea, changes 

in menstruation, 

mood, and 

weight; rarely, 

cardiovascular 

disease, including 

high blood 

pressure, blood 

clots, heart attack, 

and strokes. 

Serious side 

effects very rare.

Neither pill 

protects against 

STIs.

Vaginal Ring 1-2 out of 100

Place into vagina 

for 3 weeks then 

remove. You don’t 

have to worry 

about taking pill 

every day, getting 

an injection or 

using something 

prior to sex each 

time. Similar to 

oral contraceptivecombined pill.

Similar to oral 

contraceptivecombined pill. 

Male may feel 

it with sex. 

Can’t store in 

hot location; it 

releases hormone. 

No protection 

against STIs.

Effectiveness and Side Effects of Various Birth Control Methods
190 Prenatal Information Sheet: Resources

Method % Pregnant within 

First Year Advantages Side Effects

Evra® patch 1 out of 100

Once a week 

patch. Ability to 

become pregnant 

quickly returns 

when stopped. 

Advantages 

similar to the oral 

contraceptive - 

combined pill.

Similar to oral 

contraceptivescombined pill. 

Less effective for 

women over 198 

pounds. Skin 

irritation. No 

protection against 

STIs.

Intra-Uterine 

Devices 

Less than 1 out of 

100

Effective up to 10 

years depending 

on type. Do not 

have to think 

about it before 

sex. 

Pain, bleeding, 

infection, other 

post-surgical 

complications. No 

protection against 

STIs.

Progesterone 

Injections

Less than 1 out of 

100 

Usually no 

periods after a 

few months. May 

help breastfeeding 

women have more 

milk. 

Irregular bleeding, 

weight gain, 

breast tenderness, 

headaches. No 

protection against 

STIs. 

Implanon Less than 1 out of 

100 

Effective up to 3 

years. Fertile in 

about 2-4 months 

after removal. Do 

not have to think 

about it before 

sex.

Irregular, 

unpredictable 

bleeding. Serious 

side effects 

very rare. No 

protection against 

STIs.

Male condoms 12 out of 100

Protection against 

most STIs. Can 

use as soon 

after delivery 

as needed. 

Inexpensive and 

does not require a 

prescription.

Irritation and 

allergic reactions 

(less likely with 

polyurethane), 

must use with 

each time, can 

break or fall off. 

Should use with 

spermicides. 

Effectiveness and Side Effects of Various Birth Control Methods
Prenatal Information Sheet: Resources 191

Method % Pregnant within the

First Year Advantages Side Effects

Female condoms 21 out of 100 

Protection against 

most STIs. Can 

use as soon 

after delivery 

as needed. 

Inexpensive and 

does not require a 

prescription. 

Irritation and 

allergic reactions 

(less likely with 

polyurethane), 

must use with 

each time, can 

break or fall off. 

Should use with 

spermicides. 

Diaphragm with 

spermicide 21 out of 100

No drugs or 

chemicals are 

absorbed into the 

body. Does not 

affect your period. 

Irritation and 

allergic reactions, 

urinary tract 

infection. Risk 

of Toxic Shock 

Syndrome, a 

rare but serious 

infection, when 

kept in place 

longer than 

recommended. 

No protection 

against STIs. 

Cervical cap

Women with 

children

Women without 

children

36 out of 100

18 out of 100

No drugs or 

chemicals are 

absorbed into the 

body. Does not 

affect your period. 

Irritation and 

allergic reactions, 

abnormal Pap 

test. Risk of Toxic 

Shock Syndrome, 

a rare but serious 

infection when 

kept in place 

longer than 

recommended. 

No protection 

against STIs. 

Spermicides 26 out of 100

Inexpensive and 

do not need a 

prescription. 

Much more 

effective if used 

with a barrier 

method (condom, 

diaphragm, 

cervical cap).

Irritation and 

allergic reactions, 

urinary tract 

infections. No 

protection against 

STIs. 

Effectiveness and Side Effects of Various Birth Control Methods
192 Prenatal Information Sheet: Resources

Method % Pregnant within the

First Year Advantages Side Effects

Withdrawal 19 out of 100 Nothing to buy, 

inject or put on. 

Takes lot of selfcontrol, presence 

of sperm in 

fluid prior to 

ejaculation. Not 

effective. No 

protection against 

STIs. 

Fertility awareness 

(Natural Family 

Planning) 

3 out of 100 (if 

done daily and 

accurately)

No physical 

health risks to its 

use and can also 

be used to get 

pregnant. Need 

to know how to 

record daily basal 

body temperature 

and note cervical 

mucous. 

Difficult to learn 

this method after 

delivery because 

your cycles will 

not be regular. 

Involves careful 

checking and 

recording of daily 

body signs. No 

protection against 

STIs. 

Male sterilization: 

Vasectomy 0.15 out of 100 

Done only once 

and highly 

effective. 

Pain, bleeding, 

infection, 

other minor 

post surgical 

complications. No 

protection against 

STIs. 

Female 

sterilization: 

Tubal Ligation

0.5 out of a 100 

Done only once 

and highly 

effective.

Pain, bleeding, 

infection, other 

post-surgical 

complications. No 

protection against 

STIs. 

Hysteroscopic 

Tubal Occlusion 

Method (e.g. 

Essure®)

Less than 1 out of 

1000 if occlusion 

confirmed by 

pregnancy

Can be done in 

the clinic

No protection 

against STIs

Effectiveness and Side Effects of Various Birth Control Methods
Prenatal Information Sheet: Resources 193

Method % Pregnant within the

First Year Advantages Side Effects

Emergency 

contraceptives 

(morning after 

pills)

Reduces 

pregnancy from 

single episode by 

80%

Only method 

that can be used 

after intercourse 

to prevent a 

pregnancy. 

Effective as a 

back-up method to 

other methods. 

Nausea, vomiting, 

abdominal 

pain, fatigue, 

headache. No 

protection against 

STIs. 

Lactation 

Amenorrhea 

Method (LAM)

2 out of 100 

Nothing to take 

therefore no risks 

to baby or you. 

Only effective 

if not giving 

supplements, and 

feeding every 4 

hours in the day 

and every 6 hours 

at night. Much 

more effective 

if used with 

condoms, or other 

barrier methods. 

Listing of medications/drugs does not represent endorsement by VA/DoD

Effectiveness and Side Effects of Various Birth Control Methods
194 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 195

Breastfeeding

Among the many things you must consider before you deliver is how you will feed 

your infant(s). More and more mothers are choosing to breastfeed, because it is 

one of the most important contributors to a baby’s health. Additional benefits are 

that breastfeeding helps you feel and be healthier and saves money. Breastfeeding 

is recommended for the first two years of a baby’s life. Many studies have shown 

that any amount of breastfeeding is beneficial. It is important to know that there 

are a number of resources available to help you succeed. 

Learning as much as you can about breastfeeding early in your pregnancy is 

the best preparation. The more comfortable you feel with breastfeeding, the 

easier it will be for you. There are a number of books, pamphlets, and web 

based resources you can use. Ask your doctor or the nursing staff in the clinic for 

information regarding local lactation resources. 

Benefits to Mom

• Breastfeeding relaxes you – when you breast feed, hormones are released 

which calm and relax you.

• Breastfeeding saves money by reducing or eliminating the cost of buying 

formula.

• Breastfeeding reduces health care costs.

• Breastfeeding is convenient – no mixing or measuring.

• Breastfeeding burns extra calories, so it makes it easier to lose the pounds you 

gained during your pregnancy.

• Breastfeeding helps the uterus to get back to its original size and lessens any 

bleeding you may have after giving birth.

• Breastfeeding can help you bond with your baby - physical contact is important 

to a newborn and can help them feel more secure, warm and comforted.

• Breastfeeding is associated with decreased risk of breast cancer, heart disease, 

osteoporosis, and depression. 

Benefits to Baby

• Breast-fed babies have a healthier start in life, because breast milk contains all 

the nutrients baby needs, regardless of whether your baby is premature or full 

term.

• Breast milk has the perfect mix of nutrients for your baby’s digestive system.

• Breast milk protects a baby from many illnesses such as diarrhea, ear 

infections, respiratory tract infections, diabetes, urinary tract infections, and 

severe bacterial infections.

• Breast milk is always the right temperature for your baby.
196 Prenatal Information Sheet: Resources

• Breast-fed babies are less likely to become overweight.

• Breastfeeding promotes the proper development of jaw and facial structures.

• Breast milk aids in the development of baby’s brain and nervous system.

• Breastfeeding is associated with decreased risk of chronic conditions such as 

obesity and diabetes.

• Some studies even indicate that breast-fed babies have higher IQs than formula 

fed babies. 

Myths and Truths

There are many myths or “old wives tales” and breastfeeding has more than its 

share of them. Listed on the next page are just a few of the more common myths 

that you may have heard and the truth behind them.
Prenatal Information Sheet: Resources 197

Breastfeeding Myths and Truths

Myth Truth

You need large breasts to 

make enough milk.

Shape and size is due to the layers of muscle and fat. 

Size has no effect on milk production.

You cannot work and 

breastfeed.

Breast milk can be expressed and stored for feeding the 

baby while you are at work.

You cannot smoke and 

breastfeed.

The American Academy of Pediatrics states that it is 

better to breastfeed than formula-feed even if you smoke. 

If you do smoke, try to cut down as much as possible. Do 

not smoke right before breastfeeding and never smoke 

in the house or anywhere around the baby. Second-hand 

smoke increases the incidence of pneumonia, bronchitis 

and SIDS in your baby. 

You cannot use birth control 

and breastfeed.

There are several birth control methods that are safe 

for breastfeeding women, such as condoms, IUDs, 

foam, diaphragms, and birth control pills that contain 

progesterone (mini-pill). 

You cannot become pregnant 

while 

breastfeeding.

Exclusive breastfeeding (no pacifiers or bottles) can delay 

ovulation for some women. The Lactational Amenorrhea 

Method (LAM) is more effective when used with another 

birth control method such as condom. If you plan to use 

this method of birth control, talk with your health care 

provider for details.

You will be tied down.

A breast-fed baby is very portable. You do not have to 

carry extra gear with you. If you return to work or need 

to be away from your baby, you can express milk for a 

baby sitter.

You must drink milk to make 

milk.

Cow’s milk is an inexpensive source of calcium and 

protein. It is not necessary to drink milk in order to 

produce breast milk. You can get calcium by eating dairy 

products, collards, canned salmon, calcium enriched 

tofu, and juices. Other good protein sources are meats, 

eggs, peanut butter, soy/tofu, legumes/dried beans and 

nuts/seeds.

Each member of the family 

has to feed the baby to bond 

too.

Bonding can occur in a variety of ways such as: 

cuddling, playing, holding, talking or reading to and 

rocking the baby. Holding a baby skin to skin is one of 

the best ways to bond with baby.

You cannot breastfeed if you 

have had breast surgery 

(augmentation or reduction). 

Mothers who have had breast surgery can breastfeed 

their babies. Milk production may be reduced and 

supplementation with formula may be needed. Contact a 

lactation consultant to discuss the best way to successfully 

breastfeed after breast surgery.
198 Prenatal Information Sheet: Resources

Diet

• Eat well to feel well 

• Eat at least 1800 calories daily

• You should have 1200mg calcium a day

• You need three or more servings of protein a day

• Fluid intake: 

 - Drink six to eight glasses (eight ounce) of non-caffeinated fluids a day 

 - Drink when you are thirsty 

 - Drink a glass water each time you nurse your baby 

 - You may drink caffeinated drinks in moderation. If your baby has trouble 

 sleeping, you may need to eliminate caffeine from your diet.

You do not have to avoid any particular food, unless you have a family history of 

allergy (shellfish, citrus, dairy, etc). You may eat anything you are used to eating. 

If your baby is fussy, it does not mean he is allergic to your milk. Babies can be 

sensitive to something you have eaten. Do not start eliminating foods from your 

diet. The most common food sensitivity is an excess intake of cow’s milk. You may 

want to reduce or eliminate milk from your diet and see how baby reacts. Usually 

baby will improve within one to three days.

Supplies

Nursing bras: These will support your breasts and make breastfeeding a lot 

more convenient. It is recommended that you buy your nursing bras in the last 

month or two of your pregnancy when your breasts have already increased 

in size. Sometimes, breasts do not increase in size until after delivery. You 

may need to purchase a new bra after your milk has come in and the swelling 

that accompanies your milk “coming in” has subsided (two to three weeks 

after delivery). When you buy your bras, make sure they’re all-cotton, they fit 

comfortably around your rib cage when fastened on the loose setting, and there 

is extra room in the cup. A tight bra is uncomfortable and can cause sore nipples, 

plugged ducts, and breast infections. When trying on nursing bras, make sure you 

can open the nursing flap with one hand (so you will not have to put baby down 

each time you feed). Purchase one or two bras to see if you like them, then buy 

more as needed.

Nursing shirts: Most maternity stores sell clever nursing shirts. These shirts are 

great, because they are attractive, most people do not know they are for nursing, 

and they make it easier to breast feed while you are learning. Some mothers are 

comfortable wearing large T-shirts. Button front tops and two-piece sets work well 

once you’re comfortable with breastfeeding. Some mothers like nursing cover ups 

or drapes that cover mom/baby when breastfeeding in public. 

Nursing pads: These are placed in your bra to protect your bra and clothes. 

At the beginning, many mothers experience periodic leaking of their 

breast milk. Pads range from disposable to washable cotton to silicone. 
Prenatal Information Sheet: Resources 199

Change pads frequently, especially in warm weather, to prevent yeast infection/

bacteria growth. Nursing pads may only be needed the first few weeks. 

Pumps: A pump is useful to have for a few reasons. You may need to be away 

from your baby for short time periods, so you will need to provide your babysitter 

with some breast milk to feed your baby(ies). If you plan to return to work, you’ll 

need to pump your breasts to maintain your milk supply. An electric pump can be 

rented or purchased. This is the most efficient type of pump. 

Most electric pumps can pump both breasts at the same time. Manual or minielectric pumps are less expensive and more portable, but not as efficient. Most 

manual pumps will pump only one breast at a time. Your health care provider or 

other breastfeeding expert can help you with questions about getting and using a 

pump that will meet your needs.

Hand expression (nothing to buy): Hand or manual expression of breast milk is a 

good skill to learn even if you plan to purchase a pump. It is definitely the most 

portable of all methods and costs nothing. Some women express as much milk 

by hand as they can by using a pump. You may find it helpful for someone to 

demonstrate this technique for you. Ask your health care provider or breastfeeding 

expert for guidance.

Breastfeeding and working

Working mothers who breastfeed say that breastfeeding is easier for them than 

using formula because: 

• They have babies who are sick less often

• Night feedings are faster

• Giving breast milk to their babies makes them feel close even when they are 

away at work

• They are able to continue breastfeeding at home

Let your supervisor know that you plan to continue breastfeeding when you return 

to work, so you can locate a clean, private area where you can pump your milk. 

You will need to pump on breaks and during lunch, so you will need to talk about 

some flexibility in your work schedule. Your breaks should not take longer than 

15 - 20 minutes if you use a double pump. Milk can be stored in a refrigerator or 

a cooler with ice packs. 

Expressed breast milk (EBM)

Expressed breast milk can be used to feed your infant while you’re away. Your 

health care provider or other breastfeeding expert can help you with questions 

about expressing breast milk and help you to determine a plan that is best for you. 

You may begin expressing milk for storage after two to three weeks of nursing. 

Check with a lactation consultant or lactation center to assess your pumping needs. 

Hospital grade electric pumps are available for rent. Personal use double electric 

breast pumps are quite efficient and more cost effective than renting.
200 Prenatal Information Sheet: Resources

You can choose one or more of the following methods for expressing milk:

• Hand expression - This means not using a mechanical pump. Some women 

express as much milk by hand as they can by using a pump.

• Rent or buy an electric pump - This is the most efficient type of pump. If you get 

one that pumps both breasts at the same time, expressing takes 10 - 15 minutes 

total.

• Buy a mini-electric, battery operated or manual pump - These are less 

expensive, but not as efficient as an electric pump. Most will only pump one 

breast at a time. They are best used for occasional pumping.

• Milk Expression Pointers

- Always wash your hands before you begin.

- Empty your breasts on a routine schedule to help maintain your milk supply. 

- It is helpful to express your milk on your baby(ies) nursing schedule.

- Gently massage your breasts before expressing your breast milk.

Storing expressed breast milk

Since many consider breast milk to be a “living substance”, storage is an 

important thing to consider. Breast milk actually has anti-bacterial properties that 

help it stay fresh. There are many resources available to answer any questions you 

might have. Talk with your health care provider or lactation consultant. Keep the 

following guidelines in mind when expressing milk.

- All milk should be dated before storing.

- The containers used should be washed in hot, soapy water and rinsed well.

- Milk may be stored in hard-sided plastic or glass containers with well-fitted 

tops or in freezer milk bags designed for storing human milk.

- Breast milk can be stored:

 At room temperature for up to six hours (Note: the warmer the room, 

 the less time the milk should be left unrefrigerated)

 In an ice chest/cooler with frozen gel packs for up to 24 hours

 In a refrigerator for up to eight days

 In a freezer compartment inside a refrigerator (variable temp due to door 

 opening frequently) for up to two weeks

 In a freezer compartment with separate door for up to six months (keep 

 in the back of freezer, not on door)

 In a separate deep freeze for up to 12 months

- When using frozen milk it should defrosted in the refrigerator. Thawed milk 

can be safely kept in the refrigerator but must be used within 24 hours. 

Freeze breast milk in small quantities to avoid waste.
Prenatal Information Sheet: Resources 201

- Breast milk should not be refrozen

- Breast milk in containers should be swirled, not shaken hard

- Thawing breast milk containers

 Never use the microwave to thaw breast milk

 Thawing should take place under warm, running water

 Frozen milk may be placed in the refrigerator or in a bowl of warm 

 water. 

Breastfeeding after Cesarean Delivery

It is very possible to breast feed after a cesarean delivery. Be sure to tell your 

health care provider if you want to do this, so that he/she can make provisions to 

help you. You can also write this in your birth plan. Some helpful hints include:

• Nurse as soon as possible after delivery as baby will become sleepy soon after 

birth. Keep baby skin to skin for the first hour after delivery or until after the first 

breast feeding. Most procedures and infant measurement/assessment may be 

delayed until after the first feeding. Many facilities are changing their routines 

to get your healthy baby(ies) to you within one to two hours after delivery.

• Take pain medications as needed; they will not hurt your baby and you will be 

more comfortable.

• Get help, especially if baby is not latching on or nursing well.

Breastfeeding Challenges

Sore nipples: Studies have shown that the majority of breastfeeding women 

experience some nipple soreness. In about a quarter of these moms, the soreness 

progresses to cracking and extreme nipple pain. The most frequent causes of sore 

nipples are incorrect positioning and poor infant latch. 

The first two to four days after delivery, your nipples may feel tender at the 

beginning of a feeding as your baby’s early sucking stretches your nipple and 

areolar tissue. If a baby is positioned well at the breast, this temporary tenderness 

usually diminishes once the milk lets down and then completely disappears within 

a day or two.

Some common treatments for sore nipples include: 

• Massage your breast to encourage breast milk flow and emptying of your 

breast.

• Short frequent feedings are far more beneficial than long extended periods of 

feeding and reduces the likelihood of the infant being too vigorous at the breast 

and too irritable. 

• Bathing a crack in the nipple with freshly expressed breast milk. This is both 

soothing and naturally healing. 
202 Prenatal Information Sheet: Resources

• If you desire to use a “nipple cream”, use anhydrous lanolin. This is the only 

cream/ointment recommended for use on nipples. Apply a thin layer to each 

nipple after breastfeeding.

• Learn proper positioning of your baby at your breast. Your baby should be 

nose to nipple, and tummy to tummy with you. The baby’s chin should be just 

below the nipple, and pressed to the breast. The baby needs to open wide to 

take in a good mouthful of breast. Never let someone push your baby’s head 

onto the nipple. Instead, keep the shoulders and neck well supported but the 

back of the head free. Babies tend to resist pressure on the back of their head.

• Talk to your healthcare provider, your lactation consultant or your nearest La 

Leche League if the above remedies don’t help

Avoid:

• Placing wet tea bags on your nipples. Tannic acid in the tea can act as an 

astringent causing drying and cracking, rather than healing.

• Using a hair dryer or sun lamp to dry the skin. 

• Most commercial preparations sold for the treatment of sore nipples. They are 

not useful and some may even cause harm.

•	 Toughening nipples prior to breastfeeding. This may cause damage and does 

not help with breastfeeding.

Tingling sensations: After baby has nursed for a few minutes many (but not all) 

women feel a tingling sensation followed by a strong surge of milk. This is known 

as the “let down” response and is natural and expected. This can happen with 

nursing, with just seeing a baby, hearing a baby cry or even thinking about your 

baby. Often this let down is accompanied by leakage of milk from both breasts. 

To stop the milk from leaking, gently press on your nipples with a clean cloth or 

with your forearm. Some women wear nursing pads (without plastic liners) to help 

prevent leaking.

Engorgement: You will most likely feel your breast milk come in (usually around 

two to four days after delivery). This is especially true if it is your first time 

breastfeeding. For first time moms who breast-feed, within a relatively short time 

period (sometimes only a few hours) your breasts become swollen, and may 

become painful and difficult for baby to latch on to. These are signs that your 

breasts are making the final changes necessary to make milk for your baby. This 

lasts only a few days at most. It is caused by blood engorgement (swelling) that 

comes with filling of the breast and usually goes completely away by day ten. 
Prenatal Information Sheet: Resources 203

If this is not your first baby, you probably will not experience engorgement, even 

though you are producing more milk now than you were at this time with your last 

baby. This is often perceived as decreased milk supply, but is not the case. Usually 

engorged breasts feel much better within 12 - 24 hours of practicing the following 

comfort measures:

• Gentle breast massages: stroking the breast from the outer edges to the nipple 

area, especially when in a warm shower or in dependent position.

• Warm packs followed by expressing some milk before feedings.

• Breast feed baby frequently. As many as 8 - 12 feedings per 24 hours is 

expected. Your baby may feed every one to three hours. 

• Start your feedings on the least sore side. 

• You may use over the counter pain relief medications such as Motrin® or 

Tylenol®, if needed. Consult with your health care provider for the best 

medication for you.

• After breastfeeding, if you are engorged, you may apply cold compresses 

to your breasts intermittently (10 minutes on/20 minutes off) to help reduce 

swelling.

Plugged ducts: Occasionally the ducts that store milk inside your breasts can 

become blocked and inflamed causing a very tender spot, redness or sore lump 

in the breast. There are many causes including: improper positioning of the baby 

at your breast, too long between feedings, supplementary bottles, overuse of 

pacifiers, dried milk secretions covering one of the nipple openings, or wearing 

tight nursing bras or other restrictive clothing.

To remedy this:

• Loosen all constrictive clothing, especially your bra. Avoid underwire bras.

• Rest often.

• Massage your breasts to help release milk from ducts prior to putting your infant 

to breast. 

• Apply warm compresses to the affected area and massage any lump(s) to help 

promote release of the plug.

• Nurse your baby on the affected side frequently. 

• Change nursing positions often to put pressure on different ducts.

• Clean nipples to ensure no milk is blocking the ducts.
204 Prenatal Information Sheet: Resources

• Make sure the sore breast gets emptied of milk either through baby or 

expression by hand or pump.

• Soaking the sore breast in a basin of warm water may help. 

• DO NOT STOP OR SLOW DOWN ON FEEDINGS as this can add to the 

problem.

Since plugged ducts can lead to infection, it is important to remedy the situation as 

quickly as possible. If symptoms do not resolve within 24 hours or your pain gets 

worse, call your healthcare provider or lactation consultant for assistance.

Breast infections: If you notice the signs of a plugged duct becoming more severe 

and combined with fever or flu-like symptoms, you could have a breast infection 

called mastitis. You need to treat a breast infection immediately. Continue 

breastfeeding! Apply heat to the affected area, massage breast and try to get 

plenty of rest. If these steps don’t resolve the symptoms within 24 hours, call your 

provider without delay. You will most likely be treated with antibiotics and mild 

pain relievers. While taking the medications you will also need plenty of rest, 

increased fluid intake, moist heat applications to your breasts and frequent nursing 

beginning with the infected breast. Let your health care provider or lactation 

consultant know if you have history of mastitis. 
Prenatal Information Sheet: Resources 205

Bottle Feeding

Feeding time is an important time for you and your baby to get to know and love 

each other. This is true whether you breastfeed or bottle feed. Always use feeding 

time to share comfort and closeness.

Do not give your baby anything but breast milk or iron fortified formula until 

instructed by your healthcare provider. Any commercial infant formula is adequate 

for normal infant growth. In the first months, the baby will take two to four ounces 

every two to four hours. Follow the instructions on the can carefully. Some formulas 

are “ready to feed” and don’t need added water, others are concentrated and 

have to be diluted. If your baby has problems with the brand of formula you are 

using, contact your health care provider before switching to another formula.

Always check the expiration date and the lot number on the formula cans. Do not 

use dented, leaking, or damaged containers of formula, since these could have 

bacteria in them. 

• If you are using tap water to mix the formula, let the water run for several 

minutes before you add it to the container. You do not have to boil the water. 

Do not keep uncovered formula cans in the refrigerator.

• Warm the milk by setting the bottle in warm water (never in the microwave).

• Once you have warmed the bottle (or removed it from the refrigerator), it should 

be given immediately. Hold the baby with his/her head higher than his body 

and touch the nipple to his lips. Let baby open his/her mouth to take the nipple. 

Do not force the nipple in.

• Never prop the bottle or put the baby to bed with a bottle. This can lead to 

choking and it causes tooth decay.

• Let the baby decide when he/she has had enough. If baby refuses the bottle, 

try burping. If baby still refuses to eat after burping, stop until the next feeding.

• A healthy baby will stop eating when full. 

• Throw away the formula or breast milk left in the bottle from that feeding. Rinse 

the bottle and nipple after use with cold water. It makes clean up easier.

• Bottles and nipples can be washed in the dishwasher or in hot, soapy water.

• Breast milk digests easier than formula. Breast-fed babies (or those taking breast 

milk from a bottle) may feed more often than formula fed babies.

Bottle feeding supplies

• Baby bottles and caps

• Nipples

• Bottle and nipple brush

• Measuring cups
206 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 207

Safety Tips for Baby

• General

– Never shake or toss your baby in the air - it can cause brain damage, 

blindness or even death.

– Be sure anyone having direct contact with your baby always washes their 

hands first.

– Have your infant seen by a pediatric provider at 2 weeks, 2 months, 4 

months, 6 months, 9 months and 1 year of age.

– Avoid direct sun exposure during the first few months of life.

– Never leave a baby unattended in any water. One inch of water is enough 

for a baby to drown in.

– Never leave baby alone on any surface above the floor. Don’t put your baby 

in an infant seat on the counter or table.

– Never hang anything on baby’s stroller as this can cause it to tip over. 

• Sleeping

– Always place baby on his or her back to sleep.

– Infants must sleep on a firm surface, such as a safety approved crib mattress 

covered by a fitted sheet. Never place your infant on pillows, quilts, 

sheepskins, or other soft surfaces.

– Keep soft objects, toys, and loose bedding out of the infant’s sleep area. 

Never use a pillow in the crib.

– Do not allow smoking around the infant.

– The infant should not sleep in a bed or on a couch/arm chair with adults or 

other children. The infant may sleep in the same room as you.

– You may offer a clean, dry pacifier when placing the infant down to sleep, 

but don’t force the infant to take it. For the strictly breastfed infant, a pacifier 

may be introduced when a good breastfeeding pattern has been established.

– Avoid products that claim to reduce the incidents of Sudden Infant Death 

Syndrome (SIDS) because most have not been tested for effectiveness or 

safety.

– Crib slats should be no farther apart than 2 inches (6 cm).

– Keep crib away from drapery and blind cords, heaters, wall decorations, 

and other potential hazards.

– Keep mobiles and other crib toys out of baby’s reach.

– Never give a baby a bottle in the bed.
208 Prenatal Information Sheet: Resources

• Car Seat Safety

– Infant should be in a properly installed, safety approved car seat when 

vehicle is moving - never in your arms.

– Never place a rear facing seat in front of a passenger side airbag.

– Infants must ride in the back seat facing the rear until at least one year of 

age.

– Have a certified passenger safety technician check your car seat installation.

• Feeding

– Never prop a bottle or leave baby alone with a bottle.

– Do not microwave baby’s bottle.

– Never attach a pacifier around baby’s neck.

– Shake or stir all bottles and food before giving to baby.
Prenatal Information Sheet: Resources 209

Common Terms

Analgesia 

Medication used to reduce your ability to feel pain. 

Anemia 

Condition in which your blood has decreased oxygen carrying ability as a result 

of low number of cells (hematocrit) or a decrease in hemoglobin. Adequate intake 

of iron in the diet can help prevent iron deficiency anemia. 

Anesthesia 

Medication that causes a loss of feeling or sensation. 

Amniocentesis 

With the help of an ultrasound, a needle is inserted through your abdomen into 

your uterus and a small sample of amniotic fluid from the amniotic sac is taken to 

test for several genetic problems, as well as, for your baby’s lung maturity. This test 

is usually performed between 16 and 20 weeks on women with risks for genetic 

problems. May be performed near due date when testing for maturity of baby’s 

lungs. 

Amniotic Sac 

Fluid filled, thin-walled sac in which the fetus develops that is often called the “bag 

of waters.” This sac protects the baby from injury and regulates its temperature. 

Aneuploidy 

A chromosomal abnormality where there are either extra or missing 

chromosome(s). This is a common cause of genetic disorders (birth defects). Occurs 

very early in pregnancy during cell division if chromosomes do not separate 

properly. Down Syndrome is a form of aneuploidy.

Antepartum 

The period of time from conception to labor.

Antibody 

Substance in blood that is produced in response to foreign protein to develop 

immunity. 

Antigen 

Substance that can induce an immune response and cause the production of an 

antibody.

Anus 

Opening of the rectum located behind the vagina.

Asymptomatic Bacteriuria (ASB) 

Bacteria in urine that does not cause any signs or symptoms of an infection. 

Occurs in two to seven percent of pregnant women and can lead to complications 

in pregnancy such as pre-term delivery and low birth weight babies. You are 

checked for this by a urine test at your first visit. 

Bloody Show 

Bloody discharge of mucus, which forms in the cervix and is expelled right before 

or at the beginning of labor.
210 Prenatal Information Sheet: Resources

Braxton-Hicks Contractions (False Labor) 

Irregular tightening of the uterus you may feel as your body prepares for delivery; 

may be felt weeks before labor.

Cervix 

The neck or opening of the uterus through which the baby passes during the birth 

process. The cervix projects into the vagina and is made up of mainly fibrous 

tissue and muscle. Labor contractions result in effacement (thinning or shortening) 

and dilatation (opening) of the cervix. 

Cesarean Delivery (also referred to as Cesarean Section or Birth) 

A surgical procedure where the baby is delivered through an incision in the 

mother’s lower abdomen rather than through the vagina. Cesarean deliveries may 

be planned, unplanned or emergency. If you have had a prior cesarean delivery, 

you may be able to deliver future babies vaginally if your provider and hospital 

offer this service.

Chlamydia 

Sexually transmitted infection that can cause pelvic inflammatory disease, 

infertility, and problems during pregnancy. This is tested for at your 10 - 12 week 

appointment through a speculum (pelvic) exam and can be treated with antibiotics. 

Chorionic Villus Sampling (CVS) 

This procedure tests for the same genetic problems as an amniocentesis but it is 

performed earlier in your pregnancy (usually between your 10th and 14th week). 

With the help of an ultrasound to see inside your uterus, a needle is inserted 

through your abdomen and into your uterus to take a small sample of cells from the 

placenta for testing. The risks involved include a 1/10 to less than 1/1000 risk of 

miscarriage. There is also a risk of limb defects (especially when done before 10 

weeks gestation). 

Contraction 

The shortening and tightening of the uterus, which results in the dilation (opening) 

and effacement (thinning or shortening) of the cervix.

Crowning 

The bulging out of the perineum as the baby’s head or presenting part presses 

against it at time of delivery. 

Cystic Fibrosis 

A genetic disease that is inherited from both parents and causes life-long illness 

affecting breathing and digestion. A blood test can tell if you or the baby’s father 

carries this trait. If both of you carry the Cystic Fibrosis trait, your baby has a 25% 

chance of acquiring the disease. Usually the woman is tested first; then, if positive, 

the father of the baby will be tested. You may sign a consent form to have this test 

performed. 

Doppler 

Device that allows your baby’s heartbeat to be heard through a speaker.

Doula 

An assistant who provides various forms of non-medical support to women in childbirth process. 
Prenatal Information Sheet: Resources 211

Down Syndrome (Trisomy 21) 

Genetic disorder caused by the presence of an extra chromosome and 

characterized by mental retardation, abnormal features of the face, and medical 

problems such as heart defects. Chances of your baby carrying this disorder 

increase with increasing age of the mom. This can be tested for between 15 and 

20 weeks of your pregnancy with the Maternal Serum Analyte Screen. 

Elective Repeat Cesarean Delivery

A planned cesarean delivery in a woman who has had one or more prior 

cesarean deliveries. The delivery may or may not be scheduled. 

Embryo 

The developing organism from about two weeks after fertilization to the end of the 

seventh or eighth week.

Epidural 

Type of regional anesthesia in which medication is inserted into the spinal space 

through a small plastic tube. 

Estriol 

Hormone made by the placenta and the fetal liver. The estriol level is measured as 

part of the Maternal Serum Analyte Screen (Triple or Quad Screen).

Fetus 

A developing baby in the uterus after the eighth week of gestation until birth. 

Forceps 

An instrument placed on both sides of the baby’s head, while in the birth canal, to 

gently guide the baby out if needed. 

Fundal Height 

Measurement from the pubic bone to the top of the uterus (fundus). Routinely used 

to measure the growth of the baby in the uterus from 20 to 36 weeks gestation. 

Gestation 

Development of the new baby within the uterus from conception to birth. 

Gestational Hypertension

A condition associated with the terms pre-eclampsia or toxemia. This is high blood 

pressure that develops during pregnancy. High blood pressure during pregnancy 

may cause many complications for both mother and baby. Some of the biggest 

concerns include pre-eclampsia, eclampsia and placental abruption (when 

placenta pulls off uterus prior to birth). You will be monitored for this condition 

throughout your pregnancy with blood pressure checks at each visit and lab work, 

if needed.

Gonorrhea (GC, the clap) 

Sexually transmitted infection that may lead to pelvic inflammatory disease, 

infertility, and arthritis. It is tested at your 10 to 12 week visit by taking a sample 

of your vaginal secretions. It can be treated with antibiotics.
212 Prenatal Information Sheet: Resources

Group B Streptococcus (GBS) 

A bacteria commonly found in the vagina and the rectum. GBS grows in the 

vagina or rectum in about 10 - 40% of women and rarely causes symptoms. In 

pregnancy, it can increase your chances of infection of your amniotic fluid and 

serious infection in your baby. A different type of streptococcus bacteria causes the 

condition known as “strep throat.” To find out if you have any GBS, vaginal and 

rectal secretions are collected between the 35th and 37th week of your pregnancy. 

If you are found to have GBS, antibiotics during your labor are given to protect 

your baby from these bacteria. 

Hematocrit 

Blood test that measures the number of cells in your blood. This test shows whether 

you are anemic (low in iron). 

Hemoglobin 

Blood test that measures your oxygen carrying ability of your blood and gives 

information on whether you are anemic (low in iron).

Hepatitis B Virus 

Attacks and damages the liver, causing inflammation, cirrhosis, and chronic 

hepatitis that can lead to cancer. This is tested for at your first prenatal visit. It 

can be transmitted to your baby and infect the baby. If you think you have been 

exposed to this you will be tested, and given a vaccine. If you have the disease, 

you will receive treatment that greatly reduces your baby’s risk of getting the 

disease. 

Human Immunodeficiency Virus (HIV) 

Attacks certain cells of the body’s immune system and causes Acquired ImmunoDeficiency Syndrome (AIDS). There is a blood test which can be drawn at your 

first prenatal visit to determine if you have the disease. If you test positive, you can 

receive treatment that can greatly reduce the baby’s risk of getting the infection. 

Human Papilloma Virus (HPV) 

Sexually transmitted infection characterized by soft wart like growths on the 

genitalia. Commonly referred to as genital warts. Pregnancy can cause warts to 

increase in size or appear for the first time. Usually no treatment is needed and 

they go away on their own after the delivery. If the warts grow very large and 

obstruct the birth canal, treatment and/or cesarean section may be needed. HPV 

infection can also be without symptoms and only show up years later as a result of 

a pap test. Certain strains of HPV have been linked to increased cervical cancer. 

Induction of Labor 

Artificially cause labor to start by giving medications such as Pitocin or 

prostaglandin or rupturing the bag of water.

Iso-immunization 

Occurs when an Rh (D-)negative mom develops antibodies to her baby’s Rh (D)

positive blood. RhoGAM injection prevents this from occurring to protect the baby 

and future pregnancies. 
Prenatal Information Sheet: Resources 213

Labor 

The series of uterine contractions that dilate (open) and efface (thin out) the cervix 

for birth.

Libido 

Sexual desire.

Maternal Serum Analyte Screen 

Group of blood tests, also known as a Quad Screen, that check for substances 

linked with certain birth defects such as Down Syndrome (Trisomy 21), neural tube 

defects, Edwards Syndrome (Trisomy 18) and other related birth defects. The test is 

done during the 15th to 21st week of your pregnancy. If you get an abnormal test 

result, your pregnancy will be further evaluated. This test has many false positives.

Maturation 

Achievement of full development or growth.

Meconium 

Baby’s first bowel movement, usually passed after birth. When it is passed before 

birth, it stains the amniotic fluid and may be a sign of fetal stress or fetal maturity. 

When this occurs, it is referred to as meconium staining.

Mucous Plug

A collection of cervical mucus that seals the opening of the cervix. It keeps 

bacteria from entering into the cervix, providing a protective barrier for the baby. 

As the cervix opens, the mucous plug may fall out. It may be noticed as a thick 

glob of stringy mucous, usually thicker than what is seen with normal vaginal 

secretions. Some women will lose their mucous plug or part of their mucous plug 

weeks before they go into labor. Losing the mucous plug does not always mean 

labor will begin shortly. Women with a history of preterm labor, or who have 

blood tinged mucus before 36 weeks should call their provider right away. After 

36 weeks, loss of the mucous plug is of no concern.

Neonatology

Branch of medicine that specializes in the care of ill or premature newborns.

Neural Tube Defects (NTDs) 

Birth defects that result from improper development of the brain, spinal cord, 

or their coverings. This can be tested for between 15 and 21 weeks in your 

pregnancy with a Maternal Serum Analyte Screen blood test. 

Non-Reassuring Fetal Heart Rate 

Fetal heart rate pattern changes that raise concern that baby may not be getting 

enough oxygen. 

Pap Test 

Cells are taken from the cervix and vagina by gentle scraping and examined to 

check for abnormalities that may lead to cervical cancer. 

Perinatologist (Maternal Fetal Medicine Specialist) 

Obstetrician with specialized training to provide care for women with complicated 

pregnancies.
214 Prenatal Information Sheet: Resources

Perineum 

The surface area between the vagina and anus in females; between the scrotum 

and anus in males.

Placenta (Afterbirth) 

An organ of pregnancy attached to the wall of the uterus where oxygen, nutrients, 

and waste exchange takes place between the mother and fetus. It usually delivers 

within 30 minutes of the baby’s birth. 

Postpartum 

The 6-week period following childbirth.

Pre-Eclampsia

A condition in pregnancy when blood pressure rises and protein in the urine 

increases. This increases the risk of seizure and other complications in the mother. 

Quad Screen - see Maternal Serum Analyte Screen

RhoGAM®

A medication given through an injection (shot) at 28 weeks to Rh (D-) negative 

women to prevent iso-immunization. If baby is Rh (D) positive, the new mother will 

receive another injection after delivery. 

Rubella Test 

Blood test taken at your first visit to see if you are protected against Rubella 

(German measles). If you are not protected against this disease, you are 

encouraged to avoid anyone who has or may have this disease. You are also 

encouraged to get immunized against this disease after you deliver.

Sexually Transmitted Infection (STI) 

An infection spread by sexual contact: Gonorrhea, Syphilis, Chlamydia, HIV, HPV, 

Hepatitis B, Trichomonas, and Herpes Simplex Virus (HSV). 

Syphilis 

Sexually transmitted infection that is caused by an organism called Treponema 

Palladium; it may cause major health problems or death in its later stages. The 

blood test is taken at your first prenatal visit. 

Trial of Labor (TOL) 

A planned attempt to labor in a woman who has had a previous cesarean 

delivery, also known as trial of labor after cesarean (TOLAC).

Ultrasound 

Through the use of sound waves, this technology gives a live black and white 

picture of your baby. Routinely performed at 18 - 22 weeks gestation to screen for 

problems and confirm your due date.

Umbilical Cord 

A fetal structure that connects the fetus to the placenta; contains two arteries and 

one vein to provide blood flow between the fetus and placenta.

Unsuccessful Trial of Labor 

Delivery by cesarean in a woman who has had a trial of labor - sometimes 

referred to as a “failed” trial of labor. 
Prenatal Information Sheet: Resources 215

Uterus (womb) 

The hollow muscular organ in which an unborn baby develops and grows. The 

muscles of the uterus contract during labor and help push the baby out through the 

vagina.

Vacuum Extraction 

Assist with delivery of baby out of the birth canal with application of a metal or 

plastic cup to baby’s head with suction from a wall or portable suction machine.

Vagina 

Lower part of the birth canal behind the bladder and in front of the rectum.

Vaginal Birth after Cesarean Delivery (VBAC) 

Vaginal delivery after a trial of labor by a woman who has had a previous 

cesarean delivery.

VDRL (Venereal Disease Research Laboratory - also called RPR) 

Blood tests taken at your first visit to screen for Syphilis, a sexually transmitted 

infection. If you test is positive, you will be offered treatment and the risk to your 

baby will be discussed with you.
216 Prenatal Information Sheet: Resources

Types of Providers

Anesthesiologist 

A physician specialized in pain relief. 

Certified Nurse Midwife (CNM)

A registered nurse with a Master’s degree and certification by the American 

Midwifery Certification Board. Nurse midwifery practice is the independent 

management of women’s health care that focuses on pregnancy, childbirth, the 

postpartum period, newborn care, family planning, and the gynecological needs 

of women with an emphasis on education and health promotion. 

Family Nurse Practitioner (FNP)

A registered nurse with advanced degrees specializing in the treatment and care 

for patients of all ages. FNPs can provide prenatal care and coordinate care with 

a physician for delivery of the baby. FNPs do not deliver babies.

Family Practice (FP) Physician

A physician specially trained to provide medical care to patients of all ages, 

diagnose and treat all illnesses. They provide prenatal care and delivery services.

Genetic Counselor 

A health professional with specialized education and experience in the areas of 

medical genetics and counseling. They provide information and support to families 

who may be at risk for inherited conditions or who have members with birth 

defects or genetic disorders. 

Maternal Fetal Medicine (MFM) Specialist 

An obstetrician with advanced education in maternal-fetal medicine. This 

education provides additional competence in managing various obstetrical, 

medical, and surgical complications of pregnancy. The relationship and referral 

patterns between Obstetrician-Gynecologists and MFM specialists will depend on 

the acuity of the patient’s condition and local circumstances.

OB/GYN Physician

A physician specialized in the area of Obstetrics and Gynecology. He or she can 

provide routine or complicated care and can provide surgical services as needed. 

Neonatologist

A pediatrician specialized in the care of newborns.

Nurse Anesthetist

A registered nurse with advanced training and specialization in pain relief.

Pediatrician

A physician specialized in the care of infants and children.
Prenatal Information Sheet: Resources 217

Physician Assistant (PA) 

A healthcare professional licensed to practice medicine with supervision of a 

licensed physician. They perform physical exams, diagnose and treat illnesses, 

order and interpret tests, counsel on preventive health care, assist in surgery, and 

write prescriptions. They may provide prenatal care but do not delivery babies. 

Resident

A physician who has graduated from medical school and is in training at a 

teaching hospital. 

Social Worker 

Social workers are educationally prepared to assist families or individuals in 

coping with and solving problems. This is often done by assisting clients to obtain 

services or navigate through complex systems. They may also provide counseling 

and psychotherapy.

Women’s Health Nurse Practitioner (WHNP)

A registered nurse with an advanced degree specializing in the care of women 

throughout their life-span, including prenatal, contraception, and menopause. 

They can provide routine prenatal care and postpartum care, with an emphasis on 

education and health promotion. WHNPs do not deliver babies.

In addition to the providers listed above, throughout your prenatal experience 

you will encounter a variety of staff members working to assist you. They may be 

registered nurses, including ambulatory, perinatal, and postpartum nurses, licensed 

vocational nurses, medical assistants, corpsmen, and clerical support staff. They 

work to assist with your needs as their qualifications allow.
218 Prenatal Information Sheet: Resources

Notes:
Prenatal Information Sheet: Resources 219

EPDS - Complete at Postpartum Visit

Name: ________________________________________________ Date _______________ 

As you will soon have a baby, we would like to know how you are feeling. Please CIRCLE 

the answer which comes closest to how you have felt IN THE PAST 7 DAYS, not just how 

you feel today. 

 1. I have been able to laugh and see the funny side of things.

 0 As much as I always could 2 Definitely not so much now 

 1 Not quite so much now 3 Not at all 

 2. I have looked forward with enjoyment to things.

 0 As much as I ever did 2 Definitely less than I used to

 1 Rather less than I used to 3 Hardly at all 

 3. I have blamed myself unnecessarily when things went wrong.

 3 Yes, most of the time 1 Not very often

 2 Yes, some of the time 0 No, never 

 4. I have been anxious or worried for no good reason. 

 0 No, not at all 2 Yes, sometimes

 1 Hardly ever 3 Yes, very often 

 5. I have felt scared or panicky for no very good reason. 

 3 Yes, quite a lot 1 No, not much 

 2 Yes, sometimes 0 No, not at all 

 6. Things have been getting on top of me. 

 3 Yes, most of the time I haven’t been able to cope at all 

 2 Yes, sometimes I haven’t been coping as well as usual 

 1 No, most of the time I have coped quite well 

 0 No, I have been coping as well as ever 

 7. I have been so unhappy that I have had difficulty sleeping. 

 3 Yes, most of the time 1 Not very often

 2 Yes, sometimes 0 No, not at all 

 8. I have felt sad or miserable. 

 3 Yes, most of the time 1 Not very often

 2 Yes, quite often 0 No, not at all 

 9. I have been so unhappy that I have been crying.

 3 Yes, most of the time 1 Only occasionally

 2 Yes, quite often 0 No, never 

10. The thought of harming myself has occurred to me. 

 3 Yes, quite often 1 Hardly ever

 2 Sometimes 0 Never 

Adapted from: Cox JL, Holden JM & Sagovsky R (1987). Detection of postnatal depression: 

Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. 

Prenatal Information Sheet: Resources 221

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