Pregnancy

If you are pregnant or even just thinking about it, now is the 

time to begin caring for your unborn baby. Doing so involves 

caring for your own health both before and during pregnancy. 

It also involves learning about important pregnancy topics 

and milestones. Taking these steps will help you to have a safe 

pregnancy and healthy baby. Also, knowing what to expect will 

help to ease any worries you might have so you can enjoy this 

exciting time. 

Your health before pregnancy

The chances of having a safe pregnancy 

and healthy baby are best when pregnancy is planned. This way, you can take action early on to prevent health problems 

that might affect you or your baby later. 

If you are sexually active, talk to your 

doctor about your preconception health. 

Be sure to discuss your partner’s health, 

too. Ask your doctor about:

l	 Family planning and birth control.

l	 Taking folic acid.

l	 Vaccines you may need.

l	 Managing health problems such as 

diabetes, high blood pressure, thyroid 

disease, obesity, depression, eating 

disorders, and asthma. Find out how 

Pregnancy 169

Preconception Health

This is a woman’s health before she 

becomes pregnant. It means knowing 

how health problems and risk factors 

could affect a woman or her baby if 

she becomes pregnant.

pregnancy may affect, or be affected by, 

health problems you have.

l	 Tests for hepatitis, HIV, and other 

sexually transmitted infections (STIs).

l	 Medicines you use, including overthe-counter, herbal, and prescription 

drugs and supplements.
170 The Healthy Woman: A Complete Guide for All Ages

Unplanned Pregnancy

If you have an unplanned pregnancy, 

start taking care of yourself right away. 

You will feel good knowing that you 

are doing all you can to care for your 

unborn baby.

l	 Ways to improve your overall health, 

such as reaching a healthy weight, 

making healthy food choices, being physically active, caring for your 

teeth and gums, quitting smoking, and 

avoiding alcohol.

l	 How to avoid illness. Some infections, like cytomegalovirus (SEYEtoh-MEG-uh-loh-VEYE-ruhss), can 

cause birth defects.

l	 Health problems that run in your family, such as phenylketonuria (fee-nuhlkee-toh-NUR-ee-uh) (PKU) or sickle 

cell anemia (uh-NEE-mee-uh). (See 

page 408 of the Appendix for more 

information about genetic testing and 

working with a genetic counselor.)

l	 Problems you have had with prior 

pregnancies.

Becoming pregnant

You are most likely to become pregnant 

if you have sex just before or just after 

ovulation. Most women ovulate between 

day 11 and day 21 of their menstrual 

cycle. Count day one as the first day of 

your last normal period. Most couples 

who are trying are able to conceive 

within 1 year. If you think you might be 

pregnant, you can take a home pregnancy 

test 1 to 2 weeks after a missed period. 

Your doctor can confirm pregnancy with 

a blood test and pelvic exam.

For at least 3 months before and throughout your pregnancy:

• Get 400 micrograms of folic acid daily to lower the risk 

of certain birth defects, including spina bifida. Folic acid 

pills are best. You can also take a multivitamin that contains at least 400 micrograms of folic acid or eat foods 

with folic acid.

• Stop alcohol, tobacco, and drug use, which can harm 

your baby. Only use medicines your doctor says are okay.

• Eat healthy foods like fruits, vegetables, whole grains, 

calcium-rich foods, and lean meats.

• Drink extra fluids, especially water.

• Try to control stress and keep active. Set limits and get plenty of sleep. Talk with 

your doctor about safe ways for you to stay fit during pregnancy.

• Avoid exposure to unsafe substances, including lead, mercury, arsenic, cadmium, 

pesticides, solvents, some household chemicals, and cat and rodent feces. Exposure to some toxins and substances that carry infection can harm your unborn 

baby or increase the risk of miscarriage, preterm birth, and other pregnancy problems. To be safe, check product labels for warnings and ask your doctor how you 

can protect yourself from unsafe substances found in your workplace or home.
Pregnancy 171

For more information on your reproductive system, see the Reproductive 

Health chapter on page 153.

Infertility

Some women want children but either 

can’t conceive or keep miscarrying. This 

is called infertility. Both women and 

men can have fertility problems. Many 

things can affect fertility, including stress, 

smoking, STIs, and other health problems. Also, the older a woman becomes, 

the harder it is for her to get pregnant. 

Talk to your doctor if you have not been 

able to conceive after 1 year of trying, or 

after 6 months if you are 35 or older.

Happily, doctors are able to help many 

infertile couples go on to have babies. 

Treatment can include:

l	 lifestyle changes, such as reducing 

stress

l	 medicine, such as those to help women 

ovulate

l	 surgery to repair reproductive organs

l	 assisted reproductive technology, such 

as in vitro fertilization

Infertility can be stressful, tiring, and expensive. Many couples find that support 

groups or counseling can help them to 

cope.

Prenatal care

Medical checkups help keep you and 

your baby healthy during pregnancy. At 

your first visit your doctor will perform 

a full physical exam, take your blood for 

lab work, and calculate your due date. 

Typically, routine checkups occur: 

l	 once each month for weeks 4 through 

28

l	 twice a month for weeks 25 through 36

l	 weekly for weeks 36 to birth

At each visit, your doctor will check your 

blood pressure and weight. Once you 

begin to show, your doctor will measure your abdomen to check your baby’s 

growth.

You also will have some routine tests. 

Some tests are suggested for all women, 

such as blood work to check for anemia, 

your blood type, HIV, and other factors. 

Most women have a glucose challenge 

screening at 26 to 28 weeks or earlier 

to check risk of gestational (jess-TAYshuhn-uhl) diabetes. (See page 180 for 

more information.) Before delivery, your 

Ectopic (ek-TOP-ihk) 

Pregnancy

This happens when a fertilized egg 

implants outside the uterus, usually 

in the fallopian tube. It is a medical 

emergency. Get medical care right 

away if you have these signs:

• abdominal pain 

• shoulder pain 

• vaginal bleeding

• feeling dizzy or faint

With ectopic pregnancy, the egg cannot develop. Drugs or surgery are used 

to remove the ectopic tissue so that 

your organs are not damaged. Many 

women who have had ectopic pregnancies go on to have healthy pregnancies later.
172 The Healthy Woman: A Complete Guide for All Ages

doctor also will test you for group B 

strep, harmful bacteria that your doctor 

can treat to prevent passing them to your 

baby during labor.

Other tests might be offered based on:

l	 your age

l	 your personal or family health history

l	 your ethnic background

l	 the results of routine tests you have had

Some tests are screening tests. These 

detect risks for or signs of possible health 

problems in you or your baby. One common example is an ultrasound. This tool 

allows your doctor to view your baby’s 

organ and body systems through the use 

of sound waves. Based on screening test 

results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or 

rule out health problems in you or your 

baby. Genetic disorders and certain birth 

Stages of Pregnancy

Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three “trimesters” (TREYE-mess-turs).*

First trimester (week 1–week 

12)—All the major organs are 

formed. The eyes and ears are 

in position. If you push on your 

abdomen, your baby moves. 

At week 12 your baby is about 

3 inches long and weighs less 

than an ounce.

Second trimester (week 13–

week 28)—Essential organs 

begin to function. Fingers, 

toes, eyelashes, and eyebrows 

develop. Your baby can suck 

his or her thumb. At week 24, 

your baby is about 11⁄2 pounds 

and 12 inches long.

Third trimester (week 

29–week 40)—Kicks become 

more frequent. Your baby 

gains about half a pound per 

week. You might notice the 

baby “dropping,” or moving 

lower in your abdomen.

*According to the American College of Obstetricians and Gynecologists.
Pregnancy 173

defects are examples of health problems that might be confirmed or ruled 

out with diagnostic tests while you are 

pregnant. An amniocentesis (AM-neeoh-sen-TEE-suhss) is an example of a 

diagnostic test.

Talk to your doctor if you don’t understand or are concerned about any tests 

suggested for you. Your doctor also can 

explain what your test results mean and 

possible next steps if a problem is found. 

Keep in mind that women who get early 

and regular prenatal care have healthier 

pregnancies and babies.

High-risk pregnancies

Pregnancies with greater chance of complications are called “high-risk.” But this 

doesn’t mean there will be problems. The 

following factors may increase the risk of 

problems during pregnancy: 

l	 being very young or older than 35

l	 overweight or underweight

l	 problems in previous pregnancy

l	 health conditions (high blood pressure, 

diabetes, or HIV)

l	 being pregnant with twins or other 

multiples

Health problems also may develop during a pregnancy, which make it high-risk. 

Women with high-risk pregnancies need 

prenatal care more often and sometimes 

from a specially trained doctor. 

Eating for two

Eat a variety of healthy foods and drink 

plenty of water during pregnancy. Pregnant women need more protein, iron, 

calcium, folic acid, and fluids than at 

other times. Ask your doctor about:

l	 How much weight you need to gain 

and your calorie needs. This will depend on your pre-pregnancy weight.

l	 Taking prenatal vitamins.

l	 Whether drinking caffeine is okay for 

you. Small amounts of caffeine (about 

one 12-ounce cup of coffee) appear to 

be safe during pregnancy. But the effects of too much caffeine are unclear.

Also, talk with your doctor about special 

diet needs: 

l	 Diabetes—Review your meal plan and 

insulin needs with your doctor. High 

blood glucose can be harmful to your 

baby. (See page 69 of the Diabetes

chapter for information on diabetes.)

l	 Lactose intolerance—Find out about 

low-lactose or reduced-lactose products and calcium supplements.

l	 Vegetarian—Ensure that you are eating enough protein, iron, vitamin B12, 

and vitamin D.

l	 PKU—Keep good control of phenylalanine levels in your diet.

You can learn more about what kinds 

and how much food you should eat while 

pregnant at the MyPyramid for Pregnancy and Breastfeeding Web site listed 

in the resource section on page 185.
174 The Healthy Woman: A Complete Guide for All Ages

Keep You and Your Baby Safe From Food-Borne Illness

Health concern How to lower risk

Listeria (lih-STEER-ee-uh)

This harmful bacteria found in some refrigerated and ready-to-eat foods can cause early 

delivery or miscarriage.

Do not eat:

• Hot dogs or deli meats unless steaming hot

• Refrigerated meat spreads

• Unpasteurized milk

• Store-made salads, such as chicken, egg, or tuna salad

• Unpasteurized soft cheeses, such as unpasteurized feta, 

Brie, queso blanco, queso fresco, and blue cheeses

Toxoplasmosis (TOK-soh-plaz-MOH-suhss) 

Caused by a parasite, this infection can be 

passed to your unborn baby and cause hearing loss, blindness, or mental retardation.

• 

• 

• 

• 

• 

Wash hands with soap after touching soil or raw meat. 

Cook meat completely.

Wash cooking utensils with hot soapy water.

Wash produce before eating.

Don’t clean cats’ litter boxes.

Mercury

Too much of this metal found in some fish 

can harm your baby’s nervous system.

• 

• 

Do not eat shark, swordfish, king mackerel, or tilefish.

Eat only 6 ounces per week of white (albacore) tuna.

Being active

For most pregnant women, physical activity is safe. However, first check with 

your doctor and avoid:

l	 being hit in the abdomen—NO kickboxing, soccer, or basketball

l	 falling—NO horseback riding, 

downhill skiing, or other sports 

that risk falling or require good 

balance

l	 scuba diving

Is it safe to wear a seatbelt 

while pregnant?

Yes—you should always wear a seatbelt. The lap strap should go under 

your belly, across your hips. The shoulder strap should go between your 

breasts and to the side of your belly. 

Make sure it fits snugly.

Having sex 

Unless your doctor tells you otherwise, 

sex is safe. Call your doctor if sex causes 

pain, vaginal bleeding, or fluid leakage. 

You may find that your interest in sex 

changes during pregnancy. Talk to your 

partner about other positions if the way 

you usually have sex is awkward or no 

longer feels good.
Pregnancy 175

Understanding body changes 

Body changes differ for each woman 

and may differ for each pregnancy. 

Many physical and emotional changes 

are normal. Still, tell your doctor about 

any changes you have—they may signal 

problems. 

Body Changes During Pregnancy

Change What might help

Body aches • Back, abdomen, groin, and thigh 

pain

• 

• 

Lie down. 

Rest. 

• Apply heat.

Breast 

changes 

• 

• 

Heavy and tender breasts

Leaking breast “pre-milk” 

• 

• 

Wear a maternity bra with good support.

Put pads in bra to absorb leakage.

Constipation • Hard, dry stool • Drink 8 to 10 glasses of water daily. 

• Fewer than 3 bowel movements • Don’t drink caffeine.

per week • Eat fiber-rich foods.

• Painful bowel movements • Try mild physical activity.

Digestive problems• 

• 

• 

• 

Nausea and vomiting, called 

“morning sickness,” but often occurring at other times of day

Bloating 

Indigestion 

Heartburn

• 

• 

• 

• 

• 

Ca

wh

Eat 6 to 8 small meals—eat slowly.

Don’t eat greasy or fried foods. 

Eat dry toast, saltines, or dry cereals.

Drink club soda between, but not with, meals. 

Take small sips of milk or eat ice chips.

ll your doctor if you have flu-like symptoms, 

ich may signal a more serious condition.

Dizziness • Feeling faint or dizzy • Stand up slowly. 

• Avoid standing for too long.

• Don’t skip meals.

• Lie on your left side.

• Wear loose clothing.

Call your doctor if you feel faint and have vaginal 

bleeding or abdominal pain.

Fatigue, sleep 

problems

• 

• 

• 

Tiredness, fatigue

Restless sleep

Trouble falling or staying asleep

• 

• 

Lie on your left side.

Use pillows for support, such as behind your 

back, tucked between your knees, and under 

your tummy.

• Practice good sleep habits. (See pages 27–28 

for more information.)

• Go to bed a little earlier.

• Nap if you are not able to get enough sleep at 

night.

• Drink needed fluids earlier in the day, so you 

can drink less in the hours before bed.
176 The Healthy Woman: A Complete Guide for All Ages

Body Changes During Pregnancy

Change What might help

Hemorrhoids

(HEM-roids)

• Itchiness around anus

• Swelling of veins around anus

• Drink lots of fluids. 

• Eat fiber-rich foods. 

• Try not to strain with bowel movements. 

Itching • Itchiness in abdomen, palms, and 

soles 

• Use gentle soaps and moisturizing creams. If 

symptoms don’t improve after a week, talk to 

your doctor.

• Avoid hot showers and baths.

• Avoid itchy fabrics. 

Leg cramps • Sudden spasms in legs or feet • Gently stretch muscles. 

• Try mild physical activity.

• For sudden cramps, flex your foot forward.

• Ask your doctor about calcium supplements.

Nasal 

problems

• Nosebleeds 

• Stuffiness

• Blow your nose gently. 

• Drink fluids and use a cool mist humidifier.

Call your doctor if bleeds are frequent and do not 

stop in a few minutes. 

Numb or tingling hands

• Feeling of swelling, tingling, and 

numbness in fingers and hands, 

called carpal tunnel syndrome

• Take frequent breaks to rest hands.

• Ask your doctor about fitting you for a splint to 

keep wrists straight. 

Stretch marks, 

skin changes

• Pink, red, or brown streaks on 

thighs, buttocks, abdomen, and 

breasts

• Darker colored nipples

• Line on skin running from belly 

button to pubic hairline

• Patches of darker skin, usually 

over the cheeks, forehead, nose, 

or upper lip. Patches often match 

on both sides of face.

• Be patient—stretch marks and other changes 

usually fade after delivery. 

Swelling 

(edema) 

• Puffiness in face, hands, or ankles • Drink 8 to 10 glasses of fluids daily. 

• Don’t drink caffeine or eat salty foods. 

• Rest and elevate your feet. 

• Ask your doctor about support hose. 

Call your doctor if your hands or feet swell suddenly or you rapidly gain weight—it may be preeclampsia. (See page 179 for more information 

on preeclampsia.)
Pregnancy 177

Body Changes During Pregnancy

Change What might help

Urinary fre- • More frequent need to urinate • Take frequent bathroom breaks.

quency and 

leaking • Leaking of urine when sneezing, 

coughing, or laughing

• Drink plenty of fluids to avoid dehydration. 

• Do Kegel exercises to tone pelvic muscles. 

(See page 256 of the Urologic and Kidney 

Health chapter for information on how to do 

Kegel exercises.)

Call your doctor if you experience burning along 

with frequency of urination—it may be an infection.

Varicose veins • Twisted or bulging veins raised 

above the skin’s surface, usually 

on the legs 

• 

• 

Avoid tight knee-highs. 

Sit with your legs and feet raised.

Mothers of Multiples

Moms of twins and other multiples 

have more severe body changes:

• rapid weight gain in first trimester

• intense nausea and vomiting

• extreme breast tenderness

There also is a greater risk of early 

delivery, low birth weight, and preeclampsia. More frequent prenatal 

visits help to monitor the health of 

mother and babies.

Complications of pregnancy

Complications of pregnancy are health 

problems that occur during pregnancy. 

They can involve the mother’s health, the 

baby’s health, or both. Whether a complication is common or rare, there are 

ways to manage problems that come up 

during pregnancy. Talk to your doctor if 

you have symptoms described in the following chart or if you’re not feeling like 

yourself. Seek medical attention if you 

suspect the baby is moving less or you 

have:

l	 severe headaches or abdominal cramps

l	 bleeding or fluid leaking from your 

vagina

l	 severe and sudden swelling

l	 nausea or vomiting that doesn’t ease

l	 blurred vision or dizziness

l	 fever
178 The Healthy Woman: A Complete Guide for All Ages

Pregnancy Complications

Problem Symptoms Treatments

Anemia

Lower than normal number 

of healthy red blood cells

• Feel tired or weak

• Look pale

• Feel faint

• Shortness of breath

• Take iron and folic acid supplements.

• Monitor iron levels.

Depression

Extreme sadness during 

pregnancy or after birth 

(postpartum)

(See page 215 for more 

information.)

• Intense sadness

• Helplessness and irritability 

• Appetite changes

• Thoughts of harming self or baby

Tell your doctor about any symptoms 

of depression. Seek medical attention 

right away if you have thoughts of harming yourself or your baby.

• Therapy

• Support groups

• Medication 

Fetal problems

Unborn baby has health issue, such as poor growth or 

heart problems.

• Baby moving less

• Baby is smaller than normal for gestational age

• Fewer than 10 kicks per day after 26 

weeks

• Some problems have no symptoms, 

but are found with prenatal tests

• Monitor baby’s health more 

closely until delivered.

• Special care until the baby is 

delivered.

• Early delivery may be required.

Gestational diabetes

Too high blood sugar levels 

during pregnancy

(See page 180 for more 

information.)

• Usually, there are no symptoms. 

Sometimes, extreme thirst, hunger, 

or fatigue

• Tests show high blood sugar levels 

Control blood sugar levels 

through:

• Healthy meal plan from your 

doctor

• Medication (if needed)

Hepatitis B

Viral infection that can be 

passed to baby

There may be no symptoms. Symptoms 

can include: 

• Nausea, vomiting, and diarrhea

• Dark urine and pale bowel movements

• Whites of eyes or skin look yellow 

Lab tests can find out if a mother 

is a carrier of hepatitis B. 

• First dose of hepatitis B vaccine plus HBIG shot given to 

baby at birth

• Second dose of hepatitis B 

vaccine given to baby at 1–2 

months old

• Third dose of hepatitis B vaccine given to baby at 6 months 

old (but not before)

High blood pressure (pregnancy related)

High blood pressure that 

starts after 20 weeks of 

pregnancy and goes away 

after birth

• High blood pressure without other 

signs and symptoms of preeclampsia

• Closely monitor health of 

mother and baby to make sure 

high blood pressure is not preeclampsia. (See below to learn 

more about preeclampsia.)
Pregnancy 179

Pregnancy Complications

Problem Symptoms Treatments

Hyperemesis gravidarum • Nausea that does not go away • Dry foods and fluids if can keep 

(HEYE-pur-EM-ih-suhss gravuh-DAR-uhm)

Severe, persistent nausea 

• Vomiting several times every day

• Weight loss

down

• Sometimes, medication to 

ease nausea

and vomiting during pregnancy—more extreme than 

“morning sickness” 

• Reduced appetite 

• Dehydration

• Feeling faint or fainting

• In extreme cases, hospitalization for IV fluids and medicines

Miscarriage Signs of a miscarriage can include: • In most cases, miscarriage 

Pregnancy loss from natural • Vaginal spotting or bleeding* cannot be prevented. 

causes before 20 weeks. As 

many as 20 percent of preg- • Cramping or abdominal pain • Sometimes, treatment is needed to remove any remaining 

nancies end in miscarriage. • Fluid or tissue passing from the pregnancy tissue in the uterus.

Often, miscarriage occurs 

before a woman even knows 

she is pregnant.

vagina

*Spotting early in pregnancy doesn’t 

mean miscarriage is certain. Still, contact your doctor right away if you have 

any bleeding.

• Counseling can help with emotional healing.

Parvovirus B19 (fifth • Low-grade fever • Rest

disease) • Tiredness • Special care, as needed

Viral infection that can harm 

baby • 

• 

Rash on face, trunk, and limbs 

Painful and swollen joints 

Placental abruption

Placenta separated from 

uterine wall

• 

• 

Vaginal bleeding 

Cramping, abdominal pain, and uterine tenderness

• 

• 

Bed rest 

Special care 

Placenta previa • Painless vaginal bleeding during sec- • Bed rest 

Placenta covers part or en- ond or third trimester • May require hospital care and 

tire opening of cervix inside • For some, no symptoms c-section 

of the uterus

Preeclampsia (pree-ee- • High blood pressure • Deliver baby if near term.

CLAMP-see-uh) • Swelling of hands and face • If too early to deliver baby, 

A condition starting after 

20 weeks of pregnancy that • Too much protein in urine medications and bed rest to lower blood pressure; somecauses high blood pressure • Stomach pain times must stay in hospital 

and problems with the kid- • Blurred vision until safe to deliver baby.

neys and other organs. Also 

called toxemia. • 

• 

Dizziness

Headaches

• 

• 

Monitor health of mother and 

unborn baby.

Medicine to prevent mother 

from having seizures.

Preterm labor • Increased vaginal discharge • Stopping labor with medicine

Going into labor before 37 • Pelvic pressure and cramping • Bed rest

weeks of pregnancy. • 

• 

Back pain radiating to the abdomen

Contractions

• Early delivery (Giving birth 

before 37 weeks is called “preterm birth.”)
180 The Healthy Woman: A Complete Guide for All Ages

Pregnancy Complications

Problem Symptoms Treatments

Urinary tract infection (UTI) • Pain or burning when urinating • Antibiotics

Bacterial infection in urinary • Frequent urination

tract • Pelvis, back, stomach, or side pain

• Shaking, chills, fever, sweats

Uterine fibroids Some women have no symptoms. But • Rest.

Noncancerous tumors that uterine fibroids can cause: • Monitor for miscarriage and 

grow within the wall of the • Pain premature or breech birth.

uterus • Bleeding

• Feeling “full” in lower abdomen

• C-section delivery, if blocking 

birth canal.

Gestational Diabetes

If you have gestational diabetes, pregnancy is causing your blood sugar level to be too 

high. With your doctor’s help, you can keep your blood sugar well controlled. Poorly 

controlled diabetes can increase the risk of:

• preeclampsia

• early delivery

• c-section

• having a big baby, which can complicate delivery

• baby born with low blood sugar, breathing problems, and jaundice

Gestational diabetes usually goes away after delivery. But you are at higher risk of 

developing type 2 diabetes later in life. A healthy lifestyle can lower this risk. If you 

want to get pregnant again, have a blood sugar test up to 3 months before becoming 

pregnant to make sure your blood sugar levels are normal. High blood sugar early in 

pregnancy increases the risk of birth defects.

Getting ready for your newborn

Becoming a parent is both a joy and a 

responsibility. Look for a baby book that 

tells how to prepare and care for a newborn. Your doctor’s office might also have 

free patient booklets with this information. Also, take these steps to prepare:

l	 Make sure smoke and carbon monoxide detectors are working.

l	 Take childbirth, parenting, and CPR 

classes.

l	 Select a doctor for your baby.

l	 Buy a car seat and crib with mattress.

l	 Childproof your home.

In the United States, the preterm 

birth rate has been on the rise since 

1990. About 1 in 8 babies is born 

early. Researchers are trying to find 

out why and how to prevent preterm 

birth.
Pregnancy 181

Kegel Exercises

Doing Kegel exercises while pregnant 

can help control bladder leakage and 

lowers your chance of getting hemorrhoids. Toning pelvic muscles also will 

help you to push during delivery and 

recover from childbirth. For information on learning to do Kegel exercises, 

see page 256.

Preparing for delivery

Labor and delivery will be less stressful if 

you plan ahead. To get ready:

l	 Decide where you will deliver. Most 

women deliver in a hospital or birthing center. Contact your health plan 

to learn your options. Visit the facility 

beforehand—note directions, parking, 

and where to check in.

l	 Find out how to reach the doctor 

when you are in labor.

l	 Ask your doctor about what to expect 

during labor. If you are worried about 

pain, ask about ways to manage pain 

during labor. Some women do fine 

with natural childbirth. Others are 

helped by epidural or pain medicines.

How do I know if 

contractions are real labor?

It is common to have Braxton Hicks, 

or “practice,” contractions in the last 

weeks of pregnancy or earlier. The 

tightening of your uterus might startle 

you. But these contractions are not in 

a regular pattern, and they taper off 

and go away. If you are unsure whether contractions are real labor, time 

them. If they become regular, stronger, 

or more frequent, call your doctor.

l	 Discuss how to care for your newborn, 

including deciding about breastfeeding 

or bottle-feeding, and circumcision if 

you have a boy. (See page 187 for more 

information.)

l	 Pack a bag with your health insurance 

card, bras and nursing pads, nursing 

pillows, sleeping clothes, toiletries, and 

going-home outfits for you and your 

baby.

Signs of labor

Call your doctor right away if you have 

any of these signs of labor:

l	 contractions becoming stronger at regular and increasingly shorter intervals 

l	 lower back pain and constant 

cramping

l	 water breaking

l	 bloody mucus discharge

Labor occurs in three stages. How labor 

progresses and how long it lasts are different for every woman. The first stage 

begins with the onset of labor and ends 

when the cervix is fully opened (dilated). 
182 The Healthy Woman: A Complete Guide for All Ages

Many women spend the early part of 

labor at home. Your doctor will tell you 

when to go to the hospital or birthing 

center. The second stage involves pushing 

and delivery of your baby. Pushing is hard 

work, and a support person can really 

help keep you focused. The third stage 

involves delivery of the placenta (afterbirth). Once the placenta is delivered, you 

can rest and enjoy your newborn.

Types of deliveries

The baby’s position and your and your 

baby’s health will determine how you 

will deliver your baby. You and your doctor will discuss the best options for you. 

Some terms used during labor and delivery include:

l	 Vaginal birth—as the head appears, 

the doctor guides the baby through the 

birth canal. Your doctor may make a 

small cut, called episiotomy (uh-peezee-OT-oh-mee), near the canal.

l	 Cesarean section (c-section)—surgery 

to deliver the baby. The doctor removes 

the baby by making a cut in the abdomen and uterus. The surgery is relatively safe for mother and baby. Still, 

it is major surgery and carries risks. It 

also takes longer to recover from a csection than from vaginal birth.

l	 Induced labor—medicines, or other 

methods, are used to jump-start the 

birth process.

l	 Assisted birth—your doctor uses forceps or suction to deliver the baby.

l	 Breech presentation—the baby’s feet 

or buttocks are in position to deliver 

first. The doctor may try to turn the 

baby or suggest a c-section.

Did my water break?

It’s not always easy to know. If your 

water breaks, it could be a gush or a 

slow trickle of amniotic (AM-nee-OTihk) fluid. Let your doctor know the 

time your water breaks and any color 

or odor. Also, call your doctor if you 

think your water broke, but are not 

sure. Often a woman will go into labor 

soon after her water breaks. When this 

doesn’t happen, her doctor may want 

to induce (bring about) labor. This is 

because once your water breaks, your 

risk of getting an infection goes up as 

labor is delayed.

Your newborn

Most newborns weigh between 5 pounds 

8 ounces and 9 pounds 2 ounces. Doctors will examine your baby right away, 

checking temperature, weight, length, 

and head size. Your baby will have several other health tests before leaving the 

hospital.

Before you go home, ask your baby’s 

doctor how to spot problems with your 

baby’s health. Also, pick up your doctor’s 

records or discharge summary, as well as 

your baby’s health records to give to your 

baby’s doctor. Schedule your baby’s first 

doctor’s visit. During this visit, discuss 

vaccines.

Recovering from birth 

It takes time for your body to go back to 

the way it was before pregnancy. During 

your recovery, you may have:

l	 Vaginal discharge called lochia (LOHkee-uh). It is the tissue and blood that 

lined your uterus during pregnancy. It 

is heavy and bright red at first, becom-
Pregnancy 183

ing lighter in flow and color until it 

goes away after a few weeks.

l	 Cramping and constipation.

l	 Swelling in legs and feet. 

l	 Tender breasts that may leak milk.

Your doctor will check your recovery at 

your postpartum visit, about 6 weeks after birth. Ask about resuming normal activities, as well as eating and fitness plans 

At Home: When to Call the 

Doctor

Once home, look out for signs of problems that might need a doctor’s care. 

Call your doctor if you have: 

• unexplained fever

• more vaginal bleeding or you soak 

more than one pad an hour

• more redness and swelling or pus 

from a c-section or episiotomy

• new pain or swelling in legs

• hot-to-the-touch, very red, and sore 

breasts or nipples that are cracked 

and bleeding

• vaginal discharge that smells bad

• pain with urinating or sudden urge 

to urinate

• more pain in the vaginal area

• flu-like symptoms, chest pain, or 

vomiting

• feelings of depression

• thoughts of harming yourself or your 

baby

to return to a healthy weight. Also ask 

your doctor about having sex and birth 

control. Your period could return in 6 to 

8 weeks, or sooner if you do not breastfeed. If you breastfeed, your period might 

not resume for many months. Still, using reliable birth control is the best way 

to prevent pregnancy until you want to 

have another baby.

Many women also feel sadness called 

“baby blues” after having a baby. These 

feelings usually go away quickly. But if 

sadness lasts more than 2 weeks, go see 

your doctor. Don’t wait until your postpartum visit to do so.

Keep in mind that adjusting to a new 

baby takes time, and your daily routines 

will change. Talk to your partner about 

sharing household and family duties. 

Ask for and accept help from family and 

friends. Caring for yourself—both physically and emotionally—will help you 

more fully enjoy your new baby and the 

rewards of motherhood. n
184 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

At the start of my last trimester, my glucose screening test indicated that I might have gestational diabetes. Shortly thereafter, a glucose tolerance test showed definitively 

that I had it. I wasn’t too surprised, as my mother had gestational diabetes during all four 

of her pregnancies. Nevertheless, I felt comforted by my nurse-midwife’s explanation that 

my gestational diabetes could be controlled and it did not mean that I currently had type 

2 diabetes. But I am at risk for type 2 diabetes in the future, so eating right and keeping 

fit will be especially important as I get older. 

Soon, I made plans to meet with a dietitian at a local medical center who 

explained the personal eating plan to 

which I should adhere in order to control the gestational diabetes without 

medication. If the eating plan alone 

didn’t work, I would have medication 

prescribed to me. I was given a monitor 

to test my blood sugar level. 

After the first week, my blood sugar level was not being maintained as needed 

with the eating plan alone, so I was prescribed a dosage of insulin that would 

keep my blood sugar at a safe level 

while not harming the baby. Even with 

the insulin, I needed to follow the same personal eating plan and see my nurse-midwife 

weekly to monitor my health. Together, these steps meant a healthy pregnancy after all. 

I was able to maintain a healthy weight gain. And my son was born after a relatively easy 

labor and delivery at just under 8 pounds—a nice, healthy weight. 

At times it was challenging to stick to my eating plan—especially when I wanted to down 

a whole quart of ice cream—but I am extremely pleased with how everything turned out! I 

even learned a lot about disciplining myself to eat healthier!

Ji

Gaithersburg, Maryland

...my mother had 

gestational diabetes 

during all four of her 

pregnancies.
Pregnancy 185

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/

pregnancy

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

U.S. Department of Agriculture

3101 Park Center Dr, Room 1034

Alexandria, VA 22302-1594

Web site: www.mypyramid.gov/

mypyramidmoms

Phone number: (888) 779-7264

National Center on Birth Defects and 

Developmental Disabilities, CDC

1600 Clifton Rd

Atlanta, GA 30333

Web site: www.cdc.gov/ncbddd 

Phone number: (800) 232-4636, 

(888) 232-6348 TTY

Eunice Kennedy Shriver National 

Institute of Child Health and Human 

Development, NIH

PO Box 3006

Rockville, MD 20847

Web site: www.nichd.nih.gov 

Phone number: (800) 370-2943, 

(888) 320-6942 TTY

Office of Women’s Health, FDA

5600 Fishers Ln

Rockville, MD 20857 

Web site: www.fda.gov/womens 

Phone number: (888) 463-6332

American College of Nurse Midwives

8403 Colesville Rd, Suite 1550 

Silver Spring, MD 20910 

Web site: www.mymidwife.org

American College of Obstetricians and 

Gynecologists

409 12th St SW, PO Box 96920

Washington, DC 20090-6920

Web site: www.acog.org 

Phone number: (202) 863-2518 Resource 

Center

American Pregnancy Association

1425 Greenway Dr, Suite 440

Irving, TX 75038

Web site: www.americanpregnancy.org 

Phone number: (800) 672-2296

American Society for Reproductive 

Medicine

1209 Montgomery Highway

Birmingham, AL 35216-2809

Web site: www.asrm.org

Lamaze International

2025 M St NW, Suite 800

Washington, DC 20036-3309

Web site: www.lamaze.org 

Phone number: (800) 368-4404

March of Dimes

1275 Mamaroneck Ave

White Plains, NY 10605

Web site: www.marchofdimes.com

Postpartum Support International

Web site: www.postpartum.net 

Phone number: (800) 944-4773

RESOLVE: The National Infertility 

Association

8405 Greensboro Dr, Suite 800

McLean, VA 22102-5120 

Web site: www.resolve.org
186 The Healthy Woman: A Complete Guide for All Ages