Pregnancy After 35

Having a baby when you're over 35 can mean more health concerns and extra tests, but it shouldn't be cause for alarm or distress. In fact, nearly 1 in 10 babies are born to women over 35, and the majority are delivered without complications. "Women over 35 are at higher risk for developing high blood pressure and gestational diabetes, but with good prenatal care, they should be off to a healthy start," says Lynn Simpson, M.D., an ob/gyn at Columbia Presbyterian Medical Center in New York City. Here, a look at what older pregnant women should consider:

General health Women this age need to eat properly, exercise, and attend all prenatal appointments. "Since older women tend to be a bit heavier, they should follow a well-balanced diet throughout pregnancy," says Dr. Simpson. Most women need to add about 300 calories to their daily diet.

Testing It's standard for women over 35 to be offered genetic testing, as the risk of chromosomal abnormalities increases at this age. You can usually choose between a chorionic villus sampling (CVS) at 9 to 11 weeks or an amniocentesis at 15 to 16 weeks. (Miscarriage risks are a bit higher with the CVS test.) If the results are positive, further tests or counseling can be arranged, says Maria Hayes, M.D., a reproductive endocrinologist at Oakwood Hospital in Dearborn, Michigan.

Complications Pregnancy in women over 35 can trigger high blood pressure and diabetes, and the risk of preeclampsia (pregnancy-induced hypertension) may also increase. The risk of miscarriage and stillbirth goes up with age as well, possibly due to chromosomal abnormalities or uterine fibroids (benign tumors found in nearly one-quarter of women over 35), which may interfere with fetal development. The incidence of twin births also increases and can cause preterm labor, which occurs in almost half of all multiple pregnancies. Older women have a higher rate of cesarean sections as well, which involve a longer recovery.

Emotions Moms-to-be over 35 are usually ready for the life change that comes with the birth of a baby. Managing the emotions and added strain that may accompany pregnancy, however, is important as high stress levels have been linked to an increased risk of complications. In addition to eating well and exercising, making time to relax should be a priority. Yoga, massage, and leaning on a support network of friends and family will help expectant mothers wind down during this emotionally charged time. 

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Caffeine

Many women are told by their doctors or midwives to limit their caffeine consumption while they are pregnant. Giving up that morning cup (or cups) of coffee may be a struggle for some pregnant women, and many question if it is really necessary to give up caffeine completely while they are pregnant.

The topic is a controversial one and the answer is still under debate. Some studies have shown a slightly higher risk of miscarriage with women who consume more than 300 mg of caffeine a day. Others have shown that babies born to women who consumed more than 500 mg of caffeine a day while pregnant had faster heart and breathing rates, and spent more time awake in the first few days after birth. However, the research is inconclusive and the amounts of caffeine generally used in the studies were vastly greater than what a normal person would consume on a daily basis. The most consistent finding with studies performed on caffeine consumption during pregnancy was a possible association with low birth weights. According to the March of Dimes, high caffeine consumption may slightly increase the risk of preterm labor or low birth weight; and in a fetus who is already experiencing difficulties, this slight increase could make all the difference.

Most experts agree that moderate caffeine consumption is probably safe for a healthy woman experiencing a normal pregnancy. However, decreasing or cutting out caffeine altogether will probably make you feel better because caffeine can cause or exacerbate many common pregnancy-related complaints. Since caffeine is a stimulant, it can cause insomnia, nervousness, and headaches. It can contribute to heartburn because it stimulates the secretion of stomach acid, and it's a diuretic so it will enhance dehydration. It also causes your bones to lose calcium; and contains phenols which impede your body's ability to absorb iron, a nutrient many pregnant women are already lacking.

Coffee and tea are the most obvious culprits for caffeine, but it's also found in chocolate, some soft drinks (including several orange sodas and root beers), energy drinks, and some over-the-counter medications.

Here is a list of common caffeinated foods and beverages and their caffeine content:

Food or Beverage	Quantity	Caffeine Content
Brewed coffee	8 ounces	100-300 mg
Espresso	2 ounces	40-70 mg
Decaffeinated coffee	8 ounces	1-8 mg
Brewed tea	8 ounces	35-175 mg
Green tea	8 ounces	8-30 mg
Instant tea	8 ounces	40-80 mg
Iced tea	12 ounces	65-75 mg
Soft drinks	12-ounce can	30-60 mg
Hot cocoa	8 ounces	3-30 mg
Milk chocolate	1 ounce	1-15 mg
Dark or semisweet chocolate	1 ounce	5-35 mg

If you are a regular coffee, tea or cola drinker and want to kick the habit completely while you are pregnant, ease off gradually. Going cold turkey may cause headaches, fatigue, and lethargy.

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Stages of Child Birth

The stages of childbirth

Approved by the BabyCenter Canada Medical Advisory Board

Last reviewed: October 2010

• The stages of labour
  
• Early phase
  
• Active phase
  
• Transition
  
• Second stage
  
• Third stage
  

The stages of labour

Labour is divided into first, second and third stages. The first stage of labour results in the neck of the womb - the cervix - dilating to a full ten centimetres and consists of early, active, and transitional phases.

Early phase 

The early phase is sometimes called the latent period or pre labour. The uterus starts to contract or tighten regularly. The contractions gradually become more painful, unlike your Braxton Hicks contractions which were irregular and didn't hurt. Each woman has her own rhythm and pace of labour. Some may not even be aware of the very early contractions and are several centimetres dilated before they realize they're in labour. As the cervix begins to open, its position in your pelvis changes, moving forwards. It softens and effaces which means that it gets thinner and springier. Feel your nose: it's firm and muscular. Now feel you lips: they're soft and stretchy. Your cervix starts out firm like your nose, and has to become soft and stretchy like your lips.

What you can do

You'll probably be able to putter around the house, go for a walk, watch a video, take a warm bath, or have a nap. Relax as much as you can. Have lots of snacks, unless you feel sick. Carbohydrate-rich foods are best - bread, potatoes, pasta, raisins. If you find the contractions are hard work, try using massage, relaxation techniques, a warm bath and experiment with positions that you find comfortable.

Active phase

Midwives and doctors say you are in active labour when your cervix has dilated, or opened, to three to four centimetres. Your contractions will be getting stronger and more frequent. They're also getting longer. Eventually they may be coming as frequently as every three to four minutes and lasting 60 to 90 seconds - and feel very intense.

What you can do

The time to go to the hospital or the birth centre is when you and your birth companion feel you would be more relaxed there than at home. If you are having a home birth, phone your midwife when you need some reassurance. Contractions may start to feel as if they are coming one on top of another. Try to work with your body. What is it telling you to do? Would you be more comfortable in a different position? Do you need a drink or some food to give you energy? Would it help to go to the toilet? Do you need more information from your midwife to reassure you?

Breathing exercises and relaxation techniques really come into their own at this point, and your partner can help you remember how to use them. You could try some nitrous oxide to see if it takes the edge off the contractions.

Consider taking a warm shower or bath - warm water can really help ease the pain of labour. Or you may choose to use a birth pool. You hear stories of women who sink into a bath or pool when they're five or six centimetres dilated, relax, and are fully dilated an hour later!

Sometimes, women reach a point in labour when the rate at which their cervix is dilating slows or even stops. Try a change of scenery; a walk down the hospital corridor may help. Ask your partner or doula, if you've hired one, to give you a massage to help you relax. Sometimes a good cry releases the emotional tension and helps you "let go". If your waters haven't broken yet, your midwife may suggest breaking them to see if this will speed labour up. Be aware though that you may find contractions tougher once the waters have gone.

If you find that the things you can do to help yourself aren't making contractions manageable, you can choose to have Demerol or an epidural.

Transition

During the transitional phase, the cervix dilates from eight to ten centimetres. Contractions may last as long as one to one-and-a-half minutes and occur every two to three minutes. You might feel shaky, shivery and sick. (Or you might feel none of these things!) Many women report that this phase is so intense they feel as if they're having an out-of-body experience.

What you can do

Hang on to the thought that you are nearly there. Make the most of the time in between contractions to rest and relax. During contractions, find the position that suits you best. Keep your breathing as rhythmic as possible (breathe in through your nose and blow out through a soft mouth), and if you want to shout, groan, and make a lot of noise - go for it!

Second stage

Once the cervix has dilated to ten centimetres, the work and excitement of the second stage begin. This is the stage of labour when your womb pushes your baby down the vagina (sometimes called the birth canal) into the world and, at long last, you meet him or her for the first time. There's often a lull at the end of the first stage when the contractions stop and you and your baby can rest for a while. When the contractions start again, you'll feel the pressure of your baby's head between your legs. With each contraction and every push, your baby will move down through your pelvis a little, but at the end of the contraction, he'll slip back up again! Don't despair. As long as the baby keeps on moving on a little further each time, you're doing fine. When your baby's head is far down in your pelvis and stretching the opening of the vagina, you'll probably feel a hot, stinging sensation and your midwife will tell you that your baby's head has "crowned". As your baby's head begins to be born, she may ask you to stop pushing and gently pant. This helps make sure that your baby is born gently and slowly, and should reduce the risk of you tearing.

If you have had a baby before, the second stage may only take five or ten minutes. If this is your first baby, it may take several hours.

What you can do

Listen to your body and push when you get a strong urge. Try not to hold your breath when you're pushing. Push for as long as you want to. Then push again. You'll find that you push several times (not just once) with each contraction. Use gravity to help you by standing up, kneeling or squatting. If you are very tired and want to lie down, lie on your left hand side. This makes more room in your pelvis for your baby than sitting on the bed because you're not pushing your coccyx (tail bone) forwards.

If you've had an epidural, listen to your doctor, nurse, or midwife who will tell you when to push. She may suggest not pushing until she can actually see your baby's head.

Third stage

What happens

In the third stage, you deliver the placenta - the baby's life-support system that has supplied your baby with nutrients, and taken waste products away, as it has grown inside you. After the baby is born, contractions resume after a few minutes, but at a much lesser intensity. These contractions cause the placenta to peel away from the wall of the uterus and drop down into the bottom of your womb. You will probably feel that you want to push. The placenta, with the membranes of the empty bag of waters attached, will pass down and out of your vagina. Your midwife will carefully examine the placenta and membranes to make sure that nothing has been left behind. She will also feel your tummy to check that your uterus is contracting hard in order to stop the bleeding from the place where the placenta was attached.

Delivering the placenta usually takes from five to 15 minutes, but it can take up to an hour.It depends on whether you have a managed or natural third stage. Most women are surprised at how much easier it is to deliver the placenta than to push the baby out. You may like to have a look at this organ that has supported your baby throughout the pregnancy.

What you can do

You may hardly be aware of the third stage, as your focus has probably shifted to your baby. Seeing and handling your baby, and offering him or her the breast will stimulate hormones that help the placenta to separate.

Now that the birth is over, you may feel shaky due to adrenaline and the adjustments your body immediately starts to make. Or you may simply be on a high, ready to pick up your baby and dance around the room. Some women find it hard to pay attention to the baby if they have had a long labour, or if they've had Demerol. There's nothing wrong with their maternal instincts; they're simply exhausted. If this happens to you take your time. After a rest you will be much more interested in getting to know your baby. A lot of women are very hungry and ready for a hearty meal, while others crack open the champagne, and want to telephone everyone and tell them the wonderful news.

Admire your new baby. Count the fingers and toes. Hold him or her close to your body, preferably skin to skin. If you're too tired, your partner can hold the baby against his chest. If you're going to breastfeed, offer the breast as soon as possible: your midwife or nurse will help you. Don't worry if your baby doesn't seem very interested. Even if he's only touching and nuzzling you, this will help you to get going with breastfeeding.

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16 Weeks Pregnant: Traveling While Pregnant

16 Weeks Pregnant

In this article

• Pregnancy Week 16: All About You
• Pregnancy Week 16: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact

There's no better time to plan a trip than right around 16 weeks pregnant. Find out what you need to know to make your vacation fun, safe, and healthy.

Now that it's finally sinking in that this baby thing is really going to happen, it's time to think about where it's going to happen! Plan your trip to the local hospitals and birth centers—and it's not too soon to think about your birthing plan.

Speaking of trips ... this is a great time to plan a get-a-way, too!

Pregnancy Week 16: All About You

In the coming weeks you should start to feel your baby move. You'll only feel a flutter at first, but before long you'll be able to distinguish kicks and hiccups, too. As your baby-to-be gets bigger, expect more soreness in your abdomen and back. Your breasts may also feel sore and larger as the tissue fills in and readies for milk production. As pregnancy hormones continue to pulse through your system to direct your body in baby production, you may experience headaches, dizziness, and even mood changes.

Travel while Pregnant

Your second trimester starts a window of weeks when you're feeling better than you have in a long time (goodbye nausea, hello baby bump). Your pregnancy glow is in full bloom, and your rounded belly fits beautifully into maternity pants. If you're going to travel at any point in your pregnancy, now is the time.

Physicians advise against travel in the first trimester due to the increased risk of miscarriage. According to the American College of Obstetricians and Gynecologists (ACOG), travel during the third trimester is also discouraged because of the chance of going into early labor (no one wants to go into preterm labor on the beach in Oahu). With a few safety precautions in mind you can head off for some R&R before your days and nights are filled with feedings and diapers.

Talk to your healthcare provider: Before you make any plans, discuss travel with your healthcare provider. While you may be feeling good, she needs to evaluate your health before you go. Have a few destinations in mind when you talk to her about your travel plans. For example, if you've had problems with water retention, she may advise you against a humid locale, which may aggravate your condition. Also, ask her to copy your prenatal records so that you can bring them with you—just in case. And don't forget to make sure that you have her number handy on those records if you need to call her.

Bring an approved first aid packet: You should pack a basic first aid kit, filled with medicines that come in handy when traveling (for instance Tylenol, anti-diarrhea, heartburn, and cold medicines). Review with your physician any over-the-counter and prescription medications that you plan to bring on your trip. Not all over-the-counter medicines are safe for pregnancy.

Plan on some restrictions: Keep in mind while making your travel arrangements that you won't be able to do everything, even with a physician's OK. Resorts, theme parks, and other travel providers may have restrictions on pregnant women for insurance reasons—they don't want you going into preterm labor or having complications any more than you do. Plan on sitting out the thrill rides and skipping scuba diving in favor of more relaxing vacation pursuits, such as time at the spa.

While you're there: Pregnancy is not the time for adventure travel. Keep a leisurely pace during your travels and take care or yourself. You might be tempted to do everything available and be out all day, but this can cause problems. Walking too much can lead to uncomfortable swelling.

Staying hydrated is key, too. Dehydration can cause preterm labor pains. So, be sure to drink plenty of water and take frequent potty breaks. (Avoiding bathroom breaks can aggravate your bladder and lead to urinary tract infections.)

Don't hesitate to contact your healthcare provider at any time during your trip. If you have questions about how you're feeling or medications that you plan on taking, give your physician a quick call.

Where to go: Where you choose to travel depends on your physician's guidelines. An hour-long car ride might be preferable over a long plane trip if you've had concerns during your pregnancy.

You may also want to choose US beaches over foreign locales. Some foreign destinations, especially those in third world countries, have amazing resort facilities but few medical care options if you were to have a problem.

Pregnancy Week 16: All About Baby

By week 16, your baby-to-be's body is doing more to support itself. Her kidneys function and produce urine that then passes through the umbilical cord. Within her stomach, bile is secreted, although she relies on you for all of her nutrients. Her appearance changes as her scalp hair grows and may even have color. Her developing facial muscles make it possible for her to open and close her mouth, maybe even give you a smile or two.

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17 Weeks Pregnant: Your Weight Gain

17 Weeks Pregnant



In this article

• Pregnancy Week 17: All About You
• Pregnancy Week 17: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact
• Follow The Chronicles of a Real-Life Pregnancy
• Join Your Due Date Club

At 17 weeks pregnant, chances are, you're not just starting to show but you're gaining some pregnancy weight as well. Here are important tips to keep you on the healthy track.

Each time you go to the doctor or clinic, they dip a strip of paper in a cup of your urine to measure your blood sugar level. What's with that blood sugar test, anyway? It's to make sure you're not developing gestational diabetes, a condition that affects around one to two percent of all pregnant women. When blood sugar levels are controlled (through diet and sometimes medication), women can have normal pregnancies and normal, healthy babies.

Pregnancy Week 17: All About You

Pregnancy Weight Gain and Other Symptoms
Daily, your body's changing inside and out to accommodate your baby-to-be. As your skin stretches, your breasts and abdomen may become itchy. Your baby bump will begin to change your posture so that your back may ache. Inside your body, your stomach is getting more cramped, sometimes leading to heartburn, indigestion, and flatulence. You may also notice mood swings as pregnancy hormones continue to play with your emotions.

Unsightly Pregnancy Signs
Your body undergoes many changes to give your baby-to-be enough room to grow. Some of these changes are comforting—your rounded belly and your full breasts, for example—while other signs can be troubling. Keep in mind that many of these physical changes will last only until your baby arrives.

• Bleeding gums: Your blood volume has increased dramatically to provide nutrients to your baby-to-be. This increase, along with swelling caused by pregnancy hormones, might make your gums bleed.
• Stretch marks: Whether or not you have stretch marks is a matter of genetics. No amount of specialty abdominal creams or Vitamin E pills are going to prevent stretch marks (despite claims to the contrary), but most women find that these stretch marks fade over time after the baby's birth.
• Weight gain: You should expect to gain 25 to 35 pounds during your pregnancy. As distressing as weight gain can be for some women, those pounds are necessary for your growing baby. Much of the weight is extra fluids (such as blood), tissues (like your breasts), and of course, your baby. (Find out how it all adds up here.) If you eat a sensible pregnancy diet and stay fit, you should be able to lose much of your pregnancy weight after your baby's birth. (Some women are able to shed pounds in a matter of weeks; others need as much as a year to get their bodies back in shape).
• Dark line (linea nigra): As your abdominal muscles stretch to make room for your growing uterus, you may notice a dark line extending from your belly button to your vaginal area. After birth, this line will disappear.
• Swelling (edema): Your body retains water to provide the necessary fluids for your growing baby-to-be. You can prevent much of this swelling from drinking plenty of fluids and keeping your legs up. You may also want to purchase socks designed to improve the circulation in your feet.
• Skin spots: The skin's pigmentation may deepen around certain parts of your body during pregnancy, such as your nipples and freckles. You may also notice spots of color on your face, called the mask of pregnancy or chloasma. These pigmentation changes will fade after your baby's born.

Pregnancy Week 17: All About Baby

Around this time your baby's ears pop from his head and Baby-to-be can now sense sounds. After all, he has plenty to listen to in utero! He's accustomed to the strong beating of your heart, blood rushing through your veins, and your stomach grumbling. He can also discern sounds outside the uterus, like your voice and music. Although, according to the Mayo Clinic, whether he can distinguish the sound of your voice versus other sounds is not yet clear.

On average, most moms are feeling fetal movement by week 17. Kick, little one, kick!

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18 Weeks Pregnant: Understanding Prenatal Tests

18 Weeks Pregnant

In this article

• Pregnancy Week 18: All About You
• Pregnancy Week 18: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact

Wondering what's going on with all the prenatal tests your healthcare provider is ordering? Find answers here.

Did you know that studies have shown that a full 60 percent of all expectant fathers show some symptoms of pregnancy? They may experience nausea, mood swings, weight gain, and odd cravings.

Pregnancy Week 18: All About You

By now you're feeling your baby-to-be wiggle inside you. The excitement surrounding her first movements will probably help you forget some of your pregnancy woes. As your tummy continues to expand you may notice stretch marks and have itchy skin. Your back will ache as your body adjusts to its new alignment. Thankfully, nausea is mostly likely a distant memory.

Understanding Pregnancy Tests
Between your sixteenth and twentieth weeks of pregnancy you'll be offered a series of tests to determine if your baby-to-be is at risk for certain genetic problems. Notice that these tests are offered but not required. Before you submit to the tests, it's important to understand what each entails and what the results will tell you about your developing baby.

Risk Assessments, Not Tests
Rather than view genetic tests as pass/fail, physicians see them as risk assessments, looking at whether your baby-to-be has a greater risk for certain genetic problems. For instance, a "positive" result doesn't necessarily indicate a problem with your baby, but that you might consider additional—and more definitive testing—to determine your baby's health. "The way I describe it to my patients is that these tests are like casting a wide net," explains Dr. Joanne Motino Bailey, PhD, a certified nurse midwife and a professor of women's studies at the University of Michigan. "You have plenty of healthy babies that are caught in the net" along with a handful of babies with genetic concerns.

Non-Invasive Tests
The main reason for so many false positives, according to Dr. Motino Bailey, is that physicians want to offer the safest, most non-invasive way to test your unborn baby for certain genetic disorders. These tests involve a simple blood test with virtually no risk to your baby-to-be.

• Quad test/triple screen: Your healthcare provider will draw your blood and test it for elevated levels of certain hormones and proteins, which may indicate your unborn baby has a genetic problem. The quad tests for Down syndrome, spina bifida, and other genetic problems. Keep in mind that this test has a high false positive and a high false negative rate.
Depending on your healthcare provider, you may be offered the triple screen, which includes looking at two hormone levels and one protein, or the quad test (quickly becoming the norm), which tests for an additional protein that may indicate genetic problems.
• Nuchal translucency screening (NTS): A more recent test option combines a blood test with an ultrasound to look for risk factors that may indicate that your unborn baby has Down syndrome. The test is highly specialized, however, so it may not be available in your area.
• Cystic fibrosis: Your blood sample will also be tested for cystic fibrosis. The test will determine if you are a CF carrier. If you are, your partner may then be tested. Because this is a recessive disorder, both you and your partner must be carriers for your unborn baby to be at risk. If both parents are carriers, according to ACOG, your unborn baby has a one in four chance of developing the disease.
• Ethnicity-based blood tests: Certain genetic disorders tend to appear in certain ethnicities. Your physician will ask a series of questions about your background to determine whether these tests are necessary for you.

Invasive Tests

If your first round of screening comes back with positive results (again, not meaning that your baby has a problem, but that she might be at a risk) you will be offered additional tests to give you a definitive answer about your unborn baby's genetic makeup. While these tests offer the yes/no answers you may be looking for, they do carry a risk of miscarriage.

• Amniocentesis: With an amnio, your healthcare provider inserts a long needle through your abdomen and into the uterus to collect a small sample of amniotic fluid. The fluid is then tested for genetic problems, such as Down syndrome, neural tube defects, and other disorders. The test is done between pregnancy weeks 16 and 20.
• Chorionic villus sampling (CVS): In CVS, a needle placed through your abdomen or through your vagina withdraws a tiny portion of the placenta. The sample can then be tested for Down syndrome, sickle-cell anemia, and cystic fibrosis. The test is performed between pregnancy weeks 10 and 12.

Note: CVS, a first-trimester test, provides parents with an earlier diagnosis than amniocentesis, a second-trimester test. Until recently, CVS had been associated with a slightly higher rate of miscarriage, but findings published in the September 2006 issue of Obstetrics & Gynecology show that the miscarriage rate is actually the same for both CVS and amnio, below two percent.

These tests are not to be taken lightly, advises Dr. Bailey. Take time to ask your healthcare provider about each test.

Pregnancy Week 18: All About Baby

At week 18, your baby-to-be's senses are maturing. She's able to hear sounds within her own comfortable environment, such as the sound of your heart beating, as well as external sounds, such as your voice. She may become more active for certain sounds, and you'll feel her movements. At this point in her development she's still small enough that she has plenty of room to wiggle.

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19 Weeks Pregnant: Celebrity Baby Bumps

19 Weeks Pregnant

In this article

• Pregnancy Week 19: All About You
• Pregnancy Week 19: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Facts

Do you find yourself seeking out magazines with pregnant celebrities? You're not alone. A lot of expecting women find themselves seeking out connections with fellow pregnant women.

Pregnancy Week 19: All About You

Your belly is getting rounder by the day. You may find that you need to rest more to keep your energy up. Your back and abdomen may be achy with the added weight. Expect to have some uncomfortable pregnancy symptoms fade and others get worse—your nausea has probably ended while heartburn and indigestion have taken its place. Continue to plan on plenty of bathroom breaks.

Celebrity Baby Bumps
Quick—name three pregnant celebrities. Chances are you can name more than that! You can probably even name a handful of celebrities who've given birth over the past year. Why are we so obsessed with celebrity baby bumps? "I think a big part of the fascination with celebrities' pregnancies is it humanizes them in our eyes," explains Dr. Joanne Motino Bailey, a certified nurse midwife and a woman's studies professor at the University of Michigan. Seeing a star go through pregnancy—by means of candid pictures—makes them seem more like the rest of us. After all, what could make your favorite round-bellied starlet more endearing than seeing snapshots of her downing a Big Mac in a track suit? But as with all things Hollywood, some effects of the celebrity baby boom may leave you with unrealistic expectations for your own pregnancy.

Maternity Fashions
Pregnancy clothing options used to be little more than raiding your partner's closet for shirts. Yet the celebrity baby boom has brought designers running to make pregnant women look their best. Gone are the days of ugly elastic-waist jeans and tent-like dress jumpers. You can now find maternity fashions on any budget.

The downside: We can't all afford a completely new wardrobe for a few months of use. But if you're sensible with your selection of maternity clothes, you can dress up simple shirts with stylish accessories.

Baby Bump Behavior
Back in the 1950s, pregnancy seemed almost indecent. Women wore bulky clothes to hide their bumps and spent a fair amount of time at home. This is no longer the case. Many women are often just as active and outgoing during their pregnancies as they were before conception. You can find pictures of celebrities still going to the gym, enjoying (many) a night out, and working until delivery day.

The downside: You never see the pictures of the celebrities taking naps or passing off daily tasks to their assistants. Expect to slow down and simplify your schedule during your pregnancy. Your body needs extra energy to fuel your growing baby-to-be.

Celebrity's Birth Options
Water birth, at-home birth, doula, midwife … pregnant women have many options for how they're going to deliver their babies. Celebrities made public the very private topic of pregnancy. As a result, some birth options—like home births—that were once taboo, aren't anymore.

The downside: Celebrities have an entourage of medical help to make some of their more far-flung birth requests possible. Delivering a baby in a third-world country may not be the safest option for you. And elective C-sections carry real risks.

Post-Pregnancy Body
How many times have you seen magazine covers boasting titles such as, "How [insert a celebrity's name] got her body back"? Losing post-pregnancy pounds can be extremely difficult. Some celebrities openly discuss their battles with the bulge. Knowing it's not easy for them might help you stick to your own post-pregnancy diet plan.

The downside: Many celebrities go to extremes when it comes to losing weight fast. Some even get surgical help to lose a few pounds. Others are just blessed with forever slender shapes. Watching a celebrity walk the red carpet a week after delivery can give you false sense of how quickly you'll realistically be back into your pre-pregnancy jeans.

Celebrity baby bump watching can be fun. You may feel some kinship to a once svelte siren who's now packed on the pounds, but don't compare your own experience or your body to your favorite celebrities'.

Pregnancy Week 19: All About Baby

In your 19th week of pregnancy, your unborn baby's organs continue to grow. His body is covered with lanugo soft hairs and a sticky protective coating that keeps his skin from drying out in the amniotic fluid. Your baby is moving frequently, and by now you should be able to feel those movements. Your physician can hear your baby-to-be's heartbeat with a stethoscope placed on your abdomen.

Baby is covered in vernix, a white, cheesy "cream" that protects her skin from the long bath in amniotic fluid. Preemies are covered in vernix at birth "posties" have almost none.

How Big Is Baby?

Your little one weighs in at around 7 to 8 ounces and he's between 5 and 6 inches long (crown to rump).

Most Common Pregnancy Questions

I'm 19 weeks pregnant and worried about my weight gain. How do I know if I'm gaining just the right amount? Could I be gaining too much or too little weight?
An important consideration when determining how much weight is appropriate for you is your pre pregnancy weight and your body mass index or BMI. BMI is a measurement of body fat based on your height and weight. There are some general guidelines to follow, and your healthcare provider should work with you to get you on the right track.

Most women will gain between four and six pounds during the first trimester. The weight gain in the second and third trimesters depends on what category you fall into based on your pre-pregnancy weight.

Don't try to lose weight during pregnancy or try to stay within the parameters for your pre-pregnancy weight. Too much weight gain puts you at risk for high blood pressure and diabetes. Also having a large baby can cause complications at delivery. Too little weight gain may put your baby at risk for being underweight. A woman who is underweight pre-pregnancy should gain between 28 and 40 pounds. Try to gain slightly over a pound a week in the second and third trimesters.

A woman with a normal pre-pregnant weight should gain between 25 and 35 pounds. Many women may not gain much weight during the first trimester due to nausea. But the average is four to six pounds for a healthy weight gain for your first 12 weeks of pregnancy. After the first trimester, you should gain about a pound a week. If you are overweight pre-pregnancy the recommended weight gain is 15 to 25 pounds. You should put on about one pound every two weeks in the second and third trimesters.

Don't ever try to lose weight during pregnancy.

Where Does All The Weight Go?

• Baby: 7 to 8 pounds
• Larger breasts: 1 to 3 pounds
• Larger uterus: 2 pounds
• Placenta: 1 1/2 pounds
• Amniotic fluid: 2 pounds
• Increased blood volume: 3 to 4 pounds
• Increased fluid volume: 2 to 3 pounds
• Fat stores: 6 to 8 pounds pregnancy.

Talk with your healthcare provider about what weight gain is the best for you and try to stick within those recommended parameters. Eat well! When you are feeling hungry (and you will!) try to make healthy food choices, doing so will not only help you feel better, it provides the best nutrition for your growing baby.

Multiple Madness

Famous Baby Bumps
The number of celebrities who've recently welcomed twins into the world is staggering. It's almost as though having twins is the newest PR strategy!

It's fun to watch the Hollywood crowd anticipate the arrival of stardom's newest multiples, but it's also important to keep a few things in mind.

Women sometimes get a bit frazzled when they see a celebrity who has 8-week-old twins looking slim and svelte. Don't discount that many celebrities, especially the most photographed ones, have access to dieticians, chefs, personal trainers, and airbrushing! And most have nannies who tend their children while they eat properly and run five miles each morning!

Rather than staring enviously at the latest new mom on the cover of People magazine each time you're in the checkout line, strive to emulate the celebrities who do things on their terms—or on terms that resonate with you as "real." Focus on how much they are enjoying this time. Consider moms like Jennifer Garner or Kate Hudson who openly relished time with their new babies and publicized that weight loss was not their first priority.

And remember that we see celebrities on the covers of magazines, but we don't see what goes on beyond closed doors. Nannies, chefs, and trainers aside, celebrity new moms are still new moms. They, too, experience the emotional ups and downs of new motherhood (case in point: Brooke Shields and her public battle with postpartum depression).

Take it easy on yourself. And be thankful you don't have to worry about the possibility of being photographed and critiqued each time you head to Starbucks!

For Your Partner

Famous Dads
Many women find themselves scoping out pregnant celebrities while they are also expecting. The unique sense of connection with these Hollywood figures stems from them experiencing the same things at the same time. Famous dads-to-be are harder to spot, but more and more celebrity men are "coming out" to extol the exciting, life-altering, and amazing nature of fatherhood.

Our society is changing, giving men more of a voice to be honest and open about how fatherhood feels and how it is changing their lives. And as a result, dads in the spotlight are sharing their stories.

In a society where motherhood is revered and fatherhood is seen more as a supporting actor's role, it is fun to see male stars come out and freely state how fatherhood is affecting them. Brad Pitt has been quoted several times stating fatherhood is the greatest role in his life so far. Tiger Woods talks about changing diapers and getting less sleep. "It's an awakening," says Philip Seymour Hoffman, who reports that when you become a parent everything changes; you look at your own parents differently, and at your own childhood differently. "When you have a child, as anyone knows who has them, that's basically all you want to talk about," he adds.

Take a note from these Hollywood dads and make a point to share with your spouse how you feel and what you think about your impending fatherhood. She'll appreciate the insight! The more involved you become in the lives of your children, the more likely they are also to experience benefits from being involved.

Fun Facts

Pregnancy on TV has come a long way. When Lucille Ball was pregnant during her run on I Love Lucy, TV censors thought using the term "pregnancy" on air would be in appropriate. Instead, the script called for the actors to refer to Lucy as "expecting."

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20 Weeks Pregnant: Let's Talk About Gender



20 Weeks Pregnant



In this article

• Pregnancy Week 20: All About You
• Pregnancy Week 20: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Facts

Boy or girl? Right around your 20th week of pregnancy, an ultrasound can answer that big question for you.

Sex and more sex! Remember that unless you've been advised against it by your healthcare provider because of bleeding or risk of miscarriage, sex is fine, a good stress reliever, and a great way to "touch bases" with your partner. Don't feel up to it? That's OK, too. Read Sex and Pregnancy and remember that cuddling is a good thing, too.

Pregnancy Week 20: All About You

The Gender Ultrasound
You're finally comfortable in your maternity clothes—your protruding baby bump proudly declaring you're going to be a mom, soon. In fact, you're halfway there! By now you're feeling your unborn baby wiggle and kick—which may be caused by your baby experiencing hiccups. Along with your progressing pregnancy, you may also notice more aches and pains. Your lower back and abdomen may be sore from your growing belly. Heartburn, indigestion, and flatulence are frequent as your expanding uterus allows less space for your stomach. Swelling, called edema, may make your hands and feet uncomfortable, too.

The Big Ultrasound
This week you'll get a sneak peak at your unborn baby! At 20 weeks, most physicians request that you receive an ultrasound to determine that your baby-to-be is developing normally, that your due date is accurate, and—if you're interested—whether there are pink or blue baby booties in your future.

Ultrasound BasicsUltrasound is a safe, relatively comfortable procedure that gives physicians more information about your developing baby. An ultrasound technician will apply a topical gel to your abdomen so that the high-frequency sound waves can travel easily through your belly. The technician then moves a transducer, a handheld device that looks something like a grocery store scanner, around your abdomen, sending sound waves as it goes. These waves, once translated through the ultrasound machine, generate a picture. The ultrasound technician will take several measurements of different parts of your unborn baby's body to make sure her development is on track.

Don't be surprised if you're asked to arrive for your ultrasound with a full bladder. A full bladder constricts your baby-to-be's wiggle room, making for easier imaging. But because things are so crowded in there, the ultrasound technician may have to prod your unborn baby into resituating so that all the measurements can be made. With a full bladder and pressure from the transducer on your abdomen, the ultrasound may be slightly unpleasant—but don't worry, the pictures will be worth it!

The ultrasound usually lasts around 30 minutes. Depending on the office where you receive your ultrasound, you may be able to receive a recording of the session or at least several pictures to show off your baby-to-be. Not all lab offices offer recordings of the ultrasound for moms-to-be so call beforehand to check what the lab offers. You can also ask if you can take home a picture or two.

Your baby's gender: In most cases, your ultrasound technician will be able to tell you if you're having a girl or boy. If you don't want to know, tell the technician before you begin so that you don't inadvertently see or hear something you shouldn't. (Try your hand at predicting Baby's gender with our Gender Predictor!)

For those women who do want to know the baby's sex, the results are usually accurate. Usually. The accuracy rates for determining your unborn baby's gender by ultrasound are about 80 to 90 percent. Keep in mind, the ultrasound technician needs to get a clear picture of your unborn baby's "parts" to be certain. For girls, the technician will be looking for three small lines between her legs indicating the female labia. For little boys, the technician will be looking for a developed penis and scrotum. Be forewarned some babies do not cooperate for this look at their private parts and wiggle and squirm to the point that the technician may not be able to say with any degree of certainty whether you're having a boy or a girl.

Take a look at our great collection of second trimester ultrasounds—and see if you can tell boys from girls.

Is ultrasound necessary? While the 20-week ultrasound is traditional, it's not necessary. "There's no advantage to performing an ultrasound if a woman's pregnancy is otherwise normal and healthy," explains Dr. Joanne Motino Bailey, PhD, CNM. "While it has become standard practice, there's no medical evidence that shows that performing standard ultrasounds improves a baby's outcome." That said, Dr. Bailey points out that most mothers find the ultrasound to be a comfort, getting a chance to finally see their unborn babies. In other countries, such as Japan, many women receive an ultrasound at every office visit, notes Dr. Bailey. This is also the case for many moms experiencing high-risk pregnancies, were trips to the ultrasound technician may occur once or twice each week.

Pregnancy Week 20: All About Baby

By week 20, your baby-to-be is gearing up for the next phase in his development—filling out. His organs are getting into their proper places. His kidneys are now in position with their familiar bean shape. His testes (or ovaries for girls) have reached their position. His brain continues to form and grow. His teeth are beginning to appear, and he can swallow. If you haven't been able to feel him move, chances are you'll be feeling him move more and more over the coming weeks.

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21 Weeks Pregnant: Bonding With Baby-to-Be

21 Weeks Pregnant

In this article

• Pregnancy Week 21: All About You
• Pregnancy Week 21: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact

You don't have to wait until your baby arrives to begin bonding. Try these simple ideas to feel closer to your little one during your 21st week of pregnancy, and beyond.

Pregnancy Week 21: All About You

Now that your body is accustomed to your new addition, you'll notice several pregnancy symptoms disappear: Nausea becomes a distant memory and fatigue more manageable. Your breasts and abdomen are less tender, but you may experience itchiness and see stretch marks as your body continues to expand. As your internal organs are pushed aside to make room for the growing fetus, you may have heartburn, indigestion, and bloating. Your mood swings lessen, but you may have more anxiety about labor and motherhood as the reality of your baby's birth draws closer.

Bonding with Your Baby-to-Be

You don't have to wait until your baby arrives to begin bonding. Throughout your pregnancy you may have thoughts and impressions about your baby-to-be's personality. Maybe she constantly wiggles at a certain time of day, or her movements become less frequent when you're listening to particular kinds of music. Try these simple ideas to feel closer your little one.

Talk to your baby-to-be: According to a 2005 study by Barbara Kisilevsky, a nursing professor at Queens University in Ontario, Canada, babies prefer their mothers' voices even before they're born. Kisilevsky, who conducted the research with a team of psychologists from Queens and obstetricians in Hangzhou, China, found that babies' heart rates in utero accelerated at the sound of their mothers' voices. You can help your baby get to know your voice by talking to him. Sing to him in the car, rattle off the ingredients as you cook dinner, or read to him. Let other family members in on the fun; your partner or other children can talk to your tummy, too!

Start a library for your little one: If this is your first child, you may not have any baby books in your home. Before your baby arrives, pick out stories you can share with her. You'll be reading these stories over and over again, so choose carefully. (And remember, you don't have to wait she's born to start reading to her.)

Listen to music together: Your baby can hear sounds, including music, in utero (how well she hears it is still a matter of scientific study). While you may not convert your baby-to-be to your preferred bands, you'll feel a connection to her as she kicks during your favorite tunes. Try picking an anthem for your baby—maybe a Beatles classic, a country ballad, or a calming lullaby.

Ready the nursery: Preparing your child's room can help you envision what life will be like once he arrives. Choosing colors, picking out crib sheets, and adding decorations to plain walls may make your impending motherhood feel all the more real.

Buy baby clothes: Shopping for a little one can be fun. Just look at how small those newborn socks are! Display your finds on hangers in the nursery.

Blog your pregnancy: Help your family and friends know more about how you're feeling through a website designed around your pregnancy. Post ultrasound pictures or—if you're brave enough—pictures of your growing baby bump. Friends and family can offer support and share in your excitement. (Or use our tools to create your own online pregnancy journal!)

Keep a journal of your thoughts: Take time to reflect on what it means to be carrying your child. Record these thoughts in a diary so that you'll never forget how you felt during your pregnancy. You may even share this journal with your child once he gets older.

Pregnancy Week 21: All About Baby

Your little one will begin to fill out over the next few weeks. Fat layers form throughout your unborn baby's body. These layers will eventually keep him warm and insulated once outside the womb. Soft hair, called lanugo, covers his body, too. His eyelids are still closed, making him appear like he's sleeping, but frequent wiggles will let you know he's awake. You may also feel Baby hiccupping.Those jerky motions you feel in your belly are a result of little lungs practicing the important task of breathing.

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Exercising during pregnancy

KEEPING HEALTHY WHILE YOU ARE PREGNANT

Is exercising bad during pregnancy? Although you may not feel like running a marathon, most women benefit greatly from exercising throughout their pregnancies. But during that time, you'll need to discuss your exercise plans with your doctor or other health care provider early on and make a few adjustments to your normal exercise routine. The level of exercise recommended will depend, in part, on your level of pre-pregnancy fitness.

Benefits of Exercising During Pregnancy

No doubt about it, exercise is a big plus for both you and your baby (if complications don't limit your ability to exercise throughout your pregnancy). It can help you:

• feel better. At a time when you wonder if this strange body can possibly be yours, exercise can increase your sense of control and boost your energy level. Not only does it make you feel better by releasing endorphins (naturally occurring chemicals in your brain), appropriate exercise can:
  • relieve backaches and improve your posture by strengthening and toning muscles in your back, butt, and thighs
  • reduce constipation by accelerating movement in your intestine
  • prevent wear and tear on your joints (which become loosened during pregnancy due to normal hormonal changes) by activating the lubricating fluid in your joints
  • help you sleep better by relieving the stress and anxiety that might make you restless at night
• look better. Exercise increases the blood flow to your skin, giving you a healthy glow.
• prepare you and your body for birth. Strong muscles and a fit heart can greatly ease labor and delivery. Gaining control over your breathing can help you manage pain. And in the event of a lengthy labor, increased endurance can be a real help.
• regain your pre-pregnancy body more quickly. You'll gain less fat weight during your pregnancy if you continue to exercise (assuming you exercised before becoming pregnant). But don't expect or try to lose weight by exercising while you're pregnant. For most women, the goal is to maintain their fitness level throughout pregnancy.

While the jury's still out on the additional benefits of exercise during pregnancy, some studies have shown that exercise may even lower a woman's risk of complications, like preeclampsia and gestational diabetes.

What's Safe During Pregnancy?

It depends on when you start and whether your pregnancy is complicated. If you exercised regularly before becoming pregnant, continue your program, with modifications as you need them.

If you weren't fit before you became pregnant, don't give up! Begin slowly and build gradually as you become stronger. The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2½ hours) of moderate-intensity aerobic activity each week for healthy women who are not already highly active or doing vigorous-intensity activity.

If you're healthy, the risks of moderate-intensity activity during pregnancy are very low, and do not increase risk of low birth weight, preterm delivery, or early pregnancy loss.

Before you continue your old exercise routine or begin a new one, you should talk to your doctor about exercising while you're pregnant. Discuss any concerns you may have and know that you might need to limit your exercise if you have:

• pregnancy-induced high blood pressure
• early contractions
• vaginal bleeding
• premature rupture of your membranes, also known as your water (the fluid in the amniotic sac around the fetus) breaking early

Exercises to Try

That depends on what interests you and what your doctor advises. Many women enjoy dancing, swimming, water aerobics, yoga, Pilates, biking, or walking. Swimming is especially appealing, as it gives you welcome buoyancy (floatability or the feeling of weightlessness). Try for a combination of cardio (aerobic), strength, and flexibility exercises, and avoid bouncing.
Many experts recommend walking. It's easy to vary the pace, add hills, and add distance. If you're just starting, begin with a moderately brisk pace for a mile, 3 days a week. Add a couple of minutes every week, pick up the pace a bit, and eventually add hills to your route. Whether you're a pro or a novice, go slowly for the first 5 minutes to warm up and use the last 5 minutes to cool down.
If you were a runner before you were pregnant, you might be able to continue running during your pregnancy, although you may have to modify your routine.
Whatever type of exercise you and your doctor decide on, the key is to listen to your body's warnings. Many women, for example, become dizzy early in their pregnancy, and as the baby grows, their center of gravity changes. So it may be easy for you to lose your balance, especially in the last trimester.
Your energy level might vary greatly from day to day. And as your baby grows and pushes up on your lungs, you'll notice a decreased ability to breathe in more air (and the oxygen it contains) when you exercise. If your body says, "Stop!" — stop!
Your body is signaling that it's had enough if you feel:

• fatigue
• dizziness
• heart palpitations (your heart pounding in your chest)
• shortness of breath
• pain in your back or pelvis

And if you can't talk while you're exercising, you're doing it too strenuously.
It also isn't good for your baby if you become overheated because temperatures greater than 102.6° F (39° C) could cause problems with the developing fetus — especially in the first trimester — which can potentially lead to birth defects. So don't overdo exercise on hot days.
When the weather is hot, avoid exercising outside during the hottest part of the day (from about 10 AM to 3 PM) or try to exercise in an air-conditioned place. Also remember that swimming makes it more difficult for you to notice your body heating up because the water makes you feel cooler.

Exercises to Avoid

Most doctors recommend that pregnant women avoid exercises after the first trimester that require them to lie flat on their backs.
Unless your doctor tells you otherwise, it's also wise to avoid any activities that include:

• bouncing
• jarring (anything that would cause a lot of up and down movement)
• leaping
• a sudden change of direction
• a risk of abdominal injury

Typical limitations include contact sports, downhill skiing, scuba diving, and horseback riding because of the risk of injury they pose.
Although some doctors say step aerobics workouts are acceptable if you can lower the height of your step as your pregnancy progresses, others caution that a changing center of gravity makes falls much more likely. If you do choose to do aerobics, just make sure to avoid becoming extremely winded or exercising to the point of exhaustion.
And check with your doctor if you experience any of these warning signs during any type of exercise:

• vaginal bleeding
• unusual pain
• dizziness or lightheadedness
• unusual shortness of breath
• racing heartbeat or chest pain
• fluid leaking from your vagina
• uterine contractions

Kegel Exercises

Although the effects of Kegel exercises can't be seen from the outside, some women use them to reduce incontinence (the leakage of urine) caused by the weight of the baby on their bladder. Kegels help to strengthen the "pelvic floor muscles" (the muscles that aid in controlling urination).
Kegels are easy, and you can do them any time you have a few seconds — sitting in your car, at your desk, or standing in line at the store. No one will even know you're doing them!
To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax. You're using the correct muscles if you feel a pull. Or place a finger inside your vagina and feel it tighten when you squeeze. Your doctor can also help you identify the correct muscles.
A few things to keep in mind when you're doing Kegel exercises:

• Don't tighten other muscles (stomach or legs, for example) at the same time. You want to focus on the muscles you're exercising.
• Don't hold your breath while you do them because it's important that your body and muscles continue to receive oxygen while you do any type of exercise.
• Don't regularly do Kegels by stopping and starting your flow of urine while you're actually going to the bathroom, as this can lead to incomplete emptying of your bladder, which increases the risk of urinary tract infections.

Getting Started

Always talk to your doctor before beginning any exercise program. Once you're ready to get going:

• Start gradually. Even 5 minutes a day is a good start if you've been inactive. Add 5 minutes each week until you reach 30 minutes.
• Dress comfortably in loose-fitting clothes and wear a supportive bra to protect your breasts.
• Drink plenty of water to avoid overheating and dehydration.
• Skip your exercises if you're sick.
• Opt for a walk in an air-conditioned mall on hot, humid days.
• Above all, listen to your body.

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C-section

What is a cesarean section?

A cesarean section, or c-section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it's done in response to an unforeseen complication.

According to the Centers for Disease Control and Prevention, about 30 percent of American women who gave birth in 2005 had a cesarean delivery, up from 6 percent in 1970, 17 percent in 1980, and 23 percent in 1990.

 C-section is major abdominal surgery, so it is riskier than a vaginal delivery. Moms who have c-sections are more likely to have an infection, excessive bleeding, blood clots, more postpartum pain, a longer hospital stay, and a significantly longer recovery. Injuries to the bladder or bowel, although very rare, are also more common.

C-section

In addition, if you plan to have more children, each c-section you have increases your future risk of these complications as well as placenta previa and placenta accreta. That said, not all c-sections can, or should be prevented. In some situations, a c-section is necessary for the well-being of the mother, the baby, or both.

Why would I have a planned c-section?

Sometimes it's clear that a woman will need a cesarean even before she goes into labor. Conditions that may require a planned c-section include:

You've had a previous cesarean with a "classical" vertical uterine incision or more than one previous c-section. (If you've had only one previous c-section with a horizontal incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC.If you're not trying for a VBAC, your practitioner will schedule your c-section for no earlier than 39 weeks to minimize the risk that the baby's lungs are still immature.)

You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).

You're carrying more than one baby. (Some twins can be delivered vaginally, but all higher-order multiples require a c-section.)

Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)

You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

The baby has a known illness or abnormality that would make a vaginal birth risky.

You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.

Why would I have an unplanned cesarean delivery?

You may need to have a c-section if problems arise that make continuing or inducing labor risky. These include the following:
Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.


Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby can't withstand continued labor or induction.

The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.

Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.

You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.

What happens right before a c-section?

First, your practitioner will explain why she believes a c-section is necessary, and you'll be asked to sign a consent form. If your prenatal practitioner is a midwife, you'll be assigned an obstetrician for the surgery who will make the final decision and get your consent.

Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there's no time for your partner to change clothes — or you need general anesthesia, which would knock you out completely — your partner might not be allowed to stay in the operating room with you.

An anesthesiologist will then come by to review various pain-management options. It's rare these days to be given general anesthesia, except in the most extreme emergency situations or if you can't have regional pain relief for some reason.


More likely, you'll be given an epidural or spinal block, which will numb the lower half of your body but leave you awake and alert for the birth of your baby.

If you've already had an epidural for pain relief during labor, it'll be used for your c-section as well. Before the surgery, you'll get extra medication to ensure that you're completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)

A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is started if you don't have one already. The top section of your pubic hair is shaved, and you're moved into an operating room.

Anesthesia will be administered, and a screen will be raised above your waist so you won't have to see the incision being made. (If you'd like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else.) Your partner or husband, freshly attired in operating room garb, may take a seat by your head.

How is a c-section done?

Once the anesthesia has taken effect, your belly will be swabbed with an antiseptic, and the doctor will most likely make a small, horizontal incision in the skin above your pubic bone (sometimes called a "bikini cut").

The doctor will cut through the underlying tissue, slowly working her way down to your uterus. When she reaches your abdominal muscles, she'll separate them (usually manually rather than cutting through them) and spread them to expose what's underneath.

When the doctor reaches your uterus, she'll probably make a horizontal cut in the lower section of it. This is called a low transverse incision.

In rare circumstances, the doctor will opt for a vertical or "classical" uterine incision. This might be the case if your baby is very premature and the lower part of your uterus is not yet thinned out enough to cut. (If you have a classical incision, it's much less likely that you'll be allowed to attempt a vaginal delivery with your next pregnancy.)

Then the doctor will reach in and pull out your baby. You'll have a chance to see the baby briefly before he's handed off to a pediatrician or nurse. While the staff is examining your newborn, the doctor will deliver your placenta and then begin the process of closing you up.

After your baby has been examined, the pediatrician or nurse may hand him to your partner, who can hold him right next to you so you can admire, nuzzle, and kiss him while you're being stitched up, layer by layer. The final layer — the skin — may be closed with stitches or staples, which are usually removed three days to a week later. Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.

After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him.

If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and your newborn lie on your sides facing each other.

You can expect to stay in the hospital for three or four days before going home.

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How To Cope With Back Pain During Pregnancy

Tips On How To Cope With Back Pain While In Pregnancy

If you are pregnant and experiencing back pain in the course of pregnancy, you might desire to know tips on how to take care of that. Have to you have agony relief pills or just let it go like that? Can you do anything at all to alleviate the discomfort? This article is going to discuss tips on how to deal with such discomfort.

Acquiring back pain throughout pregnancy is usually very typical. It can be estimated that eighty per cent of women who are pregnant suffer back pain. Fortunately, the discomfort is commonly short term. We hardly discover lengthy term back pain from being pregnant. The causes with the anguish are not truly laid out. 1 achievable cause may be the improve of mother's and child's pounds. This can be specifically true inside last trimester of the patient's pregnancy.

When we look into the age aspect, we discovered that younger mothers tend to suffer more discomfort that the older ones. Usually, the mother can continue everyday activities as usual. Only ten per cent in the patients describe the pain as very disabling. In that case, the mother has to have a excellent rest until the anguish goes away.



Pregnancy



In pregnant women, using medication must be carried out under close supervision of the doctor. If possible, the physician tends to ask the patient not to utilize any medication. Consequently, using pain killer could not be as suitable. The most recommended methods to take care of the anguish include avoiding excessive weight gain, exercising to strengthen your back muscles, maintain correct postures throughout the day and wearing sensible shoes with no high heels. These typical measurements have helped a lot of individuals lower the possibility of obtaining back pain. You can also use them to decrease the chance of getting one.

Taking care of back pain through being pregnant might be completed without having much trouble if you know what it is possible to do. You don't want any medication and you will be happier expecting your baby to come out.

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22 Weeks Pregnant: Intimacy and Pregnancy

22 Weeks Pregnant

In this article

• Pregnancy Week 22: All About You
• Pregnancy Week 22: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact

At 22 weeks pregnant, chances are that your lingering morning sickness is beginning to subside. So, are you starting to feel amorous and frisky yet?

Pregnancy Week 22: All About You

You're probably feeling fetal movement throughout the day now that your baby's getting bigger. And as she grows, your body has to make room. Your stomach will have less space to expand, meaning you may suffer heartburn and indigestion, especially at night. Add to that the fact that pregnancy hormones can slow digestion making your tummy troubles even worse. Slight swelling may make your shoes uncomfortable. Your back may also ache with the added weight of your baby bump. Your bladder is also suffering from the space crunch, so expect plenty of potty breaks.

Intimacy and Pregnancy
Some women experience big bonuses along with their pregnancy—larger breasts, glowing skin, and a slight baby bump—if you're part of this group, chances are you feel more attractive than ever. On the flip side, if your pregnancy has been mostly about enduring nausea and fatigue, your libido may have taken a nosedive. No matter what your circumstance, the changes taking place in your body will undoubtedly affect how you and your partner feel about intimacy.

Why you may feel more attractive

Changes in your appearance: One of the first signs of pregnancy is an increased cup size. If you normally have smaller breasts, your new fuller breasts may make you feel more desirable. Couple that with an increased blood flow, which leaves you with rosier cheeks, and you might be downright irresistible.

Fluctuations in hormone levels: Pregnancy hormones may have you craving everything from pickles and ice cream to more intimacy. Keep in mind that the effects of these hormones vary for every woman, and your moods may change daily (sometimes hourly!).

Free of pressure to conceive: Perhaps you've been trying for months to get pregnant. Now that the pressure is off, intimacy may become more enjoyable and less of a task.

Why you may not feel interested

Tenderness: Your breasts and abdomen are going through quite a growth spurt, which may leave you sore. Intimacy may be uncomfortable, especially during your first and last trimesters.

Fatigue and nausea: If you've suffered strong bouts of nausea, intimacy may be the last thing on your mind. Fatigue may further zap any other desires.

Weight gain: As you've watched the scale tip upwards, you may feel frumpy.

Why intimacy is important
Intimacy allows you and your partner to express your love and concern for each other. It's a physical closeness that can reinforce your emotional connection to your partner. A gentle massage, cuddling, and kissing, can help erase some of the day-to-day pains of pregnancy and let you know your partner is there for you.

Worrying about the Baby
"Unless you have a specific medical issues like multiple births, placenta previa, or another high-risk condition, sexual intercourse won't hurt your baby," explains Dr. William Camann, MD, director of obstetric anesthesia at the Brigham and Women's Hospital in Boston, Massachusetts, and coauthor of Easy Labor.

He notes, however, that you may notice some contractions after lovemaking—that's normal. Unless your cervix is already starting to dilate, there's little reason to worry that these contractions will lead to labor.

If you have any unexplained bleeding after intimacy, or sex is extremely uncomfortable, talk to your healthcare provider about your concerns.

Pregnancy Week 22: All About Baby

Your baby's brain is growing daily. Her senses are also starting develop. She can hear the sound of your heart along with your breathing. As she wiggles her fingers, she may touch her face or even suck her thumb. Her lungs are becoming more mature, and she even goes through the motions of breathing. She can also swallow, although she won't have her first real meal until delivery day.

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