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OB/GYNs frequently are the primary healthcare providers for issues related to the female reproductive system, including pregnancy and childbirth. Thus, an OB/GYN is a common choice for prenatal care throughout pregnancy and would usually be the practitioner of choice.

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Signs of Pregnancy

Pregnancy Signs

The absence of a menstrual period is one of the first indications you are pregnant. Other early signs may include enlarged and tender breasts, needing to urinate frequently, feeling tired, slight weight gain and nausea or vomiting.

If you suspect you are pregnant, it’s fine to use a home pregnancy test (which detects a fetal hormone in the urine). These tests are not always reliable, so if the result is negative and you still think you are pregnant, you should see your health care provider, clinic or health-care center for more accurate testing.

One reason to do so is to make sure you don't have an ectopic pregnancy—a circumstance in which the pregnancy develops outside the uterus, usually in the fallopian tube. Ectopic pregnancies are often missed by home pregnancy tests because the fetal growth hormone is present in much lower amounts than when the pregnancy is uterine. Though relatively rare—ectopic pregnancies occur in about 1 in every 100 pregnancies—the condition can become life-threatening and requires surgery.

Pregnancy Information

Discomforts of Pregnancy

The majority of pregnancies are medically uneventful—only a small percentage of women experience medical complications, and those can usually be dealt with successfully. Most women experience minor discomforts associated with pregnancy, which can be vexing, nevertheless.

One of the most common problems is the nausea and vomiting referred to as morning sickness—which actually can occur at any time but often strikes immediately after awakening in the morning. Morning sickness typically begins in the first month of pregnancy and continues through the fourth or fifth month. Eating a few crackers before getting out of bed in the morning can help. Eating frequent light meals and sweet foods, avoiding spicy and high-fat foods, and drinking plenty of fluids may also ease the problem.

Severe morning sickness that does not respond to dietary and lifestyle measures may be treated with doxylamine succinate and pyridoxine hydrochloride (Diclegis), which was approved by the U.S. Food and Drug Administration (FDA) in April 2013. (This drug, sold under the name Bendectin, was removed from the market in 1983 because it was thought to be unsafe.) Studies show that this medication is safe and effective and does not pose an increased risk of harm to the unborn baby. Side effects include drowsiness and excessive sleepiness.

Other problems associated with pregnancy can include backache, constipation, heartburn, hemorrhoids, and varicose veins. You can treat most of these complaints yourself, but you should discuss the problems and any treatments or remedies with your health care provider—including any over-the-counter medications, which can be dangerous to unborn babies and pregnant women. (Also, always check warning labels of any products you use.) These problems generally resolve soon after the baby is born.

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What Is an Obstetrician / Gynecologist (OB/GYN)?

OBGYN Overview

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An Obstetrician, is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth).

A gynecologist is a physician who has a successfully completed specialized education and training in the health of the female reproductive system, including the diagnosis and treatment of disorders and diseases.

Typically, the education and training for both fields occurs concurrently. Thus, an obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, Pap test screening, and family planning.

An obstetrician/gynecologist, commonly abbreviated as OB/GYN, can serve as a primary physician and often serve as consultants to other physicians. OB/GYNs can have private practices, work in hospital or clinic settings, and maintain teaching positions at university hospitals. OB/GYNs may also work public health and preventive medicine administrations.

OB/GYNs have a broad base of knowledge and can vary their professional focus. Many develop unique practices, providing high-quality health care for women. OB/GYNs may choose to specialize in the following areas:

Acute and chronic medical conditions	Adolescent gynecology	Behavioral problems	Cancer
Endocrinology	Health maintenance during pregnancy	Operative gynecology	Infertility
Pregnancy and delivery	Preventative health	Urinary tract disorders

OB/GYN Education and Training Requirements

The education and training requirements for obstetrics/gynecology are set by the American Board of Obstetrics and Gynecology (ABOG) and include the following:

Graduation from an approved medical school

Completion of an OB/GYN residency program (minimum of 4 years in length) that is accredited by the American Council for Graduate Medical Education (ACGME)

Rotations divided between obstetrics, gynecology, gynecologic oncology, reproductive endocrinology, and ultrasonography

Experience in primary and preventive care role for the equivalent of at least 6 months of the residency, including inpatient and ambulatory care; diagnosis and management of breast disease and lower urinary tract dysfunction; performance and interpretation of diagnostic pelvic and transvaginal ultrasound

Increase in patient responsibility with each year of training

Serving as chief (senior) resident during final year of residency

OB/GYN Board Certification

Once the above requirements are met, physicians are allowed to take the certifying examinations given by ABOG. Physicians who pass the examination are granted board certified status in Obstetrics and Gynecology, a pre-requisite to subspecialty certification.

If certified in obstetrics and gynecology after 1986, the physician must complete a recertification process every 10 years to maintain certified status. If certified before 1986, the physician can take a voluntary recertification process.

OB/GYN Subspecialties

There are four recognized subspecialties in the field of obstetrics/gynecology: gynecologic oncology, maternal/fetal medicine, reproductive endocrinology and infertility, and urogynecology/reconstructive pelvic surgery. Each subspecialty has its own certification exams administered by ABOG, and physicians can become certified in one or more of them. Certification is valid provided the primary certification in obstetrics and gynecology is up-to-date.

Gynecologic Oncology

Concerned with consultation and comprehensive management of patients with gynecologic cancer

Requires knowledge of major cancer treatments, diagnosis, and complications of oncology

Maternal/Fetal Medicine

Concerned with the care and consultation of patients with complications of pregnancy

Requires knowledge of obstetrics, medical and surgical complications of mother and fetus, current approaches to diagnosis and treatment, and newborn adaptation

Reproductive Endocrinology and Infertility

Concerned with the management of complex problems relating to reproductive endocrinology and infertility

Requires knowledge of diagnosis and treatment of endocrinology and infertility disorders

Urogynecology/Reconstructive Pelvic Surgery

Classified as surgical subspecialty

Concerned with the health of the female urinary tract and surgery as a treatment

Requires knowledge of complex benign pelvic conditions, lower urinary tract disorders, pelvic floor dysfunction, and reconstructive pelvic surgery

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What Is a Midwife?

Overview of Midwifery

A midwife attends childbirth, provides support during labor and delivery, and supervises the general care of women and children directly after birth. midwife-mf.jpgThe term midwife, meaning "with a woman," was first recorded in 1300. However, accounts dating to the second century confirm the role of midwives in the birthing process. Contemporary midwives provide care to women during normal pregnancies and deliveries and call on obstetricians or other physicians if complications develop. Midwifery is a professionally regulated field.

Midwifery provides continuous support to women with uncomplicated pregnancies during pregnancy and labor. Communication between midwife and the pregnant woman is emphasized, and midwives focus on working with the woman to reduce the risk for complications during childbirth. Midwives also focus on the needs of the family, and most encourage family participation in the birth. They pay special attention to the cultural values and personal preferences of the women in their care.

Safety is also a priority in midwifery and studies show that outcomes are the same as physician-attended births. As part of their commitment to nonintervention, midwives do not advocate the use of pain medication or invasive procedures during the normal birthing process. They encourage women to actively participate in the birthing process. Midwives provide health care education and emotional and social support. The continuous presence of a midwife during labor can reduce:

The length of labor

The need for pain medication

The likelihood of forceps or other operative devices during delivery

The possibility of cesarean delivery

There are two recognized types of midwives in the United States: direct entry midwives and nurse-midwives. The credentials differ; however, certification requires that both types are trained in childbirth and committed to providing continuous care to women throughout childbirth. Midwives maintain working relationships with physicians in case of emergencies or complications.

Direct Entry Midwives

A direct entry midwife (DEM) enters the field of midwifery through an apprenticeship, community-based training, or a field other than formalized nursing education. They have a long-standing commitment to women's health care and experience-based training. Most often, DEMs provide care to women giving birth at home.

During the past 50 years, many pregnant women have chosen obstetrics for their method of care and midwifery experienced a decline. Within the last 10 years, there has been a push to standardize the education of DEMs through certification and credentialing. Since 1996, DEMs can attain certification from the North American Registry of Midwives as "Certified Midwife" (CM), a professionally recognized title. Midwifery is currently experiencing an upswing in popularity.

Requirements for Certified Midwives

Direct entry midwives may have completed apprenticeships with midwives and/or physicians, performed independent studies, and/or completed midwifery school. To attain Certified Midwife status, they must also:

Complete prerequisite health science requirements

Graduate from an accredited, university-affiliated midwifery education program

Earn at least a baccalaureate degree

Successfully complete the national certification exam

The American College of Nurse-Midwives (ACNM) developed the requirements to guarantee competency for CMs. CMs are held to the same standards for practice, philosophy, and code of ethics as certified nurse-midwives. The certification examination is the same as for certified nurse-midwives and is administered by the ACNM Certification Council (ACC).

CMs practice independently, at medical clinics, or at hospitals as physician assistants. As a relatively new profession, CMs are not recognized by every state. Insurance providers may cover their services and many CMs have a sliding scale.

Nurse-Midwives

Nurse-midwives are registered nurses who have completed accredited midwifery programs. Once certified, they are certified nurse-midwives (CNMs). Nurse-midwives can write prescriptions and provide a variety of care, including:

	Care after birth		Labor and delivery care
	Disease prevention		Menopausal management
	Family planning assistance		Newborn care
	Gynecological exams		Preconception care
	Health maintenance counseling		Prenatal care

Nurse-midwives collaborate with physicians, especially in problem pregnancies. In general health care, nurse-midwives work with other medical professionals to provide comprehensive health care resources. When additional medical advice or surgical care is needed, they refer women to the appropriate physician.

The philosophy of nurse-midwifery is based on providing health care to women, while acknowledging and respecting their needs. They encourage patient education, active participation, clear communication between the provider and the woman, and an individualized health care experience.

Perhaps the best-known facet of nurse-midwifery is the commitment to facilitating uncomplicated pregnancy. Nurse-midwives provide information about different types of care available and encourage women to enhance their pregnancy by being involved. Nurse-midwives advocate birth education, natural childbirth, and the participation of the entire family. They rely on technology only when it is medically necessary. Thus, cesarean sections and episiotomies are less common when care is provided by a CNM.

Requirements for Certified Nurse-Midwives

The tradition of nurse-midwives has existed since the 1920s and the American College Nurse-Midwives (ACNM) formed in 1955 to oversee the development of the field. The ACNM has defined the criteria for nurse-midwifery. Nurse-midwives receive education and training in nursing and midwifery and must be licensed. The requirements for certification are similar to those for certified midwives.

To become a Certified Nurse-Midwife (CNM), candidates must successfully complete these requirements:

Completion of an accredited nursing program

Licensure as a Registered nurse

Satisfactory completion of a program in nurse-midwifery from an accredited institute

Once a candidate meets these requirements, he or she can take the national certification examination administered by the ACNM Certification Council (ACC). After passing the exam, the candidate receives nurse-midwife certification. Because state licensing laws vary, there may be additional requirements.

The National Center for Health Statistics reports that in 1998, 277,811 births were CNM-attended in the United States. CNMs usually work in private physician practices, hospitals, clinics, free-standing birth centers, and health departments. They may have their own private practices and occasionally attend home births. All states mandate Medicaid reimbursement and most require private insurance reimbursement for nurse-midwifery services.

Your family physician or OB/GYN can refer you to a midwife in your area. In addition, the ACNM has a 24-hour toll-free number that provides the names of ACNM certified midwives, sorted by zip code: 1.888.MIDWIFE (1.888.643.9433). This information is also available online at www.midwife.org/find.cfm.

When choosing a midwife, it is recommended that you ask the following questions:

Where did you receive your education? Are you certified?

How long have you been practicing? Where do you now practice?

Describe your approach to midwifery, including, the role of the patient, expectations, and collaboration with physicians.

Do you attend the entire labor process or does another nurse-midwife take over?

If complications occur, what is the procedure?

What are your fees? Do you accept insurance?

Do you encourage families to be present during labor and birth?

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Vaginal Birth After Cesarean (VBAC)

Overview of VBAC

Though once valid, the belief that women who have delivered via cesarean section (c-section) are not eligible for later vaginal delivery is no longer true. Vaginal birth after cesarean section (VBAC) has become more common as risks to mother and infant have been reduced and because of the benefits. During c-section, an incision is made in the abdominal and uterine walls, the amniotic sac (bag of waters) is ruptured, and the doctor removes the infant through this incision rather than vaginally. In certain circumstances, c-section requires a vertical incision through the abdominal and uterine walls, which is more prone to tearing during subsequent deliveries than the scar left by the current technique of a low transverse (horizontal) incision.

Incidence and Prevalence of VBAC

According to the Centers for Disease Control and Prevention (CDC), more than 29% of births in the United States are by c-sections, and repeat cesareans account for approximately one-third of these. According to the World Health Organization, a rate of 10% to 15% may be more desirable. Repeat c-section is not always necessary; successful VBAC could decrease these numbers, but not all women who are eligible attempt it. In 1995, only 27% (about 76,000) of candidates attempted vaginal birth after cesarean section.

The increase in c-sections over the past decades is attributed to many factors including:

fetal monitoring, which indicates when the fetus is in danger,

medical-legal reasons, and

delivery of breech infants.

C-section rates are also higher for older women with private medical insurance and higher income than for other groups.

Who are candidates for VBAC?

Candidates for VBAC are women who:

have had not more than two horizontal (transverse) incisions in the uterus (in contrast to the previously used vertical incision in the uterus) and

have no history of uterine rupture.

Some candidacy guidelines (e.g., the ACOG Practice Bulletin) recommend that a pregnant woman undergoing VBAC should have an obstetrician and anesthesiologist immediately available to perform a c-section in the event of uterine rupture, which can threaten the lives of the mother and infant. Home births are not recommended for VBAC candidates.

Contraindications for VBAC

Women who have had a vertical incision (or "classic incision") are not considered candidates for VBAC because of their increased risk for uterine rupture. Inadequate obstetrical operating facilities and medical staff (e.g., anesthesiologist, ob/gyn) also indicate that a repeat c-section might be advisable. It is widely accepted that women who have had a uterine rupture in the past should have a c-section rather than attempt vaginal delivery.

Common signs of uterine rupture during labor include:

abnormal fetal heart patterns,

abdominal pain, and

vaginal bleeding.

Risks of VBAC

A cesarean delivery is major surgery, with all of the associated risks. When successful, VBAC is safer than c-section. VBAC is associated with a small risk of uterine rupture, but it is considered to be a safe option for some by the American College of Obstetricians and Gynecologists (ACOG). The uterus is a hollow, muscular organ. A uterine rupture is a surgical emergency that occurs during labor and sometimes before labor starts. The uterine wall tears at the site of a prior surgical incision and sometimes tears as a result of weak uterine muscle tissue (caused by multiple pregnancies or infection). The infant may be expelled from the uterus into the mother's abdominal cavity, which can result in infant brain damage or death.

The incidence of uterine rupture with VBAC in a mother who has had a low transverse incision is approximately 0.2–1.5%.

Accompanying the elevated risk of uterine rupture is an increased risk for hysterectomy (surgical removal of the uterus). However, most cases are managed by controlling the bleeding and repairing the tear surgically. Also, there are indications that a failed attempt at VBAC followed by a c-section increases the rate of infection in infants and mothers.

There is no conclusive evidence that labor induced with pitocin or prostaglandin gel creates a risk in VBAC. However, some studies indicate that the use of prostaglandin gel in VBAC cases may increase the risk of uterine rupture, hemorrhaging, and hysterectomy in the mother and of subsequent fetal distress and infant death.

Benefits of VBAC

Some of the benefits of VBAC are as follows:

Epidural analgesia

Fewer medical risks to mother and baby

Less blood loss and fewer blood transfusions

Less risk for infection for mother and infant

Lower cost

Shorter post-delivery recovery time for the mother

Prognosis of VBAC

The success rate for VBAC is approximately 60–80% and can be higher if the patient had a vaginal delivery prior to c-section. In patients who had a c-section performed because of dystocia (abnormal or difficult labor), the success rate is lower. The most common causes of difficult labor include:

Cephalopelvic disproportion or 'CPD' (the infant is too large for the pelvis)

Failure to progress (contractions are not productive; cervix does not dilate; labor lasts too long)

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Pregnancy in Older Women

Pregnancy after Age 35

Women over 35 now account for about 13 percent of births, or about 1 in 8. In 1999, the birth rate for women ages 40 to 44 was the highest reported since 1970. Some studies have shown that as women grow older, they run a greater risk of miscarriage, premature birth, birth defects, having a low-birth-weight baby, and experiencing complications. Yet other research suggests that the risks of delaying pregnancy until late in the reproductive years (after 35) are not related only to age but to preexisting disorders such as high blood pressure or diabetes that may worsen with age. Studies do continue to show that women older than 35 are at higher risk for miscarriage and having babies with birth defects, as well as for cesarean delivery—although the latter may reflect physician-patient anxiety rather than an absolute need for cesareans. In addition, fertility in women declines with the years.

None of this means, however, that it’s inadvisable to have a baby when you’re over 35 or even in your 40s. A woman attempting a first pregnancy at 35 or older should take the following precautions (in addition to those already noted):

If pregnancy does not occur readily, seek professional advice early. If either partner needs treatment for infertility, the sooner it is begun, the better.

Women over 35 should consider amniocentesis to determine whether there are genetic abnormalities in the fetus. Genetic counseling for couples is a good idea.

Try to embark on pregnancy before age 40, since fertility declines quickly after that, and the chances of genetic abnormalities in the fetus increase. Nevertheless, women in their early 40s can still conceive and bear healthy babies.

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General Teen Pregnancy Information

Early prenatal medical care, proper nutrition, and healthy choices (e.g., not smoking, not drinking alcohol, not taking illegal drugs, exercising regularly) are important parts of a healthy pregnancy. If you are sexually active and think you might be pregnant, ask a parent or another trusted adult (e.g., family member or friend, teacher, school counselor, clergy) to help you locate a physician, prenatal clinic, or social service organization for pregnant teens as soon as possible.

There are a number of resources available to help pregnant teens and their families decide the best option for their particular situation (e.g., adoption, raising the child). The earlier you obtain medical care, the better your chances for having a healthy pregnancy. An OB/GYN (obstetrician/gynecologist) is a physician specialist who has particular expertise in pregnancy, childbirth, and disorders of the reproductive system.

Ideally, women should visit a health care provider before becoming pregnant; however, because many pregnancies are unplanned and unexpected, this is not always possible. If you suspect you may be pregnant, it's important to see an OB/GYN as early as possible in your pregnancy. Although dealing with a teen pregnancy can be difficult, your OB/GYN is there to help and the primary importance is your health and the health of your unborn baby.

Early signs of pregnancy include the following:

Abdominal bloating

Breast sensitivity (e.g., tenderness, swelling)

Fatigue

Food cravings or aversions

Frequent urination

Light bleeding or spotting (called implantation bleeding)

Missed menstrual period

Nausea or queasiness

During your first appointment, your health care provider (e.g., physician, midwife, physician's assistant, nurse practitioner) will take a detailed personal and family medical history, perform a physical examination (including pelvic exam), and conduct laboratory tests (e.g., blood tests, urine tests, and tests to detect sexually transmitted diseases [STDs], including HIV). Make sure your health care provider knows about past or current medical conditions, such as diabetes, and about any prescription or over-the-counter medications you are taking, including herbal remedies and vitamin supplements.

Here are some questions to ask your health care provider. Print this page and take it with you to your appointment. Answers to these questions can help you achieve the best possible outcome for your pregnancy.

How many weeks along is my pregnancy? What is my due date?

Does my pregnancy appear to be healthy and progressing normally?

Can you recommend resources for additional information about adoption, abortion, and raising a child?

Can you recommend a class or program in the area or an online support group for pregnant teens?

Is there a group that provides support to expectant teenage fathers?

Should I begin taking a prenatal supplement? Which one(s)?

In addition to cigarettes, alcohol, and illegal drugs, what other substances should I avoid while pregnant?

How can I be sure to eat a healthy diet during pregnancy? Are there any foods that I should avoid?

What types of exercise do you recommend during pregnancy? Are there activities that I should avoid?

How can I make sure to get enough sleep during pregnancy?

How often will I be seen in the office? Next appointment: Date: Time:

Will I see different members of the obstetric team (e.g., nurse practitioner, midwife, nurse-midwife)?

What types of tests (e.g., ultrasound, blood tests) may be used to monitor my pregnancy?

Is my pregnancy considered high risk? Am I at increased risk for pregnancy complications, such as anemia, high blood pressure, or premature delivery?

Does my baby have a higher-than-normal risk for medical problems?

What are some warning signs that may indicate a problem with my baby? Emergency telephone number to call:

Should I attend special childbirth classes for teens?

At which hospital or childbirth center will I deliver?

What is the cesarean rate for your practice?

If complications develop during delivery, might I or my baby be transferred to another facility?

How do I select a pediatrician for my child?

Can you recommend sources for additional support if needed?

Download/Print this page (PDF)

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Before Pregnancy

Before You Become Pregnant

If you are planning to have a child, you should see your doctor for a thorough physical examination before you attempt to become pregnant. One reason for this is that you may have a condition that can complicate your pregnancy, but that initially has no obvious symptoms (such as diabetes, high blood pressure, or genital herpes). Your doctor can advise you about how to deal with any health problems before you try to become pregnant. You can also find out whether any medication you are taking could be harmful and if a safer substitute is available. If you are overweight, your doctor may advise you to slim down to prepare for the weight gain that will occur during pregnancy.

If you plan to become pregnant (or already are an expectant mother), a doctor or another health-care professional can also counsel you (and your partner) about prenatal care and help you evaluate your diet, physical activity, and lifestyle as it will affect your baby. During the time you are trying to become pregnant, you should avoid smoking and drinking alcohol, and either avoid caffeine or minimize it (no more than one cup of coffee a day), since these substances increase the risk of miscarriage and other complications. (Smoking also affects your chances of conceiving: according to a study from the School of Public Health at the University of California, Berkeley, a woman reduces her chances of becoming pregnant by 50 percent if she smokes even less than half a pack a day.)

Nutritional savvy: All women capable of becoming pregnant are also advised to consume 400 micrograms of folacin daily, from foods or supplements, in order to ward off birth defects such as spina bifida (see opposite page). Because spina bifida and similar birth defects occur in the first two weeks of pregnancy—long before most women know they have conceived—women must start building up folacin stores at least 28 days before becoming pregnant. Since half of all pregnancies are estimated to be unplanned, it’s recommended that intake should be kept high at all times.

Epidural Overview

Overview of Epidural

Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.

Epidural & Anatomy

The brain is covered by three membranes (dura, arachnoid, and pia), called the meninges that extend through the base of the skull and surround the entire spinal cord. The spinal cord travels down the entire length of the spinal column through the spinal canal. The epidural space is located between the dura and the interior surface of the spinal canal and contains veins, arteries, and fat. Epidural injection is the injection of medication into the epidural space.

Epidural Procedure

Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.

A mild sedative and a local anesthetic may be given prior to the procedure to relax the patient and numb the injection site. Medications, usually an anesthetic such as bupivacaine (Marcaine®) or a muscle relaxant, and a corticosteroid such as methylprednisolone (Medrol®), are injected directly into the epidural space. (The injection is commonly called a cortisone shot.)

Effectiveness of Epidural Injection

Approximately 30% to 70% of people who receive an epidural injection benefit from it. Some patients notice improvement within hours of the injection; others improve over a number of days; and others experience no improvement with the treatment. In some cases, two or three injections are given over weeks or months.

Epidural Complications

Complications resulting from an epidural injection are rare. Possible conditions that may develop following the procedure include infection (e.g., epidural abscess), bleeding into the epidural space, and headache caused by a cerebrospinal fluid leak. Approximately 2% of patients experience side effects from the corticosteroid, such as mild fluid retention.

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After Pregnancy

Concerns After Pregnancy

Breastfeeding: All women should seriously consider breast-feeding their babies, as breast milk is an ideal source of nutrients and can supply the newborn with antibodies to various infections. Breastfeeding also helps a woman’s uterus return to normal size after delivery. And the contact between mother and child provides a nurturing psychological bond.

Nevertheless, some women dislike the idea of breast-feeding or have a job that would make it very inconvenient to breast-feed. Also, some women should not breast-feed, including those taking certain medications that pass into breast milk or women with certain infections, such as HIV, chicken pox, or active tuberculosis. A woman who cannot or chooses not to breast-feed should not feel guilty, since babies do fine on formula.

If you decide to breast-feed, talk to your doctor about the care and preparation of your breasts. Even though breast-feeding is a natural process, many women can benefit from learning how to do it properly. Your doctor can instruct you or may refer you to a “lactation coach.” Some women develop sore, swollen breasts and/or cracked nipples; if this happens, see your doctor.

Also, talk to your doctor about when you can resume having sexual intercourse (generally about three weeks after birth) and about any steps you want to take to avoid another pregnancy right away. (Breast-feeding does not prevent pregnancy.) You should also have a pelvic exam four to six weeks after the birth.

Postpartum depression: After a child is born, it is normal for the mother to experience a range of feelings. Joy and a sense of relief are part of this emotional spectrum, but it is common for new mothers to feel inexplicably “blue” at times, which may stem from fatigue, hormonal changes, and shifting emotions. Such intermittent feelings often develop a few days after the baby is home and may persist for several weeks.

The support of family members in taking care of the baby usually helps diminish the blue feelings, and so does talking to other new mothers. It’s also important to avoid becoming too tired. If you feel overwhelmed, you should talk to your doctor, who may be able to help you work through your feelings or can recommend a counselor or support group to provide assistance.

Severe depression is rare, but a few women do become so depressed after childbirth that they cannot take care of themselves or their babies. Depression of this nature is usually evident within a month of the birth. If it develops, the mother and/or father or other family members should seek professional help right away.

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Prenatal Care

Care during Pregnancy

Prenatal care should start as soon as you know you are pregnant—at which point (if you haven’t already heard it) your doctor will caution you about the potential hazards of using tobacco, alcohol, and drugs. All three can impair fetal development in different ways, and you should avoid them entirely, except for drugs that you take at your doctor’s direction.

Pregnancy and Nutrition

Nutrition can have a profound effect on your health and your baby’s. Poor eating habits not only can interfere with your baby’s growth but can also aggravate some of the common discomforts of pregnancy.

The 38 weeks of a normal pregnancy is one period in your life when you are encouraged to gain weight. Recommendations about healthy weight gain vary somewhat among experts, but according to current guidelines from the Institute of Medicine at the National Academy of Sciences, most women should gain 25 to 35 pounds: three to five pounds during the first trimester, and one to two pounds per week after that.

A large percentage of this weight gain is from the baby, the placenta, and the increased volume of fluid in a woman’s body. Failing to gain sufficient weight can be harmful to the baby’s health. At the same time, pregnancy is not an excuse to become excessively heavy. Too much weight can complicate delivery, impede postpartum weight loss, and result in other complications such as hypertension. It is also harder to lose excess weight after pregnancy.

Your doctor or other caregiver will assess how much weight is best for you to gain. Women who are overweight at conception may need to add weight at only half the rate of an average-weight woman, but it is important that they gain at least 15 to 25 pounds, since lower increases are associated with retarded growth of the fetus. Similarly, underweight women and some very young women may need to gain more weight than the average woman—up to 40 pounds, depending upon their stature and weight at conception.

The demands of pregnancy will require, on average, an additional 300 calories daily. In addition to extra calories, pregnant women should eat a nutritious diet based on the food groups and portions shown in the food guide pyramid devised by the U.S. Department of Agriculture, which provides specific amounts of food to be eaten daily. If you’re having trouble gaining weight, eat more breads and other grains, rather than consuming foods high in fat. If you’re gaining too much weight, reduce your consumption of high-fat foods like butter and margarine, packaged snack foods, salad dressings, and rich desserts..

The National Research Council, which sets recommended daily amounts of nutrients, advises that pregnant women who eat a well-balanced diet don’t need vitamin and mineral supplements. Many women, however, may have trouble meeting the recommended amounts of iron, calcium, and folacin, and, depending on their diet, other nutrients as well. Women following a vegetarian diet, for example, may need additional zinc and possibly some B vitamins. Many doctors, therefore, will prescribe a supplement especially formulated for pregnant women to provide various essential nutrients. These supplements are not a substitute for a balanced diet; your health and that of your child depend on getting the bulk of your nutrients from foods.

Pregnancy and Exercise

Proper exercise during pregnancy can have many benefits. For a woman who enjoys working out, it can be important psychologically to continue with a regular exercise program after she becomes pregnant. If you do not already exercise, pregnancy can help you feel more in control as your body changes. Moderate exercise during pregnancy can also help prevent pregnancy-related complaints such as excessive weight gain, back strain, and constipation. Another potential benefit: Exercise may help ease or shorten labor and delivery, and help speed recovery after birth. Medical experts say that your exercise program must be geared to your level of fitness, your medical history (particularly any problems during past pregnancies), the stage of development of the fetus, and maternal complicating factors. Therefore, it is important to consult your physician.

Remember that being pregnant puts extra demands on your heart and lungs, so cut back on the intensity of any exercise routine. As pregnancy advances, breathing becomes harder work because each breath must displace the enlarging uterus downward.

For exercise to be effective, it should be regular. Try to exercise at least three times a week in half-hour sessions. The best exercise is an activity you enjoy. Walking and swimming are particularly good for pregnant women who have been relatively sedentary. Muscle-strengthening and joint flexibility exercises are also excellent for helping you support the extra weight you’ll carry and improving your balance.

Be sure to warm up and cool down—but stretch carefully because muscles and joints are looser than usual. Cool down with leisurely walking, which helps return blood to your heart from your lower extremities.

If you feel comfortable and your doctor allows it, you can continue most forms of exercise into your ninth month, although you may have to make some modifications to meet your body’s changing demands.

What to avoid. Avoid bouncing, jarring, twisting, and any activity that could lead to a fall or a blow to the abdomen. Contact sports are too risky, as is any activity that requires rapid stops and starts, since your center of gravity has changed and it is easier to lose your balance.

In addition, take the following precautions:

Avoid exercising to exhaustion. If you feel very tired or experience discomfort, stop and rest. You should not exercise so intensely that you are unable to talk. You should recover your preexercise heart rate within 15 minutes after your exercise session.

After 20 weeks into your pregnancy, don’t exercise for more than a few minutes while lying on your back This can block the blood supply to the uterus and depress the fetal heart rate.

If you need to rest during an exercise session, lie down on your side, not on your back.

Don’t exercise vigorously in hot, humid weather; always drink plenty of water before and after exercising. This avoids the dehydration and elevated body temperature that could injure the fetus.

Remember that your muscles and connective tissues are gradually undergoing hormonal changes that will relax them. This will facilitate the baby’s birth, but it also makes you more susceptible to strains and sprains. Wear properly fitting shoes that support your feet in whichever activity you choose.

Pregnancy & Nutrition Overview, Weight Gain during Pregnancy

Overview of Pregnancy & Nutrition

Recognizing early symptoms of pregnancy can help women seek early prenatal care, which is important for both the mother and her developing baby.

Pregnant women must eat well and are encouraged to eat a variety of foods. Weight gain is a normal and healthy part of pregnancy, especially during the second and third trimesters (i.e., the 14th week through the end of pregnancy). Most women gain a normal amount of weight by eating healthfully, staying active, and allowing their appetite to guide their food intake.

Physicians usually recommend general guidelines for healthy eating. The pregnant woman's diet should be include the basic nutrients necessary to meet the demands of the developing fetus. Junk food should be avoided, because it provides little more than empty calories. For women who normally do not follow a healthy diet, pregnancy is a good time to start.

Healthy eating helps ensure that the baby will have a healthy birth weight and will not be born with infections or other problems, reduces the risk for premature birth, builds up fats and fluids for use during breastfeeding, and reduces the risk for complications during pregnancy. It is also important that women continue to eat well after the birth, especially if the baby is breastfeeding.

Weight Gain during Pregnacy

Pregnancy is no time to diet. Every woman is different, depending on body type and weight before conception, but most women who deliver healthy babies gain about 25 to 35 pounds or more during pregnancy. Women who are underweight prior to pregnancy should gain a little more, and overweight women, a little less.

Women who do not gain enough weight have an increased risk for delivering babies with low birth weight (less than 2500 gm, or 5.52 pounds). The National Institutes of Health considers low birth weight (LBW) a major public health problem in the United States. LBW is a major cause of infant mortality, as well as many childhood developmental, physical, and psychological problems.

Although infant mortality in the United States has declined over the past several decades, it is still a significant public health problem. Among African Americans, approximately 13% of newborns are underweight; among Hispanics, 6% to 9%; among Asian Americans, 5% to 8%; and among Caucasians, approximately 6% of newborns are underweight. Racial variations in birth weight may reflect socioeconomic differences and this is an important focus of research funded by the National Institutes of Health.

Babies who are underweight are at risk for physical and psychological childhood disorders:

They are more likely to experience asthma, respiratory tract infections, and ear infections.

Babies who are born weighing less than 1000 gm (2.2 lbs), are at greater risk for cerebral palsy (a neurological abnormality).

They are more likely to score low on intelligence tests and are more likely to have delayed development.

Gaining too much weight can also be a problem. It can make pregnancy an unpleasant experience, causing backache, leg pain, varicose veins, and fatigue. It may lead to hypertension and diabetes. Excess weight may also be difficult to lose after delivery.

Excessive weight gain may also cause problems for the baby. Technically, an overweight baby is one who weighs more than 4500 gm, or 9.9 lbs. Large babies make vaginal deliveries difficult, increasing the risk for cesarean section. Overweight babies may have an increased risk for health problems later in life (e.g., obesity, adult rheumatoid arthritis, diabetes).

Women who are gaining too much weight during pregnancy should follow the guidelines for healthy eating; avoid foods that do not have nutritional value; and consult a doctor, midwife, or dietitian.

Every woman's body is different, and determining how much weight a woman should gain is an estimate. The following table provides recommended weight gain based on a woman's body mass index (BMI) at the beginning of the pregnancy. Body mass index measures the weight-to-height ratio and is calculated by dividing weight (measured in kilograms) by the square of height (in meters). A normal BMI ranges from 19.8 to 26.

For women whose BMI is normal, the recommended weight gain over the course of the pregnancy is 25 to 35 pounds. Women who are underweight, or have a low BMI, should gain more weight, and women who are overweight, or have a high BMI, should gain less.

BMI (kg/m2)	Recommended Weight Gain
Low (BMI <19.8)	12.5-18 kg (28-40 lb)
Normal (BMI 19.8-26)	11.5-16 kg (25-35 lb)
High (BMI 26-29)	7-11.5 kg (15-25 lb)
Obese (BMI >29)	6 kg (15 lb)

Pregnant women should consult a physician or midwife if they have questions about how much weight they can expect to gain on a week-to-week basis during pregnancy. Generally, little weight is gained during the first trimester (3 or 4 lbs.). The most weight (about 12 to 14 lbs.) is gained during the second trimester. In the third trimester, a woman should expect to gain about 8 to 10 lbs.

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Pregnancy & Nutrition, Healthy Diet Guidelines

Healthy Diet during Pregnancy

Women who follow a healthy diet before pregnancy may only need to make some basic changes to ensure that she and the developing baby get the proper nutrition. During pregnancy, increase the daily intake of calories through healthy food choices, eat more protein, and take a prenatal vitamin that contains folic acid (as directed by a qualified health care provider). Women who generally do not follow a healthy diet should start making healthy changes before becoming pregnant.

To give birth to a healthy, thriving baby, the nutritional value of a woman's diet is just as important as the total caloric intake. Sometimes this may require vitamin or mineral supplements, especially iron, calcium, folate and, for some women, vitamin D. Generally, sodium should be restricted to avoid developing high blood pressure (hypertension).

Iron & Pregnancy

There are more than 200 million molecules of hemoglobin in a single red blood cell. Iron is the main component of hemoglobin, which carries oxygen through the body. During pregnancy, a woman's blood supply increases to supply nutrition to the growing fetus. Iron deficiency may cause iron-deficiency anemia.

Pregnant women should eat iron-rich foods to prevent iron deficiency. Iron-rich foods include leafy greens such as spinach and broccoli, strawberries, meats, whole grains, prune juice, dried fruit, legumes, and blackstrap molasses.

Routine prenatal care is a good way to determine if a woman should take an iron supplement during pregnancy. Some women require a 30 mg supplement per day or, if diagnosed with iron-deficiency anemia, as much as 60 to 120 mg of iron per day.

Calcium & Pregnancy

Calcium is essential for maintaining the bone integrity of a pregnant woman and providing the skeletal development of the fetus. The U.S. RDA (recommended daily allowance) for pregnant woment is 1200 mg, which is sufficient to meet both the maternal and fetal needs. Women should increase their intake of calcium-rich foods, such as milk products. Women who do not consume dairy products should take a calcium supplement of 600 mg per day.

Folate & Pregnancy

Folate is essential for protein synthesis, the formation of new cells, and the production of new blood. It is required for a pregnant woman's increasing blood supply and the growth of both maternal and fetal tissues. Sufficient folate also decreases the risk of neural tube defects.

The recommended intake for folate increases during pregnancy from 200 mcg (micrograms) to 400 mcg per day. It is possible to meet this requirement through a well-selected diet: folate-rich foods include eggs, leafy vegetables, oranges, legumes, and wheat germ. Some women may require 300 mcg of folate supplement daily.

For women who have previously delivered infants with neural tube defects, the U.S. Center for Disease Control recommends 400 mcg supplements daily, starting at least 4 weeks before conception and for the first 3 months of pregnancy.

Multivitamins containing folate should not be used to achieve the desired level of supplementation, as potentially harmful quantities of other nutrients (such as vitamin A) could be ingested.

Vitamin D & Pregnancy

Vitamin D is necessary for the absorption of calcium and is important for normal bone growth. Women with a low intake of vitamin D-fortified milk and minimal exposure to sunlight should take a daily supplement (10 mcg).

Protein & Pregnancy

The estimated requirement for protein during pregnancy is 60 gm, which is about 15 gm more than normal. Protein-containing foods can be excellent sources of vitamins and minerals such as iron, vitamin B6, and zinc. In the United States, protein deficiency is uncommon because most people consume and adequate amount of protein-rich foods.

Getting enough protein is important to help the woman maintain, and the baby build, muscle and other tissues, enzymes, hormones, and antibodies. Good sources of protein include lean meats, poultry, fish, beans, nuts, and low- or non-fat dairy products.

A 3-ounce serving of lean beef, fish, or poultry provides 20–25 grams of protein. There are 6–8 grams of protein in the following:

1/2 cup of beans

2 tablespoons of peanut butter

1/4 cup of nuts

1 cup of low- or non-fat milk or yogurt

1 ounce of cheese

1 egg

Sodium & Pregnancy

Although sodium need not be restricted during pregnancy, excessive use is not recommended. A diet of primarily natural foods can be safely salted "to taste." Pregnant women should avoid processed or "junk" foods that are high in sodium. Excessive intake of salt can cause high blood pressure (hypertension) and may lead to excessive weight gain.

General Nutrition Guidelines

General guidelines to help ensure a healthy pregnancy and birth include the following:

Pregnant women should eat a variety of foods (e.g., vegetables, fruits, grains) to ensure a sufficient supply of basic nutrients.

The diet should include low-fat dairy products and lean meat.

If a woman experiences nausea or morning sickness, or if she feels too full too soon in the later stages of pregnancy, it may be helpful to eat several small meals rather than a few large meals.

Pregnant women should limit their consumption of caffeine and excess salt and should avoid alcohol.

Pregnant women are encouraged to engage in moderate exercise after consulting with their physician or midwife. Exercise should be geared to increasing the woman's sense of well-being and maintaining her general overall health. Pregnant women who exercise regularly tend to enjoy their pregnancy more. Exercise may also reduce the stress of the delivery for both the mother and baby.

Pregnant women should limit fish consumption to 2 servings per week and limit the intake of white or albacore tuna to no more than 6 ounces per week. Avoid shark, swordfish, king mackerel, and tilefish due to potentially high levels of mercury.

The U.S. National Academy of Science recommends a vitamin and mineral supplement that contains the following:

30 mg iron

15 mg zinc

2 mg copper

250 mg calcium (600 mg for women younger than age 25 and for those whose daily intake of calcium is less than 600 mg)

2 mg vitamin B6

3 mg folate

5 micrograms vitamin D (10 micrograms for women who do not drink vitamin D-fortified milk, have minimal exposure to sunlight, or are vegan)

2 micrograms of vitamin B12 for women who are vegan

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Food Safety during Pregnancy

Prevent Foodborne Illness & Food Poisoning

According to the Centers for Disease Control and Prevention (CDC), women who are pregnant are about 13 times more likely to get a rare, serious foodborne infection called listeriosis (or listerosis) than the general population. Listeriosis is caused by Listeria monocytogenes—bacteria present in contaminated soil and the intestines of infected animals.

Meningitis (infection of the membranes of the brain or spinal cord) is the most common manifestation of listeriosis in adults. Most people have a high degree of resistance to the bacteria that cause listeriosis, but in expectant mothers, infection can be transmitted through the placenta to the unborn baby—resulting in spontaneous abortion or other severe complications. When listeriosis infection occurs in a newborn, it's often fatal—especially during the first few days of life.

Other foodborne illnesses can also cause serious health problems during pregnancy—both for the expectant mother and her unborn baby. Pregnancy weakens the mother-to-be's immune system (which helps fight infections), and a baby's immune system doesn't fully develop for several months after birth, increasing the risk.

The following tips can help Reduce foodborne illness risk in women who are pregnant:

Wash your hands often, especially before eating and drinking, when preparing food, and after touching raw meat, uncooked eggs or unwashed vegetables.

Don't share food, eating utensils or cups—especially with young children. When you're in close contact with or caring for young children, wash your hands frequently.

Avoid undercooked meat and processed meats like hot dogs and deli meat. Use a meat thermometer to make sure meat is well done (an internal temperature above 160°, depending on the type).

Avoid raw (unpasteurized) milk and milk products, including unpasteurized soft cheeses like feta, brie and queso fresco, and eggnog during the holiday season.

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Pregnancy Apps

Whether you are in the pregnancy planning stage, are expecting your first baby—or your third, pregnancy apps can provide helpful tips for a healthy pregnancy. Using a pregnancy app on your mobile device offers instant access to important information about all stages of pregnancy and helps you track your pregnancy and your baby's growth and development—from day to day, week to week, month to month, and trimester to trimester.

Here are the top 10 pregnancy apps for Android, Blackberry and iPhone/iPod as determined by Mobilewalla—an app reporting site that ranks all apps on the market using criteria such as app store rank, user reviews and comments found on Twitter and other social media spaces and more.

Top Pregnancy Apps for Android

Search for these apps and more at Android Market.

My Pregnancy (Free)

Pregnancy Assistant (Free)

Pregnancy Tracker (Free)

Pregnancy Calendar (Free)

Pregnancy Ticker (Free)

Pregnancy Widget (Free)

Pregnancy Due-Date Calculator (Free)

BabyBump Pregnancy Pro ($2.99)

Pregnancy Contraction Timer (Free)

Pregnancy Guide Tips (Free)

Top Pregnancy Apps for Blackberry

Search for these apps and more at Blackberry App World.

Pregnancy Wheel (Free)

Pregnancy and Parenting Groups from 'What to Expect' (Free)

Pregnancy Week by Week ($5.99)

Prenatal Yoga ($0.99)

ontraction Calc ($0.99)

Pregnancy Pal ($0.99)

Pregnancy Checklist ($0.99)

Top Pregnancy Apps for iPhone/iPod

Search for these apps and more at iTunes.

Healthy Pregnancy ($2.99)

Pregnancy Fitness ($2.99)

Pregnancy Nutrition ($0.99)

BabyBump Pregnancy (Free)

Pregnancy & Baby Development (Free)

Pregnancy Health Guide (Free)

BabyCenter My Pregnancy Today (Free)

Baby Pregnancy Tracker (Lite) (Free)

I'm Expecting – Pregnancy App (Free)

iPregnancy (Pregnancy App) ($3.99)

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What Is Postpartum Depression?

The "baby blues" are a normal experience, but postpartum depression should be treated

The days and weeks after giving birth are a time of mixed emotions for most women. But when the mother feels intensely sad, anxious or "empty" a week or more after her baby is born, she may have postpartum depression.

Is it Postpartum Depression, or the "Baby Blues"?

Postpartum depression is different from what is sometimes called postpartum blues, or "the baby blues." An estimated 50% to 85% of women have the baby blues for a week or two after birth. Women can expect to feel overwhelmed, tearful, moody, anxious or irritable during this period, but these feelings are short-lived and aren't strong enough to impair the mother's functioning.

If these symptoms persist and interfere with daily living, however, a woman may be diagnosed with postpartum depression. Estimates vary, but 10% to 15% of mothers will develop the condition. The symptoms of postpartum depression, such as sleep disturbance, sadness and feelings of worthlessness, generally appear within the first three months after delivery; in some cases, they show up a year later.

What Causes Postpartum Depression?

There is no single cause for postpartum depression. Physical changes caused by hormones, lifestyle issues like financial difficulties, and emotional changes brought about by sleep deprivation or feeling overwhelmed can all play a part.

According to the Office on Women's Health, women are at increased risk of postpartum depression if they:

Are under age 20

Abuse alcohol or drugs, or smoke

Did not plan the pregnancy or had negative feelings about the pregnancy

Had been diagnosed with depression or an anxiety disorder prior to the birth

Had a stressful event during the pregnancy or delivery

Have a family member with depression or anxiety, or a family history of these mood disorders

Have a bad relationship with a significant other

Are single

Have financial problems

Get little support from family or friends

What Are the Symptoms of Postpartum Depression?

Postpartum depression generally shows up within three months after delivery, but it may occur up to a year later. The symptoms of postpartum depression are similar to the symptoms of clinical depression and can include:

Agitation, anxiety or irritability

Eating too little or a lot

Sleeping too little or a lot

Sadness

Frequent crying

Feelings of worthlessness or guilt

Feeling withdrawn or unconnected

Lack of pleasure or interest in most activities

Poor concentration or memory

Loss of energy or fatigue

Problems doing tasks at home or work

Lack of interest in or negative feelings toward the baby, or intense worry

Thoughts of death or suicide

It's typical for women to have some of these symptoms in the days following delivery, which is commonly referred to as "the baby blues." The baby blues will usually go away within a week or so.

If, however, you or someone you know has these symptoms for two weeks or more after giving birth, contact your doctor or a health care professional—it might be necessary to get treatment for postpartum depression.

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Treatment for Postpartum Depression

A range of options exists for treating postpartum depression

Mild depression after giving birth—a common condition known as "the baby blues"—usually goes away after several days. But when the symptoms of depression linger for two weeks or more following delivery, it’s important for mothers to consider treatment for postpartum depression.

Just like with clinical depression, a doctor will need to rule out other medical conditions before diagnosis of and treatment for postpartum depression begins. Thyroid disease, anemia and other illnesses can cause symptoms that resemble depression; additionally, some medications have depression-like side effects.

Treatment Options for Postpartum Depression

There are a number of treatments available for postpartum depression. Therapy, including cognitive behavioral therapy, interpersonal therapy and group therapy, has been proven effective at managing the symptoms of depression, according to Massachusetts General Hospital.

Antidepressants may be provided to women with postpartum depression. Breastfeeding moms may be reluctant to take these or other medications, but paroxetine (Paxil), sertraline (Zoloft) and nortriptyline (Aventyl) are considered relatively safe by experts and are among the preferred antidepressants, according to LactMed.com, a database that describes the effects of drugs on breast milk and infant health, hosted by the National Library of Medicine.

In addition to these therapies for postpartum depression, new parents may want to take a few simple steps to alleviate some of the pressures associated with having a newborn:

Don't try to do everything.

Ask for help—your partner, family, friends or a hired babysitter can help in the home or with the baby.

Rest as much as possible, and nap when the baby does.

Talk about your feelings with your partner, a family member or a close friend.

Avoid major life changes during pregnancy or right after giving birth.

Make time to go out, shop, visit friends and spend time alone with your partner.

Talk with other parents or join a support group.

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What Is a Midwife?

Overview of Midwifery

The length of labor

The need for pain medication

The likelihood of forceps or other operative devices during delivery

The possibility of cesarean delivery

Direct Entry Midwives

Requirements for Certified Midwives

Complete prerequisite health science requirements

Graduate from an accredited, university-affiliated midwifery education program

Earn at least a baccalaureate degree

Successfully complete the national certification exam

Nurse-Midwives

	Care after birth		Labor and delivery care
	Disease prevention		Menopausal management
	Family planning assistance		Newborn care
	Gynecological exams		Preconception care
	Health maintenance counseling		Prenatal care

Requirements for Certified Nurse-Midwives

To become a Certified Nurse-Midwife (CNM), candidates must successfully complete these requirements:

Completion of an accredited nursing program

Licensure as a Registered nurse

Satisfactory completion of a program in nurse-midwifery from an accredited institute

When choosing a midwife, it is recommended that you ask the following questions:

Where did you receive your education? Are you certified?

How long have you been practicing? Where do you now practice?

Describe your approach to midwifery, including, the role of the patient, expectations, and collaboration with physicians.

Do you attend the entire labor process or does another nurse-midwife take over?

If complications occur, what is the procedure?

What are your fees? Do you accept insurance?

Do you encourage families to be present during labor and birth?

What Is Postpartum Psychosis?

Postpartum psychosis requires prompt medical attention

Giving birth can be a trying time for mothers, but in a few cases, women can develop a rare but serious condition called postpartum psychosis. This can start as soon as 48 hours after delivery, but in most cases, symptoms appear within the first two weeks after birth.

The earliest signs and symptoms of postpartum psychosis are insomnia, irritability and restlessness. The condition is characterized by rapidly shifting episodes of manic or elated moods, followed by lethargy and depression. Disorientation, erratic behavior, delusions and hallucinations are common. There is also some risk of suicide or infanticide. Women with bipolar disorder, schizoaffective disorder or schizophrenia have an increased risk of the condition.

For this and other postpartum conditions, it's important to get treatment as soon as possible. The Office on Women's Health recommends a doctor or health care provider be contacted if:

Postpartum blues don't go away after two weeks

Symptoms of post-partum depression get stronger

It's hard for the mother to perform tasks at work or at home

The mother cannot care for herself or her baby

The mother has thoughts of harming herself or her baby

The mother has thoughts that are not based in reality, or starts hearing or seeing things that other people cannot

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Multiple Pregnancy Overview, Infertility Treatment

Overview of Multiple Pregnancy

A multiple pregnancy is a pregnancy involving more than one fetus. Twins, triplets, and quadruplets are multiple pregnancies. The largest multiple pregnancy on record led to the birth of nine offspring.

Twins are the most common type of multiple pregnancy. But worldwide, the incidence of multiple pregnancies of all types - twins, triplets, quadruplets, quinteplets, sextets, and more - is increasing as advanced types of infertility treatment become more common.

In the United States, the number of twin births has risen more than 50% over the last 2 decades since the advent of IVF (in vitro fertilization) in 1978, from about 68,000 to approximately 104,000 in 1997. The incidence of higher-order multiple pregnancies (triplets or greater) has increased 100-fold. Births of single individuals (singletons) rose only 6% in that same time period. The trend is evident in other countries as well. In Sweden, for example, the incidence of twin deliveries has increased nearly 80% over the last 20 years.

The increase of multiple births is age related. According to the National Center for Health Statistics, over the last 20 years, multiple pregnancies in the United States have increased 400% among women in their 30s and 1000% in women in their 40s. This trend is due in part to the fact that older women are less able to get pregnant naturally and are more likely to undergo infertility treatment.

Multiple Pregnancy and Infertility Treatment

How is it that a couple who has not been able to conceive is suddenly faced with the challenge of two, three, four, or more possible new babies? One of the features of IVF that makes it such a successful infertility treatment is that it usually involves implanting more than one embryo to increase the chance of a viable pregnancy.

Because there are multiple embryos, the chance of a multiple pregnancy increases. IVF babies are 20 times more likely to be born as multiple birth babies; one study shows that about 45% of all IVF newborns are born as multiple birth babies.

About 5% of infertility treatment involves IVF or other forms of assisted reproductive technology. The use of hormones to stimulate superovulation, coupled with insemination, is a more common method of infertility treatment. Superovulation involves using gonadotropin (a hormone) to induce ovulation of more than one ovum. The more ova that are available to be fertilized, the greater the chance that a multiple pregnancy will result. Because it is a more commonly used, and because it is so potent, superovulation accounts for as many, if not more, multiple births than IVF. Researchers estimate that 33% of the increased frequency of multiple births can be explained by IVF and another 33% by the use of ovarian stimulation.

Multiple Pregnancy - Twins, Other Multiple Births

Twins

There are two types of twins: identical and fraternal (non-identical). Scientists use the terms "monozygotic" and "dizygotic" because these terms are biologically meaningful. Monozygotic twins result from a single fertilized egg that, sometime during the first week following conception, divides into 2 embryonic discs, which develop into 2 separate embryos; dizygotic twins result from 2 eggs being fertilized during the same menstrual cycle.

Monozygotic (identical) twins possess characteristics that make them virtually indisguishable. Because they come from the same egg and sperm, monzygotic twins are genetically identical, similar in physical appearance, and the same sex. Physical differences are caused by environmental factors inside the womb.

Dizygotic (fraternal) twins arise from different eggs and sperm, look as different as siblings born at different times would look, and can be either the same or different sex. A dizygotic pregnancy does not always result from the same act of sexual intercourse, which means it is theoretically possible for dizygotic twins (as well as triplets and other higher-order pregnancies) to have different fathers.

Most twins, about two-thirds, are dizgotic, the other one-third monozygotic. The frequency of dizygotic twins varies widely among different populations. The monozygotic twin rate is remarkably constant among different ethnic groups and worldwide.

Occasionally, identical twins do not separate completely in the embryonic disc phase of devlopment and are born conjoined (i.e., attached to each other with shared organs). Conjoined twins are commonly known as "Siamese twins," named after conjoined twins who were born in Thailand (formerly Siam) in the early 1800s. Conjoined twins are described according to the body region where they are attached (e.g., thoracopagus twins are twins joined at the chest). In some cases, the twins are connected only by their skin. Some conjoined twins are successfully separated by surgery. It has been estimated that about 1 out of every 40 monozygotic twin pregnancies results in conjoined twins.

Other Multiple Births

If there are more than 2 ova, or a single ovum splits into 3 or more ova, higher-order pregnancies (e.g., triplets, quadruplets, and so on) result.

Triplets occur in the general population about once out of every 8100 pregnancies. They can develop in one of three ways:

[1]. From a single zygote that splits into three (identical or monozygotic triplets)

[2]. From 2 zygotes, one of which splits (identical twins and a singleton)

[3]. From 3 separate zygotes

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Multiple Pregnancy Formation

Formation of Multiple Pregnancy

Women are born with several hundred thousand primary oocytes (from the Greek "oon" meaning "egg" and "kytos" meaning "cell") in the ovaries. Primary oocytes are the cells that eventually develop into mature eggs which, if fertilized, become embryos. Most of them degenerate during childhood and only several hundred mature during the course of a woman's reproductive lifetime.

The eggs are released by the ovaries and are available for fertilization about once a month (except during pregnancy). The release of the egg from the ovary is called ovulation. When it is released, it is caught by the fingerlike ends of the fallopian tubes, through which it travels for about 4 days to the uterus.

Fertilization can occur any time during those 4 days following ovulation. If it is not fertilized during that time, the egg degenerates and flows out of the body with the menstrual blood.

If the egg is fertlized, it becomes a zygote (from the Greek "zygotos" meaning "yolked"). During the first week after fertilization, the zygote divides exponentially (i.e., splits into 2 cells, then 4, then 8, 16, 32 and so on). By the end of the first week, it is a few hundred cells that form a hollow ball with a swelled inner cell mass (embryonic disc) that eventually develops into an embryo and, later, a fetus. It is during this very early stage of development that monozygotic, or identical, twins develop: the embryonic disc splits into 2 or more separate discs that develop into 2 or more embryos.

About one-third of monozygotic twins result from a division that occurs within the first 2 or 3 days following conception. If the embryonic cells divide much later than about 9 days, the twins are rarely (only 4% of the time) delivered alive.

Sometimes, two eggs are released during a single menstrual cycle and, if both eggs are fertilized, lead to dizygotic twins. If more than 2 eggs are released, as often occurs when an infertile women is treated with superovulation therapy, a higher-order pregnancy can result.

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Multiple Pregnancy Maternal Risks & Complications

Complications of Multiple Pregnancy

Dealing with a multiple pregnancy involves more than the economic, emotional, and parental challenges of having several babies at once. There are serious medical risks and complications associated with carrying more than one fetus and giving birth to more than one infant at the same time. A multiple pregnancy is considered high risk; it requires early detection, specialized, extensive clinical management and monitoring, and awareness of possible complications.

Complications for the mother and infant can be very serious, and the risks increase with the number of fetuses.

Maternal Risks and Complications

Multiple fetuses pose health risks to the mother that can compromise her pregnancy and childbirth. In a multiple pregnancy, fetal requirements are proportionately greater and maternal blood volume is approximately 500 mL greater than in a singleton pregnancy. Prenatal (before birth) screening and care is critical in order to detect complications early so they can be properly managed.

Miscarriages— They are at least twice as common in multiple pregnancies.

Hyperemesis gravidarum— "Morning sickness" is common in multiple pregnancies and is characterized by excessive nausea and vomiting.

Pregnancy-induced high blood pressure— Hypertension is 3 times more common in multiple pregnancies, and it is more severe.

Increased incidence of preeclampsia — This is a toxic condition that can develop in late pregnancy. It is characterized by a sudden rise in blood pressure, excessive weight gain, swelling, severe headache, visual disturbances, and excessive protein in the urine (proteinuria). Severe preeclampsia can be life threatening.

Gestational diabetes — This form of diabetes develops for the first time during pregnancy as a result of hormones produced by the placenta. The condition usually subsides after delivery.

Iron- and folate-deficiency anemias — It is generally recommended that women take 60–80 mg of iron and 1 mg of folic acid supplementation daily to prevent anemia. A high-protein diet is also recommended.

Acute polyhydramnios — An excessive amount of amniotic fluid, the liquid inside the sac that holds the fetus, occurs in about 5 - 8% of women who have a multiple pregnancy.

Vaginal and uterine hemorrhaging — This condition is characterized by antepartum (before childbirth) heavy or uncontrollable bleeding.

Preterm labor and delivery — The average length of pregnancy is 39 weeks for singletons, 35 weeks for twins, 33 weeks for triplets, and 29 weeks for quadruplets. Multiple pregnancy is, on average, 12 times more likely to be preterm. Preterm labor often requires prolonged bed rest or hospitalization. Generally, once the pregnancy reaches about 32 weeks, the complications associated with premature delivery are significantly reduced.

Prolonged hospitalization and surgical delivery (i.e., caesarian section)—Caesarian section is often necessitated by malpresentation (abnormal position of the fetuses) that makes a vaginal delivery difficult, if not impossible.

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Multiple Pregnancy Complications, Multifetal Pregnancy Reduction (MFPR)

Fetal Complications in Multiple Pregnancies

Infants born from multiple pregnancies are at risk for various complications. Multiple pregnancies often require aggressive neonatal intensive care, which is costly and stressful for the family and the infant.

Low birth weight — Birth weight below 2500 gm is considered low, and birth weight below 1500 gm is considered very low. This condition results from having less room to grow in utero. Two-thirds of infants born from a multiple pregnancy are low birth weight and are at risk for significant short-term and long-term health problems as a result.

Birth defects — Monozygotic twins (develop from one egg that divides into two) are twice as likely as dizygotic twins (develop from two fertilized eggs) to be born with congenital malformations.

Infant mortality — Infants born from a multiple pregnancy are at a greater risk for infant mortality and mental and physical problems that can result from premature delivery. Most infant mortalities in preterm multiple deliveries occur in gestations less than 32 weeks and birth weights below 1500 gm. Respiratory distress syndrome (RSD) accounts for 50% of neonatal deaths resulting from premature birth.

Cerebral palsy — Infants born from a multiple pregnancy have a higher risk for cerebral palsy and other types of permanent neurological damage.

Multifetal Pregnancy Reduction (MFPR)

Some couples choose to reduce the number of fetuses to lessen the risk for maternal and fetal complications. The decision to undergo multifetal reduction is difficult, and the experience can be traumatic. The procedure is usually performed when there are 4 or more fetuses. About 4-5% of women who undergo multifetal reduction miscarry the entire pregnancy as a result of the procedure.

Multifetal reduction is an outpatient procedure that is most successful when performed between 10 and 12 weeks of gestation. It involves using ultrasound to guide the insertion of a needle through the abdomen to inject potassium chloride into one or more of the fetuses.

Multifetal reduction is sometimes performed earlier in the pregnancy (between 6 and 8 weeks) using a transvaginal approach and embryo aspiration. This procedure is performed less often because it requires general anesthesia and carries a risk for infection. There is a chance for spontaneous fetal reduction at this stage, and it is too early in the pregnancy to perform fetal screening for defects.

Multiple Pregnancy Management

Patient education and trained health care providers can significantly reduce medical complications and mortality associated with multiple births. Hospitals that deal with high-risk pregnancies and deliveries sponsor support groups for the parents of multiple births.

Patients should be monitored carefully during fertility drug treatment to prevent a multiple pregnancy. During in vitro fertilization (IVF), the number of embryos transferred should be limited and should be based on the mother's age and the quality of the embryos.

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Explore ObGyn

An OB/GYN is a physician specializing in obstetrics and gynecology.

Obstetrics is the medical discipline focusing on pregnancy and childbirth, and gynecology is the general care and management of the female reproductive system. OB/GYNs are usually well-versed in both areas, although some may choose to focus on one or the other in their practices. In order to be board-certified as an OB/GYN, a physician must complete medical school and then a four-year residency approved by the American Board of Obstetrics and Gynecology.

OB/GYN Board Certification,

Often pregnant women have concerns about the safety of hair dyes and permanents during pregnancy. There is no scientific data on this question, but it seems unlikely that these types of exposures are harmful. Top of Page

OB/GYN Subspecialties,

Maternal/Fetal Medicine

Requires knowledge of obstetrics, medical and surgical complications of mother and fetus, current approaches to diagnosis and treatment, and newborn adaptation

OB/GYN Education

Rotations divided between obstetrics, gynecology, gynecologic oncology, reproductive endocrinology, and ultrasonography

Travel Recommendations During Pregnancy

It is very common for our patients to ask whether they can travel during their pregnancies. There is potential risk of complications anytime during your pregnancy. If it is essential that you travel, below are some guidelines we hope will be of benefit. · While travel during the first trimester, up to 13 weeks gestation, is likely to be safe, once you have had a normal ultrasound. There is still a 2% risk of miscarriage, which means there is a risk of hemorrhage requiring D&C. While a D&C is considered a minor procedure in Saginaw, it is virtually impossible on a cruise ship or on a beautiful beach in Cancun. Therefore, if you choose to travel in the first trimester, be sure you have easy access to a hospital that provides gynecologic services. · Once you become pregnant, pregnancy hormones increase your risk of developing blood clots in your legs. No matter what stage in the pregnancy, it is important that you not sit for extended periods of times. Our recommendation is that if you will be sitting for an extended period of time, either in an airplane or in the car, you should get up to walk every hour in an effort to decrease the risk of blood clot development. Call immediately if you develop leg pain, swelling, shortness of breath or chest pain. Although rare, blood clots can migrate to the lungs. · If you choose to travel between 20-36 weeks gestation, there are special considerations. This is strongly discouraged for any patients with a history of preterm labor, preterm delivery, previous surgery on their cervix, or any other risk factors for preterm birth, such as infection, uterine anomaly, etc. If you find that travel is essential, we suggest that you make an appointment shortly before your departure so that your doctor may check your cervix. Be sure that you travel to places within an hour of a neonatal unit (a special hospital that cares for premature babies.) Take your white card with you so that if you do experience problems, the physicians have information about you available to them. · After 36 weeks, the baby shouldn’t have problems with maturity, but we recommend that prior to traveling, you locate hospitals that have in-house anesthesia coverage with epidurals available and in-house pediatric care similar to that at Covenant HealthCare-Harrison.

What can I do for cold and allergy symptoms?

Colds are miserable things, even at the best of times, but there are increased concerns during pregnancy. Many things can relieve symptoms at home, sometimes eliminating the need for an office visit. · Use a cool mist vaporizer/humidifier at night. This moistens the air you breathe to keep secretions flowing. · Saline gargles (one teaspoon of salt in ½ cup warm water) every four hours while awake will cut the mucus in the back of the throat and relieves mild soreness. · Any brand of saline nose drops (NOT regular Afrin or Neo-Synephrine) at bedtime and on arising in the morning will help moisten secretions. · Tylenol (plain) two tablets every four hours if necessary for aches (maximum of six tablets in 24 hours.) Preferably not during the first trimester and not at all for one week before your triple test. · Take your temperature, orally, twice daily – call us if your temperature is greater that 100.4 Fahrenheit. · Coughing can be relieved with one teaspoon of honey and 2-3 drops of lemon juice. Hold this in your mouth until the honey thins and then swallow. If coughing interrupts sleep or causes vomiting, call your doctor. You may try Robitussin DM, an over-the-counter cough medication, after the first trimester. · Increase fluids (especially water) to two quarts a day. · Get extra rest, if possible. · Actifed or Sudafed may also be use for symptom of congestion when taken as directed on the package. It is preferable that you not take this in your first trimester of pregnancy.

May I color or perm my hair during pregnancy?

Are saunas, hot tubs, and tanning booths safe during pregnancy?

The use of saunas, hot tubs, and tanning booths is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100 ° Fahrenheit. What can I do for nausea and vomiting during pregnancy? The following suggestions may be useful in relieving nausea and vomiting: · Remember, "any calorie is a good calorie" so eat what stays down for you. These foods may not be well tolerated: Greasy or fried foods, as they take longer to leave the stomach Very sweet foods Spicy hot foods Foods with strong odors · Eat smaller, more frequent meals, that is six small meals and snacks. · Drink fluids between meals, not with meals. · Eat foods that are at room temperature or cooler. Hot foods may trigger nausea. · Drink beverages chilled or cold. Decaffeinated soda is often well tolerated. Don't opt for diet soda, you need the calories right now. · Eat slowly and rest after meals. It is best to rest sitting in an upright position for about one hour after eating. · Dry toast, soda crackers, or dry pre-sweetened cereals may relieve periods of nausea. · Keep track of when you feel nausea and what causes it. · If continued vomiting occurs, do not eat or drink anything until the vomiting has stopped. As you feel better, try some small amounts of clear liquids (broth, Jell, apple, grape, or cranberry juice, and/or popsicles.) · Tart or salty foods such as lemons or pickles may help decrease nausea. · Avoid mixing hot and cold foods at a meal, as it may stimulate nausea. · Ask your doctor about medicine to control nausea. · Avoid eating in a room that is stuffy, too warm, or has cooking smells/odors that may disagree with you. · Wear loose fitting clothing. · To avoid the sight/smell of foods, eat meals out or have others bring prepared food to you. · These are signs that you need to call your doctor: o Unable to keep anything down for more than two days o Fainting o Vomiting blood o Rib pain o Jaundice (skin is greenish or yellow) o Your weight drops more than five pounds within a week.

Is it safe to exercise and continue work during pregnancy?

Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant. This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good "rule of thumb" is to limit exertion to about 2/3 of what you could do before pregnancy. Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments. Your family should be able to help you at home as fatigue increases at the end of your pregnancy.

What can I do for headaches during pregnancy?

Headaches are common during pregnancy. Usually headaches do not signal a serious problem. How often they occur and how bad they are may vary. It is important to discuss with your health care team which medications you can use for the headache. You should contact your doctor if your headache does not go away, returns very often, is very severe, causes blurry vision or spots in front of your eyes, or is accompanied by nausea. You may use Tylenol (acetaminophen) two regular tablets or one extra-strength tablet for headaches.

Is it normal for swelling to occur?

A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer. Let your doctor or nurse know if you have swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed for you. · Elevate you legs when possible · Rest in bed on your side · Lie down with your legs raised on a small footstool or several pillows · Do not wear stockings or socks that have a tight band of elastic around the legs. · If you must sit a lot on the job, stand up and move around from time to time. · Try not to stand still for long periods of time.

What can I do to relieve constipation?

At least half of all pregnant women seem to have problems with constipation. One reason for this may be changes in hormones that slow the movement of food through the digestive tract. Sometimes iron supplements may also cause constipation. During the last part of pregnancy, pressure on your rectum from your uterus may add to the problem. Here are some suggestions that may help: · Drink plenty of liquids – at least 6-8 glasses of water each day, including 1-2 glasses of fruit juice such as prune juice. Liquids (such as coffee, tea and cola) which make you go to the bathroom should not be drunk. They will tend to create a negative water balance in your body and thus make your stools harder and more difficult to pass. li> Eat food high in fiber, such as raw fruits and vegetables and bran cereals. · Exercise daily – walking is a good form of exercise.

If I am pregnant and a family member has or has BEEN EXPOSED to CHICKENPOX, what should I do?

Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant. This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good "rule of thumb" is to limit exertion to about 2/3 of what you could do before pregnancy. Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments. Your family should be able to help you at home as fatigue increases at the end of your pregnancy.

Is it normal for my gums to bleed during pregnancy?

During pregnancy, the extra hormones in your body may cause your gums to swell and bleed. Floss and brush regularly, using a soft toothbrush, to keep your teeth in good shape. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy. Local anesthesia, if needed, does not pose a risk during pregnancy. Dental x-rays should only be done if necessary and with your abdomen shielded.

ARE LEG CRAMPS NORMAL?

In the last three months of pregnancy, you may find that you have more leg cramps. Get plenty of calcium (three glasses of milk or supplement) and potassium (oranges or bananas.) Stretching you legs before going to bed can help relieve cramps. Avoid pointing your toes when stretching or exercising.

Is it SAFE to paint during pregnancy?

Latex paints manufactured before 1991 used small amounts of mercury as a preservative. There was some concern that this mercury could present a health hazard, so mercury is no longer used in latex paints. The fumes from latex paints are not felt to be a specific risk to a developing baby, but it is always wise to paint in a well-ventilated area. The fumes from oil-based paints, turpentine, paint thinner, etc., are best avoided by pregnant women. Also, remember when painting to avoid use of a ladder to reduce the risk of injuries due to a fall.

Is it safe to continue to have SEXUAL INTERCOURSE during pregnancy?

Some people worry about having intercourse during pregnancy. They may be afraid it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. For your comfort, you and your partner may want to try different positions. Your doctor or midwife may advise you to limit or avoid sex if there are signs of problems in your pregnancy.

What can YOU do to reduce or prevent heartburn?

Indigestion is commonly called heartburn, but it does not mean that anything is wrong with your heart. It is a burning feeling that starts in the stomach and seems to rise into the throat. It occurs when digested food from your stomach, which contains acid, is pushed up into your esophagus (the tube leading from the throat to the stomach.) Liquids that you drink also take up space in your stomach, so they may also add to the problem. Changes that take place in your body during pregnancy may worsen indigestion. Changes in your hormone levels slow digestion and relax the muscle that normally prevents the digested food and acids in your stomach from entering the esophagus. In addition, your growing uterus presses up on your stomach. To help relieve heartburn, try the following: · Eat five or six small meals a day instead of two or three large ones. (A glass of fluid may be equal in volume to a small meal, so avoid drinking large amounts of fluids with meals.) · Avoid foods that cause gas, such as spicy or greasy foods. · Do not eat or drink several hours before bedtime. · Wait two hours after eating before exercising. · Antacids may be helpful, such as Maalox, Tums, or Gaviscon. Liquid will be more effective than tablets. If the problem is frequent and only briefly relieved by antacids, speak with your doctor or midwife.

ARE hemorrhoids common during pregnancy?

Very often pregnant women who are constipated also have hemorrhoids. Hemorrhoids are varicose (or swollen) veins of the rectum. They are often painful. Straining during bowel movements and having very hard stools may make hemorrhoids worse and can sometimes cause them to protrude from the rectum. Do not take drugstore cures while you are pregnant without first checking with your doctor or nurse. Hemorrhoids usually improve after the baby is born. Several things can help give relief or avoid the problem in the first place: · Avoid getting constipated. · Eat a high-fiber diet. · Drink plenty of liquids.

Are yeast infections common during pregnancy?

It is not uncommon to develop a yeast infection during pregnancy. If such an infection does occur, it is safe for you to use over-the-counter products, such as Monistat. These are readily available at stores. However, if you are early in your pregnancy, before 12 weeks, it is important that the cream be used externally only. After 12 weeks, it is safe to gently use the applicator internally.

Are herbs and extra vitamins safe during pregnancy?

No, your prenatal vitamins should be the only supplement used during pregnancy unless your provider specifically directs you to use an additional product.

Because ob-gyns deal with such personal and sensitive health issues, the thought of seeing one, especially for the first time, may be troubling to some women. You might be nervous or embarrassed at having a doctor see the most private parts of your body. Or you may be reluctant to discuss your most intimate issues with an ob-gyn.

You wouldn't want to trust just anyone with the most sensitive parts of your body. That's why you need to think carefully about your choice of an ob-gyn.
Don't just randomly pull a doctor's name off your health insurance list. Get a referral from a friend, family member, or your primary care provider.

Basics of Pregnancy

Pregnancy : What to Expect

Pregnancy : Every day Care

Complications of Pregnancy

Twins, Triplets and More

Pregnancy Signs

The absence of a menstrual period is one of the first indications you are pregnant. Other early signs may include enlarged and tender breasts, needing to urinate frequently, feeling tired, slight weight gain and nausea or vomiting.

Discomforts of Pregnancy

The majority of pregnancies are medically uneventful—only a small percentage of women experience medical complications, and those can usually be dealt with successfully. Most women experience minor discomforts associated with pregnancy, which can be vexing, nevertheless.

OBGYN Overview

OB/GYN Education and Training Requirements

OB/GYN Board Certification

OB/GYN Subspecialties

Overview of Midwifery

Direct Entry Midwives

Requirements for Certified Midwives

Direct entry midwives may have completed apprenticeships with midwives and/or physicians, performed independent studies, and/or completed midwifery school. To attain Certified Midwife status, they must also:

CMs practice independently, at medical clinics, or at hospitals as physician assistants. As a relatively new profession, CMs are not recognized by every state. Insurance providers may cover their services and many CMs have a sliding scale.

Nurse-Midwives

Nurse-midwives are registered nurses who have completed accredited midwifery programs. Once certified, they are certified nurse-midwives (CNMs). Nurse-midwives can write prescriptions and provide a variety of care, including:

The philosophy of nurse-midwifery is based on providing health care to women, while acknowledging and respecting their needs. They encourage patient education, active participation, clear communication between the provider and the woman, and an individualized health care experience.

Requirements for Certified Nurse-Midwives

To become a Certified Nurse-Midwife (CNM), candidates must successfully complete these requirements:

When choosing a midwife, it is recommended that you ask the following questions:

Overview of VBAC

Incidence and Prevalence of VBAC

The increase in c-sections over the past decades is attributed to many factors including:

C-section rates are also higher for older women with private medical insurance and higher income than for other groups.

Who are candidates for VBAC?

Candidates for VBAC are women who:

Contraindications for VBAC

Common signs of uterine rupture during labor include:

Risks of VBAC

The incidence of uterine rupture with VBAC in a mother who has had a low transverse incision is approximately 0.2–1.5%.

Benefits of VBAC

Some of the benefits of VBAC are as follows:

Prognosis of VBAC

The success rate for VBAC is approximately 60–80% and can be higher if the patient had a vaginal delivery prior to c-section. In patients who had a c-section performed because of dystocia (abnormal or difficult labor), the success rate is lower. The most common causes of difficult labor include:

Pregnancy after Age 35

None of this means, however, that it’s inadvisable to have a baby when you’re over 35 or even in your 40s. A woman attempting a first pregnancy at 35 or older should take the following precautions (in addition to those already noted):

Early signs of pregnancy include the following:

Here are some questions to ask your health care provider. Print this page and take it with you to your appointment. Answers to these questions can help you achieve the best possible outcome for your pregnancy.

Is there a group that provides support to expectant teenage fathers?

Download/Print this page (PDF)

Before You Become Pregnant

Overview of Epidural

Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.

Epidural & Anatomy

Epidural Procedure

Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.

Effectiveness of Epidural Injection

Epidural Complications

Concerns After Pregnancy

Care during Pregnancy

Pregnancy and Nutrition

Nutrition can have a profound effect on your health and your baby’s. Poor eating habits not only can interfere with your baby’s growth but can also aggravate some of the common discomforts of pregnancy.

Pregnancy and Exercise

Remember that being pregnant puts extra demands on your heart and lungs, so cut back on the intensity of any exercise routine. As pregnancy advances, breathing becomes harder work because each breath must displace the enlarging uterus downward.

Be sure to warm up and cool down—but stretch carefully because muscles and joints are looser than usual. Cool down with leisurely walking, which helps return blood to your heart from your lower extremities.

If you feel comfortable and your doctor allows it, you can continue most forms of exercise into your ninth month, although you may have to make some modifications to meet your body’s changing demands.

What to avoid. Avoid bouncing, jarring, twisting, and any activity that could lead to a fall or a blow to the abdomen. Contact sports are too risky, as is any activity that requires rapid stops and starts, since your center of gravity has changed and it is easier to lose your balance.

In addition, take the following precautions:

Overview of Pregnancy & Nutrition

Recognizing early symptoms of pregnancy can help women seek early prenatal care, which is important for both the mother and her developing baby.

Weight Gain during Pregnacy

Babies who are underweight are at risk for physical and psychological childhood disorders:

Gaining too much weight can also be a problem. It can make pregnancy an unpleasant experience, causing backache, leg pain, varicose veins, and fatigue. It may lead to hypertension and diabetes. Excess weight may also be difficult to lose after delivery.

Women who are gaining too much weight during pregnancy should follow the guidelines for healthy eating; avoid foods that do not have nutritional value; and consult a doctor, midwife, or dietitian.

For women whose BMI is normal, the recommended weight gain over the course of the pregnancy is 25 to 35 pounds. Women who are underweight, or have a low BMI, should gain more weight, and women who are overweight, or have a high BMI, should gain less.

Healthy Diet during Pregnancy

Iron & Pregnancy

Pregnant women should eat iron-rich foods to prevent iron deficiency. Iron-rich foods include leafy greens such as spinach and broccoli, strawberries, meats, whole grains, prune juice, dried fruit, legumes, and blackstrap molasses.

Routine prenatal care is a good way to determine if a woman should take an iron supplement during pregnancy. Some women require a 30 mg supplement per day or, if diagnosed with iron-deficiency anemia, as much as 60 to 120 mg of iron per day.

Calcium & Pregnancy

Folate & Pregnancy

Folate is essential for protein synthesis, the formation of new cells, and the production of new blood. It is required for a pregnant woman's increasing blood supply and the growth of both maternal and fetal tissues. Sufficient folate also decreases the risk of neural tube defects.

For women who have previously delivered infants with neural tube defects, the U.S. Center for Disease Control recommends 400 mcg supplements daily, starting at least 4 weeks before conception and for the first 3 months of pregnancy.

Multivitamins containing folate should not be used to achieve the desired level of supplementation, as potentially harmful quantities of other nutrients (such as vitamin A) could be ingested.

Vitamin D & Pregnancy