This article is for information only. Consult your physician or health care provider to discuss specific concerns with any pregnancy issue.
Experts agree the first step in planning a healthy pregnancy begins before conception. Important genetic developments in the embryo occur before a woman realizes that she is pregnant; therefore, maintaining a healthy lifestyle before pregnancy occurs can reduce the risk of complications later on in the pregnancy. Women who are attempting to conceive should begin taking a multivitamin that contains folic acid. Studies show that by avoiding folic acid deficiency, a woman can reduce the chance of having a baby with a neural tube defect such as spina bifida. Cigarette smoking should be discontinued, or at the very least, efforts should be made to cut back on the number of cigarettes smoked. Alcohol consumption should be avoided whenever possible. Achieving your ideal body weight before pregnancy is recommended because dieting is not medically advised during pregnancy. Women who are obese going into a pregnancy may be at greater risk of developing complications such as high blood pressure and diabetes.
WHAT FOLLOWS IS A DISCUSSION OF SOME OF THE MOST COMMON QUESTIONS AND ANSWERS ASSOCIATED WITH PREGNANCY
1. DURING WHAT PART OF THE MENSTRUAL CYCLE IS PREGNANCY MOST LIKELY TO OCCUR?
In general, ovulation occurs about 14 days before the start of the next menstrual flow, for example, day 10 of a 24-day cycle, day 14 of a 28-day cycle, or day 18 of a 32-day cycle. It is a good idea to track your menstrual period over several months to determine when ovulation is occurring. Day 1 is considered to be the start of your menstrual flow. For many women, menstrual periods may vary slightly from one month to the next. Therefore, the precise day of ovulation may vary from month to month.
Some other ways to determine ovulation include:
Assessment of cervical mucus - Immediately following a menstrual period, there is usually no obvious vaginal discharge. Close to ovulation, a woman begins to sense a feeling of wetness as the amount of mucus increases. Close to ovulation, the mucus becomes watery, clear and slippery. Sperm deposited in this type of mucus can survive until ovulation occurs.
Measurement of basal body temperature - A special thermometer that measures temperature in tenths of a degree is used. The woman records her oral temperature each morning upon awakening. During the early part of the cycle, a woman's temperature remains fairly constant. Just prior to ovulation, the temperature will fall about 0.3 of 1 degree. This fall in body temperature is followed by a rise in temperature of about 0.5 of 1 degree. Ovulation is likely to be occurring when the temperature first rises. Normally, the woman's body temperature stays elevated until the next menstrual period begins.
2. HOW SOON CAN I TELL IF I AM PREGNANT?
Pregnancy can be diagnosed about two weeks after conception, which is about the day that your period is expected. But you are more likely to get accurate results if you wait at least another three to four days. When pregnancy occurs, the embryo releases a hormone called human chorionic gonadotropin (HCG) into your bloodstream. This hormone also spi lls over into your urine and can be detected with a home pregnancy test. Depending on which pregnancy kit you are using, the home pregnancy test can be performed between one and four days after your period was due. If a false reading is obtained but your menstrual period does not follow, the test should be repeated because you may have tested your urine before enough of the detectable hormone was present. It is recommended you use your first voided specimen of the morning for testing because your urine tends to more concentrated at this time.
3. IF I AM PREGNANT, WHEN SHOULD I BEGIN SEEING A DOCTOR OR NURSE MIDWIFE?
You should contact your health care provider when you suspect or know that you are pregnant. They will schedule a visit for somewhere between six to eight weeks after your last menstrual period. In the meantime, you will be advised to start taking prenatal vitamins. Other immediate concerns and questions that you may have can be discussed when you schedule your appointment.
During your first prenatal visit, a family and personal health history is done. An internal examination determines the size and contour of your uterus. A PAP smear is taken. Your weight and blood pressure is recorded. Several vials of blood are taken for various laboratory tests. These results are discussed with you on subsequent return visits. Urine is routinely checked at each prenatal visit.
In the early months of pregnancy, one visit a month is usually enough. During the last half, visits are every two to three weeks, and during the last month, every week. Based upon your circumstances, your doctor may individualize your visit frequency.
4. HOW CAN I DETERMINE WHEN THE BABY IS DUE?
Using the following formula, you can estimate the date that your baby is due:
- Add seven days to the first day of your last menstrual period.
- Subtract three months and add one year.
This formula assumes that the woman has a 28-day cycle and that the pregnancy occurred on day 14. Your practitioner may make an adjustment to this date if your cycles are longer or shorter than 28 days. Research shows only 4 percent to 10 percent of women deliver on their due dates, but the majority of women will deliver in the period extending from seven days before to seven days after the due date.
5. HOW IS THE BABY'S SEX DETERMINED?
A woman's egg cells and a man's sperm cells each contain 23 single chromosomes, which are not paired until they meet their opposite number. Of the 23 single chromosomes, one is always a sex chromosome. Each egg always has an X (female) sex chromosome, but the sex chromosome present in any sperm can be either X (female) or Y (male). Hence, the sex of the baby is dependent on which type of sperm cell fertilizes the egg. The sex of the baby is determined at conception.
6. HOW MUCH WEIGHT SHOULD I GAIN DURING PREGNANCY?
Most practitioners agree a weight gain between 25 and 35 pounds is recommended during pregnancy. If you are underweight, your doctor may advise more, and if you are obese, your doctor may advise less weight gain. Some women may gain more with no ill effects. Your total weight gain in pregnancy is estimated as follows:
Fetus
Placenta
Amniotic fluid
Increase in the size of the uterus
Increase in maternal blood
Increase in breast size
Fluid in the skin and other tissues
Maternal reserves
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7.5 pounds
1.4 pounds
1.8 pounds
2.1 pounds
2.8 pounds
0.9 pounds
3.7 pounds
7.4 pounds
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Weight gain in pregnancy begins slowly only to pick up steadily later on. The timing of your total weight gain is about:
0-12 weeks - little or no weight gain
12-20 weeks - 25 percent of weight gain
20-30 weeks - 50 percent of weight gain
30-36 weeks - 25 percent of weight gain
36-40 weeks - little or no weight gain
7. WHAT BODILY CHANGES CAN I ANTICIPATE DURING PREGNANCY?
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Breast Changes - Breast changes in preparation for milk production begin early in pregnancy. The brown circles around the nipples (areolae) become darker. The blood vessels become more prominent. Your breasts may feel tender and heavy. Many women note an increase in breast size early on.
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Fatigue - While your body is undergoing enormous metabolic changes to adjust to your growing baby, it is not surprising that during the first eight to 10 weeks, many women complain of extreme tiredness. As your body adjusts to the pregnancy, many women report fatigue lessens during the second trimester.
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Nausea - Nausea is another common sign of pregnancy commonly occurring in the morning and might be accompanied by vomiting. Tiredness and an empty stomach are thought to contribute to nausea. Small frequent snacks of bland food may help.
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Frequent urination - The growing uterus stretches the base of the bladder, resulting in a feeling of fullness.
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| #3 : 12 weeks |
#4 : 14 weeks |
#5 : 18 weeks |
#6 : 22 weeks |
| #7 : 28 weeks |
#8 : 35 weeks |
#9 : 40 weeks |
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Abdominal Enlargement - The pregnancy may begin to "show" at the twelfth week, depending on the woman's height, weight and previous pregnancies. The growth in the size of the uterus is proportional to the gestational age of the baby. Your practitioner routinely measures the height of the uterus as a way to evaluate fetal growth. The diagram gives an illustration of how the uterus expands in pregnancy.
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Gum softening - Gums often bleed during pregnancy, even with mild irritation from a toothbrush. This is normal and disappears after pregnancy.
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Constipation - Constipation is a common complaint in pregnancy because of slowed action of the intestines and pressure on the rectum by the growing baby.
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Dizziness - Lightheadedness, particularly when standing up too quickly, is common. It is related, in part, to the delay in the return of blood to the heart because of the pressure the uterus exerts on the veins in the abdomen.
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Swelling - This commonly occurs in the feet and ankles toward the end of pregnancy, but swelling may be present in other body parts because of the accumulation of fluid in the tissues.
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Mood swings - Many women report wide mood swings and unusual sensitivity to their surrounding environment. Crying episodes may be common and occur with little provocation.
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Quickening - This refers to the active movements of the baby that are felt by the mother. They usually begin somewhere between 16 to 20 weeks of pregnancy and are often described as a "fluttering" sensation.
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Fetal heartbeat - With the aid of ultrasound techniques, the heartbeat of the baby can be detected through the abdominal wall as early as eight weeks. Your practitioner will begin listening for the heartbeat during your routine office visits by the third or fourth month.
8. DO I NEED TO MODIFY MY ACTIVITY AND EXERCISE ROUTINES DURING PREGNANCY?
Experts have varying opinions on exercise during pregnancy. The amount of exercise that a pregnant woman can comfortably and safely carry out is usually related to what she has been accustomed to before pregnancy. During any form of exercise, it is especially important for a pregnant woman to "listen to her body" and rest when she begins to feel fatigued or stop exercising during any routine that causes pain or strain. Activities that involve sudden and excessive jolting motions along with those that impose a danger of falling such as horseback riding, skiing, contact sports, and inline skating are best avoided, especially as the abdomen enlarges.
Employment of the pregnant woman can continue up until the time of delivery, as long as there are no complications. A job may need to be modified if it involves significant physical labor.
9. HOW DO MY NUTRITIONAL NEEDS CHANGE DURING PREGNANCY?
Your baby depends on what you eat and drink for adequate nourishment in the uterus. If a woman is nutritionally deprived, her baby is deprived. Although you need to make good food choices, you do not need to "eat for two." Most pregnant women require about 300 extra calories per day during pregnancy. These extra calories should be used to increase your protein and calcium intakes. Foods rich in protein include lean meats, fish, beans, nuts, milk yogurt, cheeses and other dairy products. Increases in milk consumption are usually recommended for the pregnant woman because milk is an obvious source of calcium. Consumed in large quantities, whole milk is fattening, so low-fat milk is a good alternative. Experts recommend the equivalent of about 1 pint of milk per day.
A prenatal multivitamin is recommended during pregnancy. If you are already taking a daily vitamin, check with your practitioner to be sure you are getting enough iron and mineral supplements. Most daily vitamins do not contain the recommended number of vitamins and minerals for pregnancy. Consider taking a daily vitamin with at least 400 micrograms of folate for at least six weeks before conceiving. Folic acid may decrease the risk of serious birth defects in your unborn baby that can occur early in prenatal development.
10. WHAT DRUGS OR MEDICATIONS CAN I SAFELY TAKE DURING PREGNANCY?
It is wisest to take the fewest possible medications during pregnancy because the full range of substances to which the embryo and fetus may be vulnerable is not yet known. What is known is that drugs can cross the placenta and affect the baby. The best policy in pregnancy seems to be to use medications only if there is no alternative and the symptoms are annoying, disruptive or dangerous. Both prescription and over-the-counter medications should be treated this way. Your practitioner can tell you how to balance the benefits of the medication versus the risks to the baby. If you're taking medications for an underlying medical condition, talk to an obstetrician or your delivering physician before stopping them.
Experts agree that alcohol is best avoided during pregnancy.
11. HOW WILL I KNOW WHEN LABOR HAS BEGUN?
The onset of labor is usually indicated by one of the following:
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A bloody show: This is the bloodstained mucus discharge that appears when the cervix (the opening of the uterus) begins to stretch. Until labor, this plug in the cervix seals off the uterus. The bloody show can precede the onset of labor by several weeks, so your practitioner will not have you come to the hospital unless other signs of labor are also present.
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The water bag breaks: When the membranes surrounding the baby have been pressed to the point where they can no longer withstand the pressure, the bag pops. It may occur suddenly with a gush of water or more slowly. The practitioner will want to know as soon as possible if you think your "water" has broken.
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Contractions begin: Contractions usually feel like a tight elastic belt over the lower portion of the abdomen and around into the back. They usually increase in intensity over 15 to 20 seconds and then ease up. Once you begin to feel several contractions in a row, they should be timed. Contractions have a regular rhythm and progressively last longer while the interval between them is reduced. Many women experience what are referred to as Braxton-Hicks, or rehearsal contractions, before the onset of true labor. Your practitioner will give you precise instructions about when to call if you begin having contractions.
Once labor is underway, it is divided into three stages:
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Stage 1: This begins with dilation of the cervix and ends when the cervix is fully dilated at 10 centimeters. It is the longest stage of labor, beginning with mild contractions and ending with progressively stronger contractions. Typically, stage one is longer in first pregnancies and shorter in subsequent ones.
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Stage 2: This begins once the cervix has fully dilated. It is the stage where expulsion or birth of the baby occurs and is usually shorter than stage one and is accomplished by the woman's bearing down with each contraction in an effort to push out the baby. Stage two ends with delivery of the baby.
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Stage 3: This is the final stage of labor that involves the expulsion of the placenta or afterbirth. This is the shortest stage, usually lasting about 15 minutes. Little pain is associated with this stage. Vaginal bleeding is normal, with most women averaging about a half pint of blood loss.
12. HOW CAN I DEAL WITH THE PAIN OF LABOR?
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Narcotics: These are the most widely used medications during labor. They can be given intravenously or by injection and take effect in two to 15 minutes. They will "take the edge off" of the pain, and some women report that they help them to cope with the difficult contractions.
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Local anesthetics: These medications can either be injected into the area around the vagina and perineum or given directly into the spinal region. When given into the spinal region, these medications can provide complete relief of pain, while allowing you to remain conscious during the birth. Epidural anesthetics are widely used in the United States and administered by anesthesiologists.
Discuss your wishes about pain management with your practitioner before the onset of labor, keeping in mind that your actual labor experience may cause you to change your plan once labor is underway.
To take an active part in your pregnancy and birth experience, prepare yourself. Many publications explain the physiological changes that your body goes through during pregnancy and in preparation for delivery. When selecting a health care provider, keep in mind your choices. Pregnancy is an exciting, inspiring and deeply satisfying experience. Make the most of it by developing your understanding to the fullest.
This article was reviewed and updated June 2007.
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