Yay! You’re pregnant! So what’s next?
Hopefully you are already taking a prenatal vitamin (or at least a folic acid supplement); if you’re not, go ahead and start one. Next, you should schedule an appointment with your doctor or midwife soon. Click here to read about what happens at your prenatal visits.
If you don’t have a doctor yet, you might wonder what you should look for in an Ob/Gyn. The Internet is full of advice about this question, but here’s ours:
- A good OB will have a low cesarean delivery rate (don’t be afraid to ask – if she doesn’t know her rate, it’s probably too high)
- A good OB will never cut episiotomies
- A good OB will be okay with letting you do almost anything during your pregnancy or delivery
- A good OB will be supportive of vaginal birth after cesarean
- A good OB will not push you towards induction of labor
Sometimes the best place to start is by picking the hospital. Don’t be afraid to call the OB units of your local hospitals and ask the same questions. A lot of hospitals have cesarean rates well above 30% – even above 50%. Those are probably places to avoid.
If you have specific concerns, ask specific examples. For example, let’s say you have a previous cesarean and want to have a trial of labor; don’t just ask whether a doctor or hospital allow women to try, ask them instead what percentage of their patients do try and succeed.
Hopefully you already have a doctor or midwife you know and trust, or at least will find one soon. If you are stuck seeing someone who you think isn’t quite what you want, don’t be afraid to switch. Remember, it’s your pregnancy – not theirs.
Click here for full explanation of what should happen at your prenatal visits.
How your due date is calculated is often confusing and different from what you expect. Pregnancy is 40 weeks or 280 days long, starting from the first day of the last menstrual period. This means that at the time of conception, a woman is already two weeks pregnant. This assumes that her menstrual cycles are 28 days apart.
Many times women do not remember the exact day of their last menstrual period, or they may not have menstrual cycles that are 28 days long, or they might've been on birth control at the time of conception. Sometimes women just ovulate a little bit late for the bleeding that they thought was there last menstrual period was actually something different, like implantation bleeding. All of these factors contribute to dating based on the last menstrual period being wrong about 40% of the time. Your doctor will compare the date derived from the last menstrual period dating to a date determined by an ultrasound, and in some cases your due date will be changed based on the ultrasound.
The first ultrasound performed that is able to give a measurement for the baby is always the most accurate for determining the due date. Sometimes, patients are confused because subsequent ultrasounds will show a baby that has a slightly different due date and they will wonder if they're due date should be changed again based on these later ultrasound. The answer is no. The later ultrasound reflect a baby that is just a little bigger or smaller than the average for that gestational age or very just because of the margin of error.
Make sure you clarify at one of your first prenatal visit what your final estimated due date is; then, don't get too fixed on that day. Only 2% of women deliver on their due date. Maybe we should've called it a due month.
Good question. The truth is, you can eat just about anything you want. Visit our page here for a full explanation. But here's the quick answer. Don't eat:
- Big fish with high levels of mercury (shark, swordfish, king mackerel, and tile fish).
- Unpasteurized milk and soft cheeses
- Raw or undercooked meats
- Unreheated meats
Finally, make sure you wash your fruits and vegetables well before eating them. The absolute risk of the anything that happening from eating any of these foods is incredibly low. So you shouldn't worry too much; but pregnancy isn't the time to explore strange and new foods from uncertain sources.
Normal weight women gain 25-35 lbs during their pregnancies. Underweight women may need to gain more and overweight women less. For overweight women, dieting is safe and beneficial during pregnancy. Most weight gain comes in the second half of pregnancy and often women have gained no weight or even lost weight by 20 weeks; this is healthy. We check your weight at every visit, but don’t focus on how much you gain. We are usually not worried about you gaining too little weight but instead gaining too much. Excess weight gain increases the risks of pregnancy, including the risks of preeclampsia, diabetes, fetal macrosomia, and cesarean delivery.
Many overweight women will gain no weight for the entire pregnancy or even lose weight if they're actively dieting. This is not a bad thing. Maternal weight gain when it is excessive is associated with excessive fetal size; but gaining too little weight during pregnancy will not make your baby too small if you are overweight at the start of the pregnancy.
Yes you can.
As with most things in life, moderation is the key. Scientific studies have not demonstrated any problems with caffeine consumption during pregnancy until a woman consumes over 700 mg per day. That's a lot of caffeine! To be safe, and to make sure that a woman never approaches that amount of caffeine consumption, we recommend that women limit themselves to 350 mg of caffeine per day.
Check out this list to learn how much caffeine is in common beverages. In general terms, the average cup of regular coffee and the average serving of a caffeinated soft drink. But beware: it is possible to overdo it with a large special order from Starbucks.
Pregnant women are often excessively tired in the first and third trimesters, but probably for different reasons. In the first trimester, your body undergoes rapid physiological changes a company by high levels of hormones that conspire to exhaust you. Couple this with food aversion or nausea and vomiting, and the result for many women is complete exhaustion.
This tends to get better by the second trimester and then in the third trimester, particularly the last few weeks of pregnancy, exhaustion returns as you sleep less at night and carry around 30 extra pounds during the day. If you have another small baby or two at home already, then the effect is even worse.
What can you do? In the first trimester, work on minimizing the effects of nausea and vomiting of pregnancy. Keep your energy up by eating several small meals or snacks throughout the day and try adding vitamin B6 if you haven't already. Naps sometimes feel like a good idea, but they often have the opposite effect then what you desire. Napping can interfere with your ability to get good rest at night and create a vicious cycle. Going for a walk for getting some exercise is probably a better idea and will improve your nighttime sleep.
Some women in the first trimester are excessively tired because they have cut caffeine completely out of their diets. Remember, you were still allowed to have up to 350 mg of caffeine today; so don't feel too badly about having that cup of coffee in the morning or maybe after lunch.
Many pregnant women need to work on maximizing their sleep habits. Make sure you have a dark room, maybe with a noisemaker, like a fan or something else that makes background noise, to minimize interruptions. Try to use your bedroom for sleep only; don't make a habit of watching TV from your bed or staring at your phone. Women in the third trimester often find every little uncomfortable spring in their mattress with their rounder bellies and hips. Try adding an extra layer of egg crate or a phone topper to your mattress and make sure you have a long pillow that you can hug with your legs.
Also, be sure to empty your bladder right before you go to sleep and if you find that you are awakening to pee several times a night, you might need to restrict water intake for 2-3 hours before going to sleep.
In rare cases, excess fatigue might indicate another problem like a thyroid abnormality or anemia; if you feel like you are more tired than the average pregnant woman, be sure to talk to your doctor.
Nausea and vomiting during pregnancy is no one's idea of a good time. The good news is, nausea and vomiting is not associated with risk to the pregnancy; the bad news is, you aren't nauseated and throwing up.
What can you do?
- Eating several small meals per day and avoiding high fat foods may help.
- Emphasize bland foods and avoid smells that are noxious.
- Increasing protein and liquid content of your food maybe beneficial.
- Ginger ale, ginger teas, or ginger capsules may be helpful.
- Taking a vitamin B6 supplement 2 to 3 times per day alone or in combination with doxylamine at night may be beneficial.
- Your doctor may need to prescribe you an anti-nausea medicine. There are several drugs that are safe in pregnancy to choose from.
- Make sure that your acid reflux and constipation are treated as well; both can contribute to the problem.
- In bad cases, you may need to be hospitalized for IV fluids and other treatments.
Hopefully, you should feel better by the end of the first trimester. If you don't, or if the above remedies are not working, your doctor may need to investigate other causes of your nausea and vomiting apart from pregnancy. Typically, you shouldn't be concerned as long as you can maintain your bodyweight or even lose a few pounds during the first trimester and as long as you can stay hydrated.
Almost all women have some cramping or other pains during pregnancy, particularly in the first trimester. This cramping is almost never anything to be worried about, particularly if you're not bleeding. In the first trimester, the uterus grows rapidly and most of the cramping that a woman experiences is simply growing pains. As the uterus gets bigger, it becomes top-heavy and has a tendency to pull and tug from one side to the other. This will stretch ligaments, particularly the round ligaments, and cause either cramping or sharp pains. None of these symptoms put the baby at risk.
Sometimes cramping is not related to your uterus at all. Many women become constipated during pregnancy in the cramping that they experience is actually related to their bowels slowing down. Sometimes cramping is related to the bladder and might be a sign bladder infection, but almost always there will be other symptoms like burning when you pee.
In the second and third trimesters, cramping is often what's cold Braxton-Hicks contractions. These are common and occur more often in subsequent pregnancies. They do not increase your risk of preterm labor.
In most cases, the answer is no.
There is a whole industry that markets supplements in other products to pregnant women. Even among prenatal vitamins, from most women the only ingredient that is actually required is folate, and that folate is only necessary until the baby's neural tube is closed, which happens early in the first trimester. The truth is, prenatal vitamins are best taken ended 2 to 3 minutes before pregnancy and provide little to no benefit past the first half of the first trimester. In fact, if you are beyond six weeks and prenatal vitamins are making you nauseous for constipated, there's no reason for you to not stop them.
Aside from the folate in a prenatal vitamin, the other ingredients often found in these vitamins are not science based. Don't get caught up on buying the most expensive prenatal vitamin because the company says it will make your child smarter or reduce the risks of pregnancy; this simply is not true.
In some cases, due to restrictive diets or pre-existing anemia or other risk factors, your doctor might ask you to take an additional supplement or medication.
Most women find out the sex of their baby at the time of the anatomy ultrasound at around 18 to 20 weeks. In some cases, you might find out earlier. If you happen to have an ultrasound anytime after 14 weeks, usually the sex is visible. Ultrasounds at around 12 weeks can sometimes lead to a guess about the baby's sex, but are only about 85% accurate. Sometimes, women have genetic testing called noninvasive prenatal screening (NIPS) as early as 10 weeks gestation that can accurately reveal the baby's sex. However, finding out the baby's sex is not a good reason alone to have this test done.
Many women choose to not find out the sex of their baby until after it is born, but most women can't handle not knowing. If you're planning a gender reveal party, make sure you tell your doctor and your ultrasonographer ahead of time so that they don't give away something accidentally. They can always put the answer in a sealed envelope. If you don't want to find out until after the baby is born, make sure you tell whoever might do an ultrasound at any time that you don't want to know; if it's a later ultrasound, they will assume that you already know and they may say or show something that you don't want.
The scientific ways of determining the baby's sex are:
- Ultrasound
- Noninvasive prenatal testing
- Amniocentesis
- CVS
There are also some not so scientific ways that you'll read about on the Internet. None of these work:
- Fetal heart rate (under 140=boy, over 140=girl)
- Chinese gender charts
- Wedding ring test (pendulum=boy, circle=girl)
- Peeing on Draino (brown=boy, no color change=girl)
- Carrying high vs low (high=girl, low=boy)
- Morning sickness (bad=girl)
- Location of weight (hips and butt=girl, belly=boy)
- Placental location (right=boy, left=girl)
Most of these are harmless fun, but there are some products on the market that take advantage of these myths. Don't waste your money.
Pregnant women are often excessively tired in the first and third trimesters, but probably for different reasons. In the first trimester, your body undergoes rapid physiological changes a company by high levels of hormones that conspire to exhaust you. Couple this with food aversion or nausea and vomiting, and the result for many women is complete exhaustion.
This tends to get better by the second trimester and then in the third trimester, particularly the last few weeks of pregnancy, exhaustion returns as you sleep less at night and carry around 30 extra pounds during the day. If you have another small baby or two at home already, then the effect is even worse.
What can you do? In the first trimester, work on minimizing the effects of nausea and vomiting of pregnancy. Keep your energy up by eating several small meals or snacks throughout the day and try adding vitamin B6 if you haven't already. Naps sometimes feel like a good idea, but they often have the opposite effect then what you desire. Napping can interfere with your ability to get good rest at night and create a vicious cycle. Going for a walk for getting some exercise is probably a better idea and will improve your nighttime sleep.
Some women in the first trimester are excessively tired because they have cut caffeine completely out of their diets. Remember, you were still allowed to have up to 350 mg of caffeine today; so don't feel too badly about having that cup of coffee in the morning or maybe after lunch.
Many pregnant women need to work on maximizing their sleep habits. Make sure you have a dark room, maybe with a noisemaker, like a fan or something else that makes background noise, to minimize interruptions. Try to use your bedroom for sleep only; don't make a habit of watching TV from your bed or staring at your phone. Women in the third trimester often find every little uncomfortable spring in their mattress with their rounder bellies and hips. Try adding an extra layer of egg crate or a phone topper to your mattress and make sure you have a long pillow that you can hug with your legs.
Also, be sure to empty your bladder right before you go to sleep and if you find that you are awakening to pee several times a night, you might need to restrict water intake for 2-3 hours before going to sleep.
In rare cases, excess fatigue might indicate another problem like a thyroid abnormality or anemia; if you feel like you are more tired than the average pregnant woman, be sure to talk to your doctor.
Every pregnant woman at some point in her pregnancy will be given to wonder if she is in labor. Most women have a few false starts. Braxton-Hicks contractions can be confusing and can become frequent and regular, at least for a short time. Women frequently have physiologic discharge or will urinate and wonder if their water is broken. So how can you tell real labor from false labor?
The answer is time. Real labor is progressive in every way, but you won't be able to see this until some time has passed. If you're having some regular contractions, the best thing to do is to see what happens over the next two or three hours. If you are really in labor, your contractions will become more frequent (maybe going from every 6 to 7 minutes apart to every 3 to 4 minutes apart), they will last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), they will become more painful, they will become more regular and predictable, and they will persist. False labor, on the other hand, may seemingly start strong but over two or three hours will lose steam and wane.
If it's your first baby, you have plenty of time. Labor will likely last many hours and you will have plenty of time to arrive at the hospital. If it's your fourth baby, then you already know what to expect; if you are reading this anyway, your labor probably won't last that long and you should head to the hospital a little sooner.
In some cases, your doctor may ask you to come to the hospital a bit earlier; for example, if you're positive for group B strep, then you will need four hours of IV antibiotic therapy in addition to however long it takes to get to the hospital, get admitted, and get an IV started, before the baby born.
If your water breaks, you should probably head on the hospital. This may be a sign that your labor is already very advanced, since women's water tends to break at an average of about 8 cm. If your water is broken and you're not already in labor, then you should still go to the hospital because your labor likely needs to be augmented or induced.
If you have had a previous cesarean delivery, then you should come to the hospital much sooner because you do not want to risk laboring at home. A trial of labor after cesarean is a good idea for most women, but because of the risk of you rupture, that trial of labor should happen at the hospital as much as possible.
How can you tell if your water is truly broken? You can't always tell; but in general, once your water breaks, it keeps coming. Ruptured membranes is not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.
You can't always tell; but in general, once your water breaks, it keeps coming. Ruptured membranes is not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.
Discharge is common in pregnancy but usually never results in more leakage than would fill a small pad or pantiliner. Probably the most common reason why women believe that their water has broken is because they have peed on themselves. Most women cannot believe that they have in fact peed on themselves but in the third trimester, with the baby's head smashed right against your bladder, this is a common occurrence. If it happens on your bedsheets or in your underwear, you won't always be able to tell that it is urine by smell or color alone. Amniotic fluid has a unique odor that is like a combination of ejaculate and bleach; that may not be helpful if you've never smelled amniotic fluid before, but when you do maybe you'll recognize it.
There's no reason to check your cervix unless you're having signs of labor, like regular contractions or maybe bleeding or leakage of fluid. If you're considering an early induction, checking your cervix might help determine how good an idea that might be. If your cervix isn't ready for labor (already dilated, for example), then an induction might unnecessarily increase your chances of a cesarean delivery.
Inductions happen for lots of good reasons – but also some not so good ones. Unless there's a medical reason to do so, you shouldn't be induced before 39 weeks. Even at 39 weeks, induction might not be a good idea unless your body is ready for labor. Checking your cervix can help determine this. Otherwise, it might be better to wait until 41 weeks. After 41 weeks, it's unusual that going any further makes much sense.
Sometimes you might need to be induced much earlier, but it should be because you have a medical problem like high blood pressure or some other complication.
No!
Except in some very rare emergency cases, episiotomies should never be performed. If your doctor performs routine or frequent episiotomies, then he may not be practicing up-to-date medicine. We have known since the mid-1980s that episiotomies are harmful and unnecessary except in a handful of rare emergencies, such as severe shoulder dystocia.
This doesn't mean that you might not tear, but however badly you might tear an episiotomy would've made things worse.
We hope not! But some women do, of course.
Cesarean delivery is definitely over-used in the United States. There are some good reasons why a woman might need one:
- If she's had a prior "Classical" cesarean delivery (where the incision on the uterus is made higher than normal)
- If she's had more than two prior regular ("low transverse") cesareans
- If she has placenta previa, where the placenta covers (or is very close to) the cervix or vase previa (where placental blood vessels cover the cervix)
- If her baby is breech or sideways (and the doctor is unable to turn the baby to be head down)
- If her baby is unable to tolerate labor (this should be unusual)
- If her baby is too big (which is more than 5,000 grams or about 11 lbs for a nondiabetic mother or more than 4,500 grams or just under 10 lbs for a diabetic mother)
- If her labor doesn't progress or she is unable to push the baby out after sufficient time (most doctors don't given women enough time for these things)
- If she has triples or quadruplets
- If she has active genital herpes or uncontrolled HIV
Those are just about all the reasons. We don't know for sure, but probably half of all cesareans done are unnecessary. Most of the unnecessary cesareans are related to impatience, and new guidelines from the American College of Obstetricians, will result in significantly fewer cesareans if doctors follow them.
Probably not.
This is a test question, though. You have to separate out laboring in the water and actually giving birth in water. Most of the known advantages of water birth are actually related to the process of labor in water while the known disadvantages of water birth are associated with giving birth in the water.
For example, the benefits of reduced pain during the first stage of labor (that is, the part leading up to pushing), a shorter first stage of labor, and less need for anesthesia, all occur before the birth itself takes place. At the same time, the reported disadvantages of the water birth all take place during the actual process of delivery, including newborn aspiration, drowning, infections, fatalities, hyponatremia, depressed Apgar scores, and umbilical cord rupture.
So it probably makes the most sense to labor in the water and then get out when it's time to push and have the baby on dry land.
If you think about it, nature designed the birth process to happen on dry land. One of the benefits of a vaginal delivery over a cesarean delivery is that the baby gets most of the amniotic fluid squeezed out of her lungs while traveling through the birth canal so that her first breath, once delivered, is full of nice, clean air. This doesn't always happen with a cesarean delivery and consequently babies have higher rates of respiratory problems with cesarean delivery as compared to vaginal delivery. In any event, when a baby is born vaginally underwater, the first inspiration by the baby may be underwater and therefore lead to aspiration of water with subsequent increased risk of infections, drowning, and other respiratory maladaptions.
Keep these things in mind when you read about water births being more natural than land births. In fact, water births are a rather modern invention. Currently, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend against deliveries occurring under water.
If you've had a previous cesarean delivery (or two), you may be a candidate for a trial of labor after cesarean (TOLAC). This is a complicated issue. The short answer is that most women with only one prior cesarean delivery should try to VBAC (vaginal birth after cesarean), but you should read more about it here.