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Your pregnancy and postpartum health resource guide
All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.
500 NE Multnomah St., Suite 100, Portland, OR 97232.
Whether it’s your first child or your next, each pregnancy and birth is a brand-new
experience. Welcome to parenthood!
If you’re like most new moms, you have lots of questions. Throughout pregnancy, you
will notice changes in your body, emotions, and activities. Your Kaiser Permanente
health care team is here to support you through it all.
We created this guide especially for you. It has answers, information, and resources so
you know what to expect during pregnancy and the first few weeks of your baby’s life.
You’ll see some sections organized by trimester so you can keep track of what’s
happening and when. You’ll learn about your baby’s development, how to care for
yourself, tests you might need, getting ready for your newborn, and more.
When you come in for a visit, bring this guide with you. Together we’ll review the
contents that match your needs and answer questions.
We’ve all heard about that healthy glow in pregnant moms-to-be. Now it’s your turn to
shine. Use the information in this guide to help you and your baby thrive. We are here
for you, every step of the way.
We look forward to meeting you and sharing this special time in your life!
Best wishes,
Kaiser Permanente Northwest
YOUR CARE TEAM............................................... 5
Your care team................................................ 7
Healthy smiles during pregnancy................. 55
Finding clinicians and services....................... 8
RISKS AND SAFETY........................................... 57
PRENATAL VISITS................................................ 11
Risks and safety............................................ 59
Things to avoid............................................. 60
Prenatal visits................................................. 13
Prenatal visit schedule................................... 14
Prenatal visit records.....................................15
CLASSES AND EDUCATION...............................21
Childbirth and parenting classes...................23
GENETIC TESTING............................................ 25
Genetic testing............................................. 27
HEALTH AND WELLNESS.................................. 29
Your health and wellness.............................. 31
When to call for help.................................... 62
FIRST TRIMESTER............................................... 65
First trimester............................................... 67
SECOND TRIMESTER......................................... 71
Second trimester.......................................... 73
THIRD TRIMESTER............................................. 79
Third trimester.............................................. 81
HOME AND NURSERY....................................... 85
Getting ready for baby................................. 87
Staying fit...................................................... 32
Healthy eating during pregnancy................. 34
What if I get sick?......................................... 40
A safe nursery............................................... 88
PREPARING FOR BIRTH..................................... 91
Your birth preferences.................................. 93
Managing emotions .................................... 42
Birthing options............................................ 98
Body changes and discomfort..................... 45
Preparing for labor...................................... 100
What to bring to the hospital...................... 101
NAVIGATING COMPLICATIONS....................... 149
Timing contractions..................................... 105
Overview..................................................... 151
Timing contraction chart............................. 106
Asthma........................................................ 152
Early labor................................................... 108
Active labor: First stage.............................. 110
Domestic abuse...........................................158
Active labor: Second stage..........................111
Fifth disease................................................ 159
Third stage: After your baby is born............112
High-risk pregnancy....................................160
Postpartum recovery and coping.................114
INFANT CARE....................................................117
Preeclampsia and high blood pressure.......166
Infant care overview.....................................119
Preterm labor...............................................168
Newborn experience................................... 120
Toxoplasmosis............................................. 170
Newborn appearance.................................. 126
Urinary tract infection.................................. 172
Newborn behavior....................................... 128
Baby care..................................................... 130
Feeding your baby...................................... 132
Multiples...................................................... 138
Keep your baby healthy............................... 140
Infant oral care............................................. 142
Keep your baby safe.................................... 144
Common newborn problems...................... 146
When you’re pregnant, you want the best
possible care for you and your baby. Your Kaiser
Permanente team is dedicated to providing
just that.
Each year, more than 90,000 pregnant women
receive the care they need at Kaiser Permanente
clinics. We help them bring their babies into
the world at our own Kaiser Permanente or
affiliated hospitals.
In the Oregon/Washington region, you’ll have
access to a team of doctors, nurses, midwives,
and other health professionals who partner with
you to keep you and your baby healthy. It’s an
integrated approach that puts you at the center.
Use to manage your
health online. You can:
• Email your clinician.
• View lab test results.
• Refill prescriptions.
• Make or cancel routine appointments.
• And more!
You can also find clinicians and medical offices.
Go to and click the “Locate our services”
tab. Scroll down and select “Find doctors &
locations.” On the next page, follow the prompts
to narrow your search.
Obstetric and gynecological care is available at
many Kaiser Permanente medical offices in Oregon
and Southwest Washington. Our obstetrics advice
line and the Mother-Baby Program offer additional
resources, classes, and tips.
Do you or your baby need care during regular
medical office hours? You can call to request a
same-day appointment (as available) from 8 a.m.
to 5 p.m. weekdays.
Call the regional advice nurse for help outside
regular medical office hours or Urgent Care
hours. The nurse can discuss your health concern
and direct you to the most appropriate place
for treatment.
To contact medical and dental offices, hospitals,
the Mother-Baby Program, or an advice nurse,
please see the phone number and resource list in
pocket of this booklet.
When the time comes, Labor and Delivery
and birthing services at Kaiser Permanente
Sunnyside Medical Center, Kaiser Permanente
Westside Medical Center, and our partner
hospitals have you covered.
Contact a member of your health care team
anytime with questions or concerns. They can
help you make decisions that support you and
your growing family.
You and your baby are undergoing a lot of
changes. Week by week, your pregnancy reaches
new milestones and turning points. It’s critical to
ensure you both stay healthy through it all.
That’s why one of the most important steps you
can take during pregnancy is to attend all your
prenatal visits.
As soon as you know you’re pregnant, make an
appointment with your physician or certified
midwife. The schedule on page 14 outlines how
often you should come in and what to expect
during examinations.
Beginning around week 28, you can take time
to talk with your clinician about your labor and
delivery options. As you identify your preferences,
you may want to write them down. See pages
93 to 96 for more information about this
important step.
At each visit, you can use the prenatal visit
records to log your progress. Bring this guide
with you and enter the information with your
care team.
During these checkups, you’ll discuss your baby’s
development, how to care for yourself, tests
you might need, preparations for your newborn,
and more. These visits help you keep tabs on
your health and your baby’s progress along the
way. You review current priorities and things to
consider. Each visit brings something new.
Regular prenatal exams are a priority during any pregnancy. Here’s the visit schedule for a low-risk term
pregnancy. If you have a pre-existing medical condition, develop complications, or are a teen, you may
require more frequent visits.
WEEK 6–9
Confirm pregnancy.
Lab tests.
First visit with your clinician.
Discuss genetic testing options.
Educational and diet information.
Physical exam.
WEEK 10–12
• Fetal heart tones.
• Confirm genetic testing decision.
• Review lab results.
• Discuss birth control plans; sign tubal ligation
consent form if desired.
• Schedule hospital tour.
• Discuss breastfeeding.
• Discuss circumcision.
• Optional visit, per clinician and patient.
WEEK 15–16
• Blood screening tests.
• Schedule ultrasound.
• Group B strep test.
• Confirm baby’s position.
• Discuss signs and symptoms of labor and
• Confirm birth preferences.
• Discuss ultrasound results.
• Due date confirmation.
• Hospital registration.
• Optional visit, per clinician and patient.
• Discuss readiness for labor and delivery.
• View preterm labor video.
• Schedule childbirth class.
WEEK 40–41
• Learn to count fetal kicks.
• Diabetes and blood count test; Rh Immune
Globulin if Rh negative.
• Start birth plan discussion.
• Tdap vaccination.
• Optional visit, per clinician and patient.
• Discuss postdates plan.
• Schedule postpartum visit.
• Routine postpartum visit (sooner if needed).
• Physical exam.
• Discuss birth control, feeding, depression,
return to work.
Note: Kaiser Permanente recommends pregnant women receive an Influeza vaccination (flu shot)
at any appointment from October through March.
Due date
6–9 weeks
Appointment date
Mom’s weight
Questions to ask
Clinician instructions
10–12 weeks
Appointment date
Mom’s weight
Questions to ask
Clinician instructions
15–16 weeks
Appointment date
Mom’s weight
Baby's heart rate
Questions to ask
Clinician instructions
20 weeks
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
24 weeks
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
28 weeks
Appointment date
Mom’s weight
Tummy measurement
Questions to ask
Clinician instructions
Baby’s heart rate
32 weeks
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
34 weeks (optional visit)
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
36 weeks
Appointment date
Mom’s weight
Tummy measurement
Questions to ask
Clinician instructions
Baby’s heart rate
37 weeks (optional visit)
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
38 weeks
Appointment date
Mom’s weight
Tummy measurement
Baby’s heart rate
Questions to ask
Clinician instructions
39 weeks (optional visit)
Appointment date
Mom’s weight
Tummy measurement
Questions to ask
Clinician instructions
Baby’s heart rate
40 weeks
Appointment date
Mom’s weight
Tummy measurement
Questions to ask
Clinician instructions
Ultrasound results
Lab results
Baby’s heart rate
Your journey through pregnancy will teach
you many new things. Prepare yourself for the
healthiest experience possible by learning what
you need to know.
Kaiser Permanente Northwest offers a variety
of programs designed just for expectant and
new parents.
• Your health goals.
To find details on classes and resources, visit
Call 503-286-6816 or 1-866-301-3866 (toll free)
and select option 2. This service is free for Kaiser
Permanente members. It is available Monday
through Friday, 8 a.m. to 5 p.m.
For more information and to sign up, call
Health Engagement and Wellness Services at 503286-6816 or 1-866-301-3866 (toll free), option 1.
You can get support and motivation in a brief chat
with a coach as you discuss:
• The process of change.
• Your options for next steps.
There are a variety of programs to choose from
to support you in your journey to motherhood. To
find information, visit and look for
these topics:
• Hospital birth tour. One-time session.
• Preparation for birth. Two or five sessions.
• Preparation for birth. Online program lets
you work at your own pace.
• Life with baby. Ongoing online sessions.
• Tool kit for new parents. One-time session.
For many women, the chance of having a child
with a genetic disease or chromosomal problem is
quite low (about 3 to 4 percent).
These tests can be helpful for some people, but
they also have drawbacks. It is always your choice
to have testing or not.
If you have questions, talk with your health care
There are tests that can tell you if your baby has
one of these problems or is at risk. They include
blood tests, ultrasound, amniocentesis, and CVS
(chorionic villus sampling).
One of the best ways you can care for your baby’s health is to take care of yours.
The following pages offer tips on how to exercise, eat, and feel your best during one of the most
dynamic times of your life. You’ll learn about:
• Staying fit.
• Healthy eating during pregnancy.
• What if I get sick?
• Managing emotions.
• Body changes and discomfort.
Moderate exercise during pregnancy can help
you feel your best and ward off discomforts,
such as backache and fatigue. Exercise is a good
warm-up for childbirth because physical activity
improves your circulation and energy for labor.
Also, exercising during pregnancy can help you
maintain muscle strength and shed unwanted
pounds after your baby is born. If you’re physically
active most days, great! If not, this is a good time
to start. Begin slowly, build up gradually, and try
to exercise at least 30 minutes per day.
• Check with your clinician before starting any
exercise routine.
• Whatever activity you choose, don’t overdo it.
Listen to your body and rest if you feel tired.
You should be able to carry on a conversation
during any activity.
• Drink extra water before, during, and after
exercise to avoid dehydration.
• Get plenty to eat so that you don’t run low
on glucose.
• Do not exercise to lose weight. Read about the
importance of weight gain during pregnancy.
• Avoid overheating. During hot weather,
exercise indoors and (ideally) in an airconditioned space.
• Walking. It’s safe and easy for most women
from the moment you find out you’re pregnant
until the final weeks. Wear a fitness tracker
or use an app to motivate you to stay active.
Remember to use a handrail when walking up
or down stairs.
• Swimming or water aerobics. Both are
gentle on your joints and provide a feeling of
weightlessness (a welcome break in the later
months of pregnancy).
• Stretching or yoga. Stretching eases back
pain and helps you maintain flexibility. Look for
classes or DVDs designed for pregnant women.
• Low-impact dance or aerobics. Moving to
music is fun for both you and your growing
baby. Stay balanced by avoiding jumps, kicks,
leaps, and bouncing.
The muscles in your lower abdomen, lower back,
and around the vagina (birth canal) come under
great strain during pregnancy. During delivery,
these same muscles must relax and stretch. In the
event of a lengthy labor, increased endurance
can be a real help. Go to and search for
"exercise during pregnancy" for examples of
exercises and stretches.
During your first trimester, you should be able
to continue your same exercise routine if you’re
having a healthy pregnancy. Try for a combination
of aerobic, strength, and flexibility exercises. In
your second and third trimester, you may need to
vary your routine slightly.
During pregnancy and delivery, the pelvic floor
can become stretched and weak. This can lead
to urine control problems after your baby is born.
Kegel exercises help you strengthen your pelvic
floor muscles.
As you enter your second trimester, you may find
that your achy joints, growing belly, and changing
center of gravity make you unstable on your feet.
During this time, you’ll probably need to make
adjustments to your normal exercise routine. Here
are some activities to avoid:
Start doing Kegel exercises daily as soon as you
become pregnant. Kegels can be done anytime,
standing or sitting. No one will even know. Here’s
• Firmly tighten the muscles around your
vagina, as you would to stop urinating. (It’s
not recommended to practice Kegel exercises
while on the toilet because this may strain the
pelvic floor muscles.)
• Hold tightly for as long as you can (8 to 10
seconds). Remember to keep breathing as you
hold the muscles.
• Then slowly release the muscles and relax.
• Repeat 10 to 15 times, at least 3 times a
day. Kegel exercises are effective only when
done regularly.
• Bouncing, jumping, or movements where
you could lose your balance, especially in the
third trimester.
• Contact sports, such as soccer, softball,
and basketball.
• Scuba diving.
• Exercise in high altitudes (above 6,000 feet).
• Water or downhill skiing.
• Horseback or motorcycle riding.
• After your fourth month, avoid anything that
requires you to lie flat on your back (such as
sit-ups and some yoga poses).
• Avoid overheating or extreme sweating.
Congratulations on your pregnancy. A healthy pregnancy depends on a healthy lifestyle. This includes
eating a balanced diet, staying well hydrated, and getting physical activity most days of the week. Strive
to build a plate like this at every meal.
mindful eating
Choose food that
is satisfying and
nourishing, sit at the
table in a relaxed
and tune in to
your hunger and
fullness levels.
Make a little more than
∕4 of your
plate whole grains
or starches.
Stay hydrated
Aim for 64 ounces
of water per day.
Make ½ your plate
fruits and vegetables.
Move more
Make a little less
than ¼ of your plate
lean meat or other
protein foods.
Exercise daily or
most days of the
week. The benefits
are endless.
Choose fruit as
your sweet treat
Limit foods and
beverages with
added sugars.
Select a 9-inch plate and use this guide to help keep your portions in control.
One serving is:
Fruits and vegetables
Choose 6 or more servings per day
• 1 cup raw vegetables
• ½ cup cooked vegetables
• 1 medium fruit
• 1 cup fruit
• 3–4 ounces juice
Choose 2–3 fruits and 4 or more
vegetables for optimal nutrition
and less calories.
One serving is:
Protein-rich foods
Choose 7–11 servings
per day
• ½ cup beans, split peas, or lentils
• ½ cup tofu or tempeh
• ¼ cup nuts or seeds
• 2 tablespoons peanut or almond
butter, or tahini
• 1 ounce pasteurized cheese
(Swiss, mozzarella, queso
fresco, cheddar)
• ¼ cup cottage or
ricotta cheese
• ½ cup Greek yogurt
• 1 cup regular yogurt
• 1 egg
• 1 ounce fish, seafood,* skinless
chicken or turkey, or lean cuts of
beef or pork
One serving is:
Starches (grains and
starchy vegetables)
Choose 5–8 servings
per day
• ½ cup beans, corn, peas, taro, or
potatoes (Yukon gold, red, sweet)
• 1 cup winter squash
• 1∕3 cup cooked brown rice, quinoa,
buckwheat, millet, or pasta/noodles
(1 cup cooked = 3 servings)
• 1 slice whole-wheat or
sourdough bread
• ½ cup cooked cereal (oatmeal)
• 4–6 whole grain crackers
• 2–3 corn tortillas
• 1 whole-wheat tortilla
• 3 cups popcorn
One serving is:
Calcium-rich foods
Choose 3 servings per day to get
the recommended 1,000 milligrams
of calcium
• 1 cup (8 ounces) milk
• 1 ½ ounces cheese
• 8 ounces yogurt
• 1 cup calcium-fortified soy, rice, or
almond milk
• ½ cup calcium-set tofu
• 1 ½ cups cooked kale, bok choy,
turnip greens, mustard greens,
beet greens, or broccoli
• 1∕3 cup soy nuts
• 2 cups white beans
One serving is:
Choose 4–7 servings per day
• 2 tablespoons avocado
• 1 teaspoon olive, canola, or
peanut oil
• 5 olives
• 1 tablespoon nuts or seeds
• 1 teaspoon peanut, almond, or
sunflower seed butter, or tahini
• 1 tablespoon
salad dressing
• 1 teaspoon mayonnaise
• 1 teaspoon butter
• 2 tablespoons cream, half & half,
or sour cream
• 1 tablespoon cream cheese
*Seafoods that are rich sources of omega-3 fatty acids include mackerel, salmon, albacore tuna, sardines, and lake
trout. For more information on safe and healthy seafood choices, visit
Examples of mini meals and snacks with
approximately 200 to 300 calories:
In general, most women need 1,600 to 2,000
calories per day. During the second and third
trimester of pregnancy, your calorie needs go
up by only 200 to 300 calories per day. Eating a
meal or snack every 3 to 4 hours can help prevent
nausea, control appetite, and keep your energy
levels up throughout pregnancy, during labor and
delivery, and after you have your baby
1 piece of fruit with 1–2 tablespoons
peanut butter
1 slice whole-grain toast with avocado
¼ cup nuts or seeds with a piece of fruit
Carrot sticks with ½ cup hummus
½ of PB&J or tuna fish sandwich
Handful of tortilla chips with cottage
cheese and salsa
Smoothie — blend yogurt with
½ cup berries
4–6 whole-grain crackers with 1
ounce cheese
Carton of Greek yogurt with ¼ cup
granola and berries
This depends on your body mass index (BMI) at the time of conception
Less than 18.5 (underweight)
28–40 lbs
2.2–6.6 lbs
5 lbs per month
18.5–24.9 (normal weight)
25–35 lbs
2.2–6.6 lbs
4 lbs per month
25–29.9 (overweight)
15–25 lbs
2.2–6.6 lbs
2.6 lbs per month
More than 30 (obese)
11–20 lbs
0.5–4.4 lbs
2 lbs per month
It doesn't matter if I gain too much weight; I'll
just lose it after the baby comes.
• Veggies with lean protein (carrots and
hummus, or a salad with beans and dressing).
Gaining too much weight during pregnancy may
harm your health and the health of your baby.
Gaining too much weight increases the risks for
a cesarean birth, early delivery, or a bigger baby,
which can make for a complicated birth.
• Lean protein with whole grain (string cheese
with whole-grain crackers).
Gaining too much during pregnancy can also
affect your children for generations — increasing
their risk for diabetes, high blood pressure, and
Losing pregnancy weight can be difficult. About
half of all women retain about 10 pounds of their
pregnancy weight gain, and 1 out of every 4
women retain more than 20 pounds.
How can I help prevent too much weight gain
when I'm so hungry?
Try eating a meal or snack every 3 to 4 hours.
• Choose whole foods as often as you’re able.
• Choose fruit as your sweet treat. Limit foods
and beverages that are high in added sugars
or white flours (and other processed grains) —
they don’t provide many nutrients or keep you
feeling full for very long.
• Stay hydrated. Aim for 64 ounces of water
per day.
• Practice mindful eating. Choose food that is
satisfying and nourishing, sit at the table in
a relaxed environment, and tune into your
hunger and fullness levels.
• Move more. Exercise daily or most days of the
week. The benefits are endless.
Make meals and snacks more filling by including
a combination of foods that contain protein, fiber,
and fat each time that you eat. Some examples:
What else can I do?
• Fruit with nuts or seeds (apple slices with
peanut butter).
• Try using a calorie and activity tracking system
online or on your mobile phone. “Super
Tracker” on can be a
great place to start.
• Yogurt, fruit, nuts (plain Greek yogurt,
blueberries, and almonds).
• Whole-grain bread, lean protein, and fat
(turkey on whole-wheat bread with avocado).
• Whole grains, protein, fruit, and nuts (oatmeal,
milk, peaches, and pecans).
• Whole grain, lean protein, and vegetables
(brown rice, chicken, and vegetable stir-fry).
Have a plan for daily physical activity. Check out
the ideas on
• Plan to breastfeed your baby. Women who
breastfeed exclusively for three months tend
to lose more weight than those who do not.
Also, teens and adults who were breastfed as
babies are 15 to 30 percent less likely to be
obese as adults.
Most women can benefit from prenatal vitamins,
even before they start trying to conceive. Taking
a prenatal vitamin is especially important for
women who are pregnant with multiples or
women who have dietary restrictions, certain
health issues, or pregnancy complications.
Prenatal vitamins are available without a
prescription. Take a vitamin supplement or prenatal
vitamin with 150 micrograms (0.15 milligrams) iodine
and 400 micrograms (0.4 milligrams) of folic acid
daily. Folic acid is a B vitamin that can help prevent
birth defects.
If you have questions, talk to your clinician.
Although you can enjoy most foods while
pregnant, there are some that you should cut
back on or eliminate. This list includes:
• Alcohol. Drinking alcohol can harm your baby
and cause him or her problems later in life.
There is no amount of alcohol that has been
proven safe in pregnancy, so it’s better not to
drink any alcohol.
• Raw or undercooked meat, chicken, and
fish. Cook raw foods thoroughly and cook
ready-to-eat meats — such as hot dogs
or deli meats (ham, bologna, salami, and
corned beef) — until they’re steaming hot.
Wash your hands, knives, cutting boards, and
cooking surfaces with warm, soapy water after
handling raw or undercooked meat.
• Unpasteurized soft cheeses. Avoid brie, feta,
fresh mozzarella, and blue cheese because
they contain bacteria that could harm your
baby. Hard cheese, processed cheeses, cream
cheese, and cottage cheese are safe, but look
for reduced-fat options.
• Caffeine. Coffee, tea, soda, hot chocolate, or
sports and energy drinks may contain caffeine.
It’s a good idea to keep your caffeine intake
below 200 milligrams a day, because more
caffeine may be connected to higher rates of
miscarriage. However, there is not enough
evidence to know for sure. In addition,
caffeine is a diuretic, meaning it makes you
urinate more often, which can cause you to
lose important minerals, including calcium.
Caffeine may also interfere with sleep for both
you and your baby.
• Shark, swordfish, king mackerel, tilefish,
and albacore tuna. Some fish may have high
levels of mercury, which is dangerous to your
baby. Eat no more than 12 ounces a week of
fish or shellfish with low mercury levels. Check
for the latest information on
contaminated species.
• Raw eggs and foods containing raw egg.
Lightly cooked eggs (such as soft-scrambled
eggs), Caesar dressing, or hollandaise
sauce can increase your risk of exposure
to salmonella.
• Liver. This has excessive amounts of vitamin
A, and too much vitamin A may cause birth
defects. However, fruits and vegetables that
contain beta carotene (a precursor to vitamin
A) are perfectly safe to eat.
• Papaya, especially when unripe. Papaya
is sometimes recommended for soothing
indigestion, which is a common ailment during
pregnancy. Although a fully ripe papaya is not
considered dangerous, a papaya that is at all
unripe contains a latex substance that triggers
uterine contractions. Contractions of the
uterus could lead to a miscarriage.
If you take any medications or herbal remedies,
your developing baby takes them, too. That’s why
it’s important to ask before taking any form of
medication. In general, follow these guidelines:
• If you’re taking prescription medications,
continue to take them unless your clinician
tells you otherwise. Make sure to follow the
directions carefully.
• Tell your clinician about all medications
(prescription and over-the-counter), vitamins,
homeopathic remedies, herbs, or home
remedies that you’re taking.
• Don’t take any prescription medications unless
they’re prescribed or approved by a clinician
who knows you’re pregnant.
• Use over-the-counter medications only if you
really need them. Stop taking them as soon as
you feel better. Try natural remedies for relief,
if possible. (See the chart on the right.)
Call your clinician if:
• You feel worse after you take any medication.
• Your symptoms don’t improve.
Drinking plenty of fluids during pregnancy, you will be less likely to become dehydrated, be
constipated, get urinary tract infections, or experience preterm (premature) contractions.
You’ll also have softer skin and be at less risk of retaining water. Your baby needs fluids for
proper growth. To get enough fluids for yourself and your baby:
• Drink about 8 to 10 full glasses (64 to 80 ounces) of fluid each day.
• Keep a full glass of water with you.
• Try a variety of fluids, like milk and soups, in moderate amounts.
• Choose caffeine-free, nonalcoholic drinks.
• Massage.
• Rest.
• Cool washcloth on forehead.
• Acetaminophen (such as Tylenol).
• Do not take aspirin or ibuprofen (such as
Motrin, Advil, Nuprin, or Medipren).
Cold and cough • Rest.
• Drink plenty of warm liquids.
• Use a vaporizer, humidifier, or shower
for nasal congestion.
• Acetaminophen (such as Tylenol) for
aches and fever.
• Pseudoephedrine (such as Sudafed) for
stuffy or runny nose, may be used after
13 weeks gestation.
• Chlorpheniramine (such as
Chlor-trimeton) for allergies.
• Saline nasal drops.
• Cough drops.
• Dextromethorphan or guaifenesin.
• Loratidine (Claritin) for allergy symptoms.
• Increase fluids and fiber in diet (such
as prunes).
• Exercise regularly.
• Metamucil (plain), Fiberall, or Colace.
• Drink clear liquids.
• Imodium.
• Eat smaller meals.
• Wear loose-fitting clothing.
• Elevate head when lying down.
• Tums (for occasional heartburn relief).
• Aluminum hydroxide, Gelusil, Magnesium
hydroxide, or Simethicone.
• Use witch hazel pads, Tucks pads, or
ice packs.
• Take a warm sitz bath.
• Preparation H, Anusol, or
1% hydrocortisone cream.
Nausea and
• Take vitamin B6 (25 milligrams three
times a day).
• Eat crackers or dry toast.
• Use acupressure on wrist.
• Ginger tea or capsules.
Vaginal itch
• Eat yogurt that contains live
Lactobacillus organisms.
• Wear cotton underwear.
• Reduce or eliminate sugar from diet.
• 7-day treatment Monistat or
Gyne‑Lotrimin (for yeast infections).
Emotions during pregnancy differ for every
woman. You may experience highs and lows or feel
uncertain — even if your pregnancy was planned.
Increased hormones and the fatigue of pregnancy
can spur mood swings. At times, you may feel
exhausted, forgetful, or moody. You may worry
about your body, how to manage symptoms, or
how different your life is becoming.
Many women fear that their baby will have
a problem. Or they may feel anxious about
childbirth or that their pregnancy isn’t going well.
• Second trimester. Fatigue, morning sickness,
and moodiness usually improve or go away.
You may feel more forgetful and disorganized
than before. Looking heavier than normal,
then looking visibly pregnant and feeling the
baby move, can make you feel any number
of emotions.
• Third trimester. Forgetfulness may continue.
As your due date nears, it is common to feel
more anxious about the childbirth and how
a new baby will change your life. As you feel
more tired and uncomfortable, you may be
more irritable.
Other concerns can come up, too. Keeping up
with everyday life, finances, and relationships
with family and friends are potential sources of
confusion or stress.
Feeling waves of emotion during pregnancy is
natural. To keep your stress low, try doing relaxation
exercises and time management practices at home.
Here are a few tips to get started:
As you adjust to your changing world, it’s
important to understand why things feel different
and how to find relief.
Guided imagery
• Use the free podcasts at You
can listen online or download for later use.
Each trimester brings new streams of thought
and body sensations. Here are general ways your
emotional life may shift along the way:
• First trimester. Extreme fatigue or
morning sickness can color your daily life.
Moodiness (as with premenstrual syndrome)
is normal. Happiness and anxiety about a
new pregnancy, or feeling upset about an
unplanned pregnancy, are also common.
It is possible to feel calm just by imagining it.
Guided imagery suggestions:
• Work with audio recordings, an instructor, or a
script (a set of written instructions) to lead you
through the process.
• Imagine yourself in a calm, peaceful setting to
help you relax and relieve stress.
• Use all of your senses (touch, smell, taste,
hearing, and sight) in guided imagery. For
example, if you want a tropical setting, you
can imagine the warm breeze on your skin, the
bright blue of the water, the sound of the surf,
the sweet scent of tropical flowers, and the
taste of coconut so that you actually feel like
you are there.
Note: Let your health care team or clinic know about changes to your emotions if they are
persistent or severe or if the techniques on this page don't help.
Breathing exercises
Deep breathing can help you feel relaxed, reduce
tension, and relieve stress. Try some of these
breathing exercises to calm and relax your mind
and body:
Gentle massage can help relieve muscle tension
and pain and help you relax. It can also be a nice
way for you and your partner to bond.
• Belly breathing. Sit in a comfortable position
with one hand on your belly just below your
ribs and the other hand on your chest. Take
a deep breath in through your nose, and let
your belly push your hand out. Your chest
should not move. Breathe out through pursed
lips as if you were whistling. Feel the hand on
your belly go in, and use it to push all the air
out. Do this breathing 3 to 10 times. Take your
time with each breath.
• 4-7-8 breathing. Put one hand on your belly
and the other on your chest. Take a deep,
slow breath from your belly, and silently count
to 4 as you breathe in. Hold your breath,
and silently count from 1 to 7. Breathe out
completely as you silently count from 1 to 8.
Try to get all the air out of your lungs by the
time you count to 8. Repeat 3 to 7 times or
until you feel calm.
• Morning breathing. From a standing position,
bend forward from the waist with your knees
slightly bent, letting your arms dangle close
to the floor. As you inhale slowly and deeply,
return to a standing position by rolling up
slowing, lifting your head last. Hold your breath
for just a few seconds in this standing position.
Exhale slowly as you return to the original
position, bending forward from the waist.
These are just a few of the breathing exercises out
there. Consult your care team to find out which
exercises are the best fit for your specific needs.
Calming activities
Take time every day to relax, even if only for 10
or 15 minutes. Sitting in a quiet room, listening
to music, taking a warm (not hot) bath, or taking
a walk are simple ways to quiet your mind and
feel centered.
Progressive relaxation
Learning to relax will increase your energy and
lower your stress during pregnancy, as well as
help you know how to relax during labor. Try
this progressive relaxation exercise, in which you
tense then relax each muscle group:
• To begin, get into a comfortable position,
preferably lying on your side or propped up
with pillows in a semi-sitting position on a bed
or a couch.
• Close your eyes and take a deep breath
through your nose. Exhale completely through
your mouth. Repeat this “cleansing breath.”
Now, allow your breathing to become slower
and effortless.
• Next, you'll tense then relax each muscle
group. Start with your forehead and move
progressively toward your toes.
• Raise your eyebrows toward your hairline and
contract your forehead while inhaling. Try not
to laugh; it tightens the rest of your face. Now
exhale … and release the tension.
• Keeping your forehead relaxed, bite down and
clench your teeth as you inhale. Now exhale
… and release the tension; let your mouth
open slightly.
• Next, raise your shoulders and tense up the
neck and upper shoulder as you inhale. This is
where many of us carry a lot of tension. Is your
face still relaxed? Now exhale … and release
the tension.
• Extend your right arm as you inhale. Make a
fist and tense your right arm all the way to
your shoulder. Now exhale … and release
the tension; let the arm drop to your lap.
Feel the tension and distraction dissolve with
every exhalation.
Feel the relaxation flood your body with every
inhalation. Calm in … tension out. Focus in …
distraction out.
Continue these steps with your left arm,
abdomen, buttocks, left toes (flex toward nose),
then right toes. When your whole body is relaxed,
take a deep breath and exhale any remaining
tension. Visualize that the tension is moving from
your head, down your body, and out through your
toes. Take another cleansing breath.
Notice how relaxed your muscles feel. If there’s
one area where you still feel tension, focus on
it, breathe in and out 4 or 5 times, and relax it
further each time.
Move through this exercise at a comfortable pace.
If possible, have your partner touch each area
that you’re relaxing as you inhale and contract
the muscle. Have your partner feel the difference
in muscle tone as you exhale and relax the
area. If you’re practicing alone, concentrate on
tensing each muscle group, relaxing it, feeling
the difference between tension and relaxation,
and breathing.
This is an excellent technique to use in your daily
life when you feel stressed. At work or at home,
find a quiet place and practice this exercise. After
2 or 3 weeks of daily practice, you’ll be able to
produce the same relaxed feelings on the spur
of the moment. You’ll also get a head start on
preparing your mind and body for labor.
Time management
When you’re pregnant, demands on your time
can increase. Medical appointments, classes,
and preparing for the new baby — plus all of
your normal obligations — add up fast. Finding
a system to manage your time, activities, and
commitments helps make your life easier,
less stressful, and more meaningful. Time
management suggestions:
• Prioritize tasks. Make a list of all your tasks and
activities for the day or week. Then rate these
tasks by how important or urgent they are.
• Control procrastination. The more stressful
or unpleasant a task, the more likely you are
to put it off. This only increases your stress.
Try this instead: Structure your time, break up
large tasks, create short-term deadlines, and
avoid perfectionism.
• Let go. Liberate yourself from doing it all.
Learn what’s important to you, recognize that
you have limits, and decide how you want to
spend your time. When you do, you’ll breathe
a little easier.
• Make commitments. Commit first and
foremost to your health during the pregnancy.
Add other commitments as you can without
overloading your schedule. Once you commit,
see it through. Commit as fully as you can,
don’t back out of obligations, and be open to
new ideas and suggestions.
Your body changes a lot in 9 months with a baby
growing inside of you!
Although they can range from mild to
severe, the following conditions are common
during pregnancy.
You may be very hungry, or you may find it hard
to eat much at all. Both are normal. Be sure
to choose quality “baby-building” foods (see
"Healthy eating during pregnancy"). During your
first trimester, a healthy weight gain is about half a
pound per week. Ask your clinician for help if you
think you’re gaining too much or too little weight.
Most women develop back pain at some point
during pregnancy. As the size and weight of your
growing belly place more strain on your back,
you may notice your posture changing. To protect
your back:
• Avoid standing with your belly forward and
your shoulders back.
• When standing, rest one foot on a small
box, brick, or stool. Try not to stand for long
periods of time.
• Sit with a back support or pillow against your
lower back. If you must sit for prolonged
periods, take a break every hour.
• Avoid heavy lifting. Lift only by raising from a
squat, keeping your waist and back straight.
• Avoid stretching to reach something, such as
on a high shelf or across a table.
During of pregnancy, your breasts will become
larger and heavier. You may need a larger and
more supportive bra. As your breasts become
larger, veins become more noticeable under
the skin. The nipples and the area around the
nipples (areola) darken, and small bumps may
appear. You may also notice yellowish discharge
(colostrum) from your nipples. Colostrum is what
your breasts produce when they are preparing
for breastfeeding.
A thin, milky-white discharge (leukorrhea) is
normal throughout pregnancy. You may also have
yeast infections that reoccur or are difficult to get
rid of. Review the “What if I get sick?” section for
treatment options.
Pregnancy hormones cause the digestive tract
to relax and function more slowly. Constipation
is likely to result, especially as your pregnancy
progresses. The following suggestions may
decrease constipation:
• Drink more fluids (keep a bottle of water near
you during the day).
• Eat more high-fiber foods like fruits,
vegetables, beans, and whole-grain breads
and cereals.
• Exercise regularly.
• Establish a regular time for bowel movements.
• Try Metamucil, bran tablets, or Fiberall.
• Sleep on a firm mattress (plywood under a
mattress helps). Lie on your side with a pillow
between your knees.
• Try an over-the-counter stool softener called
Colace (also called docusate sodium) as
directed by your clinician.
• Stay active, and do the simple back exercises
from the section on excercise
during pregnancy.
• Don’t use laxatives (such as Ex-Lax) without
first talking with your clinician.
Women often feel dizzy when they’re pregnant,
but dizzy spells should lessen or disappear
as your blood supply increases to meet your
baby’s growing needs. If you feel faint, try
these suggestions:
Most women struggle with fatigue during
pregnancy, especially during the first and third
trimesters. To manage fatigue during pregnancy:
• Sit down immediately and put your head
down, as low as possible, between your legs.
• If you can’t sit, kneel with your head and hands
down, as if you were going to touch your
hands and forehead to the floor.
• Lie down and keep your legs higher than your
head (use pillows to prop your feet up).
To reduce the likelihood of dizziness, try:
• Standing up slowly. Move slowly, especially
when changing from a lying or sitting position.
• Eating frequently to help your blood
sugar stay constant, and so you don’t feel
lightheaded or faint. Eat healthy snacks like
fruits, vegetables, bread, or crackers.
• Drinking plenty of fluids, especially water.
• If you sit in the sun, wearing a hat.
• Avoiding closed-in spaces and getting plenty
of fresh air.
Fainting is rare. Be sure to report fainting. If you
fall to the ground or hit an object, you’ll need to
be examined right away.
• Take frequent rest breaks during the day. If
you feel tired, that's your body's way of telling
you to slow down.
• Reduce nonessential activities and responsibilities.
• Exercise regularly — get outside, take walks,
keep your blood moving with your favorite
workout. If you don’t have your usual energy,
don’t push it.
• Eat a balanced diet and drink plenty of water.
When you are first pregnant, you may notice
that you need to pee frequently. This is because
your uterus is in your pelvis and, as it expands, it
puts pressure on your bladder. By your second
trimester, your growing baby will move the uterus
out of the pelvis, putting less pressure on your
Continue to drink plenty of fluids and monitor how
you feel.
If you ever feel burning or pain when you urinate,
call your clinician. These symptoms may indicate a
bladder infection, and you will need to be tested.
Call immediatley if you have chills and fever or a
temperature of 100.4 degrees or greater, with or
without backache. These symptoms could be a
sign of a more serious infection.
Pregnancy can be an emotional roller coaster for
some. You’re not alone if you have mood swings,
cry easily, feel easily annoyed, or feel disorganized
and have trouble concentrating.
Accept your feelings and share them with
someone who cares. Talk to your clinician if you
need help coping with your feelings.
During pregnancy, hormonal changes can affect
how your hair looks and feels. You may notice that
your hair is thicker and healthier looking than usual.
But some women find that their hair is more limp
and lifeless during pregnancy. It is normal during
pregnancy to grow hair on other parts of your
body, such as your abdomen, face, or back.
After pregnancy, your hair’s growth cycle returns
to normal.
Tingling, numbness, and pain in the hands are
common during pregnancy, especially in the last
trimester. These problems are usually caused
by carpal tunnel syndrome, and they usually go
away after pregnancy. To reduce discomfort, try
changing or avoiding activities that may be causing
symptoms and take frequent breaks. You can also
try using wrist guards, especially when sleeping.
Lie down and relax if possible. Put a cool cloth on
your head and neck, and ask your partner to give
you a neck and shoulder massage.
Don’t take aspirin, ibuprofen (such as Advil and
Motrin), or migraine medication while you’re
pregnant unless directed by your clinician.
Call your clinician if:
• You have severe headaches after week 20 of
• You have headaches along with muscle
weakness, visual disturbance, or fever.
• Acetaminophen (such as Tylenol) doesn’t help
your headache.
You may experience heartburn along with a sour
taste in your mouth. Heartburn is caused when
stomach acids bubble back into the esophagus.
It’s not cause for concern, but it’s unpleasant and
uncomfortable. For relief:
• Eat small, frequent meals.
• Avoid fatty, fried, or spicy foods.
• Avoid beverages that contain caffeine, such as
coffee, tea, or soda.
• Avoid bending over or lying down after meals.
Take a walk instead.
• Avoid tight clothes and waistbands.
• If heartburn is a problem at night, avoid eating
just before bedtime and sleep propped up
with pillows.
• Take an antacid, such as Tums or Mylanta,
for instant relief. If your heartburn does not
go away, you may use acid blockers such as
cimetidine (Tagamet) or ranitidine (Zantac).
• Don’t take high-sodium antacids such as AlkaSeltzer or baking soda.
Hemorrhoids (dilated, twisted blood vessels in
and around the rectum) are common, especially
in the last months of pregnancy when the
uterus is pushing constantly on the rectal veins.
Hemorrhoids can cause pain, itching, and
bleeding during a bowel movement. They usually
improve without treatment shortly after birth.
• Keep your stools soft by increasing your intake
of liquids, fruits, vegetables, and fiber.
• Avoid sitting for long periods of time. Lie on
your side several times a day.
• Cleanse the area with soft, moist toilet paper,
witch hazel pads, or Tucks pads.
• Try ice packs to relieve discomfort.
• Take a sitz bath (a warm-water bath taken in
the sitting position where only the hips and
buttocks are covered) for 20 minutes, several
times a day.
• Use Preparation H, Anusol, or 1%
hydrocortisone cream to help relieve the pain.
They are common in late pregnancy. Leg cramps
usually occur late at night and may wake you
up. They may be caused by the pressure of the
enlarged uterus on nerves or blood vessels in
your legs, from lack of calcium, or occasionally
from too much phosphorous in your diet.
To relieve leg cramps:
During the second or third trimester (any time
after 12 weeks), you might notice a yellowish or
whitish fluid leaking from your nipples. This fluid is
called colostrum, the first breast milk.
• Sit on a firm bed or chair. Straighten your leg
and flex your foot slowly toward the knee.
It’s the perfect food for your newborn. It also
supplies antibodies to help protect your baby
from infections.
Although leakage is common for many women,
some women don’t have any leakage until after
delivery. Colostrum may continue to leak from
time to time through the rest of your pregnancy. If
your blouse or dress gets wet from leaking:
• Use breast pads (all cotton, no plastic liners)
inside the cup of your bra.
• Keep your breasts clean and dry.
As your growing uterus puts pressure on your
bladder, you might notice that you leak urine
when you laugh or cough. This is common and is
called stress incontinence.
You can help prevent leaking by doing Kegel
exercises (page 23 for instructions). Kegels
strengthen your pelvic floor muscles and
help reduce.
• Stand on a flat surface (a cold surface is even
better) and lift your toes up, as if to stand on
your heels. Then try walking while keeping
your toes up. Note: for safety use a counter or
chair back for balance.
• Use a heating pad or hot water bottle.
To prevent leg cramps:
• Avoid too much phosphorous in your diet. This
is found in highly processed foods, such as
lunch meats, packaged foods, and carbonated
• If you have frequent cramps (more than twice
a week), increase the amount of calcium in
your diet or take calcium supplements that
don’t contain phosphorous.
• Do leg stretches before bedtime.
• Wear leg warmers at night.
• Exercise moderately every day.
• Take a warm (not hot) bath before bedtime.
Although uncommon, a blood clot can form in
a deep vein of the leg (deep vein thrombosis,
or DVT) during pregnancy. DVT can be lifethreatening and requires medical treatment.
Consult your care team if you are concerned you
may have a blood clot in your leg.
Morning sickness is nausea, sometimes with
vomiting, caused by hormones released during
pregnancy. Morning sickness occurs most often
during the first 3 months of pregnancy.
Your baby may settle into a position that is very
uncomfortable for you. Your baby’s kicks and
twists can be strong and sometimes painful.
When your baby drops into your pelvis (called
“lightening”), the kicks will probably be less
uncomfortable. If you’re having your first baby,
lightening can occur several weeks before
delivery. For subsequent babies, it usually doesn’t
happen until just before labor. If the baby’s
movements are causing you discomfort:
You may find that nausea and vomiting are
worse in the morning. But symptoms can occur
at any time of the day or night. Most women
feel better at the beginning of the second
trimester. However, symptoms can continue
throughout pregnancy.
Review the “What if I get sick” section for
treatment options.
You may have a stuffy nose, fluid dripping into
your throat (post-nasal drip), or frequent sinus
headaches. You can even get nosebleeds from
blowing your nose too hard. Increased hormones
make the mucous membranes inside your nose
and sinuses swell.
The tiny blood vessels in your nose have more
blood while you’re pregnant. They can break with
the slightest strain or even no pressure at all.
Stuffiness and nosebleeds should get better after
your baby is born. In the meantime:
• Use saline nose sprays to moisten dry nasal
• Dab Vaseline in each nostril and use a cool
mist vaporizer.
• Avoid nasal decongestant spray, which can
actually make stuffiness worse.
• Don’t use any drugs without asking your
health care team first.
Call your clinician if you can’t control the bleeding
from a nosebleed or if the bleeding gets
too heavy.
• Change your position and hope your baby
changes position, too.
• Try taking a deep breath while you raise your
arm over your head and then breathe out
while you drop your arm.
• Try cupping your hands around your baby’s
buttocks and gently moving the baby.
As your pregnancy progresses, you may develop
aches and pains in your hips and pelvic area.
This is a normal sign that your pelvic girdle is
preparing for childbirth. Pregnancy hormones are
relaxing your ligaments, loosening up your pelvic
bones so they can shift and open for childbirth.
To help manage pelvic and hip pain at home:
• When lying on your back, propped up on your
elbows or a pillow, squeeze a pillow between
your knees. This can help realign your pelvic
bones and may give you temporary pain relief.
• Wear a prenatal belt or girdle around your
hips, under your abdomen, to help stabilize
your hips.
• Sleep with a pillow between your knees.
• Rest as much as possible, applying heat to
painful areas.
• Talk to your health professional about whether
a safe pain reliever might help.
Pregnancy sleep tips
Round ligaments help support your uterus. As
pregnancy progresses, these ligaments can
stretch. Any movements that stretch these
ligaments can cause pain. It can occur when
turning over in bed, walking quickly, or sneezing
and coughing. These tips can help you avoid
the pain:
• Use extra pillows to support your legs and
back. Try sleeping on your side with pillows
between your knees and behind your back.
• Change positions slowly.
• Use your hands to support your weight when
changing positions.
• Have a light snack or a glass of milk before
going to bed.
• Get regular exercise during the day to help
you sleep more soundly at night.
• Practice relaxation exercises before going to
sleep or if you wake up during the night.
• Rest as much as possible.
• Take a warm (not hot) bath or shower before
going to bed.
• A maternity girdle or belt can help lift the
weight of the uterus off the pelvic floor.
• Avoid caffeine, including chocolate, especially
late in the day.
• Do not use sleeping pills or drink alcohol
because they could harm your baby.
Hormonal changes, plus the discomforts of later
pregnancy, may disrupt your sleep cycle. Regular
exercise, shorter naps, and relaxation techniques
can help you get the best possible sleep during
After your first trimester, lying on either side is
better for you and the baby. When you lie on your
back, the weight of your uterus and your baby
rests on the vena cava, the largest vein in your
abdomen. When there is pressure on that vein,
your blood pressure can go down, and you may
feel dizzy or light-headed.
After week 16 of pregnancy, avoid exercises
that involve lying on your back for longer than
3 minutes.
As pregnancy progresses, leg cramps,
breathlessness, contractions, the frequent need
to urinate, and an active baby may interfere
with your sleep. You may not be able to find a
comfortable position.
Stretch marks are most common on the belly, but
they can also develop on the breasts and thighs.
Other skin changes can also occur:
• A dark line known as a linea nigra may appear
on the skin between your navel and your
pubic area. It generally fades after delivery.
• Dark patches may develop on your face. This
is known as the “mask of pregnancy,” or
chloasma, and it usually fades after delivery.
• Blotchy skin and acne may increase or clear up
during pregnancy.
• Tiny, red elevated areas (vascular spiders,
or angiomas) may appear on the face, neck,
chest, and arms. These are not serious and
usually go away after pregnancy.
You may notice that your feet, ankles, hands,
and fingers become swollen, particularly at the
end of the day. It’s normal to have extra fluid in
your tissues during pregnancy, but much of the
swelling should disappear after a good night’s
sleep. If your fingers are puffy, remove your
rings. Do not take diuretics (water pills) because
they interfere with your normal fluid balance.
Minimal bleeding or spotting may be
normal in some pregnancies. But any bleeding
during pregnancy needs to be evaluated by
your clinician.
To prevent swelling or puffiness:
• Avoid high-sodium (salty) foods. (Aim for less
than 2,400 milligrams of sodium per day.)
Enlarged, swollen veins are common during
pregnancy, particularly in women with a family
history of the problem. Varicose veins typically
develop on the legs but can also affect the vulva.
• Drink 8 to 10 glasses of fluids each day.
Your calves may ache or throb, even when the
veins aren’t visible. Most varicose veins will shrink
or disappear after birth. Until then:
• Keep your feet up on a stool or couch
whenever possible.
• Try not to stand for long periods of time.
• Avoid standing for long periods of time.
• Don’t wear tight shoes or knee-high
• Wear support stockings, and put them on
before you get out of bed in the morning.
• Lie on your side to remove fluid from your
puffy tissues.
• Try sleeping with your feet slightly higher
than your heart. Raise the foot of your bed
by putting a thick blanket or pillows under
the mattress.
• When sitting, avoid crossing your legs at the
• Elevate your feet and legs whenever possible.
• Avoid tight clothing or stockings that hamper
• Wear compression stockings. You can buy
them at the Kaiser Permanente pharmacy after
being measured at your ob-gyn appointment.
• Exercise regularly to improve your blood
circulation. Try walking for at least 30 minutes
each day on most days.
To learn more about common body changes and discomforts, visit and look
for “symptoms and discomforts.” Consult with your care team for specific treatment advice.
Good oral health is an important part of
overall wellness, which is especially crucial
during pregnancy.
Pregnant women are susceptible to some very
specific oral conditions that can be prevented or
treated by a visit to the dentist.
Also, mothers’ prenatal oral health is thought to
influence the future oral health of their children
(based on transmission of oral bacteria from
mother to child).
It’s important to receive routine cleanings
and exams when pregnant, as well as
necessary treatments.
Your prenatal dental appointments also offer
an opportunity to discuss with your dentist how
to help your child develop good oral hygiene
habits from a young age to ensure a lifetime of
healthy smiles.
By paying attention to your oral hygiene and
eating habits while pregnant, you can go a
long way toward keeping your and your baby’s
mouths healthy.
• Brush your teeth gently twice daily with a
soft-bristled toothbrush and a toothpaste
containing fluoride.
• Replace your toothbrush every 3 or 4 months,
or sooner if the bristles are frayed.
Eat a healthful diet with a balanced mix of grains,
vegetables, fruits, dairy, protein, and fats and oils.
Try to limit your snacking – especially foods high
in sugar, since they cause your mouth to release
acids that increase your risk of cavities.
If your last dental visit took place more than six
months ago, or if you are experiencing any oral
health problems, schedule an appointment.
As part of a full examination, your dentist may
need to take X-rays. Oral health care, including
the use of X-rays, pain medication, and local
anesthesia, is safe throughout pregnancy.
You may experience some unique oral health
problems during your pregnancy. For example,
hormonal changes can affect your gums, causing
swelling or tenderness.
Your gums also may bleed a little when you
brush or floss. This condition is called gingivitis.
The gum tissue itself can develop red lumps
called “pregnancy tumors.” These lumps are not
cancerous and typically go away after the baby
is born.
Contact your dentist if you experience any of
these problems or have other concerns. Please
see the phone number and resoure list in the
pocket of this booklet.
• Floss daily to help remove plaque from the
surface of your teeth and food particles from
between your teeth and under the gumline.
Pregnancy is a sensitive time in a woman’s life.
These guidelines summarize some healthy
habits, risks to avoid, and warning signs when
you’re expecting.
During the middle of your pregnancy, you may
feel great, have lots of energy, and be able to
enjoy a relaxing vacation — free of strollers and
diapers (you’ll have plenty of time for those later).
During this period, your risks for miscarriage and
early labor are at their lowest. If travel is an option
during your pregnancy, the second trimester is
typically the best timing.
• Pregnancy over age 35 poses some risks, but
most older women have healthy pregnancies.
• Some immunizations (also called vaccinations)
should be done only before pregnancy. You
can get other vaccinations during pregnancy.
• Flu vaccine is safe and recommended for all
pregnant women. The vaccine also can help
prevent H1N1 flu.
If your pregnancy is normal and healthy, it is
generally OK for you to travel during your second
trimester (weeks 13 to 28).
• Tetanus, diphtheria, and acellular pertussis
(Tdap) immunization or booster is
recommended for all pregnant women
between 27 weeks and 36 weeks of gestation,
to maximize passive antibody transfer to
the newborn.
• Pregnancy after bariatric surgery may
mean that you keep seeing the doctor who
did your weight-loss surgery, along with
seeing the clinician who is caring for you
during pregnancy.
• Domestic violence can happen more often
and/or get worse when women are pregnant.
It is dangerous for both mother and baby. See
page 158 for more information.
Certain substances aren’t good for you any time,
but the list grows when you’re pregnant. Make
sure you know what to steer clear of. Here are tips
about things to avoid and moderate:
• Hazardous chemicals, radiation, and certain
cosmetic products. Avoid exposure to
dangerous substances, such as pesticides,
some household cleaners, lead, and mercury
during pregnancy and while breastfeeding.
These toxins can be harmful to a developing
fetus and/or cause birth defects or
miscarriage. If you are exposed to chemicals
in your work place, consult your Material
Safety Data Sheets (MSDS). Another available
resource is Artificial nails
and hair permanents also contain strong
chemicals. It is wise to reduce your exposure
to these chemicals and be sure the room is
well‑ventilated if you use them.
pregnancy. Keep in mind that your core body
temperature remains elevated for some time
even after you get out of the hot tub.
• Many prescription and over-the-counter
medicines (including herbs and other
supplements). Some over-the-counter and
prescription medicines are not safe to take
when you’re pregnant. Tell your clinician
about all the drugs and supplements
you take. They can help you decide what
medicines are best for you. Review the
“What if I get sick?” section in this guide for
general recommendations.
• Smoking during pregnancy. This unhealthy
habit increases the risk of problems such as low
birth weight, preterm labor, miscarriage, and
sudden infant death syndrome (SIDS).
• Hot tubs and saunas. If you use a hot tub
or sauna during pregnancy, be conservative.
Avoid uncomfortably high temperatures, and
limit your exposure. Raising your core body
temperature (hyperthermia) can harm your fetus,
particularly during the early and later weeks of
Problems during and after pregnancy have warning
signs. To stay as healthy as possible, familiarize
yourself with these signs. If anything does go
wrong, you will know just what to do and when.
Call your clinician with urgent questions. Emails
may take a few days for response, and should be
used only for routine questions.
• Sharp or continuous pain in your stomach.
• Abdominal pain that does not go away.
• Severe emotional or social issues.
• Your baby has stopped moving or is moving
less than 10 times in 2 hours once you are past
28 weeks gestation.
A common method of checking your baby’s
movement is to count the number of kicks or
moves you feel in an hour. Ten movements
(such as kicks, flutters, or rolls) in an hour are
normal. To count:
When to call your clinician
During your pregnancy, call your health
care professional immediately if any of the
following occur:
• Pick your baby’s most active time of
day. Some clinicians suggest that you
count in the morning until you get to 10
movements. Then you can quit for that day
and start again the next day.
• Vaginal bleeding.
• Vaginal discharge that causes itching,
soreness, or bad odor.
• If you do not feel 10 movements in an hour,
your baby may be sleeping. Wait for the
next hour and count again.
• Signs of preeclampsia:
• Severe headache that does not go away
with acetaminophen (such as Tylenol).
• Visual disturbances, blurred vision, flashes
of light, or spots before your eyes.
• Sudden, increased swelling of the face,
hands, or feet.
• Uterine tenderness, unexplained fever,
or general weakness (possible symptoms
of infection).
• Contractions:
• Between 20 and 37 weeks, more than 4 to
6 contractions in an hour could indicate
preterm labor.
• Sudden weight gain, 2 to 3 pounds in a
week, in your third trimester.
• Very bad, continuous headaches.
• After 37 weeks, contractions every
5 minutes for 1 to 2 hours could
indicate labor.
• Pain or burning when urinating.
• Decreased urine output, despite drinking
large amounts of fluid.
• Between 20 and 37 weeks, preterm
labor could be indicated by low back
pain or pelvic pressure that does not
go away, or intestinal cramping with or
without diarrhea.
• Continuous vomiting or loose stools.
• Fever with a temperature above 100.4
degrees, or feeling chills.
• Painful, hard veins in the legs or elsewhere.
• A gush or leak of water from the vagina.
• An accident, hard fall, or other injury.
When to call 911
You or someone else should call 911 or other
emergency services immediately if you think you
may need emergency care. For example, call if you:
• Have a seizure.
• Pass out (lose consciousness).
• Have severe vaginal bleeding.
• Have severe pain in your belly or pelvis.
• Have had fluid gushing or leaking from your
vagina (the amniotic sac has ruptured) AND
you know or think the umbilical cord is bulging
into your vagina (cord prolapse). This is quite
rare, but if it happens, immediately get down
on your knees and drop your head and upper
body lower than your buttocks to decrease
pressure on the cord until help arrives. Cord
prolapse can cut off the baby’s blood supply.
When to call your clinician
Watch closely for changes in your health, and be
sure to contact your clinician if:
• You are not getting better after 2 to 3 days.
• Your breasts are painful or red and you
have a fever, which are symptoms of breast
engorgement and mastitis.
• You have severe vaginal bleeding. You are
passing blood clots and soaking through
a new sanitary pad each hour for 2 or
more hours.
• Your vaginal bleeding seems to be getting
heavier or is still bright red 4 days after
delivery, or you pass blood clots larger than
the size of a golf ball.
• You feel dizzy or lightheaded, or you feel as
if you may faint.
• You are vomiting or you cannot keep
fluids down.
• You have a fever.
• You have new or more belly pain.
• You pass tissue (not just blood).
• You have a severe headache, vision problems,
or sudden swelling of your face, hands, or feet.
You or someone else should call 911 or other
emergency services immediately if you think
you may need emergency care.
• You have vaginal discharge that smells bad.
• You have signs of postpartum depression,
such as:
• Feelings of despair or hopelessness for
more than a few days.
• Troubling or dangerous thoughts
or hallucinations.
Your due date or estimated delivery date is based
on the first day of your last menstrual period. It is
about 40 weeks (280 days) after your last period.
However, your baby is considered to be full term
between 37 and 40 weeks.
During the week after fertilization, the fertilized
egg grows into a microscopic ball of cells
(blastocyst). It implants on the wall of your uterus.
This implantation triggers a series of hormonal
and physical changes in your body.
Having reached a little more than 1 inch in
length by the ninth week of growth, the embryo
is called a fetus. By now, the uterus has grown
from about the size of a fist to about the size of
a grapefruit.
By the end of the first trimester, most of your
baby's critical development is complete. The
reproductive organs have developed, but an
ultrasound won't clearly show whether the fetus
is a girl or a boy until later (about week 20). Your
baby is now about 2 to 3 inches long and weighs
about an ounce.
The third through eighth weeks of growth are
called the embryonic stage. At this time the
embryo develops most major body organs. Arm
and leg buds are visible, and some bones are
forming. The head may seem larger than the
rest of the body because the brain is developing
faster than the other organs.
During the first 3 months, your baby develops
quickly and is especially sensitive to toxins and
stresses. Avoid harmful substances, such as
tobacco, alcohol, recreational drugs, radiation,
and infectious diseases. Try to reduce stress and
get enough sleep.
Extreme fatigue or morning sickness can color
your daily life during the first trimester. Moodiness
(as with premenstrual syndrome) is normal.
Happiness and anxiety about a new pregnancy, or
feeling upset about an unplanned pregnancy, are
also common.
• Limit your caffeine intake to less than
200 milligrams daily.
The first trimester can bring insomnia and night
waking. Most women feel the need to take naps
to battle daytime sleepiness and fatigue.
By the second month, you may start to notice
early signs of pregnancy: breast tenderness,
increased urination, fullness or mild aching in your
lower abdomen, nausea with or without vomiting,
and food cravings or aversions. A milky vaginal
discharge is also common in your first trimester.
By the end of your first trimester, you may not
have a baby bump, but you probably will feel
pregnant. The third month can be hard — you
may feel tired and need extra rest, and morning
sickness can peak. But fatigue and nausea will
lessen, and you'll start to feel normal as you
approach your second trimester.
• Some cramping as the uterus enlarges and
contracts is normal. During this time, your
uterus will increase in weight from about an
ounce to more than 2 pounds.
• Your breasts may feel larger and tender
when touched.
• Some bleeding in your gums is common, but
don’t forget to brush and floss regularly.
• Whitish vaginal discharge is normal
throughout pregnancy. You may also have
yeast infections that recur or are difficult to
get rid of.
• Ask your clinician about the safety of any
medications you’re taking.
• Eat a healthy, well-balanced diet.
• Avoid alcohol.
• Eat a variety of foods including those high
in iron, calcium, and protein each day. It’s
quality, not quantity, that counts.
• Exercise in moderation unless your clinician
has instructed otherwise. Learn about the
benefits of exercise during pregnancy.
• Drink plenty of water throughout the day.
• If you smoke, your baby smokes, too. See the
“Health and wellness” section of this guide.
• Cat feces can sometimes cause an infection
called toxoplasmosis, which could harm
your baby. If you have a cat, ask someone
else to change the litter box. If that’s not
possible, wear rubber gloves and wash your
hands well.
• Avoid very hot baths and hot tubs
(temperature should be below 101 degrees),
saunas, steam rooms, and tanning beds.
High temperatures may harm your
developing baby.
• You should gain about 1 pound a month for
the first three months of your pregnancy.
Too much weight gain in pregnancy can lead
to a variety of health problems for you and
your baby.
• Pregnant women need 1,200 milligrams
of calcium daily. Calcium builds your
baby’s bones and teeth. It also prevents
osteoporosis later in your life. Good sources
include skim milk, yogurt, dark-green leafy
vegetables, canned salmon, and tofu.
Plan for baby expenses by creating a budget.
If you haven’t already done so, use our medical
staff directory to help you select a clinician with
whom you feel comfortable.
Get plenty of rest.
This trimester is an important time for testing.
If you are worried about Down syndrome
or other chromosomal problems, a blood
test (called first trimester screening) is done
around 9 to 11 weeks. Talk to your clinician
about genetic testing options to screen for
chromosomal defects.
Learn as much as you can. This guide has
information to guide you through your
pregnancy, childbirth, and the challenging first
months of parenthood.
Go to and get familiar with the
pregnancy health and wellness topics. You’ll
find a wealth of material, tools, and calculators.
You’ll also find information on pregnancy and
childbirth classes offered in this region.
Though some mild cramping is normal, call
your clinician if cramping is severe.
Practice Kegel exercises to start preparing for
childbirth (you can do it any time, anywhere).
Refer to page 33 for instructions.
Your first visit is usually scheduled between
9 and 12 weeks. Make sure you schedule your
appointment if you haven’t already.
Create your own at-home spa to pamper
yourself and relieve stress.
Keep the lines of communication with your
partner open. It’s important for you both to
share your feelings about your pregnancy and
impending parenthood.
Your second trimester officially begins at week
13. This is when your risk of miscarriage drops
dramatically. Take this time to enjoy your
pregnancy — you’ll probably find the weeks of
your second trimester to be the easiest.
The second trimester lasts from weeks 13 to 28 of
pregnancy. It’s when your baby’s movement takes
off. If this is your first pregnancy, you’ll begin to
feel your baby move at about 14 to 28 weeks after
your last period.
If you’ve been pregnant before, you may notice
movement earlier, sometime between weeks 16
and 18. This is a time of rapid growth for your
baby. At the start of the second trimester, your
baby now has more muscle tissue, and the bones
have developed and become harder. Your baby
is rolling, kicking, and moving a lot — flexing tiny
arms and legs. The skin is beginning to form, but
it’s almost transparent at this point.
Your baby’s kidneys are functioning and start
to pass urine. Most of the amniotic fluid that
nourishes and protects your baby comes from the
urine. The intestinal tract is starting to work too,
producing meconium, which will later be used as
your baby’s first bowel movement.
As the trimester progresses, your baby is
swallowing more amniotic fluid, which is
good practice for the digestive system. The
umbilical cord that connects you and your
baby is thickening and continues to carry blood
and nutrients.
Your baby’s sucking instinct develops, and he or
she may have started thumb-sucking. Your baby’s
head is no longer so big compared to the rest of
the body. Hair is starting to grow on the scalp,
and tiny eyelashes and eyebrows are appearing.
Your baby also sleeps and wakes regularly.
The baby is still small enough to change position
frequently — from head-down to feet-down, or
even sideways. The eyes are beginning to open
and close, and the brain is very active now.
Your baby hears sounds outside your womb and
responds by kicking or moving. Talk to your baby
often so that he or she will recognize your voice
and be comforted by it, both now and after birth.
By the end of the trimester, your baby can grip
firmly with little hands, which now have fingernails
and fingerprints. The skin goes from being
wrinkled, red, and shiny, to smoother. The hair
on the head is getting longer. The lanugo, a soft,
fine, downy hair that once covered your baby's
body, is beginning to disappear. The vernix
caseosa, a white, creamy substance that protects
the skin from long exposure to amniotic fluid, still
covers your baby’s body. The lungs are maturing,
and your baby is starting to practice breathing.
At 16 weeks, your baby is about 6 inches long and
weighs about 3 to 4 ounces. By the end of this
trimester (28 weeks), your baby will be about 11 to
14 inches and weight about 2 to 2.5 pounds.
By the start of your second trimester, you'll likely
feel better and more energetic. Morning sickness
and breast tenderness are easing. It's probably
time to break out the maternity clothes because
your belly is starting to grow. Your breasts
will become larger and heavier in the second
trimester. You may need a larger and more
supportive bra.
As your breasts become larger, the veins become
more noticeable. The nipples and the area around
the nipples (areola) become darker and larger.
Small bumps may appear on the areolae and
disappear after delivery.
As early as the 16th to 19th week, you may notice
a thin, yellowish discharge (colostrum) from your
nipples. Colostrum is what your breasts produce
when they are preparing for breastfeeding.
If this is not your first pregnancy, you might feel
your baby move. (It takes a little longer to feel this
the first time you are pregnant.) These first flutters
you feel are called quickening.
Emotional shifts also occur during this trimester.
While fatigue and moodiness usually improve
or go away, you may feel more forgetful and
disorganized than before. Looking heavier than
normal, then looking visibly pregnant and feeling
the baby move, can make you feel any number
of emotions.
Many pregnant women report an increase in
nightmares as their pregnancy progresses. Don’t
worry. These vivid dreams are just your mind’s
way of helping you process and adapt to the
changes in your life.
You may also notice that you and your partner
are not experiencing your pregnancy in the same
way (or at the same pace). It’s important to have
frequent conversations about the new baby
to reconnect to each other and share in your
excitement for the future.
You can enjoy a sexual relationship with your
partner throughout pregnancy, unless you have
been told that you’re at high risk for preterm labor
or that your placenta is over your cervix (placenta
previa). If you have either of these conditions, talk
with your clinician.
As your second trimester draws to a close, new
symptoms may start to crop up: aching back, leg
cramps, minor swelling, and sleep problems, to
name a few. Continue to get moderate exercise,
which can help prevent and relieve some of
these symptoms.
Feel as if you can’t catch your breath? It’s your
growing uterus pressing up on your diaphragm
and crowding your lungs. Relief usually comes
when your baby settles into your pelvis.
• You may experience heartburn along with a
sour taste in your mouth. It’s not a cause for
concern, but it’s uncomfortable.
• Pregnancy hormones also cause the digestive
tract to relax and work more slowly. As a
result, you might feel constipated, especially
as your pregnancy progresses.
• You may experience round ligament pain.
Round ligaments help support your uterus.
As pregnancy progresses, these ligaments
can stretch. Any movements that stretch
these ligaments can cause pain. It can occur
when turning over in bed, walking quickly, or
sneezing and coughing.
• You may begin feeling Braxton Hicks
contractions, especially if this isn’t your first
pregnancy. This painless tightening of muscles
in the uterus is normal as long as it is random
and not in a regular pattern.
• Notice brown patches on your face? It’s
called the “mask of pregnancy” and is due
to a temporary increase in estrogen. The
brown patches may darken in the sun, so
use sunscreen.
• You may see a narrow, dark line (the linea
nigra) running from your belly button to
the top of your pubic bone. After birth,
the darkened area should lighten and
then disappear.
• You may notice a rhythmic jerking motion
that can last several minutes. This means your
baby has the hiccups! You don’t need to do
anything about hiccups. They will stop soon
and won’t hurt either of you.
• You may also notice that your baby kicks and
stretches more (and you may even be able to
see squirming under your clothes). You will
feel more movement or less movement at
certain times of the day and night.
• Toward the end of the second trimester, your
blood pressure may increase slightly, returning
to its normal pre-pregnancy state.
• Sometimes your baby settles into a position
that is very uncomfortable for you. Your
unborn baby’s kicks and twists can be strong,
very noticeable, and sometimes painful.
• You may feel pelvic pressure or pain if your
baby’s head is low in your pelvis. Lying on
your side may help relieve this discomfort.
• Keep weight gain under control by watching
your portion sizes. This will make it easier to
lose weight after the baby is born.
• Make sure you get vitamin C daily, and
drink plenty of water to reduce your risk of
bladder infections.
• We recommended that pregnant women get a
flu vaccination.
• Even as your belly expands, continue to wear a
seat belt any time you are in a car. Wear both
the lap belt and the shoulder harness, but
place the lap belt low, below the baby (not
across your stomach or uterus).
• To soothe aching legs and prevent varicose
veins, elevate your legs often, don’t cross your
legs when sitting down, and slip on support
hose made especially for pregnant women.
• Keep taking your prenatal vitamin supplement
and eating a diet rich in nutrients.
• Pump up your daily iron intake (you now
need about 30 milligrams) to prevent irondeficiency anemia.
• Lying on your side promotes good circulation
and improves oxygen flow to your baby. Use
pillows for comfort and to help maintain the
side position.
• Practice relaxation exercises to increase your
energy, reduce your stress, and prepare for
a relaxing labor. For ideas, check out our
healthy pregnancy and childbirth guided
imagery podcasts at
• If you have one or more children at home, your
pregnancy can’t be your central focus. Get
tips on parenting while pregnant.
• If at any time, even during the last weeks
of pregnancy, you detect a lack of fetal
movement, call your clinician.
• Learn the signs of preterm labor. Read more
about preterm labor further in this guide.
• You may experience hemorrhoids because of
the amount of pressure your uterus is placing
on the veins in your rectum. Talk to your
clinician about your treatment options. Eat a
high-fiber diet, drink water, and avoid sitting
or standing for long stretches of time.
• Drink plenty of fluids and avoid processed
foods and other super-salty snacks to prevent
swelling in your legs and fingers.
• Make sure to get the nutrients that will fuel
your growing baby and keep you healthy:
folate, iron, and calcium. (See pages 34 to 36.)
• Be aware of the warning signs
of preeclampsia.
• Sleep on your side. When you lie on your
back, the weight of your uterus and baby rests
on a large vein in your abdomen, which can
cause your blood pressure to go down and
make you feel dizzy or light-headed.
Your clinician may recommend prenatal blood
tests, such as an alpha-fetoprotein screening
(AFP) or a maternal serum quadruple test (also
called a quad test or expanded AFP screening),
which detect signs of a possible birth defect.
• Between 24 and 28 weeks, you will be given
an oral glucose tolerance test to screen
for gestational diabetes, a pregnancy
complication affecting 4 percent of
expectant moms.
Your clinician may also recommend an
amniocentesis at 15 to 20 weeks of
pregnancy to check for birth defects and
genetic problems.
• Prepare for changes in your relationship
with your partner. Take a “babymoon,” a
weekend away with your partner to relax
and enjoy yourselves before the new baby
comes (and while you can still travel). Ask a
health care professional for tips on traveling
while pregnant.
Around 20 weeks, your clinician will
recommend an ultrasound to measure your
baby’s growth, examine your baby's anatomy,
estimate your due date, screen for certain
abnormalities, and rule out twins (or more).
Check your employer’s maternity leave policy.
You may be entitled to 12 weeks of unpaid
leave under the Family and Medical Leave Act.
Start discussing your maternity leave with your
supervisor. Think about how long you’ll take
off, and get the terms of your leave in writing.
If you plan to return to work after your leave,
start to make arrangements for child care.
Quality child care providers often have
waiting lists.
Elastic waistbands will go only so far.
Time to start shopping for (or borrowing)
maternity clothes.
• Select a pediatrician or family practice clinician
to care for your baby. Get recommendations
from friends and family.
• Keep track of your baby’s movements.
• Talk with your spouse or partner about how
you’re feeling and your expectations of family.
• Take your childbirth preparation class and
learn all you can about labor and childbirth,
including your pain management options.
• Accept your growing body as beautiful.
At 20 weeks, you’ve reached the halfway mark of
your pregnancy. Your clinician may recommend an
ultrasound to check your baby’s anatomy. During
the test, you might be able find out if you’re having
a boy or a girl (if you want to know).
for the childbirth education class listings,
and call to find out the dates of the classes.
Most expecting parents begin classes in the
seventh month.
The third trimester lasts from about 29 weeks
of pregnancy until birth. On average, women
gain about 11 pounds — and babies gain about
5 pounds and grow 5 inches — in the third
trimester alone.
Take care of yourself and your baby by continuing
to exercise and eat well. By the end of the
trimester, you may feel a surge of energy, but
make sure you're also getting plenty of rest. If
you work outside the home, start winding down
projects and have plans in place for your leave.
Only 5 percent of babies are born on their due
date. But don’t worry; your baby will arrive soon.
During the third trimester, the fetus’ size increases
and organs mature. As the last weeks go by,
your baby's:
• Brain and vision are in a major developmental
spurt, and eyesight is sharpening.
• Bones are fully developed, but still soft and
flexible for delivery.
• Nervous system is perfecting itself.
• Skin is now pink and smooth, and the arms
and legs look chubby.
• Lungs are maturing, and your baby continues
to practice breathing in anticipation of the first
breath of air.
After week 32, your baby becomes too big
to move around easily inside your uterus and
may seem to move less. At the end of the third
trimester, your baby usually settles into a headdown position in your uterus. You will likely feel
some discomfort as you get close to delivery.
Your baby will spend the final few weeks putting
on weight. At birth, most full-term babies weigh
6 to 9 pounds and measure 19 to 21 inches long.
But healthy babies come in many different shapes
and sizes.
As you enter the final months of your pregnancy,
the fatigue that you felt during the first trimester
may return as your body grows and sleep
becomes more difficult.
You’ve probably noticed how easy it is to get off
balance and feel clumsy. This is partly due to your
center of gravity moving forward as your baby
grows. You also release a pregnancy hormone
called relaxin that softens the cartilage in your
joints and pelvis. The pubic bone also opens up
to make more room for the baby, causing the
waddle that most pregnant women have when
they walk.
In the third trimester, your chest wall may widen
because of your growing baby. You may need a
larger bra or a bra extender.
You may also experience Braxton Hicks
contractions. These are “warm‑up” contractions
that are usually painless and irregular. They do not
lead to labor.
The third trimester is a time to expect increasing
insomnia and night waking. Most women wake
up a few times a night, usually because of such
discomforts as back pain, needing to urinate, leg
cramps, heartburn, and fetal movement. Strange
dreams are also common in the last few weeks of
pregnancy. You might need more rest during this
time. It is important to listen to your body.
Your good health continues to be important
because your immunities are passed on to your
baby, helping fight off infection after birth.
Around 36 weeks, you’ll have a test for Group B
streptococcus (GBS), which is harmless in adults
but can cause serious complications if you pass
it on to your baby during birth. GBS is fairly
common; about 25 percent of our members
are GBS carriers. Moms who have positive GBS
cultures need to be treated with antibiotics during
labor to prevent their babies from becoming ill.
If your GBS culture is positive when you go to
Labor and Delivery, you will receive antibiotics
in your IV before the baby is born. To make sure
there is time to receive the antibiotics, please call
Labor and Delivery and go in as soon as your bag
of waters breaks. If you are laboring at home and
your bag of waters is not broken, call Labor and
Delivery to have the nurse help you determine
when to come in. Make sure when you call that
you tell them you are GBS positive.
Try to relax and enjoy these last few weeks and
days before your baby comes. Go see a movie.
Read. Take walks. At week 37, you’re considered
full term, and by week 40, you’ve reached your
official due date!
Your pregnancy is not post-term or overdue until
after 41 weeks (or 1 week after your due date),
when risks go up for the baby. Delivery is typically
recommended by 42 weeks.
Near the end of your pregnancy, your clinician
may perform a pelvic exam as part of your
prenatal visit to check your cervix and the position
of your baby. Your cervix may begin to thin out
(efface) and open (dilate) by the time you go into
labor. For some women, these changes begin
weeks before their due date, as their bodies
prepare for labor and birth
• Your feet, ankles, hands, and fingers may
become swollen, particularly at the end of
the day. It’s normal to have extra fluid in your
tissues during pregnancy, but much of the
swelling should disappear after a good
night’s sleep.
• As your growing uterus puts pressure on
your bladder, you might notice that you
leak urine when you laugh or cough. This is
common. If you notice any consistent leaking,
whether it is a large or small amount, call your
clinician’s office to make sure that your water
hasn’t broken.
• Your growing uterus is also crowding other
surrounding organs, leading to all sorts of
common discomforts and annoyances, including
heartburn, constipation, and hemorrhoids.
• Leg cramps, breathlessness, contractions, the
frequent need to urinate, and an active baby
may interfere with your sleep. If you’re having
trouble finding a comfortable position, try
some of the tips on page 50.
• Feel achiness or numbness in your fingers,
wrists, or hands? You may have carpal tunnel
syndrome. See page 47 for more information.
• By your last month:
• You'll be seeing your clinician every week.
Forgetfulness may continue. As your due date
nears, it is common to feel more anxious about
childbirth and how a new baby will change your
life. As you feel more tired and uncomfortable, you
may be more irritable.
• Your baby does not have much room to move
around, so you will probably notice less big
movement than before.
Note: It is recommended to get a Tdap
booster at 27–36 weeks of pregnancy.
• Labor could begin at any time. Review the
signs and stages of labor.
If your pregnancy extends beyond 41 weeks, your
clinician will conduct tests to determine whether
to induce labor or continue to wait for your baby
to come on his or her own.
• Keep exercising. Moderate, gentle exercise
can help with common pregnancy discomforts
and prepare you for the rigors of labor.
Start thinking about your childbirth
preferences. Discussing these preferences
with your health care team beforehand can
be helpful.
• Your gums might be more sensitive and may
swell and bleed. Check with your dentist if you
experience pain or discomfort. Continue to
practice good dental hygiene.
Take a free hospital birth tour. To register, call
Health Engagement and Wellness Services (see
phone list).
• To help avoid varicose veins, wear maternity
support hose and prop your feet up when
you sit.
Splurge on a new pair of comfortable shoes.
The bones in your feet spread when you’re
pregnant, and some women find their shoe
size goes up.
• Get enough omega-3 fatty acids (found in fish,
flaxseed, and walnuts) each day.
Pamper yourself. Get a manicure and haircut
(pregnancy hormones make your hair and nails
grow faster).
• Prevent or ease leg cramps by elevating your
legs or getting a massage.
Start to look into health care benefits for
your baby.
• Eat, even if you’re not especially hungry.
• Practice squatting to keep your leg
muscles strong.
Make a note in your calendar to add your
newborn to your health plan within 31 days
of birth.
• Do your Kegel exercises.
• Get lots of rest. When labor starts, you’ll need
all your energy (and you may not sleep for
a while).
Practice the breathing and relaxation
techniques you learned in your childbirth
preparation classes.
• Cook and freeze meals ahead of time and
have a stock of groceries on hand. Check out
the restaurants in your neighborhood that
offer takeout. Find out if there are any grocery
delivery services in your area.
Listen to our healthy pregnancy and successful
childbirth podcast at
Know the signs of labor.
Keep track of your baby’s movements.
• Arrange for a friend or family member to help
with housework, errands, watching older
children, and so on. Let people know what
you need, and take them up on their offers
to help.
Start thinking about names for your baby. Find
out the popularity of names and how they
have changed over time on the Social Security
Administration website,
Try to tie up loose ends at work or home.
Pack your bags for the hospital. See the
checklist on page 101.
As your pregnancy enters its final weeks, actually
having a new baby and bringing this tiny person
home becomes a reality. When you first find out
that you’re pregnant, 9 months may seem like
a long time, but with so much to do and think
about, it’s not too early to plan ahead.
Car seat (the law requires that you have a car
seat to safely transport your child in a car). Since
most car seats are not installed properly, consider
scheduling a car seat safety inspection. Visit to find an inspection site near you.
You’re preparing for labor and delivery, adjusting
to the idea of becoming a parent, and getting your
home ready for your newborn. If you can get your
household in order before delivery, you’ll be able
to focus on caring for and enjoying your new baby.
The impact of a car crash can pull an infant
from an adult's arms with a force exceeding 300
pounds. To make travel as safe as possible for
your child, please remember:
Have these supplies on hand:
• The law requires that you use a child safety
seat for your baby's first ride home from the
hospital — and for all trips thereafter.
• A box of large sanitary pads. It’s normal
to have vaginal bleeding for a few weeks
following delivery, and you may have some
blood-tinged discharge for up to 6 weeks.
Don’t use tampons during this time.
• Your baby is safest when the child safety seat
is secured in the middle of the back seat.
• Digital thermometer.
• Acetaminophen (such as Tylenol) for pain.
• Diapers or diaper service.
• Basic layette of baby clothes and hats, crib
sheets, receiving blankets, and washcloths.
• A box of nursing pads and 3 nursing bras for
breastfeeding mothers.
• Never place a child safety seat in the front seat
of a vehicle. If the air bag deploys, it could
injure or kill your child.
• The law says babies must ride rear-facing
until they reach both 1 year of age and 20
pounds, and child passengers must use a
safety seat until they weigh 40 pounds. Kaiser
Permanente best practices recommend that
children under age 2 remain rear-facing within
their safety seat's height and weight limits.
• Crib or bassinet for baby to sleep in.
• Waterproof matress pads.
Although there are many cute and convenient
baby items on the market today, babies need very
few things to keep them happy and healthy in the
first few weeks.
The nursery is your baby’s home — a place where
your baby should be safe and protected. A variety
of nursery equipment is available, but some pieces
are safer than others. Here are some guidelines
that you should use when selecting equipment.
More infants die every year in accidents involving
cribs than with any other nursery product. If you
already have a crib or are buying a used one,
make sure that:
Don’t use baby gates with a V-shaped, accordionstyle opening, which can trap a child’s head. Safe
gates have vertical slats that are no more than 2³/8
inches apart.
Diaper pails are dangerous targets for curious
babies. Choose pails with protective lids, and
keep the pails out of reach.
• Crib slats are no more than 2³/8 inches apart.
• Corner posts don’t extend above the
end panel.
• Plastic bags aren’t used as a mattress protector.
• There are no dangling curtain cords within your
child’s reach if the crib is near the window.
• Toys, laundry bags, or other objects with
strings aren’t hanging near the crib.
• All nuts, bolts, and screws are
tightened periodically.
• Your baby is always placed on his or her back
to sleep.
Pacifiers must be strong enough so that they
won’t tear into pieces and cause your baby to
choke or suffocate. Pacifier guards or shields must
have holes that allow breathing and must be large
enough to prevent the pacifier from entering
the baby’s throat. Pacifiers cannot be sold with
ribbon, string, yarn, or a cord attached. Don’t put
a pacifier on a string around your baby’s neck.
An infant’s mouth is extremely flexible and can
stretch to hold larger items than you might
expect. Remove all toys and other small objects
from the crib when your baby sleeps. If a toy has a
part smaller than 15/8 inch, throw it away. Teethers,
such as pacifiers, should never be fastened
around a baby’s neck.
The American Academy of Pediatrics
recommends that pacifiers not be introduced
until 2 to 4 weeks postpartum for full-term,
breastfeeding babies, since early use of pacifiers
may interfere with breastfeeding.
If you get a changing table, buy one with safety
straps — and always use them. More than 1,300
children are injured every year from falling off a
changing table. Keep one hand on your baby at
all times while he or she is on the changing table.
More than 800 children are treated in emergency
departments every year because of accidents
involving high chairs. Most of these injuries are
due to falls because adults are not watching, or
because the baby is not strapped into the chair.
Restraining straps should be strong, and the high
chair should have a wide base for stability.
Over the months of pregnancy, you’ve likely been
imagining what your birth experience will be like.
As you prepare for the big day, take some time to
finalize or review your birth preferences.
A list of birth preferences is an ideal picture of
what you would like to happen. Creating one helps
you think through the choices you may have during
labor and the exciting moments right after your
baby is born. It also allows you to communicate
your preferences to the staff who will care for you
and your baby.
Since no labor and delivery can be predicted or
planned in advance, be flexible. As you think about
how you’d handle possible complications, give
yourself permission to change your mind at any
time. And be prepared for your childbirth to be
different from what you planned.
We would like to work with you to ensure the
safety of you and your baby. We will continue to
attempt to honor your birth preferences keeping
in mind that you and your baby's health are most
important to us. We will continue to keep you
informed of an issues that come up so that we can
work together to formulate a plan for delivery.
A healthy mom, a healthy baby, and a positive
birth experience — that’s our goal at Kaiser
Permanente. As your baby’s birth gets closer, you
may be thinking about what labor will be like and
how you can have a good experience. Making a
birth preference list is a good way to share what
you want with your hospital caregivers. We cannot
know exactly what the birth of your baby will be
like before it happens, so we cannot guarantee
that all of your preferences will be appropriate for
your labor. But we will work with you to keep your
birth experience as close to what you want as
possible, while keeping the safety of you and your
baby our most important priority.
It is our intention that every woman be treated with
respect for who she is and what she prefers. We:
• Support women who would like a birth that
is unmedicated. You’re encouraged to have
people present to help support this decision.
• Support women who prefer a birth that is as
pain free as possible by using medicine for
pain or epidural anesthesia at a suitable time
in labor.
In addition to creating a birth preference list,
there are a few things that you can do to feel
more at home while you are in labor. This
includes bringing:
• Photographs or familiar objects that might be
comforting to you. These can include a special
blanket, pillow, or something that might serve
as a focal point while you breathe through
your contractions. Your labor room is for your
comfort; make it cozy!
• Music (check with your birth hospital as to
what kind of player is offered).
• Food and drink for your birth partner and
other support people with you (some hospital
cafeterias may be closed at night). You may
also bring clear liquid drinks for yourself.
Your preferred drink may not be available at
the hospital.
Above all, Kaiser Permanente is committed to
help all mothers, babies, and families have a
healthy and safe birth experience.
• Strongly recommend childbirth preparation
classes. Even for women planning on using
pain medication, childbirth classes help
develop the skills necessary to deal with
early labor.
• Support movement while in labor, as appropriate.
• Do not order routine enemas, shaves (except
for cesarean births), or episiotomies.
• Recommend that you take a tour of the
hospital where you plan to give birth to
familiarize yourself with that hospital’s policies.
We are committed to working with you to make your childbirth experienc, the best it can be. Your
individuality and personal preferences are important to us. This is your birth experience, and we want
you to tell your health care team about any preferences that you have for your birth. We will strive to
meet your expectations while keeping you and your baby’s health and safety our top priority. In keeping
with this philosophy, we will:
• Respect your wishes about pain management and breastfeeding.
• Keep you informed at all stages of your labor.
• Be committed to listening to and communicating with you in a compassionate manner.
Is there anything your caregivers should know
that will help you to create the atmosphere or
the memories that will make this birth exerience
everything you would like it to be?
Birth support:
Others attending the birth and their role:
Your baby
I would like to limit the number of guests and
phone calls while I am in labor to the people
listed above.
Soon after birth, we will give you special bonding
time with your familiy that will include direct skinto-skin contact with mom and baby. Are there any
requests you have for this bonding time?
Special concerns during labor:
Cultural/family traditions
Do you have any cultural or family traditions you
will observe while in the hospital?
Comfort measures/pain relief
I wish to try:
I would like:
Relaxation techniques.
To choose my birthing position.
Breathing techniques.
A mirror available to view the birth.
Visualization techniques.
To touch my baby's head as it crowns.
Movement, walking, position changes.
That my baby be "lightly" dried off.
Warm shower.
To have ________________________ (name)
cut the cord if possible.
Jacuzzi tub.
Dim lights.
Birthing ball.
Narcotic medicine.
Epidural analgesia.
I wish to exclusively breastfeed my baby.
I, or a support person, plan to participate in
my baby's first bath.
I need more information about routine
procedures such as vitamin K, erythromycin
ointment, and hepatitis B vaccine.
The following statement best describes how I feel
about pain medicine/epidural:
If I have a boy, I plan to have him circumcised.
Other comments or requests:
I want pain medicine/epidural to be given as
soon as medically safe to do so.
I want to go as far as I can but may choose to
have medicine/epidural if I really need it.
I wish to avoid pain medicine/epidural and do
not want to be offered these unless I ask.
When you create your birth preferences list,
you’ll address many factors. The location of your
delivery, who will deliver your baby, and whether
you want continuous labor support from a
designated health professional, doula, friend,
or family member are important details
to consider.
After you’ve set the stage, think through your
preferences for comfort measures, pain relief,
medical procedures, and fetal monitoring.
Also, think about how you’d like to handle your
first hours with your newborn. The following
information can help you weigh these options.
There are many ways to reduce the stresses of
labor and delivery. Consider:
• Continuous labor support from early labor
until after childbirth, which has a proven,
positive effect on childbirth. Women who have
continuous one-on-one support (for example,
from a mother’s support person, or doula;
nurse; midwife; or childbirth educator) are
more likely to give birth without pain medicine
and are less likely to describe their birthing
experience negatively. Although there is not a
proven direct connection between continuous
support and less labor pain, having a support
person does help you feel more control and
less fear, which are strong elements of mental
pain control.
• Use of a birthing ball, or exercise ball.
• Walking during labor, including whether
you prefer continuous electronic fetal heart
monitoring or occasional monitoring.
• Nonmedication pain management (“natural”
childbirth), such as continuous labor support,
focused breathing, distraction, massage, and
imagery. This can reduce pain and help you
feel a sense of control during labor.
• Laboring in water, which helps with pain,
stress, and sometimes slow, difficult
labor (dystocia).
• Playing music during labor.
• Acupuncture and hypnosis, which are
low-risk ways of managing pain that work
for some women.
Your options for pain relief with medicine
may include:
• Opioids (narcotics), which are used to reduce
anxiety and partially relieve pain. Sometimes
opioids can affect a newborn’s breathing,
so they are usually not administered close
to delivery.
• Epidural anesthesia, which is an ongoing
injection of pain medicine into the epidural
space around the spinal cord. Some women
prefer to use epidural anesthesia for pain relief
during labor.
Some pain-relief medicines are not the type that
you would request during labor. Rather, they
are used as part of another procedure or for an
emergency delivery. But it’s a good idea to know
about them.
• Local anesthesia is the injection of numbing
pain medicine into the skin. This is done before
inserting an epidural or before making an
incision (episiotomy) that widens the vaginal
opening for the birth. Local anesthesia may
be used before the midwife or doctor places
stitches if the woman has a laceration during
the birth.
• Spinal block is an injection of pain medicine
into the spinal fluid that rapidly and fully numbs
the pelvic area for assisted births, such as a
forceps or cesarean delivery (no pushing
is possible).
• General anesthesia is the use of inhaled or
intravenous (IV) medicine, which makes you
unconscious. It has more risks, yet it takes
effect much faster than epidural or spinal
anesthesia. General anesthesia is used only
for some emergencies that require a rapid
surgical delivery, such as when an epidural
line (catheter) has not been installed in
advance or is not working well or when
medical reasons prevent you from having a
spinal block or epidural anesthesia.
Birthing positions for pushing include sitting;
squatting; reclining; hands and knees; or using
a birthing chair, stool, or bed.
Fetal heart monitoring is a standard practice
during labor, but other procedures are used
as needed.
• Labor induction and augmentation includes
a simple “sweeping of the membranes” just
inside the cervix, rupturing the amniotic sac,
using medicine to soften (ripen) the cervix, and
using medicine to stimulate contractions. This
is not always, but can be, a medically necessary
decision — such as when a mother is about
two weeks past her due date or when the
mother or baby has a condition that requires
immediate delivery.
• Antibiotics if you tested positive for Group B
strep during your pregnancy.
• Electronic fetal heart monitoring may be
either continuous or periodic depending on
pregnancy or baby risk factors or medications
being administered.
• Episiotomy (not a routine procedure) widens
the perineum with an incision. This is used to
prevent further tearing when visible tearing is
noticed or to create more space when needed
for delivery. (Perineal massage and controlled
pushing can also prevent or reduce tearing.)
• Forceps delivery is used to assist a vaginal
delivery, when a little assistance is needed.
• The need for a cesarean birth during labor
is primarily based on the baby’s and
mother’s conditions.
If you have had a cesarean delivery before, you
may have a choice between a TOLAC and a
planned cesarean birth. You and your clinician can
review your history to decide if you are a candidate
for a trial of labor after cesarean (TOLAC).
Later in your pregnancy, you and your partner
are probably focused on checking off your list
of things to do before the baby arrives. But it’s
important that you set aside time and energy to
prepare your mind and body for labor.
Some of the following suggestions can help you
feel more mentally organized leading up to the
birth of your baby.
Stretches, exercises, and deep breaths can
help you feel more relaxed and ready for the
extraordinary act of childbirth.
• Know what to expect. Review the signs and
stages of labor and familiarize yourself with the
warning signs for preterm labor. Also, learn the
difference between false labor (Braxton Hicks
contractions) and the real thing so you know
when it’s time to grab your bag and go to the
hospital. Use a chart to help time and record
your contractions.
The muscles in your lower abdomen, lower back,
and around the vagina (birth canal) come under
great strain during pregnancy. During delivery,
these same muscles must relax and stretch.
Simple exercises such as the pelvic tilt and tailor
stretch will help you strengthen the muscles that
support your growing uterus.
See page 32 and 33 of this guide and visit to learn more about these
and other exercises.
Learning to relax your muscles, control your
breathing, and focus your mind are skills you will
need to call upon during labor and delivery. And
they take some practice to master.
Check the "Managing Emotions" section on page
42 to 44 for a refresher on different practices.
• Take a childbirth class. If you haven’t done so
already, sign up for a childbirth preparation class.
• Stop smoking. If you’ve been smoking during
your pregnancy, try to quit now. Women who
smoke are more likely to have problems in
pregnancy and childbirth. Get help quitting with
the free online program at or
by talking with a health coach (see page 17).
• Pack your bags. Make sure you have everything
to make your hospital stay comfortable. Review
the next page of this guide for a checklist. Add
to it any special items you want to bring from
home, such as music or photographs, that may
help you during labor and delivery.
• Get ready for baby. Make sure you have the
necessary items to bring your baby home safely
and set up a comfortable environment.
Don’t wait until your first labor pains to get ready
to go to the hospital. Pack your bag at least three
weeks before your due date with these items.
Infant safety seat (required by law to be in the
car when you leave the hospital).
Outfit for going home (undershirt, outer
garment, and hat, depending on the weather).
Kaiser Permanente ID card.
One or two receiving blankets.
Toiletries (toothbrush, toothpaste, lip balm,
brush, hair clip or band, lotion, cosmetics).
Nightgown, robe, or loose-fitting T-shirt (if you
prefer to wear your own; front-opening if you
plan to breastfeed).
Nonskid slippers.
Cotton socks.
Mittens (many babies have long fingernails and
can scratch their faces).
• Electrical devices (curling iron, hair dryer).
• Valuables, jewelry, or cash.
Hand fan or spray mist bottle.
Underwear (and your favorite brand of
sanitary pad if desired).
Supportive bra or nursing bra (for
breastfeeding mothers).
Comfortable, loose-fitting clothing to
wear home.
MP3 player or CDs and CD player to play
relaxing music or audio programs.
Camera for photos or videos.
Cellphone and numbers of friends and
relatives you plan to contact.
Eyeglasses and contact lens supplies.
Snacks, a change of clothes, and toiletries
for your partner.
Beverage of your choice not carried by the
hospital (such as Gatorade).
A contraction is a tightening of the uterine
muscle that becomes frequent or regular as labor
begins. It might feel like cramping or pressure in
the uterus.
You should count contractions around the time
your baby is due. Place your hands on your
abdomen and feel for a tightening and then a
relaxing (softening) of your uterus. The tightening
sensation should be felt over the entire abdomen.
If this is your first baby and your contractions are
every 3 to 5 minutes for at least an hour and are
uncomfortable, you may be in labor.
If this is not your first baby and your contractions
are every 5 to 7 minutes for at least an hour and
are uncomfortable, you may be in labor.
Talk to your clinican about when you should notify
Labor and Delivery and go to the hospital. The
following are some general guidelines about
when to call.
Use a watch or a clock with a second hand and
answer these 2 questions:
• How long do the contractions last (duration)?
Time the length of each contraction from the
moment it starts until it subsides.
• You can no longer walk or talk
through contractions.
• How far apart are the contractions
(frequency)? Time each contraction from the
beginning of one to the beginning of the next.
You’re having a contraction if your uterus stays
tight for 30 seconds or more and then repeats.
It’s normal for most women to have Braxton Hicks
contractions throughout pregnancy.
Braxton Hicks contractions don’t usually come in
a rhythmic pattern and don’t continue for more
than an hour. They often disappear if you change
your activity.
Call your clinician or advice line if you are not due
and experience contractions or cramping that you
do not think are Braxton Hicks.
If you’re a first-time mother, call when:
• Contractions are regular, usually every 3 to 5
minutes over an hour-long period. Count from
the start of a contraction to the beginning of
the next.
• Contractions last at least 45 to 60 seconds.
Contractions that last 30 seconds are probably
very early labor or Braxton Hicks contractions.
• Contractions become much stronger when
you’re walking.
• Your water breaks.
If you’re not a first-time mother, call when:
• Contractions are every 5 to 7 minutes for at
least one hour.
• Contractions last at least 45 to 60 seconds.
• Contractions become stronger when walking.
• Your water breaks.
Use this chart to help you track the duration and frequency of your contractions. You also can use a
contraction calculator app, such as the one on
11 a.m.
60 sec.
75 sec.
10 min.
80 sec.
8 min.
The birthing process is known as labor and
delivery. No one can predict when labor will start.
One woman can have all the signs that her body
is ready to deliver, yet she may not have the baby
for weeks. Another woman may have no advance
signs before she goes into active labor. First-time
deliveries are more difficult to predict.
Signs that early labor is not far off include
the following:
• The baby settles into your pelvis. Although
this is called dropping, or lightening, you may
not feel it.
• Your cervix begins to thin and open (cervical
effacement and dilation). Your clinician checks
for this during your prenatal exams.
• Braxton Hicks contractions become more
frequent and stronger, perhaps a little painful.
You may also feel cramping in the groin or
rectum or a persistent ache low in your back.
• Your amniotic sac may break (rupture of the
membranes). In most cases, rupture of the
membranes occurs after labor has already
started. In some women, this happens before
labor starts. Call your clinician immediately
or go to the hospital if you think your
membranes have ruptured.
Early labor is often the longest part of the
birthing process, sometimes lasting 2 to 3 days.
Uterine contractions:
• Are mild to moderate (you can talk while
they are happening) and last about 30 to
45 seconds.
• May be irregular (5 to 20 minutes apart) and
may even stop for a while.
• Open (dilate) the cervix to about 3
centimeters. First-time mothers can
experience many hours of early labor without
the cervix dilating.
It’s common for women to go to the hospital
during early labor and be sent home again until
they progress to active labor or until their water
breaks (rupture of the membranes). This phase of
labor can be long and uncomfortable. Walking,
watching TV, listening to music, or taking a warm
shower may help you through early labor.
If you arrive at the hospital or birthing center in
early labor that is dilating and effacing the cervix
or is progressing quickly, you can expect some or
all of the following:
• In the birthing room, you will change into a
hospital gown.
• Your blood pressure, pulse, and temperature
will be checked.
• Your previous health, pregnancy, and labor
history will be reviewed.
• You will be asked about the timing and
strength of your contractions and whether
your membranes have ruptured.
• Electronic fetal heart monitoring will be used to
record the fetal heart rate in response to your
uterine contractions. Fetal heart rate shows
how your baby is doing.
Unless you have a cesarean birth, you will labor,
deliver, and recover in the same room.
In the hospital, you may be:
• Encouraged to walk. Walking helps many
women feel more comfortable during early
labor. Walking is thought to help labor
progress, but recent research suggests that
walking doesn’t actually speed or slow labor.
• Either intermittently or continuously monitored
for your baby’s well-being and contractions,
depending on your or your baby’s risk factors
or medications administered.
• Allowed visitors. As your labor progresses
and you become more uncomfortable, you
may want to limit visitors to your partner and/
or labor coach.
• Offered a birthing ball that can be used for
different positions during labor.
• You will have vaginal exams to check whether
your cervix is thinning and opening (effacing
and dilating).
• Depending on your physical needs and your
clinician’s recommendations, you may have an
intravenous (IV) catheter inserted in case you
need extra fluids or medicine later.
The first stage of active labor starts when the
cervix is dilated about 3 to 4 centimeters. This
stage is complete when the cervix is fully dilated
and effaced and the baby is ready to be pushed
out. During the last part of this stage (transition),
labor becomes particularly intense.
Compared with early labor, the contractions
during the first stage of active labor are more
intense and more frequent (every 2 to 3 minutes)
and longer-lasting (50 to 70 seconds). Now is
the time to be at or go to the hospital. If your
amniotic sac hasn’t broken before this, it may now.
As your contractions intensify, you may:
• Feel restless or excited.
• Find it difficult to stand.
• Have food and fluid restrictions. Some
hospitals allow you to drink clear liquids.
Others may only allow you to suck on ice chips
or hard candy. Solid food is often restricted,
because the stomach digests food more
slowly during labor. An empty stomach is
also best in the rare event that you may need
general anesthesia.
The end of the first stage of active labor is
called the transition phase. As the baby moves
down, your contractions become more intense
and longer and come even closer together than
before. During transition, you will be focused
on yourself, concentrating on what your body
is doing. You may be annoyed or distracted by
others’ attempts to help you but still feel you
need them nearby as a support. You may feel
increasingly anxious, nauseated, exhausted,
irritable, or frightened.
A mother in first-time labor will take up to
three hours in transition, and a mother who has
vaginally delivered before will usually take no
more than an hour. Some women have a very
short, intense, transition phase.
• Want to try breathing techniques, laboring in
water, acupuncture, hypnosis, or other calming
measures that you’ve chosen to manage pain
and anxiety.
• Feel the need to shift positions often.
This is good for you, because it improves
your circulation.
• Want pain medicine, such as epidural anesthesia.
• Be given intravenous (IV) fluids.
The second stage of active labor is the actual
birth, when the baby is pushed out by the
tightening uterine muscles (contractions).
During the second stage:
• Uterine contractions will feel different.
Though they are usually regular, they may
slow down to every 2 to 5 minutes, lasting 60
to 90 seconds. If your labor stalls, changing
positions may help. If not, your clinician may
recommend using medicine to stimulate
(augment) uterine contractions.
• You may have a strong urge to push or bear
down with each contraction.
• The baby’s head is likely to create great
pressure on your rectum.
• You may need to change position several times
to find the right birthing position.
• You can have a mirror positioned so you can
watch your baby crown and emerge from the
birth canal.
• When the baby’s head passes through the
vagina (crowns), you will feel a burning pain.
The head is the largest part of the baby
and the hardest part to deliver. If this is
happening quickly, your clinician may advise
you not to push every time, which may give
the perineum, or area between the vulva
and the anus, a chance to stretch without
tearing. Or he or she may make an incision
in the perineum (episiotomy). This is not
recommended unless there is a medical need.
• Your medical staff will be ready to handle
anything unexpected. If an urgent problem
comes up, people will move quickly. You may
suddenly have more people and equipment in
the room than before.
This pushing stage can be as short as a few
minutes or as long as several hours. You are
more likely to have a fast labor if you have given
birth before.
After your baby is born, your body still has
some work to do. This is the third stage of labor,
when the placenta is delivered. You will still
have contractions. These contractions make the
placenta separate from the inside of the uterus,
and they push the placenta out. Your health
care team will help you with this. They will also
watch for any problems, such as heavy bleeding,
especially if you have had it before.
The third stage can be as quick as 5 minutes.
With a preterm birth, it tends to take longer. But
in most cases, the placenta is delivered within
30 minutes. If the placenta does not fully detach,
your clinician will probably reach inside the uterus
to remove by hand what is left. Your contractions
will continue until after the placenta is delivered,
so you may have to concentrate and breathe until
this process is complete.
Your clinician's goal is for the third stage to
proceed normally and for all of the placenta
to leave the uterus. This is what keeps your
bleeding down.
You may be given medicine to help the uterus
contract firmly. Oxytocin or Pitocin may be given
as a shot or in a vein (intravenously) after the
placenta is delivered. Oxytocin is given to make
your uterus shrink and bleed less (this is the
same medicine that is sometimes used to make
contractions more regular and frequent during
labor). Breastfeeding right away can also help the
uterus shrink and bleed less.
After childbirth (postpartum period), your body
goes through numerous changes, some of
which continue for several weeks during your
postpartum period. Like pregnancy, postpartum
changes are different for every woman.
• Breast engorgement is common 3 or 4 days
after delivery when the breasts begin to fill
with milk. This can cause breast discomfort
and swelling. Placing ice packs on your
breasts, taking a hot shower, or using warm
compresses may relieve the discomfort of
• Shrinking of the uterus to its pre-pregnancy
size (uterine involution) starts when the
placenta is delivered and continues for
about two months. Within 24 hours, the
uterus is about the size it was at 20 weeks of
pregnancy, and after a week, it is half the size
it was when you went into labor. By 6 weeks
after delivery, the uterus is nearly as small as it
was before pregnancy.
• Recovery from pelvic bone problems, such as
separated pubic bones (pubic symphysis) or
a fractured tailbone (coccyx), can take several
months. Treatment includes ice, nonsteroidal
anti-inflammatory drugs (NSAIDs), and
sometimes physical therapy.
• Contractions called afterpains shrink the
uterus for several days after childbirth. These
sharp pains are usually not as problematic
after a first childbirth as they are after later
deliveries. Afterpains typically improve by the
third day postpartum.
• Sore muscles (especially in the arms, neck,
or jaw) are common after childbirth. This
is a result of the hard work of labor and
should go away in a few days. You may also
have bloodshot eyes or facial bruising from
vigorous pushing.
• Difficulty with urination and bowel movements
(elimination problems) can occur for several
days after childbirth. Drink plenty of fluids and
use stool softeners if needed.
• Postpartum bleeding (lochia) may last for 2
to 4 weeks and can come and go for about
2 months.
• Recovery from an episiotomy or perineal tear
in the area between the vagina and anus can
take several weeks. You can ease the pain
with home treatment, including ice, pain
medicine, and sitz baths. Pain, discomfort, and
numbness around the vagina are common
after any vaginal birth.
Call your clinician if you are concerned about any
of your postpartum symptoms.
When you have returned home, you may find it
a challenge to meet the increased demands on
your limited energy and time. Take it easy on
yourself. Pause for a moment and think of what
you need. Tips for coping during the postpartum
period include accepting help from others, eating
well and drinking plenty of fluids, getting rest
whenever you can, limiting visitors, getting some
time to yourself, and seeking the company of
other women who have new babies.
Depression is common during pregnancy and in
the postpartum period. If you have symptoms of
depression during pregnancy or are depressed
and learn you are pregnant, make a treatment
plan with your clinician right away.
If you are being treated for depression and
are planning a pregnancy, talk to your clinician
ahead of time. You may be able to taper off your
antidepressant medicine before your pregnancy,
to see how you feel during your first trimester. It’s
best to be medicine-free, especially during the
first trimester. But if you are severely depressed,
your clinician will probably want you to stay on
your medicine.
Don’t ever suddenly stop taking antidepressants.
This can cause difficult emotional and physical
symptoms, and may also affect your fetus. Your
clinician can tell you the best way to taper off
your medicine.
If you are not severely depressed, interpersonal
counseling or cognitive-behavioral therapy may
be all that you need.
• Interpersonal counseling focuses on your
relationship and life adjustments, giving you
emotional support and help with problemsolving and goal-setting.
• Cognitive-behavioral therapy helps you take
charge of the way you think and feel, while
giving you a supportive relationship.
If counseling alone isn’t enough, or if your
symptoms are severe and disabling, talk to your
clinician about other possible treatments:
• Light therapy uses regular doses of bright
light (not full-spectrum light, which includes
ultraviolet light). Typically, a person having
light therapy will sit in front of a high-intensity
(2,500- to 10,000-lux) fluorescent lamp, slowly
building up to 1 to 2 hours each morning.
(Possible side effects include eye strain,
headache, feeling “wired,” and trouble falling
asleep when light therapy is used later in
the day.)
There is a small chance that your baby will have
minor, temporary symptoms (such as poor
feeding and irritability) related to SSRI exposure
during pregnancy. But not treating depression
can also cause problems during pregnancy and
birth. If you become pregnant again, you and your
clinician must weigh the risks of taking an SSRI
against the risks of not treating depression.
The U.S. Food and Drug Administration (FDA)
has issued an advisory on antidepressant
medicines and the risk of suicide. The FDA
does not recommend that people stop using
these medicines. Instead, a person taking
antidepressants should be watched for warning
signs of suicide. This is especially important at
the beginning of treatment or when the doses
are changed.
Whether you use counseling, medicine, light
therapy, or a combination, be sure to also get
regular exercise, healthy food, fresh air, and
time with people who care about you. These
are important parts of preventing and treating
depression and having a healthy pregnancy.
It is important to have a routine postpartum
visit with your clinician 4 to 6 weeks after delivery.
This appointment will include a physical exam and
will give you a chance to discuss birth control,
feeding, depression, and your return to work.
• Antidepressant medicine, most often a
selective serotonin reuptake inhibitor (SSRI),
such as fluoxetine (Prozac) or sertraline
(Zoloft), is also an option. Zoloft is the most
commonly prescribed antidepressant during
pregnancy. If you are planning to breastfeed
and are taking an antidepressant, talk about
this with your clinician.
Congratulations on your new baby!
The day you’ve been waiting for is finally here — your baby is home with you.
Like pregnancy, the postpartum period can be a time of mixed emotions. You may feel
excitement and joy as well as concern and exhaustion. Your new family member has a
unique personality and needs, which may take some adjustment.
Remember to enroll your newborn in a health insurance plan within 30 days after birth.
Check with your employer’s human resources department or a Kaiser Permanente
Member Services representative to learn about coverage for your baby.
The time after birth is usually a mix of emotions.
We want you to feel supported while also
ensuring the safety and health of your infant.
The following information should help give you
ideas about what to expect while you are in the
hospital after the birth of your child. You’ll spend
most of the time bonding as a new family and
practicing breastfeeding.
The time immediately following delivery is
not only joyous but also very important for
establishing a good connection with your new
arrival. As long as it is safe, we encourage placing
your infant on your chest, skin to skin, and to
begin breastfeeding as soon as possible. This
also provides warmth for your baby. Partners are
encouraged to get involved in this period as well.
If your clinician determines that your baby needs
additional help to breathe or to be checked just
after delivery, we have pediatric clinicians nearby.
If this occurs, we try to respect the bonding time
for your family as soon as we determine the health
and safety of your newborn.
The timing of your baby's first bath will be
determined between you and your clinician based
on your baby's needs.
Screening tests help your clinician diagnose
and treat certain potentially serious diseases or
conditions before symptoms appear. All states
require newborn screening, although the required
tests vary from state to state. They may include
testing for galactosemia and phenylketonuria
(metabolic disorders), sickle cell disease, thyroid
hormone, and others. When your baby is at least
24 hours old, we take a few drops of blood from a
heel for testing. If the tests results are abnormal,
further testing may be needed.
Your baby will also have other screening tests,
including hearing, oxygen level, and jaundice
tests. Often a baby may not pass the hearing test
for simple reasons like the presence of fluid in
the ear canal. We then repeat the test before or
after you go home depending on when you are
discharged. The oxygen test helps determine if
there is a problem with your baby’s heart. If you
have any questions about these, please talk to
your clinician.
If you want your newborn son circumcised,
Kaiser Permanente Sunnyside Medical Center,
Kaiser Permanente Westside Medical Center, and
our partner hospitals have health care professionals
who can perform the procedure. We also have
an outpatient clinic available after your discharge
from the hospital. Health plans charge differently
for the procedure. You may want to find out what
your costs related to the procedure will be.
There are state and national requirements
regarding medications for newborns, including
the hepatitis B vaccine, an antibiotic eye ointment
to prevent infection, and a vitamin K shot to
prevent bleeding. These are administered in the
first couple of hours following delivery.
Some infants may require other medications
based on your health history. For instance, if you
test positive for hepatitis B, your baby needs an
additional injection of immune globulin at birth
to help prevent transmission. Or if you had an
infection during labor or delivery, your baby may
need additional medications, such as antibiotics.
We also recommend that families and caregivers
be vaccinated against pertussis (whooping cough)
and influenza.
Erythromycin is an antibiotic that kills certain
germs in mom and baby. It is applied to your
newborn’s eyes within 1 to 2 hours of delivery
to prevent infection. This treatment has proved
effective and rarely has side effects. Past
therapies caused some discomfort or irritation,
but this ointment has proved to be safe.
Why do we give erythromycin ointment?
Eye infections were a significant cause of
blindness in newborns before this treatment was
started. Chlamydia and/or gonorrhea bacteria, as
well as other less common bacteria, can cause eye
infections in newborns. The bacteria cause red,
irritated eyes with profuse white drainage, and
can lead to blindness if left untreated.
How are chlamydia and gonorrhea transmitted?
Chlamydia and gonorrhea are sexually transmitted
infections and are routinely screened for early in
pregnancy because many women do not have
symptoms and may not know they have the
infection. Treatment of these infections helps
decrease the chance of infection in newborns.
A newborn can get infected regardless of the
method of delivery. There is also a chance of
contracting the infection after this screening.
How safe is erythromycin ointment?
It is very safe, and side effects are rare.
Occasionally mild eye irritation may be noticed,
but it is usually not bothersome to the newborn.
What happens if my infant does not get
the ointment?
One study showed that in infants who were
not at high risk (mothers tested negative for
gonorrhea, had good prenatal care, had stable
social situations, and had only one sexual partner),
the rate of newborn eye infection was about
1 in 5 newborns with no ointment. There were
smaller rates of eye infections in infants treated
with erythromycin ointment. If you have active
gonorrhea infection, your newborn should also be
treated with additional antibiotics to help prevent
the disease.
Warning signs of eye infection
Signs of potential eye infection include, but are
not limited to:
• Thick white eye discharge.
• Eyelid swelling.
• Eye redness.
The first vaccination in a series of 3 is given
to your baby shortly after birth to provide
immunization against hepatitis B. Hepatitis B is
caused by a virus that can cause liver damage,
leading to a transplant or even death. When
babies get infected, the virus usually remains in
the body for life (this is called chronic hepatitis
B). About 1 out of 4 infected babies will die of
liver failure or liver cancer as adults. Hepatitis
B is a deadly disease, but it’s preventable with
vaccination. The vaccine is safe and, when given
as recommended, very effective.
How is hepatitis B virus spread?
Anyone can become infected with hepatitis B
virus at any time during their lives. Hepatitis
B virus is spread by contact with an infected
person’s blood or other body fluids. For example,
babies can get hepatitis B virus from their
infected mothers at birth. Children can get it
if they live with or are cared for by an infected
person or if they share personal care items (such
as a toothbrush) with an infected person. About 1
out of 20 people in the United States have been
infected with the hepatitis B virus.
How many people have hepatitis B?
In the United States, tens of thousands of people
get infected with the hepatitis B virus each year.
About 1 out of 20 people in the United States
have been infected with the hepatitus B virus.
Every year, about 3,000 Americans die from
liver failure or liver cancer caused by hepatitis B.
Worldwide, 350 million people are infected.
Is there a cure for hepatitis B?
No. Although there are several medicines to
help people who have lifelong hepatitis B virus
infection, there is no medicine that cures it. The
good news is that hepatitis B can be prevented
by vaccination.
Who recommends that all babies get a
hepatitis B vaccination at birth?
Medical groups such as the American Academy
of Pediatrics, the American Academy of Family
Physicians, the American College of Obstetricians
and Gynecologists, and the Centers for Disease
Control and Prevention recommend that every
baby get a hepatitis B vaccination at birth, before
leaving the hospital.
Why does my baby need a hepatitis B
vaccination at birth?
It is important to vaccinate babies at birth so they
will be protected as early as possible from any
exposure to the hepatitis B virus. A child who
gets infected with the hepatitis B virus during the
first 5 years of life has a 15 to 25 percent risk for
premature death from liver disease, including liver
failure or liver cancer. Hepatitis B vaccine is your
baby’s “insurance policy” against being infected
with the virus.
Won’t my baby just recover from hepatitis B?
Babies are not able to fight off hepatitis B as
well as adults. About 9 out of 10 babies who get
infected in the first year of life will stay infected
for life.
It is impossible to know if a person is infected
with the hepatitis B virus by looking at them. Most
people have no symptoms, do not feel sick, and
don’t know they are infected. As a result, they can
spread the virus to others without knowing it. The
only way to know if a person is infected is through
a blood test.
How many doses of hepatitis B vaccine will my
baby receive?
The basic series is 3 or 4 doses. The first dose
should be given in the hospital (at birth), the
second dose 1 to 2 months later, and the third
dose at age 6 months or later. Because many
health care professionals choose to use certain
combination vaccinations during well-baby
checkups, some infants will receive 4 doses
of hepatitis B vaccine. Either alternative is
considered routine and acceptable.
How effective is hepatitis B vaccine?
Very. More than 95 percent of infants, children,
and adolescents develop immunity to the
hepatitis B virus after 3 doses of properly
spaced vaccine.
Is hepatitis B vaccine safe?
Yes. Hepatitis B vaccine has been shown to be
very safe when given to people of all ages. In the
United States, more than 120 million people have
received hepatitis B vaccine. The most common
side effects from hepatitis B vaccine are soreness
at the injection site or slight fever. Serious side
effects are rare.
Some parents worry that their baby’s immune
system is immature and cannot handle vaccination
at such a young age. But as soon as they are born,
babies start effectively dealing with trillions of
bacteria and viruses. In comparison, the challenge
to their immune systems from vaccine is tiny.
Why does my baby need so many vaccinations?
It’s true that babies get lots of vaccinations, which
can cause temporary discomfort. The good news is
that more vaccinations mean more protection from
serious diseases than in the past. Like hepatitis
B, many of these diseases, such as rotavirus,
whooping cough, and meningitis, can result in
severe illness, hospitalization, and even death.
Make sure your baby gets all his or her vaccinations
at the recommended ages. It’s the safest and
surest way to protect children from deadly
infectious diseases. Your baby is counting on you!
Vitamin K helps our blood clot. It is given to
infants as an injection. Babies have little or no
vitamin K stored up when they are born, and they
do not absorb or make it adequately in the first
few weeks of life. If they become deficient, they
may have serious bleeding, even leading to brain
damage or death.
Why do we give vitamin K?
Newborns have low vitamin K at birth and are at
risk of low levels for several reasons. First, vitamin
K does not move across the placenta well during
pregnancy. Second, vitamin K is made by bacteria
in the intestines, and babies have sterile intestines
when they are born. Third, breast milk is low in
vitamin K. While formula has some, it may not be
enough. Infants whose mothers are on certain
seizure medications are at an even higher risk of
low vitamin K. Low vitamin K in newborns may
result in vitamin K deficiency bleeding (VKDB).
What is VKDB?
Vitamin K deficiency bleeding is a potentially
devastating and sometimes fatal disease that can
show up days to months after birth. VKDB is easily
prevented, and both the American Academy
of Pediatrics and Oregon law support giving a
vitamin K injection to all newborns. VKDB shows
up any time from the first day of life, typically
in infants whose mothers were exposed to antiseizure medications or certain tuberculosis drugs,
to about 4 months of age. These infants are
almost always primarily breastfed and did not
receive the vitamin K injection at birth. Some of
them have liver disease or other diseases that
make it difficult to absorb the vitamin. Some
infants will have no signs of a problem until it
is too late.
Additional information about vitamin K
Vitamin K can be given as an injection or taken
orally. The oral version involves giving multiple
doses (usually at birth, 1 week, 4 weeks, and 8
weeks of age), and though it may decrease the
risk for VKDB, it is not nearly as effective as the
injection. Some European countries that switched
from the injection to the oral form have seen an
increase in VKDB. In 1997, a review of 4 countries
that made this change showed that oral vitamin
K led to VKDB in 1.2 to 1.8 per 100,000 births,
compared with no cases from the injection.
Incomplete oral administration resulted in failure
in 2 to 4 per 100,000 births. Part of the reasons
for these findings was that oral vitamin K tastes
bad, and its effectiveness depends on parental
compliance for all of the doses.
How common is VKDB?
It is a rare disease, but in infants who do not
receive vitamin K at birth, about 4 to 7 per
100,000 will be affected. Even though it is rare,
it is nearly 100 percent preventable by giving the
vitamin K injection at birth.
In the early 1990s, two small studies suggested a
link between vitamin K and childhood leukemia.
Since then, two large studies in the United
States (54,000 infants) and Sweden (1.3 million
infants) have found no correlation between
childhood leukemia and the vitamin K shot at
birth. Go to
How safe is vitamin K?
There are no known serious side effects
associated with vitamin K. Any injection may
cause mild redness, soreness, or swelling at the
site; a small amount of blood; or infection, though
this is rare since we clean the skin before giving
the medicine.
Signs of VKDB
Some infants do not have warning signs of serious
bleeding. Others may have bleeding, bruising, or
change in alertness including, but not limited to:
• Blood in feces, urine, vomit, or spit-up.
• Black, sticky feces after the immediate
newborn period.
• Bloody nose, belly button, or circumcision site.
• Bruising anywhere.
• Not acting right, not eating well,
seizures, lethargy.
If you have more questions, please discuss them
with your pediatrician or family practice clinician.
Pertussis (whooping cough) and influenza can
cause serious and sometimes fatal illness,
especially in newborns. Newborns are too young
to be vaccinated for these diseases, but family
and caregivers are strongly recommended to
get the Tetanus, Diptheria, and Pertussis (Tdap)
booster and annual flu vaccinations to help
prevent passing these diseases onto newborns.
Group B strep. When you have a positive
Group B strep test during your pregnancy,
we give antibiotics during labor to prevent
transmission of the bacteria to the baby.
Antibiotics are most effective when given
at least 4 hours before birth. If your baby
arrives before the antibiotic is given, we
generally observe your infant for 48 hours in
the hospital to make sure he or she is safe and
healthy when we send you home. Sometimes
we need to do blood work on your baby to
check for infection. This is done in the first few
hours after delivery.
Diabetes and small or large babies. When
babies are born to women with diabetes, or
they are smaller or larger than average, we
routinely check sugar levels in the baby. If
levels are low, frequent and effective feeding
can almost always prevent the need for
significant interventions.
Infection. If your clinician is worried about an
infection you may have, your pediatrician or
family practice clinician will talk to you about
making sure the infection is not passed to
your baby. This typically involves blood work
and antibiotics for your baby until we can
be sure.
Preterm infants. A baby born 3 or more
weeks early is considered premature.
Premature infants can have problems that
range from serious to mild and most often
relate to how early they are born. Common
problems include difficulty feeding or
breathing, temperature regulation, jaundice,
and sugar-level control. More serious
problems can include infections, brain injury,
and cerebral palsy, and may require a blood
transfusion or breathing machine. Premature
infants need closer monitoring, and some
need specialized care in the neonatal intensive
care unit (NICU).
All infants must meet certain criteria to go
home healthy. They have to be eating within
expected norms, passing urine and stool, have
the appropriate screening tests, and be able
to maintain normal temperature and other vital
signs. Kaiser Permanente’s Mother-Baby Program
provides a lactation nurse who sees recently
discharged mothers and infants and can assess
any concerns that arise after discharge. You will
see the lactation nurse 1 to 3 days after being
discharged. This, along with your baby’s first
clinician appointment, will be made before you
leave the hospital.
Your baby’s head may seem large and out of
shape. It makes up about 25 percent of total
length (compared with about 10 percent for an
adult). Your baby’s head may look drawn out and
come to a point in the back. During labor, your
baby’s head molded itself into this shape to safely
pass through your pelvic bones. It will not be
long before the head takes on a smoother shape.
Sometimes there are rounded bumps on the
back and side or the top of the head. These are
harmless swellings that will disappear eventually.
Your baby’s head has two soft spots — both in
the middle of the head, one in front and a small
one in the back. These areas may be touched and
washed like any other area of the head.
Your baby’s skin may be dry or moist. Some
babies have scaly skin that may peel in a few
weeks. This is normal. We do not recommend
using oils or lotion because they may clog the
pores and result in rashes. If the skin cracks at the
wrists or ankles, apply Eucerin cream on those
areas 3 or 4 times a day.
Your baby’s skin is very sensitive. Things that will
not hurt your skin can cause a variety of rashes
on your baby. A heat rash looks like many tiny
red pimples, usually on the face, neck, chest, or
abdomen. This rash does not need treatment.
Baby oil or lotion often make it worse.
Your baby’s breasts may be swollen. The same
hormones that make your breasts larger during
pregnancy can affect your baby’s breast tissue.
It may take several months for the swelling to
disappear naturally. This can occur even for
boys. Your baby’s breasts may produce a
milk-like substance.
Your baby may have red blemishes on the eyelids,
bridge of the nose, forehead, or nape of the neck.
These frequently disappear before your child
is a year old. Your baby may have a blue-gray
pigmented area above the buttocks (sometimes
called a Mongolian Spot) that is normal and is not
a bruise.
Your infant may have milia — white, slightly raised
pimples. They most often are tiny and numerous
on the nose, but may be anywhere, especially
the face.
If your baby has a peculiar rash that doesn’t fit the
description of those above, call your clinician.
If your pregnancy was full term, your baby
probably weighed 5½ to 10 pounds at birth. In
the first 3 days, babies will lose 5 to 10 percent of
their weight. Small babies lose the least but take
the longest to gain it back. Large babies lose the
most but usually gain rapidly, often within 1 to
2 weeks. This weight loss will happen no matter
what or how much your baby eats. Your baby will
gain back the weight, at his or her own rate.
If you have a girl, you may notice that her genitals
appear swollen. This is caused by the same
hormones that make the breasts larger. She may
have blood on her diaper at the end of the first
week for 3 to 4 days. Infant girls also may have a
white vaginal discharge beginning on the second
day that may last until the 10th or 12th day.
If you have a boy, you may choose to have him
circumcised. There is no medical indication for
routine circumcision. If you are uncertain about
circumcision, discuss it with your clinician. After
circumcision, your son may be fussy. When you
look at the circumcision area during the first 3 or
4 days after the procedure, it will look red. There
also may be a yellow-greenish discharge. This is
normal healing and not a sign of infection.
If your clinician uses a plastic ring for circumcision,
do not try to remove it. It will drop off on its own
in 4 to 10 days. You may notice a few drops of
blood on the diaper the first day or two after
circumcision. You should report any bleeding
after 3 days to your baby’s clinician, even if a ring
was not used.
For circumcision not using a plastic ring, the site
should be kept clean and covered with petroleum
jelly for 5 to 7 days or until the site appears pink
and healed. For circumcision with a plastic ring,
keep the area clean, but do not use petroleum
jelly. When your son is 2 weeks old, the site
should be healed.
The birth process may cause your baby’s eyelids
to look puffy. Sometimes there is a difference
from side to side. This should improve within
a few days. Your baby’s eyes may be red
immediately after delivery, especially if it was a
fast or difficult delivery. This is caused by broken
blood vessels in the whites of the eyes and will
resolve on its own. Your baby may frequently
become cross-eyed because of undeveloped
muscles. As the muscles strengthen, the eyes will
begin to track symmetrically.
Often a newborn’s hands and feet are bluish
or spotted. This is normal and will go away on
its own.
During the first month, your baby may breathe
irregularly. He or she may breathe rapidly and
shallowly. At other times, breathing may be deep
and sighing. You will notice that the abdominal
muscles do more of the work than the chest
muscles do. Noisy breathing, when the noise
seems to come from the back of the nose, is
normal. Coughing, sneezing, and hiccupping
are common. Feeding may or may not help stop
hiccups, which are not harmful.
Your baby will cry. This is how your baby
communicates needs. Comforting and holding
your baby will not spoil your baby. Babies will
cry when hungry, cold, and uncomfortable. They
may cry because they need to be cuddled and
loved. Some babies cry more than others. For
inconsolable crying, call the advice nurse.
Your baby will probably sleep a lot during the first
24 hours but may sleep less and less, even in the
hospital, before you go home. Babies vary in their
need for sleep. Whether your baby sleeps a lot or
hardly at all, you will learn what is normal for your
baby. Health care professionals recommend that
infants, when being put down to sleep, be placed
on their back. Co-sleeping is not recommended
because of the risk of suffocation.
By 2 weeks of age, many infants will have
established a fussy time, usually around the same
time each day and frequently in the late afternoon
or early evening. This fussiness should begin
to ease by 4 months of age. Often rocking or
walking will help calm a fussy baby.
Your baby may not urinate frequently during the
first 3 days — and possibly only once or twice
during the first 24 to 28 hours. When babies are
getting adequate milk, they should have 6 to 10
wet diapers a day.
Make a plan for what you will do when your
baby cries for longer than usual. It is normal
to feel frustrated. It is important to have a
plan to help with these feelings so you don’t
hurt your baby. Try one of these ideas:
The first 2 days, your baby will pass a sticky, black
substance called meconium. Gradually baby’s
bowels will move more frequently, and a loose,
greenish stool will replace the meconium. Your
baby may have a bowel movement after each
feeding or 1 or 2 stools a day. Within the first
week, the stool will transition to a loose, yellow,
seedy texture. Breastfed babies tend to have
more frequent stools. If your baby develops hard
stools, contact the advice nurse for information/
treatment. If your baby develops foul-smelling
liquid stools, call the advice nurse.
• Take a deep breath.
• Turn the lights down and find a quiet
place. Hold your baby next to your chest
and breathe slowly to calm yourself and
your baby.
• Try singing or cooing to your baby.
• Take your baby for a walk in a stroller.
• Take your baby for a ride in the car
(always use a car seat).
• Call a family member or a friend to chat.
• Ask someone you trust to take over for a
while, to give you a break.
If these tips don’t help, call the advice nurse.
Be sure anyone who cares for your baby
knows these steps as well.
This is equal in importance to feeding and
protecting your infant. Remember, your baby
has been cuddled, comfortable, warm, and safe
these past months, leading an easy life inside your
womb. As you walked, the baby enjoyed a gentle
to-and-fro rocking motion. Now your baby has
many jobs to do, such as breathe, suck, swallow,
digest, eliminate, and keep warm — all things
that, until now, were taken care of in the womb.
It is important to keep the diaper below the belly
button until the umbilical cord has fallen off.
Use warm water to clean the diaper area during
changes and a mild soap as needed. Desitin is
often helpful if a diaper rash should develop. If
the rash does not go away in 3 to 5 days, or gets
worse, consult your baby’s pediatrician or family
practice clinician for further advice.
Cleaning the labia
It is important to wipe your daughter’s bottom
from front to back. Gently separate the folds
(labia) and wash and rinse. There may be a
white coating inside the folds, along with a
clear, jelly-like discharge containing streaks of
blood. These are normal. Do not try to scrub
them off. They will eventually disappear.
There will be many times when you will wonder if
you are doing the “right thing” in the “right way.”
This will be especially true if you have a wellmeaning friend or relative who gives you advice
whether you need it or not. There are many ways
to care for babies, and nearly all of them are right.
If you are enjoying your baby and your new role
as a parent, it is almost impossible for you to do
something wrong — you will most naturally do it
right. Trust yourself, but reach out if you need help.
Cleaning the scrotum and penis
It is important to clean around your son’s
scrotum, especially the underneath side.
Carefully lift the scrotum and wash gently,
being sure to rinse well if you use soap.
It is best to have few visitors during the first few
weeks at home while you and your baby recover
together and your family adjusts to new roles.
Babies can be fussy from overstimulation or too
many visitors.
Care of the uncircumcised baby
Care of the uncircumcised boy is
uncomplicated. Washing and rinsing your
son’s genitals daily is all that is needed. Do
not pull back the foreskin (the skin covering
the tip of the penis) in an infant. Forcing the
foreskin back may harm the penis, causing
pain, bleeding, and possible scar tissue. The
natural separation of the foreskin from the
tip of the penis may take several years. When
your son is older, he can learn to pull back the
foreskin and clean under it on a daily basis.
The diaper area should be kept clean and dry.
If there is no diaper rash and your baby is not
uncomfortable, routine changes at feeding time
may be all that is necessary.
The room should be warm and free of drafts. You
may use mild soap or baby shampoo, but water
is the best daily cleaner. Avoid highly perfumed
soaps. Be careful to not get soap or shampoo in
your baby’s eyes. Do not use cotton swabs inside
your baby’s nose or ear canals. Your baby should
have a sponge bath until the umbilical cord and/
or circumcision heals.
Until the cord falls off, keep the navel dry and
clean. After the cord falls off, you may gently
clean the area with warm water. If there is a little
oozing of blood or yellowish-whitish discharge, be
sure the diaper or diaper covering is not over the
cord, causing it to remain moist. Slight bleeding
a few days before and after the cord falls off
is normal. Please call your clinician if the skin
around the navel becomes red or swollen or has a
foul odor.
Do not use baby oil. These products may
cause skin rashes. Do not use baby powder or
cornstarch. Your baby may breathe in particles
of the powder, which may cause lung irritation.
Keep your baby’s skin care simple. It is normal for
babies to have some dry skin after birth, but in
most babies this old skin will flake off during the
first weeks of life; you do not have to use baby
lotion while this dry skin is flaking off. For mild
irritation in the diaper area, use Desitin ointment.
To avoid skin irritation, launder cloth diapers and
clothing in a mild detergent. Soak cloth diapers
after use, and double-rinse after washing.
For a few days after birth, your baby’s eyes may
be puffy and have a yellowish discharge from
the antibiotic used to prevent infection. Use
clear, warm water on a cotton ball to wipe away
the discharge. If swelling or redness with a
draining, yellowish discharge continues or returns,
this may indicate infection, and you should notify
your clinician.
The stump of the cord is firm, rubbery, and moist.
Some of the baby’s skin may cover the closest part
of it. The cord will become very dry, wrinkled, and
dark. It usually falls off between the 6 and 21 days.
It is a good idea not to touch the cord or the skin
around it unless your hands are freshly washed.
Touch your baby on the chest or back for proper
skin temperature. If your baby feels comfortably
warm, he or she is OK, even if the hands and feet
feel cool (but not blue). If your baby feels cool,
add clothes, including a hat in cold weather. If
your baby feels hot, take his or her temperature
using a thermometer in the armpit. If your baby
has a temperature of 100.4 degrees or higher, call
the advice nurse. If your baby feels warm but his
or her temperature is below 100.4 degrees, take
off some of his or her clothes and recheck the
temperature in an hour.
You should keep your baby out of direct sunlight.
Protect your baby from the sun with an umbrella,
shade, hat, and clothing.
You should also keep your baby away from drafts.
It is common for your baby’s fingernails to be
long and/or sharp at birth. You can cover your
baby’s hands with socks or baby mittens or use
a soft emery board to file down the nails. It is
sometimes easier to file down the nails when your
baby is sleeping.
Breastfeeding is an enjoyable and natural way
of feeding your baby. The American Academy
of Pediatrics (AAP) recommends exclusive
breastfeeding for about the first 6 months
of a baby's life, followed by breastfeeding
in combination with the introduction of
complementary foods until at least 12 months
of age, and continuation of breastfeeding for as
long as mutually desired by mother and baby.
Breastfeeding helps keep baby (and mom!)
healthy in a variety of ways:
Breastfeeding is a simple system of supply and
demand — the more you nurse, the more milk
your body will produce for your baby. Your Labor
and Delivery nurse will help you initiate the first
steps to breastfeeding with skin-to-skin contact
the first half hour immediately after birth. At
first, your baby gets your first breast milk called
colostrum, a rich, yellowish fluid that protects
against infection, is high in protein, and serves
as a laxative to help clear out his or her digestive
system. Colostrum is the perfect food until the
mature breast milk comes in. Your milk production
depends on the amount of stimulation at your
breasts. Therefore, you should start breastfeeding
soon after birth and frequently thereafter to
support milk production. Mature breast milk can
appear thin and bluish or creamy. Your milk is
perfectly suited to your baby’s digestive system
and nutritional needs.
• Provides all of the necessary nutrients in the
proper proportions and is easily digested
by baby.
• Provides important immune system support
and protection against allergies, sickness, and
childhood cancers.
• Protects against chronic diseases such as
diabetes and obesity.
• Reduces the risk of SIDS.
• Increases the effectiveness of immunizations
• Reduces risk of pre-and post-menopausal
breast cancer in mothers who breastfeed.
Since many misconceptions and myths exist about
breastfeeding, we advise that you consult your
lactation specialist.
Breastfeed your baby as soon as possible after
birth. Some babies are eager to breastfeed
immediately after birth, and others take hours to
become interested in latching on to the breast.
Don’t be concerned if your baby needs time to
learn to breastfeed. Remember, every baby is
an individual and will respond and breastfeed
at his or her own pace. Give your baby lots of
skin-to-skin contact while frequently offering
the breast; this will help encourage your baby’s
natural instinct to suck. You are both new at
breastfeeding, so have patience and give yourself
and your baby time to establish this skill.
Get into a comfortable position — sitting up or
lying down is fine. Take advantage of the rooting
reflex, which is what causes your baby to seek
the nipple when the cheek is stimulated. Tickle
your baby’s bottom lip with your nipple, and your
baby will turn toward that side and open the
mouth. Pull your baby close to you and support
your breast so that your baby grasps as much
of the areola (dark area) as possible and not just
the nipple. Your baby will then use the tongue to
hold the nipple against the roof of the mouth and
begin to suck.
Your baby may nurse on one or both sides. If your
baby nurses on both sides, start on the same side
you ended with last time. If you need to release
your baby’s grasp on your breast, you can insert
your little finger in the corner of your baby’s
mouth to gently break the suction.
Allow your newborn to nurse as long and
frequently as he or she demands. Most babies will
feed a minimum of 8 times in 24 hours or up to
12 to 14 times in 24 hours. Spend a few minutes
between sides burping your baby and changing
the diaper. Newborns often fall asleep after the
first breast, and such activity between sides can
stimulate them to nurse on the second breast.
Incorrect positioning and latch are primary causes
of sore nipples. Proper positioning will help
decrease nipple soreness. Ask your nurse for help
with positioning before your nipples get sore.
Remember, cracking, bleeding, or blistering is not
normal — call the advice nurse, your clinician, or
the lactation consultants (IBCLCs) at the MotherBaby Program (see the phone list).
Barring any medical indications, there should
be no need to supplement your baby’s
breastfeeding, as this can delay your milk coming
in. Many babies lose interest in breastfeeding
when a bottle is introduced too early or too often.
They use the tongue differently on a bottle nipple
and may decrease the ability to latch on to the
breast. Check with your clinician or lactation
consultant if you have concerns or questions.
Breast milk digests quickly and easily, so newborns
nurse often, at least every 2 to 3 hours during the
day and night. Most babies will feed a minimum
of 8 times in 24 hours or up to 12 to 14 times in
24 hours. Some babies are quite sleepy and don’t
wake up often to be fed in the early days of life.
It is advisable to wake and feed your sleepy baby
to ensure he or she is getting enough food and to
stimulate your milk supply. Babies tend to "cluster"
feeds or breastfeed very frequently, on and off
the breast, for a few hours in a row. This is normal
newborn behavior and should not be seen as a
sign that the baby is "not getting enough."
Many newborns have their days and nights mixed
up at first — be patient and encourage frequent
breastfeedings during the day, but expect to be
up during the night feeding your baby. Roomingin at the hospital will allow you to notice your
baby's early feeding cues such as stirring, mouth
opening, turning head, and rooting or brining his
or her hand to mouth. This is the time to put your
newborn to the breast because the baby is telling
you that he or she is hungry. This frequent, cuebased feeding will help your milk come in sooner.
You may take medications prescribed by your
obstetric or family practice clinician while
breastfeeding. If you are subsequently placed on
medications, be sure to tell your clinician that you
are breastfeeding.
Nurses and other clinicians at your medical
office can schedule appointments if you have
breastfeeding difficulties. Please call your medical
office advice nurse, or the lactation consultants at
the Mother-Baby Program, if you need additional
help with breastfeeding.
Many breastfeeding mothers find the need for a
breast pump at some point during breastfeeding.
Breast pumps are provided without cost to
breastfeeding mothers. Check with your clinician
if you need one.
Breastfeeding also requires an increased intake of
vitamins and minerals. You can get what you need
by eating a well-balanced diet and by taking your
prenatal vitamin/mineral supplement as advised
by your clinician. Your requirements for vitamin
C, calcium, phosphorus, and folic acid increase
during breastfeeding. If you are anemic, you may
need to include more iron-rich foods in your diet.
Calcium and phosphorus are found in milk and
other dairy products. If you do not like milk or
cannot tolerate it, your clinician may recommend
a calcium supplement.
Freshly pumped breast milk may be safely stored
in the refigerator for up to 3 days and up to 6
months when frozen. Thawed breast milk may
be stored in the refrigerator up to 24 hours.
For additional information regarding storage
guidelines refer to La Leche League
You must feed yourself to be able to feed your
baby. While you were pregnant, what you ate
and drank provided nourishment to you and
your baby. Now that your baby has been born,
what you eat and drink is still important. For the
first 6 months, your breast milk supplies all the
nutrients and calories your baby needs to grow
and develop.
Good sources of iron include liver, beef, raisins,
oysters, dried fruit, and iron-fortified cereals. Iron
is best absorbed in vitamin C. Good sources of
vitamin C include citrus fruits, broccoli, melons,
berries, tropical fruits, cabbage, and tomatoes.
Folic acid is commonly found in green leafy
vegetables such as spinach, mustard greens,
romaine lettuce, and kale. Some cereals are
fortified with folic acid.
You will need extra calories to produce milk.
The current recommendation is 500 additional
calories per day, as well as an additional 20 grams
of protein. You will also want to drink extra water
to stay hydrated.
• If you are a vegetarian, be sure to get enough
calories, protein, calcium, iron, zinc, vitamin D,
and vitamin B12. Because many foods you eat
regularly — fruits, vegetables and grains —
are low in calories, you need to be sure to eat
adequate amounts each day. You may need a
vitamin B12 and iron supplement.
• Dieting while breastfeeding is
not recommended.
• Caffeinated products such as coffee, tea,
chocolate, and many sodas should be used
in moderation. Caffeine acts as a stimulant to
your baby in large amounts.
• Talk to your clinician about alcohol
consumption while breastfeeding.
• While medications can pass into breast
milk, many medications are compatible
with breastfeeding and do not require a
cessation of breastfeeding. If a medication
is problematic with breastfeeding,
alternatives can also be offered. Talk with
your clinician and lactation consultant while
you are breastfeeding. Please see the
reference list in the pocket of this booklet for
helpful resources.
Many babies have a need to suck that often is not
satisfied with breastfeeding or bottle-feeding.
These babies can be soothed by sucking on your
clean finger.
It is recommended by the American Academy
of Pediatrics to wait until breastfeeding is wellestablished before introducing a pacifier or
bottle nipple.
Please consult your clinician, or the lactation
consultants (IBCLCs) at the Mother-Baby Program,
if you are confused or have questions about your
baby’s sucking needs.
It is important to burp your baby during and after
each feeding. Some babies spit up more than
others. This loss of milk, if not excessive, does not
interfere with weight gain.
• Due to the risk of too-high levels of
methylmercury, which can be passed to
baby via breastmilk, the U.S. Food and Drug
Administration advises breastfeeding women
to avoid eating several types of fish such as
shark, swordfish, king mackeral, and tilefish. It
is also suggested that consumption of other
kinds of fish, (shellfish, canned fish, smaller
ocean fish, or farm-raised fish) should average
no more than 12 ounces per week. Although
pregnant women are advised to avoid
sushi, the consensus among breastfeeding
experts seems to be that eating sushi (with
raw fish) does not pose any problem for a
breastfeeding baby.
Here are some useful tips if you choose to
bottle-feed your baby:
Powdered formula is less expensive and easy to
use. Read the label for instructions on preparing
the formula to be sure you are mixing it correctly.
• Put the nipple deep in the baby's mouth.
If baby nurses on the tip, formula may leak
out of the sides of the mouth. Keep the
bottle tipped up enough to keep formula in
the nipple.
• Your baby has a strong, natural desire to
suck and will keep on sucking nipples even
after they have collapsed. Take the nipple
out of the mouth occasionally to keep it
from collapsing. After feeding, offer baby
a pacifier (if desired) for additional comfort
sucking needs.
• Your baby needs the security and pleasure of
being held at each feeding. This is the time
for both of you to relax and enjoy each other.
Hold baby close to your chest. The baby likes
your heartbeat. You may change arms when
you feed baby.
Water that is mixed with formula should be boiled
if it is not from a source that is regularly checked
for harmful bacteria. It should then be allowed
to cool to room temperature before mixing
with formula. This applies to all private wells.
Do not boil the milk itself, or you will destroy
the vitamins.
There is a wide variety of prepared milk formulas
on the market. Some are available in ready-tofeed bottles or cans. While prepared formula is an
expensive way to feed your baby, some parents
find this option useful on long trips. The milk
mixture will remain sterile as long as the bottle or
can is unopened. Prepared cow’s milk formulas are
most common.
• Never prop the bottle up and leave your baby
to self-feed. The bottle can easily slip into the
wrong position and cause choking.
Let your baby feed “on cue” or “demand” feed.
Babies should not be placed on a “schedule” for
feeding. Baby will show you he or she is hungry
with feeding cues such as bringing hand to mouth
and “rooting.” Your baby’s appetite will vary — let
baby tell you how much he or she needs at each
feeding. Your clinician will also advise you on the
proper amount of formula to feed your baby.
It is not necessary to sterilize bottles, nipples,
formula, or water. However, great care should be
taken when preparing formula and foods:
At your baby’s 2-week checkup, the clinician will
talk with you about your baby’s need for vitamins
or fluoride drops.
• Wash your hands carefully before
preparing formula.
• Wash bottles and nipples thoroughly in
dishwashing detergent using a nipple brush
and a bottle brush. Rinse and drain well. The
top rack of a dishwasher is also safe to use for
most bottles and nipples.
According to the American Academy of
Exclusive breastfeeding is sufficient
to support optimal growth and
development for approximately the
first 6 months of life and provides
continuing protection against
diarrhea and respiratory tract
infection. Breastfeeding should be
continued for at least the first year
of life and beyond for as long as
mutually desired by mother and
child. Complementary foods rich in
iron should be introduced gradually
beginning around 6 months of age.
During the first 6 months of age,
even in hot climates, water and juice
are unnecessary for breastfed infants
and may introduce contaminants
or allergens.
• If using liquid infant formula, clean the can lid
and shake the can well before opening.
• Prepare only enough formula for 24 hours.
Always store it in a covered container in the
refrigerator until ready to use. Do not save
formula when a feeding is finished. Formula
must be thrown out and not given to baby
at the next feeding. Discard any remaining
prepared formula after 24 hours.
• Formula should be served at room
temperature. If the formula has been
refrigerated, the bottle can be warmed in
a pan of hot water. Never heat your baby’s
bottle or food in a microwave oven. The
heating may be excessive or uneven and
potentially very dangerous to your baby.
Your pediatrician or family physician will advise
you when it is appropriate to introduce solid
foods to your baby. Do not put solid foods in your
baby’s bottle.
If you have 2 or more babies on the way, you may
have twice as many questions. Good information
is important because women who are pregnant
with more than one baby are at higher risk of:
If the babies you’re carrying are identical, they:
• Preterm birth.
• Preeclampsia.
• Probably will have the same body type and
the same color skin, hair, and eyes. But they
won’t always look exactly the same. They also
won’t have the same fingerprints.
• Gestational diabetes.
• Require specialized care by a perinatologist.
• Cesarean birth.
Babies who come from different eggs are called
fraternal (nonidentical). This happens when 2
or more eggs are fertilized by different sperm
(dizygotic). Fraternal babies tend to run in
families. This means that if anyone in your family
has had fraternal babies, you’re more likely to
have them too.
• Low birth weight.
You will need to see your clinician more often
than women who are carrying only 1 baby, so you
and your babies' health can be monitored. Your
clinician will also tell you how much weight to
gain, if you need to take extra vitamins, and how
much activity is safe. With close monitoring, your
babies will have the best chance of being born
near term and at a healthy weight.
After delivery and once your babies come home,
you may feel overwhelmed and exhausted. Ask
for help from your partner, family, and friends.
Support groups for parents of multiples can also
ease the transition.
• Are either all boys or all girls.
• All have the same blood type.
If the babies you’re carrying are fraternal, they:
• Can be both boys and girls.
• Can have different blood types.
• May look different from each other or
may look the same, as some brothers and
sisters do.
A multiple pregnancy means that you have 2 or
more babies in your uterus. These babies can
come from the same egg or from different eggs.
If you take fertility drugs or have in vitro
fertilization to help you get pregnant, you’re more
likely to have a multiple pregnancy. Fertility drugs
help your body make several eggs at a time. This
increases the chance that more than one of your
eggs will be fertilized.
Babies who come from the same egg are called
identical. This happens when 1 egg is fertilized
by 1 sperm (monozygotic). The fertilized egg then
splits into 2 or more embryos. Experts think that
this happens by chance. It isn’t related to your
age, race, or family history.
In vitro fertilization is the most common kind of
assisted reproductive technology used to help
women get pregnant. Several of your eggs are
mixed with sperm in a lab. When the eggs are
fertilized, they’re put back inside your uterus. The
doctor puts in several fertilized eggs to increase
your chances of having a baby. But this also makes
a multiple pregnancy more likely.
You’re also more likely to have more than 1 baby
at a time if:
• You’re 35 or older.
While you may feel like you’re carrying more
than 1 baby, only your clinician can say for sure.
He or she will do a fetal ultrasound to find out.
This test can give your clinician a clear picture of
how many babies are in your uterus and how well
they’re doing.
• You’re of African descent.
• You’ve had fraternal babies before.
• Anyone on your mother’s side of the family
has had fraternal babies.
• You’ve just stopped using birth control pills.
Any pregnancy has risks. But the chance of having
serious problems increases with each baby you
carry at the same time.
If you’re pregnant with more than 1 baby, you’re
more likely to:
• Develop preeclampsia.
• Develop gestational diabetes.
• Deliver your babies early. When babies are
born early, their organs haven’t had a chance
to fully form. This can cause serious lung,
brain, heart, and eye problems.
• Have a miscarriage. This means that you may
lose 1 or more of your babies.
• Have 1 or more babies with a disease that is
caused by a bad gene or group of genes. If
you or anyone in your family has had a child
with a disease that is linked to a gene change,
let your clinician know.
If the test shows that you’re carrying more than 1
baby, you’ll need to have more ultrasounds during
your pregnancy. Your clinician will use these tests
to check for any signs of problems that your
babies may have as they grow.
If you’re pregnant with more than one baby,
you’ll need to see your clinician more often than
you would if you were having just one baby. This
is because you and your babies have a greater
chance of developing serious health problems.
After your babies are born, you may feel
overwhelmed and tired. You may wonder how
you're going to do it all. This is normal. Most new
moms feel this way at one time or another. Ask
your family and friends for help, rest as often
as you can, and join a support group for moms
with multiples.
Keep in mind that these problems may or may
not happen to you. Every day, women who are
pregnant with more than 1 baby have healthy
pregnancies and healthy babies.
You've been thinking about your baby's
health a long time — maybe before you even
became pregnant.
Once your baby arrives, one of the best ways
to help him or her be healthy is to stay up-todate with scheduled immunizations and wellchild checkups.
Kaiser Permanente recommends vaccinating
children — as do an overwhelming majority
of other health professionals, researchers, and
organizations. These include the American
Academy of Pediatrics, American Academy
of Family Practice Physicians, and Centers for
Disease Control and Prevention.
If you have questions or concerns, please call
us before coming into a medical office. Our
professional staff can advise you what to do. In
many instances, a concern can be handled over
the phone.
If your baby needs to be seen, we can arrange for a
visit. The best time to receive care is during routine
office hours. Most appointment center hours are
7 a.m. to 5 p.m. When calling for appointments, be
ready to provide your child’s name, birth date, and
health record number.
• One to three days after discharge from the
hospital with the lactation nurse.
Immunizations are vital for keeping children
healthy and preventing the spread of disease.
• At about 2 weeks of age with a pediatrician or
family clinician.
Outpatient services include routine (well-child)
visits, same-day appointments, urgent care visits,
and telephone advice:
• At 2, 4, 6, 9, and 12 months of age with
your clinician.
• Well-child checks are regularly scheduled
appointments to monitor your baby’s growth
and development.
• Same-day appointments are made when your
baby has a condition or illness that cannot wait
until a well-child checkup. This appointment is
made during regular medical office hours.
• Urgent care is provided after regular
clinical hours for conditions that cannot
wait until morning.
At these visits, your pediatrician or family
physician will look at your baby’s growth by
measuring his or her height, weight, and head
circumference. The clinician will check your baby’s
development and ask about any concerns that
you may have.
Use these opportunities to learn how you can
keep your baby as healthy and safe as possible.
• Telephone advice nurses can often assist
you with nonurgent problems or advise
whether your baby needs to see a health
care professional.
The following symptoms need attention:
To see a list of recommended immunizations, go
to Immunizations prevent
your child from getting diseases for which there
are often no medical treatments. These illnesses
can result in serious complications, permanent
handicaps, and even death.
• Any fever (armpit temperature of 99.4
degrees or higher) in an infant 4 months or
younger requires an immediate exam by a
clinician. Temperature under 97 degrees may
also indicate serious illness and should be
reported to a clinician.
Immunizations are often required by law. In
Oregon, immunizations are required for children
in attendance at child care facilities, Head Start
programs, preschools, and public and private
schools. In Washington, the requirement is for
children in licensed child care and public and
private schools.
• Marked change in feeding pattern
(significantly decreased appetite, vomiting,
sweating, or shortness of breath with feeding).
You can find the guidelines for each state at
• Breathing problems (more than 60 breaths per
minute while sleeping or quiet, struggling or
pulling hard to catch breath, pausing longer
than 15 seconds between breaths).
Any symptoms should at least be discussed
by phone with a clinician or advice nurse as soon
as noticed. A baby who appears ill should be
seen immediately.
To take your baby’s temperature, use a digital
thermometer under the armpit. A normal
temperature is 97.6 to 99.8 degrees. Do not use a
mercury glass thermometer. Ear thermometers are
not always accurate and thus not recommended
for babies.
• Marked change in behavior (decreased
activity, sleeping through 2 or more feedings
in a day, unusual irritability, convulsions, or
jerking movements of the body).
• Change in color (blueness, paleness,
increasing yellowness).
• Explosive watery bowel movements.
• Feeding poorly, crying excessively, increased
frequency of stools, or foul-smelling stools.
• Significant decrease in urine (fewer than 3 or 4
wet diapers per 24-hour period).
• Bleeding from any place, other than a
small amount from the navel, circumcision,
or vagina.
• Any soft, fluid-filled blister.
You should also call your clinician if you are
crying a lot, feel sad for no apparent reason,
or are concerned that you may hurt your baby.
A lifetime of healthy smiles starts at a very young
age. Children should have their first dental visit
within 6 months of when the first tooth breaks
through the gums, or by age 1.
This first visit often takes place on mom’s or dad’s
lap, not in a dental chair. It’s an opportunity for
the dentist to provide anticipatory guidance
on topics such as nutrition, oral hygiene, injury
prevention, and nonnutritive habits like pacifiers
and thumb-sucking.
It may seem like baby teeth don’t matter, since
they fall out, but children with decay in their
primary teeth are more likely to develop cavities
in their permanent teeth.
Now is the time to create a healthy oral
environment and help your child establish good
hygiene habits, because it’s always better to
prevent problems than to treat them.
Starting at birth, clean your child’s gums with a
soft infant toothbrush or cloth and water. As soon
as the first tooth comes into place, start brushing
your child’s teeth with a soft-bristled toothbrush
designed for children. Use a smear of fluoridecontaining toothpaste (about the size of a grain
of rice).
As your child gets older, it’s important to maintain
a routine of regular dental cleanings and exams,
as well as proper home care. Tooth decay is the
most common chronic childhood disease, and
it’s a preventable problem. Good oral health
is important to your child’s overall health and
impacts everything from communication and
school readiness to nutrition and self-esteem.
Your child can either see a general dentist or
a pediatric dentist. However, most will see a
pediatric dentist through 3 years of age, as
pediatric dentists receive special training to
understand kids' needs — particularly very
young kids.
The greatest danger to your baby is an accident,
not disease. You, as the parents of this newborn,
are responsible for constantly exercising sound
judgment to keep your baby safe. The 4 most
common dangers to an infant are drowning,
suffocation, falls, and car accidents. Prevention
is the key to a baby’s safe environment.
Your baby should be well-protected at all times
from entering areas near spas, jacuzzis, hot tubs,
bath tubs, or swimming pools without constant
adult supervision.
During bathing, never leave your baby alone.
Always support your baby with one hand. If you
are interrupted during bathing by the phone or
doorbell, either let it ring (they will call back), or
wrap up your baby and take him or her with you.
Your baby should not be able to reach or play with
plastic bags, telephone cords, ropes, cords from
window coverings (such as mini-blinds), electrical
cords, harnesses, soft pillows, or wide-slat
openings in cribs made before 1976. These all have
the potential to smother, strangle, or suffocate
your baby. Don’t place necklaces around your
baby’s neck. Small objects of any type have the
immediate potential for choking a baby.
The only safe place a baby can be left alone for
even a few moments is in a safety-approved crib
with all sides up or in a playpen. Babies can kick,
scoot, and wiggle off high surfaces such as beds,
tables, stairs, couches, and chairs. Floors and
full-size beds are unsafe if you are not able to
constantly watch your infant.
Once your infant becomes mobile (e.g., rolling,
scooting, crawling), all stairways should be
secured (top and bottom) with approved infant
safety gates. Install operable window guards on
all windows above the first floor. Do not use a
baby walker — your child may tip it over, fall out
of it, or fall down the stairs in it. Baby walkers may
allow children to get to places where they can pull
hot foods or heavy objects down on themselves.
In Washington and Oregon, the law requires
that everyone wear seat belts. Children younger
than 1 year and less than 20 pounds must be in
a rear-facing car seat. The American Academy of
Pediatrics recommends a rear-facing car seat until
age 2 and more than 20 pounds.
A safety seat:
• Prevents your child from being thrown.
• Absorbs the force of impact.
• Distributes the force of impact more evenly
over a child’s body.
As a responsible parent, keep these points in
mind regarding car safety:
• Infants should always be transported in
an infant/child car safety seat — never in
someone’s lap or arms.
• A car seat is effective only if installed and used
correctly according to manufacturer’s instructions.
• Remove or secure all loose objects from your
car that could become airborne in an accident.
• The safest place for a child is in the center of
the back seat securely fastened in a federally
approved car seat.
• If your car has an airbag, transport your child
only in the back seat.
• The best safety seat is one you will use each
time your child rides in the car, that fits your car
securely, and that is comfortable for your child.
Your baby should sleep near you in a safe crib
or bassinet but not in the same bed. It is safe to
bring your baby into bed to nurse or comfort.
But return your baby to his or her crib or bassinet
when you are ready to go back to sleep.
The cause of SIDS is unknown, but there are
several things you can do to help prevent it:
• Put your baby on his or her back to sleep, every
time. If your baby is old enough to roll and
does so on his or her own, there is no need to
correct the position. But you should always put
your baby down directly on the back for sleep.
• Use a firm, flat sleeping surface.
• Keep soft toys and loose bedding out of
the crib.
• Do not use pillows, bumpers, comforters,
stuffed toys, or other soft objects.
• Make sure your baby’s head remains
uncovered during sleep.
• Do not string toys across the crib. They can
choke your baby.
• Some studies have suggested that pacifiers
lower the risk of SIDS.
• Put your baby to sleep in an area with good
ventilation, and consider using a fan in the
room (not blowing directly on the baby).
• Do not expose your infant to smoke or use
sedating medications.
You can help your baby sleep safely in a crib by
following these guidelines:
• Use a firm, flat mattress that fits tight next to
the edge of crib.
• Make sure that the crib slats are less than 2³/8
inches apart. Your baby’s head can become
trapped if the openings are too wide.
• Remove corner post knobs if attached to
the crib. They can become loose and cause
choking. Also, tighten all nuts, bolts, and
screws every few months, and check the
mattress support hangers and hooks regularly.
• Older cribs may not meet current safety
standards. Check used cribs especially
carefully. For more information on crib safety,
Always check the temperature of warmed milk
before feeding it to your baby by squirting some
on your wrist. Never microwave milk or the bottle
directly. Check to make sure your water heater
is set to no higher than 120 degrees. Water
heaters have a dial on the side that allows for this
adjustment. Never carry hot liquids or foods when
holding your baby, as a spill can burn your infant.
Keep your baby’s environment smoke free at all
times. Smoking increases the risk of infections,
asthma, and SIDS.
Newborn skin is very sensitive. Newborns do
not need to be exposed to sunlight. If you want
to take your baby out on a sunny day, keep him
or her shaded, with most of the skin covered. It
is a good idea to consider putting on sunblock
even if your baby will be covered, to prevent any
accidental exposure. For babies younger than
6 months: Use sunscreen on small areas of the
body, such as the face, if protective clothing and
shade are not available; use caution applying
around the eyes.
About 1 in 5 babies will be noticeably jaundiced
by the second or third day of life. Jaundice is a
result of the normal breakdown of red blood cells
that occurs during the newborn period. There can
be a relatively high number of excess red blood
cells breaking down, and/or the liver is not quite
ready to handle the waste load. Before birth, the
mother’s liver does this for the baby. Bilirubin is
a byproduct of this metabolic process; bilirubin
circulates through the bloodstream and gives the
skin a yellowish color.
The liver filters bilirubin and sends it out with the
bowel movement and urine. You should notice
that in a few days, your baby’s bowel movement
starts to turn yellow. This is the bilirubin leaving
your baby’s system.
Your baby’s jaundice may gradually increase for
up to 7 days and may last as long as 2 weeks.
During this time, it is important that your baby
gets plenty of fluids. Feeding your baby every 2
to 3 hours, particularly if you are breastfeeding,
is important. If your milk is in, your baby should
have at least 6 wet diapers a day. If your baby
is increasingly sleepy, or the urine output is
decreasing, please call the advice nurse. Your
baby may need to have a bilirubin level drawn
and a feeding evaluation.
How do we check for jaundice?
Jaundice usually turns the baby’s skin, and
sometimes the whites of their eyes, yellow. It is
most noticeable in daylight. It usually starts in
the face and then continues to the chest, belly,
arms, and legs as the bilirubin increases. We also
check every baby’s blood for the bilirubin level to
measure the level of jaundice. This is usually done
when we do the state newborn screen after the
first day of life.
Can jaundice hurt my baby?
Most infants have mild jaundice that is harmless,
but in unusual situations the bilirubin level can get
really high and can cause brain damage. This is
why newborns are checked carefully for jaundice
and treated to prevent a high bilirubin level.
Signs of worsening jaundice
Jaundice usually moves from head to toe, so if
you think it is worsening, call your pediatrician or
family practice clinician. If your baby is jaundiced
and is hard to wake, fussy, or not nursing or taking
formula well, jaundice may be contributing, so call
right away.
Does my baby need closer attention
for jaundice?
Some babies have a greater risk of developing
high levels of jaundice and need closer follow-up.
These include babies:
• With a high bilirubin level before discharge.
• Who were born more than two weeks early.
• Who had jaundice in the first 24 hours of life.
• Who are not breastfeeding well.
• With lots of bruising or bleeding from delivery.
• With a family member who had high bilirubin
and received phototherapy.
How is harmful jaundice prevented?
Most jaundice requires no treatment. When
treatment is necessary, placing your baby under
special lights while undressed will help lower the
bilirubin level. This method, called phototherapy,
can be used in the hospital or at home depending
on the jaundice level. Jaundice is treated using
this method only at lower levels, when brain
damage is not a concern. This treatment can help
prevent the harmful effects of jaundice.
How do the special lights work?
They cause a slight chemical change to bilirubin
and allow your newborn’s system to more easily
expel it. They work only while your infant is
exposed to the lights, so the more time your
baby is in the lights, the faster it works. It is also
important to have as much skin exposed to the
light as possible to ensure that enough bilirubin
gets changed.
All babies have fussy periods that may last from
one feeding to the next. This is not colic. If a
baby sleeps for only 1 to 2 hours at a time and
fusses after each feeding and passes a lot of gas,
drawing up the legs and crying, this may be colic.
Are there risks to phototherapy?
Phototherapy is very safe. The biggest complaint
is that the baby needs to be left in the lights for
extended lengths of time to be most effective.
This means your baby will be allowed out only
for short periods (20 to 30 minutes) to allow for
feeding. Families sometime complain about the
fussiness of the infant in lights or that the blue
lights in the room are annoying. We use eye
protection on infants in the lights, but there is no
need for adults to wear eye protection.
• Rock your baby gently.
When does jaundice go away?
Jaundice most commonly will go away on its own
unless the level is high and needs treatment.
In breastfed infants, jaundice often lasts 2 to 3
weeks, and in formula-fed infants, most jaundice
goes away by two weeks. If your baby is jaundiced
for more than 3 weeks, see his or her clinician.
Cradle cap is a yellowish, dry, crusty scale on the
scalp. This may extend onto the face as a rash. If
this occurs, you may try the following:
If this occurs, you may try any of these suggestions:
• Feed your baby more slowly, with
frequent burping.
• Wrap your baby firmly in a light, soft blanket.
• Provide a soft, steady humming noise.
• Avoid sudden loud noises, bright lights, or
extreme temperature changes.
• Take an infant massage class.
While the cause is not known, colic is not harmful,
and it usually passes by 3 to 4 months of age
even without treatment. Contact your clinician if
your baby develops fever, vomiting, bloody stools,
or any symptoms that do not fit the colicky
pattern described.
Diaper rash is common. It is caused by wet
diapers irritating the skin. To reduce diaper rash
problems, change diapers frequently and clean or
bathe the diaper area frequently. Keep the area
exposed to the air as much as possible. Protective
ointments, such as Desitin cream, can help.
• Soften the scales with baby oil and let the oil
remain on the scalp for 15 minutes.
• Loosen scales with a very soft brush.
• Shampoo gently with your usual baby
shampoo. Rinse and dry well. Repeat this daily
for one week and then as needed.
Most women go through pregnancy and
childbirth without any medical problems or
complications. Early and regular prenatal care can
help keep you and your baby safe.
In this section, you’ll find information about:
If you have a suspected or diagnosed problem,
you’ll need to take precautions to help your
pregnancy go well. Many complications, such
as gestational diabetes, are manageable with
proper treatment.
• Domestic abuse.
Even in a healthy pregnancy, it is possible to start
labor too early. Learn the signs of preterm labor
and what to do if contractions begin. This section
provides you with the critical information you
need to know.
• Asthma.
• Diabetes.
• Fifth disease.
• High-risk pregnancy.
• Obesity.
• Preeclampsia and high blood pressure.
• Preterm labor.
• Toxoplasmosis.
• Urinary tract infection.
Review these pages to learn about common
complications and how to navigate them. If you
experience any problems during or after your
pregnancy, contact your health care team. The
“Risks and safety” section outlines warning signs
and when and if to call for help.
Asthma is a fairly common health problem for
pregnant women, including some women who
have never had it before.
During pregnancy, asthma not only affects you,
but it can also cut back on the oxygen your fetus
gets from you. But this does not mean that having
asthma will make your pregnancy more difficult or
dangerous to you or your fetus. Pregnant women
with properly controlled asthma generally have a
normal pregnancy with little or no increased risk
to themselves or the fetus.
All asthma treatments are safe to use when you
are pregnant. After years of research, experts
now say that it is far safer to manage your asthma
with medicine than it is to leave asthma untreated
during pregnancy. Talk to your clinician about the
safest treatment for you.
If you have not previously had asthma, you may not
think that shortness of breath or wheezing during
your pregnancy is asthma. If you know you have
asthma, you may not consider it a concern if you
only have mild symptoms. But asthma can affect
you and your fetus, and you should act accordingly.
If your asthma is not controlled, risks to your
baby include:
• Death immediately before or after birth
(perinatal mortality).
• Abnormally slow growth of the fetus
(intrauterine growth restriction). When born,
the baby appears small.
• Birth before the 37th week of pregnancy
(preterm birth).
• Low birth weight.
The more control you have over your asthma, the
less risk there is.
Pregnant women manage asthma the same way
nonpregnant women do. Like all people with
asthma, pregnant women should have an asthma
action plan to help them control inflammation and
prevent and control asthma attacks.
Part of a pregnant woman’s action plan should also
include recording fetal movements. You can do this
by noting whether fetal kicks decrease over time.
If you notice less fetal activity during an asthma
attack, contact your clinician or emergency help
immediately to receive instructions.
Considerations for treatment of asthma in
pregnancy include the following:
• If more than one health professional is
involved in the pregnancy and asthma care,
they must communicate with each other about
treatment. The prenatal care clinician must be
involved with asthma care.
• Monitor lung function carefully throughout
your pregnancy to ensure that your growing
fetus gets enough oxygen. Because asthma
severity changes for about two-thirds of
women during pregnancy, you should have
monthly checkups to monitor your symptoms
and lung function. Your clinician will use either
spirometry or a peak flow meter to measure
your lung function.
• Monitor fetal movements daily after 28 weeks.
• Try to do more to avoid and control asthma
triggers (such as tobacco smoke or dust
mites) so that you can take less medicine if
possible. Many women have nasal symptoms,
and there may be a link between increased
nasal symptoms and asthma attacks.
Gastroesophageal reflux disease (GERD),
which is common in pregnancy, may also
cause symptoms.
• It is important that you have extra protection
against the flu (influenza). Get a flu vaccination
as soon as it’s available, whether you are in
your first, second, or third trimester at the
time. The flu vaccine is effective for one
season. The flu vaccine is safe in pregnancy
and is recommended for all pregnant women.
Many women also have allergies, such as allergic
rhinitis, along with asthma. Treating allergies is an
important part of asthma management.
• The antihistamines loratadine or cetirizine
are recommended.
Albuterol (ProAir) is a fast-acting pulmonary
airway muscle relaxer that can help quickly
reverse signs and symptoms in some cases of
asthma. If you use this inhaler, you should carry it
with you at all times.
Budesonide is labeled by the U.S. Food and
Drug Administration (FDA) as the safest inhaled
corticosteroid to use during pregnancy. One
study found that low-dose inhaled budesonide
in pregnant women seemed to be safe for the
mother and the fetus.
• Inhaled corticosteroids at recommended
doses are effective and can be used by
pregnant women.
Never stop taking or reduce your medicines
without talking to your clinician. You might have
to wait until after delivery to make changes in
your medicine.
• If you are already getting allergy shots, you
may continue getting them, but starting allergy
shots during pregnancy is not recommended.
Always talk to your clinician before using any
medicine when you are pregnant or trying to
become pregnant.
Diabetes is a condition that affects the body’s
natural way of storing and using energy. It causes
a high level of glucose (sugar) in the bloodstream,
which may lead to many health problems.
• You are part of an at-risk ethnic group,
including African-American, Asian-American,
Hispanic/Latina, Native American, Native
Alaskan, or Pacific Islander.
In pregnancy, high blood glucose levels can cause
the baby to grow too large, making a natural
delivery difficult. This could result in cesarean
birth (also called a C-section) or lead to injury of
the baby at the time of vaginal delivery (such as a
broken collarbone or nerve injury in the arm).
• You have prediabetes or glucose intolerance.
The baby may also have problems after delivery
(low blood sugar), and may need to be cared
for in a special care nursery. This is why it’s so
important to control your blood sugar while you
are pregnant.
If your blood sugar becomes too high for the first
time while you are pregnant, you have gestational
diabetes. Gestational diabetes is the most
common form of diabetes in pregnant women.
Gestational diabetes usually begins after the first
trimester of pregnancy. Most women with this
type of diabetes have normal blood sugar in the
first part of pregnancy.
Because you can have gestational diabetes
without knowing it, all women are tested for
diabetes during pregnancy. Your chances of
having diabetes in pregnancy are higher if any of
the following warning signs are true:
• You had high blood sugar during a
previous pregnancy.
• You have had other babies who weighed
more than 9 pounds at birth.
• You are overweight.
• A close relative, such as a parent or sibling,
has diabetes.
Some women who have diabetes during
pregnancy will continue to have diabetes after
pregnancy. For most women, blood sugar levels
return to normal after pregnancy.
However, women who have gestational
diabetes are at risk for recurrence in subsequent
pregnancies and for developing type 2 diabetes
several years after delivery.
Type 2 diabetes is the second most common
form of diabetes in pregnancy. Type 2 diabetes
is usually diagnosed in adulthood. It has become
more common in childhood and adolescence due
to the increase in childhood obesity. This type of
diabetes can be managed with lifestyle changes
(diet and exercise) or may need medications such
as insulin or oral medication.
Women with type 2 diabetes should see their
clinician before they become pregnant to discuss
steps they can take to ensure a safe pregnancy
and a healthy baby. Women with type 2 diabetes
should also be seen as soon as they find out they
are pregnant, so that blood sugar levels can be
monitored carefully.
Type 1 diabetes is less common but more likely to
cause problems in pregnancy. Type 1 diabetes is
usually diagnosed in children and young adults.
In type 1 diabetes, the body does not produce
insulin, a hormone that is needed to help your
body properly use and store glucose. Type 1
diabetes can be managed with diet, exercise, and
insulin to control blood sugar.
By taking steps that will keep your blood sugar
levels as close to normal as possible, you will
be doing all that you can do to have a healthy
and normal pregnancy. These steps include
the following:
• Make healthy food choices. Healthy eating
will give you all the nutrition you need without
extra sugars and fats that can cause your
diabetes to get out of control.
• Exercise. Physical activity will help your body
lower blood sugar levels, help you better
control your rate of weight gain, and help
improve your overall well-being.
• Gain the right amount of weight. Proper
weight gain is necessary to provide your
baby with good nutrition during pregnancy.
But gaining too much weight increases insulin
resistance in the body, making blood sugar
go up and increasing the risk of having a
big baby.
• Check blood sugar levels. An important
part of treating diabetes is checking your
blood sugar level at home. You will need to
do a home blood sugar test as directed by
your clinician.
• Take oral medications or insulin shots. The
first way to treat gestational diabetes is by
changing the way you eat and exercising
regularly. If your blood sugar levels are still
too high after changing the way you eat
and exercising regularly, you may need oral
medications or insulin shots. Synthetic insulin
or oral medications can help lower your
blood sugar level without harming your baby.
Special monitoring usually starts between 32
and 34 weeks if you are taking insulin or oral
medications. If you are not on medications,
then special monitoring usually starts by week
40 of your pregnancy.
• Monitor fetal growth and well-being.
Your clinician will want you to monitor fetal
movements called kick counts. You may also
have fetal ultrasounds to see how well your
baby is growing. If your blood sugar levels
are high or your baby is growing larger than
normal, you may need to take oral medication
or insulin shots. If you take oral medications or
insulin, you may have a nonstress test to check
how well your baby responds to movement.
Even if you do not take insulin, you may have
a nonstress test and ultrasound as you get
closer to your due date.
• Get regular medical checkups. Having
gestational diabetes means regular visits to
your clinician. At these visits, your clinician will
check your blood pressure and test a sample
of your urine. You will also discuss your blood
sugar levels, what you have been eating, how
much you have been exercising, and how much
weight you have gained.
• Learn the warning signs of preeclampsia.
Women who have diabetes during pregnancy
may have a greater chance of developing
high blood pressure and preeclampsia. Call
your clinician right away if you develop any of
the symptoms (see pages 166 to 167).
There are no absolute guarantees, but with careful
lifestyle changes, including healthy food choices,
physical activity, and good blood sugar control,
it is less likely that there will be any problems.
If there are problems, your health care team will
be there to assist you and your baby. Problems
of a baby born to a mother with diabetes may
include the following:
• Mothers with high blood sugar levels at the
beginning of pregnancy are at an increased
risk for having a baby with birth defects.
However, this risk can be lowered if blood
sugars are well-controlled before pregnancy.
• Babies of some mothers who have diabetes
have a slightly increased chance of stillbirth.
• Polyhydramnios (excess amniotic fluid)
happens in a relatively small number (about
10 percent) of the women with pre-existing
diabetes. Excess fluid can cause premature
labor or other problems.
• Macrosomia (large baby) happens when your
baby grows too big from receiving too much
blood sugar from you. The growing baby
changes the extra blood sugar to fat and
may grow too large to fit through the birth
canal. To avoid possible injury to your baby
during a vaginal delivery, your clinician may
recommend a cesarean birth.
• Hypoglycemia (low blood sugar) may occur if
your blood sugar levels have been consistently
high during pregnancy. This causes the fetus
to develop high levels of insulin in the blood.
After delivery, your baby no longer has the
high level of sugar from you but continues to
produce high levels of insulin. As a result, your
newborn’s blood sugar becomes very low.
Immediately after birth, your baby’s blood
sugar level will be checked. If it is too low,
your baby may need to be fed right away.
When your blood sugar remains normal
throughout pregnancy, diabetes should not affect
the delivery of your baby. Sometimes a cesarean
birth may be necessary to deliver a baby that is
too big to fit through the birth canal. Choices
about delivery are very individual. You should
discuss your concerns with your clinician or other
medical professional.
We strongly encourage breastfeeding. The body
uses the calories stored during the first part of
pregnancy to make breast milk. About 300 to 500
calories per day are used for breastfeeding. By
6 weeks after delivery, women who breastfeed
usually have lost an average of 4 pounds more
than women who bottle-feed. This can be
especially important for women with gestational
diabetes, since keeping a normal body weight
may reduce the risk of developing diabetes later
in life.
Breastfeeding is also good for your baby.
Breast milk offers health benefits that formula
can’t duplicate.
If you have had gestational diabetes, you should
be able to breastfeed without any complications.
The amount and type of milk your body makes is
the same as a woman without gestational diabetes.
If you took insulin or oral medications before
you were pregnant, your insulin or medication
needs may be different while breastfeeding. In
particular, women with type 1 diabetes should be
aware that their blood sugar may drop during or
after nursing. You may want to check your blood
sugar before and after feedings during the first
few weeks of breastfeeding. You may need to
eat snacks to prevent low blood sugar, especially
during the night.
Most likely, you will need to control your blood
sugar with healthy food choices, exercise,
and possibly with oral medications or insulin
while breastfeeding. If you took one of these
medications before pregnancy, talk to your
clinician before using it again.
Once you have delivered your baby, the impact of
diabetes often changes dramatically.
If you have gestational diabetes, you will probably
not need insulin or oral medication after you
deliver. But, as many as 60 percent of women with
gestational diabetes will develop type 2 diabetes
later in life.
It is important that you have a blood sugar test in
the laboratory 6 weeks after your baby is born to
see if you still have diabetes. You may need this
test again after you stop breastfeeding. If you do
have diabetes, your clinician will let you know if
you need to take diabetes medications.
You should continue with the dietary changes
made during pregnancy and exercise regularly
to help prevent the development of type 2
diabetes or recurrent gestational diabetes in
the future. If your blood test is normal, it is
still important to keep in mind that you have
an increased risk of developing diabetes later,
especially if you gain weight.
To decrease your risk of diabetes, remember
the following:
• Try to reach or maintain a healthy weight.
Losing the weight you gained during
pregnancy will help decrease your risk.
• Try to eat plenty of fruits, vegetables, and
whole grains.
• Aim for at least 30 minutes of physical activity
each day.
• Have a laboratory test of your blood
sugar every 1 to 3 years to see if you have
developed diabetes.
• Plan your pregnancies and consult with your
clinician or other medical professional before
getting pregnant again to be sure your blood
sugar is normal. Very high blood sugar in
early pregnancy may cause miscarriage or
birth defects in the developing fetus. If your
blood sugar is under control before you
get pregnant, you can reduce the risk of
miscarriage and birth defects.
If you took insulin or oral medications to treat your
diabetes before you were pregnant, there may be
dramatic changes in your insulin needs the first
few days after delivery.
That’s why it is important to check your blood
glucose frequently before meals to know when to
adjust your medication. If you were on insulin prior
to pregnancy, you probably needed to increase
your dose frequently during your pregnancy.
After delivery, your body’s insulin needs will
be closer to what they were prior to pregnancy.
If you are breastfeeding, you are encouraged to
use oral medications or insulin after talking with
your clinician.
Domestic violence is more common in pregnancy.
If someone is hurting you, making you feel afraid,
putting you down, making threats, or pushing or
hitting you, it is not right, and it is not your fault.
Abuse occurs when someone uses their body,
words, or objects to hurt you. An abuser is usually
trying to control another person through harmful
words or actions.
• If you are having problems with someone who
threatens you or hurts you, tell your clinician
or other medical professional.
You and your baby can get free and
confidential help.
• Talk to someone you trust about what is
going on.
• Call the police in an emergency.
• Keep a set of car keys and money stashed
where you can find them.
• Keep important papers (birth certificates,
photo ID, bank book) in a safe place.
The National Domestic Violence Hotline has
counselors who speak English, Spanish, and other
languages. Please see the phone number and
resource list in the pocket of this booklet.
• Remember: It’s not your fault, no matter
what anyone tells you. Nobody deserves to
be abused.
• You need to take care of yourself because if
you are hurt, your children are hurt, too.
• Please see reference list in the pocket of
this booklet.
In an emergency call 911. In nonemergency
situations you are not alone. Help is available. Call
The National Domestic Violence Hotline at
1-800-799-SAFE (7233), local police, or a women's
shelter in your community.
If someone has hurt you before, it may happen
again while you are pregnant or after your baby is
born. Sometimes abuse starts when you become
pregnant. Bringing a new baby into your home
may bring added stress to you and your partner.
Remember that stress is never an excuse for
someone to hurt you or your baby.
Fifth disease is often referred to as “slapped
cheek” disease because of the rash some people
get on their face. Thirty to 60 percent of all adults
are already immune to fifth disease. It is more
common for children to contract this virus.
The disease is spread by coughing and sneezing.
As a rule, people can spread fifth disease only
while they have flu-like symptoms and before they
get a rash. Some people who have fifth disease,
such as those who have certain blood disorders or
weak immune systems, may be able to spread the
disease for a longer time.
In extremely rare cases, the infection can cause a
condition called fetal hydrops, in which the fetus
develops life-threatening anemia and severe
swelling throughout the body. The mother and
fetus should be closely monitored with fetal
ultrasounds to detect this condition.
When fetal hydrops is detected, the fetus may
be treated with blood transfusions while in the
uterus, although this is not usually necessary.
Some babies born to mothers who were infected
with fifth disease during pregnancy may also be
treated with blood transfusions.
For women who have not previously had fifth
disease, contracting the illness during pregnancy
can increase the risk for certain complications. If
you are pregnant and have been exposed to the
illness, contact your clinician right away.
A very small number of pregnant women who get
fifth disease will have a miscarriage.
Your pregnancy is considered high risk if you or
your baby has an increased chance of a health
problem. Many things can put you at high risk. It
may sound scary, but it’s just a way for your health
care team to make sure that you get special
attention during your pregnancy. Your clinician will
watch you closely during your pregnancy to find
any problems early.
The conditions listed below put you and your
baby at a higher risk for problems, such as slowed
growth for the baby, preterm labor, preeclampsia,
and problems with the placenta. But it’s important
to remember that being at high risk doesn’t mean
that you or your baby will have problems.
In general, your pregnancy may be high risk if:
• You have a health problem, such as:
o Diabetes.
o Cancer.
o High blood pressure.
o Kidney disease.
o Epilepsy.
• You use alcohol or illegal drugs, or you smoke.
• You are younger than 17 or older than 35.
• You are pregnant with more than one baby
(multiple pregnancy).
• You have had 3 or more miscarriages.
• Your baby has been found to have a genetic
condition, such as Down syndrome, or a heart,
lung, or kidney problem.
• You had a problem in a past pregnancy,
such as:
o Preterm labor.
o Preeclampsia or seizures (eclampsia).
o Having a baby with a genetic problem,
such as Down syndrome.
• You have an infection, such as HIV or hepatitis C.
Other infections that can cause a problem
include cytomegalovirus (CMV), chickenpox,
rubella, toxoplasmosis, and syphilis.
• You are taking certain medicines, such as
lithium, phenytoin (such as Dilantin), valproic
acid (Depakene), or carbamazepine (such
as Tegretol).
Other health problems can make your pregnancy
high risk. These include heart valve problems,
sickle cell disease, asthma, lupus, and rheumatoid
arthritis. Talk to your clinician about any health
problems you have.
You may have more office visits than a woman
who does not have a high-risk pregnancy. You
may have more ultrasound tests to make sure that
your baby is growing well.
During your third trimester, you may have
additional fetal monitoring (a nonstress test). You
will have regular blood pressure checks, and your
urine will be tested to look for protein (a sign of
preeclampsia) and glucose (sugar, a sign of high
blood sugar).
Tests for genetic or other problems also may be
done, especially if you will be 35 or older at the
time of delivery, or if you had a genetic problem
in a past pregnancy.
Your clinician will prescribe any medicine you
may need, such as for diabetes, asthma, or high
blood pressure.
Talk to your clinician about where you will
give birth. Your clinician may recommend that
you have your baby in a hospital that offers
special care for women and babies who may
have complications.
If your clinician thinks that your health or your
baby’s health is at risk, you may need to have
the baby early, or you may be hospitalized for
evaluation or treatment.
Some women will see someone who has
extra training in high-risk pregnancies. These
clinicians are called maternal-fetal specialists, or
perinatologists. You may see this person and your
regular clinician. Or the specialist may be your
clinician throughout your pregnancy.
To help yourself and your baby be as healthy
as possible:
• Go to all your scheduled visits so that you
don’t miss tests to catch any new problems.
• Eat a healthy diet that includes protein, milk
and milk products, fruits, and vegetables. Talk
to your clinician about any changes you may
need in your diet.
• Take any medicines, iron, or vitamins that
your clinician prescribes. Don’t take any
vitamins or medicines (including over-thecounter medicines) without talking to your
clinician first.
• Take folic acid daily. Experts recommend that
you take 0.4 to 0.8 milligrams (400 to 800
micrograms) of folic acid every day. Folic acid is
a B vitamin. Taking folic acid before and during
early pregnancy reduces your chance of having
a baby with a neural tube defect or other birth
defects. It also helps prevent anemia.
• Follow your clinician’s instructions for activity.
You will discuss if it is safe for you to work
or exercise.
• Do not smoke. If you need help quitting,
talk to your clinician about stop-smoking
programs and medicines. Avoid other
people’s tobacco smoke.
• Do not drink alcohol.
• Stay away from people who have colds and
other infections.
You may be asked to keep track of how much
your baby moves every day. One way to do
this is to note how much time it takes to feel
10 movements.
Like any pregnant woman, you need to watch for
any signs of problems. This doesn’t mean that you
will have any problems. But if you have any of these
symptoms, it’s important to get care quickly.
Call 911 or other emergency services right
away if you think you need emergency care.
For example, call if you:
• Have passed out (lost consciousness).
• Have severe vaginal bleeding.
• Have severe pain in your belly or pelvis.
• Have had fluid gushing or leaking from your
vagina and you know or think the umbilical
cord is bulging into your vagina. If this
happens, immediately get down on your
knees so your rear end is higher than your
head. This will decrease the pressure on the
cord until help arrives.
Call your clinician immediately or seek medical
care right away if:
• You have signs of preeclampsia, such as:
• You have a fever.
• You have 4 to 6 contractions (with or without
pain) for an hour.
• You have a sudden release of fluid from
your vagina.
• You have low back pain or pelvic pressure that
does not go away.
• You notice that your baby has stopped moving
or is moving much less than normal.
There are many ways to evaluate the health and
well-being of a fetus throughout pregnancy.
If you have a pregnancy that is at higher risk
for complications, certain tests can be done
to check your baby. These tests help to see
if your baby is receiving enough oxygen and
nourishment through the placenta (sometimes
called the “afterbirth,” the organ that connects
you and your baby). You may be tested to see if
you are having contractions. This is usually done
during the last three months of pregnancy.
Two tests are commonly offered in late pregnancy
if you have a high-risk pregnancy:
o Sudden swelling of your face, hands,
or feet.
• Nonstress test (NST).
o New vision problems (such as dimness
or blurring).
If you have a high-risk pregnancy, talk with your
clinician about any prenatal tests you will be
given. Testing is also done in low-risk pregnancies
if your baby’s activity suddenly decreases. If you
notice this occurring, you should call Labor and
Delivery right away.
o A severe headache.
• You have any vaginal bleeding.
• You have belly pain or cramping.
• Biophysical profile (BPP).
Nonstress test
A nonstress test (NST) checks your baby’s heart
rate in response to his or her movements. An NST
takes about 20 to 45 minutes. You don’t need to
do anything special to prepare for it.
A device that monitors your baby is attached
by a belt to your abdomen. Another monitoring
device is attached to your abdomen to see if
you are having any uterine contractions. Neither
device poses any risk to you or your baby. Babies
are usually active, and as your baby moves,
the monitor records your baby’s heart rate in
response to his or her movements.
If your baby is healthy, his or her heart rate will
go up when he or she moves and will stay steady
when resting, just as ours does. Sometimes, your
baby will not move much because he or she could
be sleeping or resting. A device that makes a
loud buzzing noise may be used to wake up your
baby. Often a brief ultrasound is done at the
same time to check the amount of amniotic fluid
(“bag of waters”).
Contraction stress test
A contraction stress test (CST) measures the
effect of contractions (stress) on your baby’s heart
rate. You do not need to do anything special to
prepare for this test. It is typically performed in a
hospital setting.
A monitor records your baby’s heart rate as your
uterus contracts. If your baby is not receiving
enough oxygen, or is under stress, the heart rate
may slow down when there is a contraction. If the
heart rate stays steady with contractions (or even
goes up), that is generally a sign that your baby is
not under stress.
Biophysical profile
A biophysical profile (BPP) uses ultrasound to
evaluate your baby’s health. The BPP looks at
your baby’s breathing pattern, body movements,
muscle tone, and the amount of amniotic fluid
(“bag of waters”). Often, a nonstress test is
included as part of the BPP. You may have a
biophysical profile done weekly toward the end of
your pregnancy.
Test results
It is reassuring if these tests are normal. A
test may be repeated in a few days to a week,
depending on risk factors. If the test results
are worrisome, your clinician or other medical
professional will talk to you about what to do
next. Additional tests may be ordered. In some
cases, it may be decided that inducing or starting
labor and delivering your baby is the safest plan.
As with a nonstress test, 2 monitoring devices are
attached to your abdomen. One measures your
baby’s heart rate and the other records uterine
contractions. Then, a low dose of a medicine
called Pitocin may be given to you through a
vein to cause your uterus to contract. Sometimes
stimulation of the nipples may be used to cause
uterine contractions.
Most pregnant women have healthy babies — and
that includes women who are obese. But being
very heavy does increase the chance of problems.
No. Pregnancy is not the time to lose weight. Your
baby needs you to eat a well-rounded diet. Don’t
cut out food groups or go on any type of weightloss diet.
Babies born to mothers who are obese have a
higher risk of:
• Birth defects, such as a heart defect or neural
tube defects.
• Being too large. This can cause problems
during labor and delivery.
Mothers who are obese have a higher risk of:
• Problems during pregnancy, such as
high blood pressure, gestational diabetes,
or preeclampsia.
Your clinician will work with you to set a weight
goal that’s right for you.
Although pregnant women often joke that they’re
“eating for 2,” you don’t need to eat twice as much
food. In general, pregnant women need to eat only
about 300 extra calories a day. You can get this in
a sandwich or in an apple and a cup of yogurt.
• Cesarean (or C-section) birth and a higher risk
of postoperative complications.
• Miscarriage or stillbirth.
How much you can eat depends on:
• Incomplete ultrasound fetal evaluations.
• How much you weigh when you get pregnant.
If you’re not pregnant already, being obese can
make it hard to get pregnant.
• Your body mass index (BMI).
These are scary problems, and it’s common to
worry about you and your baby’s health. But
being obese doesn’t mean that you will have
these problems. You can do a lot to improve your
chances of having a healthy pregnancy.
Like any pregnant woman, you need to eat a
variety of foods from all the food groups. You
especially need to make sure to get enough
calcium and folic acid.
Work with your clinician to get the care you need.
Go to all your appointments, and follow your
clinician’s advice about what to do and what to
avoid during pregnancy.
• How much you exercise.
You may want to work with a dietitian to help
you plan healthy meals to get the right amount
of calories.
You will have the same number of office visits as
a woman of average weight, unless you start to
have problems. Then you would see your clinician
more often. But you’ll have the same type of tests
to look for problems and make sure your baby
is healthy.
The best things you can do to have a healthy
pregnancy are to eat a variety of foods, get regular
exercise, avoid alcohol and smoking, and go to
your medical appointments. If you didn’t exercise
much before you got pregnant, talk to your
clinician about how you can slowly get more active.
Bariatric surgery (such as gastric bypass or
banding) helps people lose weight. It’s only used
for people who are obese and have not been able
to lose weight with diet and exercise.
This surgery makes the stomach smaller. Some
types of surgery also change how your stomach
connects with your intestines.
This surgery may increase your risk of having a
cesarean birth. But there is some debate about
why. It may be that past C-sections increase the
risk, rather than the weight-loss surgery. Talk with
your clinician if you have concerns about your
chance of a C-section.
In most ways, your prenatal care will be the
same as for other women. But there are a
few differences:
• You may need to keep seeing the clinician
who did your surgery. This is to make sure that
you aren’t having any delayed problems from
the surgery.
• A dietitian may work with you to make sure
you’re getting the nutrition you need and to
help you plan meals.
• You may need to take extra vitamins and
minerals. Weight-loss surgery can make it hard
for your body to absorb some nutrients, such
as folic acid, calcium, vitamin B12, and iron.
Some women may have a hard time with the
idea of gaining weight for pregnancy after
losing all that weight. Talk to your clinician if this
bothers you.
Weight-loss surgery before pregnancy can:
• Help you get pregnant if obesity was the
reason you had trouble getting pregnant.
• Lower your chance of some pregnancy
problems. These include high blood pressure,
gestational diabetes, and preeclampsia.
• Reduce how much weight you gain
during pregnancy.
Blood pressure is a measure of how hard your
blood pushes against the walls of your arteries.
If the force is too hard, you have high blood
pressure (also called hypertension). When
high blood pressure starts after 20 weeks of
pregnancy, it may be a sign of a very serious
problem called preeclampsia.
Blood pressure is shown as 2 numbers. The top
number (systolic) is the pressure when the heart
pumps blood. The bottom number (diastolic) is
the pressure when the heart relaxes and fills with
blood. Blood pressure is high if the top number is
more than 139 millimeters of mercury (mm Hg), or
if the bottom number is more than 89 mm Hg. For
example, blood pressure of 150/85 (say “150 over
85”) or 140/95 is high. Or both numbers can be
high, such as 150/95.
You may have high blood pressure (chronic
hypertension) before you get pregnant. Or
your blood pressure may start to go up during
pregnancy (gestational hypertension). If you
are being treated with high blood pressure
medications prior to pregnancy, please discuss
this in advance with an advice nurse or clinician as
soon as possible.
If you have high blood pressure during pregnancy,
you need to have checkups more often than
women who do not have this problem, and you
may need some additional lab work. There is no
way to know if you will get preeclampsia. This is
one of the reasons that you are watched closely
during your pregnancy.
High blood pressure and preeclampsia are
related, but they have some differences.
Normally, a woman’s blood pressure drops during
the second trimester. Then it returns to normal by
the end of pregnancy. But in some women, blood
pressure goes up very high in the second or third
trimester. This is sometimes called gestational
hypertension and can lead to preeclampsia. You
will need to have your blood pressure checked
often, and you may need treatment. Usually, the
problem goes away after your baby is born.
High blood pressure that started before
pregnancy usually doesn’t go away after your
baby is born.
A small rise in blood pressure may not be a
problem. But your clinician will watch your
pressure to make sure it does not get too high.
You'll also be checked for preeclampsia.
Very high blood pressure keeps your placenta
from getting enough blood and oxygen for your
baby. This could limit your baby’s growth or
cause the placenta to pull away too soon from
the uterus. High blood pressure also can lead to
stillbirth. High blood pressure can be treated.
Preeclampsia is a pregnancy-related problem.
The symptoms of preeclampsia include new high
blood pressure after 20 weeks of pregnancy
along with other problems, such as protein in your
urine. Preeclampsia usually goes away after you
give birth. In rare cases, blood pressure can stay
high for up to 6 weeks after the birth.
Preeclampsia can be deadly for the mother and
baby. It can keep the baby from getting enough
blood and oxygen. It also can harm the mother’s
liver, kidneys, and brain. Women with very bad
preeclampsia can have dangerous seizures. This is
called eclampsia.
Experts don’t know the exact cause of
preeclampsia and high blood pressure
during pregnancy. But they have some ideas
about preeclampsia:
• Preeclampsia seems to start because the
placenta doesn’t grow the usual network of
blood vessels deep in the wall of the uterus.
This leads to poor blood flow in the placenta.
• Preeclampsia may run in families. If your
mother had preeclampsia while she was
pregnant with you, you have a higher chance
of getting it during pregnancy. You also have
a higher chance of getting it if the mother of
your baby’s father had preeclampsia.
• Your immune system may react to the father’s
sperm, the placenta, or the baby.
• Already having high blood pressure when
you get pregnant raises your chance of
getting preeclampsia.
• Problems that can lead to high blood
pressure, such as obesity, polycystic ovary
syndrome, and diabetes, could raise your risk
of preeclampsia.
High blood pressure usually doesn’t cause
symptoms. But very high blood pressure
sometimes causes headaches and shortness of
breath or changes in vision.
Mild preeclampsia usually doesn’t cause
symptoms, either. But preeclampsia can cause
rapid weight gain and sudden swelling of the
hands and face. Severe preeclampsia causes
symptoms of organ trouble, such as a very bad
headache and trouble seeing and breathing. It
also can cause belly pain and decreased urination.
High blood pressure and preeclampsia are usually
found during a prenatal visit. This is one reason
it’s so important to go to all of your prenatal visits.
You need to have your blood pressure checked
often. During these visits, your blood pressure is
measured with a blood pressure cuff. A sudden
increase in blood pressure often is the first sign
of a problem.
In the later weeks of pregnancy, you will have a
urine test at every visit to look for protein, a sign
of preeclampsia.
If you have high blood pressure, tell your clinician
right away if you have a headache or belly pain.
These signs of preeclampsia can occur before
protein shows up in your urine.
Your clinician may have you take medicine if your
blood pressure is too high.
The only cure for preeclampsia is delivering your
baby. You may get medicines to lower your blood
pressure and to prevent seizures. You also may
get medicine to help your baby’s lungs get ready
for birth. Your clinician will try to deliver your baby
when the baby has grown enough to be ready for
birth. But sometimes a baby has to be delivered
early to protect the health of the mother or the
baby. If this happens, your baby will get special
care for premature babies.
If you have high blood pressure during pregnancy
but had normal blood pressure before pregnancy,
your pressure is likely to go back to normal after
you have the baby. But if you had high blood
pressure before pregnancy, you probably will still
have it after you give birth.
Causes of preterm labor include:
Preterm labor is the start of labor between 20 and
37 weeks of pregnancy. A full-term pregnancy lasts
37 to 42 weeks. In labor, the uterus contracts to
open the cervix. This is the first stage of childbirth.
• The placenta separating early from the uterus.
This is called placenta abruptio.
Preterm labor is also called premature labor.
The earlier the delivery, the greater the risk of
serious problems for the baby. This is because
many of the baby’s organs — especially the
heart and lungs — are not fully grown, or
mature. Premature infants born after 32 weeks
of pregnancy tend to have less chance of
problems than those born earlier.
For infants born before 24 weeks of pregnancy,
the chances of survival are extremely slim. Many
who do survive have long-term health problems.
They may also have other problems, such as
trouble with learning and talking and with moving
their body (poor motor skills).
Preterm labor can be caused by a problem with
the baby, the mother, or both. Often the cause is
not known.
Preterm labor most often occurs naturally.
But sometimes a clinician uses medicine or
other methods to start labor early because of
pregnancy problems that are dangerous to the
mother or baby.
• Elevated blood pressure or preeclampsia.
• Being pregnant with more than one baby, such
as twins or triplets.
• An infection in the uterus that leads to the
start of labor.
• Problems with the uterus or cervix.
• Drug or alcohol use during pregnancy.
• The amniotic fluid breaking before
contractions start.
It can be hard to tell when labor starts, especially
when it starts early. So watch for these symptoms:
• Regular contractions for an hour. This means
more than 4 to 6 contractions an hour, even
after you have had a glass of water and
are resting.
• Leaking or gushing of fluid from your vagina.
You may notice that it is pink or reddish.
• Pain that feels like menstrual cramps, with or
without diarrhea.
• A feeling of pressure in your pelvis or
lower belly.
• A dull ache in your lower back, pelvic area,
lower belly, or thighs that does not go away.
• Not feeling well, including having a fever you
can’t explain and being overly tired. Your belly
may hurt when you press on it.
If your contractions stop, they may have
been Braxton Hicks contractions. These are
a sometimes uncomfortable, but not painful,
tightening of the uterus. They are like practice
contractions. But sometimes it can be hard to
tell the difference.
If preterm labor contractions do not stop, the
cervix begins to open (dilate) or thin (efface).
Before or after contractions begin, the amniotic
sac that holds the baby may break. This is called
a rupture of membranes. It causes a leakage or
a gush of amniotic fluid. Rupture of membranes
before contractions start is called premature
rupture of membranes, or PROM. Before
37 weeks of pregnancy, it is called preterm
premature rupture of membranes, or pPROM.
• Try to delay the birth with medicine. This may
or may not work.
If you think you have symptoms of preterm labor,
call your clinician. He or she can check to see if
your water has broken, if you have an infection, or
if your cervix is starting to dilate.
You may also have urine and blood tests to
check for problems that can cause preterm labor.
Checking the baby’s heartbeat and doing an
ultrasound can give your clinician a good picture
of how your baby is doing.
If you are in preterm labor, your clinician must
weigh the risks of early delivery against the risks
of waiting to deliver. Depending on your situation,
your clinician may:
• Use antibiotics to treat or prevent infection.
If your amniotic sac has broken early, you
have a high risk of infection and must be
watched closely.
• Give you steroid medicine to help prepare
your baby’s lungs for birth. This treatment
has some risks, but it can improve your
baby’s chances of surviving a premature birth
between 24 and 34 weeks of pregnancy.
• Give you magnesium for potential reduction in
long-term neurologic sequelae.
• Treat any other medical problems causing
trouble in pregnancy.
• Allow the labor to go on because delivery is
safer for you and your baby than letting the
pregnancy go on.
Amniotic fluid can be tested for signs that your
baby’s lungs have grown enough for delivery.
You may have a painless swab test for a protein
in the vagina called fetal fibronectin. If the test
does not find the protein, then you are unlikely to
deliver soon. But the test cannot tell for certain if
you are about to have a preterm birth.
Toxoplasmosis is a common infection found in
birds, mammals, and people.
If you get toxoplasmosis, you may feel like you
have the flu, or you may not feel sick at all. Most
people who get the infection don’t even know
that they have it. Symptoms may include:
For most people, it doesn’t cause serious health
problems. But for a pregnant woman’s growing
baby, it can cause brain damage and vision loss.
Still, the chance of a pregnant woman getting the
infection and passing it on to her baby is low.
If you’re pregnant or planning to have a baby and
are worried that you may have toxoplasmosis, ask
your clinician about getting tested. After you have
had the infection, you can’t get it again or pass it
on to your baby. You’re immune.
But if you aren’t immune, you’ll want to take
special care while you’re pregnant. Avoid anything
that may be infected, such as infected meat and
infected cat feces.
A parasite causes toxoplasmosis. You can get the
infection by:
• Eating infected meat that hasn’t been fully
cooked or frozen.
• Swollen glands.
• Muscle aches.
• Fatigue.
• Fever.
• Sore throat.
• Skin rash.
A blood test can tell whether you have or have
ever had toxoplasmosis. If you’re worried about
getting the infection, ask your clinician about
having the test.
If you get the infection while you’re pregnant,
you’ll need to have your baby tested. Your
clinician can take some fluid from the sac that
surrounds your baby and check for the infection.
• Changing an infected cat’s litter box. Cats
infected with the parasite pass it on to others
through their feces.
• Digging or gardening in sand or soil where an
infected cat has left feces.
• Eating anything that has touched infected cat
feces, including fruits and vegetables that
haven’t been washed. You can also get the
infection by eating food that has touched
tables and counters your cat has walked on.
In healthy people, the infection often goes
away on its own. But babies and people whose
bodies can’t fight infection well will need to
take medicine to treat the infection and prevent
serious health problems.
If you get toxoplasmosis while you’re pregnant,
you’ll take an antibiotic to treat the infection.
This medicine may:
• Keep your baby from getting the infection.
• Lower your baby’s chance of having serious
health problems if he or she does get it.
Your baby has a better chance of being healthy at
birth if you get treatment while you’re pregnant.
Most newborns who have been infected with
toxoplasmosis have no symptoms at birth. If your
baby has the infection, he or she will need to take
antibiotics for a year after birth. This lowers the
chance of having problems later on.
There are several things you can do to avoid
getting toxoplasmosis:
• If you have a cat or are caring for one, ask
someone to clean or empty the litter box
while you’re pregnant. Wash tables and
counters well if a cat may have walked on
them. If you have to clean the cat’s litter box,
wear gloves and a face mask. Be sure to wash
your hands after you’re done.
• If you eat meat, make sure it has been fully
cooked or frozen. Avoid dried meats, such as
beef jerky.
• Avoid contact with cat feces in your garden.
If you touch soil, be sure to wear gloves and
wash your hands after you’re done.
• Wash fruits and vegetables before you
eat them.
• Wash your hands and anything you use
to prepare raw meat, chicken, fish, fruits,
or vegetables.
Your urinary tract is the system that makes urine
and carries it out of your body. It includes your
bladder and kidneys and the tubes that connect
them. When germs get into this system, they can
cause an infection.
Most urinary tract infections are bladder
infections. A bladder infection usually is not
serious if it is treated right away. If you do not
take care of a bladder infection, it can spread to
your kidneys. A kidney infection is serious and can
cause permanent damage.
Usually, germs get into your system through your
urethra, the tube that carries urine from your
bladder to the outside of your body. The germs
that usually cause these infections live in your
large intestine and are found in your stool. If these
germs get inside your urethra, they can travel
up into your bladder and kidneys and cause
an infection.
You may be more likely to get an infection if you
do not drink enough fluids, you have diabetes,
or you are pregnant. The chance that you will
get a bladder infection is higher if you have any
problem that blocks the flow of urine from your
bladder, such as kidney stones.
For reasons that are not well-understood, some
women get bladder infections again and again.
You may have an infection if you have any of
these symptoms:
• You feel pain or burning when you urinate.
• You feel like you have to urinate often, but not
much urine comes out when you do.
• Your belly feels tender or heavy.
• Your urine is cloudy or smells bad.
• You have pain on one side of your back under
your ribs. This is where your kidneys are.
• You have fever and chills.
• You have nausea and vomiting.
Women tend to get more bladder infections
than men. This is probably because women have
shorter urethras, so it is easier for the germs to
move up to their bladders. Having sex can make it
easier for germs to get into your urethra.
Call your clinician right away if you think you have
an infection and:
• You have a fever, nausea and vomiting, or pain
in one side of your back under your ribs.
You can help prevent these infections. Here are
actions that can help:
• You have diabetes, kidney problems, or a
weak immune system.
• Drink lots of water every day.
• Urinate right after having sex.
Your clinician will ask for a sample of your urine.
It is tested to see if it has germs that cause
bladder infections.
• Urinate often. Do not try to hold it.
• In some cases, your clinician may ask
that you take an antibiotic daily.
If you have infections often, you may need extra
testing to find out why.
Antibiotics will usually cure a bladder infection.
It may help to drink lots of water and other fluids
and to urinate often, emptying your bladder
each time.
If your clinician prescribes antibiotics, take
the pills exactly as you are told. Do not stop
taking them just because you feel better. You
need to finish taking them all so that you do not
get sick again.
©2015 Kaiser Foundation Health Plan of the Northwest
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