Parenting & New Baby Advice Blog

At first sight, your newborn may not be quite what you had expected. For the first half minute or so, his skin might be bluish grey, and he may appear lifeless. That may be a shock if you are not expecting it, but this is the color of all babies in the uterus. As your baby begins breathing and more oxygen enters his body, his color will turn pinker or ruddier-first the head and body, then the arms and legs, and last the feet and hands.

Your baby will be soaking wet, streaked with blood, and smeared with vernix, a white sticky substance.. Some babies have a great deal of vernix all over their bodies, and some have only small amounts, only in the creases and folds. Vernix is almost like a hand cream, in that it protects the baby’s skin while he is floating in amniotic fluid.

His face may be swollen and he might have long fingernails. You may also be surprised by the size of your baby’s genitals. The size and color subside in a few days, when their genitals take on a more normal appearance.

Immediate Care

Even though most babies do not really need it, care-givers routinely suction babies noses and mouths very soon after birth to remove excess amniotic fluid and mucous. In fact, sometimes they begin suctioning when only the baby’s head is out. It is done with a rubber bulb syringe or with a little jar and tube called a mucous trap. The mucous trap is used if the baby’s airway seems to be very congested or if the baby was under stress during labor and breathing problems are anticipated at the time of birth.

Your baby’s umbilical cord will be clamped in two places close to his abdomen. Then the cord will be cut between the two clamps. Sometimes the father cuts the cord. Otherwise, the doctor does it. Even though there is a spurt of blood when the cord is cut, neither you or your baby will feel it at all, sense there are no nerves in the umbilical cord. Then your baby will be either be placed on your abdomen or taken to a special warm bed in the corner of the room for examination and other care. If he is placed on your abdomen, you will feel the warm, wet baby on your now soft belly. Many women find this a very pleasant sensation.

Your baby is dried off by rubbing briskly with soft towels to keep him from getting a chill [a major concern of your doctor]. Your baby will be wrapped in a warm blanket or two, and his head will be covered. In fact, it is a very good idea to have a warm little hat to place on the baby’s head as soon as possible after the birth because the baby’s head is such a large part of his body that a lot of heat can be lost through it.

Since the 1970s, remarkable improvements in ultrasound technology have opened a real “window on the womb.” Ultrasound consists of high-frequency sound waves that are bounced off the baby to give a photographic picture of the fetus. Unlike X-rays, which have much higher powers of penetration, ultrasound will identify soft tissues. Thus, it can give a complete picture of the growing baby and is a very useful diagnostic tool.  An ultrasound scan may be used to date the pregnancy, and thereafter used as needed in hospitals with the equipment. If not, women who may be at special risk because of problems with a previous pregnancy, or who would like to have a scan, can often be referred to a hospital where it can be performed. The pregnancy can be very accurately dated at around 16 weeks by measuring the circumference of the baby’s head. This knowledge is useful in avoiding problems later if the mother is unsure of her dates and does not know when the baby is due. The scan can locate the position of the placenta, which can be helpful if there is any bleeding later in pregnancy, and it can be used to check that the baby has no major physical abnormalities such as anencephaly. Ultrasound can show congenital heart defects, kidney disease and other severe abnormalities. Ultrasound can also detect if the mother is expecting more than one baby.  There has been some controversy about the safety of ultrasound, which has concerned some women. They are not sure whether they should accept a scan. Ultrasound has now been in use for many years without any evidence of harmful effects to the baby.  All indications are that the benefits of having ultrasound outweigh any potential risk. Not least is the benefit of reassurance given to many women on seeing their baby is alive and well, particularly those who have waited a long time to have a baby or who have experienced a miscarriage. However, a large study carried out in the United States by the National Institutes of Health on 15,000 women with a low risk of problems in pregnancy showed that while detection of twins and malformations was increased, and pregnancy could be dated more accurately, the outcome-in terms of healthy babies-was not improved when ultrasound was employed. There was no difference in the rate of fetal or neonatal death or subsequent illness. Rates for preterm births, for the outcomes of postdate pregnancies and for low-birth-weight babies were similar for those who had had ultrasound and those who had not. Although the percentage of abnormal fetuses detected in the group who had ultrasound was three times higher, the termination rate was about the same in both groups.  

So, while ultrasound is of undoubted benefit to women at high risk or in special situations where a problem is detected, its routine benefits are unproved for now. Ultrasound can help some mothers anxious about their pregnancies by reassuring them, but can also create anxieties for others:  “Towards the end of my pregnancy they started to worry about whether my baby was growing as he should. I don’t know what started it, but once they got this idea into their heads they wouldn’t leave me alone. I was in and out of the hospital having my blood pressure taken and having ultrasound scan after scan. My blood pressure was up-with worry, no doubt-and they couldn’t decide what to do. They said they would have to induce the baby early to make sure that all would be well. Then they changed their minds and decided to wait. I was in the hospital for the last few weeks of the pregnancy and, of course, the baby decided to be late. I was two weeks overdue before they decided induce the birth. By then I was so desperate I said, ‘Yes.’ It was a terrible birth, ending with an emergency Cesarean, and when he was born he was 7 pounds, 1 ounce. He didn’t look overdue. I asked my doctor later, ‘So what happened with this small baby?’ There was nothing wrong at all! My worries were for nothing. They said they couldn’t explain it but he had appeared small on the scan. So much for all their wonderful technology!”  Some women-and doctors and midwives, too-feel that, with the increased reliance on new technology, many of the old skills in obstetrics are being lost:  “I had shared care and I noticed a tremendous difference between my visits to the well-baby clinic and my visits to my very experienced doctor. At the clinic, people seemed to poke and probe for a long time and suggested that I have another scan to see the baby was growing OK. When I went to my doctor, she examined me very quickly and said, ‘Oh, this baby’s doing fine, I think he weighs about 4 pounds now.’ I asked how she knew and she just said, ‘Experience.’ In the clinic, I feel like you only see the junior staff, with the senior staff called for special occasions. No wonder you don’t always get the best care and they give you all kinds of unnecessary tests!”

Having an Ultrasound Scan.

An ultrasound scan is a simple, noninvasive procedure. In early pregnancy you are usually asked to drink a lot of water an hour or two before your appointment and not to empty your bladder. This pushes the womb up in the pelvis and will give the ultrasound operator a clearer view. You will be asked to lie down on a couch and remove any clothing that covers your abdomen. A cold gel is rubbed over the abdomen to enable the ultrasound operator to move the scanner smoothly over the area. As she does so you will see the baby’s outline appear on the television screen and you will also see the fetal movements.   It can be difficult to interpret what you are seeing, so ask if you are not told. The operator can freeze the picture at any time and point out things to you without exposing the baby to any more sound waves than necessary. You will usually be able to see the baby’s head, the arms and legs moving around, and some of the internal organs at work. You may even be able to see the baby sucking his thumb.   “The woman took a lot of time to explain to me what she was looking for and what she could see. I found all of it so reassuring. She pointed out the heart beating, the cord and the placenta, the kidneys and the spine and showed me how much he was moving around.”  Other women find the process unnerving, especially if nothing is explained.  “No one said anything to me and I was afraid to ask in case anything was wrong. She kept on looking at everything and taking measurements and I started to get very jumpy. Then she suddenly got up and said, ‘I just want to get a second opinion on this,’ and I was terrified. I thought, ‘This is it. Something’s really wrong.’ I was in tears. Someone else came back and they were both looking at the screen, still not saying anything to me. ‘What is it, what is wrong?’ I finally asked. ‘Nothing’s wrong, I’m just checking these measurements,’ she said. I felt as if I weren’t a person-just a scientific toy.”  Usually the baby’s father is welcome to come and watch the process and see the baby on the screen. Many dads find this is a very positive experience, not only because they are able to give support, but also because the baby becomes real to them in an even more dramatic way than to the woman: “It was hard for me to take in that she was pregnant until I saw the baby on the screen. It was fantastic-it made it come alive for me.” 

Normally the baby is born with the head down, facing backwards, so the widest part of the baby’s head passes through the widest part of the pelvis. The baby’s head pressing down on the cervix helps it dilate, and the baby rotates as it is born, helping the body slip out behind the head.

Some babies, however, are born in a different position. This normally causes problems in labor. A posterior presentation means that the baby faces forward; its spine can press against the mother’s as it moves down, causing her pain and slowing labor. And because the widest part of the baby’s head is passing through the narrowest part of the pelvis, the baby can get stuck here more easily, again prolonging labor and sometimes requiring the use of forceps.

A breech birth occurs when the baby does not turn, so that the head is not born first; breech babies are normally born buttocks-first, occasionally feet-first. About four births in a hundred are breech. Most breech births are straightforward, though you are most likely to need intervention, especially in a first birth. Many women are advised to have an epidural; usually the baby’s head is delivered with forceps to protect it, and you are likely to have an episiotomy to help the baby’s head out. If you wind up needing an emergency Cesarean, the epidural will already be set up.

Medical Intervention

Over the past decade or two, hospitals have increasingly used a variety of techniques that have revolutionized the process of childbirth. Most of these are intended to save lives, and frequently they do. However, many interventions have become routine in some hospitals, thus interfering with the birth process for many mothers who are not at risk. Hospitals are now more likely to discuss any possible intervention with you. You should make your views clear, although obviously everyone involved should accept that intervention may be necessary in case of an emergency.

Episiotomy

An episiotomy is a small incision made in the perineum, the skin between the vagina and the anus, to enlarge the vaginal opening and help the delivery of the baby’s head. The cut is made with scissors under a local anesthetic when the baby’s head comes into view. Done properly, the perineum will have stretched very thin and the cut can be made with a minimum of damage and bleeding. An episiotomy should not be necessary in a normal delivery, and you can ask not to have one if you prefer.

However, there is some controversy over whether it is better to have a small episiotomy or risk tearing the perineum when the baby’s head is born. Some feel that a small tear is better and heals more rapidly, while others believe it is easier to sew up a clean cut. You should not be in great pain when the stitches are put in; if you are, ask to have more local anesthetic. 

Being pregnant doesn’t mean being fat. It doesn’t have to mean being tired all the time, nor does it mean looking dumpy and saggy as a new mother. The way you feel [terrific or fatigued] and the way you look [sleek or bulgy] depend to a great extent to what actions you take during pregnancy regarding diet and exercise. By eating a wide variety of wholesome foods and by exercising aerobically on a regular basis, you can maintain or improve your fitness and health during this time of extra demands on your body.

Decide how you want to look and feel after delivery. Then accept the challenge of making necessary changes in eating and exercise. That’s the first step. Look at your schedule and make changes to include sensible eating and an exercise program. The two go hand in hand. Just because you are pregnant doesn’t mean you’re fragile. Give your exercise program top priority. Plan your day around your exercise program, not the other way around.

This section describes a safe and effected fitness program for pregnant women at any level of fitness. The emphasis is on aerobic exercise, with some discussion of the other important components of a complete fitness program- stretching and strengthening exercises.

Starting an Exercise Program for the First Time

Becoming fit during pregnancy requires safe, regular, sustained, moderate exercise-not embarking on a new sport or doing strenuous workouts. Even if you have never exercised regularly before, you can safety begin a workout program during pregnancy. The safest and most productive activities during pregnancy [especially for the woman exercising for the first time] are swimming and brisk walking. They are best because can usually be continued until almost the day of delivery, and carry little risk of injury that would prevent further exercising. All you need before beginning is a sound program, appropriate clothing, and a health clearance from your personal physician.

Guide for Safe and Effective Exercise

For anyone engaged in an exercise program, it is important to know if you are under or overworking your heart. If you under work your heart muscle, you won’t build stamina or endurance. If you are overworking your heart, you could become short of breath, dizzy, nauseated, or faint.

During pregnancy, it is especially important not to overwork. There are many internal body changes taking place that require oxygen and energy. In addition to the fact that you are growing a whole new person! That is why you should learn how to measure your body’s responses to exercise.

One sign of overworking aerobically is shortness of breath. If you are working at just the right pace, you should be able to carry on a normal conversation while exercising [the" talk test"]. But, to be more accurate, you can learn to use your own pulse to tell you exactly how your body is responding to exercise.

Taking Your Pulse

Your pulse varies according to your activity level. It is lowest when you are least active. It also varies to response to illness and emotions. Your pulse can tell you about your physical fitness level, too. The more fit you are, the lower your resting pulse rate. Most women have a resting pulse rate of seventy-two, to eighty beats per minute [bpm], but this may decrease as their level of fitness improves. During pregnancy, the resting pulse normally varies within the same day and from day to day. As pregnancy advances, the pulse rate increases just slightly.

There are many pulse locations you can use, including the ones at your temples, your wrists and inside your upper arms. Do not use the carotid artery, [the pulse at the side of your throat]. Pressing this artery often alters the pulse beat, giving an inaccurate reading. Also, if you should accidentally press too hard or “massage” your neck trying to locate the pulse [especially during a workout], you may alter or decrease blood flow to the brain, making yourself feel faint or dizzy. Never take your pulse with your thumb. There is a pulse in your thumb and it is easy to confuse that pulse with the one in the artery you are trying to measure.

For practice, try to find the pulse in your wrist right now. To locate it, look on the thumb side, just below the small round bone on the side. Press firmly with your index and middle fingers. You should feel it beating. If not, get up and move briskly around the room for a couple of minutes and try it again. Practice several times during non-exercise times to become proficient at locating and counting your pulse.

Pulse Monitoring During your Workout

Three or four times during your workout, monitor your pulse. If you are attending an aerobic dance or exercise class with an instructor, monitor your own pulse whether or not the instructor has the entire class doing it. You should check your pulse after each aerobic dance or exercise segment, approximately every four minutes. After a while, you will be able to’ read your body” and will know when your pulse is at the right level. You will then be able to check your pulse less frequently. But at first, be consistent in checking your pulse often.

Try to keep moving while you check your pulse. It will take practice at becoming proficient at doing this, but it is very important. Each time you stand still to take your pulse, it drops or changes. At the same time, the blood has a tendency to pool in the lower part of your body, affecting the blood pressure, and you may become dizzy or lightheaded. So keep moving to get an accurate pulse. [Of course if biking is your aerobic activity, you will have to stop to take your pulse. "No- hands" biking is not a good idea! Try jogging in place to keep your pulse rate up.

The most precise way to count your pulse is with a digital watch turned face up on the inside of your left wrist. Place the index and middle fingers of your right hand on your left wrist, finding your pulse beat. Keep moving as you begin counting [to yourself] how many times you feel the beat. The first beat is called zero, then one, two, three, and so on. For six seconds count each beat. Then simply place a zero after the number of your count. For example if your count is twelve your pulse is 120 bpm.

Finding Your Target Heart Rate Zone

Which pulse range is right for you? In order to improve your heart muscle and receive the other benefits of exercise, you must keep your pulse within your individual “target” heart rate zone. This target zone [in pregnancy and until approximately twelve weeks after delivery] is achieved when the heart is beating at between sixty and seventy percent of your safe maximum attainable heart rate [SHR].

A formula is used to determine each person’s target zone. 220 [which is considered the highest pulse] minus your age equals your SHR Multiply that by sixty or seventy percent to get the limits of your target zone. The chart that follows contains the target zones for pregnant women and new mothers of all ages. Use it to determine your own target zone. If you cannot carry on a conversation in your target zone, you should reduce your activity, lowering your pulse to the level at which you are able to converse comfortably.

Use your target zone to help you regulate your activity during exercise. If your pulse is below your target zone, you need to work harder. If it is above your target zone, you are working too hard for your fitness level; you need to slow your activity to slow your pulse down to your target zone.

Target Heart Rate Zones for Pregnant Women and New Mothers

*Target heart rate is calculated at sixty percent to seventy percent of the safe maximum attainable heart rate. In pregnancy, maximum heart rate should never exceed 140 beats per minute.

Stamina and endurance are achieved sooner by working at the lower end of your target zone, nor the higher. Therefore, don’t try to rush yourself to fitness by overworking, because it doesn’t work and could cause harm.

Remember that your target zone is just for you. If you haven’t exercised regularly before, you may have to do very little to zoom your pulse up. The more fit you become, the harder you will have to work to get your pulse in the target zone. Do not compare yourself with others; there is no norm to achieve. Each pregnant woman should work at her own individual level.

Memorize the low and high numbers of your target zone. If you are above the high number, you need to slow yourself down-by walking, pedaling your bicycle more slowly, or reducing the vigor of your arm and leg movements. Unless you believe you are going to collapse or faint, do not stop moving or sit down. Keep yourself moving until your pulse drops to your target zone and you are ready to resume exercising.

If at any time during exercise you begin feeling faint, dizzy, lightheaded, nauseated, clammy or cold even though you are sweating or extremely fatigued, stop exercising, but walk around for a while and then have a seat. If you are in a structured class, talk with the instructor before leaving-let her know you are feeling unwell. She may want to keep her eye on you for a bit, or she may want to help you seek medical assistance. Also, see your physician before resuming exercise. These are warning signs. Listen to your body. There may be a very simple cause or one that is complicated and serious. Your physician, not your fitness instructor, or you should determine the cause.

It’s almost certain that every parent trying to find a good day care situation has thought of the sexual abuse that has been reported in the media. How do you know that you are leaving your child in a safe place and what are the different options? 

Breastfeeding can be a problem of convenience, though for some working women who are adaptable and willing to experiment, it is possible to have the best of both worlds-working and nursing. Your success will depend on your working conditions, your day care arrangements, your milk supply, and other factors. The tiniest of babies can be incredibly flexible, and you may be able to nurse the baby in the evenings and on the weekends when you are at home and have your caregiver feed the baby bottles of formula or your expressed breast milk. Your breast milk can be safely stored by refrigerating it for up to twenty-four hours or freezing it for two weeks. An occasional woman is lucky enough to find as a caregiver a nursing mother who will feed her infant charge as well as her own baby. 

First, consider your child’s needs. Some centers may expect your child to play quietly all day, others may provide a pre-school atmosphere with structured activities. Consider how many children will be there during the day, large groups may not work well for a shy, easily “lost” child. The point here is that the “ideal” daycare situation will be different for each child. One one-year old may be ready for a structured pre-school type day care center, while another may be much happier staying with a neighbor. 

Consider your needs. What hours will you need care, and what location will be the most convenient? And don’t forget to consider how much you can afford. 

The most difficult problem is leaving a baby only a few weeks old is that of finding adequate care for him of her while you are gone. Most new mothers who return to work leave their babies with trusted and competent relatives. If you do not have family members who can provide this care, you my have trouble finding a sitter or day care center that will accept responsibility for such a young baby, and charges will probably be higher than they would for an older baby. 

The change from a microscopic cell to a seven pound baby requires substantial alterations in the body of the mother carrying the baby as well. However, while the baby changes most rapidly in the first few weeks, the mother undergoes her most dramatic changes in the later stages of pregnancy. In the first six weeks, the mother’s physical changes are due primarily to alterations in hormone levels. These changes are subtle, and she may not even realize she is pregnant. She may have few symptoms or may easily attribute them to other causes. After this time, the mother’s physical changes are partly dependent on the growth of the baby and become more noticeable as the baby gets larger and larger. Although the most obvious changes occur in the uterus and abdomen, almost all of the organs in her body are altered.

When a woman becomes pregnant, her uterus is the part of her body that is affected first and that undergoes the most significant changes. It increases to five or six times its original size, twenty times its original weight, and one thousand times its initial capacity. The amount of muscle, connective and elastic tissue, blood vessels, and nerves increases.

The shape changes from elongated to oval by the second month, to round by mid-gestation, then back through oval to elongate at term. The uterus softens beginning at the sixth week. It changes position as it increases in size, ascending into the abdomen by the fourth month and eventually reaching to the liver. It also becomes more contractile, with irregular, painless, Braxton-Hicks contractions beginning in the first trimester. These contractions may be felt in the last weeks of pregnancy, when they are known as false labor.

Other parts of the reproductive system change along with the uterus, the cervix and vagina have increased blood supply, which causes a darkening in color. This is apparent by the sixth week. The amount of the elastic tissue increases to prepare the way for the stretching that will be required during delivery. Secretions increase, and a mucous plug develops in the cervix. The fallopian tubes, ovaries, and ligaments supporting the uterus all enlarge and elongate. The ovaries, of course, cease to ovulate.

During the fourth month, the uterus will grow into the abdomen, causing the abdominal wall to expand to accommodate it. The connective and elastic tissues are stretched and straitened, creating thin areas called striae [stretch marks]. Unfortunately, while the color of the striae may fade, scars remain after delivery. In fifty percent of women, striae will develop in the third trimester. Late in pregnancy, the internal pressure from the large uterus may even cause the muscles of the abdominal wall to separate.

A woman’s breasts must undergo many changes during pregnancy to be able to produce milk. In the first two months, the breasts may feel sore or full. They will increase in size, and veins may become visible on the surface. Striae can develop. The nipples also increase in size and usually darken in color. By mid-pregnancy, colostrums [a thick, yellowish fluid] can be expressed, but milk is not produced until after delivery.

Since the baby is being fed by the mother’s blood supply and the mother’s enlarging reproductive organs require more blood flow, the amount of blood must also increase. During pregnancy, blood volume expands by twenty-five to forty percent, but the number of red blood cells [the oxygen carrying component of blood] increases to a lesser extent. Therefore pregnant women are generally anemic-that is, their blood’s oxygen-carrying ability is somewhat decreased.

To pump an increased amount of blood through the body, the heart must work slightly harder, the heart pumps more blood per beat and beats slightly faster. Heart murmurs attributed to the flow through the heart may develop.

The blood vessels are also affected by pregnancy. The enlarging uterus pressing on veins in the pelvis, increasing the pressure in the veins from the legs. The increased pressure causes the leg veins to enlarge producing varicosities [areas of enlargement]. It may also cause fluid to leak out of the veins and into the tissues, causing swelling of the feet and ankles. Late in pregnancy, the uterus can also compress a major vein, the vena cava, in some women when they lie on their backs; if this occurs, blood is prevented from returning to the heart and a feeling of faintness results.

The enlarging uterus not only pushes forward on the abdominal wall and down on the pelvic veins, but it also pushes up on the bottom of the rib cage and on the diaphragm [the muscle that stretches across the bottom of the chest cavity and assists in breathing]. The rib cage widens, and most women breathe slightly faster. Some feel short of breath.

Urination and digestion are also affected during pregnancy. The urinary tract is changed both by pressure from the uterus and by hormonal influences. The uterus presses against the bladder, which may cause a pregnant woman to urinate more frequently. Hormones cause the ureters [the tubes conducting urine from the kidneys to the bladder] to distend and the flow of urine in them to slow. The sluggish urine flow predisposes a pregnant woman to infection. Hormones, along with the increased blood volume, also causes the kidneys to filter more blood, however, the kidneys may not reabsorb sugar and protein efficiently because of this increased workload, and these substances may spill into the urine. Since the presence of sugar in the urine can also be caused by diabetes and the presence of protein can be caused by infection, most doctors screen the urine frequently during pregnancy and may do other tests if any abnormality is found.

The changes in digestion during pregnancy are well known and frequently kidded about. A pregnant woman craving for pickles and ice-cream has been the premise of many a joke. Women may have unusual cravings, and may also notice changes in the senses of smell and taste, which may cause them to alter eating habits. During pregnancy women often produce more saliva and the saliva will be more acidic, which promotes tooth decay. The gums are more sensitive and may bleed easily. In the first trimester, a woman may have morning sickness characterized by vomiting and a poor appetite. She may also be constipated. One of the pregnancy hormones causes the muscles of the digestive tract to relax, and they therefore pass digesting food more slowly through the intestines. In addition, the uterus can press on the colon, inhibiting passage of feces. Similar mechanisms produce heartburn. The muscles at the junction of the esophagus and the stomach relax and the uterus presses on the stomach from below, causing the stomach contents to flow back into the esophagus. In late pregnancy, the stomach may even be pushed up into the chest, producing a hiatal hernia.

A number of changes are necessary in the structures supporting the uterus to stabilize it as it grows. The ligaments in the pelvis and abdomen stretch to accommodate the uterus, in late pregnancy the upper part of the spine bends backward to compensate for the enlarging abdomen. Hormones loosen the joints of the pelvis in preparation for childbirth.

Hormonal influences are also responsible for changes in the skin. Pigmentation of the nipples, vulva [the external genital organs], the center of the lower part of the abdomen, and the umbilicus increases. Darkening across the face may appear; this is known as chloasma, or the mask of pregnancy. Hormones can also cause reddening of the palms and the appearance of small red spots on the skin; these are nests of blood vessels, which are known as spider nevi or telangiectasias. Sweat and all glands also become more productive.

One of the most important changes during pregnancy is the increase in metabolism, which is necessary to provide nourishment to the fetus .A woman must eat more in order to supply adequate protein, carbohydrates, and fat to the fetus and her own enlarging body. Most women gain about twenty-five pounds, three pounds in the first trimester, and ten to twelve pounds in each of the second and third trimesters. The placenta, fetus and amniotic fluid and the increased volume of blood and breast and urine tissue account for twenty pounds of that weight gain. The rest of the weight is fat and extra fluid. A pregnant woman must also take in more vitamins and minerals for the growing of the fetus. Calcium, which is needed for developing bones, and iron, which is used to make new blood cells, generally needs to be ingested in greater amounts from the fourth month of pregnancy on.

The physical changes during pregnancy are miraculous. Amazingly, though, the physical alterations in the mother reverse after birth, and her body returns to its normal state. For the new baby, however, the process of change that started nine months before has just begun.

Cigarettes

Cigarette smoking poses a serious threat to the well being of your developing baby. Mothers that smoke have smaller babies than mothers who do not smoke. Smoking is also associated with a greater incidence of miscarriage, prematurity, stillbirth, and death of the baby soon after birth. According to congressional testimony of members of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, nearly fourteen thousand prenatal deaths per year are attributable to smoking by pregnant women. Further smoking by mothers has been shown to be associated with impaired intellectual and physical in their children.

Still, if you have always smoked it may be difficult to stop during pregnancy. If you cannot stop entirely, just cutting down is helpful since the harmful effects of smoking are close related.

The following tips may help you cut down or quit smoking.

1. Cut down on the number of cigarettes you smoke each day. Try to continue to reduce the number of cigarettes a little more each week.
2. Cut each cigarette in half and smoke only the half with the filter.
3. Choose a brand that is lowest in tar and nicotine.
4. Take fewer puffs on each cigarette you smoke.
5. Use a water filter, which can be purchased at the drugstore.
6. Consider entering a program designed to help you quit. The American Lung Association can help you find one.

If you cut down on your smoking or quit altogether during your pregnancy, try not to resume the habit after having your new baby. Children of smokers have been shown to have a greater susceptibility to respiratory diseases.

Marijuana

Marijuana use has been associated with pulmonary cancer. It has been shown to have negative effects on memory and can cause menstrual irregularities.

Studies in animals have shown that the active ingredient in marijuana crosses the placenta and accumulates in the fetus. Effects on the offspring include intrauterine growth retardation, low birth weight, and changes in secondary sex characteristics. In humans, precipitate labor [which ends with rapid expulsion of the fetus]; prolonged labor, low birth weight, prematurity and a greater risk of fetal distress have been associated with marijuana use.

Cocaine

Cocaine has profound effects on the mother and her fetus. It causes an increase in maternal heart rate,; constriction of the blood vessels of the placenta, allowing less blood to reach the fetus; increased secretion of stress hormones, which cause constriction of uterine blood vessels and increased uterine contractility.

It has been difficult for researchers to isolate the effects of cocaine since so many users take others as well. However, cocaine use is also thought to be related to a high incidence of spontaneous abortion and to placenta abruption. Infants whose mothers use cocaine have a difficult time adjusting to environmental stimuli after birth and may be addicted to the drug.

Alcohol

Heavy drinking during pregnancy [more than five or six drinks daily] puts the baby at risk for fetal alcohol syndrome. Affected babies are born with physical malformations, including microcephaly [abnormally small head], certain heart defects and often subsequent mental retardation.

Even moderate [one or two drinks per day] and social [three or four drinks per day] drinking have been associated with problems. Some research points to a higher miscarriage rate among women who drink moderately. Other studies associate this level of drinking with a more frequent occurrence of birth defects and lower birth weights.

No safe level of alcohol has been established yet. As a result it is probably best to take a cautious approach to alcohol consumption by abstaining or drinking very little and very infrequently. Probably the best way to handle social situations is to choose a non-alcoholic substitute, such as tomato juice, sparkling water, or fruit juice.

Other Medications and Drugs

Pregnancy is a time for prudent use of drugs. Since no drug has been proved safe for the unborn child, and some of the drugs have been proved unsafe, you will want to be cautious about the medications you take. Drugs and medication include any of the over the counter remedies you may buy as well as prescriptions authorized by your doctor. Your doctor can help you to decide when medications are indicated for you during pregnancy.

Your pregnancy involves very many people besides yourself and your new baby. Your family, of course, is affected. You may have a Lamaze teacher and an exercise instructor. And you will certainly have a doctor; your obstetrician is a partner in your pregnancy. He or she will have the responsibility for you and your baby’s health, so you want to be sure the doctor is qualified and competent. In addition, he or she will intimately participate in a very special event in your life-you want someone with whom you can cooperate and feel comfortable.

Finding the right obstetrician may take some work. You may need to talk to people and visit a few doctors before you are satisfied. You can get recommendations from many different sources. Friends and relatives may suggest their obstetricians. Another doctor, such as your internist, may provide a name. Maternity nurses, or obstetrical residents [doctors in training], at your local hospital often know which obstetricians in the community are good. You can ask the department of obstetrics and gynecology at the nearest university hospital for the names of graduates, or faculty members who work n your area. If these avenues fail, try contacting a childbirth education group, such as the International Childbirth Educational Association, or a local Lamaze instructor.

When you have the name of an obstetrician who sounds promising, your next step is to find more information about her. To be sure she is a competent doctor, check out her training. An obstetrician should have completed an obstetrics residency at a registered hospital and should be certified by the American Board of Obstetrics and Gynecology.

Next, find out which hospital she is affiliated with the hospital should be accredited by the Joint Commission on Accreditation of Hospitals [JCAH]. Find out whether the hospital is a teaching institution. If it is, be sure you understand how residents will participate in your delivery. The hospital should be covenant for you, and it should have the facilities you want or need for your delivery. Some hospitals have only the traditional separate labor and delivery rooms. Others have elaborate birthing centers. If you are at risk for having problems during pregnancy or delivery, the hospital should have an infant intensive care nursery.

Find out about the people the doctor works with. If she works with a group of doctors, they probably take turns being on call at night, if you go into labor on a night your doctor is not on call, will she come in or will one of her partners perform the delivery? If one of her partners may deliver your baby, you will have to be sure that you are comfortable with the other members of the group and that they have the same attitudes towards childbirth as your doctor. Otherwise, the delivery you so carefully planned may be changed at the last minute. Some obstetricians employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement.

Finally, don’t be afraid to ask about finances. Be sure your insurance will cover the doctor’s charges and find out how and when payment is expected. Find out what happens to the charges if there are any complications.

When you have collected your information, you are ready for your first meeting with the doctor. It is a good idea for Dad to accompany you so he can ask questions and form an opinion of the doctor as well. If you haven’t been seeing an internist or gynecologist regularly, it is a good idea to choose an obstetrician before you conceive; arrange a pre-pregnancy appointment to make sure there are no medical conditions that make pregnancy inadvisable at the time. If you have been receiving regular medical care, your first appointment should occur as soon as you think that you are pregnant, usually two weeks after the missed period. During the first visit the doctor will take a complete medical history including discussion of past and present illnesses and past pregnancies. A complete physical exam, not only a pelvic exam, should be done. You should have an opportunity to discuss with the doctor issues about your pregnancy and delivery. Be prepared for this part of your visit. Make a list of questions you want to ask. The obstetrician should be willing to answer any questions and discuss the type of care you will receive. She should be flexible about issues that are important to you, but if she feels that something you want will compromise your care, she should be willing to explain to you why.

You will want to talk about pregnancy and delivery. Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby’s development. Discuss with the doctor what you should eat. How many more calories will you need? How does she feel about you drinking coffee or other caffeinated beverages? What about alcohol consumption? She will probably recommend vitamins and calcium supplements. Discuss with her how much exercise you should get. Would she recommend an aerobics class? Find out what you should do if you become ill. What medicines can you take and what should you avoid? An obstetrician can monitor a pregnancy with blood tests, urine tests, ultrasound studies and amniocentesis. What does she think is appropriate for you?

There are many decisions regarding delivery that should be made beforehand. You need to decide where you want to give birth-in a regular delivery room or in a birthing center. If you want your husband or other children there, be sure your doctor agrees. If you have strong opinions about the medical treatment during labor and delivery, be sure to discuss them with your doctor. For example, some women do not want an intravenous line, anesthesia or an episiotomy [a surgical incision to enlarge the external opening to the birth canal and make delivery easier]. Fetal monitoring is another topic you wish to inquire about. You may want to find out your doctor’s opinions about inducing labor and cesareans. Ask her how many cesareans she performs. If her rate is high, try to find out why. Does she have a high risk population or is she just quick to operate?

By the time you are finished discussing all of these topics, you should have a good idea how well you like the obstetrician. Do you feel at ease with her? While you may not agree on very subject, you should feel confident that you can develop a working relationship and that you can discuss a problem and reach a compromise that will be satisfactory for both of you.

Finding an obstetrician may be easy, or it may require an extensive search. Because the doctor plays such an important role in your life at this time, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and baby delivery will be as safe and as joyful as possible.

Conception occurs two weeks after the women’s last menstrual period. The egg and the sperm fuse to produce one cell. In the first three months, or trimester, the embryo takes shape and all the organs are formed. In the last six months, the fetus grows and matures.

In the first weeks after conception, the single cell rapidly divides into many cells. A hollow ball of cells is formed and becomes attached to the womb. Some of the cells will become the placenta; the rest will become the embryo. The latter group of cells develops into a four-layered disc. Each layer will be converted into different areas of the body. The outer layer of ectoderm, for example will develop into skin, hair, nails and the nervous system. The inner layer, or endoderm, will develop into the intestines and lungs. The middle layers will develop into the heart, bones, and muscles.

By three weeks after fertilization, or about one week after the first period is missed, the embryo already is one-tenth of an inch long and has an oval shape. In the next few weeks, it becomes more curved in shape and a head and tail are discernable. The beginning of the spinal cord and brain take shape. A tubular heart begins to form. Tiny eyes can be seen. Arms and legs begin to bud.

By the fourth week after fertilization, traces of all the organs of the body are present. Bulges that become the ears and nose appear. The gut is formed from blind pouches within the embryo; these push forward, creating an opening in the head that will become the mouth. A crude face begins to take shape. At this point, the embryo is only one quarter of an inch long.

The embryo is called a fetus at the seventh or eighth week. It has grown to be the length of one inch; the head is disproportionately large because of the size of the developing brain, while the abdomen seems large because of the growing liver. Fingers and toes appear. The rudiments of all the hormone- producing glands-the pituitary, thyroid, and the adrenal glands-are present. Amazingly, the tiny heart begins to beat.

By the end of the third month, the fetus is two to three inches long and weighs less than an ounce. Nails form on the fingers and toes. The bones begin to calcify. The male or female sex organs begin to develop. The tooth buds form in the mouth. The fetus begins to make breathing movements and starts to swallow amniotic fluid. The muscles in the intestines begin to contract and relax, as if digesting food. Skeletal muscles begin to work as well, so the fetus can move to response to local pressure.

Although the organs are present by the end of the first trimester, the fetus is not yet able to live outside the mother’s body. The second trimester is devoted to primarily to maturation of the organs. By the fourth month, the fetus moves spontaneously but is too small for the mother to feel. The fetus is four to five inches long and weighs three ounces.

By the fifth month, however, the baby is six inches long and weighs one half pound, and is strong enough to make his presence felt. The mother’s perception of the baby’s movement is known as quickening. In the fifth or sixth month, the body becomes covered in fine hair, or lanugo and coarse hair appears on the head.

The baby is fully developed by the beginning of the third trimester. The last three months, therefore, are devoted to growth. The baby is about ten inches long and weighs one to two pounds by the seventh month. The skin is red, wrinkled and thin. It becomes covered in vernix, a thick, whit, sticky material composed of skin cells, ` and oily skin secretions. If the baby were born at this time, he would have a fifty percent chance of survival, provided he received appropriate medical care. Babies born this early can respond to taste, light, and sound.

If the baby is born in the eighth month of gestation, his chance of survival increases to ninety percent. By this time, he is ten to twelve inches long and weighs three to four pounds.

The final preparations for independent existence occur during the ninth month. Surfactant, a substance that lines the lungs and allows them to expand easily, develops. Fat is stored, and its deposition under the skin smoothes out the wrinkles. Much of the lanugo disappears.

By the final month of pregnancy, the fetus is usually fourteen to sixteen inches long and weighs seven to eight pounds. He is large and strong enough for the next step-birth and independent life. That one cell has come a long way, from embryo, to fetus, to newborn baby.