Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 3 Common Changes and Concerns in Pregnancy

Pregnancy brings about profound physical changes in you, dynamic growth and development in your baby, and emotional adjustments for you and your partner. It’s an amazing and exciting time, yet you may find yourself wondering and worrying how your pregnancy is affecting you and your baby. You may try to imagine what your baby looks like in your womb. You may be unsure how you’ll react to the many changes ahead. Learning what to expect during a normal and healthy pregnancy may help put your feelings and worries into perspective and let you enjoy your pregnancy.

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In this chapter, you’ll learn about:

• Physical and emotional changes you may experience during pregnancy

• The dramatic growth and development of your baby before birth

• Common emotions of expectant fathers or partners

• Common concerns and special challenges in pregnancy

Your Body’s Preparation for Pregnancy

Since roughly the time you reached puberty, your body has naturally been preparing for pregnancy. The design of your body’s reproductive system makes pregnancy possible.

Your reproductive anatomy includes both internal and external structures. The labia, urethra, clitoris, and vaginal opening are your external genitals, shown below. These body parts plus your anus are your perineum. Many pairs of muscles attached to your pelvis support the perineum and form a strong sling with openings for your urethra, vagina, and anus. These are your pelvic floor muscles.

The drawing on page 35 shows your internal reproductive organs. Your uterus (or womb) is a hollow, muscular organ the size and shape of a pear, and your vagina is a stretchy tube-shaped canal. The lower part of your uterus, which protrudes into your vagina, is your cervix. Your fallopian tubes provide the paths for an egg (ovum) to travel from your ovaries (sex glands) to your uterus.

Your ovaries produce the female sex hormones estrogen and progesterone (see page 37). After puberty, your ovaries undergo a cycle of changes every month (give or take a few days), unless you’re pregnant. During a cycle, an egg matures in one ovary and causes increased secretion of estrogen, which along with progesterone stimulates growth of the uterine lining (endometrium). Usually only one egg ripens each cycle and is released into one of your fallopian tubes. This process is called ovulation, and it usually occurs about halfway through your cycle, but it can occur earlier or later. As the fine hairs in your fallopian tube propel the egg slowly toward your uterus, your ovary produces more progesterone, which stimulates the uterine lining to become a rich, nourishing home for a fertilized egg. If fertilization doesn’t occur (which means you’re not pregnant), your estrogen and progesterone levels diminish and your uterus sheds its unneeded lining. This shedding process is called menstruation.

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Conceiving Your Baby

Conception occurs (and you become pregnant) when a sperm from your partner fertilizes (penetrates) your egg.

When your partner has an orgasm, he ejaculates about 1 teaspoon of semen, which contains 150 million to 400 million sperm. If ejaculation occurs during sexual intercourse, these sperm travel from your vagina into your uterus and out to your fallopian tubes. Sperm can live inside you for up to three days, while your egg is viable for only twelve to twenty-four hours after ovulation. Conception usually happens in the part of the fallopian tube farthest from the uterus when a single sperm fertilizes the awaiting egg.

Occasionally, a woman ovulates more than one egg, and a separate sperm fertilizes each one, resulting in fraternal (non-identical) twins, triplets, quadruplets, or higher-order multiples. Sometimes, a single fertilized egg divides into two and produces identical twins. For information on pregnancy with multiples, see page 53.

Common Q & A

Q: If my partner and I have trouble conceiving, what can we do?

A: Difficulty conceiving a child can be frustrating. Visit our web site, http://www.PCNGuide.com, for ways you can improve your health before conceiving and ways to enhance fertility. If you’ve been trying for more than a year, you may want to consult an infertility expert who can look for possible complications with ovulation or a low sperm count. If a problem is discovered, you may choose to use assisted reproductive technology (ART). To learn more about ART, visit http://www.cdc.gov/ART or http://www.marchofdimes.com/pnhec/173_14308.asp.

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Now That You’re Pregnant

When you suspect that you’re pregnant, you may experience some or all of the early signs of pregnancy, which are caused by hormonal changes that begin almost immediately after conception. Here are symptoms that you may notice:

• Breast changes: fullness, tenderness, tingling in the nipple area, and a darkened areola (the area around each nipple)

• Missed menstrual period

• Fullness, bloating, or ache in your lower abdomen

• Fatigue and drowsiness

• Feeling lightheaded or faint

• Nausea or vomiting at any time of the day (“morning sickness”)

• Frequent urination

• Increased vaginal secretions

CONFIRMING YOUR PREGNANCY

If you don’t experience the above physical symptoms, you might not suspect you’re pregnant until you’ve missed a menstrual period, at which time you may take a home pregnancy test. These do-it-yourself kits check your urine for human chorionic gonadotropin (hCG), a hormone that’s produced only during pregnancy. Available in most drugstores and discount stores, they usually provide supplies for two tests. Taking one test after missing a period and another a few days later is more accurate than taking only one test.

To confirm your pregnancy, you can make an appointment for a blood test with a medical professional. If you’re pregnant, he or she may give you basic information to help ensure a healthy pregnancy, such as taking folic acid supplements, until you have your first prenatal appointment and can learn more about prenatal health. Even before starting your prenatal visits, it’s wise to begin adopting a healthy lifestyle and eating a well-balanced diet. (See Chapters 45, and 6.)

CALCULATING YOUR DUE DATE

Pregnancy (or gestation) lasts an average of 280 days or forty weeks after the first day of your last menstrual period. Although conception occurs within twelve to twenty-four hours of ovulation, it’s difficult to know exactly when ovulation occurred. For many women, ovulation happens about two weeks after the first day of their last period, but it can occur earlier or later in the cycle. This uncertainty makes it difficult to know exactly when a woman becomes pregnant, especially if she has sexual intercourse frequently and conception can’t be traced back to a particular day.

For these reasons, caregivers calculate the due date by using this simple formula: Subtract three months from the date of the first day of your last period (a date you can confirm), then add seven days. For example, let’s say the first day of your last period was February 1. Subtracting three months from that day leads to November 1, then adding seven days gives you a due date of November 8. Most caregivers also suggest an optional ultrasound scan in early pregnancy to help estimate your due date. (See page 69.)

Keep in mind that a due date is just an estimate of when your baby will be born. Generally, babies are born healthy and normal any time from three weeks before to two weeks after their due dates. In fact, most babies are born within ten days of their due dates, and only about 5 percent are born on their due dates.

If a due date is just a guess, why is it important? A due date is based on many assessments and decisions that help your caregiver do the following:

• Determine when best to do genetic testing

• Recognize whether results of specific lab tests are within the normal range

• Diagnose a preterm or post-date pregnancy

• Identify a baby who’s growing more slowly or rapidly than normal

Because normal pregnancies vary in length, your caregiver will look at a range of normal test results when making these assessments.

HORMONAL CHANGES DURING PREGNANCY

Changes in hormone production cause many of the physical and emotional changes in pregnancy, helping ensure a healthy pregnancy and the optimal development of your baby. The placenta is the major source of these hormones. (See page 39.) Here’s how the various hormones affect you and your pregnancy:

• Human chorionic gonadotropin (hCG) is a hormone produced only during pregnancy. (Pregnancy tests check for hCG in your blood or urine.) This hormone ensures that your ovaries produce estrogen and progesterone for the first two to three months of your pregnancy, until your placenta matures and produces the appropriate amount.

• Estrogen promotes the growth of your uterine muscles and their blood supply, encourages production of vaginal mucus, and stimulates the development of the ductal system and blood supply in your breasts. Changes in water retention, body fat buildup, and skin pigmentation are related to estrogen levels. In late pregnancy, rising estrogen levels increase the uterus’s sensitivity to oxytocin and help start labor.

• Progesterone relaxes your uterus during pregnancy, keeping it from contracting too much. It also relaxes the walls of blood vessels (helping you maintain a healthy blood pressure) and the walls of your stomach and bowels (allowing for greater absorption of nutrients and sometimes causing constipation). In late pregnancy, progesterone has less effect on your uterus, letting contractions increase and start labor.

• Relaxin from your ovaries relaxes and softens your ligaments, cartilage, and cervix, making these tissues more stretchable during pregnancy and letting your pelvic joints spread during birth.

• Prostaglandins, produced in your amniotic membrane, increase in level during late pregnancy. Prostaglandins soften and ripen your cervix in preparation for labor, and stimulate muscles in your uterus and bowels.

• Corticotropin-releasing hormone (CRH) comes from your baby, placenta, and tissues within your uterus. Increased levels of CRH in late pregnancy change the ratio of estrogen to progesterone.

• Oxytocin, produced in your pituitary gland, stimulates uterine contractions to help trigger the onset of labor and promote labor progress. Often referred to as the “love hormone,” oxytocin is present during an orgasm. It’s also responsible for the urge to push at the end of labor and for the let-down reflex during breastfeeding. Oxytocin improves mood and produces feelings of calmness and well-being.1

Pregnancy also produces greater quantities of many hormones that are present when you’re not pregnant. These increased hormone levels cause other physical changes and influence your metabolism, mineral balance, tissue and organ growth, levels of still other hormones, and the onset of labor.

First Trimester Changes for You and Your Baby

Pregnancy is divided into three trimesters, each one lasting about three months. The first trimester is the “formation” period, because by the end of it all of your baby’s organ systems are formed and functioning. For you, the first trimester is a time of physical and emotional adjustment to being pregnant.

THE FIRST FOUR WEEKS OF PREGNANCY

This time marks conception through the first two weeks of your baby’s life (four weeks gestational age).

Changes in Your Baby

At conception, your baby gets inherited characteristics from you and her father. Every normal human cell contains forty-six chromosomes of genetic material; an egg and sperm each contains half that number. When a sperm fertilizes an egg, the resulting twenty-three pairs of chromosomes combine to form a unique genetic blueprint for development. This blueprint decides at conception your baby’s sex, blood type, eye and hair color, nose and ear shape, and some personality traits and mental capabilities. To a great extent, this blueprint also guides your baby’s growth and development throughout her life.

Throughout pregnancy, the terms used to describe a baby change to reflect age and development. After conception, the fertilized egg quickly divides from one cell into two, then four, eight, sixteen, and so on until it becomes a multicellular structure called a blastocyst. Within five to nine days, the blastocyst has made its way along the fallopian tube and implants in the uterine lining, usually in the upper part of the uterus. By two weeks, the baby is called an embryo and another part of the fertilized egg is developing into the placenta. This primitive placenta has tiny rootlike projections that penetrate the uterine lining and acquire nutrients for the developing embryo.

Changes in You

While these changes are taking place in your baby, you may have noticed only some breast tenderness or a slight ache in your belly. But you’re about to miss your menstrual period, and the remarkable changes that you’ll experience have just begun!

THE 5TH THROUGH 14TH WEEKS OF PREGNANCY

This time marks the third through twelfth weeks of your baby’s life (five to fourteen weeks gestational age).

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Changes in Your Baby

During the first few weeks of this trimester, your baby is an embryo that’s developing rapidly. His nervous system and circulatory system are forming, and his heart is beating by the twenty-fifth day after conception. Your baby has simple kidneys, a liver, a digestive tract, and a developing umbilical cord. When he’s only half the size of a pea, arm and leg buds appear and his face begins to form.

Although your baby’s sex is determined at conception, male and female babies appear the same until the embryo is about nine weeks old. Then, if the embryo is male, he begins producing androgens, male hormones that signal the development of the scrotum and penis. If female, her external genitals and internal reproductive organs form.

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By eight weeks after conception (ten weeks gestational age), your baby is structurally complete. His mouth has lips, a tongue, and teeth buds in his gums. His arms have hands with fingers and fingerprints. His legs have knees, ankles, and toes. His arms and legs move at this time, but coordinated movements don’t begin until about fourteen weeks. His developing brain begins to send out impulses. His heart is beating strongly and can be seen easily during an ultrasound scan. Your baby grows about 1 millimeter a day. When he’s nine weeks old (eleven weeks gestational age), he’s called a fetus.

During the first three months, your baby becomes quite active, although you’re probably unaware of any movements. Legs kick and arms move. Your baby can suck his thumb, swallow amniotic fluid, and urinate drops of sterile urine into the amniotic fluid, which is completely exchanged about every three hours. Your baby makes breathing movements (that is, his chest rises and falls); “breathing” amniotic fluid into his lungs appears to help with lung development. By ten to twelve weeks (twelve to fourteen weeks gestational age), your baby’s eyelids cover his eyes, but his eyes remain closed until the sixth month.

Development of the Placenta and Changes in the Uterus

During the early weeks of pregnancy, your uterine lining becomes thicker and provides a rich source of nourishment for your growing baby. At the end of the first month of development, projections (chorionic villi) extend into your uterine lining, becoming a primitive placenta. Your baby’s blood circulates through the chorionic villi, while your blood circulates into the spaces surrounding them (intervillous spaces). A thin membrane separates the two bloodstreams, which normally don’t mix.

The membranes (amnion and chorion) create the amniotic sac that surrounds your baby. The amniotic fluid protects your baby by absorbing bumps from the outside, maintaining an even temperature, and providing a medium for easy movement.

By twelve weeks of pregnancy, the placenta is completely formed and serves as an organ for producing hormones and exchanging nutrients and waste products. Most identical twins share the same placenta. Fraternal twins have separate placentas, though the placentas sometimes fuse into one large organ.

The umbilical cord links the placenta to your baby’s navel, and together the umbilical cord and placenta pass oxygen and nutrients from you to your baby. While the placenta provides a barrier against most (but not all) bacteria in your bloodstream, most viruses and drugs cross to your baby. The placenta also exchanges waste products from your baby, which your blood then carries to your kidneys and lungs for excretion.

By fourteen weeks of pregnancy, your uterus has grown to just above your pubic bone. The cervix is about 4 centimeters long and, though softer than before pregnancy, still fairly firm. The mucous plug that fills the cervical opening provides a barrier to help protect your baby.

Different Views on the First Trimester

Expectant mothers were asked: “What emotional changes did you notice in the first trimester?” Although there were many different views, the responses shared the following sentiments:

I found myself crying at silly things.

I felt like a worrywart over my baby’s health.

Besides being more emotional, I felt pretty good overall. It feels good to be pregnant.

Changes in You

By five weeks (possibly earlier) from the first day of your last menstrual period, a pregnancy test should show a positive result. During the first trimester, you may feel unusually tired and need more sleep because of your changing metabolic rate and your increased energy needs while growing a baby. You may urinate more often as your enlarging uterus presses on your bladder. Many women experience nausea and vomiting during the early months of pregnancy. (See page 119.) Although usually called morning sickness, this symptom of pregnancy may occur at any time of the day. While the cause of morning sickness is unknown, it’s thought that hormones produced by the developing placenta play a role.

Although your breasts develop in puberty, your milk glands don’t fully develop until pregnancy. As hormone levels increase, your breasts change in preparation of providing milk for your baby. Your breasts enlarge, your veins appear bigger, and your nipples may be tender or have a tingling sensation. Your nipples and areolae also enlarge and become darker. Little bumps on your areolae (called Montgomery glands) enlarge to produce more lubricant in preparation for breastfeeding.

Although these early pregnancy changes feel dramatic to you, you might not look much different to others or to yourself.

Your Emotions

Finding out that you’re pregnant may bring about many emotions for both you and your partner. You may be proud that you conceived a child, worried about miscarriage, hesitant to focus on the baby if awaiting genetic testing results, afraid of losing your independence, fretful about changes in your relationship, doubtful of your ability to parent, and happy about becoming parents. You may cry easily or react strongly to minor inconveniences. Your mood swings seem more pronounced, which may be difficult for you and your partner to understand. Talking with your partner and sharing your thoughts and feelings can help you work through this transition together.

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Calendar of Pregnancy: First Trimester

Changes in Baby, Placenta and Uterus

Gestational Age: Six Weeks

• About 0.1 inch long

• Brain and spinal column begin to form.

• Beginning development of gastrointestinal system, heart, and lungs.

• Amniotic sac envelops the preliminary tissues of entire body.

• Is called a blastocyst from five days to two weeks, then called an embryo.

• Uterus is enlarging.

• Uterine lining is thick, with increased blood supply.

• Placenta and umbilical cord are forming.

• Human chorionic gonadotropin (hCG) is present in mother’s blood and urine.

Gestational Age: Ten Weeks

• About 1 inch long

• Face is forming with simple eyes, ears, nose, mouth, and teeth buds.

• Arms and legs begin to move.

• Fingerprints are present.

• Brain is forming.

• Fetal heartbeats can be seen on ultrasound scan.

• External genitals begin to appear.

• Is called an embryo.

• Uterus is size of tennis ball.

• Umbilical cord has definite shape.

• Amniotic fluid cushions fetus, maintains even temperature, and allows easy movement.

Gestational Age: Fourteen Weeks

• About 3 inches long

• Weighs about 1 ounce.

• Can move arms, legs, fingers, and toes.

• Can smile, frown, suck, and swallow.

• Sex is distinguishable.

• Bone cells begin to appear.

• Can urinate.

• Heartbeat can be heard with ultrasound stethoscope.

• Vocal cords complete

• Is called a fetus.

• Uterus is size of grapefruit and reaches just above pubic bone.

• Amniotic fluid fills uterine cavity and is continually replaced.

• Placenta is small but complete, with full exchange of nutrients and waste products.

• Placenta is major source of estrogen and progesterone.

First Trimester Changes (You may experience some or all of these.)

Common physical changes in mother

• No menstrual periods

• Fullness, bloating, or ache in pelvis or lower abdomen

• Constipation

• Nausea and vomiting (morning sickness)

• Fatigue and sleepiness

• Feeling faint or lightheaded.

• Frequent urination

• Breast changes: fullness, tenderness, tingling of nipples, darkened areolae

• Aversions to some foods and odors

• Metallic taste

• Increased salivation

• Increased vaginal secretions

• Weight loss or gain up to 5 pounds

Common emotional changes in mother

• Mood swings

• Greater interest in meaning of motherhood

• Increased worries about everything

Common emotions of father or partner

• Difficulty acknowledging pregnancy

• Difficulty seeing baby as real until proof by ultrasound scan or audible heartbeat

• May gain weight and experience nausea as an empathetic response to her pregnancy.

Common changes for both parents

• Mixed feelings about pregnancy: happy, excited, relieved, surprised, proud, anxious, scared, and/or nervous

• Concern about mood swings and fatigue

• Changes in sexual relationship

• Fear that sexual intercourse harms baby

• Examination of feelings toward own parents and their parenting techniques

• Determining parenting roles and family values

• Concerns about finances

• Concern for baby’s well-being

Second Trimester Changes for You and Your Baby

The second trimester is the “development” period, because your baby’s organs and structures begin to enlarge and mature. For you, this trimester is a time of feeling well, energetic, creative, and emotionally sensitive—often at the same time.

THE 15TH THROUGH 27TH WEEKS OF PREGNANCY

This time marks the thirteenth through the twenty-fifth weeks of your baby’s life (fifteen through twenty-seven weeks gestational age).

Changes in Your Baby

In this trimester, your baby starts to grow hair, eyelashes, and eyebrows. Fine, downy hair (called lanugo) develops on her arms, legs, and back. Fingernails and toenails appear. At eighteen weeks of pregnancy, your baby can do all the movements you’ll see her do as a newborn.

Forming in your baby’s intestines is meconium, a collection of digestive enzymes and residue from swallowed amniotic fluid. Your baby won’t expel the meconium until after birth. (When she does, it’ll look like a thick, sticky, greenish-black substance.) Her skin is wrinkled and covered with a creamy protective coating called vernix caseosa. During this trimester, you’ll probably feel your baby move for the first time (an experience called quickening). You may feel a light tapping or fluttering sensation that reminds you of gas bubbles. Or you might not notice your baby’s gentle movements. Although still very immature, some babies born near the end of this trimester (twenty-five weeks gestational age) survive.

Changes to the Placenta and Uterus

Your uterus expands into your abdominal cavity to accommodate your growing baby, placenta, and level of amniotic fluid. During prenatal appointments, your caregiver measures the height of your uterus to check that your baby is growing adequately. Although a baby’s size and the amount of amniotic fluid differ among pregnancies, the length of your pregnancy in weeks approximates the distance in centimeters between your pubic bone and the top of your uterus (called the fundus). For example, at twenty-five weeks, fundal height is about 25 centimeters.

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During this trimester, your uterus normally contracts periodically, although you might not notice it. Called Braxton-Hicks contractions, they make your uterus hard for about a minute but aren’t painful. Different from labor contractions, Braxton-Hicks contractions don’t cause changes in your cervix. If these contractions do cause your cervix to change and it begins to open, you’re in preterm (or premature) labor and require medical attention. (See page 136.)

Changes in You

During these middle months of pregnancy, you probably feel physically well, and your nausea and fatigue likely have disappeared or diminished. The milk glands in your breasts begin making small amounts of colostrum (a highly nutritious yellowish fluid produced before breast milk) by mid-pregnancy.

Just as hormonal changes make your nipples and areolae darker, they also make other skin areas more pigmented. A dark line (called linea nigra) may appear between your pubic bone and navel. The skin around your eyes may darken, especially after sun exposure. This “mask of pregnancy” (called chloasma) usually disappears within a few weeks after your baby’s birth.

Your Emotions

Along with these physical changes, you may experience a wide range of emotions. You may enjoy how your pregnant body looks and feels, or your growing body may make you feel unattractive, inconvenienced, and restricted. Heightened emotions may bolster your creativity and make you respond strongly and with more sensitivity to a kind word, a beautiful sunset, or a touching photo. Pregnancy may affect your sleep, and you may recall more of your dreams than you did before becoming pregnant. You also may become introspective and find yourself easily distracted by a need to examine your thoughts and feelings.

During this trimester, your swelling belly usually becomes more obvious, and your pregnancy becomes real and exciting for your partner, family, and friends. Now they can feel the baby wiggle or kick. Being able to see evidence of the growing baby, your partner typically feels more involved in your pregnancy and more interested in your baby. Like you, your partner may have a range of thoughts and feelings about your changing appearance and about becoming a parent. (See pages 53–57.)

Share your feelings and thoughts with your partner often, and make sure to listen when your partner shares his or her feelings with you. You need each other’s support, now and in the months and years to come, as you adapt to parenthood. This trimester is a good time to start preparing for parenthood by reading books on parenting and newborn care, visiting web sites about babies, or buying baby clothes and equipment. (See page 160.)

Different Views on the Second Trimester

Expectant mothers were asked: “What emotional changes did you notice in the second trimester?” Although there were many different views, the responses shared the following sentiments:

I love feeling the baby move, but it’s weird having a separate person inside me.

Pregnancy is hard because I have no control over my emotions.

I’m looking forward to having the baby, but I like being pregnant. I’ll miss it.

I haven’t exactly “glowed” like my friends, but pregnancy has been a lot easier since I stopped having morning sickness.

Calendar of Pregnancy: Second Trimester

Changes in Baby, Placenta and Uterus

Gestational Age: Nineteen Weeks

• About 5–6 inches long

• Weighs about 4 ounces.

• Heartbeat is strong.

• Skin is thin, transparent.

• Downy hair (lanugo) covers body.

• Fingernails and toenails are forming.

• Has coordinated movements; is able to roll over.

• Uterus is 3 inches above pubic bone.

• Placenta performs nutritional, respiratory, excretory, and most hormonal functions for fetus.

• Amniotic fluid volume increases.

Gestational Age: Twenty-three Weeks

• About 10–12 inches long (6–8 inches crown to rump)

• Weighs 1/2–1 pound.

• Heartbeat is audible with ordinary stethoscope.

• Hiccups

• Hair, eyelashes, eyebrows are present.

• Uterus is at level of navel.

• About 2–3 pints of amniotic fluid

• Placenta is fully developed and covers about half the inner surface of uterus.

Gestational Age: Twenty-seven Weeks

• About 11–14 inches long (9–10 inches crown to rump)

• Weighs 1–2 pounds.

• Skin is wrinkled and covered with protective coating (vernix caseosa).

• Eyes are open.

• Begins to hear.

• Meconium is collecting in bowel.

• Has strong grip.

• Uterus is above level of navel.

• Placenta covers less of inner surface of uterus as uterus grows.

• Uterus contracts periodically (Braxton-Hicks contractions), which might not be noticeable.

Second Trimester Changes (You may experience some or all of these.)

Common physical changes in mother

• Sense of well-being; increased energy

• Noticing movement of baby.

• Increased appetite

• Disappearance of nausea

• Constipation

• Food cravings or nonfood cravings (pica)

• Skin changes: linea nigra, mask of pregnancy (chloasma)

• Less tenderness in breasts

• Nasal congestion

• Bleeding gums or nosebleeds

• Relaxation of pelvic joints

• Groin pain from round-ligament contractions

• Leg cramps

• Weight gain averaging 0.8–1.0 pound per week

Common emotional changes in mother

• Feeling more dependent on others.

• Introspective; have trouble concentrating

• More daydreaming and dreaming at night

• Developing sense of growth and creativity.

• Varying feelings about changing appearance

• Increased interest in babies

Common emotions of father or partner

• Feelings of closeness to the baby

• Evaluating readiness and ability to be a parent.

• Greater involvement in pregnancy

• Varying feelings about partner’s changing appearance

Common changes for both parents

• Changes in sexual desire and activity

• More enjoyment of pregnancy

• Eager to be prepared for baby’s arrival

• Increasing interest in and awareness of parenting styles

Third Trimester Changes for You and Your Baby

The third trimester is the “growth” period, because your baby is growing into the size and shape of a newborn. A baby born during this time usually survives, although his chances for an easy transition to life outside the womb improve the closer his birth date is to his due date. (For more information on prematurity, see pages 291–293.)

As your body continues to expand to accommodate your growing baby, you may start looking forward to the end of pregnancy and its physical discomforts and to the long-awaited joy of holding your newborn in your arms.

THE 28TH THROUGH

38TH WEEKS OF PREGNANCY

This time marks the twenty-sixth through thirty-sixth weeks of your baby’s life (twenty-eight through thirty-eight weeks gestational age).

Having Fun with Your Baby before Birth (after Twenty-five Weeks of Pregnancy)

• Every day, sing the same song to your baby or play him your favorite music. He’ll recognize it after birth. You also may want to read the same children’s book or poem aloud every day.

• Talk to your baby. Have your partner lay his or her head on your lap and “speak” to your belly. Your baby is learning to recognize your voices and may respond when he hears them.

• Press on your belly when you feel your baby’s hand or foot push against your uterus. See if he responds to your touch. Try pressing twice (like double-clicking a mouse) and see if your baby mimics your action.

• Shine a flashlight on your belly. See if your baby responds to the light.

Changes in Your Baby

In late pregnancy, your baby’s lungs mature, and your antibodies pass through the placenta to her, providing some short-term immunity to the diseases to which you’re immune.

Your baby’s fingernails reach her fingertips and may even need to be cut at birth. The hair on her head grows, the lanugo on her body almost disappears, and fat is deposited under her skin. Buds for her permanent teeth appear behind her primary (baby) teeth buds.

Your baby has periods of sleep and wakefulness. She may move in response to bright light and loud noises. She hears and becomes familiar with your voice and your partner’s voice, and with other sounds such as the placental circulation, your gurgling stomach, your heartbeat, and external sounds (for example, music or barking dogs). After birth, your baby will show a clear preference for a familiar voice by turning her head toward the speaker. In addition, sounds that mimic the placental sounds heard in the womb (such as the rhythmic sloshing of water in a dishwasher, the droning of a vacuum cleaner or a fan, or shushing sounds) often soothe a fussy newborn.

As your baby continues to grow and gain weight, she has less room to move around, and you may feel just her arms and legs move rather than her whole body. When your baby has hiccups, you feel a series of rhythmic jolts. At some point during the last trimester, your baby assumes a favorite position—usually head down. During prenatal visits, your caregiver determines the baby’s position by feeling your abdomen using a technique called Leopold’s maneuvers.

Changes in the Placenta and Uterus

At this point in your pregnancy, changes to the system connecting you to your baby help prepare you to give birth and breastfeed. The changes also help prepare your baby for birth. (See page 165.) Your cervix softens, your uterus becomes more sensitive to oxytocin, and you notice more contractions. The volume of amniotic fluid decreases, from about 1½ quarts at seven months to about 1 quart around your due date.

Changes in You

In this trimester, your uterus expands, possibly causing shortness of breath or sore lower ribs. High levels of progesterone and pressure from your uterus may cause indigestion, heartburn, varicose veins in your legs, hemorrhoids, or swollen ankles. You may have more backpain as your pelvic ligaments relax for birth, and your heavy uterus and growing baby change your center of gravity. (See Chapter 11 for ways to prevent and treat back pain.)

Small red bumps (called vascular spiders) may appear on the skin of your upper body, along with stretch marks (striae gravidarum) on your abdomen, thighs, or breasts. These marks are reddish during pregnancy and become glistening white lines after birth. Some women attempt to prevent stretch marks by using various lotions or oils, but no evidence shows that these products effectively work.

About two weeks before the birth, your baby “drops” into your pelvic cavity. This descent is called engagement or lightening. You may feel less pressure on your diaphragm and find breathing and eating easier. The tradeoff is, however, as the baby’s head presses on your bladder, you need to urinate more frequently. Some women notice that colostrum leaks from their breasts, but some don’t. Either case is normal.

Your Emotions

In the final trimester, you may think and worry more about labor, birth, and your baby. Talk to your caregiver about your thoughts and fears, and take childbirth preparation classes. Talking to other mothers about birth can be informative and reassuring; however, some of their stories may increase your fears. The same reasoning applies to surfing the Internet for information. Be aware of sources and try to avoid scare stories and alarmist web sites. Aim to balance the points of view so you’re accurately informed and not unduly upset.

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Different Views on the Third Trimester

Expectant mothers were asked: “What emotional changes did you notice in the third trimester?” Although there were many different views, the responses shared the following sentiments:

I’m having more loving feelings toward my baby at this time.

I’m more sensitive now, a little paranoid and worried—and these feelings are new and strange to me.

I just can’t get comfortable lying in bed; sometimes I need to sleep in the recliner.

I have trouble getting to sleep even though I feel exhausted.

I feel special carrying a new life that’s a combination of my partner and me.

At this point, you may feel tired most of the time. You may get more sleep if you lean on a big body pillow or use many pillows. You also may welcome a relaxing warm bath or a soothing massage. As your belly grows and you become less agile, you may depend more on your partner and others. Your sexual relationship also may require some adjustments, due to your physical limitations. (See pages 53–54.)

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As you anticipate the responsibilities of parenthood, you may begin thinking more about how your own parents raised you. You may want to follow some of your parents’ techniques to raise your child, but you may want to avoid others.

You and your partner may worry about your health or your baby’s well-being, especially if you develop a condition that makes your pregnancy high-risk. Know that a healthy lifestyle and early, consistent prenatal care can greatly diminish many of these conditions. If you find yourself worrying excessively, or dreaming about death or harm to you or your baby, share these fears with your partner, your caregiver, a childbirth educator, a relative, or an empathetic friend. Talking about your fears doesn’t make them more likely to happen. Instead, sharing your concerns with a supportive person can comfort you and help you put your fears into perspective.

THE 39TH AND 40TH WEEKS OF PREGNANCY

This time marks the thirty-seventh and thirty-eighth weeks of your baby’s life (thirty-nine and forty weeks gestational age).

Changes in Your Baby

In this last phase of pregnancy, your baby’s organs continue to mature in preparation for life outside your uterus. He also adds fat and gains about 1 pound. A newborn averages 20 inches in length, but a range of 18 to 22 inches is normal. At birth, a baby typically weighs 7 to 7½ pounds, although a normal weight for a full-term baby can vary from 5½ to 10 pounds. From the time your baby was just a fertilized egg, his weight has increased six billion times!

Changes in the Placenta and Uterus

Depending on the size and weight of the baby, the size of the placenta varies. Once you expel the placenta after the birth, it appears round, flat, and about 1 inch thick. The side that was implanted in your uterine wall is divided into lobes and appears rough and bloody. The side that was near your baby is smooth, pale, and shiny, and is covered by the amniotic membrane. The membranes (amniotic and chorionic) extending from the edge of the placenta formed the sac (bag of waters) that contained the amniotic fluid and your baby.

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The moist, white umbilical cord contains two arteries and one vein. Often twisted like a corkscrew, the umbilical cord measures 12 to 39 inches when pulled straight. At birth, when your baby breathes, her circulation pattern begins to change. Blood flow through her umbilical cord shuts down and more blood flows to her lungs.

Toward the end of pregnancy, prelabor uterine contractions become more obvious and frequent. These contractions enhance circulation in your uterus, press your baby against your cervix, and work with prostaglandins to soften and thin your cervix.

Changes in You

At this point, you may be looking forward to the end of pregnancy. You may be fed up with the light sleep, fatigue, and other typical discomforts of late pregnancy. At times, you may feel as though you’ll be pregnant forever! Visits to your caregiver, childbirth preparation classes, baby showers, nursery preparation, and other common late pregnancy activities should help you realize that your baby is coming soon and a new stage in your life will begin.

THE 41ST WEEK OF PREGNANCY AND BEYOND: POST-DATES

This time marks the thirty-ninth week (and beyond) of your baby’s life in the womb (at least forty-one weeks gestational age).

Although the average length of pregnancy is forty weeks, many pregnancies last longer and are considered post-date. Some post-date pregnancies are cases of mistaken due dates; others involve babies who need more time to grow and mature. Occasionally, the baby is ready to be born, but for unexplained reasons, labor doesn’t begin.

In a post-date pregnancy, a caregiver determines whether the baby and placenta are healthy by performing specific diagnostic tests. (See Chapter 7.) If all is well, pregnancy can continue until labor begins on its own.

Changes in Your Baby

Even if your pregnancy lasts beyond your due date, your baby might not be post-mature—that is, he doesn’t have symptoms such as an absence of lanugo; scant vernix caseosa; long fingernails and toenails; dry, peeling, or cracked skin; and unusual alertness at birth. True post-maturity is rare even in babies born two weeks after their due dates.

If your baby is not post-mature, he’s taking the extra time he needs to grow and prepare for life outside your womb.

Changes in the Placenta

In many post-date pregnancies, the placenta continues to support the growth and well-being of the baby.

In rare cases when the baby is truly post-mature, tests reveal that the placenta isn’t functioning as well, that the volume of amniotic fluid is dropping, and that the baby is showing signs of distress. Under these circumstances, the baby’s health can’t wait for labor to begin on its own, and the caregiver either induces labor or performs a cesarean section.

Changes in You and Your Emotions

Physically, you may continue feeling much as you did during late pregnancy. Emotionally, however, you may find waiting for labor to begin frustrating, worrisome, or depressing. Consider trying self-induction methods that may encourage labor to begin. (See pages 277–279.)

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Calendar of Pregnancy: Third Trimester

Changes in Baby, Placenta and Uterus

Gestational Age: Thirty-one Weeks

• 14–17 inches long (11–12 inches crown to rump)

• Weighs 21/2–4 pounds.

• Is adding body fat.

• Is very active.

• Breathing movements are present.

• Responds to sound.

• Uterus is three finger–breadths above navel.

Gestational Age: Thirty-five Weeks

• 161.2.18 inches long (12.13 inches crown to rump)

• Weighs 4.6 pounds.

• Has periods of sleep and wakefulness.

• May assume birth position.

• Bones of head are soft and flexible.

• Stores iron in liver.

• Uterus is just below breastbone and ribs.

• Uterine contractions (Braxton-Hicks) are more frequent.

Gestational Age: Thirty-eight to Forty-two Weeks

• 19–21 inches long (13–15 inches crown to rump)

• Weighs 6–8 pounds.

• More body fat and skin is less wrinkled.

• Lanugo is mostly gone.

• Vernix caseosa is thick.

• Lungs are mature.

• Is rapidly gaining antibodies from mother.

• In birth position

• May descend or “drop” into pelvis (engagement).

• Placenta is 6–8 inches in diameter, 1 inch thick, and about 1 pound.

• More frequent uterine contractions

• Cervix is softening (ripening) and thinning (effacing).

• Amniotic fluid volume is decreasing.

Third Trimester Changes (You may notice some or all of these.)

Common physical changes in mother

• Heartburn or indigestion

• Shortness of breath

• Soreness in lower ribs

• Urinary urgency and frequency (not painful urination)

• Tingling or numbness in hands

• Stretch marks; abdominal itching

• Increased perspiration and feeling warmer

• Increased colostrum

• Backache

• Changes in balance and agility

• Light sleep or insomnia

• Vascular spiders

• Hemorrhoids

• Varicose veins

• Swollen ankles

• Anemia

• Total weight gain of 25–35 pounds

Common emotional changes in mother

• Excitement and doubts about readiness for baby

• Focus on labor and birth, fear of childbirth pain, anxiety about the unknown

• Variety of feelings about body changes

• Feelings of clumsiness

• Difficulty in focusing attention

• Increased dependency on others; desire for protection

• Decreased sexual interest

• Increased attention from family and friends may be enjoyable at times, tiresome at others

• Relief that pregnancy is almost over

Common emotions of father or partner

• Protectiveness toward family

• Anticipation of parenthood

• Fear for health of mother and baby during childbirth

• Anxiety over support role in labor

• Longing for relationship to return to normal

• Frustration about inability to “fix” partner’s discomforts

• Worries when something is wrong

Common changes for both parents

• Continuing changes in sexual relationship

• Fear of harm to baby during sexual activity

• Excitement about baby’s arrival

• Emotional and mental preparation for birth

• Eagerness for pregnancy to end

• Choosing names for the baby

• Worries about labor pain and responsibilities of parenthood

• Simultaneous feelings of anticipation, exhilaration, excitement, and apprehension

Common Concerns and Considerations in Pregnancy

The following are typical concerns of pregnant women. Some apply only to women in specific situations. Others are of concern to all.

AGE OF THE MOTHER

In general, women between the ages of eighteen and thirty-five have few problems in pregnancy. Girls in their early teens and women over age forty may face more pregnancy risks; however, a healthy pregnant woman of any age is likely to have a healthy baby.

Teenage Pregnancy

If you’re a pregnant teenager, you have several strengths and some special needs. A teenager’s body is usually fit, and your chances of a healthy pregnancy are good. Because you’re young, your uterus is probably strong and your tissues are stretchy. Your labor will likely progress normally and won’t need medical interventions.

Because your body is still developing, you must eat well during pregnancy to properly nourish you and your growing baby. Just like every pregnant woman, you need to stay away from drugs, alcohol, and tobacco. Make sure you keep your scheduled prenatal appointments with your caregiver. Taking these steps helps prevent giving birth too early and delivering a baby with low birth weight—the main problems for teen pregnancies.

Some challenges of being a pregnant teenager include:

• Dealing with your parents’ reactions to your pregnancy

• Working with your baby’s father to address his role and responsibilities

• Attending school with peers who can’t relate to your situation

• Deciding whether to keep your baby or consider adoption

• Making decisions about your health care

You can work through these challenges by talking with a school counselor, a city or county health nurse, someone at a pregnancy counseling organization or the YWCA, or understanding friends and family members.

Pregnancy after Age Thirty-five

More than ever before, women in their thirties and forties are giving birth, many for the first time. Between 1980 and 2004, the birth rate in the United States increased twofold for women in their early thirties, threefold for women older than thirty-four, and fourfold for women forty and older. As an older woman, you may have delayed pregnancy for various reasons such as career or education priorities, financial considerations, infertility, or lack of a partner.

Advice from the Authors

Pregnant teenagers have unique needs and may require resources geared toward them. Here are some great books on teenage pregnancy:

• Life Interrupted: The Scoop on Being a Young Mom by Tricia Goyer (2004). Practical help on juggling school and single parenthood.

• Your Pregnancy & Newborn Journey: A Guide for Pregnant Teens by Jeanne Warren Lindsay and Jean Brunelli (2004). Easy-to-read guide on pregnancy.

• The Unplanned Pregnancy Book for Teens and College Students by Dorrie Williams-Wheeler (2004). Stories by young women, helpful resources, and useful strategies.

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When compared to a younger pregnant woman, your risk of having the following problems is higher: high blood pressure, gestational diabetes, growth problems or inherited disorders in the baby, preterm labor, problems with the placenta, fibroids, labor complications, and cesarean birth.

Why are you at greater risk of having these problems? The answer is simple: The longer a woman lives, the more likely poor health practices, accidents, illnesses, or environmental hazards have affected her body. Also, high blood pressure and diabetes (the two most common risks for older pregnant women) are disorders that increase with one’s age.

Despite these possible age-related complications, you’re less likely to develop problems in your pregnancy if you’ve enjoyed good health and taken care of yourself over the years.

As you age, infertility problems increase. If you used fertility drugs or treatments to get pregnant, you may be pregnant with more than one baby. If this is the case, you’ll experience many of the same pregnancy risks as women having multiples.

Your risk of problems in pregnancy varies depending on the number of children you’ve borne. In one study, researchers found that first-time mothers (primiparas) who were older had increased risks of preterm labor, excessive bleeding, or cesarean birth. But pregnant mothers who had birthed before (multiparas) and were older had increased risks of diabetes and chronic or gestational hypertension.2

Older women are more likely than younger women to be pregnant with a baby with a genetic disorder such as Down syndrome. Another potential risk factor is the age of the baby’s father. The risk of Down syndrome increases for babies whose fathers are older than thirty-five at conception; the risk further increases if both parents are older than thirty-five. In addition, babies whose fathers are older than forty at conception have an increased risk of certain rare congenital disorders such as dwarfism.

Various screening and diagnostic tests offered in early pregnancy can detect these conditions. (See pages 67 and 277.) Because the risk of genetic disorders gradually increases as a woman ages, caregivers typically use thirty-five as the starting age to recommend testing. At this age, the potential benefits from invasive tests, such as amniocentesis and chorionic villus sampling (CVS), begin to outweigh the risks. Now that more noninvasive screening tests are available (such as ultrasound scans and blood tests), younger women are also offered these tests.

As an older pregnant woman, your age and experiences may affect your attitude toward pregnancy. If you have a history of infertility or miscarriage, you may feel vulnerable. You may seek reassurance that your baby is normal and healthy by undergoing numerous tests and procedures designed to detect and treat problems. Be aware that some women find the testing process stressful, especially because the tests don’t always give clear results and thus lead to more testing. (See Chapter 7.)

If you’re thirty-five or older, what can you do to improve your chances for a healthy pregnancy and baby? Unless you have a preexisting health problem such as high blood pressure or diabetes, you should do what any well-informed pregnant woman does: Take good care of yourself, reduce stress, and have regular prenatal visits with a caring and competent caregiver. Although some problems may arise during your pregnancy, they’re almost always treatable or manageable. In fact, most women over age thirty-five give birth to healthy, full-term babies.

EXPECTING MULTIPLES: TWINS, TRIPLETS, OR MORE

Most often a woman discovers that she’s pregnant with multiples when an ultrasound scan reveals two or more babies. Your caregiver may suspect a multiple pregnancy if he or she hears two or more heartbeats or if your uterus seems to be growing faster than normal. A comprehensive ultrasound scan confirms a multiple pregnancy.

Twins account for about 3 percent of all births. Although just one-fifth of 1 percent of births results in triplets or more, their incidence has increased in recent years.

A woman pregnant with more than one baby has an increased risk of preterm birth, and thus premature babies. Prematurity causes most problems for multiples. Thankfully, improved medical care for women expecting multiples has helped decrease the risk of preterm birth of extremely small and immature babies.

If you’re expecting multiples, you may be both excited and stressed out. Growing more than one baby requires more energy, so you’ll probably need to consume more calories and rest more often because of discomfort, fatigue, and the increased risk of preterm labor.

Because birthing multiples is often more complicated than birthing one baby, the chance of cesarean birth rises with the number of babies you’re expecting. You may need the care of an obstetrician or a perinatologist. In addition to the increased medical attention, you can also expect more attention from your friends and relatives during your pregnancy. Friends and family usually offer new parents more help in the weeks after the birth of multiples. Be sure to take advantage of any such offer! See Appendix C for a list of resources for parents of multiples.

SEX DURING PREGNANCY

For most couples, pregnancy changes their sexual relationship, but how it changes isn’t the same for every couple. While one pregnant woman may feel clumsy and fat, another may feel ripe, beautiful, and sexual. One woman may feel sick and uncomfortable, while another feels radiant and wonderful. One woman may be alone or in a difficult or abusive relationship, while another may feel secure in a loving relationship. One woman’s partner may find the woman’s growing belly a turnoff, while another relishes her gorgeous appearance.

Fact or Fiction?

The only chance a woman has of conceiving multiples is if multiples run in her family or the baby’s father’s family.

Fiction. A woman also increases the likelihood of becoming pregnant with multiples if she:

• Is large and tall.

• Is older than thirty-five.

• Is Caucasian or African-American. (Multiples are less common in Asian and Hispanic women.)

• Had at least one other pregnancy.

• Used fertility drugs that increase the number of eggs released during ovulation.

• Had more than one egg implanted during procedures, such as in vitro fertilization.

Most of these factors affect only the rate of fraternal twins, triplets, or higher-order multiples, because the occurrence of identical siblings is an unpredictable and random event.

As your pregnancy progresses, you can expect your sex life to have its ups and downs. For some women in the first trimester, hormonal changes and increased blood flow to pelvic organs (plus, no worries about getting pregnant) increase a desire for sex. For other women, experiencing symptoms such as nausea, vomiting, fatigue, and breast tenderness decrease libido.

During the second trimester, many women notice a stronger libido and experience more sexual pleasure than in the other trimesters. At this stage of pregnancy, many women experience fewer physical discomforts, have more energy, and may be enjoying their new curvy bodies.

In the last trimester many women notice a decreased desire for sexual intercourse, likely because of their bigger bellies and increasing fatigue. If you share this feeling, it’s helpful to remember that sex doesn’t always mean sexual intercourse. There are other ways you and your partner can stimulate and pleasure each other. Use your imagination and explore new ways to be sensual. Note: Avoid having your partner blow air into your vagina. This practice can produce an air embolus (air bubble) in your blood, a potentially fatal condition.

How safe is sex during pregnancy? In general, it’s safe; however, your caregiver may suggest that you avoid intercourse for the following high-risk reasons:

• You’re at risk for preterm labor (or you’re expecting multiples).

• Your partner has a sexually transmitted infection (STI).

• You have placenta previa (low-lying placenta).

• You have an incompetent cervix (one that opens early), which may be the result of previous cervical surgery.

• You have vaginal bleeding during pregnancy (though spotting after intercourse in the first month of pregnancy might not be a complication).

• You have continuing or painful cramps after intercourse.

• Your membranes have ruptured.

If you’re not at risk, most caregivers recommend having sex as often as you desire. Uterine contractions are a normal part of having an orgasm and don’t harm a healthy pregnancy or baby. Remember that the sealed, fluid-filled amniotic sac cushions and protects your baby from outside forces and elements. If you experience discomfort during sexual intercourse, try positions that don’t put your partner’s weight on your belly (side-lying, hands-and-knees, or woman on top) or try gentle, shallow penetration.

As your feelings about sex fluctuate throughout pregnancy, your partner might or might not understand or accept them, which can create tension in your relationship. To help prevent long-term problems, keep the lines of communication open. Working through these changes in your sexual relationship can help you prepare for future challenges in your sex life after the birth.

A Note to Expectant Fathers*

Waiting for fatherhood is a unique emotional experience that’s just as meaningful as waiting for motherhood. You may have never felt so important yet so ignored, so committed yet so abandoned, and so deeply in love and sexual yet so afraid of sex. Sharing these feelings with your pregnant partner or close friends may help you through this exciting but challenging time. Consider talking with other expectant fathers (casually or in a discussion group) to help you understand and develop your unique role during the pregnancy and birth, and as a parent.

THE REALITY OF YOUR BABY

During the first trimester, it’s difficult to see many physical changes in your pregnant partner, and you might not yet think of your baby as real. When your partner’s pregnancy is around sixteen to twenty weeks along, however, changes in her body become obvious and you may begin to feel your baby move inside her. You may even see the bulge of a foot or elbow on her abdomen. Like many expectant fathers, you may fully comprehend your baby’s existence when you see her during an ultrasound scan and hear her heartbeat. Plan to be at the appointments when these exams are done.

Although some men emotionally connect with their babies during pregnancy, many men don’t begin to attach to their babies until after the birth. Some fall in love upon first seeing their newborns, while others grow to love their babies more gradually over the first months.3

Different Views of Expectant Fathers

Expectant fathers were asked: “How did you feel when the pregnancy test was positive?” Some one-word responses included: excited, relieved, happy, anxious, surprised, and proud. Many men had mixed feelings:

When we found out we’re going to have a baby, I felt terror and excitement.

Though I’m excited, I worry about money.

I’m happy, but I worry about losing my freedom.

EXCITEMENT, STRESS, AND WORRIES OF BECOMING A FATHER

On one hand, expecting a child may bring you pride and fulfillment because you’re creating another generation of your family. On the other hand, you may worry about the health of your partner and baby. It’s interesting that many men find life during pregnancy more stressful than life with a newborn. This may be because seeing a healthy mother and baby reduces anxiety and makes parenthood a reality.

If you have worries during the pregnancy, use them as motivation to improve the health of your growing family. You and your partner can eat nutritious foods, avoid potentially risky activities or exposure to illness, and improve your lifestyle.

With a new life soon to come, you may begin to reflect on your own mortality. You may decide to buy more life insurance and write or update your will. One expectant father began riding his motorcycle with a helmet; another quit his job in high-rise construction to take one in a safer trade. These actions show an interest in being present for the baby and providing for him as much as possible.

During pregnancy, some men experience empathy symptoms, which mimic their partners’ physical symptoms or discomforts. These include weight gain, food cravings, abdominal cramps or bloating, nausea, vomiting, backaches, toothaches, loss of appetite, and insomnia. If any physical changes or problems concern you, make an appointment with your caregiver for a checkup.

INCREASED RESPONSIBILITY OF FATHERHOOD

When contemplating fatherhood, many men fear losing their freedom and independence; some feel they’ve already lost both. To these men, becoming a father means becoming a responsible, mature adult. For example, earning a steady or higher income may become a priority, especially if financial concerns arise. If the duties and responsibilities of impending parenthood overwhelm you, talk to your partner about your feelings. Together you may be able to create a plan for reducing expenses or increasing your income. You can also begin developing realistic expectations of your role as a parent and provider.

CHANGES IN YOUR RELATIONSHIP

As your partner focuses on her pregnancy and becomes more preoccupied with your baby’s arrival, you may feel left out at times. You may feel displaced if others focus more on her than you, and if she turns to friends and relatives instead of you for emotional support. You may feel that you’re expected to care more for her and your relationship, but that she’s less available to you emotionally, physically, and sexually. To further complicate matters, you may feel guilty for any resentment or lack of enthusiasm you have about the pregnancy. One way to deal with these emotions is to talk with a friend or relative who has felt the same way. It’s also important to share these feelings with your partner; she may be unaware of them and able to help put your mind at ease.

YOUR ROLE DURING LABOR AND BIRTH

All expectant fathers wonder how they’ll perform during labor and birth. They may think, “Will I faint at the sight of blood? Can I handle watching my partner experience pain?” To boost your confidence and prepare for your role during this exciting event, take a childbirth preparation class, watch DVDs or read books on childbirth, and discuss any worries you may have with other fathers and your partner. Also consider having a friend, relative, or doula at the birth to offer additional guidance and help you support your partner. (See page 190.)

YOUR ROLE AS A FATHER

As the birth of your baby approaches, you may wonder what kind of father you’ll be. You may wonder whether you’ll act as your own father had when you were a child. You may have already decided that you want to be more emotionally and physically involved with your baby than your father had been with you.

Research shows that certain hormone levels in expectant fathers change during pregnancy. Fathers-to-be have lower levels of testosterone and cortisol and higher levels of estradiol than men who aren’t expecting babies. These hormonal changes may explain why many expectant fathers have more caring and nurturing feelings than they had before learning they’re to become parents.4

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The following suggestions may help you adjust to your new role:

• Learn about the normal development and behavior of newborns by reading books on the subject and attending your baby’s well-baby checkups.

• Talk with other new fathers about what to realistically expect during the first weeks after the birth.

• After the birth, be prepared for changes in your daily activities. Consider your priorities and those of your family, and create strategies to care for your baby, maintain your relationship with your partner, and find time for yourself.

• Determine how you can get the help that you and your partner will need after the birth.

• Think about how you can care for your new baby (such as holding, rocking, diapering, comforting, or playing with him) and learn more about those skills.

• Plan on having the most amazing adventure in the weeks and months ahead!

Nontraditional Families

All kinds of relationships make up today’s families. The traditional nuclear family (father, mother, and their biological offspring) is no longer the norm. Despite this fact, culture and customs have been slow to acknowledge the changing family structure, and society seems to offer little guidance and support to nontraditional families. While parents in nontraditional families face many of the challenges that all parents face, they also may tackle puzzling or troubling situations.

IF YOUR PARTNER ISN’T THE BABY’S BIOLOGICAL PARENT

If your partner isn’t the baby’s biological parent, he or she may feel that the pregnancy is “yours,” not “ours.” Your partner may question his or her role in making decisions and providing financial support for your growing family. If the baby’s biological father is involved in the pregnancy, your partner may feel even less sure about his or her role.

Strangers, acquaintances, friends, relatives—and even you—likely have misplaced or unrealistic expectations and assumptions about your nontraditional family that further challenge your relationship with your partner and with the baby.

Resources for Expectant Fathers

Books

• The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin (2008). Skillfully explains what’s involved in the support role during late pregnancy, birth, and afterward.

• The Expectant Father: Facts, Tips, and Advice for Dads-to-Be by Armin A. Brott (2001). Information-packed guide to the emotional, financial, and physical changes the father-to-be may experience during the course of his partner’s pregnancy.

• Father’s First Steps: 25 Things Every New Dad Should Know by Robert W. Sears and James M. Sears (2006). Discusses labor support, new fatherhood, bonding with baby, understanding baby talk, and being a good partner and father.

• The New Dad’s Survival Guide: Man-to-Man Advice for First-Time Fathers by Scott Mactavish (2005). Humorous guide to basic parenting skills, from birth through three months. Its military references might not appeal to some readers.

Classes

Classes for dads-to-be focus on learning the basic skills of baby care and fatherhood. Look for Conscious Fathering classes, Boot Camp for New Dads, or another program in your area.

If you’re in a lesbian relationship with your partner, the law doesn’t sanction your roles as parents to the same extent that it does for married heterosexual couples. Try to seek out the empathy and support of other lesbian parents to help define your roles as two mothers. For example, will one or both of you return to work after a maternity leave? Does your partner want to adopt the baby? What role will the biological father play, if any?

If you’re in a heterosexual relationship with someone new since becoming pregnant, the roles and relationships among you, your partner, and the baby’s father may be tense or unclear. For example, who will accompany you to prenatal appointments and who will be with you during the labor and birth?

If you conceived your baby with a donor egg or sperm, you or your partner may have difficulty coming to terms with the fact that the baby isn’t the biological offspring of one or both of you.

You and your partner can overcome challenges such as these and build a strong and loving family, but it requires creativity, honesty, and respect for each other and the baby. See Appendix C for a list of resources that offer nontraditional families support and advice.

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IF YOU’RE PREGNANT AND SINGLE

If you’re pregnant and single, you face a different set of challenges. Although single parenthood is common today, society often offers single parents little support. For example, you may notice that not everyone reacts positively to your pregnancy.

As a single parent, you take on a role usually shared by two people. Parenting is hard work, and at times you may be relieved that you don’t have to deal with the added burden of an incompatible partner. But there may be times when you doubt whether you can—or want to—parent alone. You may feel vulnerable or lonely and wish for the companionship and support of a reliable partner. At these times, it’s best to reach out to others for help.

If your baby’s biological father chooses not to be involved in your baby’s life, you have options. You can agree to parent alone, with or without his financial help. Or you can take legal action to confirm his paternity and compel him to provide child support. If you choose this option, you need to create a plan that specifies his involvement in your baby’s life.

Special Challenges in Pregnancy

For some women, past traumatic experiences can present additional challenges in pregnancy. With the proper care and support of trusted caregivers, family, and friends, these women can have positive and healthy pregnancies and childbirth experiences.

HISTORY OF CHILDHOOD TRAUMA

Early childhood trauma sometimes causes unexpected reactions during pregnancy, birth, or afterward. Women who are physically, sexually, or emotionally abused as adults can also experience these reactions. Some are surprised by their feelings; others know the effects can continue long after the abuse stops. A woman abused as a child learned some long-lasting, damaging lessons about herself and others. For example, many abused women have difficulty trusting others, especially those in authority (such as physicians or midwives).

It’s estimated that 25 to 40 percent of women were sexually, physically, or emotionally abused in childhood,5 so it’s not surprising that many survivors (though not all, as it’s impossible to generalize the effects of abuse) experience some of the following aftereffects during pregnancy, birth, or afterward.

• A survivor may find vaginal exams, nakedness, or the prospect of a baby coming through her vagina extremely disturbing or even intolerable.

• She may respond to the inevitable loss of control over her body that occurs in labor in the same way she had as a child, when she was helpless to stop her abuser from hurting her.

• She may equate the thought of giving another person total access to her breasts, even for breastfeeding, to her inability to prevent her abuser’s violation of her body.

The extent of these problems varies and many factors influence them, including the nature of the abuse, the age at which it occurred, how long it lasted, and the presence or absence of other loving and trustworthy adults in her life. Psychotherapy and emotional support promote healing and help survivors find positive ways to deal with past childhood abuse.

Some caregivers and childbirth educators are more aware than others about the impact of child abuse in adulthood. With empathy and understanding, these professionals can help pregnant survivors have safe, satisfying childbirth experiences and a less stressful postpartum period. If you’re an abuse survivor and you trust your caregiver, you may choose to disclose your history of abuse and explain how you think it’s affecting your feelings about your body, your baby, the upcoming labor, and your important relationships. If your caregiver has experience working with survivors, he or she may be able to help you address your concerns and communicate them in a birth plan. See Appendix C for a list of resources for survivors of childhood abuse.

PREGNANCY AFTER A PREVIOUS MISCARRIAGE OR STILLBIRTH

If you’ve lost a baby during a previous pregnancy or at birth, becoming pregnant again can bring about a wide range of emotions. You may have trouble getting excited about your pregnancy because you fear that you may lose another baby. You may be relieved that you’re pregnant again and are hopeful for a healthy pregnancy. You may find that it’s easier to remain emotionally detached until you have passed the point in your pregnancy when your last baby died. Or you might not want to become attached to your baby at all until after the birth, when you can see and hear your healthy newborn.

Common Q & A

Q: My previous pregnancy ended in a miscarriage. I worry this pregnancy will end the same way or in a stillbirth. What can I do to help ease my fear?

A: After you’ve suffered the loss of a baby, it’s normal to be anxious and worried when you’re pregnant again. Consult with your caregiver about the reason for the loss and find out if there’s anything you can do this time to ensure a healthy pregnancy. To help put your fears into perspective and focus on the positive, talk with other couples who have lost babies to miscarriage or stillbirth, or with supportive friends and family.

For further information, read these books on pregnancy after a previous loss:

• Pregnancy after a Loss: A Guide to Pregnancy after a Miscarriage, Stillbirth, or Infant Death by Carol Cirulli Lanham (1999)

• Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss by Ann Douglas, John R. Sussman, and Deborah Davis (2000)

Knowing why a previous pregnancy ended in miscarriage or stillbirth may help you and your caregiver plan for a healthier pregnancy this time. Your caregiver may attempt to diminish your fears by offering more prenatal testing (See page 277), or you may request extra testing yourself to help manage your fears. Another way to help relieve your anxiety is to closely watch your baby’s health. For example, you may monitor the baby’s activity by counting his movements during a set time. (See page 69.)

Just as each person experiences grief and loss differently, each expectant parent has unique feelings about a pregnancy after a loss. Most people find it helpful to talk with family members, friends, grief counselors, and medical professionals about their feelings and fears. By sharing your concerns with others, you and your partner may learn how to put your grief into perspective and reduce your worries.

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Key Points to Remember

• Pregnancy lasts about forty weeks from the date of the first day of your last menstrual period. (Ovulation usually takes place about two weeks after your period begins, and for conception to occur, it must happen within twelve to twenty-four hours after ovulation.)

• Normal pregnancies vary in length, so due dates are approximate. Expect your baby to be born any time from two weeks before to two weeks after your due date.

• Pregnancy is divided into three trimesters. The first trimester is your baby’s “formation” period, the second is the “development” period, and the third is the “growth” period.

• For better or worse, your previous experiences can affect your feelings about pregnancy and birth. Talking with someone about your circumstances can help you have a more positive and satisfying pregnancy and childbirth experience.

* Other expectant parents will experience many of the same emotions that expectant fathers feel. See page 57 for further discussion on nontraditional families.