Enjoying Your Pregnancy Guide to Understanding - Brigham and ...

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Guide to Understanding
and
Enjoying Your Pregnancy
MARY HORRIGAN CONNORS CENTER FOR WOMEN’S HEALTH

Dear Mother-To-Be:
Congratulations on your pregnancy! With that exciting news, we are here to help
guide you safely through your pregnancy and birth. It will be a team effort, including
you, your partner, doctors, midwives, nurse practitioners and nurses. We also have
nutritionists and counselors available for extra information and support if you need
them. Together, we will care for your pregnancy to help ensure the best possible outcome
for both you and your baby.
At the Center for Women in Newborns in the Mary Horrigan Connors Center for
Women’s Health at Brigham and Women’s Hospital, we respect your high expectations
for clinically advanced care provided in a personal, comfortable environment. The
Center offers the most comprehensive range of state-of-the-art obstetrical services in the
country under one roof. Our physicians, midwives, nurse practitioners and nurses are
world-renowned, and we are committed to providing compassionate, individualized
care – birth by birth, family by family.
You will get a lot of advice in the coming weeks, but remember, each pregnancy is
different. When you hear what seems to be a good idea, jot it down and discuss it with
us at your next visit. Between your regular visits, we will also be available to answer
any questions you may have.
You can expect the very best professional and medical advice and high-quality care
throughout the coming months as we care for you and your baby. We look forward to
helping you during the exciting days ahead and again, welcome to Brigham and
Women’s Hospital.
Sincerely,
Robert L. Barbieri, MD
Chairperson, Department of Obstetrics and Gynecology
Brigham and Women’s Hospital

Congratulations!
You're Pregnant!
You’re expecting, and you probably have a lot of questions. Whether this is
your first pregnancy or your third, this booklet is designed to help answer
those questions. You’ll be going through some changes during the following months,
both physical and mental. Sometimes you’ll wonder “Is this normal?” and “What is
going on?” This booklet will reassure you and keep you informed. Please read it from
cover to cover so you’ll know exactly what to expect during your pregnancy. Refer
to it when you have specific questions. The answers may be right here.
For the first few weeks after you have found out that you are pregnant, all you’ll
be able to think about is “I’m really pregnant.” It’s a happy and emotional
revelation. Yet you may also be thinking about the impact on your life, your family,
finances, and other matters. So there’s work to be done and many things to learn
and understand. In partnership with your health care providers and with this guide
as a reference, you can both understand and enjoy your pregnancy.

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Table of Contents
INITIAL PRENATAL CARE ............................................................................................................................................5
The First Office Visit ................................................................................................................................................5
Frequency of Office Visits ........................................................................................................................................5
HIGH-RISK PREGNANCY ..............................................................................................................................................6
Prenatal Diagnosis of Genetic Disorders ..................................................................................................................6
Genetic and Family History ......................................................................................................................................7
KEEPING TRACK OF YOUR BABY’S HEALTH ............................................................................................................7
Ultrasound ................................................................................................................................................................7
Amniocentesis ..........................................................................................................................................................8
Chorionic Villus Sampling (CVS) ............................................................................................................................8
Alpha-Fetoprotein Test..............................................................................................................................................8
Triple Screen Test ......................................................................................................................................................9
Non-Stress and Contraction Stress Testing ..............................................................................................................9
Biophysical Profile ....................................................................................................................................................9
Glucose Tolerance Test..............................................................................................................................................9
Fetal Movement (Kick Count) ............................................................................................................................9-10
Fetal Maturity Tests ................................................................................................................................................10
Preserving Your Baby’s Umbilical Cord Blood ........................................................................................................10
UNDERSTANDING YOUR BABY’S DEVELOPMENT ................................................................................................11
EXPECT SOME CHANGES ....................................................................................................................................11-16
Physical Changes..................................................................................................................................................11-16
Weight Gain ......................................................................................................................................................11-12
Breasts ....................................................................................................................................................................12
Urination ................................................................................................................................................................12
Nausea ....................................................................................................................................................................12
Morning Sickness Survival Tips..............................................................................................................................13
Excessive Salivation ................................................................................................................................................13
Heartburn ................................................................................................................................................................13
Constipation............................................................................................................................................................13
Uncomfortable Breathing ........................................................................................................................................13
Backache..................................................................................................................................................................13
Insomnia..................................................................................................................................................................14
Skin Changes ..........................................................................................................................................................14
Varicose Veins..........................................................................................................................................................14
Hemorrhoids ..........................................................................................................................................................14
Vaginal Discharge ....................................................................................................................................................14
Abdominal Pain/Round Ligament Pain ............................................................................................................14-15
Cravings ..................................................................................................................................................................15
PICA (unusual cravings) ........................................................................................................................................15
Dizzy Spells ............................................................................................................................................................15
Arthritis ..................................................................................................................................................................15
Swelling ..................................................................................................................................................................15
Stretch Marks ..........................................................................................................................................................15
Nose Bleeds ............................................................................................................................................................15
Headaches................................................................................................................................................................15
Contractions............................................................................................................................................................16
Emotional Changes....................................................................................................................................................16
Depression/Anxiety ................................................................................................................................................16
Emotional Mood Shifts ..........................................................................................................................................16
What To Do About Moods ......................................................................................................................................16
Sexual Changes..........................................................................................................................................................16

Table of Contents 3
CARING FOR YOURSELF............................................................................................................................................17
Diet..........................................................................................................................................................................17
The Food Pyramid Guide........................................................................................................................................17
Estimated Dietary Needs for Non-Pregnant and Pregnant Women ......................................................................18
Serving Sizes............................................................................................................................................................18
Proper Dietary Balance and Calorie Intake ............................................................................................................18
THINGS YOU SHOULD KNOW BEFORE HAVING YOUR
BABY AT BRIGHAM AND WOMEN’S HOSPITAL ............................................................................................19-22
CARING FOR YOURSELF (Continued) ......................................................................................................................23
Appropriate Exercise and Rest ................................................................................................................................23
Fluid Retention ......................................................................................................................................................23
Work........................................................................................................................................................................23
Travel ......................................................................................................................................................................23
Baths........................................................................................................................................................................23
Tampons..................................................................................................................................................................23
Exercise ..............................................................................................................................................................23-24
Rest..........................................................................................................................................................................24
Seat Belts ................................................................................................................................................................24
Clothing ..................................................................................................................................................................24
Douching ................................................................................................................................................................24
Caring For Your Breasts ..........................................................................................................................................24
Infant Feeding: Breast or Formula..........................................................................................................................25
Teeth........................................................................................................................................................................25
Immunization..........................................................................................................................................................25
Insecticides and Household Chemicals ..................................................................................................................25
Saunas and Hot Tubs ..............................................................................................................................................26
Sex ..........................................................................................................................................................................26
PLAN AHEAD................................................................................................................................................................26
EXERCISES FOR PREGNANCY ..................................................................................................................................27
Standing Up ............................................................................................................................................................27
The Pelvic Rock ......................................................................................................................................................27
Kegel Exercise ........................................................................................................................................................27
All Fours..................................................................................................................................................................27
The Squat ................................................................................................................................................................27
Stress and Tension ..................................................................................................................................................27
CARING FOR YOUR UNBORN BABY ........................................................................................................................28
Alcohol ....................................................................................................................................................................28
Medications ............................................................................................................................................................28
Caffeine ..................................................................................................................................................................28
Aspartame (Nutrasweet ® )........................................................................................................................................28
Street Drugs ............................................................................................................................................................28
Smoking ............................................................................................................................................................28-29
X-Ray Studies ..........................................................................................................................................................29
Genital Herpes ........................................................................................................................................................29
German Measles ......................................................................................................................................................29
Toxoplasmosis ........................................................................................................................................................29
Hepatitis B in Pregnancy ........................................................................................................................................29
Hepatitis C ..............................................................................................................................................................30
Chickenpox (Varicella) ..........................................................................................................................................30
Influenza (Flu)........................................................................................................................................................30
HIV/Human Immunodeficiency Virus ....................................................................................................................30
Cytomegalovirus (CMV) ........................................................................................................................................30
Mumps ....................................................................................................................................................................30

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Table of Contents
PROBLEMS DURING PREGNANCY............................................................................................................................31
Early Pregnancy Bleeding........................................................................................................................................31
Late Pregnancy Bleeding ........................................................................................................................................31
High Blood Pressure in Pregnancy..........................................................................................................................31
Diabetes ..................................................................................................................................................................32
Preterm Labor ........................................................................................................................................................32
RH Disease and its Prevention (RhoGam)..............................................................................................................33
Group B Strep (GBS) ..............................................................................................................................................33
CARING FOR THE REST OF YOUR FAMILY, TOO ..................................................................................................34
Partner ....................................................................................................................................................................34
Other Children........................................................................................................................................................34
BACK TO YOU - Changes the Very Last Weeks ..........................................................................................................34
IS THIS REALLY LABOR..............................................................................................................................................35
False Labor ..............................................................................................................................................................35
Real Labor ..............................................................................................................................................................35
What to Expect at the Hospital ..............................................................................................................................35
LABOR AND BIRTH......................................................................................................................................................36
The Birthing Process ..............................................................................................................................................36
Vaginal Birth............................................................................................................................................................36
Vaginal Birth After Cesarean (VBAC)................................................................................................................36-37
Cesarean Birth, or C-Section ..................................................................................................................................37
ANESTHESIA AND PAIN RELIEF ..............................................................................................................................38
Regional Analgesia and General Anesthesia ........................................................................................................38
Epidural Analgesia ..............................................................................................................................................38
Combined Spinal-Epidural Analgesia ................................................................................................................38
Local and Pudendal Block ..................................................................................................................................38
Paracervical Block ..............................................................................................................................................38
GETTING TO KNOW YOUR BABY ............................................................................................................................38
YOUR OWN CHANGES DON’T STOP NOW ............................................................................................................39
NOW YOU’RE A MOTHER! ........................................................................................................................................39
It’s a New Experience...Even if You Have Other Children ....................................................................................39
INDEX............................................................................................................................................................................40
CHILDBIRTH CLASSES
We hope this guide answers any questions you may have about your pregnancy and the birthing process at
Brigham and Women’s Hospital. However, we wholeheartedly encourage you to learn more by taking advantage
of the many parent and childbirth education classes offered at the hospital. Mothers who take these classes report
they need less pain medicine and anesthesia during labor and have had more positive feelings about their birthing
experience. It is extremely beneficial for expectant fathers or support persons to attend these childbirth classes
with you and practice what you learn at home. Please refer to the Parent and Childbirth Education class brochure
in your obstetrical admitting packet for information on classes (labor, birth, infant care, etc.) and tours offered at
Brigham and Women’s Hospital or visit www.brighamandwomens.org/classes. You may also call (617) 732-4081
for information.

INITIAL PRENATAL CARE
INITIAL OFFICE VISITS
A. History*
B. Physical Examination*
C. Laboratory*
• Complete Blood Count
• Urinalysis
• Serology, Blood Type & Rh Factor
• Rubella Titer
• PAP Test
• Tuberculosis Screening
• Hepatitis B Screening
• Urine, Cervical, Vaginal Cultures (if necessary)
• HIV Test (if necessary)
• Chickenpox (if necessary)
*Includes all those procedures listed in subsequent
office visits
Your Prenatal Guide 5
FOLLOW-UP OFFICE VISITS
Mother
• Weight
• Blood Pressure
• Urine Specimen
• Uterine Growth - Ultrasound
• Pelvic Exams (late in pregnancy)
• Special Blood Testing
Baby
• Fetal Heart Tones
• Fetal Activity
• Size & Growth of Baby
• Amount of Amniotic Fluid
• Location of Baby
THE FIRST OFFICE VISIT
The First Office Appointment may take longer than your other visits. Your medical history will be taken by an
obstetrical nurse or doctor. We need to know how healthy you are, to best provide care for you and your baby.
At the first appointment we will do some lab tests relative to pregnancy and your general health. Blood tests are
especially critical since they tell us much about your medical history which could have an effect on you or your baby's
well-being. Depending on special needs or individual medical problems, other testing may be done.
Follow-up visits are much shorter in duration than your initial visit. The focus of these checkups is to make certain
that you have not developed any problems due to your pregnancy. In addition, the growth and development of your
baby is monitored. Certain blood tests and other tests may be performed at predetermined intervals throughout your
pregnancy to monitor your progress.
We’ll set your due date, if possible, at the first appointment. It becomes a special “monitoring” progress date for you
and us. Only one in 20 babies is delivered exactly on the calculated day, although most are born ± two weeks of the
expected date.
A full term pregnancy lasts 266 days from conception to birth. You may know exactly when you conceived. If so,
tell us. At your initial exam we will try to answer as many questions as possible.
FREQUENCY OF OFFICE VISITS
The closer you get to your due date, the more frequently we will need to see you. Through your sixth month, we’ll
set up an appointment every two to four weeks. Then, plan to come in every two weeks during the seventh and eighth
months, and every week during that last important month. These visits will take less time than your initial exam, but
are just as important to make sure your pregnancy is progressing well.
JUST A REMINDER . . .
Recent advancements in medical research and technology make now the best time in history to bear children. Today,
for instance, we know that environmental factors such as cigarette smoking and alcohol consumption during
pregnancy can harm the unborn baby. While good prenatal care can significantly decrease harmful risks to you and
your baby, there are no guarantees that the pregnancy will proceed normally.

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Your Prenatal Guide
• High-Risk Pregnancy •
A pregnancy is called high-risk when a pre-existing medical condition or pregnancy-related complication threatens
the well-being of you or your baby. Unfortunately, we can’t always predict high-risk pregnancies, but if complications
should arise during your pregnancy, we will monitor you very, very closely. Special testing may be performed
in order to appropriately monitor your condition and to determine the best time to deliver your baby. More frequent
visits may be required.
If you now have or should develop any of the following conditions, your pregnancy may be considered high risk:
• Viral illnesses like herpes, hepatitis B, HIV,
German Measles, cytomegalovirus, chicken pox
• Bleeding late in pregnancy
• Post dates pregnancy (one to two weeks overdue)
• Breech position or other presentations that may
complicate birth
• Nicotine, alcohol or other substance use
• Incompetent cervix
• Age 35 or older; Age 15 or younger
• History of miscarriages, stillbirths or
neurologically impaired infants
• Rh disease
• Multiple pregnancy (twins, triplets, etc.)
• Diabetes
• Heart disease
• High blood pressure
• Preterm labor or premature rupture
of membranes
PRENATAL DIAGNOSIS OF GENETIC DISORDERS
“Will my baby be normal?” That’s the question all parents ask, and some with good reason. Knowing the family
history of both you and your baby’s father will allow us to anticipate certain problems that can be minimized with
proper care. Today, we have a better chance of diagnosing certain genetically transmitted diseases thanks to medical
technology. A procedure called amniocentesis, usually performed from 14 to 16 weeks of pregnancy, tests the fluid
surrounding the baby and allows us to detect certain diseases and other factors like the sex of the baby. Other
screenings and diagnostic tests may be recommended, depending on the family’s medical history. We will discuss these
tests with you.

Your Prenatal Guide 7
• GENETIC AND FAMILY HISTORY •
There are certain family medical conditions that are important to the health of your baby. The following
questionnaire will help us determine if you are a candidate for special genetic counseling or testing.
You should make note of any questions that you answer “yes,” and discuss these with us at your earliest
appointment. Check the appropriate answer.
1. Will you be 35 or older by the due date? Yes ____ No ____
2. Have you, the baby’s father or anyone in either of your families had:
a. Down syndrome Yes ____ No ____
b. Spina Bifida or Myelomenigocoele (open spine)? Yes ____ No ____
c. Hemophilia? Yes ____ No ____
d. Muscular Dystrophy? Yes ____ No ____
e. Mental Retardation? Yes ____ No ____
f. Sickle Cell Disease? Yes ____ No ____
g. Tay-Sachs Disease? Yes ____ No ____
3. Have you or the baby’s father had a child born with a condition not listed in question two or that was stillborn?
Yes______ No______
4. Do you, the baby’s father or a close relative in either family have any inherited genetic or chromosomal
disorder not listed? Yes______ No ____
5. Are you, the baby’s father or a close relative:
a. Of Jewish ancestry or a descendant from Eastern
European people?
Yes______ No______
b. Of Mediterranean ancestry? Yes______ No______
c. Of Thalassemia ancestry? Yes______ No______
6. Have you or a previous spouse of the baby’s father had
three or more miscarriages?
Yes______ No______
Thank you for taking the time to complete this very important questionnaire. Remember to discuss with us
any item that is answered “yes.”
KEEPING TRACK OF YOUR BABY’S HEALTH
Throughout your entire pregnancy, both the health of you and your baby are our concern. Thanks to recent
breakthroughs in medical technology, we have new and innovative tools to carefully monitor your health and progress.
Today, many fetal problems can be detected and treated while the baby is still in the womb. So, expectant mothers with
complicating factors like advanced age can rest easier knowing that these tools are available. Listed below are the most
common fetal testing or evaluating techniques.
ULTRASOUND
Ultrasound can be used to detect a problem or monitor a condition in the fetus in
the mother’s uterus. During the first few months of pregnancy, this test can tell us
if the baby is developing properly. Should abnormal vaginal bleeding occur, it
might help us learn why. An ultrasound in early pregnancy can verify your due
date and determine whether or not you are carrying multiple babies.
Unlike x-rays, ultrasound uses sound waves to produce a video “picture” of the
fetus moving inside your uterus. This picture is generated from an instrument
that is placed either on your abdomen or in your vagina. You, too, can actually see the baby
on a special screen while we’re performing the test. If you are six or more months pregnant and

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Your Prenatal Guide
the baby is positioned correctly, we may be able to tell the baby’s sex. Later in pregnancy, the test can track the baby’s
growth, locate the placenta, determine the volume of amniotic fluid and detect some types of birth defects.
The procedure requires little of your time and is performed either in the office or the hospital. A full bladder may be
needed and is usually the only discomfort experienced. No harmful effects have been reported during more than two
decades of use.
AMNIOCENTESIS
An amniocentesis involves withdrawing and testing a small amount of the amniotic fluid surrounding the fetus. It
provides very reliable information about:
1) Rh disease, or blood incompatibilities between mother and baby;
2) genetic defects such as Down syndrome, and others;
3) certain defects related to abnormal brain and spinal cord development, or neural tube defects; and
4) fetal maturity near the end of pregnancy.
Amniocentesis also will reveal the sex of your baby, but if you do not want to know the sex, please inform us of your
wish.
The timing of this procedure will vary depending upon the initial reason for evaluation. Genetic and neural tube
defects, for example, usually are investigated at about 15 weeks, while fetal maturity and blood incompatibility are
looked at much later in the pregnancy.
Amniocentesis is generally performed in conjunction with ultrasound to prevent injury to the baby, the cord and
placenta.
An amniocentesis is considered 99.5 percent safe and usually involves little risk. But still, this is not a routine test.
It is performed only to detect a highly probable medical problem. You shouldn’t be concerned about the loss of
amniotic fluid. Only a small amount is withdrawn, and your body rapidly replaces it with no harm to the baby.
CHORIONIC VILLUS SAMPLING (CVS)
Chorionic villus refers to part of the placenta that attaches the placenta to the lining of the uterus or womb. An actual
sample of the placental tissue is removed to perform the chromosome test.
CVS is a method of diagnosing chromosomal or genetic abnormalities in the fetus. The procedure is performed
during the ninth to eleventh week of pregnancy and offers the advantage of an earlier and more rapid diagnosis than
amniocentesis.
Unlike amniocentesis, which analyzes substances obtained from the fluid surrounding the baby, CVS uses small
fragments of the placenta to grow the chromosomes for further analysis.
ALPHA-FETOPROTEIN TEST (AFP)
This blood test is performed between the 15th and 20th weeks of pregnancy. This special blood test detects neural
tube defects. Neural tube defects are abnormalities in the brain and spinal cord of the fetus.
Defects in the central nervous system occur when the neural tube (the brain and spinal cord tissues) fail to close as
the fetus develops. When the brain and spinal cord are exposed directly to the amniotic fluid which surrounds the
baby, it is called an “open defect.” Sometimes, the poorly developed neural tube is covered by skin or bone, referred
to as a “closed defect.”
The two common neural tube defects are anencephaly and spina bifida. Babies with anencephaly are born with
deformities of the head and brain and die soon after birth. Those born with spina bifida can live a long time, but may
suffer paralysis in the lower body and legs. Often, there is also a lack of bladder and/or bowel control which may be treated
with surgery.
The chance of producing a child with a neural tube defect is one to two for every thousand live births. Babies born to
mothers who have had a previous child with the same problem are at greatest risk, as are those with parents or
grandparents who have neural tube defects.
As with all prenatal tests, a normal test does not guarantee a normal baby at birth. About 20 percent of the infants born
with neural tube defects have normal alpha-fetoprotein (AFP) levels. Most of these are closed defects which are typically
less severe.

Your Prenatal Guide 9
Conversely, an initial abnormal test reading does not mean the fetus has a neural tube defect. Abnormal levels of AFP
are frequent - occurring in about 50 of every 1,000 women tested. Only one or two of those 50 actually have a neural
tube problem. A high AFP may be due to a miscalculation of the baby’s age, or if there are twins in the womb. Various
other temporary fetal conditions can cause an elevated AFP reading.
An ultrasound is usually done to determine the fetal age, look for more than one fetus or scan for neural tube defects
and other abnormal conditions which may be responsible for the elevated test. Second AFP tests are normal in about
half of those who are retested.
If the ultrasound shows a single fetus at the approximate age determined by the initial due date with no fetal
abnormalities, an amniocentesis is performed. An abnormally high level of AFP in the amniotic fluid indicates a 90
percent chance that a serious problem is present.
An abnormally low AFP reading may indicate that there is a chromosomal problem, such as Down syndrome.
An amniocentesis can further detect chromosome abnormalities.
TRIPLE SCREEN TEST
This optional test combines the alpha-fetoprotein results with two other blood substances to give us the triple screen
test. The results are obtained from a blood sample from the mother at 16-20 weeks of pregnancy. The majority of neural
tube defects and two out of three babies with Down syndrome can be detected with this test. Further testing such as
ultrasound and/or amniocentesis may be required with an abnormal test.
NON-STRESS TEST AND CONTRACTION STRESS TEST
Late in pregnancy, prior to the onset of labor, a fetal monitor may be
used to determine the well-being of the baby and to help decide
when a fetus should be delivered. This is most frequently used if a
baby is past due or there are complicating medical conditions in
the mother, such as high blood pressure, Rh disease, bleeding or
kidney disease. It is also helpful in evaluating a fetus who is not
growing properly, or whose fetal movement has decreased.
The non-stress test (NST) is used to evaluate fetal heart rate patterns,
especially during fetal movements. Increases in fetal heart rate are reassuring
of fetal well-being, and the test is called reactive. A non-reactive test can be caused by medication or a sleeping fetus,
and may require further testing.
The contraction stress test (CST) will allow us to evaluate how the fetal heart reacts to uterine contractions. Certain
fetal heart tracing characteristics occur in both healthy and unhealthy fetuses. The uterine contractions can be induced
by a medication called oxytocin which is administered intravenously. The “stress” created by the contractions may
reveal that the fetus is receiving a marginal blood and oxygen supply.
BIOPHYSICAL PROFILE
This test combines various parameters from the ultrasound exam (including fetal movements, breathing motions and
amount of amniotic fluid) with the non-stress test findings to evaluate each pregnancy with a score. The total score is
helpful to us in evaluating the well-being of the fetus, and it helps us determine, in part, how we will manage your
pregnancy. This is a more extensive evaluation than the non-stress or contraction stress tests.
GLUCOSE TOLERANCE TEST
This safe and simple test is performed between 24 and 28 weeks of pregnancy to screen for Gestational Diabetes as
indicated, a condition developed by some women only during pregnancy. Initially, you drink a concentrated sugar
solution, and at a timed interval, your blood is drawn and tested to determine how well your body uses or metabolizes
the sugar. Diabetes exists when there is a high amount of sugar in your blood due to the body’s failure to handle the sugar
substances in a normal fashion. (For more information on diabetes, see page 32.)
FETAL MOVEMENT (KICK COUNT)
Did you know your baby has a sleep-wake cycle lasting from 20 minutes to two hours? This and many other factors
influence the mother’s ability to feel her baby move. Women typically feel that first “flutter” of life - what we call
quickening - between 16 and 20 weeks of pregnancy. Fetal movement is more perceptible in mid-pregnancy and may
diminish as the pregnancy progresses to term. The baby’s position, the mother’s blood sugar level, her occupation and

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Your Prenatal Guide
eating habits, as well as sound, light and physical stimulus to the uterus also can affect fetal movement. Finally, each
fetus has a typical movement rhythm, and each pregnant mother has a different ability to recognize her baby’s
movement.
Some medical authorities today suggest that fetal activity levels say a lot about the baby’s well-being. The Kick Count
refers to spontaneous fetal movements experienced by the pregnant mother. Certain doctors suggest that less than 10
fetal movements in a 12-hour period is worrisome, while others suggest that less than four movements in one hour is
of concern. Unfortunately, there is no universal consensus on a critical level of fetal movement.
However, one point appears certain. Fetal activity is generally reassuring, and fetal inactivity may need further
evaluation. Please notify us immediately if you have noticed that the baby's activity has diminished from its previous
pattern of movement or come straight to the hospital.
FETAL MATURITY TESTS
Several tests can be performed on amniotic fluid to determine the maturity of the fetal lungs. The maturity of the
baby’s lungs has more to do with its ability to survive than does its weight at delivery. Babies born with immature lungs
can suffer from a condition called respiratory distress syndrome, or hyaline membrane disease, which is the leading
cause of death in newborns. This condition results from a lack of certain chemical substances which make it possible
for the lungs to breathe in oxygen. Oxygen is transferred from the lungs to our blood where it is carried to cells
throughout our body.
Amniotic fluid bathes the fetal lungs and contains chemicals that can be collected by amniocentesis and measured
to evaluate fetal lung maturity. Levels of fetal lung maturity typically occur sometime after 35 weeks of pregnancy. This
information is extremely valuable when complications of the mother or baby call for early delivery or when we have
an uncertain due date. Size of the baby is not a determining factor in lung maturity.
Amniocentesis to obtain fluid
for chromosomes and maturity
tests.
PRESERVING YOUR BABY’S UMBILICAL CORD BLOOD
More and more doctors today are recommending that parents preserve their baby’s umbilical cord blood after birth.
Umbilical cord blood cells, traditionally discarded at birth, contain special stem cells that can ultimately be used to
treat life-threatening diseases and immune and genetic disorders.
There are other sources in the body that contain stem cells, however using umbilical cord blood stem cells have many
benefits. For example, cord blood is collected in a quick, non-invasive and painless procedure, and cord blood stem
cells are a perfect match for your baby, have a 25 percent probability of being an exact match for a sibling, and can be
potentially used for parents and grandparents.
Please note that although opportunities for cord blood use are being discovered every year, there is no guarantee that
a cord blood transplant will be an appropriate treatment therapy or that it will provide a cure.
For more information on preserving your baby’s umbilical cord after birth, please speak with your obstetric care
provider.

First Month
During your first month of pregnancy, your baby
reaches a half inch in length and is called an embryo.
Amazingly, the circulatory system and other vital
organs have begun to form, including the heart, brain,
lungs, eyes and ears. The placenta and umbilical cord
are developing, and the baby is well protected from
harm in a sac of liquid called amniotic fluid.
Second Month
By eight weeks, arms and legs are starting to form,
and the embryo is beginning to look more human.
Fingers and toes are growing and facial features are
becoming more pronounced. The head seems huge
compared to the body because the brain is growing at
a very rapid pace. By the end of eight weeks, the
embryo is about one inch long.
The embryonic period ends two months after your
baby is conceived. By this time, all essential structures
are present. The fetal period, which lasts from the end
of the second month through birth, is characterized by
rapid growth and continuing definition of structures
already present.
Third Month
By three months, the baby is called a fetus. It is
starting to grow faster and is now four inches long.
Fingernails and toenails are growing and, for some, a
little hair may sprout. If you could see inside the
uterus, you could determine the sex. At this time, we
may be able to detect the baby’s heartbeat with a
special stethoscope.
Fourth Month
During the fourth month, many women begin to
“look” pregnant. After all, the fast-growing fetus is now
more than six inches long. The baby’s teeth, eyelids and
eyelashes and extremities are developing in detail.
Your Prenatal Guide 11
UNDERSTANDING YOUR BABY’S DEVELOPMENT
Fifth Month
You may feel the baby move for the first time. A word
about this: if you feel that little flutter of life one day
and not again for several days, DON’T BE ALARMED.
Because your baby is suspended in a sea of amniotic
fluid, you may not be able to feel its every move. And
then, the fetus may get very active for a day or two,
then settle down for a few days. It needs rest, too! It
has now grown to 10 inches in length.
Sixth Month
By this time, the fetus resembles a miniature infant
except for its reddish, wrinkled skin. It measures about
12 inches in length and starts to move with increased
frequency.
Seventh Month
From seven to nine months, you’ll gain the most
weight and your baby is growing incredibly fast - up to
14 inches long by now. With special care, babies born
now can survive.
Eighth Month
At this stage, the fetus is about 17 inches long and
weighs around four pounds. The baby’s bones and
nails are hardening and wrinkles disappear as fat
begins depositing under the skin. Babies born during
this month are still premature but have a very good
chance of survival.
Ninth Month
The baby's size and activity level during the last
month may cause the mother considerable discomfort.
You may have difficulty sleeping and need to urinate
more frequently than before because the baby is
putting more pressure on your bladder. At full term,
the average baby weighs seven-and-a-half pounds and
measures 20 inches in length.
EXPECT SOME CHANGES
Pregnancy is a miraculous time of constant change for you and your baby. You will experience physical and
emotional changes. Some symptoms are natural while others may be warning signs of complications.
WEIGHT GAIN
Your mother may tell you that HER doctor said to only gain 10 pounds, but times have changed...we know more
about fetal needs and development now and you should try to gain about 25 to 35 pounds during pregnancy if you
were average weight before pregnancy. This weight gain seems to best nurture you and your growing baby.
Mothers who are underweight before pregnancy may gain 28-40 pounds. Women carrying twins may gain as much
as 45 pounds. Mothers who are very overweight should limit their weight gain to 15-25 pounds. Fifteen pounds should
be a minimum weight gain for any pregnant woman.
Don’t panic! So many women have problems keeping their weight down without being pregnant, that the thought

12
Your Prenatal Guide
of gaining 25 pounds seems distressing. But you will lose
most of the weight gain when the baby is born, or right
afterwards.
Keep a weight chart and weigh yourself weekly. We’ll be
weighing you at every appointment, but keep track of
your weight yourself, too.
If you are simply ravenous, and start to gain weight
quickly...talk to us. We can suggest some foods that you
can eat a lot of and still not gain those pounds that will
make labor difficult. Refer to the Nutrition Section (pages
17-18) of this booklet for a complete outline of
suggestions.
BREASTS
Right from the beginning, your breasts may be larger,
firmer and more tender than usual. The areola, the dark
area around the nipples, may get larger and grow darker in
color. Halfway through your pregnancy, your breasts may
start to secrete fluid (colostrum) in small amounts. Be sure
to keep them clean with frequent washing, and toward the
end of your pregnancy, you may want to put gauze pads
inside your bra to protect your clothes.
The veins right under your skin may
become more noticeable, too. This is
caused by an increased blood supply
preparing your breasts for milk
production. For most women, if
you are planning to breastfeed
your infant, no special nipple
preparation is required. It is
recommended that you keep
your nipples dry and wash
with warm water - no soap.
• DANGER SIGNS •
URINATION
When your uterus expands, it puts pressure on your bladder. The need to urinate is
common in the first stages of pregnancy, and in the last weeks. Don’t try to control this
issue by drinking less fluids. Your baby needs you to drink at least two quarts of liquids a
day. You may find it more comfortable to have a readily accessible restroom during the first
three months of your pregancy and when you are nearing birth.
SOURCES OF WEIGHT GAIN
MATERNAL
Uterus - 2 1 /2 pounds
Blood Volume - 3 1 /2 pounds
Breasts - 2 pounds
Fluid - 4 pounds
FETAL
Fetus - 7 1 /2 pounds
Placenta and
Membranes - 1 1 /2 pounds
Amniotic Fluid - 2 pounds
Pregnancy is a normal state for women, but sometimes
complications arise that require our immediate attention.
Almost all complications give some kind of warning sign,
and you may be the first to notice a symptom that needs
attention.
We check your blood pressure, urine, weight and fetal
heartbeat at each appointment because changes in these
vital signs could signal a problem. Problems that are
caught early have the best chance of being treated and
eliminated. Call us immediately if you experience any of
these symptoms:
• Bleeding from breast nipples, rectum, bladder or coughing
up of blood
• Vaginal bleeding, no matter how slight (unless small
amount after a pelvic exam)
• Swelling of hands or face
• Dimness or blurring of vision
• Severe or continuous headaches
• Abdominal pains that don’t go away with heat and rest or
a bowel movement
• Chills or fever over 100o • Persistent vomiting
• Painful or burning urination
• Decreased fetal movement
• Sudden or slow escape of fluid from the vagina
These symptoms may indicate serious complications of
pregnancy that need immediate attention.
NAUSEA
Some women suffer with “morning sickness" and some
women are never nauseated. “Morning sickness” isn’t
necessarily confined to the morning hours. Try eating
smaller meals of simple foods, avoiding spicy and highly
acidic foods, and lie down immediately after eating for
just a few minutes. If your nausea is more severe than
this, try eating a dry saltine cracker just before getting up
in the morning. Sometimes a little bland food in the
stomach will help you digest a breakfast later. Few
women suffer with nausea after the fourth month, but if
it is unusually severe, call us. You need to eat well to
grow a healthy baby. Medication is usually reserved for
those who have significant vomiting or dehydration.
Take your prenatal vitamins or iron during the day when
nausea is not a problem.

Your Prenatal Guide 13
MORNING SICKNESS SURVIVAL TIPS:
1. Ginger ale and crackers are a traditional remedy. Ginger ales with a stronger “bite” seem to work better. Drinking
lemonade (or smelling a lemon) may help settle your stomach if ginger ale does not work.
2. If crackers do not work or get boring, try potato chips. They are a good source of potassium.
3. Quench your thirst and settle your stomach with anything you are craving. You need the fluids and nutrients.
4. Try to drink 10 cups of fluid a day to avoid dehydration. A cup of ice chips or a cup of watermelon cubes counts
for about a half cup of fluid.
5. Make a running list of odors which trigger nausea and post it on your refrigerator to alert others. You may want
to get help with tasks like grocery shopping or changing diapers, if you have young children.
6. Summer heat, humidity and stale air seem to aggravate morning sickness. Try to stay in an air-conditioned room
whenever possible.
7. During winter months if you are chilly, put on an extra sweater instead of turning up the heat. An overly warm
house will make you lose fluids through perspiration.
EXCESSIVE SALIVATION
This condition is frequently confused with vomiting in pregnancy. It is caused by excessive secretion of the salivary
glands in the mouth and is quite annoying and difficult to treat. It tends to diminish in the latter half of pregnancy.
Mints, chewing gum, frequent small meals and cracker snacks can be helpful.
HEARTBURN
Heartburn is another common complaint of pregnant women. It isn’t your heart that is burning, it’s your stomach!
This is common indigestion, but it can still be an aggravation. It is alright to use antacid preparations but do not use
baking soda or sodium bicarbonate preparations for your heartburn.
Before you buy an over-the-counter remedy, ask us which we recommend. In severe cases of heartburn, you might
want to elevate the head of your bed to encourage your stomach fluids to stay put! (Add 4" of books beneath the
headposts to elevate the head of the bed temporarily.)
CONSTIPATION
As we mentioned earlier, you need to drink lots of fluids while you are pregnant. This is one way to avoid
constipation, a common complaint of pregnant women. Exercise every day and eat plenty of fruits and raw vegetables.
Try all the natural remedies first, including the addition of bran and bran products to your diet ...if these don’t work,
let us prescribe a very mild laxative or stool softener. Don’t be shy about discussing this problem, it is a by-product of
your pregnancy.
UNCOMFORTABLE BREATHING
This may be a problem once the baby is large enough to interfere with your breathing muscles.
Slow down your movements and practice deep breaths from the chest. If you still have trouble
breathing, or if you have any questions about shortness of breath or chest pain, contact your
obstetric care provider. You may also want to speak with your obstetric care provider about
under garments that provide abdominal support.
BACKACHE
You may experience backaches due to the added weight gain from your pregnancy. But that
isn’t the only reason your back may hurt. As your womb grows, your pelvic bone joints relax,
which can also cause pain in your lower back. Comfortable shoes may help a little, good posture
may help too, but exercise will probably relieve your backache more than anything else. Strong
muscles can take more stress without hurting.
Develop a routine of back exercises every day from the beginning of your pregnancy. There are many good books
available about exercising and pregnancy.
Toward the end of the pregnancy, some women feel that the baby is pushing on a nerve in their back...or that the
baby has positioned itself so that pain is radiating in their back. Get on your hands and knees and let the baby’s weight
fall toward the floor. This will relieve the pressure on your back as the baby shifts, and may give you a lot of backache
relief.

14
Your Prenatal Guide
INSOMNIA
Early in your pregnancy, you may be very sleepy and sleep all the time ...then at the end of your pregnancy, you’ll
wish those days were back again. Usually, trouble with sleeping comes from the difficulty of finding a comfortable
sleeping position. If you’ve always slept on your stomach, after a while you’re going to find it difficult!
Exercising a few hours before you go to bed may help you rest easier...or a warm bath may do the same thing. It is
important not to take alcohol or sleeping pills to try to solve this problem...let’s work together to find a safer way.
Shortness-of-breath or heartburn may aggravate this situation, so prop yourself up at night. Also, an active fetus can
help keep you awake, so don’t drink caffeinated beverages in the evening after dinner.
SKIN CHANGES
Many women get very upset about changes in the color of their skin, but these changes are common. Your skin may
simply look “flushed,” like you are blushing or you may develop brownish markings on your face. Some women get a
dark line down the middle of their abdomen, where the skin darkens considerably from the navel to the pubic hair.
Acne crops up to plague some, or acne may actually be helped by pregnancy in others. Changing hormone levels
probably cause all of these skin color changes, but one thing is certain, they usually all go away or fade dramatically
after the baby is born.
VARICOSE VEINS
Varicose veins, “varicosities,” are caused when the veins in your legs get weak and enlarge with blood. They have to
work harder to carry blood back up your legs to your heart. Sometimes pregnancy can aggravate this problem. The
swelling uterus partially cuts off circulation from your legs. Exercise will help. Do not stand without moving for long
periods of time. When you sit, try to prop your legs up to make return circulation easier.
Varicose veins are more of a problem for women having their second or third child. But even if you are having your
first baby, try to do as much as you can to aid instead of hinder the circulation in your legs. Rest periodically with your
legs up.
Short walks at different times during the day will help pump your blood faster. Support pantyhose help tremendously,
but avoid all tight clothing such as knee highs that will only cut off circulation more.
The vulvar area can also suffer from varicosities during pregnancy. Again, rest periods spread out during your day
will help. This time, place a pillow under your buttocks to elevate your hips and aid circulation.
HEMORRHOIDS
Many women suffer with hemorrhoids, or get hemorrhoids for the first time while they are pregnant, but this doesn’t
necessarily have to happen to you. Hemorrhoids are enlarged veins right at the opening of the rectum. Though they
are sometimes due to the blockage of circulation caused by the increased size of the baby you are carrying, they are
also frequently caused by the straining due to constipation.
If you do suffer with hemorrhoids, try lying on your side with your hips elevated on a pillow. Soaking in a warm tub
can help, too. You can use over-the-counter ointments. Be sure to ask us if they are safe for your baby. The medication
in ointments is frequently absorbed through the skin and may affect your baby’s system. If you suspect your
hemorrhoids are bleeding, call us. Prevention is the word here! Eat correctly and add fruits, raw vegetables, bran
products and lots of water to your diet every single day.
VAGINAL DISCHARGE
You may notice more vaginal discharge during your pregnancy. You may want to wear a panty liner. This mucus
secretion occurs from the cervix in response to the hormones of pregnancy. Mucus secretion is different from leaking
of amniotic fluid. All this is quite normal and there really isn’t much that can be done to change the situation. Of
course, excessive discharges that itch or have a bad odor, should be evaluated. Many women seem to get yeast or other
vaginal infections while they are pregnant that need treatment, but they are not harmful to the baby. If you experience
discharge that is watery, call your obstetric care provider.
ABDOMINAL PAIN/ROUND LIGAMENT PAIN
Especially during the latter half of pregnancy, when the uterus and your baby are growing larger, you may experience
lower abdominal discomfort. One source is round ligament pain. Round ligaments are cord-like structures that
originate beneath the groin region and extend to the top of the uterus on both sides. Round ligament pain is described
as sharp pain in either or both groin regions and is caused by stretching and spasms of the round ligaments. Sudden

Your Prenatal Guide 15
movements like rolling over in bed or walking may aggravate round ligament pain. Reduced physical activity,
application of warm heat or use of a pregnancy support girdle may help. Constipation can also cause abdominal pain.
(See page 13.) If abdominal pain is severe or continues, please call your obstetric care provider. There can be other
more serious causes. (Refer to pages 31-33 regarding complications of
pregnancy.)
CRAVINGS
It’s important to keep eating your balanced diet, no matter what
your cravings are. If you feel like eating a pot of spinach at 2 o’clock
in the morning, go ahead. But, if you feel like eating hot chili or a
half dozen of your favorite candy bars...that’s another issue! A desire
to eat strange foods or non-food items might mean a nutritional
deficiency that needs correcting.
PICA
This is the medical term for the unusual cravings for non-food items such as clay or laundry detergent that you might
have while you are pregnant. No one knows quite why this happens, but some women experience it, and it can be
harmful. Please contact your obstetric care provider if you experience this.
DIZZY SPELLS
Some pregnant women do faint. This is caused by the circulation changes happening in your body, and usually goes
away by the second half of pregnancy. Lying on your back toward the end of pregnancy may also cause dizziness; so,
lying on your left side is recommended. Don’t change positions suddenly. When you are lying down, ease yourself up
to a standing position in stages. You don’t want to pass out on the floor - you could injure yourself.
ARTHRITIS
Not infrequently, later in pregnancy, swelling can occur in the joints and cause pain that feels like arthritis. This is
especially seen with women who develop leg swelling during the day and notice stiff sore-finger joints the following
morning after resting over night. A similar situation occurs in Carpal Tunnel Syndrome where a nerve that supplies
sensation to the hands becomes entrapped in a tunnel of tissue because of swelling. The involved nerve produces
numbness in one or both hands more frequently at night. Both conditions may be improved by bed rest and salt
restriction during pregnancy and the natural fluid loss that occurs after delivery. A hand splint may also be helpful.
SWELLING
Again, pressure from the growing uterus and your changing hormones can cause swelling, especially in your legs.
Some of this is blockage of drainage pathways and some is caused by water retention. Support pantyhose and resting
with your legs elevated will help a little. Be sure to avoid excessive salt intake, which will only make you retain more
water. Notify your obstetric care provider if swelling increases or occurs in your face or around your eyes.
STRETCH MARKS
Stretch marks show up usually on breasts, the buttocks and lower abdomen, but they might also occur in other
places. Moisturizing creams probably won’t do much to help because stretch marks are caused by the breakdown of
elastic tissue right below the skin’s surface. Excessive weight gain will make matters worse, so keeping your weight
gain under control will do more to avoid stretch marks than any single thing you can do. The good news is that
stretch marks usually change to a pale white after pregnancy, and become less noticeable.
NOSE BLEEDS
Some women have frequent nose bleeds during pregnancy caused by extra blood supply in the nasal lining. Just treat
with finger pressure on the side of the nose bleeding. Call if the bleeding is heavy and you are unable to stop with
pressure. Nasal congestion is also a common complaint. Avoid nose drops unless discussed with us.
HEADACHES
Headaches are one of the most common complaints along with nausea in the first few months of pregnancy. Most
headache remedies are not helpful. These headaches are caused by blood circulation changes and will usually stop after
the first half of the pregnancy. If you notice the headaches are associated with sensitivity to light, excessive nausea or
vomiting, fever, or blurred vision, call our office.

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Your Prenatal Guide
CONTRACTIONS
The uterine muscle contracts spontaneously from early pregnancy until the onset of real labor. Usually the
contractions are irregular and painless (Braxton-Hicks contractions) and may produce “false” labor if they become
painful. If they “progressively” become closer together, last longer and become more painful, notify us so we can make
certain you are not in early labor.
EMOTIONAL CHANGES
Depression/Anxiety
Many pregnant women may feel downright joyous one minute then break into tears the next. These up and down
mood swings are just a part of the hormonal changes going on in your body.
Emotional Mood Shifts
When any woman gets pregnant, she worries about the health of the baby, the pain of labor, about the future and
how she will adjust to being a mother, about a hundred different issues, all surrounded by the addition of a baby into
her life.
What To Do About Moods
Most of these anxieties can be eliminated by asking questions or just telling us your worries. If depression really gets
you down, don’t hesitate to ask for help.
Expect these mood shifts, and don’t think something is drastically wrong when they occur. No matter how much a
woman wants a baby, she still may feel inadequate once she becomes pregnant. The key to working through depression
and anxiety is to talk about your feelings. You should communicate your feelings, even if you think they are too
embarrassing. And try not to worry. Concentrate on living your life one day at a time. When you feel anxious, pamper
yourself with a warm, relaxing bath. Keep your thoughts on today’s events, not what could happen tomorrow. Make it
a point to get out of the house every day, even if only for a short walk. Reach out to others when you need a comforting
word.
Knowledge can erase many of your worries ...so read books on pregnancy and child care. Attending prenatal classes
is a great idea. Since this book cannot cover all aspects of pregnancy and birth, why not check out some books and
read to your heart’s content.
If you still feel depressed, be sure to talk it over with us. It can affect your overall health. Let us help you discover
that pregnancy can be a time filled with joy and happiness!
SEXUAL CHANGES
With your mood shifts come other emotional changes, too, including your feelings about sex. Desire for sex may rise
or fall significantly during pregnancy. If you lose interest in sex, don’t worry. It happens to a lot of women and doesn’t
usually last long. Be sure to discuss your feelings and have your partner read this book.
All these physical changes may have you wondering what you’ve gotten yourself into. Remember, pregnancy is a
natural process and a woman’s body is designed to handle it with a minimum of stress.

Fats, Oils, and Sweets
Use sparingly
*Milk, Yogurt and Cheese Group
four to five servings
Vegetable Group
three to five servings
Your Prenatal Guide 17
CARING FOR YOURSELF
In order to make the most of your expectations and grow a beautiful, healthy baby, you need to take extra special
care of yourself. Pregnancy can bring you both great joy and stress. As your weight and body changes, you’ll need to
alter some of your habits and routines. You might not be able to do everything you want to do for a few months.
Remember, taking good care of yourself is taking good care of your baby. Here are some guidelines for taking good
care of yourself.
DIET
Your diet is especially important because you’re eating for two. This doesn’t mean that you need to eat twice as much.
It means you need to eat all the right kinds of foods. The fetus gets all its food from its mother. Proper development
of your unborn baby depends on an appropriate amount of calories, proteins, vitamins and minerals supplied from the
mother’s diet. Only by eating a proper mixture of foods will you get the balance that's needed to nurture your baby's
growth. A pregnant mother needs about 300 calories more each day to stay healthy and nourish her baby. It's important
you get these calories by eating three or more meals spread throughout the day, instead of just eating a single meal at
night. Later in your pregnancy, you may even feel more comfortable eating five smaller meals a day instead of three.
The FOOD PYRAMID was developed by the U.S. Department of Agriculture to assist adults in choosing foods that
give these required nutrients. Each food group supplies different nutrients, so you must eat the proper amounts of
foods from each group every day to get all that you need. The "Food Guide Pyramid" will help you structure your
meals to make a healthier you and better nurtured baby.
Bread, Cereal,
Rice, and
Pasta Group
six-11 servings
Meat, Poultry, Fish, Dry beans,
Eggs, and Nuts Group
three servings
Fruit Group
three to five servings
THE FOOD PYRAMID GUIDE
Source: Modified from U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1992.
*Young mothers up to 24 years old need five servings per day.

18
Your Prenatal Guide
Estimated Dietary Needs for Non-pregnant and Pregnant Women
Nutrient Recommended Intake Recommended Intake Breast
for Non-pregnant Woman for Pregnant Woman Feeding
Calories 2000 +300 +500
Protein (gm) 55 60 65
Vitamin A (IU) 4000 4000 4300
Vitamin D (IU) 200 200 200
Vitamin E (mg) 8 10 12
Vitamin C (mg) 75 85 120
Folic Acid (mcg) 400 600 500
Niacin (mg eq) 14 18 17
Riboflavin 1.1 1.4 1.6
Thiamine (mg) 1.1 1.4 1.4
Vitamin B6 (mg) 1.5 1.9 2.0
Vitamin B12 (mcg) 2.4 2.6 2.8
Calcium (mg) 1200 1200 1200
Iodine (mcg) 150 220 240
Iron (mg) 15 30 15
Zinc (mg) 12 15 19
Magnesium (mg) 320 360 320
Source: National Academy of Sciences (2001)
SERVING SIZES
The following represent average serving sizes in various groups of the FOOD PYRAMID.
• Milk, yogurt and cheese group: 1 cup of milk or yogurt; 1 1/2 oz. of natural cheese; 2 oz. processed cheese.
• Meat, poultry, fish, dry beans, eggs and nuts group: 2-3 oz. of cooked lean meat, poultry or fish (size of deck of
cards); 1/2 cup of cooked beans; 2 eggs; 4 tbsp. peanut butter, 4 oz. tofu, 1/2 cup of nuts
• Vegetable group: 1 cup of raw, leafy vegetables; 1/2 cup of other cooked or raw vegetables; 3/4 cup of vegetable
juice.
• Fruit group: 1 medium apple, banana, or orange; 1/2 cup of cooked or canned fruit; 3/4 cup of fruit juice.
• Bread, cereal, rice and pasta group: 1 slice of bread; 1 oz. cereal; 1/2 cup of cooked cereal, rice or pasta (whole
grains preferred).
PROPER DIETARY BALANCE AND CALORIE INTAKE
Sensible weight control during pregnancy is a balance between diet, exercise, and rest. Weight gain from fluid
retention during the latter stages of pregnancy can assume an added role. Pregnancy is not a time to fad diet, so if you
start out overweight, don’t try to correct the situation now. For those attempting to control calorie intake and maintain
balance during pregnancy, the following modifications to the five food groups will be helpful.
Meat, poultry, fish, dry beans, eggs and nuts group: Eat broiled fish, chicken, lean beef and beans. Limit bacon,
luncheon meats and fried meats or meats with added sauces and gravies.
Milk, yogurt and cheese group: Eat or drink low-fat or skim milk and cottage cheese, farmer’s cheese and yogurt.
AVOID whole milk and its products, including ice cream and most cheeses.
Vegetable and fruit group: Eat as desired. AVOID high fat methods of food preparation - sauces, dressings, etc.
Bread, cereal, rice and pasta group: You can eat whole grain breads and cereals including pita bread, sourdough bread,
whole grain bread, bran and shredded wheat cereals. AVOID many breads and cereals with refined flour and sugar.
Fats, oils, and sweets: Limit whole milk dairy; i.e. butter, cream, sour cream. Include reasonable amounts of olive
oil, olives, nuts and avacado. Limit sweets because this group contains items with calories, fat and simple
carbohydrates with little or no vitamins and minerals. Such foods have no nutritional value to you.

Things You Should Know Before
Having Your Baby at...
Your Hospital Stay
Brigham and Women’s Hospital believes in providing family-focused, comprehensive care to all
patients. Our family-focused care begins preparing families even before the birth of their baby, with
prenatal care, informational and educational programs, programs for siblings and other services to ensure
that families are well prepared for the new baby.
Our expert team of obstetricians, midwives and nurses handle all types of births – from routine to high
risk. Our medical and administrative staff are always prepared for your arrival and will do their best to
make your birthing experience, from arrival to discharge, as smooth as possible.
When Labor Begins
During your pregnancy, your obstetric care team will give you the details you will need to prepare for
the birth of your baby at Brigham and Women’s Hospital. We will provide you with the best possible
care and give you as much information as we can so that you are fully prepared.
When your contractions are two to five minutes apart, call your obstetric care provider. You may be
instructed to proceed to the main entrance of the hospital at 75 Francis Street. If you arrive by car, a valet
parking attendant is available to park your car. Go to the Obstetrical Admitting Office which is next to the
Gift Shop. After you have checked in, you will be escorted to the Center for Labor and Birth in the Mary
Horrigan Connors Center for Women’s Health, where a nurse will review your medical history, your
obstetrical history, your allergies and your medication uses. She will also check your blood pressure,
temperature, pulse and the baby’s heart rate. Your obstetric care provider will be notified of your arrival.
Two support people are allowed with you in the Center for Labor and Birth. Other family members and
friends may wait in the Mary Horrigan Connors Center for Women’s Health Lobby, the Main Lobby of the
hospital, the Au Bon Pain cafe in the the Main Lobby, or in The Robert and Ronnie Bretholtz Center for
Patients and Families, which is located behind the information desk in the Main Lobby. Visiting hours in
postpartum areas are from 1 p.m. - 8 p.m., but fathers or the support person may visit any time. Children
under the age of 12 are not permitted to visit unless they are siblings of the newborn and are accompanied
by an adult.
Please refer to the Obstetric Anesthesia Service brochure to familiarize yourself with the different types of
anesthesia available to you. The brochure is located in your obstetrical admitting packet. If you have
concerns or questions or need an additional copy of the brochure, please call the Obstetric Anesthesia
Service at (617) 732-8220.
Brigham and Women’s Hospital offers a variety of Parent and Childbirth Education classes to prepare you
for the birth of your baby. Refer to the Parent and Childbirth Education brochure in your admitting packet
for class topics and details. To register for classes, please call (617) 732-4081.
NOTE: Cell phone usage is permitted in the Mary Horrigan Connors Center for Women’s Health, except for
the 6th floor which houses the Newborn Intensive Care Unit (NICU).
19

20
If You Are Induced
Due to a variety of reasons, some women are induced in order for labor to begin. At the Mary Horrigan
Connors Center for Women’s Health at Brigham and Women’s Hospital, our obstetricians, midwives,
nurses and anesthesiologists are fully prepared if you need to be induced. Unfortunately, we are not able
to determine early in your pregnancy if you will need an induction, so we encourage all expectant parents
to be prepared for the possibility.
An induction is the initiation of uterine contractions and labor by the use of vaginal and/or intravenous
medications. There are many reasons why women may need to be induced including:
• Pregnancy-induced hypertension (high blood pressure)
• Post dates (one to two weeks overdue)
• Premature rupture of membranes/amniotic sac (broken water)
• Suspected infection in the amniotic sac
• Abnormal amount of fluid in the sac (high or low)
• Maternal medical condition, such as diabetes, chronic high blood pressure or heart disease
• Concerns about the baby’s growth (too big or not growing well)
• Logistic factors (history of rapid labor, distance from the hospital)
Your obstetric care provider will discuss the reasons for your induction with you. Induction of labor can
be performed in a variety of different ways. There are different medications and methods that may be used
including:
Pitocin ® - a synthetic form of the hormone Oxytocin. It often is used to stimulate labor contractions. It is
given through an intravenous infusion (IV) in your arm. The dose of medication is regulated and increased
until an adequate labor pattern is established. While you are being induced, the baby and your uterine
contractions are monitored by a fetal monitor to evaluate your baby’s heart rhythm and the adequacy of
uterine contractions.
Prostaglandin gel (PGE2) - a hormone mixed in a gel. It softens and dilates the cervix. The gel is used on
the day before or the same day as a Pitocin ® induction. Sometimes it is necessary to receive more than one
gel application.
Cytotec ® - a hormone in a pill form which is placed in the vagina. It softens and dilates the cervix.
Cytotec ® can be used on the day before or the same day as a Pitocin ® induction and can be given more
than once.
Cervidil ® - a hormone that looks like a small tampon is placed in the vagina to soften and dilate the cervix
over a 12-hour period.
Amniotomy (breaking the bag of water) – a simple procedure which is preferred when the cervix is
dilated. A small instrument is used by your obstetric care provider during the pelvic exam to make a small
tear in the amniotic sac. The fluid that escapes will be warm. Contractions usually begin within a few
hours.
For Scheduled Inductions:
Before you leave home, please call (617) 732-4805 and ask to speak to the Nurse-in-Charge regarding
your induction time. Please note there are times when we cannot predict how many patients will be in
labor on the day of your induction. There is a small possibility that your induction will be delayed or
rescheduled for another day.

Prior to admission:
Please ask your obstetric care provider for details concerning what you may or may not eat prior to
coming to the hospital for your induction. It is important to get a good night’s rest. It is not necessary to
remove jewelry or contact lenses, however, we cannot be responsible for your valuables. You might want
to bring a small bag containing what you will need in labor, such as a book, magazines, radio, etc. Your
infant car seat and all of your luggage should be brought to your postpartum room after your birth.
Day of your induction:
A nurse will confirm the time of your induction the day before, but please also call us at (617) 732-4805
before you leave for the hospital. Plan to arrive at the main entrance of the hospital approximately 15 to
30 minutes before your planned induction time so you can check in with the Obstetrical Admitting Office,
located in the Main Lobby of the hospital next to the Gift Shop. Valet parking is available and is the most
economical parking option for patients.
Once you arrive in the Center for Labor and Birth, a secretary at the main desk will greet you. A nurse
will escort you to a triage room or a Labor and Birth room and help you to get settled. She will then go
over your medical and obstetrical histories, your allergies and your medication uses. She will also check
your blood pressure, temperature, pulse and the baby’s heart rate. Your obstetric care provider will then be
notified of your arrival.
If your induction utilizes Cytotec ® , Cervidil ® or PGE2 gel, you will be admitted to the Obstetrical Triage
area rather than to a labor room. Your obstetric care provider will be notified when you are settled. You
will be monitored continuously if given Cervidil ® , and for one to two hours if given Cytotec ® or PGE2 gel.
To protect your privacy, our staff cannot give out information to your family or friends who call to check on
your status. You will have a telephone in your labor room and after you are admitted you can provide that
number to your family and friends. Be sure to let your nurse know if you do not want calls sent to your room.
Support Person(s):
In the Center for Labor and Birth, two support people of your choice may accompany you. We must ask
that additional family or friends wait in the Mary Horrigan Connors Center for Women’s Health Lobby, the
Main Lobby of the hospital or in The Robert and Ronnie Bretholtz Center for Patients and Families. Your
family and friends may visit after you have given birth and are moved to the postpartum unit. Visiting hours
are from 1 p.m. – 8 p.m. on the postpartum unit.
If You Have A Scheduled Cesarean Birth
If your doctor has scheduled you for a cesarean birth at Brigham and Women’s Hospital, you can be
assured that with today’s techniques and our skilled medical staff, the birth of a baby through an abdominal
incision is a safe childbirth method. Cesareans, however, are a major surgical procedure so they are only
performed when medical circumstances require them.
One support person may accompany you during your cesarean birth. This support person is the only one
who will be allowed in the labor, birth and recovery area.
Before Admission:
Certain tests must be performed before your surgery. These tests often take place on the day of your baby’s
birth. Sometimes, however, they must be performed prior to admission at the Pre-Admitting Test Center
(PATC). If this is necessary, your obstetric care provider will help you arrange the tests within 48 hours of
your cesarean birth.
The night before surgery, do not eat or drink anything (including water or hard candy) after midnight. Do
not wear nail polish, cosmetics or jewelry. The hospital cannot be responsible for any of your valuables.
Hard contact lenses should not be worn. If you wear glasses or soft contacts, ask your anesthesiologist if
you can wear them during birth. We will make an effort to call you the day before your surgery to answer
any remaining questions, however, if you have not heard from us, please do not hesitate to call the Nursein-Charge
at (617) 732-4805.
21

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Morning of Surgery:
Prior to your cesarean birth, you will be told what time to report to the Obstetrical Admitting Office,
which is located in the Main Lobby next to the Gift Shop. (Please arrive two hours prior to your scheduled
cesarean birth.)
After completing paperwork and depending on the scheduled time of your cesarean birth, you will be
escorted to the Center for Labor and Birth where a nurse will ask you questions about your medical and
surgical histories, obstetrical history, allergies and medications. The nurse will also check your blood
pressure, pulse and temperature, as well as your baby’s heart rate. Your abdomen, as well as some of your
pubic hair, will be shaved. You will be given an antacid before giving birth. A Foley catheter, which is used
to drain urine from your bladder, will be inserted before the surgery begins.
Anesthesia:
In a triage or recovery room, an anesthesiologist will discuss with you the various types of anesthesia and
the advantages and disadvantages of each. You may also call the anesthesiologist on duty at (617) 732-
5435 at any time if you have specific questions or would like to discuss your options in advance. Please
refer to the Obstetric Anesthesia Service brochure in your admitting packet for additional information.
An intravenous (IV) line will be started which will administer fluids and medication during and after your
cesarean birth. Spinal anesthesia is given in the operating room due to its rapid onset. The anesthesiologist
and labor and birth nurse will stay with you and explain the procedure. You will receive oxygen from a
mask placed over your nose and mouth (the plastic may have a strange odor). Although rarely used, if you
have general anesthesia, medication will be administered through your IV line and will put you to sleep
almost immediately.
Cesarean Birth:
The individuals who will be present with you in the operating room are: your support person (at the head
of the bed with you), your obstetrician, his/her assistant, an anesthesiologist, the labor/birth nurse, the
operating room technician, a pediatrician and a neonatal nurse. There may be additional physicians
present. If you receive general anesthesia, your support person will not be with you. You will be in the
operating room for about two hours. After your baby is born and has received preliminary care, he or she
can usually stay with you in the operating room.
Recovery:
After your cesarean birth, you will be taken to the recovery room and monitored closely for at least two
hours. If you had a spinal or epidural anesthetic, you will stay in the recovery room until you can move
your legs (about two hours). You blood pressure, pulse, temperature, lochia (vaginal bleeding), fundus
(uterus) and abdominal dressing will be checked. Your baby and support person can be with you in the
recovery room until you are transferred to the postpartum unit. The time spent in the recovery room is a
good chance to get acquainted with your baby, and if you are breastfeeding, to start nursing with the help
of your nurse.
Postpartum:
You will be encouraged to get out of bed shortly after your cesarean birth. The Foley catheter will be
removed in the morning, and the IV is usually removed 24 to 48 hours after giving birth. Your physician
will prescribe pain medication in one of two ways: on a “when needed” basis, (i.e. when you ask the nurses
for it) or a “patient controlled analgesia” (PCA) pump with which you can give yourself medicine through
your IV. On your first day, we recommend you take pain medication at regular intervals to control the pain.
The discomfort from your incision should subside with each day.
When you are brought to your postpartum room, your family and friends may visit you. Visiting hours are
from 1 p.m. – 8 p.m., but fathers or support persons may visit at any time and are encouraged to stay
overnight. Please try to limit the time you spend with visitors, as you need to rest and get to know your
new baby.

Your Prenatal Guide 23
APPROPRIATE EXERCISE AND REST
A mild exercise program is much more beneficial than one that is impulsively and excessively practiced. As your
pregnancy nears term, more rest and less exercise usually will be more effective in weight control and promote wellbeing
for both you and your baby. Remember, a 20-30 pound weight gain during pregnancy will usually result in a
return to your “normal” weight afterwards.
FLUID RETENTION
A low-sodium diet is not generally recommended, but certain foods and liquids do contain an excessive amount of
salt that promote excessive fluid retention in some patients. You may want to cut out:
• Bacon, sausage, country ham, salt pork and luncheon meats
• Canned soups, canned vegetables, canned meats and fishes
• Salted popcorn, pretzels, potato chips, corn chips, salted nuts, saltines, etc.
• Tomato juice, V-8 juice, bouillon cubes, salt
Bed rest (lying on side) allows the kidneys to excrete sodium and water retained by the hormones of pregnancy. This
may prove as effective as diet manipulation for the control of fluid retention late in pregnancy.
WORK
You’ll probably be physically able to work during your entire pregnancy. But you should take some precautions. Your
job shouldn’t allow you to be exposed to chemicals or radiation which may be dangerous to your baby. You can contact
various sources in your community, such as the Department of Public Health, for lists of hazardous chemicals and
occupations. Some physical activities may become impossible because of changes in your body structure. Try to arrange
for short rest periods when you can sit and put your feet up. Many restrooms have lounges where you can lie down for
a few minutes three or four times a day.
If you have complications, certain jobs will be unwise to continue, especially in the latter stages of your pregnancy.
Discuss your job situation with us.
TRAVEL
Travel is usually no risk to you or your baby, if you follow certain guidelines. You shouldn’t plan to travel long
distances away from home the last four to six weeks of your pregnancy. Restrict your travel earlier if you’re having
twins, bleeding, or have pregnancy related high blood pressure. When you do travel a great distance, make sure you
get up and walk around at least every two hours to keep your circulation moving.
If you experience any complications with your pregnancy, it may be best not to travel at all, especially far away from
home. If an emergency arises and you must travel during the last four to six weeks of your pregnancy, ask us for advice.
A copy of your medical record to carry with you might prove helpful. Also you may need a doctor’s note if you plan
to travel by plane. If any problems arise during the trip, go to the nearest medical facility immediately.
BATHS
Some women wonder if it’s safe to bathe while they’re pregnant, especially during the last months. The only danger
to you when bathing is not being able to get up out of the tub once you get in. So, in those last couple of months, you
should bathe when there is someone who can help you in and out of the tub. This will lessen your chance of falling
at a time when you’re not as likely to be able to catch yourself.
TAMPONS
Since you’ll be having more vaginal discharge than usual, you might wonder about using tampons. You’ll want to
keep your vagina as free from irritation as possible, so we recommend you try using one of the lightweight mini-pads
instead. Then you won’t have to worry about accidentally introducing extra germs into the already sensitive balance
of your vagina.
EXERCISE
Exercise is also essential. Of course, walking is excellent exercise, and yoga is becoming very popular with pregnant
women. You may start a mild exercise program early in your pregnancy. Keep up any pre-pregnancy routine you may
have, unless you have a medical problem and we advise you otherwise. Normally, you don’t have to limit your exercise,
except when it risks injury to you or your baby. When exercising, drink lots of water, and wear good shoes and a

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Your Prenatal Guide
support bra. You should consult with your obstetric care provider before you begin any new exercise routine. You
should stop any exercise if you develop shortness of breath, chest pain, extreme fatigue, or dizziness. Notify your
obstetric care provider of these syptoms and call immediately if symptoms persist.
IN ALL CASES, YOU SHOULD APPLY THESE SENSIBLE GUIDELINES:
• Avoid impact exercise
• Avoid stresss to your low back area
• Limit the intensity of your exercise program to the same levels as you set when you weren’t pregnant
• Exercise for shorter periods of times and rest frequently
• Reduce weight-bearing exercise (running, weight machines) in favor of non-weight-bearing exercise (bicycling,
swimming)
• Avoid getting your heart rate more than 140 beats per minute
• Avoid doing full situps and raising both your legs while lying flat
If you experience certain complications during your pregnancy, you and your baby would probably benefit from a
sedentary activity level with little or no exercise. We recommend this to you if you are expecting twins or have high
blood pressure, an incompetent cervix, or a condition in which it appears that your fetus is not growing properly.
Common sense, good judgment and listening to your body’s signals are the main guides to exercising during
pregnancy.
REST
Rest is essential. Don’t let yourself get worn out during work or play. Remember, you may be more tired than usual
in the early stages of pregnancy. That’s just your body trying to tell you something - “Rest.” Get a good eight to 10
hours of sleep each night and don’t feel guilty about an hour’s nap in the middle of the day. Toward the end of your
pregnancy, you may even feel like taking two or three naps a day. If you’re working, try to arrange for extra 10 to 15
minute breaks and space them throughout the day.
SEAT BELTS
Seat belts are a safety device that protect you and your baby in important ways. It’s best you wear both the shoulder
and lap belts if possible. Place your lap belt under your abdomen, across your hips and thighs. Wearing your safety
belt makes you 60 percent less likely to be injured or killed in an accident. Most fetal injuries relate directly to the
seriousness of the mother’s injuries, rather than to those caused by the seat belt itself.
CLOTHING
Comfort is the word in clothing. Wear a supportive bra because your breasts will be getting larger and heavier. You
can buy a maternity girdle if you like. If you do buy one, make sure it’s supportive, not tight! If you plan to wear hose,
buy pantyhose instead of knee highs. Just be sure to buy pantyhose that allow your crotch to breathe.
You’ll want to allow as much circulation to your legs as you can. Support hose may help your legs if they’re feeling
tired or if you suffer from varicose veins. Wearing a good pair of shoes that is secure and comfortable is only sensible.
Needless to say, buy for comfort in all your maternity clothes and shoes.
DOUCHING
There’s rarely a need to douche during your pregnancy. If it becomes necessary, we’ll give you specific instructions.
CARING FOR YOUR BREASTS
We’ve already mentioned the need for you to wear a proper support bra during pregnancy and while nursing. This
is for your comfort.
You may notice a slight leakage of fluid (colostrum) from your nipples. Toward the end of your pregnancy you may
secrete quite a bit more, requiring you to cleanse your nipples more frequently than normal. Use warm water, but no
soap, and dry well.
If you have inverted nipples or develop them as your breasts enlarge, consult with your obstetric care provider about
exercises that draw out your nipples. Milk cups or breast shields worn in the bra the last part of the pregnancy may also
help inverted nipples. Please check with your obstetric care provider first, especially if there is question of preterm labor.

Your Prenatal Guide 25
INFANT FEEDING: BREAST OR FORMULA
The ideal food for your newborn is mother’s milk. There are many advantages of breastfeeding. First of all, the
process is simple, economical, convenient and presents less feeding problems for your infant. Also, breast milk is more
nutritious than formula and offers protection from infection for your newborn by transferring your immunity through
your breast milk. Breastfed babies tend to have less allergic diseases such as skin rashes and asthma. There are also
fewer occurrences of diarrhea, gastrointestinal disorders and ear infections for your baby. Breast milk may protect
against sudden infant death syndrome (SIDS), diabetes, allergic disease and lymphoma. Breastfeeding also promotes
something very special –– mother-infant bonding. Breastfeeding mothers may also notice a faster postpartum recovery
and weight loss. A reduced risk of breast, uterine and ovarian cancer, and protection from osteoporosis is possible for
women who breastfeed. Check with the hospital for breastfeeding classes. Even though breastfeeding is a natural
method of feeding your baby, it is a learned process. Classes can assist your breastfeeding experience and help it get
off to a good start.
Even though there are many advantages to breastfeeding, formula feeding is an acceptable alternative for many
mothers. There are a few mothers who should not breastfeed their babies. If you’ve had breast reduction surgery and
your nipples were removed, you most likely won’t be able to breastfeed. Virtually all medications you take are
transferred through your breast milk to your feeding infant. Therefore, if you’re on cancer treatment drugs, certain
antibiotics such as tetracycline, or antidepressants such as lithium, please consult with your obstetric care provider.
In the end, how you feed your baby is your choice. What’s important is for you to feel comfortable with how you
feed your baby.
TEETH
Proper dental care is very important. Don’t hesitate to see your dentist for dental problems that occur
during your pregnancy. Just make sure your dentist knows you’re pregnant so the proper
precautions can be used when taking x-rays or prescribing medications.
Frequent brushing, dental flossing and proper diet can minimize your dental problems
during pregnancy. Swollen and bleeding gums are common problems for pregnant women.
You can minimize bleeding by using proper oral hygiene (frequent brushing and dental
flossing.)
IMMUNIZATION
Talk with us about immunizations you think you might need, especially those required for foreign travel. Some
booster shots like tetanus are okay during pregnancy. Others are not.
You definitely do not want to be given live virus vaccines such as mumps, measles or rubella (German Measles)
during your first three months of pregnancy. These are potentially harmful to your developing unborn child. Ideally,
you should be immunized before you’re pregnant. This allows a certain amount of immunity to be passed on from you
to your child without the harmful effects a live virus might cause.
INSECTICIDES AND HOUSEHOLD CHEMICALS
You should avoid heavy or prolonged exposure to as many household chemicals as possible. They can absorb into
your system right through your skin, or through tiny cracks in your skin. If you must use strong household cleansing
aids, wear gloves and work in well-ventilated areas.
Also avoid insecticides, pesticides, and weed killers. If you’ve had your house sprayed for bugs, allow it to air out
before you return. Give up using aerosol sprays and use mechanical pump sprayers instead. Exercise the same caution
for hair dyes and permanents. We’re just beginning to understand the potentially hazardous affects many chemicals
have on pregnant women and their unborn babies.
When you start thinking about painting your new nursery, be sure to use latex paint if at all possible. Do not use
lead-based paint because it is harmful to your baby. Although oil-based paint and organic solvents like turpentine and
lacquer have not been proven to be harmful, they do produce strong fumes that you should probably avoid. Keep the
room well ventilated. The best bet is to have someone else paint the nursery.

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Your Prenatal Guide
SAUNAS AND HOT TUBS
You can harm your baby if you raise the
temperature of his/her environment over
100 degrees for prolonged periods of time.
So avoid hot tubs while you’re pregnant. If
you need to soak your aching feet, that’s
fine....but for a while, avoid plunging in
all the way. Saunas are out completely.
SEX
You might not want to have sex if it’s
uncomfortable during the last four to six
weeks. And, if you have a history of
miscarriages, pregnancy-related vaginal
bleeding or other complications, we’ll
probably suggest you don’t have sex.
Otherwise, there’s absolutely no reason to
interrupt your normal sex life. Orgasms
will not start labor, cause bleeding or
other problems in a normal pregnancy.
Many partners are afraid that having sex will hurt the baby. Don’t worry. Your baby is so well-protected by fluid,
muscle, and bone, your motions aren’t going to bother the baby one little bit. It’s much more healthy for you and your
partner’s relationship if you continue to be sexually intimate with each other.
PLAN AHEAD
Part of caring for yourself is planning ahead, especially for the first two or three weeks after you bring your new baby
home. It is very difficult to run around the day after hospital discharge to buy last minute necessities. Prepare yourself
for the baby ahead of time. Read up on baby care. Know that you’re going to be tired, so plan to have some help those
first two weeks if possible. If you do have friends or relatives come to help you, make one point clear before they arrive.
You are taking care of the baby. They are taking care of the vacuuming and the dishes - not the other way around! If
no one is close by to help, ask us about home visiting programs and local postpartum support agencies.
Also, plan to have your baby’s clothes, diapers and bedding ready. Girl or boy, your baby will have a number of basic
needs. The time to prepare for “homecoming” is throughout your pregnancy. Friends are most helpful. Think of those
close friends who have had babies in the last five years. Chances are they still have plenty of wearable and useable
items that their children have outgrown. Refer to the Pregnancy Planner in your admitting packet for a detailed list of
items you will need for your baby.

Your Prenatal Guide 27
EXERCISES FOR PREGNANCY
Whether you are going to have a “natural” childbirth with little or no anesthesia or whether you choose some
painkilling drugs, you still need to exercise during your entire pregnancy to develop muscle strength for labor. Exercise
also helps with backaches, circulation, insomnia and weight control as mentioned in other sections of this booklet. If you
do choose “natural” childbirth, you will attend classes and learn all the techniques and exercises specific to that birthing
method. But here are a few exercises to help everyone during pregnancy. These exercises will help you relax and stretch.
They will strengthen inner thigh muscles, pelvic muscles and limber pelvic joints. Do them faithfully on a daily basis. It
is best to avoid exercise that requires you to be flat on your back during the last 3 months of your pregnancy.
STANDING UP
Keep your back straight, tighten your buttocks, bend your knees slightly, and rock your pelvis
back and forth. This is actually a belly dancing technique, called the hinge. To enjoy your daily
exercising more, put on some music and slowly walk about doing the pelvic rock, or hinge. Your
abdomen and bottom should work like a hinge, while the rest of your body stays fairly upright.
Once you get the hang of it, you can understand why belly dancing is so popular as a form of
exercise, even for pregnant women - it’s fun!
THE PELVIC ROCK
This is probably the most common exercise taught in childbirth classes, and for good
reason - it is excellent. You can use it before and after delivery, first to give the
fetus good support and then to firm those abdominal muscles. You can do it
lying on your back, standing or in the “all fours on the ground” position.
KEGEL EXERCISE
You can also do another excellent exercise to tone muscles in the pelvic area and improve circulation.
This exercise should be continued after delivery to promote more rapid healing and to improve the tone
of the vagina. What you want to do is control and relax certain sets of pelvic muscles, one at a time. First,
contract your muscles like you are holding back a bowel movement. Finally, contract the vaginal
muscles. It may take some practice to isolate each of these sets of muscles,
but keep practicing. Relax and contract each set of muscles separately,
contracting them harder and longer each time. Do these Kegel exercises
anywhere, anytime during the day.
ALL FOURS
Get on your hands and knees with your legs and hands parallel to the floor. Pull your buttocks
down and slightly arch your back, tilting your pelvis forward. Then push your buttocks out and
back, tilting your pelvis back. Don’t let your back curve in as the pelvis is rocked.
THE SQUAT
Stand with your back against a wall. Lower your body slowly down the wall, with your hands
against it, until you are in a squatting position. Keep your feet parallel and your heels flat against
the floor. Then slowly raise your back up. A variation of the squat: hold onto a heavy piece of
furniture that won’t tip over, and squat down, keeping your heels flat on the floor, your back
straight, and letting your knees spread open. Slowly raise back up. This exercise will help your
back and it is good practice for proper lifting of heavy weights. (Always lift heavy objects with
your back straight, squatting and using your leg muscles to propel you up.) Practice both types
of squat exercises daily.
STRESS AND TENSION
Be good to yourself during pregnancy. You do not need additional stress and tension during this
special period of your life. Do not put yourself in situations that you know stress you. Do not plan
too many busy activities. Rest. Use periods of total quiet during your day to sit and breathe deeply
for a few minutes, relaxing your body and your mind.
Exercising during pregnancy is absolutely vital to a healthy pregnancy, an easy delivery, and
a speedy postpartum recovery. Don’t skimp in this area with excuses of “not enough time.”
Make time!

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Your Prenatal Guide
CARING FOR YOUR UNBORN BABY
ALCOHOL
Whatever goes into your body affects your baby, too.
Do not drink alcohol while you’re pregnant. Drinking alcohol
during pregnancy can cause birth defects, learning disabilities,
behavioral problems, and mental retardation in your baby. Fetal
alcohol syndrome is the medical term that describes the many
physical and mental problems that affect children born to mothers
who drank alcohol during their pregnancy. The adverse effects of
drinking alcohol depend on the amount consumed, the stage of
pregnancy, and certain susceptibilities in the mother and her baby.
The effects of even small amounts of alcohol on the unborn baby
are still unclear. Therefore, the safest course to take while you’re pregnant
is not to drink alcohol at all.
If you think you may have a drinking problem, please discuss this with us. If you find you can’t stop having a drink or
two, several times a week, we’ll need to work together quickly to help your situation. Your baby’s health is at stake. Don’t
be embarrassed about any problem you may have with alcohol. One in ten people have some type of drinking problem.
Talk to us! We can help.
MEDICATIONS
Avoid using medications of any kind during your pregnancy, unless we specifically prescribe one for you. This also
applies to over-the-counter drugs. Don’t even take an aspirin without consulting us, because all medicines you take
will be circulated to your developing baby as well. Even hemorrhoid treatments and cold medications should be
cleared through us before you take them. Any of these types of drugs may contain ingredients that could be harmful
or associated with transient disorders during their newborn period.
CAFFEINE
In addition, you should limit caffeine. This chemical is a powerful stimulation to your central nervous system and
its effects on your unborn child have never been conclusively tested. One to two (5 oz.) cups of coffee a day is
acceptable. Remember, soft drinks and tea also contain caffeine.
ASPARTAME (NUTRASWEET ® )
There’s no evidence to suggest that aspartame (NutraSweet ® ) is a risk to your baby while you’re pregnant. But until
more evidence is available, we advise you to limit use to one to two servings a day.
STREET DRUGS
Substance use during your pregnancy victimizes your unborn child. Amphetamines, “crack”, barbiturates, narcotics
and cocaine have all been linked with low birth weight babies, fetal distress, and premature birth. These newborns
often begin life by fighting withdrawal symptoms. They also run the risk of sudden infant death.
Some drugs reach your developing baby easier than drugs taken by mouth. They include drugs taken intravenously,
nasally, or by inhalation (cocaine, “crack,” and marijuana). These illicit drugs have proven adverse effects during
pregnancy. Infants born to drug-addicted mothers can actually be born addicts themselves and may suffer withdrawal
symptoms immediately following birth. Certain medications you take while pregnant can have permanent effects on
your baby or may be associated with transient medical disorders during their newborn period. It is also important for
your obstetric care provider to be aware of any drug in your system, as certain drugs and treatment options may not
be safe for you. Please discuss drug use with your health care providers. We can work together to help you. Your health
and your baby’s health are at risk.
It’s very important for you to tell us if you’ve used any street drugs because your newborn child could suffer
permanent damage, even death, if this problem isn’t recognized and treated during the newborn period.
SMOKING
It’s a proven fact that women who smoke during pregnancy give birth to babies whose birth weights are lower than
average. If you smoke, you’ll have a greater chance of miscarriage or stillbirth. You’ll also run a greater risk of having
a premature baby or one that dies early in life from crib death (SIDS). Certain learning disabilities and behavioral

Your Prenatal Guide 29
disorders may also be related to mothers who smoke. Second hand smoke is potentially harmful to your other children.
If you smoke, this is the perfect time to quit. More than one-fourth of all smoking women choose to give up their habit
during pregnancy. Smoking isn’t good for your health and it’s not good for your baby’s health. For information on how
to stop smoking, please call the Quit Smoking Program at Brigham and Women’s Hospital at (617) 732-8983.
X-RAY STUDIES
If necessary, dental and other limited diagnostic x-rays may be performed during your pregnancy. If your x-ray
studies are elective, postpone them until after your delivery. Be sure to tell the x-ray technician about your pregnancy
so they can shield your baby when x-rays are taken.
GENITAL HERPES
Genital herpes is a viral disease that affects the sexual organs in both men and women. It plays an extremely
important part in pregnancy since a newborn can experience serious permanent neurological damage and even death
if he or she is infected during birth. Approximately one-half of infants born to mothers experiencing their first
outbreak at the time of birth will be infected with the virus. Mothers with recurring infections (recurrent herpes) are
not nearly as likely to infect their newborn babies.
We absolutely must know if you or your partner has ever had herpes so that we can take proper precautions at the
time of delivery. You should tell us about every flare-up you have during your pregnancy so we can examine you and
take a culture if it’s necessary.
The recommended treatment of genital herpes has varied considerably over the past several years. We may perform
cultures wherever active herpes lesions are present. A cesarean delivery should be performed if you have active lesions
when you go into labor or rupture your membranes. If you have no history of recent flare-ups or visible lesions at the
time of your labor, a vaginal delivery is recommended.
GERMAN MEASLES
German Measles, a viral disease, can be especially dangerous if it occurs in the first three months of your pregnancy
when your baby’s organs are developing. It can cause many birth defects involving your baby’s eyes, ears, and heart.
Several skin rashes associated with fever mimic German Measles, but blood tests will tell us which is which.
If you suspect you’ve been exposed to German Measles, call us immediately. We may already have a blood test from
this or one of your previous pregnancies that tells us you shouldn’t be concerned about this disease. Remember, you
must actually contract the disease in order to put your developing baby at risk. Exposure alone will do no harm. Once
you’ve had the illness, you’re immune for life. If your blood test results show you’ve never had this infection, we’ll
probably recommend you get immunized after this pregnancy.
TOXOPLASMOSIS
Toxoplasmosis is an infection that you can get from eating raw or undercooked meat or from contact with soil/litter
contaminated with cat feces. Cats generally get the parasites from mice or rats, then excrete the organism in their stool.
Prevention is the key to avoiding this disease. Avoid eating raw or undercooked meat. Wash your hands carefully
after handling raw meat or fresh produce. Wear gloves if you garden or may come in contact with soil/sand/dirt
contaminated with cat feces. Allow someone else to empty your cat’s litter box. Strictly indoor cats are usually not a
problem.
HEPATITIS B IN PREGNANCY
Hepatitis is an infection of the liver caused by many different viruses. If you have ever been infected by the hepatitis
B virus and become pregnant, there may be problems for your newborn baby. A certain number of people who contract
hepatitis B develop chronic hepatitis –– a condition which can eventually destroy the liver. Also, it can allow the infected
person to give the virus to others without knowing it. This is the problem with the pregnant mother and her baby.
A very high number of mothers who test positive for hepatitis B surface antigen will unknowingly infect their newborn
babies during delivery through contact with maternal blood or secretions. One out of four of these infected babies will
die from their infection. By detecting this infection in the pregnant mother, the vast majority of these newborns can be
treated at birth. This prevents their infection and the baby's risk of dying from the disease. It also prevents the child from
unknowingly passing the infection on to others and to their own babies later in life. We will perform this relatively
simple and inexpensive test on you early in your pregnancy along with your other routine blood tests. Your baby's
doctor may now routinely immunize your newborn against this disease immediately following birth.

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Your Prenatal Guide
HEPATITIS C
Hepatitis C is a viral hepatitis that is spread through blood contact, including organ transplantation, intravenous
drug use and blood transfusion. It can also be spread through sexual relations and from an infected mother to her child
during birth. Most cases of hepatitis C are mild, and many go undiagnosed. However, a large percentage of people who
have been exposed to hepatitis C can develop chronic infection that can cause symptoms many years later. It may also
be transmitted to other people. If you have ever had unexplained hepatitis or jaundice, received blood transfusions or
underwent organ transplant prior to 1993, used intravenous drugs, or had a sexual partner with these issues, please
inform your obstetric care provider. You and your baby may benefit from testing for hepatitis C.
CHICKENPOX (VARICELLA)
Many women have already had chickenpox during their childhood. That’s why the disease is so uncommon during
adulthood. It is however likely to be more severe in adults and pregnant women who do get it.
If you are exposed to chickenpox and are not sure you have had it, contact us immediately. A simple blood test can
establish your immunity. If you are non-immune and the exposure occurred less than 96 hours ago, an injection of
varicella-zoster immune globulin (VZIG) can be given that can prevent or modify the disease. If you become infected
at or near the time of delivery, your baby will get a special immune globulin injection to prevent him/her from getting
a serious infection.
INFLUENZA (FLU)
If a pregnant woman gets the flu, she is more likely to become very sick. We will consider giving you a vaccination
if certain medical conditions or seasonal considerations put you at increased risk for infection.
HIV/HUMAN IMMUNODEFICIENCY VIRUS
HIV is a sexually transmitted infection which causes AIDS. HIV (the AIDS virus) is transmitted by having any type
of sex without a condom, and by sharing needles, for example when using intravenous drugs. Also, a pregnant woman
can transmit HIV to her baby during pregnancy or by breastfeeding.
There are now medicines available to an HIV-infected pregnant woman to decrease the chances that the infection will
be passed on to her baby during pregnancy or at the time of birth. The sooner HIV is diagnosed and
treatment is started, the better chance both mother and baby will have of staying healthy.
Studies have shown that many women with HIV do not even know they could be infected.
A simple blood test is available to see if you have been exposed to HIV. Since people may
have the virus for many years and not know it, it is important that all pregnant women be
tested. This test is recommended whether or not you think you have been exposed.
Knowing if you have HIV is very important to your health and that of your unborn
baby. The test is confidential and requires your consent. It can be performed along
with other routine tests obtained during your pregnancy. Please discuss this test
with your health care provider.
CYTOMEGALOVIRUS (CMV)
This is the most common viral infection that affects the newborn infant. If you become infected you’ll experience a
nonspecific illness characterized by sore throat, fever, and swollen glands or you may have no symptoms at all. Because
of its trivial nature it’s rarely recognized. This virus can remain in healthy adults for a lifetime and periodically become
active. When active, the virus can cross the placenta to your unborn baby and cause physical impairments at birth.
It appears that a baby is at greatest risk if the mother becomes infected for the first time during her pregnancy. Risk
to the baby is not nearly so great if the mother experiences a flare up during pregnancy from a previously acquired
infection. Fortunately, those infants born to mothers who have the most severe form of infection only rarely develop
the serious consequences of the disease in the newborn period.
Currently there is no effective treatment available for either the pregnant mother or her newborn baby and the
majority of maternal infections are not easily diagnosed. Pregnant women may reduce exposure by careful
handwashing and hygiene practices.
MUMPS
Mumps is uncommon during pregnancy because of the childhood vaccine and low infection rate in susceptible
adults. However, it does appear to increase the rate of miscarriages and premature labor. Newborns rarely have
abnormalities just because their mothers had the mumps during pregnancy.

Your Prenatal Guide 31
PROBLEMS DURING PREGNANCY
There are many problems that can arise during pregnancy. Some are trivial, but others can be serious.
EARLY PREGNANCY BLEEDING
There are many causes of bleeding during pregnancy. Possible causes depend upon when it occurs. If you experience
bleeding early in your pregnancy, we’ll perform a pelvic exam and an ultrasound to determine the cause. Two serious
causes of early pregnancy bleeding are miscarriage and ectopic pregnancy.
Miscarriage is the most common serious cause of early bleeding and occurs in 15-20 percent of all pregnancies,
usually within the first three months. Most miscarriages cannot be prevented. They are nature’s way of dealing with
pregnancies that are not developing properly. It is characterized by bleeding more than you would during a heavy
period and is usually associated with cramping.
An ectopic pregnancy, or the implantation of a fertilized egg outside the womb (usually in a fallopian tube), is
another serious cause of early bleeding. Ectopic pregnancies occur in less than one percent of all pregnancies and are
almost always associated with severe pain. Most of the bleeding is internal, which can be life-threatening because of
its hidden nature. Call your obstetric care provider immediately if you experience severe abdominal pain early in your
pregnancy.
LATE PREGNANCY BLEEDING
Bleeding late in pregnancy can be serious, but the most common cause is “bloody show,” one of the first signs of
labor. This is caused by the thinning of the cervix and is usually associated with thick mucous. Cervical irritation and
pelvic exams can also cause bleeding.
The most serious late pregnancy bleeding is caused by either placenta previa or placental abruption. When these
conditions occur, they are most often in the final three months of the pregnancy.
Placenta previa results when the placenta partially or completely covers the cervix. As your cervix thins in
preparation for labor, bleeding may occur. The other serious cause of late bleeding, placenta abruption, occurs when
the placenta prematurely detaches from the inner lining of the womb. This is usually accompanied by abdominal pain.
Either condition can lead to the death of the unborn baby.
If you experience significant bleeding in your pregnancy, you may be hospitalized for observation and evaluation. If
the bleeding is serious or if the fetal monitor shows a persistent, non-reassuring fetal heart rate pattern, a cesarean birth
may be required.
Most bleeding is the result of minor causes that require no treatment. It is important however, for you to know that
bleeding can indicate serious problems. You should report all bleeding to us immediately.
HIGH BLOOD PRESSURE IN PREGNANCY
Fewer than 10 percent of pregnant women develop a syndrome associated with high blood pressure, also known as
toxemia, preeclampsia or Pregnancy Induced Hypertension (PIH). The cause of this potentially serious condition is
unknown. When changes of blood pressure are detected early, the mother and the baby can avoid serious problems. If
undetected, however, preeclampsia can cause damage to the eyes, kidneys, brain and liver of the mother. The fetus can
suffer from a lack of oxygen and nutrients which can lead to growth problems or even death.
Teenage mothers are more likely to develop the disorder, usually during the last three months of their first pregnancy.
Women who are overweight, diabetic or older than 35 years are also at risk. Mothers with kidney disease, twins or a
history of high blood pressure are also likely candidates.
High blood pressure is caused when the blood vessels in the body contract, increasing the pressure and lessening the
amount of blood flowing to the uterus, placenta and the fetus. Mild changes in blood pressure for a brief period are
unlikely to cause problems. However, prolonged and severe spasm of the vessels can be potentially harmful to mother
and baby.
A sudden weight gain or acute swelling of the face and hands can indirectly signal high blood pressure. Some women
experience no distinct symptoms at all. Headaches, visual disturbances, or pain in the upper abdomen may indicate a
more serious problem. By monitoring your blood pressure, weight and urine at each prenatal checkup, we are able, for
the most part, to make an early diagnosis of the problem and avoid serious complications.
We treat each case of preeclampsia differently depending upon a variety of factors usually determined through special
testing and how close you are to your due date. Bed rest at home or hospitalization may become necessary, but the
eventual birth of your baby will cure the disorder.

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Your Prenatal Guide
DIABETES
There are several kinds of diabetes, all relating to the delicate balance of sugar (glucose) in the blood. Insulin is a
hormone that converts glucose into the body’s main source of energy. When the body fails to produce enough insulin
or if there is too much glucose, the level of sugar in the blood becomes too high, which can be dangerous for you and
your baby. Gestational diabetes is a kind of diabetes that only occurs in pregnant women. The condition usually
subsides after pregnancy, but women who have had gestational diabetes are more likely to develop permanent diabetes
later in life.
Some women are more likely to develop gestational diabetes than others, particularly those who have previously
delivered a large infant weighing nine pounds or more, and women who are obese. Women who have had stillborn
babies or a family history of diabetes are also more likely to develop the condition.
Gestational diabetes can cause the birth of a large baby, which may mean a difficult vaginal birth or a cesarean
delivery. Babies born to gestational diabetics are also prone to having low blood sugar levels and jaundice after delivery.
Pregnant mothers with gestational diabetes may also have too much fluid surrounding the baby which can cause
premature labor and increase the risk of respiratory distress syndrome in the baby. They are also more susceptible to
urinary tract infections and high blood pressure.
Because it is important to detect and treat gestational diabetes, we will test your blood for gestational diabetes at 24-
28 weeks of pregnancy, regardless of predetermining factors. This simple and safe test requires only that you drink a
sugar cola and have a blood sample checked one hour later. This is called a one hour glucose load test. If the test
reveals a high level of glucose in your blood, we’ll conduct a more extensive three-hour glucose tolerance test to make
a more definitive diagnosis of your condition.
Most gestational diabetics can control their sugar levels with mild exercise and modified diets. Occasionally, however,
gestational diabetes is severe enough to require insulin injections to control sugar levels.
A dietitian will assist you in your diet modification. The dietary principles to lower blood sugar involve a reduction
of carbohydrate consumption, and eating smaller and more frequent meals. Include a source of protein at all meals and
snacks, and eat plenty of non-starchy vegetables. Eat whole-grain versions of carbohydrate foods, such as rice, pasta,
bread and cereal.
By carefully screening and treating you for gestational diabetes, you will be more likely to have an uneventful
pregnancy and successful delivery of a normal baby. Mothers who have been diagnosed with gestational diabetes
should continue a strict diet and weight control following pregnancy to minimize the risks of adult onset diabetes.
PRETERM LABOR
Labor usually occurs sometime after the thirty-seventh week of pregnancy. (38-42 weeks is term.) A baby born before
37 weeks is premature. These infants may require special care in breathing and maintaining their body temperatures.
This complication represents the greatest risk overall to your newborn baby.
Warning Signs of Premature Labor
Premature labor is labor that starts before 37 weeks of pregnancy, or more than three weeks before your due date.
Signs and symptoms include:
1. Uterine contractions — more than four in one hour.
2. Menstrual cramps — may come and go or be constant.
3. Abdominal cramps — with or without diarrhea.
4. Low backache — comes and goes or constant.
5. Pelvic pressure — feels like baby pushing down.
6. Change in vaginal dishcharge — a sudden increase in amount or it may become more mucous-like, watery or
slighlty bloody.
If you have one or more of these symptoms, you might be in premature labor and you should call your obstetric
care provider immediately.

Your Prenatal Guide 33
RH DISEASE AND ITS PREVENTION (RHOGAM)
A routine blood test will be performed at one of your prenatal checkups to determine your blood type and Rh factor.
The most common blood type is Type O; the most common Rh factor is positive. People with Type O, B, A, or AB
positive blood have a positive Rh factor. Those with Type O, B, A, or AB negative blood have a negative Rh factor.
When your blood type is Rh negative, and the father’s is Rh
positive, the baby could inherit the father’s positive blood type,
which could cause a problem during pregnancy.
If your blood type is Rh negative, your body’s immune system
can recognize the baby’s Rh positive blood cells that escape into
your circulation. These cells are different from yours. Because
they are different from yours, your body will produce antibodies
to destroy your baby’s red blood cells. These antibodies not only
attack the baby's blood cells that are in your circulation, but
cross the placenta to destroy the baby's blood cells in his or her
circulation. These antibodies may not be a problem during your
first pregnancy, but can lead to a serious disease with subsequent pregnancies called hemolytic disease of the newborn.
When your body produces a high level of antibodies, more of your baby’s blood cells are destroyed. Eventually, this
produces anemia in your baby which can lead to fetal death prior to the baby’s birth. Live births can be complicated
by severe jaundice, mental retardation, hearing loss or cerebral palsy. With each successive pregnancy, the risk of
hemolytic disease of the newborn increases.
Fortunately, we can prevent hemolytic disease of the newborn most of the time by giving you a special injection of
gamma globulin (RhoGam) that prevents your immune system from reacting to your baby’s red blood cells. The
RhoGam finds the fetal red cells in your circulation and neutralizes them so you don’t produce antibodies against your
baby’s red blood cells. We give this injection routinely at 28 weeks of pregnancy and within 72 hours following birth.
If your Rh factor matches the father’s or you are Rh positive, you have nothing to worry about. Rh disease cannot
affect you or your baby under these circumstances.
GROUP B STREP (GBS)
Group B Strep is a common bacteria (germ) that can be found in up to four of 10 pregnant women. In women it is
most commonly found in the vagina or rectum and may cause serious medical problems for your baby. Most babies
who acquire this infection from their mothers fortunately do not have any problems.
Only 1-2 percent of all babies who are exposed to GBS during pregnancy become infected. Babies can develop early
infections during the first week of life or later after they leave the hospital. The early infections can be quite severe and
affect the baby’s lungs, blood, spinal cord or brain which can lead to death in 15 percent of babies. Late infections
usually manifest themselves as meningitis which can have long-term effects on the baby's nervous system.
In addition, treatment of pregnant women with GBS can not always prevent infection in the baby. A pregnant woman
can become positive again for GBS after treatment before the baby is born. The best way to prevent GBS infection is
the use of antibiotics during labor.
Certain risk factors increase the chance that a baby of a mother with GBS will become infected. These women may
benefit from treatment with antibiotics during labor and delivery. Mothers at high risk for GBS are those with:
• Fever during labor
•Previous child with GBS
• Ruptured membranes more than 18 hours
• Rupture of membranes before 37 weeks of pregnancy
•Premature labor (less than 37 weeks of pregnancy)

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Your Prenatal Guide
CARING FOR THE REST OF YOUR FAMILY, TOO
PARTNER
While you are pregnant, your family is sort of “pregnant” too. They are going through changes, anxieties, fears,
doubts, joys and stresses –– just like you!
Try to include your partner in the pregnancy as much as possible. This can be one of the closest emotional times in
your relationship, so take this time to discuss your expectations and fears. Go to birthing classes together, and make
your partner a part of your daily exercises, especially your evening walks. Bring your partner along to see us and
encourage them to ask all the questions they have about the pregnancy.
Also, try to maintain your physical intimacy, including sexual intercourse. If intercourse becomes uncomfortable, or
we recommend you stop for medical reasons, try to find other ways to express your physical love.
As always, communication is an important aspect. Your partner may feel left out and not really a part of things once
you’re pregnant. He may worry about how the baby will affect your love for him. Talk about the fears, concerns and
delights both of you are experiencing. Pregnancy is not just a special time for you alone. And, because it can help
strengthen your love, it is a special time for your relationship. After all, you both have high expectations for your new
child.
OTHER CHILDREN
If this isn’t your first child, give other children advance notice about the new baby. They will become curious as your
belly enlarges. Depending on the age of the child, you may want to tell them some of the “facts of life.” There are many
good books that cover “where babies come from.” Find books and sit down with your child to read them together and
do not take their concerns lightly. They may feel left out, too, and have questions and worries about their position in
the family. They need to be reassured before and after the birth that they are still loved.
Do not tell your children how great having a baby is going to be. Tell them the truth! Babies are a lot of fun and a
lot of trouble, too. They cry. They are messy. And, still they are wonderful. Prepare your children for the reality of
having a new baby in the house, and there will be less room for fear and resentment. Ask your child, “How do you feel
about this baby?” before and after the birth. Then just listen. And, don’t say, “That’s silly,” or “You shouldn’t feel that
way.”
Children usually have very mixed feelings about a new baby. Try including them in the pregnancy by letting them
help buy baby clothes, attend sibling classes and plan for the baby’s arrival. Don’t be shy about your body. Let them
see how it is expanding. This is a beautiful experience, so don’t hide it. Ask us about an appropriate time to bring the
older children to our office so they can hear the baby’s heartbeat. Brigham and Women’s Hospital offers tours and
classes for siblings. For more information, call the Parent and Childbirth Education Office at (617) 732-4081 or
(617) 732-8746.
BACK TO YOU
CHANGES THE VERY LAST WEEKS
You can expect more changes the last weeks of your pregnancy. It may seem you’ve been pregnant forever. You’ll also
be tired and need more rest and will be anxious to give birth.
One day, you may notice a difference in how you are carrying the baby. This is when the baby “drops” or settles down
into the bony part of your pelvis. When this happens, you might be able to breathe easier. (Sometimes this won’t
happen until you are ready to give birth.) Your breasts enlarge even more near the end of the pregnancy, and milk may
start to seep from them. Your appetite may be gone altogether, and you may be nauseated again. Pressure is sometimes
reported in the vaginal area, and you may feel the need to urinate frequently. You may feel heavy, clumsy and out of
patience with pregnancy.

IS THIS REALLY LABOR?
Your Prenatal Guide 35
First babies are notoriously slow about being born, so plan to monitor your first few contractions in the comfort of your
home. You should prepare to leave for the hospital when your membranes rupture or when your contractions are from five
to seven minutes apart. Prepare to leave earlier if you live quite a distance from the hospital. Call your obstetric care
provider before leaving for the hospital. Many women get nauseated and vomit during labor. We recommend that you eat
lightly and continue to drink fluids if you think you are in labor.
False labor is a common phenomenon. It is important to know the difference between real and false labor. False labor
involves cramps or contractions of the lower abdomen, similar to real labor, but there is a vital difference. False labor does
not cause a change in the cervix, it doesn’t come in regular intervals, and it may disappear altogether if you change positions
or walk around. Time the minutes from the start of one contraction to another for several contractions. If you have one
contraction now and one forty-five minutes later and another three hours later, then you are having false labor, especially
if you walk around during these contractions and they seem to ease up or stop.
On the other hand, if you time your contractions and find they are evenly spaced, and are coming closer and closer
together, and do NOT go away if you change position or walk around, then you are possibly experiencing real labor. Some
real labor contractions cause back pain and some cause lower abdominal pain. When you think you are in labor, sit down
and time your contractions. There isn’t any need to immediately panic and rush for the phone, especially if this is your first
baby. Labor usually takes a while.
Frequency
Time from the start of one contraction to the
beginning of another.
Duration
Time from the start of one contraction to the end of
the same contraction.
FALSE LABOR
• No “bloody show.”
• Contractions irregular and not progressively closer
together.
• Walking, changing activity or positions may relieve
or stop the contractions.
• No change in cervix.
REAL LABOR
• A “bloody show” may be the first sign. It is usually
associated with cramp-like pains.
• Contractions get stronger, occur more frequently
and last longer.
• Walking, changing activity or position doesn’t affect
intensity or frequency of contractions.
• Cervix dilates.
WHAT TO EXPECT AT THE HOSPITAL
Refer to the Pregnancy Planner in your obstetrical admitting packet for what to expect when giving birth at Brigham
and Women’s Hospital.
Some of the topics discussed in the Pregnancy Planner are:
• Pre-admission planning
• Prenatal visits and information
• Items you should bring to the hospital
• Planning for hospital discharge
• What to expect after the birth of your baby
• Going home from the hospital

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Your Prenatal Guide
LABOR AND BIRTH...
THE BIRTHING PROCESS
Every birth is unique! There are a multitude of factors that may influence each form of delivery. Vaginal birth, vaginal
birth after cesarean birth (VBAC), and cesarean birth are described in detail on the following pages.
VAGINAL BIRTH
The first stage of labor starts with the onset of labor and is completed when the
cervix is completely dilated or 10 centimeters.
The first stage of labor can take quite a long time, especially with a first baby. It isn’t
at all uncommon for the first stage of labor to last 12 to 14 hours. But don’t worry at
the sound of that. We don’t mean you will be having continuous contractions for 14
hours. Don’t try to fight these contractions by tensing your abdominal muscles. Your
uterus is doing the work for which it was designed. Tensing muscles may inhibit the
labor process. A large part of the work of the first stage of labor is to relax during the
pain of a contraction to allow the uterus to dilate the cervix. It takes active
concentration to relax muscles. This may not be easy and childbirth classes that teach
relaxation are very helpful.
The second stage of labor starts with the cervix becoming fully dilated and is completed with the birth of the infant.
The second stage of labor is much shorter than the first stage. By now your cervix
has dilated enough for the passage of the baby’s head and when the head has descended
enough you will be prepared for delivery. The contractions now are very close together
and the baby is being pushed out. You are “pushing” involuntarily. It may feel like your
bowels are moving, but don’t worry about this... it is just the pressure of the baby’s head
on the rectum. Each time you have a contraction, the baby moves farther and farther
down. At this point, it may be necessary for your obstetric care provider to perform an
episiotomy. An episiotomy is an incision in the vaginal wall that allows the baby to pass
through the vagina easier. Discuss episiotomies with your obstetric care provider prior
to labor so that questions can be answered prior to birth.
As you bear down, or push, the baby begins to appear. Finally, the baby is born. We’ll
remove any mucous or amniotic fluid from your baby’s mouth and nose. Then your
baby will take a breath of air and might begin to cry. LIFE! A new person in the world! You might begin to cry also
when we show you your new little boy or girl. You’ll feel exhausted and excited; all your great expectations are here,
finally!
The third stage of labor begins after the birth of the infant and is completed with
the delivery of the placenta.
But your work isn’t totally over. The third stage of labor is the passing of the
afterbirth, or placenta. This usually takes just a few contractions and takes only a few
minutes more. Then it’s time for some well earned rest and bonding with your new
baby.
VAGINAL BIRTH AFTER CESAREAN (VBAC)
Until very recently, most thought that once a woman had a cesarean birth, any future
babies should be delivered by a repeat C-section. Today, an effort is being made to
allow certain women to deliver vaginally after a previous cesarean birth. This option
is obviously not for everyone, but can be accomplished in more than 60 percent of the
instances where it is attempted.
When compared to a repeat cesarean birth, vaginal birth after cesarean (VBAC) is associated with a shorter hospital
stay, easier and faster recovery and an earlier resumption of normal activites. C-sections are somewhat more risky
because they involve major surgery and some type of anesthesia. Infection, bleeding and wound complications occur
more frequently with cesarean births.
The first factor that is considered in the option for VBAC is the type of uterine incision that was used with your previous
C-section. The skin incision that you have on your abdomen is not necessarily in the same direction as your

UTERINE INCISIONS
Transverse Incision Vertical Incision
Your Prenatal Guide 37
uterine (womb) incision. If you had a
classical (vertical) incision in your
uterus, you are not eligible for VBAC.
Your previous surgical records are
imperative in evaluating this factor.
Certain other factors may preclude
an attempted VBAC such as twins,
breech birth and above-average sized
babies.
Most women who’ve had a previous
cesarean birth can attempt VBAC
since the benefits outweigh the risks.
You and your baby will be closely
monitored for any complications. You
can expect an IV in your arm, the use
of an electronic fetal monitor and a
consultation with an anesthesiologist.
CESAREAN BIRTH (C-SECTION)
This is the third type of birth and involves removal of the baby through the mother’s abdominal wall. It is used when
a vaginal delivery is not possible or there is danger to the baby. There are numerous reasons for cesarean deliveries.
Some are known prior to labor, but many aren’t known until after labor begins and progresses. Any one or a
combination of the following conditions can lead to a cesarean birth.
• Previous C-section - The previous scar in the uterus may be weak and allow rupture of the uterus during labor. A
trial of labor may be allowed in many circumstances.(See VBAC, page 36)
• Fetal Intolerance to Labor or Fetal Distress - The baby’s heartbeat may appear abnormal during labor, indicating
possible trouble for the baby.
• Cephalopelvic Disproportion - The baby’s head or body is too large to pass through the birth canal.
• Abnormal Presentations - The baby’s position prevents a normal head-first delivery. The passage of a baby’s legs or
buttocks (breech birth), or arm or side (transverse - lie birth) creates a great risk to the baby’s well-being.
• Prolapsed Cord - The baby’s umbilical cord drops out of the vagina ahead of the baby and can endanger it by cutting
off its oxygen supply.
• Maternal Bleeding - The placenta can separate from the uterus prematurely and disturb the oxygen supply to the
baby. Additionally, the placenta can become positioned over the cervix and prevent passage of the baby.
• Maternal Medical Condition - Preeclampsia, active genital herpes, diabetes, heart disease, severe Rh disease and
certain other medical conditions in the mother can lead to a C-section in certain situations.
You may feel disappointed or a sense of failure if you cannot deliver your baby vaginally. There are support systems
to help you with these feelings. Support groups, social workers, nurses and your obstetric care provider are ready to
help!

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Your Prenatal Guide
ANESTHESIA AND PAIN RELIEF
Each expectant mother in labor will require different types, as well as different amounts, of medication depending
on her special situation. Patients who have attended “natural childbirth classes” may require little or no pain
medication. Other patients request specific types of analgesia and anesthesia to relieve the pain of childbirth. Our role
in your labor and birth is to safely provide pain relief for labor or anesthesia for cesarean birth, if required.
We encourage all couples to attend a natural childbirth class. This will serve to educate you about the birthing
process and take away fears. The classes will serve every laboring couple, even though they may elect an anesthetic
such as an epidural. Every person has a different tolerance to pain, and you should not feel a sense of failure if you
request anesthesia or we suggest medication for pain relief. There are two major types of anesthesia.
REGIONAL ANALGESIA AND GENERAL ANESTHESIA
Regional analgesia is the most popular method for labor, delivery and cesarean section. The main goal of regional
analgesia for obstetric patients during labor and birth is pain relief with a minimum loss of muscle strength. This can
be done either by continuous epidural analgesia or combined spinal-epidural technique. General anesthesia is seldom
used in obstetric anesthesia at the present time.
Common methods of regional analgesia include:
• Epidural Analgesia - The anesthetic is injected through a catheter in the lower back that produces numbness of the
lower abdomen, legs, and birth canal for pain relief during labor and delivery. A minimum amount of anesthetic is
used for maintenance of muscle power.
• Combined Spinal-Epidural Analgesia - An anesthetic is first injected into the lower back, followed by introduction
of the catheter. With this method, pain relief can be quick and the catheter can be used for further pain relief.
Epidural and spinal anesthesia is usually used for cesarean sections. General anesthesia is used for cesarean sections
during special situations.
• Local and Pudendal Block - The anesthetic numbs the lower birth canal and is given just prior to birth.
• Paracervical Block - The anesthetic is injected into the cervix to partially relieve pain during labor. It is rarely used.
Both the local and pudendal block and paracervical block techniques are administered by the obstetrician.
At Brigham and Women's Hospital, anesthesiologists are available 24 hours-a-day on the labor and birth floor, and
they are happy to answer any questions regarding the pain relief of labor, birth, and cesarean births.
Shaded portion represents typical area of numbness for spinal, caudal or epidural anesthesia.
GETTING TO KNOW YOUR BABY
During your pregnancy, you may have formed expectations about the sex and appearance of your baby. It may be
difficult to adjust these expectations with reality. It may take a while for you and your family to get to know your new
baby. At birth, your baby may have vernix (white, creamy, “toothpasty” coating) on its skin. This has protected your
baby’s skin in the uterus and disappeaars after the first few baths. Baby’s skin may have a normal newborn rash or
appear dry and peeling. The color of your baby’s eyes and skin may change as the baby grows and the amount of
pigment increases. Hair color and the amount of hair on your baby’s head often changes as well. After a vaginal birth,
the bones of your baby’s head may have overlapped to fit through the birth canal. The shape of the head will normalize
in a few hours. Every baby is unique. The first few days and weeks of your baby’s life can be a marvelous adventure as
your baby grows. If you are having difficulty developing a loving relationship with your baby, your obstetric care
provider can help.

Your Prenatal Guide 39
YOUR OWN CHANGES DON’T STOP NOW
Now that your months of great expectations have taken the form of a baby boy or girl, you can expect more physical
and mental changes in yourself in the weeks right after birth.
You’ll be sore from delivery and quite tired. Your hormone levels will return to normal
and, in the process, your moods may swing much the same as in the beginning of
pregnancy. You may experience some mild depression commonly referred to as “baby
blues.” These feelings shouldn’t last very long. Postpartum depression is a serious
condition that is different from “baby blues.” Any questions or concerns should be
discussed with your obstetric care provider.
You’ll have a bloody vaginal discharge for a while, as the lining of the uterus sheds
completely. Your normal periods may not start again for several months if you are
breastfeeding.
Your uterus will continue contracting which enables it to return to original size.
Expect abdominal cramps for a few days, especially if this is your second or third
baby. These may happen more during breastfeeding since breastfeeding causes the
uterus to contract more noticeably.
You might have problems with constipation again, but your routine of eating lots
of raw fruits, vegetables, bran and drinking lots of water should take care of this.
If not, we can recommend a stool softener.
If you have problems urinating right after delivery, let us know. This can be
caused by the type of anesthetic, the size of the baby, or just general discomfort,
especially with stitches. But you need to completely empty your bladder. If you have
too much trouble in the hospital, we might empty your bladder with a catheter. This is
painless. But once you leave the hospital, you shouldn’t have any problems with this.
You can resume sexual intercourse after your six week checkup. Some methods of
birth control may be started before leaving the hospital. Please be sure to discuss postpregnancy
birth control options with us during your last month of pregnancy. To foster
intimacy between you, your partner and your new baby, try feeding your baby in bed,
cradled between the two of you.
Your stomach isn’t instantly going to be flat. Don’t expect to leave the hospital and be back
to your pre-pregnant size. Your stomach won’t get back to normal right away, but with
exercise, your abdomen should flatten out again in very little time. Depending upon your
condition, we may recommend that you start exercising just a few days after birth, or we may
ask you to wait a while longer if you had a cesarean birth or tubal ligation.
NOW YOU’RE A MOTHER!
IT’S A NEW EXPERIENCE...EVEN IF YOU HAVE OTHER
CHILDREN
Whether this is your first baby or your seventh, the thrill of seeing your
own infant for the first time is still there - tiny feet, tiny hands. A wonderful fresh chance for the world. All those
months of expectation have come to life in one tiny child, and we are happy to have been a part of it.
Before leaving Brigham and Women’s Hospital, your nurse will give you a booklet containing important information
about caring for yourself and your new baby at home. If you have any questions at any point during your pregnancy
or after you give birth, please ask us, as we are here to help you during this exciting time in your life.
Congratulations!

40
INDEX
Your Prenatal Guide
abdominal pain ............................14
alcohol use ..................................28
Alpha-fetoprotein test ....................8
amniocentesis ..........................8, 10
anencephaly....................................8
anesthesia ..............................22, 38
• regional ......................................
• general ......................................
anxiety..........................................16
arthritis ........................................15
artificial sweeteners......................28
baby development ........................11
backache ......................................13
baths ............................................23
biophysical profile..........................9
bleeding............................15, 31, 37
Braxton-Hicks contractions ...... 16
blurred vision ..............................15
breastfeeding ................................25
breasts ....................................12, 24
breech birth ..................................37
Carpal Tunnel Syndrome..............15
cesarean birth ........................21, 37
chicken pox..........................5, 6, 30
childbirth classes..........................37
chorionic villus sampling (CVS)....8
cigarette smoking ........................28
clothing ........................................24
colostrum ..............................12, 24
constipation............................13, 39
contractions............................16, 35
contraction stress test ....................9
cytomegalovirus ......................6, 30
danger signs ................................12
delivery ..................................36-38
depression ....................................16
diabetes ....................................9, 32
diet ..........................................17-18
dizzy spells ..................................15
douching ......................................24
Downs Syndrome........................7-8
drugs ............................................28
ectopic pregnancy ........................31
electronic
non-stress/stress testing ..............9
emotional changes........................16
epidural anesthesia ......................38
episiotomy....................................36
exercise ............................23, 24, 27
fainting ........................................15
false labor ..............................16, 35
family history ................................7
fetal development ........................11
fetal distress..................................37
fetal maturity tests........................10
fetal movement test......................10
fever..............................................12
formula feeding ............................25
genital herpes ..............................29
German measles ......................6, 29
gestational diabetes ..................9, 32
glucose tolerance test ..............9, 32
Group B Strep ..............................33
headaches ....................................15
heartburn......................................13
hemolytic disease ........................33
hemorrhoids ................................14
hepatitis B ................................6, 29
hepatitis C ....................................30
high blood pressure ................31-32
high risk pregnancy ......................6
hot tubs ........................................25
household chemicals....................25
Human Immunodeficiency
Virus (HIV) ............................6, 30
hyaline membrane disease ..........10
immunizations ............................25
influenza ......................................30
insecticides ..................................25
insomnia ................................13-14
intercourse..............................26, 39
inverted nipples............................12
kick count ....................................10
labor ........................................36-37
• false labor ..................................
• real labor....................................
miscarriage............................6-7, 31
morning sickness ........................13
mumps..........................................30
nausea ....................................12, 34
neural tube defects......................8-9
non-stress test ................................9
nose bleeds ..................................15
painting ........................................25
paracervical block ........................38
pica ..............................................15
placenta abruption ......................31
placenta previa ............................31
postpartum depression ................39
prolapsed cord..............................37
preeclampsia ................................31
pudendal block ............................38
quickening....................................10
respiratory distress syndrome ......10
Rh disease ................................8, 33
RhoGam ......................................33
round ligament pain ....................14
salivation ......................................13
saunas ..........................................25
seat belts ......................................24
sex ..........................................26, 39
sexual changes ......................16, 29
shortness of breath ......................13
siblings ........................................34
skin changes ................................14
smoking ..................................28-29
spina bifida ....................................8
spinal anesthesia ..........................38
street drugs ..................................15
stretch marks................................15
stress test ........................................9
sudden death syndrome ..............28
swelling ..................................12, 15
tampons........................................23
teeth..............................................25
toxemia ....................................6, 31
toxoplasmosis ..............................29
travel ............................................23
triple screen test ............................9
twins ........................................6, 11
ultrasound ......................................7
VBAC ......................................36-37
vaginal discharge..........................14
varicose veins ..............................14
vertical incision ............................37
vomiting ......................................12
weight ....................................11, 18
work ............................................23
x-rays......................................25, 29

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