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	Nutrition One of the keys to having a healthy pregnancy, a good birth, and a healthy child is good nutrition. Your body will do its utmost best to "build" a healthy baby. If you do not provide all the materials required, your body will take from itself. If you do not get enough calcium in your diet, you might develop problems with your bones or teeth. If you do not get enough iron, you will develop anemia. If you do not drink enough water, your body will attempt to store its water supplies in your limbs (edema). You might also develop liver problems (toxemia). If you eat too many sweets, your baby might grow too large. Another important thing to remember is that just because you take a supplement, doesn't mean your body will absorb it. For instance, there are several different forms of iron and some of them just pass through your body, while others get a better reception. Also, vitamins and minerals need to be taken in groups for better absorbtion. For example, iron is best taken with copper and vitamins B1, B2, B6, B12 and C. In addition, your body can only absorb so much of each nutrient at one time, so it's best to take your supplements in several smaller amounts throughout the day. Recommended daily supplements: Folic Acid (400-1100 mcg) Iron (30-60 mg, best is Floradix liquid, 2-5 tsp. three times a day before meals) B Vitamins — thiamine, vitamins B1, B2, B6, B12, riboflavin, and niacin (50 mg) Vitamin C (80-2000 mg) Vitamin D (10 mcg) Vitamin A (800 RE) Vitamin E (400 i.u.) Calcium (1500 mg) Potassium (2000 mg) Zink (20-25 mg) Copper (2-3 mg) Magnesuim (1500 mg) Bioflavonoids (2000 mg) Pantothenic acid (4-7 mg) Chlorophyll (2-12 capsules) Vitamin K (100 mcg) Lecithin (minimum of 550 mg) From Midwifery Today: Prenatally, a well-balanced diet of enough proteins, fresh fruits, and vegetables and very little refined foods is critical to the integrity of the perineal muscles and tissues. Well-hydrated and oxygenated tissues promote elasticity and quick healing. Women should drink a minimum of 8 glasses of filtered water a day. Adequate fat intake is also important for skin suppleness and elasticity. Supplemental alfalfa tablets contain vitamins A, B-12, D, calcium and phosphorus. Vitamin E (200-400 IU) taken daily with foods or drink containing fat will help absorption. Daily intake of vitamin C (1000-2000 mg) will help circulation and tissue elasticity. Red raspberry tea is wonderful for relaxing and helping the entire pubococcygeal area to be supple, especially toward the end of pregnancy. Greater oxygenation of tissues is not only accomplished by diet, but also with exercise by increasing circulation. Walking, squatting, duck walking, pelvic rocks, tailor sitting, kegels, and swimming all are useful exercises. - Renee Stein, Midwifery Today Issue 33 From Wise Woman Herbal by Susun S. Weed: Eat 60-80 grams of protein daily. Protein is needed to form the growing fetus, uterus, and placenta. There are roughly 25 grams of protein in three cups of milk, or four eggs, or two cups of cooked beans, or two ounces of nuts, or four ounces of fish, meat or cheese. Eat salt to taste. Limiting salt during pregnancy does little to prevent swollen ankles and fingers. Lack of adequate salt can cause pre-eclampsia. Eat foods high in calcium. A study of worldwide eclampsia rates found them to be highest in countries of the lowest calcium intake. One thousand grams of calcium daily during pregnancy is a minimum recommendation. Spinach, chocolate, rhubarb, and brewer's yeast are thought to interfere with the absorption of calcium. Take in adequate calories. The minimum calorie requirement during pregnancy is 2400 calories a day. Tone and nourish with Raspberry, Nettle, and Dandelion leaf tea throughout pregnancy. Grate one raw apple and one raw beet together for a satisfying anf crunchy snack that balances the sodium/potassium ration of your blood, and increases available calcium in the body. Potassium supports and vitalizes proper function of liver, kidneys, and nervous system. Bananas and potato peels are exceptionally rich in potassium. Take 100 mg of vitamin B6 daily in conjunction with a high potency B complex supplement to promote better functioning of your liver and nervous system. Add up to three tablespoons of powdered Spirulina or Chorella seaweed to your daily diet to augment protein and mineral levels in your body. Based on Dr. Tom Brewer's proven Brewer Medical Diet: Eat 80-100 grams of high quality protein every day. Protein forms the foundation of every cell of your baby's body. These can be lean meats or vegetarian combinations. Take in at least 2,400 calories every day, to prevent your body from burning the protein you eat for energy. Don't hesitate to use real butter on your bread -- it's a natural and concentrated source of fat your body can use. Salt your food to taste. You actually need more sodium in pregnancy, not less, especially if you're experiencing excessive swelling or increased blood pressure. Lack of sodium will actually worsen these symptoms! Your taste buds are uniquely designed to tell you how much sodium you need, and your body is naturally able to regulate how much sodium stays and how much is excreted, according to its needs. Feel free to use alternatives to table salt, such as kelp, and let your taste buds be your guide to quantity. If your food tastes flat, don't be shy about it! Make milk and eggs the foundation of your pregnancy nutrition: four cups of milk and two eggs a day equals 50 percent of your protein needs and supplies your baby with many essential nutrients for growth. Vegetarians and the lactose intolerant will need to carefully choose equivalent alternatives. Choose whole grains over refined and processed grains whenever possible. Whole grains (including brown rice, whole-wheat flour, bran and oats) offer about 1/3 more nutrients than their processed or "enriched" counterparts. Round out your pregnancy diet with fresh fruits, vegetables, and real juices (not sweetened juice "drinks"). Include both dark green and yellow varieties, and drink plenty of pure water when you're thirsty. Fruits and vegetables contain water, as well as important nutrients to help your body fight infection and metabolize other nutrients. Based on Dr. Bradley's pregnancy diet:     Every day of the week you should have: One quart (4 glasses) or more of milk. Any kind will do: whole milk, low fat, skim, buttermilk, or cheese, yogurt, ice cream, etc.... Two eggs, (hard boiled, in french toast, or added to other foods). One or two servings of fish or seafood, liver, chicken, lean beef, lamb, pork, beans or any kind of cheese. One or two good servings of fresh green leafy vegetables: mustard, collard, turnip greens, spinach, lettuce, or cabbage. Two or three slices of whole wheat bread, cornmeal, cornbread, or tortillas. A piece of citrus fruit or glass of juice of lemon, lime, orange, tomato, or grapefruit. Three pats of butter. Other fruits and vegetables.     Also include in your diet: A serving of whole grain cereal such as oatmeal or granola. A yellow or orange-colored fruit or vegetable five times a week. Liver once a week. (if you like it) Whole baked potato three times a week. Plenty of fluids, water, juice etc. Salt food to taste for a safe increase in blood volume.
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	Exercise Maybe you've heard of the common "ailments" of pregnancy - fatigue, back pain... and the not as common, but much more dangerous one - hypertension? All these can usually be prevented through exercise. Regular exercise will strengthen your abs and back, helping your body keep its balance as the weight of your growing belly pulls you forward. Exercise will give you energy during the day and help you sleep better at night. Further, when you exercise, you regain a sense of control over your expanding body, which is a huge psychological boost. Also, you'll be better prepared for labor. The process of giving birth is physically grueling. It requires stamina and strength. By exercising, you can get your body ready. You'll build up your cardiovascular endurance and strengthen the muscles you'll use during labor, such as your pelvic floor and quadriceps. You wouldn't think of showing up to run a marathon without having trained for it; the same should go for labor. In addition, you'll regain your pre-pregnancy body more quickly. Studies have shown that women who continued to exercise vigorously throughout pregnancy gained less fat weight than women who did not. Also, these women had babies on the smaller end of the healthy range which made for a quicker recovery. The sooner you feel better post-partum, the sooner you can return to your exercise program to tone up the muscles stretched beyond recognition by your pregnancy. There are two things you need in your exercise regiment - cardio and weight training. Safe cardio workouts include swimming, walking and cycling. You need to do 20 to 40 minutes at least three times a week. In your weight lifting and muscle tone routine, you need to include at least the following muscle groups: abs, back, quads and hams. In addition to these, remember to do your kegels. Abdominal strength: After your first trimester, traditional abdominal crunches are a no-no. To effectively work the entire abdomen, start out in a quadruped (forearms and knees) position with abdominal, pelvic floor, and buttocks muscles relaxed. Exhale as you tighten the abs, pulling the belly button in toward the backbone, and inhale as you release. Concentrate on just tightening the abdominals without tightening the pelvic floor or gluteals as well. You can work your obliques (the abdominal muscles that run diagonally across your torso) by starting in a side-lying position with knees bent and at a 45 degree angle. Exhale as you lift your head and rib cage toward your hip bone, squeezing in the waist line, and inhale as you lower to the starting position. Some stretches: Place one leg forward with your knee above your toe, and the other stretched back with that knee touching the floor. Your hands can be placed on the front leg or floor to aid balance. Slowly push the pelvis forward until you feel the stretch in the upper thigh / hip flexor muscle of the rear leg. Hold for 20 - 30 seconds before repeating. Standing one foot in front of the other, feet comfortably apart, both feet facing forward, front leg bent (knee over ankle joint), back leg straight, back straight. Press the heel of the back leg into the floor until a stretch is felt in the calf muscle in the back of the lower leg. If no stretch is felt, slide the heel slowly backwards, keeping the foot on the floor. For improved stability and a greater stretch, push against a wall. Hold for 20 - 30 seconds before repeating. Sitting on the floor with the soles of the feet together, place your hands either around your ankles or lower legs. Keeping your back straight gently open out the knees towards the floor. The elbows can be pressed against the inner knee to increase the stretch. Avoid pulling up on your feet during the stretch. Hold for 20 - 30 seconds before repeating. This stretch can be performed either standing, or laying on your side. If standing use a chair or wall for support. Grab one leg at the ankle, and slowly pull your heel up towards your bottom, whilst slowly applying a stretch on the quadricep muscles (The large muscles a the front of the upper leg). If you can not reach your ankle, wrap a towel around your ankle, and pull on that, do this version lying down. Aim to keep your knees together and back straight throughout the stretch. Push your hips forward to increase the stretch on the quadricep muscles. Hold for 20 - 30 seconds before repeating. On all fours, look down towards the floor, then push your shoulders as high as they can go. This stretch is often called a cat stretch, due to the motion made. Aim to hold in the stretched up position for 10 seconds before repeating. Stand with your feet shoulder width apart, keeping a slight bend in your legs. Slowly bend over to one side, until you feel a stretch along your side. Your arms can be on your hips, or in the air to increase the stretch. Avoid leaning forward or back, and keep the movement smooth with no bouncing. Hold for 20 - 30 seconds before repeating. Stand or sit upright and place your hands on the small of your back. Slowly bring in your elbows, until you feel the stretch on your chest. Aim to keep the elbows high during the stretch. Remember to breathe comfortable throughout the stretch. Hold for 20 - 30 seconds before repeating. Can be achieved either seating or standing. Take one arm across the front of your body, and use the other arm to perform the stretch. Push the arm into the chest at a point just to the side of the elbow joint. Aim to keep the arm straight, and breathe comfortably. Hold for 20 - 30 seconds before repeating. Sit or stand tall, with good posture. Place one arm behind your head, with your hand facing down your spine. Use the other hand to gradually push down on the elbow joint, slowly increasing the stretch on the tricep muscle. Repeat again on the other side. Hold for 20 - 30 seconds before repeating. Place your arm straight against a wall, with your palm facing the wall. With your body close to the wall, slowly turn your body away from it, keeping the arm in contact with the wall. This is an excellent stretch for the biceps and chest muscles Hold for 20 - 30 seconds before repeating. Key points to remember when stretching: Begin with gradual mobility exercises of all the joints, i.e. simply rotate the wrists, bend the arm and roll your shoulders. This will allow the bodies natural lubrication (synovial fluid) to protect the surface of your bones at these joints. After exercise, slowly bring your heart rate down before you begin stretching in order to avoid blood pooling within your muscles, which can lead to cramp and dizzy spells. Never bounce whilst you stretch. Hold the stretch until you feel the muscle loosen off, then repeat for a further 15 seconds. When stretching you should feel some light pain, if you don’t feel anything, then you may be doing the stretch incorrectly, or simply the muscle has eased off. Stop immediately if you feel any severe pain. Remember to breathe regularly and rhythmically, do not hold your breath. Start with your legs, and work up the body, in order not to miss out any stretch. A few important pregnancy exercise rules: stretch before and after you exercise keep your heart rate under 140 if you cannot exercise and talk at the same time, you need to slow down don't push yourself - stop if you feel tired, hot or out of breath avoid all exercises that have you laying flat on your back laying on your back cuts off the baby's oxygen when stretching or lifting weights, don't push yourself to the limit your joints and ligaments are softer and more susceptible to injury avoid exrcises that have you jumping or require sudden changes of direction keep cool - overheating is bad for your baby keep drinking water before, during and after if swimming, don't swim on your back
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	Childbirth education classes There are many different classes out there. Chose yours depending on what kind of birth you think you might like. In addition to a childbirth class, you may want to take an Infant CPR course. These are available at your local hospitals as well as from your local Red Cross chapter or American Heart Association. If you plan to breastfeed, it may be a good idea to begin going to your local La Leche League meetings before your baby is born. Your hospital might offer a childbirth education class. This may or may not include some Lamaze, some breastfeeding information, and infant CPR. It will probably go over the hospital's usual procedured and policies. Lamaze: this method, developed by Dr. Lamaze, seems to focus on destructing the woman from what she is going through. It uses patterned breathing and "focus objects" to achieve this. If you practice your breathing exercises dilligently throughout your pregnancy, this method will definately help you deal with pain of childbirth. Lamaze International has recently changed its instructor certification requirements, so you might want to make sure you are getting an instructor who has kept up her/his credentials. Bradley Method, developed by Dr. Bradley, advocates proper nutrition and husband coached birth. The standard length of the Bradley classes is 12 weeks covering 12 units of instruction. Information covered includes physical and psychological changes during pregnancy, stages of labor and rehersal, writing a birth plan, postpartum preparation, newborn care and breastfeeding. If you know you can rely on your partner to definately be at your birth, as well as to "handle things", this might be a class for you. ALACE: Association of Labor Assistants & Childbirth Educators. ALACE Childbirth Educator training program was originally developed by a midwife. ALACE is the only one of the five nationally certifying organizations to be developed and guided principally by women - women who are midwives, childbirth educators, mothers and natural birth advocates. ALACE teaches relaxation and coping tools to work with pain and discomfort, rather than "techniques" for avoiding sensation. ALACE respects birth as a woman-centered and woman-directed right of passage. ICEA: International Childbirth Education Association. This program promotes the concept of the natural process of childbirth and the right of the expectant parent to make informed choices based on the knowledge of alternatives. CAPPA: Childbirth and Postpartum Professional Association. CAPPA believes that women should be encouraged to trust their bodies in the birth process and that myths about natural childbirth should be dispelled. Women should be given the tools to achieve a natural birth, if that is what they desire, and should be equipped with knowledge to make informed decisions about their birth. This knowledge should include a full understanding of the risks of interventions and medications as well as their benefits in certain situations.  Birthing From Within was created by Pam England, a nurse-midwife. Mentors utilize feedback from parents in the moment to determine what will be emphasized in each class. Birthing From Within's multi-sensory approach has evolved to help women and their partners make that journey in awareness, and with heightened confidence. Birth Works: Classes are innovative and experiential in design. They help women gain confidence in their ability to birth, and help birth companions become aware of ways they can make labor safer and more comfortable. The classes are interactive and provide both a physical and emotional preparation for birth. Birth Works program is suitable for parents planning a hospital, birthing center or home birth.
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	Prenatal tests A screening test is a test that is performed when there are no symptoms or known risk factors present. It is not a diagnostic test. A screening test can only show whether you may be at risk of having a baby with a certain birth defect. A diagnostic test can usually show whether your baby has the birth defect or not. If your screening test shows a risk for having a baby with a certain defect, further tests may be used for diagnosis. Most women with abnormal screening tests have normal babies. "Prenatal diagnosis may be a routine procedure, but it raises a number of troubling issues. While the women who avail themselves of the tests are usually worried about their children's health, the political, legal, and medical communities have their own reasons for encouraging large-scale screening for fetal defects. Unbeknownst to most prospective parents, moreover, scientists are still debating the safety of the most widely offered screening tests. The ethical issues raised by prenatal screening are even touchier." -Elizabeth Kristol Blood Pressure: a non-invasive test done every time you visit your prenatal care provider. The increased blood volume and fetal blood circulation that occurs in pregnancy increases the demands on your cardiovascular system, especially your heart. Your blood pressure will be measured regularly to detect any signs of high blood pressure or pregnancy-induced hypertension. About five percent of pregnant women experience pregnancy-induced hypertension starting about the 20th week of pregnancy. Urine Glucose: During each doctor's visit, you will be asked to pass a test strip through your urine stream or collect a sample of urine, which will be tested with a strip that measures the amount of glucose in your urine. The presence of glucose in the urine is an indication of gestational diabetes, a form of diabetes that usually develops around the 20th week of pregnancy. Urine Protein: The presence of protein in the urine indicates a problem in kidney function and is one of the symptoms of pre-eclampsia. Fetal Heartbeat: The baby's heartbeat can be seen in a Doppler ultrasound as early as five to six weeks of development. By 12 to 13 weeks, your doctor can hear the heartbeat using a specialized ultrasound stethoscope or Doppler stethoscope. Routine ultrasound testing is not recommended by ACOG (American College of Obstetricians and Gynecologists). After 25 weeks, your baby's heartbeat can be heard with a regular fetal stethoscope. Glucose Tolerance Test: Between week 25 to 28 gestation, you might decide to have a glucose screening test for gestational diabetes. You will have to drink a soda containing high amounts of glucose, or sugar, and will have your blood drawn one hour later. If the glucose level is high, you may be asked to take an additional glucose-tolerance test. In this test, you drink a high-glucose solution on an empty stomach and blood samples will be taken at regular intervals (usually every hour) for three hours. Alpha-Fetoprotein Test (AFP): Also called Maternal Serum Alpha-Fetoprotein Test (MSAFP). Alpha-fetoprotein is a protein produced by a growing fetus. It is present in amniotic fluid, fetal blood, and, in smaller amounts, in the woman's blood. The AFP screening test is usually performed at 15-20 weeks of pregnancy. For the test, a small amount of blood is taken from a vein in the woman's arm. The accuracy of this test depends on the accuracy of the calculation of the fetal age. Triple Screen Test: Adding certain tests to the AFP test can give more information about your risk of having a baby with Down syndrome than the AFP test alone. Besides measuring AFP, a triple screen test measures other substances in the woman's blood that come from the pregnancy. Two that might be measured are human chorionic gonadotropin (hCG) and estriol. hCG is a hormone produced by the placenta. Levels of hCG are higher than normal in most pregnancies with a fetus with Down syndrome.  Estriol is produced mostly in the placenta and in the liver of the fetus. Estriol levels are lower than normal in most pregnancies with a fetus with Down syndrome.  A triple screen test is also performed at 15-20 weeks of pregnancy. As in the AFP test, a small amount of blood is taken from a vein in the woman's arm. Usually the same blood sample is used for all the tests. Group B Strep Swab Test: Around week 35, your doctor might want to take swabs from your vagina and rectum. These swabs will be cultured to look for Group B streptococcus bacteria. These bacteria are common in many women and are considered a normal part of an adult woman's reproductive system. For an unborn child, however, these bacteria can spread during delivery and cause several problems. Ultrasound: If you are receiving your prenatal care from an OBGYN, she or he will probably want you to have one or two (or three) roune (non-emergency) ultrasounds. Just like with all other prenatal testing, it is your personal decision to accept or refuse these tests. While your doctor will assure you that ultrasound is safe, there has been very little research to conclusively prove it's safety. Routine use of ultrasound is not recommended by ACOG (American College of Obstetricians and Gynecologists). Additional envasive tests: If possible problems with the baby's development are detected by other means or the parents have risk factors for various genetic diseases, special tests may be suggested. For example, if the mother is age 34 or older, she is considered to have an increased risk of having a baby with Down syndrome. The parents, in consultation with the obstetrician, may elect to sample fluid or tissue from the baby to determine its genetic make-up. These samples can be obtained through three procedures: amniocentesis chorionic villus sampling (CVS) fetal blood sampling In these tests, the doctor uses a needle or suction tube to sample fluids or the baby's tissue with the aid of ultrasound to see what she or he is doing. These tests are not without their own serious risks, including baby with limb defects, fetal mortality, maternal Rh sensitization, infection and miscarriage. There is also the possibility that maternal blood cells in the developing placenta will be sampled instead of fetal cells and confound chromosome analysis. These tests should not be performed until you've received a full description of all potential complications. Non-stress Test: This test involves strapping an electronic monitor to the mother's abdomen. The baby's heart rate should increase when the baby moves (about 15 beats for 15 seconds at least twice in a 20 minute period). Stress Test: This test involves strapping an electronic monitor to the mother's abdomen. The baby's heart rate should increase when the uterus contracts. Uterine contractions are caused by medication to the mother (Pitocin) or by stimulating the mother's nipples. Biophysical profile: Using ultrasound, the physician can measure or observe the baby's: Heart rate pattern Breathing Body movement Muscle tone Amount of amniotic fluid
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	Various discomforts of pregnancy Pregnancy has been depicted in the media as a time when women bloom and get rosy complexions. In reality, this is often far from the truth. Morning sickness can actually occur at any time of day/night. Interestingly enough, the "treatment" is to constantly be eating a little bit of something. Keep in mind also that throwing up can dehydrate you so you need to increase your liquids intake. Hearburn and gas: During pregnancy, your digestive tract will move more slowly. You may be more prone to bloating. Ways to avoid or alleviate this problem: Eat small, frequent meals. Don't rush through your meals, eat slowly and chew your food well. Drink at least 2 liters of water daily. Avoid any foods that give you problems. Keep your head and upper body elevated while sleeping. Avoid eating while lying down Pigmentary changes: Normally hyperpigmented areas, such as the breasts and nipples, genital skin, and inner thighs, may become darker in pregnancy. Freckles, nevi and scars may appear darker as well. This condition disappears in the months following pregnancy. Melasma or chloasma, known as the "mask of pregnancy," has been reported in up to 70 percent of pregnant women. This common condition causes an increase of pigmentation that occurs almost exclusively in sun-exposed areas. Melasma can also develop on the forearms. Most cases of melasma resolve after pregnancy. Backache can be caused by many things. Some of them are the same as at any other time in your life - like lifting a heavy object the wrong way (to lift, always bend at the knees and not at the waist). As your belly grows larger, it is imperative to maintain the strength of your abdominal muscles. This will help keep some of the weight off your back (See the abs workout in the exercise section). In last months of your pregnancy another reason for back pain can be posterior fetal position - try doing the "pelvic tilt" and "knee-chest" exercises to help correct this. Swelling of feet generally occurs later in pregnancy and is considered normal unless accompanied by swelling of the face. Increasing your intake of fluids and protein and resting on your left side several hours a day is a good idea. Mild exercise such as walking and stretching will help as well. Stretch marks develop in more than 90 percent of women during the sixth and seventh months of pregnancy. These occur in response to the pulling and stretching forces in the underlying layers of skin during gestation. They most often occur as pink or purple bands on the abdomen and sometimes on the breasts and thighs. Drink plenty of fluids to help keep your skin's elasticity. Varicose veins have numerous reasons including increased blood volume and the hormones of pregnancy. Varicose veins may cause itchiness and/or pain, or they may be entirely without symptoms. To help prevent, or minimize varicose veins: Raw garlic, onions and lecithin (especially the liquid form) help veins maintain or regain elasticity. Eat them daily. Green leafy vegetables, oats, buckwheat, wheat germ, and okra nourish and strengthen the entire circulatory system. Foods rich in vitamins A, C, E, and B complex are recommended for all circulatory problems. Avoid standing still for long periods of time (if you have to stand, move your feet). Keep your feet elevated when sitting or lying down. Try not to cross your legs. Wearing support stockings may help. Avoid wearing anything that binds you around your upper legs. This can worsen varicose veins. Mild exercise, such as walking, may be of help. Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP): Itching and rash/bumps on the skin of the navel and/or under/around the navel, that may spread to your hands, thighs and legs. Itching can become very severe. It can spread to the rest of the body, but never involves the face. PUPPP usually happens in the last few weeks of pregnancy and goes away by itself within the few weeks after the birth. It's suspected to be somehow related to stretching of skin and is most common in first time mothers. Anti-itching topical medications, antihistamines and topical corticosteroids can be used to control the itching. Stay away from things containing calamine, as it can dry your skin and make things worse. Another theory is that PUPPP is caused by improper liver function. You can try taking a dandelion tincture, which is a liver tonic. Prurigo of pregnancy consists of very itchy, tiny bumps that can appear almost anywhere on the skin. This condition can appear during any trimester, with a few bumps appearing and increasing in number each day. It usually remains for several months, and may even persist postpartum. Reoccurrence during subsequent pregnancies is variable. Treatment usually includes topical corticosteroids and antihistamines. Emotions: Pregnancy can be a very emotional time. Besides various hormonal changes, you might experience various discomforts, you might have trouble sleeping, and you might start having second thoughts about becoming a parent. All of the above affect your emotional state. You might feel extra touchy or very weepy. Prepare your partner for this, but don't let him/her tell you that "it's just your hormones" - your emotions might be made more obvious and prominent by the pregnancy, but they are still how you feel and should not be ignored or blown off.
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	Prenatal complications Ectopic pregnancy: any pregnancy which implants outside of the uterine cavity. While almost all ectopics occur in the fallopian tube, they also implant on the ovary, inside the abdominal cavity or within the cervix. Surgery is no longer the only option. Early detection makes it possible for some women to be treated with medication instead of surgery. A history of pelvic inflammatory disease (PID), especially chlamydia, is the single most important risk factor. Smoking, history of tubal surgery or a previous ectopic, DES (diethylstilbestrol) exposure or IUD use also increase risk. Certain fertility techniques increase the risk of ectopic pregnancy such as in vitro fertilization, GIFT (gamete intra-fallopian transfer), even ovulation induction. However, most ectopic pregnancies occur in women with no apparent risk factors. The classic warning signs of an ectopic are a late period, vaginal spotting or bleeding, abdominal pain, shoulder pain, weakness or dizziness. In most cases not all symptoms are present, making the diagnosis more difficult. As an ectopic pregnancy develops, it may grow large enough to tear or rupture the fallopian tube causing internal bleeding and a potentially life-threatening situation. Diagnosing an ectopic pregnancy early is key to avoiding complications. Pregnancy-induced hypertension: Preeclampsia is the most common type of pregnancy-induced hypertension. Sometimes the terms pregnancy-induced hypertension and preeclampsia are used to refer to the same condition. Preeclampsia is also called toxemia. Eclampsia occurs when a woman who has preeclampsia has a seizure. The progression of PIH to pre-eclampsia to eclampsia is serious as multiple vital organs in the mother can be affected, including the liver, kidneys and brain. The blood’s ability to clot can be impaired and the most serious cases can result in swelling and bleeding of the brain. Another complication is called the HELLP syndrome (Haemolysis Elevated Liver Enzymes, Low Platelet). Eclampsia and HELLP are life-threatening emergencies and will always be treated in hospital with anti-hypertensives, anti-convulsants and anti-platelet agents. Occasionally, despite this treatment, pre-eclampsia cannot be managed adequately and the baby may have to be delivered prematurely. Poorly managed pre-eclampsia may lead to liver damage or death. Sudden weight gain of more than a pound a day Swelling of the face and hands (edema). Headache Blurred vision or spots in front of the eyes Pain in the upper right part of the abdomen. High blood pressure Protein in urine Gestational Diabetes: Generally, gestational diabetes does not have any symptoms. Most often, gestational diabetes occurs in the second or third trimester. It is largely herditary, although lifestyle can have some impact. In gestational diabetes, the body produces adequate insulin but the insulin is not used effectively. As a result, the level of glucose in the blood rises and remains high. Additionally, the woman cells do not receive optimal nutrition (in the form of glucose which is needed for energy). Gestational diabetes almost always resolves after delivery. Uncontrolled gestational diabetes can pose problems for the developing fetus. The babies tend to be excessively large (over 9 lbs.). The large size increases the risk of problems during labor and delivery. The infant of the uncontrolled diabetic is also likely to develop low blood sugar shortly after birth. Uncontrolled diabetes increases the risk of stillbirth, miscarriage, newborn complications, and newborn death. However, with proper management, the woman with gestational diabetes can have a baby that is at no greater risk of complications than the non-diabetic woman. Quite commonly, the pregnant woman will meet with a nutritional counselor to help her modify her diet. She will be encouraged to eat a healthy diet, eliminate concentrated sweets, and monitor her caloric intake to avoid excessive weight gain. In most cases of gestational diabetes, the blood glucose can be controlled adequately with changes in diet and exercise. If these measures are insufficient, though, the pregnant woman will be started on daily insulin injections. In the final weeks of pregnancy the physician may recommend weekly monitoring of the baby to assess well being. Fetal tests may include non-stress tests, stress tests, or biophysical profiles. In addition, an ultrasound may be done to estimate the baby’s size and weight in preparation for birth. Be aware that this estimation is often inacurate. Intrauterine Growth Retardation (IUGR): term used to describe babies who develop too slowly in the mother’s uterus. The slow weight gain is the result of less-than-optimal conditions in the uterus. The conditions in the uterus may be unfavorable because of lifestyle issues like poor nutrition, drugs, alcohol or cigarette smoking, or because of problems with the placenta placement, or problems with the mother’s health (high blood pressure, infections, chronic disease). If your obstetrician suspects IUGR, she or he might suggest ultrasound(s), non-stress and stress tests, amniocentesis, or umbilical blood sampling. She or he might also think that the baby may do better in the intensive care unit than inside the womb, and suggest an early cesarean delivery. Accepting or refusing these tests and the c-section is your personal decision. Placental Abruption: A condition in which the placenta partially to almost completely peels away from the uterine wall before delivery. It can deprive the fetus of oxygen and, in severe cases, cause bleeding in the mother that endangers both her and the baby. The main symptom is vaginal bleeding, sometimes with uterine discomfort and tenderness, and sudden, continual abdominal pain. Mild abruptions (in which only a small part of the placenta peels away from the uterine wall) generally are not dangerous unless they progress. If your abruption does progress, you're bleeding heavily, or your baby is having difficulties, then a prompt delivery, usually by cesarean, probably will be necessary. If your fetus is too premature to deliver immediately, and tests show that the baby isn't in trouble, your doctor may admit you to the hospital for monitoring. If your doctor suspects that your abruption is likely to result in preterm delivery, she will probably recommend treatment with corticosteroids, drugs that speed maturation of the fetal lungs and other organs and can dramatically cut the incidence of prematurity-related infant deaths and certain complications of early birth. Neural tube defect (NTD): A birth defect that occurs when the spine, the brain, or the bone and skin that protect them do not develop properly. The neural tube is the part of a developing fetus that grows into the spinal cord and brain. Normally, the bones of the skull and spine grow around the brain and spinal cord, and then skin covers the bones. A neural tube defect occurs when this process doesn't happen normally. Spina bifida or down syndrome is the most common type of neural tube defect. In spina bifida, the bones of the spine do not completely enclose the spinal cord, and the spinal cord may bulge out through the opening. Surgery is required when the opening in the spine is not covered by skin, leaving the spinal cord and nerves exposed. Anencephaly is a neural tube defect in which a child is born with only a partially formed brain and spinal cord. This condition is always fatal. Neural tube defects can be detected with prenatal tests, such as ultrasound and amniocentesis. If you know you'll keep the possibly defective baby, and that you'll be giving birth at a hospital equipped in dealing with these defects, you might decide to refuse these tests. Taking folic acid before you get pregnant and in the first trimester of pregnancy decreases the chance of NTD. Molar Pregnancy or hydatidiform mole, is a tumor of the placenta. The chorionic villi of the placenta grow into a grape-like bunch of cysts within the uterus. Most molar pregnancies are unable to support a fetus and are usually diagnosed in the first trimester. Most women with a molar pregnancy have vaginal bleeding, excessive nausea and vomiting, and some will even pass a grape-like cyst. Women with a history of molar pregnancy have an increased risk of a second molar pregnancy.
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	Fetal presentation Fetal presentation describes the way the fetus is positioned to come down the birth canal for delivery. Avoid semi-recumbent positions. These positions, such as reclining on a sofa or in an armchair, can actually turn a vertex baby to breech and anterior baby to posterior due to the position of your pelvis and uterus. Occiput Anterior Position This is the most common presentation. It is also the most desirable position for labor and birth. How to help your baby to become Anterior: Do the "pelvic rock" exercise at least three times a day. Starting at 37 weeks, even if you do not suspect a mal-presentation. (See below for picture) Assume a knee-chest position for twenty minutes, three times a day, beginning at 37 weeks even if you do not suspect a mal-presentation. (See picture below) Lie on a slant board (as with a breech position) several times a day for thirty minutes at a time. Take warm baths and gently encourage her baby to "roll over". It has been found very effective for the mother to visualize her baby in the correct position and to talk to her baby, telling it to move as well. Occiput Posterior Position This presentation is the most common cause of painful "back labor", as the baby's back presses into the mother's back. It can slow labor progress and decent of fetus in the second stage and causes the mother to often "stall" labor at 6 to 8 cm, due to inadeqaute pressure of the presenting part on the cervix. Having a posterior baby can also cause such problems as prolapse of the urethra in the mother. This can be easily corrected with positioning of mother (most effective if done before labor begins). Signs of a posterior baby pre-natally are: Constant back ache Feeling that baby is all "hands and feet". The moving limbs can be easily seen and felt Difficulty is hearing fetal heart tones, they may be indistinct. During Labor: Early labor may be marked by a long period of irregular uterine contractions with little or no dilation. The mother usually complains of a persistent backache, which even in early labor may be severe enough that the pain of contractions are secondary. Breech Position There are some risks involved in vaginal delivery (for mother and baby). For this reason, your obstetrician may suggest that your "at-term" breech baby is delivered by cesarean section. "Many studies have concluded that the shift to planned cesarean delivery has not improved breech outcomes. Both vaginal and cesarean delivery of a breech baby carries risks. More babies born vaginally will have birth injuries [often due to labour mismanagement] but almost all of them will recover. The same cannot be said for cesarean deliveries where the risk to the mother is much higher, including postpartum infection, a scarred uterus which will increase her risk of uterine rupture and placenta accretia (a condition in which the placenta grows into the uterine wall, causing complications with retained placenta and hemorrhage) in subsequent pregnancies. Though rare, cesarean sections do pose life-threatening risks to mothers and babies. Depending on the individual case, vaginal birth is as much a reasonable, responsible choice as is planned cesarean section." Henci Goer, The Thinking Woman’s Guide to a Better Birth There are many success stories of breech babies delivered vaginally, but much depends on the actual breech position. Click here for more information on breech turning techniques. Do this exercise as often as you think about during the day, doing as many as you can.   This should be done 3 time s a day or more for at least 10 minutes, more if you know the baby is Posterior. Use this positoon for rotating breech babies to a head down position. Do this twice a day for 10-20 minutes each time with an empty stomach and bladder. Pelvis should be elevated 9-18 inches. Click here for more information on breech turning techniques.
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	Your questions If you read the "philosophy" statements of most doctors, midwifes and hospitals today, you will probably find that they all "believe in the woman's ability to birth naturally". This is great, except that now you'll have to determine what it is they mean when they say "natural childbirth". You'll probably have some questions for your doctor or midwife about their management of your pregnancy and birth. If you do not feel comfortable asking your care provider questions, do you think you'll feel comfortable having this person at your birth? You might also want to visit your hospital's labor & delivery ward, and ask questions of the hospital staff. This will give you time before your labor to find ways of coming to a compromise. If you have special requests, you might need to meet with hospital management personnel and/or sign wavers. Sample questions for your doctor: Will you teach me how to tell what position my baby is in? What are your standing orders for your patients? Will you let me labor without an IV or hep. lock? How long will you let me labor before you intervene? What kind of interventions can I expect? What are the reasons for each? How long will you let me push before you intervene? What kind of interventions can I expect? What are the reasons for each? What kind of position(s) do you recommend for labor and delivery? How often and why do you perform an episiotomy? What percentage of your patients tear? How often do you use forcepts and/or vacuum extractor? How often and why do you perform a cesarean? How long will I be able to keep the cord uncut? How long will you give me to deliver the placenta before you intervene? What portion of my labor will you actually be there? Sample questions for your midwife: What will you do if my baby is breech? What are your standard procedures during each stage of labor? How many vaginal checks do you usually do? What will you do to make sure that my baby and I are doing OK, and how often will you do it? How long will you let me labor before you intervene? What kind of interventions can I expect? What are the reasons for each? If my labor slows down or stops, and my baby’s heart rate seems good, will you be able to give me time to rest? How long? How long will you let me push before you intervene? What kind of interventions can I expect? What are the reasons for each? How often and why do you perform an episiotomy? What percentage of your patients tear? How often and why do you transfer your patients to the hospital? What happens once we are at the hospital? Will an obstetrician take over? How long will I be able to keep the cord uncut? Do you usually suction babies on the perineum? After the birth? How long will you give me to deliver the placenta on my own? What are your standard procedures for the baby after it’s born? Sample questions for your doula: How many times will you meet with me before my birth? how long will these meetings be? Do you have books, magazines, articles and/or videos I can borrow? Will you be available for phone conversations if I have more questions? How many? Do you teach a childbirth education class? If not, can you recommend a good one? Who trained you? Why did you dedcide you wanted to be a doula? How far from me do you live? When in my labor will you actually be with me? Will you advocate for me to the hospital staff? How do you feel about use of pain medication? What will you do if I have a cesarean? How long will you stay with me after the birth? Sample questions for hospital staff: Will I be able to stay in one room for my labor, delivery and recovery? Do you have rooms with a bathtub? How many? What will happen if my baby is breech? What are your standard procedures during each stage of labor? Will I be able to avoid vaginal checks? Will I be able to avoid an IV and hep. lock? Will I be able to avoid continuous monitoring? Will I be able to avoid laying on my back for monitoring? Will I be able to eat and drink what I want? Will I be able to labor (and push) out of bed? What will you do to make sure that my baby and I are doing OK, and how often will you do it? How long will you let me labor before you intervene? What kind of interventions can I expect? If my labor slows down or stops, and my baby’s OK, will you be able to give me time to rest? How long? If I am completely dilated but don't feel the urge to push yet, how long will you wait before ordering me to push? How long will you let me push before you intervene? What kind of interventions can I expect? How long will you give me to deliver the placenta before you intervene? What kind of interventions can I expect? How long will I be able to keep the cord uncut? What are your standard procedures for the baby after it’s born? What do I need to sign to avoid the following: eye drops/ointment, Vitamin K shot, Hepatitis B vaccination, circumcision, blood test ("heel stick") for my baby? If everything goes well, will I be able to room-in with my baby? Is there paperwork I need to fill out for this? If there is an emergency and my baby and I are separated, do I need to fill out and/or sign any paperwork in order to avoid the following: circumcision; sugar water; formula; artificial nipples and/or pacifiers? Will my partner be able to stay with the baby at all times?
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	Your birth plan If you've already been asking questions, you will have a good idea about which of your wishes for your birth you'll need to put in writing, and which you can assume will be met. Try to keep your list of birth wishes as short as possible, including only the things that you think really matter to you. Sample list of birth wishes: This is not a list of demands. I understand that birth is unpredictable, and complications and emergencies can happen. But as long as there is no danger to me or my baby, these are my wishes for my birth. I will sign whatever waivers necessary. If things do not progress normally, I would like a chance to give informed explicit consent to all the medical interventions. Things I would like in my prenatal care: Tests for: gonorrhea, chlamydia, hep. B & C – to avoid vaccinations and eye ointment being given to my baby after birth Blood test a few days before birth – to avoid having to have a blood test while I am in labor To learn to determine my baby’s position – I am trying to learn this on my own, and would appreciate any help. I am doing exercises and practicing positions that will help keep my baby head down and facing my spine (Occiput Anterior) To avoid vaginal exams as much as possible, especially in the last weeks of my pregnancy. To avoid use of ultrasound if at all possible To have a fetal scope used instead of a Doppler after 25th week Things I would like during my labor: To avoid vaginal exams, if at all possible To avoid IV or heparin lock To avoid fetal monitoring (except for fetoscope or hand-held doppler) To not be offered any medication (or herbal remedies) To not have my membranes stripped or ruptured To have the room as dark and quiet as possible To be able to move around as much as I feel like To be able to take showers and use the bathroom as much as I feel like To be able to eat and drink whatever I want Not to be rushed during any of the stages of my birth If my labor slows down, but my baby’s OK, I’d like to be left alone & rest I would rather tear than have an episiotomy I would like to avoid being on my back or reclining I would like to give birth in a squatting position or on my hands and knees I would prefer to be left alone as much as possible I would like to be offred some hot sweet coffee during my pushing stage if I seem to be "running out of steam" I do not want the delivery of placenta to be rushed. Unless I am bleeding profusely, I would like to be given as much time as I need to deliver the placenta on my own Things I would like after the birth: I do not want the cord cut until Whorton's jelly has solidifies (at least 2 hrs). If that isn't possible I'd like to at least wait until the cord stops pulsating. I would like my baby to be placed on my stomach I do not want my baby to be washed – I’d like to wipe her/him down myself I would like to have APGAR performed while my baby is on me If possible, I would like to put off all tests for a few hours after the birth I would like to try and breastfeed within 30 minutes after birth If for emergency reasons I am separated from my baby, I do not want her/him to receive any sugar water, formula or any kind of artificial nipples or pacifiers I do not want my baby to be blood tested until at least 2 hrs after birth if at all I do not want ointment to be put into my baby’s eyes Since I will breastfeed, and don’t plan to circumcise, I don’t want my baby to receive a vitamin K shot* I do not want my baby to receive any vaccines the first week of her/his life I do not want my baby to be circumcised the first week of his life I would like to room in with my baby for the duration of my stay I would like to keep my baby with me the whole time, if at all possible I will sign all wavers required * I will accept a vitamin K shot for my baby if I had a very fast or very long labor, if the baby has a strongly cone-shaped head, or if the baby demonstrates significant heart-rate decelerations during late labor
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	Last weeks before the birth Before, during and after your labor, your task should be to eat and drink liberally. Giving birth is like running a long race, and you need sustenance to get through it. The right amount and balance of carbohydrates and fluids will be vital to your performance and recovery. Some nutritional do's and don'ts: Do eat a variety of high-carbohydrate foods. Along with bagels and pasta, get plenty of grains, fruits and anything else that's high in energizing carbohydrates. Do keep meal and snack times regular (your digestive tract will thank you). Do consider using carbohydrate-supplement products such as Gatorade. These make it easier to get the nutrients you need. Do keep a closer eye on food labels and stay away from high-fat foods. Don't skip meals (this gets back to keeping high-carbo snacks handy). Skipping meals can drain glycogen stores in a hurry. Don't stuff yourself, either. Taking in between 2,000 and 3,500 calories (65 to 70 percent of which should be carbohydrates) will be plenty. Don't eat too much of any one food (ice cream included!). This can play havoc with your intestines. Do drink frequently during the day (keep a water bottle with you at all times). Hint: Clear or pale yellow urine is a sign that you're well hydrated; darker yellow means you need to drink more. Do be conservative; eat home-cooked meals if possible. This way, there's less chance you'll get food poisoning, and you'll know exactly what you're eating. Eat small amounts throughout the day. Avoid foods you've never tried before. Don't eat gas-forming foods (such as broccoli and beans). Don't overindulge in caffeinated beverages. These act as diuretics. As such, they'll increase your urine output, which could leave you dehydrated. Don't overindulge in alcohol, either. Better yet, skip it altogether. Like caffeine, it's a diuretic, and it can also hamper glycogen metabolism in the liver. Some sample menus: Breakfast 2 cups Wheaties or other whole-grain cereal 1 cup low-fat (1 percent) milk 1 cup sliced strawberries 2 slices whole-wheat toast with 1 Tbsp honey Breakfast 2 7-inch pancakes topped with 2 Tbsp syrup .5 cup orange juice Snack 1 cup low-fat vanilla yogurt mixed with 1 sliced banana Lunch 1 cup lentil soup 2 cornbread muffins 1 cup carrot-raisin salad (made with reduced-fat mayonnaise) 2 large oatmeal cookies Lunch Turkey sandwich with 2 slices whole-wheat bread 2 oz sliced turkey 1 oz cheese mustard 1 cup grapes small frozen yogurt cone Snack 1 cup low-fat vanilla yogurt mixed with .25 cup chopped dried apricots Snack 1 sports bar 2 cups sports drink Dinner 1.5 cups cooked rice, topped with 4 oz cooked ground turkey .5 cup each of steamed broccoli and carrots 1 cup romaine salad with 2 Tbsp low-fat Italian dressing 2 Rice Crispies treats (2-inch squares) Dinner 1 large baked potato topped with .5 cup low-fat cottage cheese .5 cup steamed carrots 1 sourdough roll Snack 1 cup corn flakes .5 cup skim milk Total calories for the day: 3,000 Carbohydrates: 480 g (64 percent of total calories) Protein: 103 g (13 percent) Fat: 78 g (23 percent) Total calories for the day: 2,400 Carbohydrates: 450 g (73 percent of total calories) Protein: 92 g (15 percent) Fat: 32 g (12 percent)
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	Books If you're only going to have time to read one book, make it this one: Pregnancy, Childbirth, and the Newborn by Penny Simkin Pregnancy, Childbirth, and the Newborn : The Complete Guide by Penny Simkin Maternal Fitness : Preparing for the Marathon of Labor by Julie Tupler The Thinking Woman's Guide to a Better Birth by Henci Goer Immaculate Deception II by Suzanne Arms An Easier Childbirth by Gayle Peterson