Pregnancy and Birth Sourcebook Part 1

Pregnancy and Birth Sourcebook.

Amy L. Sutton.

Preface.

About This Book Although the months of antic.i.p.ation before a woman becomes a parent can be joyous and fulfilling, they can also mark a time filled with uncertainty and worry over potential birth defects, pregnancy complications, and chronic health conditions. These worries are not unfounded. Recent statistics show increases in preterm deliveries, low birthweight babies, and the incidence of cesarean sections among U.S.

births. Fortunately, maternal and fetal monitoring, prenatal care, and healthy habits can reduce the risk of complications and make labor, delivery, and the postpartum period less stressful.

Pregnancy and Birth Sourcebook, Third Edition provides health information about the reproductive process-from preconception through the postpartum period. It provides information about fertility, infertility, and pregnancy prevention. The book's chapters explain the physical and emotional changes that occur during pregnancy, and they discuss topics related to staying healthy during pregnancy, including eating nutritiously, exercising regularly, obtaining prenatal care, and avoiding harmful substances. Facts about high risk pregnancies-such as those in women with chronic medical conditions, advanced maternal age, or weight concerns-are included. Finally, the book answers common questions about labor and delivery, postpartum recovery, newborn screening, and infant care. A glossary of terms and a directory of resources for information and support are also provided. provides health information about the reproductive process-from preconception through the postpartum period. It provides information about fertility, infertility, and pregnancy prevention. The book's chapters explain the physical and emotional changes that occur during pregnancy, and they discuss topics related to staying healthy during pregnancy, including eating nutritiously, exercising regularly, obtaining prenatal care, and avoiding harmful substances. Facts about high risk pregnancies-such as those in women with chronic medical conditions, advanced maternal age, or weight concerns-are included. Finally, the book answers common questions about labor and delivery, postpartum recovery, newborn screening, and infant care. A glossary of terms and a directory of resources for information and support are also provided.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part I: Preconception Health: Preparing for Pregnancy provides information about health habits, screenings, and interventions women may need prior to conception. This part also addresses factors that influence fertility (such as age and stress), details common causes of infertility, and identifies methods of preventing unintended pregnancies. provides information about health habits, screenings, and interventions women may need prior to conception. This part also addresses factors that influence fertility (such as age and stress), details common causes of infertility, and identifies methods of preventing unintended pregnancies.

Part II: Understanding Pregnancy-Related Changes and Fetal Development provides trimester-by-trimester details about physical changes in the fetus. The part also identifies early signs of pregnancy, suggests strategies for determining conception and due dates, and discusses emotional concerns and physical changes that may occur during pregnancy, including depression, back pain, pelvic floor and bladder problems, and vision and oral changes. provides trimester-by-trimester details about physical changes in the fetus. The part also identifies early signs of pregnancy, suggests strategies for determining conception and due dates, and discusses emotional concerns and physical changes that may occur during pregnancy, including depression, back pain, pelvic floor and bladder problems, and vision and oral changes.

Part III: Staying Healthy during Pregnancy highlights strategies women can undertake to help promote a healthy pregnancy. These include getting prenatal care and related medical tests, using medication safely, eating nutritiously, exercising, preventing excessive weight gain, and avoiding toxic substances and other harmful exposures. This part also offers advice on how pregnant women can stay safe at work or during travel. highlights strategies women can undertake to help promote a healthy pregnancy. These include getting prenatal care and related medical tests, using medication safely, eating nutritiously, exercising, preventing excessive weight gain, and avoiding toxic substances and other harmful exposures. This part also offers advice on how pregnant women can stay safe at work or during travel.

Part IV: High-Risk Pregnancies discusses pregnancies at high risk due to maternal age, multiple fetuses, or chronic health conditions, including allergies, asthma, cancer, diabetes, epilepsy, lupus, sickle cell disease, thyroid disease, eating disorders, and obesity. discusses pregnancies at high risk due to maternal age, multiple fetuses, or chronic health conditions, including allergies, asthma, cancer, diabetes, epilepsy, lupus, sickle cell disease, thyroid disease, eating disorders, and obesity.

Part V: Pregnancy Complications describes diseases and disorders that may influence a pregnancy's outcome, such as amniotic fluid abnormalities, birth defects, bleeding, blood clots, gestational diabetes, hypertension, severe nausea and vomiting, placental complications, Rh incompatibility, umbilical cord abnormalities, and s.e.xually transmitted diseases and other infections. This part also offers information about preterm labor and pregnancy loss, including ectopic pregnancy, miscarriage, and stillbirth. describes diseases and disorders that may influence a pregnancy's outcome, such as amniotic fluid abnormalities, birth defects, bleeding, blood clots, gestational diabetes, hypertension, severe nausea and vomiting, placental complications, Rh incompatibility, umbilical cord abnormalities, and s.e.xually transmitted diseases and other infections. This part also offers information about preterm labor and pregnancy loss, including ectopic pregnancy, miscarriage, and stillbirth.

Part VI: Labor and Delivery includes information about planning for labor and delivery by choosing a birthing center or hospital, selecting xvi includes information about planning for labor and delivery by choosing a birthing center or hospital, selecting xvi a birth partner or doula, and preparing a birth plan. This part also provides details on the stages of labor, pain relief during labor, v.a.g.i.n.al and cesarean births, and emergency situations that may occur during childbirth.

Part VII: Postpartum and Newborn Care discusses common postpartum concerns, including recovery expectations for new mothers, newborn care and screening tests, breastfeeding and formula-feeding tips, strategies for bonding with a new baby, and considerations for working after a child's birth. discusses common postpartum concerns, including recovery expectations for new mothers, newborn care and screening tests, breastfeeding and formula-feeding tips, strategies for bonding with a new baby, and considerations for working after a child's birth.

Part VIII: Additional Help and Information includes a glossary of important terms and a directory of organizations that provide help, information, and a.s.sistance to low-income pregnant women and their partners. includes a glossary of important terms and a directory of organizations that provide help, information, and a.s.sistance to low-income pregnant women and their partners.

Bibliographic Note

This volume contains doc.u.ments and excerpts from publications issued by the following U.S. government agencies: Agency for Healthcare Research and Quality (AHRQ); AIDSinfo; Center for Devices and Radiological Health (CDRH); Center for the Evaluation of Risks to Human Reproduction (CERHR); Centers for Disease Control and Prevention (CDC); Environmental Protection Agency (EPA); National Cancer Inst.i.tute (NCI); National Heart, Lung, and Blood Inst.i.tute (NHLBI); National Human Genome Research Inst.i.tute (NHGRI); National Inst.i.tute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Inst.i.tute of Child Health and Human Development (NICHD); National Inst.i.tute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Inst.i.tute of Environmental Health Sciences (NIEHS); National Inst.i.tute of Mental Health (NIMH); National Inst.i.tute of Neurological Disorders and Stroke (NINDS); National Inst.i.tute on Alcohol Abuse and Alcoholism (NIAAA); National Inst.i.tutes of Health (NIH); Office of Women's Health; U.S. Department of Health and Human Services (HHS); U.S. Department of Labor (DOL); and the U.S. Food and Drug Administration (FDA).

In addition, this volume contains copyrighted doc.u.ments from the following organizations: Academy of General Dentistry; A.D.A.M., Inc.; American Academy of Family Physicians; American College of Allergy, Asthma and Immunology; American College of Nurse-Midwives; American Pregnancy a.s.sociation; American Society for Reproductive Medicine; American Society of Anesthesiologists; BabyCenter LLC; Childbirth Connection; Children's Hospital of Pittsburgh; DONA xvii International; Hepat.i.tis B Foundation; Hyperemesis Education and Research Foundation; Inst.i.tute for Women's Policy Research; Henry J. Kaiser Family Foundation; Lamaze International; March of Dimes Birth Defects Foundation; National Campaign to Prevent Teen and Unplanned Pregnancy; National Network for Immunization Information; The Nemours Foundation; Obesity Action Coalition; Organization of Teratology Information Services (OTIS); Prevent Blindness America; and the University of Pittsburgh Medical Center.

Full citation information is provided on the first page of each chapter or section. Every effort has been made to secure all necessary rights to reprint the copyrighted material. If any omissions have been made, please contact Omnigraphics to make corrections for future editions.

Acknowledgements

Thanks go to the many organizations, agencies, and individuals who have contributed materials for this Sourcebook Sourcebook and to medical consultant Dr. David Cooke and doc.u.ment engineer Bruce Bellenir. and to medical consultant Dr. David Cooke and doc.u.ment engineer Bruce Bellenir.

Special thanks go to managing editor Karen Bellenir and research and permissions coordinator Liz Collins for their help and support.

About the Health Reference Series The Health Reference Series Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. is designed to provide basic medical information for patients, families, caregivers, and the general public.

Each volume takes a particular topic and provides comprehensive coverage. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series Health Reference Series. The Series Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a subst.i.tute for the physician/patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate health care provider.

A Note about Spelling and Style Health Reference Series editors use editors use Stedman's Medical Dictionary Stedman's Medical Dictionary as an authority for questions related to the spelling of medical terms xviii as an authority for questions related to the spelling of medical terms xviii and the Chicago Manual of Style Chicago Manual of Style for questions related to grammati-cal structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the for questions related to grammati-cal structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series Series include many doc.u.ments from a wide variety of different producers and copyright holders, and the editor's primary goal is to present material from each source as accurately as is possible following the terms specified by each doc.u.ment's producer. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn's disease include many doc.u.ments from a wide variety of different producers and copyright holders, and the editor's primary goal is to present material from each source as accurately as is possible following the terms specified by each doc.u.ment's producer. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn's disease vs. vs.

Crohn disease) or that British spelling norms be retained (leukaemia vs. vs. leukemia). leukemia).

Locating Information within the Health Reference Series The The Health Reference Series Health Reference Series contains a wealth of information about a wide variety of medical topics. Ensuring easy access to all the fact sheets, research reports, in-depth discussions, and other material contained within the individual books of the contains a wealth of information about a wide variety of medical topics. Ensuring easy access to all the fact sheets, research reports, in-depth discussions, and other material contained within the individual books of the Series Series remains one of our highest priorities. As the remains one of our highest priorities. As the Series Series continues to grow in size and scope, however, locating the precise information needed by a reader may become more challenging. continues to grow in size and scope, however, locating the precise information needed by a reader may become more challenging.

A Contents Guide to the Health Reference Series was developed to direct readers to the specific volumes that address their concerns. It presents an extensive list of diseases, treatments, and other topics of general interest compiled from the Tables of Contents and major index headings. To access was developed to direct readers to the specific volumes that address their concerns. It presents an extensive list of diseases, treatments, and other topics of general interest compiled from the Tables of Contents and major index headings. To access A Contents Guide to the Health Reference Series A Contents Guide to the Health Reference Series, visit www.healthreferenceseries.com.

Medical Consultant Medical consultation services are provided to the Health Reference Health Reference Series Series editors by David A. Cooke, MD, FACP. Dr. Cooke is a graduate of Brandeis University, and he received his M.D. degree from the University of Michigan. He completed residency training at the University of Wisconsin Hospital and Clinics. He is board-certified in Internal Medicine. Dr. Cooke currently works as part of the University of Michigan Health System and practices in Ann Arbor, MI. In his free time, he enjoys writing, science fiction, and spending time with his family. editors by David A. Cooke, MD, FACP. Dr. Cooke is a graduate of Brandeis University, and he received his M.D. degree from the University of Michigan. He completed residency training at the University of Wisconsin Hospital and Clinics. He is board-certified in Internal Medicine. Dr. Cooke currently works as part of the University of Michigan Health System and practices in Ann Arbor, MI. In his free time, he enjoys writing, science fiction, and spending time with his family.

Our Advisory Board

We would like to thank the following board members for providing guidance to the development of this Series Series: * Dr. Lynda Baker, a.s.sociate Professor of Library and Information Science, Wayne State University, Detroit, MI * Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI * Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI * Karen Morgan, Mardigian Library, University of Michigan- Dearborn, Dearborn, MI * Rosemary Orlando, St. Clair Sh.o.r.es Public Library, St. Clair Sh.o.r.es, MI Health Reference Series Update Policy The inaugural book in the Health Reference Series Health Reference Series was the first edition of was the first edition of Cancer Sourcebook Cancer Sourcebook published in 1989. Since then, the published in 1989. Since then, the Series Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted. has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: Editor Health Reference Series Omnigraphics, Inc.

P.O. Box 31-1640 Detroit, MI 48231 E-mail: [email protected]

Part One

Preconception Health: Preparing for Pregnancy

Chapter 1.

Overview of Reproductive Health What is reproductive health?

Reproductive health includes a variety of topics, such as: * menstruation and menopause; * pregnancy and preconception care; * fertility/infertility; * contraception; * s.e.xually transmitted diseases and AIDS/HIV [acquired immunodeficiency syndrome/human immunodeficiency syndrome]; and * health and function of the male and female reproductive systems.

What is the menstrual cycle?

The menstrual cycle is the process by which a woman's body gets ready for the chance of a pregnancy each month. The average menstrual cycle is 28 days from the start of one to the start of the next, but it can range from 21 days to 35 days.

From "Reproductive Health," by the National Inst.i.tute of Child Health and Human Development (NICHD, www.nichd.nih.gov), part of the National Inst.i.tutes of Health, February 5, 2008.

3.

Pregnancy and Birth Sourcebook, Third Edition Most menstrual periods last from three to five days. In the United States, most girls start menstruating at age 12, but girls can start menstruating between the ages of 8 and 16.

What is pregnancy?

Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.

Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth.

What are prenatal and preconception care and why are they important?

Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.

In addition, health care providers are now recommending a woman see a health care provider for preconception care, even before she considers becoming pregnant or in between pregnancies.

Both preconception care and prenatal care help to promote the best health outcomes for mother and baby.

What is infertility?

Infertility is the term health care providers use for women who are unable to get pregnant, and for men who are unable to impregnate a woman, after at least one year of trying.

In women, the term is used to describe those who are of normal childbearing age, not those who can't get pregnant because they are near or past menopause. Women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.

Infertility is a complex problem-it does not have a single cause because getting pregnant is a multi-step chain of events. The cause of infertility can rest in the women or the man, or can be from unknown factors or a combination of factors.

What is contraception?

Contraception, also known as birth control, is designed to prevent pregnancy. Some types of birth control include (but are not limited to): 4.Overview of Reproductive Health * Barrier methods, such as condoms, the diaphragm, and the cervical cap, are designed to prevent the sperm from reaching the egg for fertilization.

* Intrauterine device, or IUD, is a small device that is inserted into the uterus by a health care provider. The IUD prevents a fertilized egg from implanting in the uterus. An IUD can stay in the uterus for up to 10 years until it is removed by a health care provider.

* Hormonal birth control, such as birth control pills, injections, skin patches, and v.a.g.i.n.al rings, release hormones into a woman's body that interfere with fertility by preventing ovulation, fertilization, or implantation.

* Sterilization is a method that permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant. Sterilization involves surgical procedures that must be done by a health care provider and usually cannot be reversed.

The choice of birth control depends on factors such as a person's overall health, age, frequency of s.e.xual activity, number of s.e.xual partners, desire to have children in the future, and family history of certain diseases. A woman should talk to her health care provider about her choice of birth control method.

It is important to remember that even though birth control methods can prevent pregnancy, they do not all protect against s.e.xually transmitted diseases or HIV.

5.

Chapter 2.Preconception

Considerations

Chapter Contents.Section 2.1-What to Do before You Conceive .............................. 8 Section 2.2-Understanding Genetic Counseling and Evaluation: Is It Right for You? ............................. 11 7.Pregnancy and Birth Sourcebook, Third Edition Section 2.1 What to Do before You Conceive From "Healthy Pregnancy: Before You Start Trying," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2007.

Some foods, habits, and medicines can harm your baby-even before he is conceived. Find out what to do and what to avoid when you're trying to get pregnant.

Before Pregnancy If you're thinking about getting pregnant, or are already pregnant, taking care of your health is more important than ever. Follow these tips for a healthy pregnancy: * Get 400 micrograms (or 0.4 mg) of folic acid daily. Get 400 micrograms (or 0.4 mg) of folic acid daily. Eat foods fortified with folic acid, take a multivitamin, or take a folic acid pill to get your daily dose. Taking folic acid in a pill is the best way to be sure you're getting enough. Including 0.4 mg of folic acid (or folate) in your diet before you get pregnant and in the first three months of pregnancy can help prevent some birth defects. If you don't get enough folic acid, your baby's spine may not form right. This is called spina bifida. Also, your baby needs folic acid to develop a healthy brain. Many doctors will prescribe a vitamin with folic acid. But you also can buy vitamins or folic acid pills at drug and grocery stores. Some foods rich in folate include: leafy green vegetables, kidney beans, orange juice and other citrus fruits, peanuts, broccoli, asparagus, peas, lentils, and whole-grain products. Folic acid is also added to some foods like enriched breads, pastas, rice, and cereals. Eat foods fortified with folic acid, take a multivitamin, or take a folic acid pill to get your daily dose. Taking folic acid in a pill is the best way to be sure you're getting enough. Including 0.4 mg of folic acid (or folate) in your diet before you get pregnant and in the first three months of pregnancy can help prevent some birth defects. If you don't get enough folic acid, your baby's spine may not form right. This is called spina bifida. Also, your baby needs folic acid to develop a healthy brain. Many doctors will prescribe a vitamin with folic acid. But you also can buy vitamins or folic acid pills at drug and grocery stores. Some foods rich in folate include: leafy green vegetables, kidney beans, orange juice and other citrus fruits, peanuts, broccoli, asparagus, peas, lentils, and whole-grain products. Folic acid is also added to some foods like enriched breads, pastas, rice, and cereals.

* Start watching what you eat. Start watching what you eat. Load up on fruits, vegetables, and whole-grains (such as whole-wheat breads or crackers). Load up on fruits, vegetables, and whole-grains (such as whole-wheat breads or crackers).

Eat plenty of calcium-rich foods such as non-fat or low-fat yogurt, milk, and broccoli. Your baby needs calcium for strong bones and teeth. When fruits and vegetables aren't in season, 8 Preconception Considerations frozen vegetables are a good option. Avoid eating a lot of fatty foods (such as b.u.t.ter and fatty meats). Choose leaner foods when you can (such as skim milk, chicken and turkey without the skin, and fish).

* Tell your doctor if you smoke or use alcohol or drugs. Tell your doctor if you smoke or use alcohol or drugs.

Quitting is hard, but you can do it. Ask your doctor for help.

* Get enough sleep. Get enough sleep. Try to get seven to nine hours every night. Try to get seven to nine hours every night.

Take steps to control the stress in your life. When it comes to work and family, figure out what you can and can not do. Set limits with yourself and others. Don't be afraid to say no to requests for your time and energy.

* Move your body. Move your body. Once you get pregnant, you can't increase your exercise routine by much. So it's best to start before the baby is on the way. Once you get pregnant, you can't increase your exercise routine by much. So it's best to start before the baby is on the way.

* Get any health problems under control. Get any health problems under control. Talk to your doctor about how your health problems might affect you and your baby. If you have diabetes, monitor your blood sugar levels. If you have high blood pressure, monitor these levels as well. If you are overweight, talk to your doctor about how to reach a healthy weight. Talk to your doctor about how your health problems might affect you and your baby. If you have diabetes, monitor your blood sugar levels. If you have high blood pressure, monitor these levels as well. If you are overweight, talk to your doctor about how to reach a healthy weight.

* Ask your mother, aunts, grandmother or sisters about Ask your mother, aunts, grandmother or sisters about their pregnancies. Did they have morning sickness? Problems with labor? How did they cope? Did they have morning sickness? Problems with labor? How did they cope?

* Find out what health problems run in your family. Find out what health problems run in your family. Tell these to your doctor. You can get tested for health problems that run in families before getting pregnant (genetic testing). Tell these to your doctor. You can get tested for health problems that run in families before getting pregnant (genetic testing).

* Make sure you have had all of your immunizations (shots), Make sure you have had all of your immunizations (shots), especially for rubella (German measles). especially for rubella (German measles). If you haven't had chickenpox or rubella, get the shots at least three months before getting pregnant. If you haven't had chickenpox or rubella, get the shots at least three months before getting pregnant.