New Mother Tips

Stages of Baby?s Development – A Newborn?s Simple Instincts

Newborns also exhibit several reflex responses to external stimulation and these patterns and reflexes help the baby to manage their power resources as well as their responses to what is around them.

 Just right after birth, there is often a short spell where the baby is attentive, searching at and responding to people.

 Sleep patterns of a newborn differ. Investigation has identified six diverse states of infant awareness:

Quiet or deep sleep: Baby will have eyes closed with no eye movements and no activity apart from occasional jerky movements standard breathing.
Active or light sleep: Baby’s eyes are closed but rapid eye movements can be observed breathing may possibly be irregular, activity level is low.
Drowsiness: Baby’s eyes might open and close but appear dull when open there is delayed response to stimulation and activity level varies.
Alert inactivity: Baby’s eyes are open and bright his/her attention will concentrate on outside stimuli such as a ceiling light or something bright.
Alert activity: Baby’s eyes are open activity level is high. Baby will react to stimulation and show increased startles and motor activity.
Crying: Intense crying that is challenging to quit high levels of motor activity.

A newborn will exhibit many reflexive responses. Some will last for life. The presence or absence of reflexes and their developmental course will give data about the baby’s neural responses. For instance when the physician runs a thumb along the left side of baby’s spinal column, the baby really should reflexively bent to the left. If this reflex occurs on 1 side but not the other it is doable the nerves are damaged on the side that shows no reflexive reaction.

Other reflexes a newborn will show include:

 Rooting Reflex: Stroke a newborn’s cheek subsequent to the side of his mouth and baby will turn his head to that side and search with his mouth.
Moro Reflex: Baby will thrust arms outward, open hands, arch back and stretch legs outward just before clenching fists across chest in reaction to a sudden sound or the loss of head support.
Palmar or hand grasp: Baby will grasp a finger or rod with his finger.
Stepping Reflex: Support baby in upright position with bare feet on flat surface and baby will make rhythmic stepping movements. This reflex disappears in two to 3 months.
Swimming Reflex: Hold baby horizontally on stomach in water and baby will alternate arm and leg movements, exhaling through mouth. This reflex disappears at six months.
Plantar or toe grasp: Press finger against ball of baby’s foot and he will curl all toes under. This reflex disappears in between eight and twelve months.

Although reflexes are typically automatic, it has been found that environmental aspects do have an effect on their appearance for instance a satiated baby may not show a rooting response.

Development in Baby’s First Month – ilestones in Infant’s Development

All babies will develop differently however investigation helps give a general indication of the various stages of development in infants and roughly when these stages might be seen.

As well as the distinct stages of development, research also assists suggest when these stages could be seen.

Just right after birth baby’s birth weight will drop and this is regained when baby is approximately ten days old.

Newborns will sleep and eat whenever they need to have it. Some babies sleep as much as twenty hours a day, waking randomly, other people might require much less sleep and may spend time crying instead.

During the initial month the baby will start to recognise mother’s voice and smell.

Sight and Hearing in the course of the Very first Few Months of Life

A newborn will turn his head from side to side when lying on his stomach he will exhibit poor head manage when lifted and display alternating movements of his legs when on stomach as if attempting to crawl. At this stage too, baby will automatically grasp and hold onto a finger.

Familiar sounds might elicit some response in baby for instance he might respond to music or a Tv program his mother watched often even though he was in her womb. He will be comforted by familiar voices and really should be left to sleep with a background of common household sounds.  Baby will turn head towards voices, from birth.

Baby can see from birth but a newborn has difficulty focusing beyond nine inches (22 cm). Adults need to make regular eye contact with baby. More than the very first few weeks baby’s sight will sharpen until at about six to eight months, he will see the world virtually as properly as an adult does.

Baby’s hearing is fully mature at the end of the 1st month. By two months baby will be able to focus both eyes and track a moving object. (Some do this earlier). Also at two months baby will see colour differences far more clearly.

How Adults Can Support Baby’s Development

Studies have shown babies prefer human faces to patterns maintain your face close to the newborn so he or she can study your features. When baby is 1 month old, almost anything passed in front of his face will transfix him. Hold shiny, colourful objects in front of baby and move them up and down. This ought to attract his attention and encourage his interest in colours. Hang eye-catching mobiles exactly where baby can see them.

Always be sure to support baby’s neck when he is being lifted. Speak to baby continuously while he is awake during the very first weeks and months. He will adore the distinct tones in voices. For the duration of his initial month baby may also try to mimic the faces you make and lip movements. Vocal interactions are essential in the development of baby so even if you really feel silly talking to him in public, just do it.

Sources:

Bee, Helen L. The Creating Child. 7th ed. New York: HarperCollins College Publishers, 1995.

Gemelli, Ralph J. Regular Child and Adolescent Development. Washington, DC: American Psychiatric Press, 1996.

Kagan, Jerome. The Nature of the Child. New York: Basic Books, 1994.

Piaget J. The Psychology of the Child. New York Basic Books 1972.

Neisser U. Cognitive Psychology. New York: Appleton-Century Crofts 1977.

Question by stacy heart: babies being born with accents do you think this?
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Page last updated at 10:38 GMT, Friday, 6 November 2009
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Babies ‘cry in mother’s tongue’
Crying newborn
Babies’ cries imitate their mother tongue as early as three days old

German researchers say babies start to choose up the nuances of their parents’ accents although still in the womb.

The researchers studied the cries of 60 wholesome babies born to families speaking French and German.

The French newborns cried with a rising “accent” while the German babies’ cries had a falling inflection.

Writing in the journal Existing Biology, they say the babies are most likely trying to form a bond with their mothers by imitating them.

FROM THE Nowadays PROGRAMME

Far more from Right now programme

The findings suggest that unborn babies are influenced by the sound of the initial language that penetrates the womb.

Cry melodies

It was already recognized that foetuses could memorise sounds from the outside globe in the last three months of pregnancy and had been especially sensitive to the contour of the melody in both music and human voices.

Earlier studies had shown that infants could match vowel sounds presented to them by adult speakers, but only from 12 weeks of age.

Kathleen Wermke from the University of Wurzburg, who led the investigation, mentioned: “The dramatic locating of this study is that not only are human neonates capable of producing distinct cry melodies, but they prefer to generate those melody patterns that are typical for the ambient language they have heard during their foetal life.

Newborns are extremely motivated to imitate their mother’s behaviour in order to attract her and hence to foster bonding
Kathleen Wermke, Unversity of Wurzburg

“Contrary to orthodox interpretations, these data support the significance of human infants’ crying for seeding language development.”

Dr Wermke’s team recorded and analysed the cries of 60 healthy newborns when they were 3 to five days old.

Their analysis revealed clear differences in the shape of the infants’ cry melodies that corresponded to their mother tongue.

They say the babies need only nicely-co-ordinated respiratory-laryngeal systems to imitate melody contours and not the vocal control that develops later.

Dr Wermke stated: “Newborns are extremely motivated to imitate their mother’s behaviour in order to attract her and hence to foster bonding.

“Due to the fact melody contour might be the only aspect of their mother’s speech that newborns are able to imitate, this may explain why we identified melody contour imitation at that early age.”

Debbie Mills, a reader in developmental cognitive neuroscience at Bangor University, stated: “This is truly intriguing simply because it suggests that they are producing sounds they have heard in the womb and that indicates understanding and that it is not an innate behaviour.

“Many of the early infant behaviours are virtually like reflexes that go away soon after the initial month and then come back later in a various form.

“It would be interesting to look at these babies right after a month and see if their ability to follow the melodic contours of their language is still there.”

Finest answer:

Answer by Shannon
hmmmm…

Know much better? Leave your own answer in the comments!

Why Your Newborn Cries? What Helps?

When your newborn cries often and for extended periods without any apparent reason, the cause may be colic. It is a fairly common problem. Baby colic affects around one third of all newborns.

Infant colic is repeated excessive crying episodes, in a baby between three weeks and three months, for no apparent reason.

Your newborn cries because he/she suffers sharp intermittent abdominal pains. Often the baby will extend its legs, arch its back, its face will become very red, fist will be clenched, gas will be passed but the baby will have a hard time passing stools.

What causes baby colic:

Since doctors don’t know the cause of colic in infants, defining the actually syndrome makes it difficult. As you may have guessed however, there are a lot of theories floating around out there.

1. The digestive system for some reason does not allow the release of gas. This build-up of gas would cause the baby severe stomach pain.

2. Adverse environmental condition, inherent sensitivity and possibly the baby’s premature nervous system. These factors make for uncontrollable crying babies.

3. Half the babies suffering from colic had some form of gastro-esophageal reflux and lactose intolerance. Baby colic is greatly influenced by gut flora which simply put is bacteria that live in our digestive tract that perform many useful functions such as helping in the digestion of our food. Some researchers refer to gut flora as the forgotten organ. Lack of gut flora in a baby causes problems with the digestive system and the result is a fussy baby.

Although colic in newborns happens worldwide it is not considered a serious disorder since it will eventually disappear without any particular treatment. It seems to be at its worst between the ages of six to eight weeks.

Breastfeeding

Mothers who are breastfeeding should avoid foods that cause gas as this can be passed on to the baby. Also it should be noted that probiotics (which are helpful with digestion) occur naturally in breast milk so therefore the gut flora of a breast fed baby is quite different than a formula fed baby. Mothers who are breastfeeding and who change their diets have found their babies to be less colicky.

There are studies being done now to see if pre-natal stress, birth mother smoking during pregnancy and trauma at the actual birth can be contributing factors to colic.

There are many theories floating around about colic in newborns so thank goodness it is something that infants seem to grow out of.

Colic is one of many other reasons why your newborn cries

Why newborn cry?

Read what may be the other most often reasons why your newborn cries: Why newborn cry

How to help your newborn sleep?

Expensive Gifts for Newborns: What For?

Expensive gifts for newborns: What for?

The idea that expensive gifts for  newborns can somehow emphasize the role of a giver is not right. Of course the  price of a present matters, but not much.

In fact, babies absolutely don’t  care about the price and they can’t appreciate your money spent on the presents  for them. But parents can, and they do appreciate but not the price. They  appreciate the usefulness and all good the present can give them.

So, if you’re hesitating and at the  very moment to make a decision I’d advise you to find “the golden mean”; between  price and functional gifts for newborns.

Of course of you have spare bucks to  spend on a newborn baby gift basket do it. If not, cheer up! Remember some  gifts for newborns that can cost a fortune in fact are a little of use or  useless at all.

Your choice shall be given to the  presents that will give much support to parents, and help them to bring up a  baby and take care of him or her.

Nowadays in baby stores we can find  a lot of multi functional gadgets designed for babies and their parents. But do  parents really need all these function in one this device? Many parents  complain afterwards that the presents which they received as gifts for newborns  were perfect at the very beginning. But then, one or two months later, these  presents with multi functions broke down and the things were of no use.

But you hardly want this to happen  to your newborn presents, right? So, the way out is not to be caught by  colorful advertisement suggesting you 5 in 1m or more. If you can cooperate  with someone on a family or a friend you know, do this. And if you want to  choose a baby crib as a present, this friend can pick up a suitable set of  bedding and one spare.

And the last piece of advice. Having  heard about a soon baby birth we become very emotional and sometimes, it  hinders to be wise and make a right choice. If you are such kind of man, at  first get cooled. Then, spend time for planning and making a list of possible  gifts for newborns considering the price and money available. When you are  though, advise with parents or experienced people about your chosen gifts.  These people can be those who are close to this family, like future  grandparents. One more plus to talk to them is that they do know what a baby  needs.

To show your love and  care can be done with cheap but practical gifts for newborns.

Question by Steena: How many months should a newborn be before he/she can go on a flight?
I’m planning to bring my newborn to another country to visit the father of my child.
I’m still pregnant though and my due date is just a week ahead.
Application for passports for infants is just a one-week process and I’m planning to buy a ticket immediately once I got the passport.
How many months old should a newborn be before he/she can go on a flight?
What should I expect or be aware of in flights with newborns?

Best answer:

Answer by tunisianbelle
As long as your child has had a check-up with the doctor and everything is fine, your child will be safe to fly almost immediately after birth. Most airlines require that a baby be at least 7 days old, unless you have a medical certificate. I have seen children as young as 1 day old fly. You should call the airline you plan to fly with to see what their policy is because it can vary from airline to airline.

I’ve been flying internationally and domestically with my children since they were 2 months (now 8&5). At least three trips a year are the children and I traveling internationally (14+ hours each way) alone. In addition to that, we do another 8-10 international and domestic flights a year as a family. I have never had any problems with my children on any of the flights. Here are a few tips and suggestions:

1.) You will need to have all your baby’s documents in order. It is a good idea to keep a copy of his/her notarized birth certificate with you.

You mentioned that you will need a passport for your child, so that means this will be an international trip. You will also have to look into whether or not your child will need a visa and if there are any required vaccinations for the country you plan to travel to.

Keep your doctors name and number with you. Also get the name and number of a doctor where you are visiting in case an emergency should come up.

Another thing you should consider bringing with you is your childs immunization book. That way if any emergency should arise while you are on vacation (no matter where you are) the treating physician will at least have some verifiable information to go on. This book also usually includes what your child is allergic to, and some small but very helpful notes from your doctor.

Verify what travel documents you will need in advance to make sure you have everything.

2.) A car seat is not mandatory, but is highly recommended. Since your child is under two, you are allowed to hold him/her as a lap child, meaning that he/she will have to sit in your lap the entire time. The Flight Attendants should place you in a front seat where you will have more room. Depending on space and availability, the Flight Attendants might give you a bassinet that attaches to the front wall to put your child in (however you can not uses this during taxi, take-offs, landings, or turbulence).

This is not the safest way for a child to fly and the airlines recommend children to have their own seat with a child safety device.

I do advise using a CRS (Child Restraint System) because it is safe for the child – especially during turbulence, makes them feel secure, is more comfortable for both parent and child, will help your child sleep, and gives both of you the opportunity to relax a bit.

A CRS is a hard-backed child or infant or child safety seat that is approved by the government for use in both motor vehicles and aircraft.

In order to be certified for use on an airplane, the car seat has to met the Federal Motor Vehicle Safety Standards. Check the labels on the side of your car restraint for a sticker (words will be printed in red) for verification that your seat is safe for airplane use. Almost all car seats pass this requirement. Here is a picture of what the sticker looks like: http://jamiehassen79.angelfire.com/flying_children_pics/FMVSS.jpg

Many airlines offer half-price tickets so parents can be guaranteed that their child can travel in a CRS device. You should call your airline to ask for a discount and/or ask what the airline’s policy is for using empty seats.

3.) You can take a stroller and gate check it. It will not count towards your checked luggage. This means that you will be able to use it all the way up until the time that you board, and one of the handlers will take it from you at your departure gate, tag it, and put it in a special compartment for you. When you exit the plane, it will be waiting for you at the door as well.

There are many products out there designed to help the traveling family. Here’s a product that can attach to most car seats so that you can use it as a stroller and get it through the airport more easily. http://www.gogobabyz.com/products/gogo_kids.html

4.) Make sure you have a check-up with your doctor before leaving to make sure your child is healthy enough to fly. If your child has even a slight cold, the pressure in his/her ears during take-off and landing (even if you do the precaution methods) could leave his/her ears aching for days after the flight.

Most doctors recommend that if anyone is sick (such as being stuffed up or already having an earache), not to take the flight because of the potential damage to the ears. I know my husband and other pilots do not work if they are sick because of this danger.

Not all children have a problem with the pressure changes in their ears. If yours does however you’ll want to know how to help. For take-offs and landings (the WHOLE way up, and starting from the BEGINNING, or TOP of descent), the best ways to alleviate ear pressure are to:

*If your child is nursing, nurse him/her.
*Give him/her something to drink (formula, milk, water, juice – it doesn’t matter)
* Give him/her a pacifier to suck on
* Place hot damp towels (usually like the ones distributed to first and business class before take-off and landing to freshen up with – just ask a flight attendant for them) or paper towels that have been soaked in hot water and wrung out, at the bottom of two paper or styrofoam cups, then hold the cups over the ears
* Gently but with some pressure, rub his/her neck repeatedly from the chin to the base of the neck. This will cause a swallowing motion that will relieve pressure build-up in the ears.

You can also try using a decongestant. It is always best to check with your doctor before using any type of medications though, to make sure you are using the one best suited to your childs needs. I personally have found pain relief medications don’t really help, and at least in my experience, decongestants are a waste of money.

5.) As long as your child is with you, you are able to take as much formula, breast milk, or regular milk that you will need for you child for the duration of the time you will spend in the airport and on the flight (as long as it is within reason).And no, you will NOT have to taste it – no matter what form you bring it in.

All that you must do is:

1. Separate the milk from the liquids, gels, and aerosols in your quart-size (1 liter) zip-top bag.
2. Declare you have the items to one of the Security Officers at the security checkpoint.
3. Present these items for additional inspection once reaching the X-ray. These items are subject to additional screening. http://www.tsa.gov/travelers/airtravel/children/formula.shtm

New regulations also allow you to take beverages (including water) from home as long as they are less than 3oz (100ml), -OR- beverages (including water) of any size that you have purchased from inside the security area onto planes. You can also bring a limited amount of baby food, yogurt, cheese, puddings, etc. with you also as long as they are in containers less than 3oz (100ml).

http://www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm#9

Save your money when it comes to buying water though because the Flight Attendants will provide you with hot or cold water (or any other drink) free at any time that you request, no matter how many times you request it.

6.) Keep your diaper bag well stocked with plenty of diapers, wipes, ointments and other essential things. Just remember the new law regulating liquids, gels, and such and pack accordingly. http://www.tsa.gov/311/index.shtm You can usually find travel size baby products in stores and they are wonderful for plane use. One thing I always like to carry with me is hand sanitizer! I always wipe the trays down with that (followed by a baby wipe) and use it for my kids after taking them to the bathroom (even though they wash their hands). I know that airplane bathrooms are not the cleanest, so that is why I try to e vigilant.

Be sure to pack 2-3 changes of clothes for your child. You will need this in case he/she gets sick, spills something on him/herself, or in case your luggage gets lost.

Bring any medications that you might need for your child should he/she get sick or that he/she takes regularly. Remember that if they are not prescription medications, the 3oz (100ml) rule applies to them and they must be kept in a clear plastic bag. http://www.tsa.gov/311/index.shtm

Do NOT give your child medicine with the hopes of it making him/her sleep. This is not only cruel, but dangerous as well.

You should be respectful of other passengers and always change your child’s diaper in the restroom. They do have diaper bed changers in there, although they can be a little small. Usually the bathrooms with the diapers beds are the handicap ones (they usually tend to be toward the rear of the plane), so they tend to be a little bit bigger and it does help.

I also know some people who say that instead of using the changing table, they say to put the toilet seat down, use the toilet as a seat for yourself, and lay the baby across your knee to change their diaper.

To make it easier on yourself, make sure that you undress your baby so that he/she has just a diaper on while at your seat. Grab your diaper, wipes, and ointment or baby powder (whatever you use for changing your childs diaper) and head to the bathroom. This will help to make the procedure faster and easier.

Try to change your childs diaper as close to boarding as possible. This will help to make you baby feel fresh and more comfortable for take-off (which could also mean less problems).

7.) Make sure to pack one or two comfort things such as a favorite blankie or stuffed animal. I always bring a small pillow and blanket from home for my children (even now) because I know 100% that they are clean, and my children are accustomed to them.

8.) Don’t worry about what the other passengers are going to think or say should your baby cry. This will only add stress, which your child can pick up on, and it could make him/her cry longer and harder. Instead, just relax, and handle the situation like you would if you were at home. Most times the other passengers are very understanding anyways and some will even try to help you. Which reminds me, if help is offered to you, TAKE it!

I wrote a small article about flying with children that goes more in-depth, gives airport security rules and regulations, plus offers tips and tricks for the travel, etc. http://www.angelfire.com/jamiehassen79/flying_children.html

If I can be of any more help or assistance, please feel free to contact me.

Add your own answer in the comments!

Pregnancy and Childbirth

Pregnancy and Childbirth

I

INTRODUCTION

Pregnancy and Childbirth, terms for the gestation period of the human reproductive cycle.

II

PREGNANCY

Pregnancy starts when a male’s sperm fertilizes a female’s ovum (egg), and the fertilized ovum implants in the lining of the uterus (see Fertilization; Reproductive System). Because pregnancy changes a woman’s normal hormone patterns, one of the first signs of pregnancy is a missed menstrual period (see Menstruation). Other symptoms include breast tenderness and swelling, fatigue, nausea or sensitivity to smells, increased frequency of urination, mood swings, and weight gain. Some women also experience cravings for unusual substances such as ice, clay, or cornstarch; this condition, called pica, can indicate a dietary deficiency in iron or other nutrients. By the 12th week of pregnancy many of these symptoms have subsided, but others appear. For example, a woman’s breasts usually increase in size, and her nipples darken. The most obvious symptom is weight gain; most physicians now recommend a gain of about 9 to 12 kg (about 22 to 26 lb) by the end of pregnancy.

The first few months of pregnancy are the most critical for the developing infant, because during this period the infant’s brain, arms, legs, and internal organs are formed. For this reason a pregnant woman should be especially careful about taking any kind of medication except on the advice of a physician who knows that she is pregnant. X rays should also be avoided, and pregnant women should avoid smoking and alcohol consumption.

III

COMPLICATIONS

Most women worry about the health of their unborn child, especially mothers over the age of 35, when genetic problems are more common. Safe, effective tests are available that can detect genetic disorders which cause mental retardation and other problems. The most common test is amniocentesis, and in about 95 percent of the cases tested the baby is found to be normal. Some doctors recommend that all pregnant women over the age of 35 have an amniocentesis test.

Although most pregnancies proceed normally, certain complications can develop. One rare but life-threatening complication is ectopic pregnancy, in which the fertilized egg implants outside the uterus, in the abdomen, or in a fallopian tube. Symptoms include sudden, intense pain in the lower abdomen about the seventh or eight week of pregnancy. If not promptly treated by surgical means, ectopic pregnancy can result in massive internal bleeding and possibly death.

About 15 percent of all pregnancies end in miscarriage, most of which occur between the 4th and 12th weeks of pregnancy. A physician should be contacted immediately if a woman suspects that she is pregnant and then experiences severe abdominal cramping or vaginal bleeding.

Toxemia is another potentially serious complication of late pregnancy. Symptoms include high blood pressure; rapid, large weight gain, due to edema (swelling), of as much as 11 to 13 kg (25 to 30 lb) in a month; and protein in the urine. If untreated, toxemia can lead to seizures and coma and death of the infant. Once severe toxemia is diagnosed, the infant is usually delivered as soon as possible to protect both mother and child. The condition disappears with birth.

IV

LABOR AND CHILDBIRTH

A normal pregnancy lasts about 40 weeks, or 280 days, after the beginning of the last menstrual period. Occasionally women go into labor before the expected date of birth, resulting in a premature infant. About 7 percent of all infants are premature—that is, born before the 37th week of pregnancy. Babies born just a few weeks early usually develop normally. Recent advances in the care of premature infants now allow many babies who are born after only 25 to 26 weeks of pregnancy to survive. Even babies born after only 23 weeks of pregnancy have survived, although survival rates for such highly premature infants are low.

Delivery, the process by which the baby is expelled from the uterus through the birth canal and into the world, begins with irregular contractions of the uterus that occur every 20 to 30 minutes. As labor progresses, the contractions increase in frequency and severity. The usual length of labor for a first-time mother is about 13 to 14 hours, and about 8 or 9 hours in a woman who has given birth previously. Wide variations exist, however, in the duration of labor.

Most women prefer some kind of anesthesia to alleviate the pain associated with childbirth. Natural (unmedicated) childbirth, however, is becoming more popular, in part because many women are aware and concerned that the anesthesia and medication given to them is rapidly transported across the placenta to the unborn baby. Heavy doses of anesthesia can make the newborn baby less alert after birth.

Other options available regarding childbirth include regional (local) anesthesia, in which only those areas of the mother that are affected by the pain of childbirth are numbed. Such anesthesias include a lower spinal block and epidural anesthesia, in which the pelvic region is anesthetized. Another option is cesarean section, in which the baby is surgically removed from the uterus. Cesarean section is usually performed only for a specific medical reason.

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Before Your Next Pregnancy

What to do before (and during) your next pregnancy to lessen the chance for birth defects?

If you are planning to become pregnant, taking certain steps can help reduce risks to both you and your baby. Proper health before deciding to become pregnant is almost as important as maintaining a healthy body during pregnancy.

The first few weeks are crucial in a child’s development. However, many women do not realize they are pregnant until several weeks after conception. Planning ahead and taking care of yourself before becoming pregnant is the best thing you can do for you and your baby.

One of the most important steps in helping you prepare for a healthy pregnancy is a pre-pregnancy examination (often called preconception care) performed by your physician before you become pregnant. A preconception visit includes assessments of your overall health and identification of potential risk factors that may complicate pregnancy. Women can receive advice and treatment for medical conditions such as diabetes or heart disease that may be changed by pregnancy. By preparing in advance, you can be your healthiest before becoming pregnant. A preconception examination may include any/all of the following:

family medical history – an assessment of the maternal and paternal medical history – to determine if any family member has had any medical conditions such as high blood pressure, diabetes, and/or mental retardation.
genetic testing – an assessment of any possible genetic disorders – as several genetic disorders may be inherited, such as sickle cell anemia (a serious blood disorder which primarily occurs in African-Americans) or Tay-Sachs disease (a nerve breakdown disorder marked by progressive mental and physical retardation which primarily occurs in individuals of Eastern European Jewish origin). Some genetic disorders can be detected by blood tests before pregnancy.
personal medical history – an assessment of your personal medical history to determine if there are any of the following:
medical conditions that may require special care during pregnancy , such as epilepsy, diabetes, high blood pressure, anemia, and/or allergies
previous surgeries
past pregnancies – including the number, length of pregnancy (gestation), previous pregnancy complications, and/or pregnancy losses
vaccination status – an assessment of current vaccinations/inoculations to assess immunity to rubella (German measles), in particular, since contracting this disease during pregnancy can cause miscarriage or birth defects. If a woman is not immune, a vaccine may be given at least 3 months before conception to provide immunity.
infection screening – to determine if a woman has a sexually transmitted infection or urinary tract infection (or other infection) that could be harmful to the fetus and to the mother.
Reducing the risk of complications:

Other steps that can help reduce the risk of complications and help prepare for a healthy pregnancy and delivery include the following:

smoking cessation
If you are a smoker, stop smoking now. Studies have shown that babies born to mothers who smoke tend to be lower in birthweight. In addition, exposure to secondhand smoke may adversely affect the fetus.
proper diet
Eating a balanced diet before and during pregnancy is not only good for the mother’s overall health, but essential for nourishing the fetus.
proper weight and exercise
It is important to exercise regularly and maintain a proper weight before and during pregnancy. Women who are overweight may experience medical problems such as high blood pressure and diabetes. Women who are underweight may have babies with low birthweight.
medical management (of preexisting conditions)
Take control of any current or preexisting medical problems, such as diabetes or high blood pressure.
preventing birth defects
Take 400 micrograms (0.4 mg) of folic acid each day, a nutrient found in some green leafy vegetables, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements. Folic acid can help reduce the risk of birth defects of the brain and spinal cord (also called neural tube defects). If you have a family history of spina bifida, congenital heart defects (heart defects present in a newborn), or cleft lip/palate, your physician may prescribe extra folic acid based on your family history.
avoid exposure to alcohol and drugs during pregnancy
Be sure to inform your physician of any medications (prescription and over-the-counter) and/or herbal supplements you are currently taking – all may have adverse effects on the developing fetus.
avoid exposure to harmful substances
Pregnant women should avoid exposure to toxic and chemical substances (i.e., lead and pesticides), and radiation (i.e., x-rays). Exposure to high levels of some types of radiation and some chemical and toxic substances may adversely affect the developing fetus.
infection control
Pregnant women should avoid the ingestion of undercooked meat and raw eggs. In addition, pregnant women should avoid all contact and exposure to cat feces and cat litter, which may contain a parasite called toxoplasma gondii that causes toxoplasmosis. Other sources of infection include insects (i.e., flies) that have been in contact with cat feces and should be avoided during pregnancy. Toxoplasmosis can cause a serious illness in, or death of, the fetus. A pregnant woman can reduce her risk of infection by avoiding all potential sources of the infection. A blood test before or during pregnancy can determine if a woman has been exposed to the toxoplasma gondii parasite.
daily vitamins
Begin taking a prenatal vitamin daily, prescribed by your physician, to make certain that your body gets all the necessary nutrients and vitamins needed to nourish a healthy baby.
identifying domestic violence
Women who are abused before pregnancy may be at risk for increased abuse during pregnancy. Your physician can help you find community, social, and legal resources to help you deal with domestic violence.

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Questions and Answers About Pregnancy

Questions and Answers About Pregnancy

Q: I consumed some alcohol before I knew I was pregnant. Should I take any special precautions or have any extra tests?

A: This is not an unusual situation. Because we know alcohol enters the unborn baby’s circulation, many pregnant women worry that they may have caused harm to the baby because they drank before realizing they were pregnant. Effects of alcohol are dose-related to some extent. If you drank very heavily and often before you discovered you were pregnant, the effects on the baby are potentially greater than if you drank too much on one occasion or drank lightly on several occasions.

There are no extra tests during pregnancy that can tell you if your baby is affected. The usual observations made by your doctor or midwife (such as height measurements, heart rate monitoring, and possibly ultrasound) can detect some problems, such as growth retardation, that are sometimes associated with alcohol use. Observations of the baby after birth will allow a clearer assessment of the baby’s condition.

The two best things for you to do during pregnancy are to stop drinking alcohol (because the baby receives alcohol in his or her bloodstream whenever you drink) and to try not to worry (which, I realize, is easier said than done). Babies are resilient and not all babies whose mothers drank have apparent alcohol-related problems. Discuss your concerns with your doctor, and maintain a healthy lifestyle.

Q: Is it true that I should not clean my cat’s litter box while I am pregnant? Why?

A: Kitty litter carries the potential for spreading toxoplasmosis, a mild infection that may cause coldlike symptoms under normal circumstances. If you are pregnant, however, toxoplasmosis can cause serious malformations or even death of the unborn baby.

Cats, especially outdoor cats that eat rats or mice, often carry the organism that causes toxoplasmosis. You can get toxoplasmosis by petting a “carrier cat,” changing its litter box, or gardening in soil where cats have passed feces. You can also get toxoplasmosis from eating raw or undercooked meat and eating unwashed vegetables that have grown underground, such as potatoes or carrots.

It is quite likely that if you have had an outdoor cat in the past, you have had toxoplasmosis. Once you have had the disease, you are immune to it in the future. The problem is that most people do not know whether they have had it or not. If you have a cat and are concerned, you can be tested for antibodies to toxoplasmosis (which indicate that you have had the disease and are now immune to it). An absence of antibodies indicates that you are at risk. To prevent catching toxoplasmosis during pregnancy, take the following precautions:

* Cook your meat thoroughly.

* Wash your vegetables thoroughly.

* Wash your hands after you pet or handle a cat.

* Have someone else clean the litter box.

* Avoid soil and sandboxes where cats pass feces.

Q: What are the benefits of folic acid for pregnant women?

A: Folic acid supplements should be taken a month or more before conception and continued through early pregnancy. Most prenatal vitamin supplements contain the recommended daily amount of folic acid (400 micrograms).

The main benefits of folic acid are the prevention of particular birth defects, such as cleft lip, cleft palate, and neural tube defects (abnormalities in the development of the brain and spinal cord, such as spina bifida and anencephaly, the absence of a large portion of the brain). These defects occur in about 1 in 1,000 newborns but are dramatically reduced when women take folic acid before and during early pregnancy.

Folic acid is present in foods such as liver, leafy green vegetables, and yeast. It is difficult for many women to get enough folic acid through their diets. For this reason folic acid is added to prenatal vitamin preparations.

Because women with unplanned pregnancies might not get enough folic acid before pregnancy, nutritionists and maternity caregivers recommend that all fertile women take a folic acid supplement every day, whether planning pregnancy or not.

Q: Is it safe for me to get a massage during pregnancy?

A: Yes, it is safe and very helpful as well. You should, however, see a licensed massage therapist (LMT) who has had additional training in pregnancy massage. She or he will know how to safely modify massage techniques to accommodate for bodily changes that occur during pregnancy (for example, avoiding having you lie on your back or your abdomen after about four to five months of pregnancy and checking for varicose veins, excessive swelling, carpal tunnel syndrome, and other conditions).

Many massage therapists have specially designed massage tables that allow you to lie on your abdomen without putting undue pressure on your abdomen or breasts. Ask your doctor, midwife, childbirth educator, or doula for referrals.

Q: Do midwives assist only with home births?

A: No, most midwives practice in hospitals or out-of-hospital birth centers because those are the locations where most women give birth. It is true, however, that almost all home births are attended by midwives, who are experts in normal birth.

In all countries outside North and South America, midwives provide most of the maternity care, but in the United States less than 10 percent of all births are attended by midwives. The percentage is growing rapidly, however, because midwifery care is highly satisfying to women and has an excellent track record in terms of safety and cost.

Q: I was wondering when a woman can get pregnant. What are the days in the menstrual cycle that you are most likely to get pregnant? How do you determine when you are fertile in your own menstrual cycle?

A: There are only a few days before and after you ovulate when you are able to become pregnant. These days come roughly in midcycle, but timing of ovulation varies from woman to woman. There are several ways that you can determine when you ovulate, including observing changes in the mucus in your vagina (cervical mucus) and recording your temperature before rising each morning.

An excellent book on the subject is Taking Charge of Your Fertility, by Toni Weschler (HarperPerennial, 2001). It provides complete and very helpful information on this subject and many others.

Q: What effects does stress have on pregnancy and what are the symptoms?

A: Stress during pregnancy may be related to a woman’s relationship to family and friends. Major life-changes, such as a death in the family, change in marital status, serious illness, or moving also play a significant role in stress levels. Financial situation and job or career demands are other common sources of stress.

Whatever its cause, stress can manifest itself as anxiety, exhaustion, fear, sadness, anger, or grief. Such emotions can lead to physiological changes, such as increased release of stress hormones and increased blood pressure. These effects of stress may cause premature labor or hypertension (high blood pressure). Both conditions can present problems for the baby, such as causing the baby to be small in size or immature in development.

Pregnancy adds stress to the lives of women who are already stressed. The right caregiver (midwife, doctor, or clinic) may be able to refer such women to appropriate services that can ease some of their stress.

Stress management techniques are also helpful. Many women find that yoga, meditation, and relaxation techniques help reduce stress. Self-help methods or counseling can help a woman learn how to avoid, eliminate, or better respond to stressful circumstances. The most important thing is practical and emotional support from loved ones and friends.

One important note: A pregnant woman in stressful circumstances must be careful not to blame her baby. Doing so may lead to inappropriate treatment of her innocent baby. Rather, she should address the real causes of her stress and reserve love and concern for her baby.

Q: Is it okay for me to eat sushi with raw fish while I am pregnant?

A: You should not eat sushi with raw fish because it sometimes contains parasites such as tapeworms. These parasites can make anyone sick, whether pregnant or not. The added risk during pregnancy is that your unborn baby could be deprived of necessary nutrients if your illness lasts for a long time.

When you are pregnant, cook fish well so as to kill any parasites, rather than follow the current trend of lightly searing the fish. Cook fish until it flakes when you insert a fork and twist it. Follow preparation directions in a good cookbook to determine cooking times for various kinds of shellfish. Freezing fresh seafood also kills parasites.

Today another concern regarding seafood is industrial pollution, which contaminates seafood in some geographical areas with chemicals or PCBs (polychlorinated biphenyls). Cooking does not destroy these substances. You should check with your community health department for information on the safety of local seafood.

Q: What vitamin supplements should I take during pregnancy?

A: Your best source of vitamins is nutritious food from all the food groups: grains; vegetables; fruits; calcium foods such as dairy products; protein foods such as meat, fish, poultry, eggs, dried beans, and nuts; and fats, oils, and sweets. Most doctors and midwives recommend a good diet plus prenatal vitamins for extra insurance. Prenatal vitamins are preferable to ordinary multipurpose vitamins because they are designed to meet the added nutritional demands of pregnancy.

It is also important to have your diet evaluated by a nutritionist. If you lack certain nutrients due to food allergies, intolerance, or dislike, additional amounts of specific supplements (such as calcium, iron, and others) may be recommended. A nutritionist can help you plan a diet that is in line with your taste preferences and consistent with your ethnic or religious background.

As for the decision on the specific choice of the brand and formula for your prenatal vitamins, there are numerous ones available. You and your doctor or midwife should make the choice jointly.

It is not wise or safe to take large doses of any vitamins, or to design your own supplementation program, without professional guidance. Vitamins have potential side effects on your unborn baby. One example is vitamin C, which, if taken in large quantities over several weeks or months (in hopes of preventing colds), creates a higher than usual requirement in the unborn baby, which continues after birth, causing temporary symptoms of vitamin C deficiency. Vitamins should be considered a form of medicine and taken with caution and knowledge.

Q: About how much weight should I gain during pregnancy?

A: If you are of normal weight before pregnancy, you should probably gain between 20 and 35 pounds. This weight gain includes the growing baby, as well as many of the changes your body undergoes to support the baby. The breakdown typically looks something like this:

Baby 6 to 9 pounds

Placenta 1 to 2 pounds

Uterus 2 pounds

Amniotic fluid 2 to 3 pounds

Added breast weight 1 to 2 pounds

Added blood volume 2 to 3 pounds

Added tissue fluid 4 to 6 pounds

Fat 5 to 8 pounds

Total weight gain 23 to 35 pounds

If you were underweight or overweight before pregnancy, you may benefit from gaining more or less than the recommendations for women of normal weight. Ultimately, the quality of your diet is more important than the number of pounds you gain during pregnancy.

Q: What is a doula, and why do women use doulas for assistance during childbirth?

A: A doula is a woman (or occasionally a man) who is trained and experienced in helping with childbirth. She accompanies women and their partners through the entire birth process, providing emotional support, physical comfort, and nonclinical advice. She also helps them get the information they need to make good decisions.

Women and their partners choose doulas for a number of reasons:

* The doula puts the parents’ interests first.

* The doula is knowledgeable and caring.

* The doula can help parents have the kind of birth they want and make adjustments if problems arise and unexpected interventions are needed for safety.

* The doula does not leave for a break or shift change. (Doulas take breaks only when the woman is asleep or when labor is unusually long and a backup doula is present.)

* Women who are anxious or fearful about birth or hospitals appreciate the support and reassurance a doula gives.

* Partners often feel overwhelmed by their responsibilities and want help and advice in carrying out their roles. They also appreciate being able to take a nap during a long labor without leaving the mother with no support.

* Expectant parents are impressed by research findings from numerous studies that prove that a doula’s support often results in shorter labors, fewer requests for epidural blocks, fewer cesarean births, fewer deliveries by forceps and vacuum extractor, and less postpartum depression.

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