Pregnancy

During pregnancy, women can experience overwhelming empowerment and joy as a new life grows inside their body. They can also experience scores of uncomfortable symptoms, physical changes and moments of fear and anxiety during one of their most vulnerable stages in life. To decrease the chances of complications, women should practice proper prenatal care, avoid dangerous drugs and choose the best method of delivery for them. Thankfully, there is a wealth of information available for women to make the best decisions to ensure a healthy pregnancy.

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Facts about Pregnancy

Pregnancy is a constant, nine-month process involving doctor visits, lifestyle adjustments and physical changes. Women who are pregnant often have numerous questions as they seek to learn as much as possible about what to expect, what’s considered normal and what they can do to protect their future child and themselves. Today, women have access to more information and resources about pregnancy than ever before.

Quick Facts About Pregnancy:

  • Pregnancies last three trimesters, for a total of about 40 weeks.
  • Common side effects of pregnancy include nausea, vomiting, swelling, varicose veins, backaches, hemorrhoids, heartburn, fatigue, constipation and sleep loss.
  • Proper prenatal care and avoidance of harmful substances and drugs can help increase the chance of a healthy pregnancy.
  • Pregnancy complications can occur from improper prenatal care and preexisting conditions, or for no obvious reason at all. But most complications are treatable if detected early.
  • There are a variety of methods for giving birth, ranging from natural births to C-sections and water births to deliveries in a hospital bed.
  • Women should maintain an open relationship and regular contact with their healthcare provider throughout their pregnancy.

Timeline of a Pregnancy

Pregnancy is the time period in which a woman carries a fetus inside of her uterus. It usually lasts about 40 weeks – just over nine months – and is divided into three trimesters.

Pregnancy occurs when a man’s sperm penetrates a woman’s egg, the egg travels through the fallopian tube to the uterus and it implants itself in the uterine wall. The fertilized egg, called a zygote, is made up of a cluster of cells that form the fetus and the placenta. The placenta is an organ that develops during pregnancy to provide nutrients and oxygen to the fetus while it grows.

Signs of Pregnancy

A woman usually knows she is pregnant when she misses a period, or multiple periods. However, missing a period does not always mean a woman is pregnant, and women often experience other symptoms of pregnancy before missing a period. But while some women experience multiple symptoms, others don’t experience any.

Women should talk to their doctor if they notice any of these signs, because they may be symptoms of other medical conditions. Many women use a home pregnancy test before calling their doctor. The tests do not require a prescription and are very accurate.

Early signs of pregnancy include:

  • Nausea and vomiting (morning sickness)
  • Slight bleeding
  • Swollen breasts or nipples
  • Fatigue
  • Headaches
  • Mood swings
  • Food cravings
  • Frequent urination

First Trimester

The first trimester lasts 12 weeks, beginning with conception.

Women should schedule their first doctor visit sometime during weeks 6-8 or after their menstrual period is two to four weeks late. Some doctors will not schedule the first exam until week eight unless there is an issue.

During the first visit, the doctor will ask many questions about the woman’s health, habits and menstrual cycle. The doctor will also perform a number of tests or exams. Women of different ethnic backgrounds often take different tests because they may be at a higher risk for certain diseases.

Initial pregnancy exams and tests include:

  • A physical
  • A pelvic and rectal exam
  • A complete blood cell count
  • A urine sample
  • A pap test
  • Blood typing and screening
  • A test for infections like syphilis, hepatitis, gonorrhea, chlamydia and HIV
  • A test for previous exposure to chickenpox, measles or mumps
  • A test for cystic fibrosis

Exam Timelime

If the initial exam does not produce warning signs women generally see the doctor on a set schedule. Between the 10th and 14th weeks, women may be screened for substances that could point to risk factors for later complications. Around 12 weeks, some women are tested for gestational diabetes, a type of diabetes that forms during pregnancy.

Pregnant women typically see their doctor:

  • Every four weeks until the 28th week
  • Every 2 weeks from weeks 28-36
  • Once a week from week 36 to delivery

Second Trimester

The second trimester lasts between weeks 13 and 28.

As early as week 12, but usually around week 16, a doctor can determine the sex of the fetus. Bones, muscle tissue and skin have formed by then.

Women usually feel movement around the 20th week. Around the 24th week, footprints and fingerprints are formed and the fetus sleeps and wakes frequently. The size and shape of the woman’s uterus may also be measured in the 22nd week to determine whether the fetus is growing and developing normally.

The 28th week is usually the earliest a baby can be born, with an estimated 92 percent of babies surviving birth at that time. However, most are born with serious health complications.

Second trimester tests include:

  • Doctors may use a needle to retrieve a sample of amniotic fluid from the womb between weeks 15 and 20 to test for substances that could lead to future complications.
  • Additional tests are often performed between weeks 16 and 18 to look for potential abnormalities or birth defects.
  • An ultrasound or sonogram is usually performed between weeks 18 and 20 to verify the expected delivery date and the baby’s anatomy, to record heartbeats and breathing movements, to check for additional fetuses and to identify potential abnormalities.
  • If a first trimester diabetes test was not performed, women typically undergo the test between weeks 24 and 28.

Third Trimester

The third trimester lasts between weeks 29 and 40, or until birth.

Around the 32nd week, the fetus’s eyes can open and close and the bones are almost fully formed. An infant born before the 37th week (preterm) is at an increased risk for developmental, hearing and visual problems.

Infants born during the 37th and 38th (early term) weeks face less serious health risks, but are usually not as healthy as babies born in the 39th and 40th weeks (full term). Babies born during the 41st week (late term) and after 42 weeks (post term) are also at a higher risk for complications.

Prenatal Care

Almost a third of women who become pregnant experience some kind of complication. Prenatal care helps prevent the risk of pregnancy complications and increase a doctor’s chance of detecting complications if they occur.

Prenatal care refers to the healthcare women receive while pregnant. It includes checkups, screenings, and dietary and lifestyle changes. In a perfect world, women would begin prenatal care before they become pregnant. When that is not possible, women should begin prenatal care as soon as they realize they are pregnant.

Healthcare providers for pregnant women include:

  • Obstetricians - doctors that concentrate in pregnancy and childbirth
  • Obstetricians/gynecologists (OB/GYNs) - doctors that concentrate in pregnancy and childbirth, in addition to women's health care
  • Family practitioners - doctors that offer a variety of services to people of all ages, usually a pregnant woman’s general practitioner
  • Midwives - may be licensed, professional midwives or certified nurses that concentrate in women’s healthcare, pregnancies and childbirth

Prenatal Supplements & Medication

A prenatal checkup before pregnancy involves testing for any diseases or conditions that could affect a pregnancy. Most women decide to either change or discontinue medications or potentially unhealthy habits during this visit. They may also begin taking prenatal vitamins, folic acid, calcium or iron supplements.

Recommended prenatal supplements include:

  • Folic Acid - helps prevent neural tube defects which affect the development of the spine and nervous system
  • Calcium - helps the fetus develop strong bones, nerves and muscles
  • Iron - helps carry oxygen to blood cells
  • Prenatal vitamins - usually contain adequate balances of folic acid, calcium and iron but lower doses of other vitamins and minerals that could be harmful

Weight Gain & General Health

Weight gain is a typical and healthy aspect of pregnancy. Most women should gain 25-35 pounds during pregnancy, but overweight women should only gain 15-25 pounds and underweight women should gain 28-40 pounds.

Although many women worry about gaining weight, a failure to do so could result in inadequate fetal growth or premature labor. Accordingly, most women should not start a weight-loss diet during pregnancy. Rather, they should begin a healthy diet if they do not already practice one.

Women should avoid foods that could contribute to foodborne illnesses, like unpasteurized cheese, milk or juice and raw meats including fish, eggs and deli meats. Additionally, some seafood contains high amounts of mercury which may harm the fetus.

General recommendations for a healthy pregnancy include:

  • Don't smoke
  • Don’t drink alcohol
  • Don’t abuse drugs
  • Get plenty of rest
  • Eat a healthy diet
  • Perform low-impact exercises

Prescription Drugs

Determining what medications are safe to use during pregnancy can be a challenge, and the stakes in pregnancy couldn’t be higher. The most important course of action is to consult with your doctor before taking or stopping any prescription drugs. But unfortunately, that may not be enough.

Because pregnant women are often not included in studies to determine the safety of prescription drugs, information is limited about how particular drugs will affect pregnant women and their babies. In fact, less than 10 percent of medications approved by the FDA since 1980 have enough information when given approval to determine the risk of birth defects.

Yet, prescription drugs often carry more serious side effects than over-the-counter drugs. Studies performed after some drugs were approved showed serious risks for birth defects in drugs including thalidomide and isotretinoin, also known as Accutane or Claravis.

It’s important to avoid those drugs while pregnant and to discuss effective contraception methods with your doctor if you need to use those and other dangerous medications.

'An Experiment of One'

Cynthia Pellegrini, senior vice president of public policy and government affairs for the March of Dimes, said changes are needed in how drugs are tested and researched so pregnant women can be informed.

The vast majority of prescription drugs don’t have any information about their effects on pregnant and lactating women.

“We don’t have much choice, but to say to pregnant women that they should talk to their doctors,” Pellegrini said. “However, that’s a very unsatisfying piece of advice because we know full well that the doctors don’t have much information either - forcing women to make these decisions with or without medical professionals based on little or no information and then expecting them to deal with the consequences.”

And for some women, they can’t just stop taking their medication because the consequences could be worse than any effect the drugs might have.

In effect, virtually every woman who takes a prescription while pregnant “becomes an experiment of one,” Pellegrini said.

“The approach to research historically has been that it was dangerous and unethical to perform research on pregnant women,” Pellegrini said. Now, she said, “we’re at the point where it’s dangerous and unethical not to do the research.”

Pellegrini said change may be afoot. A task force has been created to examine barriers and other issues that are preventing drug companies from including pregnant women in research. The idea is to create a system in which that information could be responsibly determined.

FDA Changes

In the meantime, the FDA is trying to make the information that is known about some drugs more understandable to medical professionals and patients.

For those drugs, the FDA developed categories in 1979 to help doctors determine which drugs are safe or dangerous for pregnant women. The categories were supposed to help communicate the degrees of fetal risks, but the FDA determined the categories — and other aspects of the label — lacked clarity and failed to provide meaningful information.

The FDA ordered drug manufacturers to remove the categories beginning June 30, 2015. The manufacturers were given three to five years (depending on when the drug was approved) to remove the categories. The FDA hopes a new "narrative" description on the label more effectively communicates risks and benefits.

New Labels Include:

  • The "Pregnancy" section will now include labor and delivery information.
  • The "Nursing Mothers" section will be renamed "Lactation" and will include information for nursing mothers.
  • A new section will be added called "Females and Males of Reproductive Potential."
  • The pregnancy categories will be phased off of labels from 2015-2020.

Kathryn G. Schubert, chief advocacy officer of the Society for Maternal-Fetal Medicine said the new labels are “a good first step.”

According to Schubert, the new label will provide information to health care professionals and patients about the type of data that exists for the drug if taken during pregnancy and lactation. The label will say whether the data are gathered from animal or human studies, pregnancy exposure or if there is no data available.

But, she added, “The issue I see in the future is that I suspect that ultimately for many, if not most drugs, there is very limited or no data available. Therefore, the information on the new label may not be terribly helpful.”

However, the change also requires labels to be updated when information becomes outdated, and allows for pregnancy exposure registries to collect and maintain data on the effects of approved drugs that are prescribed to and used by pregnant women. Pregnant women opting to enroll in the pregnancy exposure registry “can help improve safety information for medicines used during pregnancy and can be used to update drug labeling,” according to the FDA.

As of November 2017, the FDA said the labels on more than 500 drugs had been converted under the new rule. The FDA says the process is on track to be completed on schedule by 2020.

The new labels include what the FDA describes as integrated, narrative summaries of the risks of the prescription drugs or biological products for the woman, the fetus, the breastfeeding infant and the reproductive potential of both men and women.

While this information is primarily targeted at physicians, patients can access detailed drug label information online at the following websites:

Other useful sources of information can be found at a website of the Organization of Teratology Information Specialists called Mother to Baby. The Library of Medicine hosts a website for breastfeeding mothers called LactMed.

In cases involving drugs without information about pregnancy, the FDA encourages patients to talk to their doctors or pharmacists or contact the FDA’s Division of Drug information:

Dangerous Drugs during Pregnancy


Some avoidance of drug use during pregnancy is easily understood, such as the use of street drugs (illegal or illicit drugs) including cocaine, ecstasy and methamphetamines, heroin and marijuana. While about one in 20, or around 5 percent, of women take street drugs during pregnancy, it is typically known that these substances are harmful to adults, so naturally they would be harmful to a developing fetus as well.

But the use of prescription drugs or even over-the-counter (OTC) drugs and supplements may not be as clear-cut. For example, even prescription drugs that are used improperly during pregnancy can result in health complications to the mother and the baby, such as:

  • Problems with the placenta
  • Birth defects
  • Withdrawal symptoms in the infant after birth
  • Underweight babies
  • Preterm labor (labor occurring prior to 37 weeks)
  • Miscarriage (loss of pregnancy prior to 20 weeks)
  • Stillbirth (when the baby dies in the mother’s uterus after 20 weeks)

The Centers for Disease Control and Prevention (CDC) states that little is known about the effects of taking most medications during pregnancy. This is because, ethically, pregnant women are often not included in premarket studies to determine the safety and efficacy of a new drug or treatment. The CDC estimates that less than 10 percent of FDA-approved medications since 1980 have enough information to determine their real risk for birth defects.

However, it is necessary for some women to take medications during their pregnancy to treat certain health conditions, such as asthma, epilepsy (seizures), high blood pressure or depression. If the pregnant mother does not continue medication for the management of these and other health conditions, it can actually be more harmful to her health as well as the health of the unborn baby. It is always important for a pregnant woman to speak with her doctor before discontinuing medications.

OTC Drug Use in Pregnancy

According to an article published by American Academy of Family Physicians (AAFP), “despite the absence of randomized clinical trials to guide their use during pregnancy,” more than 90 percent of pregnant women take a prescription of over-the-counter (OTC) medication. Most OTC medications used during pregnancy are for allergy, respiratory, gastrointestinal or skin conditions. But acetaminophen, a pain reliever, is also used by approximately 65 percent of expecting mothers, although it’s generally considered safe to do so.

Cold medicines are also generally considered safe if taken short-term and outside of the first trimester. But AAFP advises pregnant women to use pseudoephedrine, a decongestant, with caution. Overall, doctors should be cautious in recommending, and mothers should be cautious in taking, any OTC medication during pregnancy due to the potential for adverse effects to occur to the developing fetus.

At least 10 percent of birth defects are believed to result from drug exposure via the mother, according to AAFP; and of all the new OTC drugs marketed between 1975 and 1994, 30 percent were previously prescription medications.

Alcohol Use and Smoking

The National Institutes of Health (NIH) points out that you’re not just “eating for two,” you are also breathing and drinking for two; meaning, if you are using alcohol and smoking, so is your baby. The NIH recommends that pregnant women do not smoke, as this exposes the unborn infant to nicotine and other cancer-causing substances. Furthermore, smoking can keep the developing fetus from getting nourishment it needs and increases a mother’s risk of stillbirth or premature labor.

The NIH also warns against drinking alcohol during pregnancy, noting that “there is no known safe amount of alcohol a woman can drink while pregnant.” The NIH stated that drinking alcohol while pregnant can cause chronic physical and behavioral problems in children, including fetal alcohol syndrome, which is a condition that can result in facial abnormalities (including wide-set and narrow eyes), growth problems and nervous system problems.

Prescription Drug Interactions in Pregnancy

Adverse drug interactions may occur in pregnancy when certain drugs present potential harmful effects to the unborn baby and in some instances, the mother as well. These interactions can include reducing the overall effectiveness of a drug due to the woman’s pregnant state, contrarily, increasing a drug’s action, or causing unexpected side effects to the mom or her baby that occur due to the pregnancy itself.

Before taking any medications during pregnancy, and sometimes before pregnancy while planning to get pregnant or after pregnancy if breastfeeding, a woman should consult with her doctor about the known (and unknown) risks versus benefits to herself as well as her baby. Some questions she may want to ask include:

  • Can I take this drug while pregnant?
  • Can I take this drug with other drugs?
  • Should certain foods, beverages, other products, or actions or inactions be avoided while taking the drug?
  • What are some possible drug interaction signs to look out for?
  • How will the drug work in a pregnant body? How might it affect the fetus’ developing body?
  • Is there more information available about the drug, the condition being treated and possible interactions during pregnancy?

Some examples of medications that have known interactions in the health of pregnant women and developing fetuses, include:

Accutane (isotretinoin)

Used to Treat: Acne

Harm to Mother: Significantly increased risk of miscarriage and premature delivery

Harm to Fetus: High risk of birth defects, including intellectual disabilities, brain malformations, heart defects and facial abnormalities.

Significantly increased risk of infant death.

Antidepressants and SSRIs (Zoloft, Prozac, paroxetine)

Used to Treat: Depression, anxiety, OCD, panic attacks, PTSD

Harm to Mother: Depression during pregnancy can lead to postpartum depression, which is a serious condition requiring treatment.

The benefits of treating depression during pregnancy sometimes outweigh the risks.

Harm to Fetus: Can cause birth defects, such as persistent pulmonary hypertension (in a newborn, this is defined as the failure of normal circulatory transition after birth), heart defects, respiratory distress, cleft palate, malformation of the skull and autism.

Benicar (olmesartan)

Used to Treat: High blood pressure

Harm to Mother: High blood pressure before and during pregnancy can increase a pregnant woman’s risk for preeclampsia and eclampsia.

Harm to Fetus: Black box warning: Fetal toxicity; Can result in fetal injury or death.

Crestor (rosuvastatin)

Used to Treat: High cholesterol; to reduce the risk of heart attack and stroke

Harm to Mother: Women should not breastfeed while taking rosuvastatin.

Harm to Fetus: Low birth weights, bone malformations and death in lab rats.

Depakote (valproic acid)

Used to Treat: Epilepsy (seizures), bipolar disorder, and migraine headaches

Harm to Mother: Risk for development of polycystic ovarian syndrome (PCOS) – health problem that affects a woman’s hormone levels, periods, ovulation, fertility and pregnancy

Harm to Fetus: Maternal exposure, especially during the first trimester, can increase the risk for serious birth defects affecting the brain, heart and limbs, including spina bifida (involving the spinal cord and backbone), cleft palate, penis abnormality, an extra digit on the hand and premature fusion of the skull

Zofran (ondansetron)

Used to Treat: Nausea and vomiting during pregnancy

Harm to Mother: Ondansetron should not be used as a first-line treatment for symptoms of “morning sickness” in pregnancy.

In addition, it should be avoided in the first trimester.

Harm to Fetus: Fetal heart malformation and increased risk of birth defects, including cleft palate

Common Complications

Even when women receive proper prenatal care and avoid dangerous drugs, they could still experience complications during pregnancy. Women who led healthy lives and maintained healthy weight before pregnancy can still experience complications. When a woman has health complications while pregnant, her pregnancy is considered high-risk.

High-Risk Pregnancies

A high-risk pregnancy can threaten the mother or the fetus’s life. With proper prenatal care, healthcare providers can detect and treat complications early to improve the chances of a healthy pregnancy.

Factors that contribute to high-risk pregnancies include:

  • Health conditions - like high blood pressure, diabetes or HIV
  • Weight - being underweight, overweight or obese
  • Multiple fetuses - twins, triplets, etc.
  • Young or old age - teens and women older than 35

High Blood Pressure

Hypertension (high blood pressure) occurs when arteries from the heart to organs narrow causing extra pressure. This makes it hard for blood to travel to the placenta and provide nutrients and oxygen to the fetus.

Women with hypertension before pregnancy should monitor and attempt to control it. Some women develop high blood pressure, called gestational hypertension, during pregnancy. About four percent of women develop the condition, and it almost always goes away after childbirth.

Gestational Diabetes

Gestational diabetes is another condition that develops during some pregnancies. It occurs when changes in hormones during pregnancy prevent the body from making insulin or using insulin properly. When this happens, glucose (sugar) builds up in the blood causing high blood sugar.

About eight percent of pregnant women develop gestational diabetes. If untreated, it can cause heart disease, vision problems, kidney disease or preeclampsia.

Preeclampsia

Preeclampsia causes high blood pressure and can lead to premature delivery or a large infant, increasing the need for a cesarean section. Preeclampsia can also lead to protein in urine or edema – fluid buildup in body tissues causing swelling.

Risk factors for preeclampsia include:

  • First time being pregnant
  • Previous history of preeclampsia
  • High blood pressure, diabetes, kidney disease or lupus
  • Being African American
  • Being 35 years or older
  • Carrying two or more fetuses
  • Obesity

Pregnancy Loss

A miscarriage is a loss of pregnancy from natural causes before the 20th week. It occurs in an estimated 20 percent of pregnancies. Signs of a miscarriage include vaginal bleeding, cramping and fluid or tissue passing from the vagina. Bleeding does not mean that a miscarriage is happening, but women should contact their health care provider if bleeding occurs.

After the 20th week, a loss of pregnancy is referred to as a stillbirth. Doctors cannot determine the cause of stillbirths in about half of all cases, but factors that could contribute to stillbirths include infections, chromosomal abnormalities, inadequate fetal growth, placental issues and a mother’s health issues.

Depression

Depression involves feelings of sadness, anxiety or emptiness that interfere with daily activities. About 13 percent of pregnant women and new mothers suffer from depression. Symptoms of depression can be mild or severe, but doctors can treat almost all of them. Women suffering for more than two weeks should contact their doctor.

A family history of mental health problems, changes in brain chemistry that occur during pregnancy, stressful life events and hormones all contribute to depression during pregnancy.

Symptoms of depression include feeling:

  • Sadness
  • Restlessness
  • Moodiness
  • Hopelessness

Postpartum Depression

Postpartum depression occurs after childbirth. The rapid change in hormone levels after childbirth or a decrease in levels of thyroid hormones after childbirth may lead to postpartum depression. Other factors like exhaustion, feeling overwhelmed, doubts about capabilities of being a good mom and lack of free time can contribute to postpartum depression.

Women struggling with depression or postpartum depression should:

  • Talk to their healthcare provider
  • Sleep as much as possible
  • Avoid trying to be a “perfect” mom
  • Ask friends and family for help
  • Talk to family and friends about feelings
  • Attempt to find free time
  • Join a support group

Less common pregnancy complications include:

  • Anemia - Iron deficiency can cause a tired feeling, shortness of breath and pale skin.
  • Hyperemesis gravidarum - Although nausea and vomiting are normal during the early stages of pregnancy, some women experience severe, long-lasting symptoms. The cause is unknown, but hyperemesis gravidarum can cause weight loss, dehydration and faint feeling.
  • Infections - Washing hands and avoiding risky foods can prevent most infections.
  • Urinary tract infections (UTI) - Bacterial infections can cause pain, fever and nausea.

Labor

Labor is the process of childbirth in which the fetus and placenta leave the uterus.

During the final weeks of pregnancy, the fetus is still developing its lungs, brain and liver. Thus, a woman should be pregnant for at least 39 weeks before giving birth to ensure the highest chance of a healthy outcome. However, a health care provider might recommend inducing labor sooner if there is a health risk to the fetus or mother.

Women can give birth in a number of different ways. The three general categories that most delivery methods fall into are medicated births, natural births and cesarean sections (C-section).

The signs of labor vary from woman to woman. Signs that a woman may be going into labor include:

  • The woman feels relief or lighter, because the fetus moves from the rib cage to the pelvic area (lightening)
  • The woman notices clear, pink or slightly bloody discharge called show as the cervix begins to dilate
  • Contractions begin
  • Vaginal discharge changes color
  • Pelvic pressure occurs
  • Lower backache occurs
  • Abdominal cramps occur
  • Less fetal movement
  • Water breaking (when the amniotic sac ruptures)
  • Diarrhea
  • Nesting (preparing for the baby)

Labor occurs in three stages:

First Stage

During the first stage, the woman’s body is working to fully open her cervix and prepare for delivery. It is the longest stage of labor, typically lasting about 12 to 19 hours. A doctor will monitor the mother’s progress by periodically checking her cervix. Towards the end of this first stage of labor, contractions will become longer, stronger and closer together. Positioning and relaxation techniques can assist women in staying somewhat comfortable throughout this time.

Some women may opt for medication, such as an epidural, which is a type of anesthesia administered via a shot in or around the spine that numbs part of the body to block pain. Sometimes a woman’s doctor may have to manually rupture the membranes (amniotic sac) in order to speed along a birthing process that is progressing too slowly, although some studies have shown that this is not particularly helpful in shortening the length of labor.

The transition is the most difficult phase of stage one as the contractions become stronger with little time to relax in between. Women can experience nausea and feel shaky during the transition. When the cervix reaches 10 centimeters, it is fully dilated and stage one comes to an end.

“Active” Stage

The second stage involves pushing and the delivery of the baby. This stage can last anywhere from 20 minutes to two hours. Pushing occurs during contractions with the mother resting in between. A woman can give birth in various positions including squatting, sitting, kneeling or lying on her back.

When the baby’s head is completely visible it is called crowning. A doctor may perform an episiotomy, which involves making a small cut to enlarge the vaginal opening and avoid unintentional tearing, to assist in delivery. Various tools, such as forceps or suction, can be used to help guide the baby through the birth canal. This is called an assisted vaginal delivery.

After the baby is born, the umbilical cord is cut.

“Placental” Stage

After the delivery of the baby, the mother must then deliver the placenta, also referred to as the afterbirth. This is the shortest stage of labor lasting only five to 30 minutes. Contractions occurring after the birth of the baby signal when it’s time to deliver the placenta. This normally takes place about five to 30 minutes following the delivery of the newborn. A woman might experience chills and shakiness during this stage. After the placenta is delivered, labor is over, and the doctor will repair any cuts or tears.

Medicated Birth

A “medicated” birth is the most popular delivery method in the U.S. About 61 percent of women give birth on pain medication, usually in the form of an epidural block, spinal block or general anesthesia. An epidural is injected into the spine, and a spinal block is injected into the spinal fluid. If given anesthesia, the woman is asleep during the delivery.

Although the natural, or non-medicated, method of delivery is growing in popularity, there is no evidence that delivering a baby while medicated affects the baby’s Apgar score – a test that measures a baby’s health immediately after it is born – or increases the chance of a C-section.

Natural Birth

About 39 percent of U.S. women give birth using no medication. Instead, they may rely on relaxation and breathing techniques to reduce pain. Many women feel a sense of empowerment by giving birth without the assistance of medication.

Some women avoid medication, because it may cause their blood pressure to drop, affect the speed of labor or cause them to become nauseated.

Cesarean Section

A C-section is a surgical procedure in which a doctor makes an incision in the mother’s abdomen and uterus to deliver the baby through. After the delivery, the doctor closes the uterus with stitches that eventually dissolve and the abdomen with staples or stitches. About 33 percent of babies are born via C-section.

C-sections are generally considered safe, but like all surgeries, complications can occur. Recovery usually takes longer, infants may be more likely to experience breathing problems and future pregnancies could be affected. Women who have had a past C-section give successful vaginal births about 75 percent of the time.

C-sections usually occur when:

  • A woman is carrying multiple fetuses.
  • The fetus is too large.
  • The fetus is upside down (breach), being delivered feet first instead of head first.
  • The mother has a disease or infection that could be transmitted to the fetus, such as HIV or herpes.
  • There are problems with the placenta.
  • Complications in labor involving the mother occur, such as the cervix failing to dilate properly.
  • Complications in labor involving the fetus occur, such as problems with the umbilical cord or an abnormal heart rate.

Alternative Birthing Methods

Alternative methods to medicated births (using epidurals and other anesthetics or pain relievers), such as immersion in water, hypnobirths (using hypnosis), and utilizing doulas and birthing coaches that focus exclusively on the mother throughout the labor and delivery process, and even for a short time after birth (postpartum), are drawing increased interest among pregnant women, U.S. News & World Report said.

Doulas Versus Midwives

DONA International defines a doula as a trained professional “who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying [childbirth] experience possible.” The doula experience involves a “fourth trimester,” following the birth of the child, offering ongoing emotional and practical support as the mother adjusts to her new role and the entire family adjusts to its newest member.

A doula differs from a midwife in that while they must go through a certification process, including assisting during live births, they do not have the same medical training and expertise required of a midwife. Additionally, doulas cannot prescribe medications, such as painkillers, or order an epidural should a mother decide she wants a medicated birth.

Despite the medical differences, doulas can act as a mother’s “best friend” throughout the birthing process and beyond into motherhood, even assisting with breastfeeding and transitions for older siblings. The American Pregnancy Association reported that many mothers who enlist a doula for assistance during labor and delivery, require less medical intervention. However, if medical intervention is needed, a doula cannot substitute for a doctor or midwife.

Midwives believe in facilitating natural childbirths as much as is possible, and seek to eliminate unnecessary interventions. They typically practice in private birthing centers or in the comfort of their patients’ homes.

While at-home births may be desirable for some, the American Pregnancy Association advises against them for women who are diabetic, have chronic high blood pressure or toxemia (preeclampsia), or have experienced preterm labor in the past or may be at an increased risk for preterm labor.

The Bradley Method

The Bradley Method is a birthing technique taught in a 12-week class that takes place throughout the last trimester of pregnancy. This method was developed by Dr. Robert Bradley in the late 1940s and it encourages women to deliver naturally, with little or no drug intervention, in the presence of their partners, looking to them as a coach.

The courses focus on nutrition, exercise, relaxation and pain management, and teach women how to “tune into their bodies” and find positions effective in easing labor pains and preparing for each stage of labor. This method is supposed to be successful in assisting women with their birthing plans and avoiding surgical deliveries (C-section).

HypnoBirth

This method, also established in the 1940s, uses hypnosis during labor to induce a state of total relaxation and allow a woman’s muscles to function the way they were designed to do so. Instead of “pushing” the baby down during labor, the woman “breathes” the baby down.

According to the American Pregnancy Association, women who have used this method report “feeling lost in a daydream, relaxed, calm, aware and in control.”

Developed by Dr. Grantly Dick-Read, HypnoBirth involves courses with an instructor, along with self-hypnosis exercises that can be used at home.

Lamaze

Lamaze is a birthing technique that involved the proper use of breathing. Women are taught to control their breathing, change positions and walk throughout labor. Dr. Ferdinand Lamaze developed the method that emphasizes distraction during contractions “decrease the perception of pain and reduce discomfort,” according to the American Pregnancy Association.

This method also encourages the support and participation of the mother’s partner, with classes focusing on partner involvement in controlled deep breathing techniques, massage, concentration and learning how to maintain control during labor.

Even though Lamaze is considered a natural birthing method, women using this method can still opt for an epidural if they should decide it’s needed.

Water Delivery

Some women may find that giving birth in a warm tub of water is relaxing, and the buoyancy is believed to help relieve discomfort and pressure. Some also believe that the water “helps the baby enter the world with less light, sound and dramatic change,” as stated by the American Pregnancy Association. However, U.S. News & World Report interviewed the chief of maternal-fetal medicine and director of obstetrics at University of Florida Health, Anthony Gregg, who concluded “there’s no evidence that [a water delivery] improves perinatal outcomes, or decreases the C-section rate.” He did, however, state that it is helpful in decreasing pain, reducing the need for anesthesia and shortening delivery times.

But OB-GYN at Cleveland Clinic’s Hillcrest Hospital in Ohio, Monica Svets, said that water births have not been studied enough to be recommended, and the American Pregnancy Association warned that this method is definitely not recommended for women with high-risk pregnancies, and that deliveries should occur out of water in situations where complications arise.

woman in non-recumbent birthing position

Non-Recumbent Birthing Positions

A woman can give birth in a number of different positions. The supine recumbent position is the traditional position for giving birth in most healthcare facilities, because many of the medical devices and monitoring tools used in hospitals limit other options.

However, women squat while giving birth in many parts of the world, including Asia, Africa and parts of South America. There is not a perfect position to give birth in, but some experts recommend changing positions during labor to help with pain.

Various positions for giving birth include:

  • Rocking
  • Standing
  • Lunging
  • Kneeling
  • Squatting
  • Leaning forward while sitting
  • Extending legs while sitting
  • Lying on the side

Other alternate methods for pain relief during labor and delivery may include:

Reflexology

Reflexology is one of the most popular non-medicinal methods of pain relief for delivery, and it can be used in almost any delivery method. It focuses on flexing certain areas of the body, including the hands, feet and various muscles. There are a variety of scientific theories that support the idea that reflexology may help relieve pain.

Acupuncture and Acupressure

Acupuncture involves inserting very fine needles into the skin and rotating, heating or electrically stimulating them to relieve discomfort. Acupressure involves applying pressure to similar points on the body to relieve discomfort. Both are used to relieve discomfort during labor, primarily in Asian cultures.

Herbs

Herbal treatments usually involve a variety of ingredients including roots, leaves, barks, twigs, fruits, berries and flowers. Some people take specific herbal supplements concocted to boost a woman’s strength and energy during labor. Other herbal treatments are used as washes or cleanses.

Aromatherapy

Aromatherapy uses scents and smells to boost a woman’s mood during labor. Many women use aromatherapy during labor, but there are no studies that prove its effectiveness.

Breastfeeding

Breastfeeding is the most popular way to feed and nourish an infant. Breastfeeding should begin within one hour after birth, and can occur up to 12 times per day in the first weeks of life.

Many infants are breastfed exclusively, receiving no other form of nutrition for the first six months of their lives.

Whether or not a woman chooses to breastfeed is a personal decision every new mother has to make for herself and her baby. However, the U.S. Department of Health and Human Services (HHS) does list several benefits for not only the newborn, but the mother as well.

Benefits of Breastfeeding

A mother’s first milk is called colostrum, and it’s referred to as “liquid gold” due to its deep yellow color. This thick type of milk is made during pregnancy and just after birth, and it is extremely rich in nutrients and antibodies that protect your newborn from infections.

Colostrum also helps a new infant’s digestive system to grow and function. As a baby grows, its mother’s milk changes, becoming mature milk within three to five days after birth. This milk consists of sufficient amounts of fat, sugar, water and protein. It is thinner than colostrum, but still packed with nutrients and antibodies.

Health benefits available to a breastfed infant comprise a lengthy list, including a lowered risk of:

  • Asthma
  • Childhood leukemia
  • Childhood obesity
  • Ear infections
  • Eczema
  • Type 2 diabetes
  • Diarrhea and vomiting
  • Lower respiratory infections
  • Disease that affects the gastrointestinal tract in premature babies
  • Sudden infant death syndrome (SIDS)

Although not quite as lengthy of a list, the mother is not without her own equally important benefits. Breastfeeding not only helps a mother to heal following childbirth, but leads to a lower risk of Type 2 diabetes, certain types of breast cancer and ovarian cancer. As a bonus, breastfeeding may help women lose weight. HHS states that “many women who breastfed their babies said it helped them get back to their pre-pregnancy weight more quickly,” however, experts are still researching the link between breastfeeding and weight loss.

But most importantly, HHS finds that breastfeeding can save lives. The governmental health department said research shows that if 90 percent of mothers breastfed their infants exclusively in their first six months of life, nearly 1,000 deaths among infants could be prevented each year. Additionally, breastfeeding is more cost-effective, more convenient, and keeps mom and baby close.

When Is Breastfeeding Not Beneficial?

Breastfeeding isn’t always the more beneficial choice. The Centers for Disease Control and Prevention (CDC) pointed out that in rare instances, human milk is not recommended for newborns.

These exceptional circumstances include when an infant is diagnosed with galactosemia (a rare genetic metabolic disorder that affects a person’s ability to metabolize — process — the sugar galactose present in many foods), and when the mother has certain infectious diseases, such as the human immunodeficiency virus (HIV) or tuberculosis, is using or dependent upon illegal drugs, or is taking prescribed cancer chemotherapy treatments or undergoing radiation therapies.

Breastfeeding Complications

New mothers should expect to have some discomfort, breast fullness or nipple tenderness as they begin breastfeeding their infant, especially if it is their first time nursing or they are first-time mothers. Although rare, it is also sometimes possible that a mother will produce too little milk. Frequent feedings, adequate rest, good nutrition and staying hydrated are all ways in which a mother can maintain a good milk supply.

Women can also take steps to alleviate discomfort and reduce the risk of complications when breastfeeding, by:

  • Alternating nursing positions to keep milk ducts emptying regularly
  • Allowing nipples to air dry after each feeding
  • Avoiding excessive use of soap on the breast and nipples
  • Wearing cotton bras and keeping breast pads as clean and dry as possible
  • Using lanolin on the nipples after feedings

Complications of breastfeeding can include:

Engorgement

When the milk ducts do not adequately empty during feedings, the breasts can become hard, painful, hot, and taut or shiny in appearance. Once the breasts are engorged, feeding can become painful and difficult, further exacerbating the problem.

Thrush

Thrush is a common yeast infection that can be passed from the mother to the infant, or from the infant to the mother, during breastfeeding. This type of yeast infection (Candida albicans) thrives in warm, moist areas, which make the baby’s mouth and the mother’s nipples prime locations for its growth.

Symptoms of thrush in the mother may include deep-pink nipples that are tender and uncomfortable, especially during feedings. The infant may have white patches and increased redness in the mouth, diaper rash or a change in mood.

Antifungal medications can help to clear the infection.

Plugged Duct

Tender spots or lumps in the breast are indicative of plugged milk ducts. When milk ducts become plugged, the milk is unable to be expressed freely. This condition can be uncomfortable or even painful, but it typically does not lead to more severe symptoms, such as fever, when treated properly with rest, moist heat, massage and pumping often in between feedings to completely empty the breast.

Mastitis

Mastitis is a breast infection and one of the more serious complications of breastfeeding. When a plugged duct or cracked nipple goes untreated, it can result in mastitis. This serious condition can also be caused by anemia, stress or fatigue. Symptoms come on much more suddenly than those associated with a plugged milk duct, and typically include:

  • High fever
  • Flu-like muscle aches
  • Fatigue
  • Headache
  • Intense, localized pain
  • Red, hot and swollen breast

Antibiotics may be a necessary part of treatment. It is important to note, however, that the use of antibiotics can sometimes lead to thrush. Additionally, some medications, including antibiotics, may be passed from the mother to the infant via breast milk.

Reminder:

Pregnancy can be a rewarding experience, culminating in bringing a new life into the world. Women must be open with their health care provider, cope with dramatic physical changes and make many sacrifices to ensure a successful pregnancy. But the result of their sacrifice is often one of the most rewarding experiences of their life.

Author

Kristin Compton is a medical writer with a background in legal studies. She has experience working in law firms as a paralegal and legal writer. She also has worked in journalism and marketing. She’s published numerous articles in a northwest Florida-based newspaper and lifestyle/entertainment magazine, as well as worked as a ghost writer on blog posts published online by a Central Florida law firm in the health law niche. As a patient herself, and an advocate, Kristin is passionate about “being a voice” for others.


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