Once again…worth the wait!

I’ve posted this before, but I love this article!  So, for your reading enjoyment, 40 reasons to go the full 40 weeks!

Pregnancy can be very challenging.  Morning sickness and extreme fatigue during the first trimester, that wonderful glucose tolerance test, blood draws, ligament pain, Braxton Hicks, shortness of air as your belly grows, apprehension about delivery…the list goes on an on.  I can’t tell you how many patients I see that are ready to have their baby as early as 34 weeks and ask if they can be induced because they are “tired of being pregnant.”  Sorry, ladies, “tired of being pregnant” isn’t an acceptable medical diagnosis that will warrant an induction prior to 39 weeks.

This article was originally published on www.health4mom.org.  It’s one of my favorite pregnancy sites.  Here’s 40 reasons to allow pregnancy to run it’s course and let your little one come when he or she is ready.  Enjoy!

Your baby needs a full 40 weeks of pregnancy to grow and develop. While being done with pregnancy may seem tempting, especially during those last few weeks, inducing labor is associated with increased risks including prematurity, cesarean surgery, hemorrhage and infection.

Labor should only be induced for medical reasons—not for convenience or scheduling concerns. Baby will let you know when she’s ready to emerge. Until then, here are 40 reasons to go at least the full 40 weeks of pregnancy:

Finish Healthy & Well

1. End right by starting right—keeping all of your prenatal appointments helps ensure a healthier ending
2. Savor the journey—soon you will meet your baby
3. Let nature take over—there are fewer complications and risks for both you and baby through natural birth
4. Recover faster from a natural birth than cesarean, which is major abdominal surgery that causes more pain, requires a longer hospital stay and a longer recovery
5. Birth a brainier baby—at 35 weeks your baby’s brain is only 2/3rds the size it will be at term
6. Set her thermostat—baby will better regulate her temperature when born at term
7. Boost breastfeeding—term babies more effectively suck and swallow than babies born earlier
8. Delight in those kicks and flips—marvel at the miracle of the life inside
9. Enjoy your convenient excuse for every mood swing and crazy craving
10. Nourish your body—diets don’t work but breastfeeding will help you return to your pre-pregnancy size
11. Let others carry the groceries, mail, packages just a while longer
12. Indulge in “we” time before you’re a threesome or more
13. Sport your bump—as your belly increases, so do your chances of getting a great seat almost anywhere

Manage Your Risks

14. Eat healthfully—indulge occasional cravings without remorse
15. Give baby’s development the benefit of time since you may not know exactly when you got pregnant
16. Let baby pick her birthday—if she decides to emerge after 37 weeks there’s no need to try to stop your spontaneous labor
17. Skip an induction—which could lead to cesarean—by waiting for labor to start on its own
18. Reduce your baby’s risks of jaundice, low blood sugar and infection by waiting until he’s ready to emerge
19. Build your baby’s muscles—they’ll be strong and firm, and ready to help him feed and flex at term
20. Maximize those little lungs—babies born just 2 or more weeks early can have twice the number of complications with breathing
21. Ignore people who say an induction is more convenient. Nothing is convenient about a longer labor and increasing your risk of cesarean
22. Respond to requests to speed baby’s birth with the facts that inductions often create more painful labors and can lead to cesarean surgery
23. Let others do the heavy lifting—and the extra housecleaning
24. Splurge on pedicures—or ask a friend to do them for you, especially when you can’t see or touch your feet
25. Relish in the fact that right now you’re the perfect mom—your healthy pregnancy habits are growing baby the best possible way
26. Finish well—more time in the womb usually means less time in the hospital

The nurses of AWHONN remind you not to rush your baby—give her at least a full 40!

Enjoy This Time

27. Relax! Babies are usually so much easier to care for in the womb
28. Shamelessly wear comfy, stretchy clothes
29. Postpone changing the eventual 5,000+ diapers baby will use
30. Be out and about without having to buckle, unbuckle, rebuckle baby into her car seat or stroller while runningerrands
31. Carry your most stylish purses especially the ones too small to hold diapers and wipes
32. Relish parenting—right now you know exactly where baby is and what he’s doing
33. Snooze when you can—what sleep you’re currently getting is actually quite a lot compared to the interruptions ahead
34. Massage remains a must—ask your partner to help ease the aches
35. Enjoy nights out without paying for a babysitter
36. Indulge in shopping without the added responsibilities of baby in tow
37. Redecorate your house around your nursery’s theme
38. Prop up your paperback—your burgeoning belly peaks at just the right reading height
39. Make the best-possible birth experience; don’t rush it
40. Write your own healthy reason—if it gets baby a full 40 weeks of pregnancy it deserves to be on this list

The pregnancy test

Last time we talked about pregnancy signs and symptoms and left off with taking a home pregnancy test.  A missed menstrual cycle is the most common symptom leading a woman to take a pregnancy test.  Taking a pregnancy test can be filled with excitement for some people, whereas for others it may be a little intimidating.  No matter how you feel about the idea of being pregnant, a pregnancy test may let you know, one way or the other, if you are pregnant.

How does a test tell if you are pregnant or not?

A pregnancy test detects the presence of a hormone called human chorionic gonadotropin (hCG) in your blood or in your urine. hCG is produced in the placenta shortly after the embryo attaches to the uterine lining and builds up rapidly in your body in the first few days of pregnancy.

Choosing a home pregnancy test

There are a lot of home pregnancy tests out there.  Two of the most recognized name brands on the market are the Clearblue pregnancy test and the First Response pregnancy test.  Beyond these you have lesser known brands and even no name bargain pregnancy tests offered at the dollar store of all places.  In the end the choice is yours and you have to strip away all the fancy claims and focus group tested names to get the test that meets your needs.  Grab 5 different brands regardless of price and they will all claim a 99% accuracy rating. All this 99% means is that when the test is administered perfectly the results are correct 99% of the time, and truthfully, you only get the 99% accuracy rating if you wait until after your period is late.

There are tests which boast the ability to read pregnancy as early as one week before you are late, however, reading the fine print will bring your baby dreams down to earth with an unpleasant bump.  The reality is, predicting pregnancy this early, even with the tests with specialize in early detection, will only give you an accurate reading rate in the 60% range.  That is only slightly better than half, so you still really don’t know for sure and certain. Which means you will find yourself testing again in a week when your period is late.

My advice:  When choosing a home pregnancy test, don’t focus so much on early detection, or the accuracy rating of 99% shared by every test on the market.  Instead, focus on following the directions of the test down to the tiniest of details to get your most accurate results.

How long do I have to wait before I take a test?

Most doctors recommend that you wait until the first day of your missed period before taking a home pregnancy test. A missed period is usually one of the first signs of pregnancy.   This is usually around two weeks after conception.

A blood test administered by your doctor is more sensitive than the early home tests and can be taken between seven and twelve days after you conceive.  It is possible that these tests can be done  too early and show a false negative result.  If you receive a negative result and still do not start your period, another test should be repeated.

How accurate are home tests?

Home tests are pretty darn accurate when used correctly.  We’re talking about a 97% accuracy.  However, there’s still a 3% margin of inaccuracy.  Part of that can be chopped up to human error or testing too soon.  The other part of that 3% fall into the false-positve category, and we’ll talk about that.

If you take a test too early, you may get a false negative (when the test says you are not pregnant but you are). Your body needs time for the hormone to rise to a high enough level to be detected in a test. If the test comes back negative but you still think you could be pregnant, wait a few days and test again.  And if you still get a negative test and suspect you’re pregnant, make an appointment to see your doctor.  While home pregnancy tests are quite accurate, there are factors that can give you negative results even when you’re pregnant, such as:

• The test is past its expiration date.
• You took the test the wrong way.
• You tested too soon.
• Your urine is too diluted because you consumed large amounts of fluid right before the test.
• You are taking certain medications, such as diuretics or antihistamines.

Again, if you get two negative tests but suspect you are pregnant, make an appointment with you doctor for a blood test.  Blood tests are done at your doctor’s office, but are used less often than urine tests. These tests can detect pregnancy earlier than a home pregnancy test, or about six to eight days after ovulation. But with these tests, it takes longer to get the results than with a home pregnancy test.Two types of blood pregnancy tests are available:A qualitative hCG test simply checks to see if hCG is present. It gives a “yes” or “no” answer to the question, “Are you pregnant?” Doctors often order these tests to confirm pregnancy as early as 10 days after a missed period. However, some of these tests can detect hCG much earlier.

A quantitative hCG test (beta hCG) measures the exact amount of hCG in your blood. It can find even very low levels of hCG. Because these pregnancy tests can measure the concentration of hCG, they may be helpful in tracking any problems during pregnancy. They may also be used to rule out a tubal (ectopic) pregnancy or to monitor a woman after a miscarriage when hCG levels fall rapidly.

Back to the home pregnancy test.  Very rarely, you can test positive for a pregnancy when you actually are not pregnant.  False positives (when the test says you’re pregnant but you’re not) are possible, but rare. A positive pregnancy test is a pretty good indication that you are pregnant.   Again, false-positive results are very rare, but they can happen.  A false-positive means you’re not pregnant but the test says you are. You could have a false-positive result if blood or protein is present in your urine. And certain medications, such as tranquilizers, anti-convulsants, or hypnotics, may also cause false-positive results.

Pregnancy signs

Notice things going on in your body?  Think you might be pregnant?  Then read on.  While the signs and symptoms are not definitive confirmations of pregnancy, they may certainly may be indicative.

10. Abdominal bloating

Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives. That’s why your clothes may feel more snug than usual at the waistline, even early on when your uterus is still quite small.

9. Heightened sensitivity to odors

If you’re newly pregnant, it’s not uncommon to feel repelled by the smell of a bologna sandwich or a cup of coffee, and for certain aromas to trigger your gag reflex. Though no one knows for sure, this may be a side effect of rapidly increasing amounts of estrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive to you.

8. Nausea or vomiting

For some women, morning sickness doesn’t hit until about a month after conception, though for others it may start a week or two earlier.  And while morning sickness is most prevalent in the a.m., it’s not just in the morning.  Nausea gravidium, the big official name for nausea and vomiting associated with pregnancy, can be a problem morning, noon, or night.  And while some lucky mamas get to skip this part of the pregnancy experience, an estimated 50-75% percent of all women experience some degree of nausea and vomiting.

About half of women with nausea feel complete relief by the beginning of the second trimester. For most others it takes another month or so for the queasiness to ease up.

 7. Frequent urination

Shortly after you become pregnant, hormonal changes prompt a chain of events that raise the rate of blood flow through your kidneys. This causes your bladder to fill more quickly, so you make more trips to the ladies room.  This symptom may start as early as six weeks into your first trimester.

Frequent urination will continue – or intensify – as your pregnancy progresses. Your blood volume rises dramatically during pregnancy, which leads to extra fluid being processed and ending up in your bladder.  As your pregnancy progresses, you little bitty will become less little bitty and will start to put more pressure on your bladder.

6. Fatigue

Feeling tired all of a sudden? No, make that exhausted.  Beyond exhausted.  We’re talking bionic fatigue.  No one knows for sure what causes early pregnancy fatigue, but there are many theories, including that rapidly increasing levels of the hormone progesterone are contributing to your sleepiness. And let’s not forget what hard work your body is doing growing your baby.

You should start to feel more energetic once you hit your second trimester, although fatigue usually returns late in pregnancy when you’re carrying around a lot more weight and some of the common aches and pains make it more difficult to get a decent night’s sleep.

5. Tender, swollen breasts

One of the early signs of pregnancy is hypersensitive breasts caused by rising levels of hormones. The soreness and swelling may feel like an exaggerated version of how your breasts feel before your period. Your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.

4. A missed period

If you’re usually pretty regular and your period doesn’t arrive on time, you may decide to do a pregnancy test before you notice any of the above symptoms. But if you’re not regular or you’re not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom could be pregnancy before you realize you didn’t get your period.  That being said, some women actually experience these symptoms and it’s simply a part of what they go through during their period.

3. Implantation bleeding

Very early in pregnancy, even before you realize you’re pregnant, you may have some spotting that lasts for only a day or two. There’s no way of knowing for sure why this happens, but it may be caused by the fertilized egg burrowing into the wall of your uterus – a process that starts just six to seven days after fertilization.  Because of this spotting, coupled with a lack of the typical early pregnancy signs, some women don’t recognize they’re pregnant until later in their pregnancy when they have more definitive pregnancy signs.

2. Your basal body temperature stays high

If you’ve been charting your basal temperature and you see that your temperature has stayed elevated for 18 days in a row, you’re probably pregnant.

And finally …

1. The proof: A positive home pregnancy test

In spite of what you might read on the box, many home pregnancy tests are not sensitive enough to reliably detect pregnancy until about a week after a missed period.  Yes, you might get a positive pregnancy test a few days before your missed period (I did with both of my children), but chances are you will not.  So if you decide to take a test earlier than your missed period date and get a negative result, don’t get discouraged and try again in a few days.  And if you still get a negative result and suspect you may be pregnant, talk to your health care provider.

Once you’ve gotten a positive result, make an appointment with your practitioner.  Congratulations!!!!

 

Prenatal vitamins

For your reading enjoyment, a bit about prenatal vitamins.  Why they are important, the types of prenatals out there, and what to do when you just can’t stomach it.

The super multivitamin.

For a mother’s health, and the health of her baby, she is advised to take so-called ‘prenatal vitamins’ during pregnancy. Prenatal vitamins are specially formulated multivitamins that make up for any nutritional deficiencies in the mother’s diet.  The super multivitamin.  If you suspect you might be pregnant or are trying to get pregnant, it’s in the best interest of your health and your unborn baby’s health to start taking your prenatal vitamins and to continue taking them throughout your pregnancy.

What makes them different from regular multivitamins?

Prenatal vitamins have extra folic acid, iron, and calcium, which are all important minerals and supplements during your pregnancy.

Folic acid can reduce your risk of having a baby with a serious birth defect of the brain and spinal cord, called the ‘neural tube.’ A baby with spina bifida, the most common neural tube defect, is born with a spine that is not closed. The exposed nerves are damaged, leaving the child with varying degrees of paralysis, incontinence, and sometimes mental retardation.

Neural tube defects develop in the first 28 days after conception, before many women realise they are pregnant. Because about half of all pregnancies are unplanned, the Department of Health recommends that you take 400 micrograms of folic acid each day while you are trying to conceive, and should continue taking this dose for the first 12 weeks of pregnancy. . A woman who has had a prior child with a neural tube defect should discuss the appropriate dose of folic acid with her doctor before her next pregnancy. Studies have shown that taking a larger dose (up to 4,000 micrograms) at least one month before and during the first trimester may be beneficial.

There are natural sources of folic acid: green leafy vegetables, nuts, beans, and citrus fruits. It is also found in many fortified breakfast cereals and some vitamin supplements.

Calcium during pregnancy can prevent a new mother from losing her own bone density, as the fetus uses the mineral for bone growth.

Iron helps both the mother and baby’s blood carry oxygen.

While a daily vitamin supplement is no substitute for a healthy diet, most women need supplements to make sure they get adequate levels of these minerals.

Not all vitamins are created equal.

No, you don’t necessarily need to take the prenatal your OB prescribes you.  You can take over the counter ones, but be careful in selecting them.  Look for vitamins containing the ingredients listed below.

• 400 mcg of folic acid
• 400 IU of vitamin D
• 200 to 300 mg of calcium
• 70 mg of vitamin C
• 3 mg of thiamine
• 2 mg of riboflavin
• 20 mg of niacine
• 6 mcg of vitamin B12
• 10 mg of vitamin E
• 15 mg of zinc
• 17 mg of iron

My prenatal makes me nauseated.  What do I do?

Unfortunately, your prenatal vitamin can make you feel a little queasy.  It’s believed to be related to the level of iron.  Some prenatal vitamins contain up to 30 mg of iron, which can be difficult to stomach.  If you have trouble stomaching your prenatal, try the following:

• Take your prenatal vitamin with food or before bed.
• Consider taking a food-based prenatal vitamin, which are typically easier on the stomach and easier to digest than mineral based vitamins.
• Chewable or liquid vitamins are also an option.
• If it’s the size of the vitamin that’s causing the problem, again, chewable or liquid vitamins are available.  You can also get prenatal vitamins without calcium that are much smaller and easier to swallow.  However, you would have to take a separate pill to get your extra necessary calcium.
• If all else fails, consider talking to your HCP about taking a prenatal that doesn’t have iron in it, at least during your first trimester when you’re typically your sickest.  You can try to eat foods high in iron (such as dark leafy greens) to make up for the lack of iron in your prenatal.  If this doesn’t work, continue to talk with your HCP until you find something that works for you.

Beware of constipation.

That extra iron in your prenatal, on top of making you nauseated, unfortunately can cause constipation.  Constipation is already common enough during pregnancy, and the extra iron is only going to add on to it.  Constipation in pregnant women is thought to occur in part due to hormones that relax the intestinal muscle and by the pressure of the expanding uterus on the intestines. Relaxation of the intestinal muscle causes food and waste to move slower through your system.

Let me tell you something.  Everything’s worse when you’re pregnant.  Even constipation.  Many moms complain of a heavy achey pressure in their pelvis and become concerned about their pregnancy.  Constipation is quite the culprit.

Preventing and treating constipation.

Prevention and treatment of constipation involve much of the same thing. Here are a few things that you can do to help prevent constipation from occurring or treat it if you are already experiencing it:

• Eat a high fiber diet: Ideally, you will consume 25 to 30 grams per day of dietary fiber from fruits, vegetables, breakfast cereals, whole grain breads, prunes and bran.
• Drink a lot of fluids: Drinking plenty of fluids is important, particularly with your increase of fiber. Drink 10 to 12 cups of fluids each day.  I can’t tell you how important staying hydrated is. It is the combination of a high fiber diet and lots of liquid that best help you eliminate your waste. Sweat, hot/humid climates, and exercise may increase your need for additional fluids.
• Exercise routinely: If you are inactive, you have a greater chance of constipation. Walking, swimming and other moderate exercises help the intestines work by stimulating your bowels. Schedule exercise three times a week for 20-30 minutes each.
• Over-the-counter remedies: There are over-the-counter products such as Metamucil which may help soften your bowel movements and reduce constipation. Always speak to your health care provider before using over-the-counter medications.  Your HCP may even prescribe a stool softener, such as Colace or Docusate, if the constipation becomes enough of a discomfort.
• Reduce or eliminate iron supplements: Iron supplements may contribute to constipation. Good nutrition can often meet your iron needs during pregnancy. Taking smaller doses of iron throught the day rather than taking it all at once can reduce constipation. Talk to your health care provider about checking your iron levels and recommendations to manage iron intake during pregnancy.

Do not!

Do not take laxatives.  Laxative pills are NOT recommended for the treatment of constipation during pregnancy because they might stimulate uterine contractions and cause dehydration.

Mineral oils, such as castor oil, should NOT be used during pregnancy because there is an increased reduction in nutrient absorption.  And if you drink enough castor oil, you might trigger the same problem laxatives can cause.

Pregnancy tips

Trying to get pregnant?  Pregnant already and about to pop?  Here’s thirty five tips all about pregnancy!

1. Make a visit with your HCP (health care provider) before becoming pregnant.
2. Start making good food choices now and start exercising (providing your HCP approves).   A healthy fit start to pregnancy usually makes for an easier pregnancy.
3. Again, exercise!  By starting an exercise program now, you lower your risk of miscarriage, start a habit that will help you stay in shape during your pregnancy, and has even been proved to help reduce labor complication and length of labor.
4. Trying to conceive?  Track your menstrual cycles.  Not every woman has the standard 28 day cycle.  Some average closer to 31.  Using an ovulation calendar, which can be found all over the world wide web, you can get a fairly accurate idea about when you’re ovulating and are most likely to conceive.  But don’t stress if you don’t get pregnant right away.  Only an estimated 25% conceive within their first month of trying.  Most couples will experience conception within the first 12 months of trying, although for some it may take up to 18 months. Most practitioners will not intervene in the conception process unless it has been more than 12 months since the couple actively began trying to conceive.  Give it time.
5. Start doing your research.  Educate yourself. Ask friends and family, read books, google stuff.
6. Check out a book about pregnancy.  My personal favorite, The Pregnancy Countdown Book.  The information is brief, too the point, and presented in the most conversational way.  It breaks your pregnancy down into weeks as opposed to months.
7. Stop the bad habits, especially smoking.
8. Take your prenatal vitamins.  There are a wide range of prenatal vitamin options to choose from, and you can easily get them over the counter.  If prenatal vitamins are hard on your stomach (or just hard to choke down) consider taking a children’s chewable multivitamin.
9. Practice good dental hygiene, such as brushing your teeth daily.  Try to make a dental appointment before getting pregnant. That way, your teeth can be professionally cleaned, your gum tissue can be carefully examined, and any oral health problems can be treated in advance of your pregnancy.  Why, you ask, is this important?  Pregnancy causes hormonal changes that increase your risk of developing gum disease, which in turn, can affect the health of your developing baby.
10. Do you have cats?  Stop changing the litter box.  Leave that to your significant other.  There is a slightly nasty parasite, toxoplasmosis, that could potentially be found in the cat’s fecal matter.  If exposed while pregnant, the parasite could result in miscarriage, early delivery, poor growth or stillbirth. A child born with this parasite may get eye problems, convulsions or mental disabilities. However, some infected babies do not develop anydisease at all.  So, avoid the kitty litter.
11. Avoid any other potentially harmful chemicals or substances.  Act pregnant.  Think pregnant.  Harmful substances include illegal substances, alcohol, or chemical exposures.    Now, if you have a drink and later find out you were pregnant, don’t fret.  It happens, and usually there aren’t any long term effects.
12. Once you find out your pregnant, relax.  Take it easy.  Rest when you can.  The first trimester can be exhausting as your body is working in overdrive to develop your little one.  Rest, rest, rest!
13. Announce your pregnancy when you are ready.  Some people like to wait until week 12(ish) or after their HCP has been able to doppler the baby’s heartbeat, at which point in time the risk of a miscarriage has dropped significantly.  Others announce minutes after their positive pregnancy test.  Neither is right or wrong.  It’s your baby.  Share the news when you feel comfortable.
14. Don’t be disappointed if everyone doesn’t exude uncontainable excitement about your pregnancy.  Maybe you tell your girlfriend, who, while excited for you, is also a little bummed or even jealous that she’s not having a baby.  You never know.  Just remember, while your family and friends might not react the way you envisioned them reacting to you announcing your pregnancy, most of the time they are really happy for you and will later share your excitement.
15. Consider starting a pregnancy journal or even a blog.  You will remember the big things (the day you first hear your baby’s heartbeat, your first ultrasound, etc.), but the little milestones could fade from your memory quickly.  There’s this thing called “pregnancy brain.”  Pregnancy brain is a condition that affects expectant mothers, usually during the first and third trimesters. Sometimes known as placenta brain or baby brain drain, the condition is usually characterized by short-term memory loss or forgetfulness. Some medical experts say thatpregnancy brain is a myth, but evidence shows that many women have experienced this condition.  Bottom line, you’re not going to remember every moment of your pregnancy, and it might be a fun project to jot down the little things.  Like the first time a stranger congratulated you on your pregnancy and wished you well, or the day you went from looking like maybe you’ve just gained weight and now look like you’re expecting.
16. Hydrate!  This important throughout the pregnancy for an abundance of reasons.  Drink 6-8 eight ounce glasses of water per day.  Not sodas, tea, or coffee.  Water.
17. Keep your prenatal appointments with your midwife or doctor and be certain to communicate any concerns you might have to them.   Keeping your scheduled appointments when help to ensure any problems that you might have are hopefully caught early and treated appropriately to ensure an uncomplicated as possible pregnancy.
18. Write your questions, comments or concerns for you HCP down because inevitably, when you have your appointment, you will forget them.
19. Be prepared for nausea, heartburn, constipation and some major fatigue.
20. Consider taking prenatal classes throughout your pregnancy.
21. Bump up your calorie intake to approximately 300 during your second trimester and 500 extra calories per day during your third.
22. Take a tour of your birth facility options (hospital or birth center).  Obviously, if you plan for a home birth, you can skip this step.
23. Be aware of preterm labor signs and symptoms.  They can be pretty vague (i.e., back pain or pelvic pressure), but error on the safe side.
24. Planning for a natural childbirth?  Get prepared!  Take classes, read books, develop a plan and make sure you have a strong support system.
25. When decorating your little one’s nursery, leave the painting to someone else if possible.  There are paints that are low VOC (volatile organic compounds), but it’s still better to let someone else do the painting when possible.  Ensure adequate ventilation (i.e., open the windows, etc) and stay out of the nursery until it’s aired out.
26. If your BFF just had a baby, see if she’ll let you babysit for a little so you can get some first hand new born experience.
27. Thinking of breastfeeding?  Take a class to help you prepare for the realities of breastfeeding your newborn.  It can be a learning process for you and your baby, so be prepared for ups and downs.
28. Leg cramps?  Be prepared for potentially breath-taking cramps in your legs.  They are not fun.  They hurt.  Try extending and flexing your foot before getting in and out of bed to stretch the legs.
29. Even if you have to slow down exercising with your growing belly, continue exercise if your HCP approves.  There are plenty of studies indicating moms who stayed fit during their pregnancy had easier and shorter labors and easier and shorter recoveries.
30. Have a birth plan.  There are lots of examples on line of what you can include in your birth plan.  Your plan may be to get an epidural as quickly as possible.  It might be to labor with minimal medical interventions.  Develop your plan early on in your pregnancy and make sure to share it with your HCP and your support persons.  You want everyone to be on board with your plan to help facilitate the best possible delivery for you.
31. Even if you know you want an epidural as soon as your physically able to get one, prepare to feel contractions.  You never know what’s going to happen once you’re admitted.  Some doctors won’t write for epidurals until “active” labor (3-4 centimeters, broken water and/or cervical change).  Some hospitals only have one anesthesiologist that may be tied up in another case.  There are conditions in which epidurals aren’t an option (some blood clotting disorders and medications, deviations in the spinal cord, HELLP syndrome).  There are IV pain medication options, but they don’t necessarily make you pain free.   Again, even if the plan is for an epidural, it’s in your best interest to have some breathing/coping skills down before you go into labor.
32. When you pack your hospital bag, make sure you have your insurance cards, picture ID, any pre-registration forms, your camera, phones, chargers, and birth plan.  There are plenty of websites out there with printable checklists for packing your hospital bag.
33. Get familiar with the signs and symptoms of labor and be prepared for these signs and symptoms to go on for…a while.  A potentially really long while.  Days.  Some times weeks.  Early labor, unfortunately, can last a long time.  If this happens, don’t get discouraged.  Your baby will come when he/she is ready.
34. Enjoy your pregnancy while it lasts.
35. Don’t feel bad if you’re miserable and “just want this over with”.  That doesn’t mean that you love your baby any less than the woman next to you talking about what a wonderful experience pregnancy is.  Pregnancy can be tough and it’s not all rainbows and sunshine every day.  You won’t be pregnant forever, and your baby is well worth the wait.

I love this book. It's great for a laugh.

Normal aches and pains

The third trimester

Let’s talk about the home stretch.  The last few months of your pregnancy.  The third trimester.  Weeks 28 and beyond.  You probably had a bit of a rough start during your first trimester.  Maybe some nausea, maybe some bionic fatigue, maybe an emotional roller coaster.  Your second trimester was probably pretty golden.  Nausea subsided, energy returned, you got your baby bump and people finally recognized that yes, you were pregnant and not just gaining weight.  Enter, the third trimester.  Now, you might start experiencing the impatience to meet your little one, you might actually get tired of being pregnant, and have to deal with an onslaught of aches and pains.

Keep in mind, each woman is unique and each pregnancy is unique so it goes without saying that no two pregnancies are exactly alike. Even with textbook pregnancies there are always a few differences. Your doctor will likely talk to you about you can expect given your specific situation, prior symptoms, and any special difficulties you may in your pregnancy.

Normal aches and pains

Braxton Hicks contractions: These are contractions that are basically your body’s way of warming up for the real thing.  They’re usually pretty weak.  Truth be told, you might not really notice them.  Many moms comment that what they’re feeling is the baby moving, or the baby is “balling up”.  Balling up usually is a Braxton hicks contraction.   Look for a tightening of your belly and uterine muscles (baby balling up).  Braxton Hicks are designed to get those muscles ready for what will come during real labor. Typically you will start experiencing Braxton Hicks around the 28^th to 30^th week of your pregnancy. If you are concerned about the contractions you are feeling or they appear to increase with frequency and rhythm be sure to call your doctor immediately.

Pain in your back, pelvis, and hips: As the baby grows and as your body continues to get itself ready for the baby’s delivery you will notice pains in your back, pelvis, and hips. The growing baby is putting more and more pressure on your back causing an increase in the back pain many women experience throughout pregnancy. Your pelvic region is changing in preparation of the birth which inevitably causes pain in the hips and pelvis.  Use a maternity belt to support the ever growing baby belly.  Try sleep positions and exercises that help alleviate the pain and discomfort.  When you sit, choose chairs with good back support. Apply a heating pad or ice pack to the painful area. Ask your partner for a massage. Wear shoes with good arch support. If the back pain doesn’t go away or is accompanied by other signs and symptoms, contact your health care provider.

Heartburn:  During the third trimester, your growing uterus might push your stomach out of its normal position — which can contribute to heartburn.  The hormones of pregnancy cause the digestive system to slow down, which results in an increased occurrence of heartburn. Doctors recommend that you eat several smaller meals throughout the day instead of the typical 3 large meals. They also recommend that you avoid eating close to bedtime and when you do go to bed that you prop yourself up on pillows as this helps alleviate heartburn.  Avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods. If these tips don’t help, ask your health care provider about antacids.

Shortness of breath:  You might get winded easily as your uterus expands beneath your diaphragm, the muscle just below your lungs. This might improve when the baby settles deeper into your pelvis before delivery. In the meantime, practice good posture and sleep with your upper body propped up on pillows to relieve pressure on your lungs.

Swelling:  As your growing uterus puts pressure on the veins that return blood from your feet and legs, swollen feet and ankles might become an issue. At the same time, swelling in your legs, arms or hands can place pressure on nerves, causing tingling or numbness. Fluid retention and dilated blood vessels might leave your face and eyelids puffy, especially in the morning.  At the end of the day, you might be surprised by how swollen you legs, ankles and feet might be.  We’ve all heard of cankles, right?  Relax and prop your feet up.  This will help work some of the excess fluid build up back into your circulatory system. If you have persistent face or eyelid swelling, or have any visual disturbances (blurry vision, spots floating in your sight), or get a headache that just won’t go away, even with Tylenol, contact your health care provider.

Frequent urination:  As your baby moves deeper into your pelvis, you’ll feel more pressure on your bladder. You might find yourself urinating more often, even during the night. This extra pressure might also cause you to leak urine — especially when you laugh, cough or sneeze. If you’re worried about leaking urine, panty liners can offer a sense of security.

Continue to watch for signs of a urinary tract infection, such as urinating even more than usual, burning during urination, fever, abdominal pain or backache. Left untreated, urinary infections increase the risk of pregnancy complications.  For more information about UTI’s, check out my previous post about them.  They’re unfortunately common and a huge pain, but are relatively easy to treat.

Difficulty sleeping:  There are some out there that speculate this discomfort is a bit of a prep for when the baby arrives.  In all honesty, as your body grows and changes you will inevitably become more uncomfortable, which certainly won’t help you sleep.  Also, as mentioned a moment ago, you will find that you have to get up several times a night to use the “little girl’s” room. Not to mention the baby moving throughout the night since he is not in a normal wake/sleep cycle. Be sure to get as much sleep as you can. You may find you need to take little naps during the day to help compensate for the lack of sleep at night.

Again, these are just a few of the common complaints of women in the third trimester, a few of the things you have to look forward to.  🙂

As with anything during pregnancy, if you are concerned about something you are experiencing talk to your doctor. If anything is bothering you or seems abnormal be sure to call your doctor so you can be checked out and you can discuss your concerns with your doctor.  Always, when in doubt, call your doctor, midwife or even your local hospital’s labor and delivery triage department if you are concerned or have any questions regarding your pregnancy.

Delayed cord clamping

Over the last year or so, I’ve really stepped back and reevaluated my approach to caring for my patients.  When I first started as a labor and delivery nurse, there were several practiced I followed because that’s what I was taught when I was in orientation.  I did things the way my preceptor did them.  I did what the doctor told me to do.  Luckily, I had a really awesome preceptor who taught me the in’s and out’s of being a labor and delivery nurse, what rules to really abide by, how to think for myself.

Over the years, there have been several things I’ve changed my approach/attitude towards.  Most recently, I’ve had a change of heart about cord clamping.  There was a point in my career, whenever we had a patient requesting to either not clamp the cord immediately or to even wait until the cord stopped pulsating, I was right out at the desk with all the other nurses and doctors talking about what a bizarre/new age/”crunchy granola” idea that was.  Of course, we never would say such a thing in ear shot of the patient.  How unprofessional.  But, nevertheless, we all thought it was a weird thing to do.

What is delayed cord clamping?

In a nutshell, delayed cord clamping means to ‘delay’ the surgical intervention of clamping the umbilical cord at birth.

The definition of ‘delay’ is subjective and can range from 30-45 seconds, two to three minutes, once the cord has stopped pulsating or the placenta delivered.  There is currently no agreed clinical definition of delayed cord clamping, and wide variations exist in clinical trials.

The benefits

After doing some research into delayed cord clamping, I’ve had a change of heart about it.  There’s a lot of evidence to the benefits of delaying clamping the cord, even for a minute.  I read one particular article written by Nicholas Fogelson, MD suggesting that delaying cord clamping should be standard practice.  There’s plenty of evidence out there backing this statement up.  PLENTY.  Taken from Fogelson’s blogcast on Academic OBGYN, here’s a bit of data supporting the practice of delayed cord clamping.

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial

Randomized 72 VLBW infants (< 1500 grams) to immediate or delayed cord clamping (5-10 vs. 30-45 seconds).  Delayed cord clamp infants had significantly less IVH (5/36 in delayed group vs. 13/36 in immediate group, p = 0.03) and less late onset sepsis (1/36 vs. 8/36, p = 0.03).

The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial

Randomized 39 preterm infants to immediate clamping vs. 60-90 second delay, and examined fetal brain blood flow and tissue oxygenation.  Results showed similar blood flow between groups, but increased tissue oxygenation in the delayed group and 4 and 24 hours after birth.

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial

Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months.  Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron.  Effects were greater in infants born to iron deficient mothers.  Delayed clamping increased total iron stores by 27-47mg.  A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints

Infants delivering at 30 to 36 weeks gestation randomized to immediate vs. 1 minute delay.  Delayed group had higher RBC volumes (p = 0.04) and hematocrits (p < 0.005), though there was no difference in RBC transfusions.  There was a small increase in babies requiring phototherapy in the delayed group (p = 0.03) but no difference in bilirubin levels between groups.

Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study

Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds.  Delayed clamping infants had higher BPs and hematocrits.  Infants < 1500 grams with delayed clamping needed less mechanical ventilation and surfactant.  Trend towards more polycythemia in delayed group, but not statistically significant.

Fogelson isn’t the only one out there publishing articles about the benefits of delayed cord clamping.  Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping as well.  In his article in the British Medical Journal, Weeks stated clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants.

For the mother, trials show that early cord clamping has no ill effects, he writes. But what about the baby?

At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth.

For pre-term babies the beneficial effects of delayed clamping may be greater, he says. Although the studies are smaller, delayed clamping is consistently associated with reductions in anaemia, bleeding in the brain (intraventricular hemorrhage), and the need for transfusion.

His article didn’t specify the gestational age of the preterm infants.

My opinion now

Providing all things go in a most uncomplicated manner with my next pregnancy, I plan for a delayed cord clamp delivery.  I’m not one who will necessarily insist on waiting until the cord has stopped pulsating, but I will insist on not waiting a few minutes before my doc clamps the cord.  I’m fortunate enough that my doctor is very open minded.

 

Second trimester

The Second Trimester (weeks 13-27)

For many moms, the start of the second trimester often means less queasiness and more energy. And you’re probably peeing less and showing more.  At the doctor’s office, expect routine monitoring for the next several weeks. Your practitioner will check your weight, the size of your uterus, height of your fundus (top of your uterus), and the baby’s heartbeat. You’ll probably be scheduled for a second between 18 and 24 weeks of pregnancy, which allows your doctor to measure the baby, check the developing organs, determine the amount of amniotic fluid, and — if you like — clue you in on your baby’s gender. Between 14 and 22 weeks of pregnancy you’ll likely have a quad screening as well; this blood test measures the levels of four substances produced by your baby and passed into your bloodstream. The results can indicate increased risk factors for chromosomal or congenital abnormalities such as Down syndrome or neural-tube defects. Amniocentesis , during which amniotic fluid is extracted and analyzed for genetic abnormalities, is typically performed between weeks 16 and 18 of pregnancy (if you decide to have one).

Week 13: Urine forms

Thirteen weeks into your pregnancy, your baby’s intestines have moved from the umbilical cord to your baby’s abdomen. Your baby is also beginning to form urine and discharge it into the amniotic fluid.

Tissue that will become bone is also developing around your baby’s head and within his or her arms and legs.

Week 14: Baby’s sex becomes apparent

Fourteen weeks into your pregnancy, your baby’s arms have almost reached the final relative lengths they’ll be at birth and your baby’s neck has become more defined. Red blood cells are forming in your baby’s spleen.

Your baby’s sex will become apparent this week or in the coming weeks. For girls, ovarian follicles begin forming. For boys, the prostate appears.

By now your baby might be almost 3 1/2 inches (87 millimeters) long from crown to rump and weigh about 1 1/2 ounces (45 grams).

Week 15: Baby’s skeleton develops bones

Fifteen weeks into your pregnancy, your baby is growing rapidly. Your baby’s skeleton is developing bones, which will become visible on ultrasound images in a few weeks. Your baby’s scalp hair pattern also is forming.

Week 16: Baby can make sucking motions

Sixteen weeks into your pregnancy, your baby’s eyes have begun to face forward and slowly move. The ears are close to reaching their final position. Your baby might be able to make sucking motions with his or her mouth.

Although still too slight to be felt, your baby’s movements are becoming coordinated and can be detected during ultrasound exams.

By now your baby might be more than 4 1/2 inches (120 millimeters) long from crown to rump.

Week 17: Fat accumulates

Seventeen weeks into your pregnancy, fat stores begin to develop under your baby’s skin. The fat will provide energy and help keep your baby warm after birth.

Week 18: Baby begins to hear

Eighteen weeks into your pregnancy, your baby’s ears begin to stand out on the sides of his or her head. Your baby might begin to hear.

By now your baby might be 5 1/2 inches (140 millimeters) long from crown to rump and weigh 7 ounces (200 grams).

Week 19: Baby’s uterus forms

Nineteen weeks into your pregnancy, a greasy, cheese-like coating called vernix caseosa begins to cover your baby. The vernix caseosa helps protect your baby’s delicate skin from abrasions, chapping and hardening that can result from exposure to amniotic fluid.

For girls, the uterus and vagina might begin to form this week.

Week 20: The halfway point

Halfway into your pregnancy, you might be able to feel your baby’s first movements, also known as quickening.

By now your baby might be about 6 1/3 inches (160 millimeters) long from crown to rump.

Week 21: Baby can swallow

Twenty-one weeks into your pregnancy, your baby is poised to gain more weight. By this week your baby is becoming more active and might be able to swallow.

Week 22: Baby’s hair becomes visible

Twenty-two weeks into your pregnancy, your baby is completely covered with a fine, down-like hair called lanugo. The lanugo helps hold the vernix caseosa on the skin. Your baby’s eyebrows might be visible.

By now your baby might be 7 1/2 inches (190 millimeters) long from crown to rump and weigh 1 pound (460 grams).

Week 23: Fingerprints and footprints form

Twenty-three weeks into your pregnancy, your baby’s skin is wrinkled, more translucent than before and pink to red in color.

This week your baby begins to have rapid eye movements. Your baby’s tongue will soon develop taste buds. Fingerprints and footprints are forming. For boys, the testes are descending from the abdomen. For girls, the uterus and ovaries are in place — complete with a lifetime supply of eggs.

With intensive medical care, some babies born this week might be able to survive.  The hospital I work for is attached to a level three NICU, some 23 weekers are able to survive.  It depends on their size and whether or not they are big enough that they can be intubated.

Week 24: Real hair grows

Twenty-four weeks into your pregnancy, your baby is regularly sleeping and waking. Real hair is growing on his or her head.

By now your baby might be about 8 inches (210 millimeters) long from crown to rump and weigh more than 1 1/3 pounds (630 grams).

At this stage of your pregnancy, if you were to go into labor on your own (which hopefully you won’t), your baby has at least a 50% chance of survival.  You would have a long road a head of you with your baby living in the NICU (Neonatal Intensive Care Unit), but for many moms, this gestation age allows for a sigh of relief.

Week 25: Baby responds to your voice

Twenty-five weeks into your pregnancy, your baby’s hands and startle reflex are developing. Your baby might be able to respond to familiar sounds, such as your voice, with movement.

Week 26: Baby’s fingernails develop

Twenty-six weeks into your pregnancy, your baby has fingernails.

Your baby’s lungs are beginning to produce surfactant, the substance that allows the air sacs in the lungs to inflate — and keeps them from collapsing and sticking together when they deflate.

By now your baby might be 9 inches (230 millimeters) long from crown to rump and weigh nearly 2 pounds (820 grams).

Week 27: Second trimester ends

This week marks the end of the second trimester. At 27 weeks,  your baby’s lungs and nervous system are continuing to mature — and he or she has likely been growing like a weed. Your baby’s crown-to-rump length might have tripled since the 12-week mark.

Some lines of thinking include week 28 as a part of the second trimester, but I’m saving week 28 for the third trimester segment.

Pregnancy cravings

About half of women in the United States report at least one food craving during pregnancy, says Judith Brown, author of What to Eat Before, During, and After Pregnancy.  You’ve probably heard tales of loved ones being dispatched at all hours to search for a certain brand of bacon double cheeseburger or rocky road ice cream to quell an expectant mom’s desire.

Truth is, nobody is sure why some women have pregnancy food cravings. “Some experts say cravings, and their flip side, food aversions, are protective, even if there is no scientific data to back up that theory,” says Siobhan Dolan, MD, assistant medical director of the March of Dimes Birth Defect Foundation and assistant professor of obstetrics and gynecology and women’s health at Albert Einstein College of Medicine in New York.

For example, you may not feel like drinking alcohol when pregnant, which is beneficial since avoiding beer, wine, and other spirits fosters your baby’s mental and physical development.

Others think a pregnant woman’s preference for certain foods such as salt-laden potato chips is nature’s way of helping her meet her daily sodium quota.

And then there’s theory number three:  food cravings are probably all in your head, a product of pregnancy hormones. Hormonal shifts during pregnancy intensify sense of smell (which heavily influences taste) and are powerful enough to affect food choices.

Food cravings typically differ from pregnancy to pregnancy. They may also change from day to day. Don’t be surprised when the food you had to have yesterday repulses you today. Sometimes, a pregnancy changes food preferences permanently.  With my son, I couldn’t get enough milk and sweets, and I didn’t like milk.  I started off taking “shots” of milk and all but gagged the milk down.  On the flip side, I really liked broccoli and spinach before I was pregnant with my son.  Since then, I’m still not crazy about one of my once favorite foods.  And with my daughter, I went from being a vegetarian to not being able to satisfy my cravings for chicken.

What do we crave?

Everyone’s different, of course, but according to a study from The American Journal of Clinical Nutrition, the top contenders were sweets (like fruit, candy or chocolate) and dairy (like ice cream and milk). Lots of moms-to-be had an urge for fish, meat or poultry too.

Craving the weird

Some women find themselves with a yen for nonfood items, including ice, dirt, clay, paper, and even paint chips, a condition known as pica. Pica may signal iron deficiency. Expectant mothers may also get the urge to eat flour or cornstarch, which, despite being food items, are a problem in large amounts. Too much can lead to blocked bowels and crowd out the nutrients your baby needs by causing you to feel full. If you have any of these urges, resist eating the items you crave, and report them to your doctor right away.

No matter how strong your desire, steer clear of foods considered health risks for pregnant women and developing babies. These include:

• Raw and undercooked seafood, meat, and eggs
• Unpasteurized milk and any foods made from it, including Brie, feta, Camembert, Roquefort, and Mexican-style cheeses
• Unpasteurized juice
• Raw vegetable sprouts, including alfalfa, clover, and radish
• Herbal teas
• Alcohol

The results of a survey conducted by Gurgle.com reveal 10 of the most common strange pregnancy cravings.

1. Ice
2. Coal
3. Toothpaste
4. Sponges
5. Mud
6. Chalk
7. Laundry Soap
8. Matches
9. Starch
10. Rubber

10 celebrity reported cravings

1. Britney Spears – reportedly craved dirt.
2. Victoria Beckham – smoked salmon.
3. Tina Fey – Entemann’s mini chocolate donuts.
4. Minnie Driver – olives. She didn’t specify whether she had a preference as to green or black.
5. Jennifer Lopez – salsa, M&Ms and orange soda.
6. Angelina Jolie – Reese’s Pieces.
7. Madonna – poached eggs.
8. Rebecca Romijn – lemonade and soy cream cheese.
9. Gwen Stefani – Tabasco. OK magazine said she carried a little bottle of Tabasco around in her purse during her pregnancy and used it on everything.
10. Katie Holmes – cupcakes.

What did you crave?

Fun labor and delivery facts

Just for fun…

In the US: Pregnancy tidbits

There are approximately 6 million pregnancies every year throughout the United States:  (hmm…wow.)

• 4,058,000 live births
• 1,995,840 pregnancy losses (not sure how many, if any, of these are terminations, but I know it includes all gestational ages, from 5 week miscarriages to term still borns.  Not really a fun fact, and I debated putting it in here).

Choosing a care provider

83% of women did not meet with multiple care providers before choosing theirs.  79% of expectant mothers chose OB/Gyn, 8% family physician, 9% midwives.

About 3 in 10 women have a visit to a health care provider to plan their pregnancy before they conceive.

• 83% of mothers learned about their pregnancy from a home pregnancy test.
• Women who received prenatal care in their first trimester: 84.1%.
• 17% of women reported that they could not get their first prenatal appointment as early as they wanted to.
• Women receiving late or no prenatal care: 3%

Ultrasound

99% of women had one. 59% had 3 or more. 15% had six or more.n  I was a part of that 15% with both of my babies.

The biggest day

The most popular day for babies to make their entrance is Tuesday, followed by Monday. Sunday is the slowest day, with 35.1 fewer births than average. Scheduled c-sections and induced labors have a big influence on the fact that far fewer babies are born on the weekend, but spontaneous (non-scheduled) deliveries occur less often on the weekend too.  My first was born on a Sunday and my second on a Thursday.

The biggest month

In 2010 more newborns arrived in September than in any other month. The second, third, and fourth most popular birthday months were August, June, and July, in that order.  May and August for me, although I was due in June and September.

Birth numbers and rates in the states

The number of births went down for 40 states and remained about the same for the rest of the states in 2009. Birth rates ranged from 51 births per 1,000 women age 15 to 44 in Vermont to 88 per 1,000 in Utah.

States with the most births

California, Texas, and New York (in descending order) had the greatest number of births.

States with the highest birth rate

Utah had the highest birth rate, with 88 births per 1,000 women age 15 to 44. Alaska, Arizona, Arkansas, Hawaii, Idaho, Kansas, Mississippi, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, and Wyoming had more than 70 births per 1,000 women.

States with the fewest births

Vermont had the fewest births, followed by Wyoming, North Dakota, and District of Columbia.

States with the lowest birth rate

Vermont had the lowest birth rate, with 51 births per 1,000 women age 15 to 44. Connecticut, Maine, Massachusetts, Michigan, New Hampshire, and Rhode Island had fewer than 60 births per 1,000 women.

The age and fertility of moms

Age of first-time moms

Over the last three decades, women have been waiting longer to start having children. In 1970 the average age of a first-time mother was about 21. In 2008 the average age was 25.1.  I was 22 with my first in 2007.  How old were you?

Birth rate

In 2009 the birth rate in the United States was 66.7 births per 1,000 women ages 15 to 44. This was a 3 percent decline from 2008 and a reversal of the increases seen in 2006 to 2008. In 2010 the birth rate dropped another 3 percent, to 64.7 births per 1,000 women ages 15 to 44.

The marital status of new moms

A rising number of new moms are not married: 41 percent of babies were born to unmarried women in 2009. That percentage has been on the upswing since 2002.

Teens accounted for 21 percent of births out of wedlock in 2009, continuing a steady decline over the past several decades. By contrast, in 1975, 52 percent of these births were to teens. The largest increase in births to unmarried women has been in women age 30 and older.

In 2010, 9.9 million single moms were living with kids under 18 in the United States, up from 3.4 million in 1970.The work status of pregnant and new moms

Stay-at-home moms in 2010: 5 million

First-time moms who worked during their pregnancy in 2008: 67 percent (and 57 percent of them worked full-time)

Between 1961 and 1965, 44 percent of first-time moms worked while pregnant.

First-time moms who worked during the month before they gave birth: 80 percent

Between 1961 and 1965, 35 percent of first-time moms worked during the last month of pregnancy.

Percentage who were working six months after they gave birth: 55 percent

In the early 1960s, the percentage of first-timers working six months after giving birth was 14 percent.

Birth and delivery

Doctors and hospitals

In 2008 most moms in the United States (99 percent) gave birth in hospitals with the help of a physician (91.3 percent). Midwives attended about 8 percent of all births (most midwife-attended births are in hospitals), up from less than 1 percent in the mid-1970s.

Of the 1 percent of births that took place outside the hospital in 2008, 66 percent were in homes and 28 percent were in birth centers. These numbers have remained largely the same since 1989, although birthing centers and home births appear they might be on the rise.  I couldn’t find any more recent statistics past 2009.

Midwives attended 61 percent of  home births in 2008. Montana and Vermont had the highest rate of home births.

Use of epidurals

Of the 27 states that kept track of epidural use in labor, 61 percent of mothers who delivered a single baby vaginally in 2008 received an epidural or spinal block

C-sections

Cesarean deliveries rose in 2009 to 32.9 percent of births, a 2 percent rise from 2008 and another record high. The c-section rate has climbed almost 60 percent in the United States since 1996.

Induction and other techniques

The number of women whose labor is induced has more than doubled since 1990. In 2008, 23 percent of labors were induced, compared with 22.5 percent in 2006.

The number of babies delivered with the help of forceps or vacuum extraction, though, is on the decline, down to 3.9 percent in 2008 from 4.3 percent in 2007. In 1990 almost 1 in 10 babies was delivered with forceps or vacuum extraction, compared with fewer than 1 in 25 in 2008.

Positions for Birth

74% of moms lay on their backs, 23% upright (propped up, squatting or sitting), 3% side-lying, 1% hands and knees.  I was the 3% with my last!
Boys vs. girls

With about 1,048 male babies born for every 1,000 female babies born in 2008, boys are keeping the edge in a ratio that’s stayed about the same over the past 60 years.

Twins

The number of twins born in the United States increased just 1 percent in 2008 – to 32.6 pairs of twins born for every 1,000 births. While this is the highest rate on record, the numbers have remained roughly the same since 2004 after skyrocketing 70 percent between 1980 and 2004.

Triplets and more

The rate of triplets and higher in 2008 was 147.6 per 100,000 births, about the same as the 2007 rate. After shooting up by more than 400 percent between 1980 and 1998, the rate has dropped, especially since 2003, in part because of improvements in fertility treatments. The 2008 rate of triplets and higher multiple births was 24 percent lower than the 1998 rate.

Big families

In 2008, 18,986 mothers gave birth for the eighth or more time.

Premature babies

The preterm birth rate declined in the United States for the third straight year to 12.18 percent of births in 2009. Between 1981 and 2006, the percentage of infants born preterm (less than 37 completed weeks) rose by more than one-third.

Weight at birth

The average U.S. newborn weight in 2008 was 7 pounds, 4.26 ounces. About 8 percent of babies born in 2009 were at “low birth weight” (defined as less than 5 pounds, 8 ounces, or 2,500 grams) – basically unchanged from 2005.