Preeclampsia and Eclampsia: Overview

Preeclampsia (pree-i-KLAMP-see-uh) and eclampsia (ih-KLAMP-see-uh) are disorders of high blood pressure that occur during pregnancy. Because of the mother's high blood pressure, in preeclampsia the blood supply to the growing fetus is reduced, and the fetus may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma. The NICHD and other agencies are working to understand what causes these conditions and how they can be prevented and better treated. 

Common Names

• Preeclampsia and eclampsia

Medical or Scientific Names

• Preeclampsia and eclampsia

Preeclampsia and Eclampsia: Condition Information

What are preeclampsia and eclampsia?

Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy. At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant. This problem occurs without other symptoms. Typically, gestational hypertension does not harm the mother or fetus and resolves after delivery. However, about 15% to 25% of women with gestational hypertension will go on to develop preeclampsia.

Preeclampsia is a condition that develops in women with previously normal blood pressure at 20 weeks of pregnancy or greater and includes increased blood pressure (levels greater than 140/90), increased swelling, and protein in the urine. The condition can be serious, and, if it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.

One of the serious complications of hypertensive disorders in pregnancy is HELLP syndrome, when a pregnant woman with preeclampsia or eclampsia sustains damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:

• H - Hemolysis, in which oxygen-carrying red blood cells break down

• EL - Elevated Liver enzymes, showing damage to the liver

• LP - Low Platelet count, in which the cells responsible for stopping bleeding are low

What causes preeclampsia and eclampsia?

The causes of preeclampsia and eclampsia are not known. These disorders previously were believed to be caused by a toxin in the blood (referred to as toxemia), but health care providers now know that is not true.

To learn more about preeclampsia and eclampsia, scientists are investigating many factors that could contribute to the development and progression of these diseases, including:

• Placental abnormalities, such as insufficient blood flow

• Genetic factors

• Environmental exposures

• Nutritional factors

• Maternal immunology and autoimmune disorders

• Cardiovascular and inflammatory changes

• Hormonal imbalances

What are the risks of preeclampsia & eclampsia to the mother?

Risks During Pregnancy

Preeclampsia during pregnancy is mild in 75% of cases. However, a woman can progress from mild to severe preeclampsia or full eclampsia very quickly¯even in a matter of days¯especially if she is not treated. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant.

Preeclampsia affects the placenta as well as the mother's kidneys, liver, brain, and other organ and blood systems. The condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm delivery, and pregnancy loss. In some cases, preeclampsia can lead to organ failure or stroke. In severe cases, preeclampsia can develop into eclampsia, which can lead to seizures. Seizures in eclampsia cause a woman to lose consciousness, fall to the ground, and twitch uncontrollably. If not treated, these conditions can cause the death of the mother and/or the fetus.

Expecting mothers rarely die from preeclampsia in the developed world, but it is still a major cause of illness and death globally. According to the World Health Organization, preeclampsia and eclampsia cause 14% of maternal deaths each year, or about 50,000 to 75,000 women worldwide.

Risks After Pregnancy

In uncomplicated preeclampsia, the mother's high blood pressure and increased protein in the urine usually resolve within 6 weeks of the infant's birth. Studies, however, have shown that women who have had preeclampsia are four times more likely to develop hypertension and twice as likely to develop ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks), a blood clot in a vein, and stroke.

Less commonly, mothers who had preeclampsia during pregnancy could experience permanent damage to their organs. Preeclampsia could lead to kidney and liver damage or fluid in the lungs.

What are the risks of preeclampsia & eclampsia to the fetus?

Preeclampsia affects the flow of blood to the placenta. Risks to the fetus include:

• Lack of oxygen and nutrients, leading to poor fetal growth due to preeclampsia itself or if the placenta separates from the uterus before birth (placental abruption)

• Preterm birth

• Stillbirth if placental abruption leads to heavy bleeding in the mother

According to the Preeclampsia Foundation , each year, about 10,500 infants in the United States and about half a million worldwide die due to preeclampsia. Stillbirths are more likely to occur when the mother has a more severe form of preeclampsia, including HELLP syndrome.

Preeclampsia also can raise the risk of some long-term health issues related to preterm birth, including learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm also risk extended hospitalization and small size. Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and hypertension.

How many women are affected by or at risk of preeclampsia?

The exact number of women who develop preeclampsia is not known. Some scientists and health care providers estimate that preeclampsia affects 5% to 10% of all pregnancies globally. The rates are lower in the United States (about 3% to 5% of women), but it is estimated to account for 40% to 60% of maternal deaths in developing countries. Disorders related to high blood pressure are the second leading cause of stillbirths and early neonatal deaths in developing nations.

In addition, HELLP syndrome occurs in about 10% to 20% of all women with severe preeclampsia or eclampsia.

Risk Factors for Preeclampsia

Preeclampsia occurs primarily in first pregnancies. Other factors that can increase a woman's risk include:

• Chronic high blood pressure or kidney disease before pregnancy

• High blood pressure or preeclampsia in an earlier pregnancy

• Obesity

• Women who are younger than age 20 or older than 35

• Women who are pregnant with more than one fetus

• Being African American

• Having a family history of preeclampsia

According to the World Health Organization, among women who have had preeclampsia, about 20% to 40% of their daughters and 11% to 37% of their sisters also will get the disorder.

Preeclampsia is more common among women who have histories of certain health conditions, such as migraine headaches diabetes , rheumatoid arthritis, lupus, scleroderma, urinary tract infection, gum disease, polycystic ovary syndrome, multiple sclerosis, gestational diabetes, and sickle cell disease.

Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro fertilization.

What are the symptoms of preeclampsia, eclampsia, & HELLP syndrome?

Preeclampsia

Possible symptoms of preeclampsia include:

• High blood pressure

• Too much protein in the urine

• Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem)

• Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain

Eclampsia

Women with preeclampsia can develop seizures. The following symptoms are cause for immediate concern¹:

• Severe headache

• Vision problems, such as temporary blindness

• Abdominal pain, especially in the upper right area of the belly

• Nausea and vomiting

• Smaller urine output or not urinating very often

HELLP Syndrome

HELLP syndrome can lead to serious complications, including liver failure and death.¹

A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine.

How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome?

A health care provider should check a pregnant woman's blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other abnormalities.

Gestational hypertension is diagnosed if the woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women with normal blood pressure levels before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can develop into preeclampsia.

Mild preeclampsia is diagnosed when a pregnant woman has:

• Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher

• Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours)

Severe preeclampsia occurs when a pregnant woman has:

• Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 6 hours apart

• Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart

• Test results suggesting blood or liver damage—for example, blood tests that reveal low numbers of red blood cells, low numbers of platelets, or high liver enzymes

• Symptoms that include severe weight gain, difficulty breathing, or fluid buildup

Eclampsia occurs when women with preeclampsia develop seizures.

A health care provider may do other tests to assess the health of the mother and fetus, including:

• Blood tests to see how well the mother's liver and kidneys are working

• Blood tests to check blood platelet levels to see how well the mother's blood is clotting

• Blood tests to count the total number of red blood cells in the mother's blood

• A maternal weight check

• An ultrasound to assess the fetus's size

• A check of the fetus's heart rate

• A physical exam to look for swelling in the mother's face, hands, or legs as well as abdominal tenderness or an enlarged liver

HELLP syndrome  is diagnosed when laboratory tests show hemolysis, elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine.

What are the treatments for preeclampsia, eclampsia, & HELLP syndrome?

Preeclampsia

The only cure for preeclampsia when it occurs during pregnancy is delivering the fetus. Treatment decisions need to take into account the severity of the condition and the potential for maternal complications, how far along the pregnancy is, and the potential risks to the fetus. Ideally, the health care provider will minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.

If the fetus is at 37 weeks or later, the health care provider will usually want to deliver it to avoid further complications.

If the fetus is younger than 37 weeks, however, the woman and her health care provider may want to consider other options that give the fetus more time to develop, depending on how severe the condition is. A health care provider may consider the following treatment options:

• If the preeclampsia is mild, it may be possible to wait to deliver the infant. To help prevent further complications, the health care provider may ask the woman to go on bed rest (to try to lower blood pressure and increase the blood flow to the placenta).

• Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see f the preeclampsia is progressing (such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels). Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment.

• Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.

• In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.

When a woman has severe preeclampsia, the doctor will probably want to deliver the fetus as soon as possible. Delivery usually is suggested if the pregnancy has lasted more than 34 weeks. If the fetus is less than 34 weeks, the doctor will probably prescribe corticosteroids to help speed up the maturation of the lungs.

In some cases, the doctor must deliver the fetus prematurely, even if that means likely complications for the infant because of the risk of severe maternal complications The symptoms of preeclampsia usually go away within 6 weeks of delivery.

Eclampsia

Eclampsia—the onset of seizures in a woman with preeclampsia—is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother’s seizures; treat blood pressure levels that are too high; and deliver the infant.

Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure.

The only cure for gestational eclampsia is to deliver the fetus.

HELLP Syndrome

HELLP syndrome, a special type of severe preeclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The health care provider may consider the following treatments after a diagnosis of HELLP syndrome:

• Delivery, particularly if the pregnancy is 34 weeks or later

• Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.

Preeclampsia and Eclampsia: Other FAQs

Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information section. In addition, Frequently Asked Questions (FAQs) that are specific to a certain topic are answered in this section.

• If I have high blood pressure, can I take steps to prevent problems like preeclampsia during pregnancy?

• If I had preeclampsia with a previous pregnancy, will I have it again in later pregnancies?

If I have high blood pressure, can I take steps to prevent problems like preeclampsia during pregnancy?

There is no known way to prevent preeclampsia. However, you can take steps to lower your risk.

If you currently have chronic hypertension (high blood pressure not due to pregnancy), you may be at higher-than-average risk for getting preeclampsia during pregnancy. Your risk is also higher if you had gestational hypertension (high blood pressure that occurs only during pregnancy) or preeclampsia with a previous pregnancy, if you are obese, or if you have other risk factors.

Talk with your health care provider about how hypertension might affect your pregnancy and what you can do to lower your risk of complications.

Before You get Pregnant

• Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight.

• If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Your health care provider may be able to recommend safer alternatives.

While You are Pregnant

• Be sure to get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks.

• Avoid alcohol and tobacco.

• Talk with your doctor about any drugs or supplements, including vitamins and herbs, that you take or are thinking of taking. 

If I had preeclampsia with a previous pregnancy, will I have it again in later pregnancies?

If you had preeclampsia during your first pregnancy, your risk of developing preeclampsia again is about 15%. Your risk is even higher if you delivered your first child before 28 weeks of pregnancy or if you are overweight or obese.

Your risk of having preeclampsia again is also higher if you developed preeclampsia early in your previous pregnancy, if you developed chronic hypertension or diabetes after the first pregnancy, or if you had in vitro fertilization or are carrying more than one fetus. Having severe preeclampsia or HELLP syndrome during the first pregnancy also raises your risk.

If you had HELLP syndrome during a pregnancy, you have about a 25% chance of getting it again.

Source: NICHD, NIH

Breastfeeding and Breast Milk: Overview

Breastfeeding provides an infant with essential calories, vitamins, minerals, and other nutrients for optimal growth, health, and development. Breastfeeding is beneficial to both a mother and her infant and also offers an important opportunity for the pair to bond. The NICHD supports many areas of breastfeeding research, including studies of the benefits of breastfeeding and breast milk, the social and cultural impacts of breastfeeding, and the nutritional components and mechanisms of disease related to breastfeeding and breast milk.

Common Names

• Breastfeeding

• Nursing

• Suckling

Medical or Scientific Name

• Breastfeeding

• Lactation

Breastfeeding and Breast Milk: Condition Information

Breastfeeding, also called nursing, is the process of feeding human breast milk to an infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant. Breastfeeding and breast milk provide an infant with essential calories and nutrients.

According to the American Academy of Pediatrics (AAP) Policy Statement on Breastfeeding, women who don't have health problems should exclusively breastfeed their infants for at least the first 6 months of life.

The AAP suggests that a woman should try to breastfeed her infant for the first 12 months of life because of the benefits to both the mother and the infant.

Although breastfeeding is the recommended method for feeding infants, and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D. The current AAP-recommended daily vitamin D intake is 400 IU per day for all infants and children beginning from the first few days of life. Human breast milk contains a vitamin D concentration of 25 IU per liter (about 4 cups) or less. Therefore, to meet the 400 IU daily requirement, supplementation is required.

What are the benefits of breastfeeding?

Benefits to the Infant:

The benefits to infants from either breastfeeding or receiving expressed breast milk are:

• Nutritionally balanced meals

• Protection against common childhood illnesses and infections

• Better survival during the first year of life, including lower risk of Sudden Infant Death Syndrome

• Less chance of developing some allergic diseases

• Less chance of developing type 1 diabetes

• Physical and emotional benefits of breastfeeding directly from the mother's breast due to skin-to-skin contact

Indirect evidence suggests that overweight and obesity occur less often among children who were breastfed.In addition, research has shown a connection between breastfeeding and better cognitive development in children through school age. More research is needed to understand whether these cognitive effects are from the chemical contents of the human milk or from other factors, such as the increased interaction between the mother and child while nursing.

Benefits to the Mother

Mothers also benefit from breastfeeding in many ways, including:

• Less blood loss following childbirth and improved healing

• Improved postpartum weight loss

• Emotional benefits from close interaction with the infant

• Lower likelihood of experiencing postpartum depression, which is seen more often in new mothers who do not breastfeed

• Less chance of developing certain health conditions, such as rheumatoid arthritis, cardiovascular disease, and certain cancers (for example, breast cancer)

• Physical and emotional benefits of breastfeeding directly from a mother's breast due to skin-to-skin contact with her infant

Economic Benefits

In the United States, breastfeeding also results in economic savings.

• Families with infants who are breastfed save hundreds of dollars per year that might otherwise be spent on infant formula.

• Improved overall health of breastfed infants could mean that fewer insurance claims are filed and fewer medical services are needed.

• Fewer illnesses in breastfed infants also could mean that employees who are parents take fewer sick days to stay home and care for ill infants.

• Fewer premature deaths of breastfed infants could mean a savings associated with the funeral costs and lost work days of the parents when an infant passes away prematurely.

What are the recommendations for breastfeeding?

For women in the U.S., the American Academy of Pediatrics (AAP) currently recommends:

• Infants should be fed breast milk exclusively for the first 6 months of life. Exclusive breastfeeding means that the infant does not receive any additional foods (except vitamin D) or fluids unless medically recommended.

• After the first 6 months and until the infant is 1 year old, the AAP recommends that the mother continue breastfeeding while gradually introducing solid foods into the infant's diet.

• After one year, breastfeeding can be continued if mutually desired by the mother and her infant.

The World Health Organization currently recommends as a global public health recommendation that:

• Infants be exclusively breastfed for the first 6 months of life to achieve optimal growth, development, and health.

• After the first 6 months, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond.

Recommendations to support breastfeeding

While 75% of new mothers start out breastfeeding, only 13% of them still exclusively breastfeed by the time their infants are 6 months old. Many factors influence a mother’s successful breastfeeding, including support from medical professionals, her family and community, and her job. The 2013 Surgeon General’s Call to Action to Support Breastfeeding makes 20 recommendations to support new mothers in their decision to breastfeed.

How do I breastfeed?

There are many mothers' groups, health organizations, and health care provider associations that provide very detailed information and support on how to breastfeed. The following overview is provided for information only—it is not meant to take the place of a health care provider or lactation consultant's advice or recommendation. Visit the Resources and Publications section to find the names of some breastfeeding organizations.

Know When to Feed Your Infant
Breastfeeding Tips: How to Get Off to a Good Start
Bring Your Infant to Your Breast to Latch
Signs of a Good Latch
How to End a Breastfeeding Sessions
How Long Should a Breastfeeding Session Last?

Know When to Feed Your Infant

Infants who are hungry will nuzzle against their mother's breast and make sucking motions or will put their hands in their mouths. During the first weeks of an infant's life, you may nurse your infant often, perhaps as often as eight to 12 times in 24 hours.

Breastfeeding Tips: How to Get Off to a Good Start

After your infant is born, follow these tips for getting started:

• Breastfeed your infant for the first time as soon as possible after the infant is born.

• Ask at the hospital whether an on-site lactation consultant is available to assist you.

• Request that the hospital staff not feed your infant any other foods or formula unless it is medically necessary.

• Allow your infant to stay with you throughout the day and night at the hospital so that you can breastfeed often. If this is not possible, ask the nurses to bring your infant to you each time for breastfeeding.

• Avoid giving your infant pacifiers or artificial nipples so that the infant gets used to latching on to just your breast. 

Bring Your Infant to Your Breast to Latch

Infants will naturally move their head while looking and feeling for a breast to feed. There are many ways to start feeding your infant, and the best approach is the one that works for you and your infant. The steps below can help with getting your infant to "latch" on to the breast for feeding.

• Hold your infant against your bare chest. Dress your infant in only a diaper to ensure skin-to-skin contact.

• Keep your infant upright, with his or her head directly under your chin.

• Support your infant's neck and shoulders with one hand and his or her hips with your other hand. Your infant may try to move around to find your breast.

• Your infant's head should be slightly tilted back to make nursing and swallowing easier. When his or her head is tilted back and the mouth is open, the tongue will naturally be down in the mouth to allow the breast to go on top of it.

• At first, allow your breast to hang naturally. Your infant may open his or her mouth when your nipple is near his or her mouth. You also can gently guide the infant to latch on to your nipple.

• While your infant is feeding, his or her nostrils may flare to breathe in air. Do not panic—this flaring is normal. Your infant can breathe normally while breastfeeding.

• As your infant tilts backward, support his or her upper back and shoulders with the palm of your hand and gently pull your infant close. 

Signs of a Good Latch

A good latch is important for both effective breastfeeding and your own comfort. Review the following signs to determine whether your infant has a good latch:

• The latch feels comfortable and does not hurt or pinch. How it feels is a more important sign of a good latch than how it looks.

• Your infant does not need to turn his or her head while feeding. His or her chest is close to your body.

• You see little or no areola (pronounced uh-REE-uh-luh), which is the dark-colored skin on the breast that surrounds the nipple. Depending on the size of your areola and the size of your infant's mouth, you may see a small amount of areola. If more areola is showing, it should seem that more is above your infant's lip and less is below.

• Your infant's mouth will be filled with breast when in the best latch position.

• Your infant's tongue is cupped under the breast, although you might not see it.

• You can hear or see your infant swallowing. Because some babies swallow so quietly, the only way of knowing that they are swallowing is when you hear or see a pause in their breathing.

• Your infant's ears "wiggle" slightly.

• Your infant's lips turn outward, similar to fish lips, not inward. You may not even see your infant's bottom lip.  

• Your infant's chin touches your breast. 

How to End a Breastfeeding Session

To break the suction and end a breastfeeding session, insert a clean finger between your breast and your infant's gums. After you hear a soft pop, pull your nipple out of your infant's mouth.

How long should a breastfeeding session last?

You should allow your infant to set his or her own nursing pattern. Many newborns will feed for 10 to 15 minutes on each breast. If your infant wants to nurse for a much longer period—say 30 minutes or longer on each breast—he or she may not be getting enough milk.

For more information on learning how to breastfeed your infant at the Office on Women's Health.

What is weaning and how do I do it?

Weaning is the process of switching an infant's diet from breast milk or formula to other foods and fluids. In most cases, choosing when to wean is a personal decision. It might be influenced by a return to work, the mother's or infant's health, or just a feeling that the time is right.

Weaning an infant is a gradual process. The American Academy of Pediatrics (AAP) recommends feeding infants only breast milk for the first 6 months of life. After 6 months, the AAP recommends a combination of solid foods and breast milk until the infant is at least 1 year old.  The Academy advises against giving cow's milk to children under 1 year old.

You may have difficulty determining how much to feed your child and when to start introducing solid foods. The general guidance below, as reported by the National Library of Medicine, demonstrates the process of weaning for infants up to 6 months of age. You should speak with your infant's health care provider before attempting to wean your infant to make sure that he or she is ready for weaning and for complete guidance on weaning.

• Birth to 4 months of age

  • During the first 4 to 6 months of life, infants need only breast milk or formula to meet their nutritional needs.

    • If breastfeeding, a newborn may need to nurse eight to 12 times per day. By 4 months of age, an infant may need to nurse only four to six times per day.

    • By comparison, formula-fed infants may need to be fed about six to eight times per day, with newborns consuming about 2 to 3 ounces per feeding. The number of feedings will decrease as the infant gets older, similar to breastfeeding.

• 4 to 6 months of age

  • • At 4 to 6 months of age, an infant needs to consume 28 to 45 ounces of breast milk or formula per day and often is ready to start being introduced to solid food.

    • Starting solid foods too soon can be hazardous, so an infant should not be fed solid food until he or she is physically ready.

    • Start solid feedings (1 or 2 tablespoons) of iron-fortified infant rice cereal mixed with breast milk or formula, stirred to a thin consistency.

    • Once the infant is eating rice cereal regularly, you may introduce other iron-fortified instant cereals.

    • Only introduce one new cereal per week so that intolerance or possible allergies can be monitored.

For more information on weaning your infant, visit the following page:
http://www.nlm.nih.gov/medlineplus/ency/article/002455.htm

What are the DGAs for Moms & Infants?

• How many calories do I need to take in when I am breastfeeding?

• How many calories does my infant need?

How many calories do I need to take in when I am breastfeeding?

Many new mothers wonder if they need to consume more calories (also called energy) during breastfeeding, but the answer is no. You can take in the same number of calories that you did before becoming pregnant. This strategy helps with weight loss after birth.

TheDGAs for caloric intake for all women 19 to 45 years old are as follows:

• Sedentary: 1,800 to 2,000 calories per day

• Moderately active: 2,000 to 2,500 calories per day

• Active: 2,200 to 2,400 calories per day

The increased caloric need for women who are breastfeeding is about 450 to 500 calories per day. Women who are not trying to lose weight following pregnancy should supplement the above DGA calories per day by 450 to 500 calories. Often an increase in a normally balanced and varied diet is enough to meet your body's needs. Whether or not to increase caloric intake during breastfeeding is a decision that should be made with the assistance of a health care provider.

Poorly nourished mothers, those on vegan diets or other special diets, and those with certain health conditions may require a supplement of docosahexaenoic acid (DHA) in addition to multivitamins to ensure complete nutrition for breastfeeding.

Women who are breastfeeding may have additional requirements for vitamins and minerals. Learn more about your specific nutritional needs during breastfeeding at ChooseMyPlate.gov.

Women also can use the U.S. Department of Agriculture's (USDA's) Daily Food Plan for Moms to develop a personalized food plan based on their activity level, amount of breastfeeding, age, and other characteristics.     

How many calories does my infant need?

The estimated energy requirements (in calories per day) for infants are based on their age, size, and sex. Estimated energy requirements developed by the USDA are as follows:

Males

• 1 to 3 months: 472 to 572 calories per day

• 4 to 6 months: 548 to 645 calories per day

• 7 to 9 months: 668 to 746 calories per day

• 10 to 12 months: 793 to 844 calories per day

Females

• 1 to 3 months: 438 to 521 calories per day

• 4 to 6 months: 508 to 593 calories per day

• 7 to 9 months: 608 to 678 calories per day

• 10 to 12 months: 717 to 768 calories per day

The above daily calorie ranges are for infants of a specific weight and length. The USDA has information on how to find out the daily calorie needs of your infant based on his or her size (PDF - 237 KB). 

The USDA also has determined the daily protein, carbohydrate, and fat requirements for infants (PDF - 237 KB).

The DGAs for infants increase as the infants get older. By the time that children are 2 to 3 years of age, daily calorie needs are 1,000 to 1,400 calories per day, depending on the child's activity level. For children who are older, see the 2010 DGAs.

Are there any special conditions or situations in which I should not breastfeed?

In special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply.

• Medications/other drugs and breastfeeding

• Health conditions and breastfeeding

• International guidelines on HIV/AIDS and breastfeeding

• Other considerations and breastfeeding

Medications/Other Drugs and Breastfeeding

Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should not breastfeed and should speak with their health care providers before considering breastfeeding:

• Antiretroviral medications (for HIV/AIDS treatment)

• Anxiety medications

• Birth-control medications containing estrogen

• Cancer chemotherapy agents

• Illegal drugs

• Migraine medications prescribed to treat migraines, such as ergot alkaloids

• Mood stabilizers, such as lithium and lamotrigine

• Sleep-aid medicines

In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding.

The above list of medications and other drugs is only a guideline. Before breastfeeding, you should speak with your health care provider about all medications that you are taking. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.

Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed.

Contact your infant's health care provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness. 

Health Conditions and Breastfeeding

Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.

If you have any of the following conditions, speak with your health care provider before breastfeeding your infant:⁵

• Infection with human immunodeficiency virus (HIV)

• Infection with human T-cell lymphotropic virus type I or type II

• Untreated, active tuberculosis

If you are sick with the flu, including the H1N1 flu (also called the swine flu), you should not stop feeding your infant expressed milk. You should avoid being near your infant, however, so that you do not infect him or her. To avoid infecting your infant, someone who is not sick should give your infant your expressed milk. 

International Guidelines on HIV/AIDS and Breastfeeding

The potential for HIV transmission to an infant during breastfeeding has been known for some time. Recommending against breastfeeding is not a simple solution, however, because breastfeeding is beneficial to both a mother and her infant. Reducing HIV transmission, while simultaneously ensuring improved HIV-free infant survival, is one of the most pressing issues of HIV/AIDS research

World Health Organization (WHO) guidelines currently recommend that an HIV-infected mother who is breastfeeding should also take antiretroviral drugs, which help prevent HIV transmission to her infant. In addition, it is recommended that HIV-infected mothers breastfeed exclusively for 6 months, and continue thereafter up to 12 months while solid foods are introduced. 

Other Considerations and Breastfeeding

In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding.

• Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes may need to eat slightly more food while they breastfeed to prevent their blood sugar levels from dropping. Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding.

• Women who have had breast surgery in the past may face some difficulties with breastfeeding.

• Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed.

• Infants who have galactosemia—a rare metabolic disorder in which the body cannot digest the sugar galactose—should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.

How do I pump & store breast milk?

• Pumping breast milk

• Storing breast milk

Pumping Breast Milk

There are many mothers' groups, health organizations, and health care provider associations that provide very detailed information and support on how to pump breast milk. The following overview is provided for information only—it is not meant to take the place of a health care provider or lactation consultant's advice or recommendation. Visit the Resources and Publications section to find organizations that provide information on pumping breast milk.

If you are unable to breastfeed your infant directly, it is important to remove milk during the times that you would normally feed your infant. Removing milk from your breasts is called expressing the milk. Expressing milk will help you to continue making milk.

Before expressing breast milk, wash your hands thoroughly. Only express milk when you are in a clean area. You do not need to wash your breasts or nipples before expressing milk. If you need help to get your milk flowing, placing an item of your infant's near to you often works.

There are three methods for expressing your breast milk:

• Hand expression: For hand expression, you use your hand to manually massage and compress your breast to remove milk. 

• Manual pump: To operate a manual pump, you use your hand and wrist to operate a hand-held pumping device that removes milk from your breast. 

• Electric breast pump: An electric breast pump runs on a battery or through an outlet plug. It can pump milk from one breast or from both breasts at the same time.

For more information on pumping breast milk, visit the Office on Women’s Health page on pumping and milk storage. 

Storing Breast Milk

Breast milk can be stored in clean glass bottles or hard, BPA-free plastic bottles with tight-fitting lids. After pumping, refrigerate or freeze milk immediately. You should store milk in small batches (2 to 4 ounces), depending on the amount that you normally feed your infant at one time.

For refrigeration, storage for as long as 5 to 8 days is acceptable only for very clean expressed milk. If freezing, store the milk in small (2-ounce to 4-ounce) batches. Frozen milk is good for 3 to 6 months. After thawing, use milk within 24 hours and do not refreeze it because of the risk of contamination.

For more information on pumping and storing breast milk, including recommended storage temperatures, visit these pages:

• Pumping and milk storage, at the Office of Women's Health webpage

• Proper handling of breast milk, at the Centers for Disease Control and Prevention webpage

• La Leche League International

Do breastfed infants need other nutrition?

• What is vitamin D supplementation for infants?

• When to supplement breastfeeding

• Mixing formula with breast milk

What is vitamin D supplementation for infants?

Although breastfeeding is the recommended method for feeding infants and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D. Vitamin D is required to prevent rickets, a type of vitamin D deficiency. This disease is rare among breastfed infants but can occur if vitamin supplementation or exposure to sunlight is inadequate. (Exposure to sunlight helps the body to make vitamin D in place of supplementation.)

The current AAP-recommended daily vitamin D intake is 400 IU per day for all infants and children beginning from the first few days of life. Human breast milk contains a vitamin D concentration of 25 IU per liter (about 4 cups) or less. Therefore, to meet the 400 IU daily requirement, supplementation is required.

If an infant is weaned to a vitamin D-fortified infant formula and consumes at least 4 cups per day, then additional supplementation with vitamin D is not necessary. 

When to Supplement Breastfeeding

Breastfeeding is supplemented by feeding an infant expressed breast milk from a bottle, formula, or breast milk from another mother. Such supplementation may be needed in the following situations:

In the Mother:

• Breast surgery or other trauma

• Primary breast insufficiency that prevents adequate milk production

• Physical separation from the infant

• Serious illness

In the Infant:

• Weight gain insufficient to maintain health (also sometimes called failure to thrive)

• Cleft lip and/or palate or other abnormality that prevents normal suckling ability

• Jaundice or liver problems

• Serious illness or prematurity that requires the infant to be cared for in a special nursery

Many of these conditions require a health care provider's care. You should always talk with your child's health care provider about whether to supplement your breastfeeding.

To keep supplementation from shortening or otherwise interfering with breastfeeding, you should supplement only after your infant is breastfeeding effectively and thriving on your breast milk. 

Mixing Formula with Breast Milk

Mixing formula with breast milk in the same container is one way of supplementing breast milk.  You may want to supplement your breast milk with infant formula if your milk supply is low or when you are physically separated from your infant.

Supplementing your breast milk with formula, however, may not be nutritionally the same as giving breast milk. Discuss the practice with your infant's health care provider before starting to mix formula with your breast milk.

Breast Feeding and Breast Milk: Other FAQs

Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information section. In addition, Frequently Asked Questions (FAQs) that are specific to a certain topic are answered in this section.

When should I breastfeed my infant?
What should I know about formula?
How do I breastfeed when I am traveling?
What are breast milk banks and when are they used?
What do I need to know about breastfeeding at work?
What are some common breastfeeding myths?
Should I breastfeed my infant if he or she is born preterm or at a low birth weight?
Should I breastfeed my twins (or triplets)?

When should I breastfeed my infant?

Healthy infants will develop their own feeding schedules, and you should follow your infant's cues for when he or she is ready to eat. Feedings may last 15 to 20 minutes or longer per breast. There is no set length of feeding—your infant will let you know when he or she is finished.

The number of times that you breastfeed your infant per day and the time of day depend on your infant's age and the infant's preference. A newborn will need to be fed eight to 12 times per day. This means that your infant will likely need to breastfeed about every hour or two in the daytime and a couple of times at night during the first few days after birth.³

What should I know about formula?

Breast milk is the optimal source of nutrition for infants. The American Academy of Pediatrics (AAP) recommends iron-fortified infant formula as an appropriate alternative during the first year of life, when breast milk is not available.

A variety of formulas are sold for infants who are not breastfed or who are partially breastfed.

Formulas include:

• Cow's milk–based formulas and soy-based formulas, which are fortified with iron

• Hypoallergenic formulas for those with or at risk for allergic conditions

• Other formulas designed to meet certain dietary needs, such as galactose-free formulas

Infants who drink enough formula and are gaining weight appropriately usually do not need extra vitamins or minerals, as long as the formula is fortified with vitamin D and iron. Your health care provider may prescribe extra fluoride if the infant formula is mixed with non-fluoridated water.

Infant formulas can be purchased in the following forms:

• Ready to use: Do not need to be mixed with water

• Powdered: Must be mixed with water

• Concentrated liquid: Must be mixed with water

The U.S. Food and Drug Administration (FDA) closely monitors infant formulas to make sure they meet certain standards of nutrition for infants.

Visit the FDA's webpage FDA 101: Infant Formula to learn more about infant formulas, nutritional specifications, and safety: Visit the AAP's policy on breastfeeding to learn more about infant formula recommendations:
http://pediatrics.aappublications.org/content/129/3/e827.full

How do I breastfeed when I am traveling?

You should always speak with your infant's health care provider before traveling for additional guidance on breastfeeding your infant while you are traveling.

You may find that breastfeeding is easier than bottle-feeding during traveling. Some things to keep in mind while traveling with your infant include the following:

• In extremely hot environments, you do not need to supplement a breastfed infant with water. Breast milk contains the right balance of water as long as you are feeding at regularly spaced intervals that are consistent with your normal feedings.

• Consider taking along a sling or other soft infant carrier to make nursing or carrying your infant easier, particularly if you need to stand for extended periods.

• If you are planning to be away from your child for an extended period, you should express and store a supply of breast milk.

• If you have a flexible schedule while traveling, take regular breaks to express breast milk to ensure an adequate supply during the trip.

• Expressed breast milk should be stored in clean, tightly sealed containers. Breast milk may be stored and transported under refrigeration, frozen, or on dry ice.

• Freshly expressed breast milk is safe for infant consumption for 6 to 8 hours when stored at room temperature.

• Fresh breast milk can be safely stored in a cooler bag with frozen ice packs for up to 24 hours.

• Refrigerated breast milk can be stored for up to 5 days.

For more information on traveling with your breastfeeding infant, visit the following Centers for Disease Control and Prevention webpage:
http://www.cdc.gov/breastfeeding/recommendations/travel_recommendations.htm.

La Leche League Internationalalso provides information and tips on breastfeeding while traveling.

What are breast milk banks and when are they used?

Breast milk banks supply fresh breast milk to those who need it. There are many reasons that a mother may need to use banked milk. For example, she may not produce enough milk to satisfy the nutritional needs of her infant. Or she may have an illness or other condition that prevents her from feeding her infant.

If you are considering feeding your infant milk from a milk bank, you should be aware of the possible health and safety risks to your infant. If a donating mother has not been properly screened, risks to an infant receiving the milk include exposure to infectious diseases, including HIV, and chemical contaminants such as illegal and prescription drugs. Discuss your choices with your infant's health care provider.

The Food and Drug Administration (FDA) recommends against feeding your infant breast milk acquired directly from another person or through the Internet. Milk purchased through the Internet is likely to be contaminated with potentially harmful bacteria. The FDA recommends that if you decide to feed an infant with human milk from a source other than the mother, such as from a milk bank, you ensure that the source has screened its milk donors and taken safety precautions, such as proper handling to prevent contamination.

For more information on milk banking and how to contact a milk bank, visit the Human Milk Banking Association of North America's website: https://www.hmbana.org

What do I need to know about breastfeeding at work?

National laws in the United States require employers to provide a reasonable break time for an employee to express breast milk for her nursing child for one year after the child's birth. There is no set limit for the number of times that an employee can express breast milk during a given day.

Employers are also required to provide a place other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, to be used by an employee to express breast milk. Special rooms provided by employers for mothers to express their breast milk during work hours are called lactation rooms.

For more information on specific breastfeeding laws in your state, including employer requirements, visit http://www.ncsl.org/issues-research/health/breastfeeding-state-laws.aspx .

Also visit http://www.womenshealth.gov/breastfeeding/going-back-to-work.php for information on breastfeeding and returning to work.

What are some common breastfeeding myths?

Common myths about breastfeeding can lead to confusion and uncertainty about the right way to breastfeed.

• Myth 1: Frequent nursing leads to poor milk production, weak let-down of milk, and unsuccessful nursing.

• Fact: Milk supply is best when a healthy infant is breastfed as often as he or she indicates the need. The body's response to hormones that help push milk out of the breast is strongest in the presence of a good supply of milk, which usually occurs when a mother feeds based on an infant's cue.

• Myth 2: Infants get all the milk they need in the first 5 to 10 minutes of breastfeeding.

• Fact: While many older infants can take in the majority of their milk in the first 5 to 10 minutes, this is not true for all infants. Newborns are not always efficient at nursing and may need longer to feed. An infant's ability to take in milk is also subject to the quality of the milk ejection. Some nursing mothers may eject their milk in small batches several times during a nursing session. Rather than guessing, it is best to allow the infant to nurse until he or she shows signs of fullness and satiety, such as self-detachment from the breast and relaxed hands and arms.

• Myth 3: A breastfeeding mother should space her feedings so that her breasts will have time to refill.

• Fact: Every infant-mother pair is unique. A nursing mother's body is always making milk. A mother's breasts hold an amount that is unique to her, some holding more, some less. The emptier the breast, the faster the body makes milk to replace what has been consumed or removed; the fuller the breast, the more the production of milk slows down. If a mother consistently waits until she thinks her breasts have "filled up" before she nurses, her body may get the message that it is making too much milk and may respond by reducing total milk production.

• Myth 4: Colostrum (the first milk) is bad for the baby.

• Fact: Colostrum actually is very helpful in promoting a newborn's health. It contains essential nutrients, provides immune factors, and supports the development of a newborn's digestive system.

For more information, visit the Common Breastfeeding Myths page of the La Leche League International website.

Should I breastfeed my infant if he or she is born preterm or at a low birth weight?

Breastfeeding is extremely important for a preterm infant. If your child is born preterm, your milk will be higher in protein and other nutrients than the milk produced by the mother of an infant born at full term. A preterm infant is an infant who is born before 37 weeks of pregnancy.

Because a preterm infant is generally smaller than a term infant, it may be difficult to position your child correctly for feeding. Certain positions, such as the "cross-cradle hold," are recommended for positioning preterm infants at the breast for feeding. Visit the La Leche League website for more information on this hold and positioning your preterm infant.

Some infants who are born preterm may not be able to breastfeed at first, but they do benefit from expressed breast milk. A new mother's breast milk contains colostrum, which has certain nutrients and immune factors. To make sure that your newborn receives your colostrum, even if he or she is too small to breastfeed, you should express your colostrum by hand or pump as soon as you can in the hospital. Ask a nurse or other health care specialist to provide you with a clean container for your expressed breast milk to feed to your newborn as soon as possible after birth.

Should I breastfeed my twins (or triplets)?

If you give birth to twins or triplets, the benefits of breastfeeding to you and your children are the same as for all mothers and infants. Some women think that breastfeeding more than one infant will be overwhelming; however, it can be done with special planning and preparation.

Most mothers are able to make plenty of milk for twins. Many mothers of triplets (three infants) or quadruplets (four infants) are able to provide enough milk to breastfeed their infants completely or partially. When a mother breastfeeds partially, she supplements her breast milk with human milk from another source or with an infant formula.

For more information on breastfeeding multiple infants, visit the HHS Office of Women's Health resources on breastfeeding and special situations.

Source: NICHD, NIH

Birth Control Methods

• What is the best method of birth control (or contraception)?

• What are the different types of birth control?

• Can all types of birth control prevent sexually transmitted infections (STIs)?

• How well do different kinds of birth control work? Do they have side effects?

• Where can I get birth control? Do I need to see a doctor?

• Are there any foams or gels I can use to keep from getting pregnant?

• How effective is withdrawal as a birth control method?

• Everyone I know is on the pill. Is it safe?

• Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

• I've heard my girlfriends talking about dental dams — what are they?

• More information on birth control methods

What is the best method of birth control (or contraception)?

There is no "best" method of birth control. Each method has its pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn't easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about:

• Your overall health

• How often you have sex

• The number of sex partners you have

• If you want to have children someday

• How well each method works to prevent pregnancy

• Possible side effects

• Your comfort level with using the method

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.

What are the different types of birth control?

You can choose from many methods of birth control. They are grouped by how they work:

Types of birth control

• Continuous abstinence

• Natural family planning/rhythm method

• Barrier methods

• Contraceptive sponge

• Diaphragm, cervical cap, and cervical shield

• Female condom

• Male condom

• Hormonal methods

• Oral contraceptives — combined pill ("The pill")

• Oral contraceptives — progestin-only pill ("Mini-pill")

• The patch

• Shot/injection

• Vaginal ring

• Implantable devices

• Implantable rods

• Intrauterine devices

• Permanent birth control methods

• Sterilization implant

• Surgical sterilization

• Emergency contraception

Detailed information on each type is provided in the following charts. Talk with your doctor if you have questions about any of the choices.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.

Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Here is a list of some birth control methods with their failure rates and possible side effects.

Where can I get birth control? Do I need to see a doctor?

Where you get birth control depends on what method you choose.

You can buy these forms over the counter:

• Male condoms

• Female condoms

• Sponges

• Spermicides

• Emergency contraception pills (girls younger than 17 need a prescription)

You need a prescription for these forms:

• Oral contraceptives: the pill, the mini-pill

• Skin patch

• Vaginal ring

• Diaphragm (your doctor needs to fit one to your shape)

• Cervical cap

• Cervical shield

• Shot/injection (you get the shot at your doctor's office)

• IUD (inserted by a doctor)

• Implantable rod (inserted by a doctor)

You will need surgery or a medical procedure for:

• Sterilization, female and male

Are there any foams or gels I can use to keep from getting pregnant?

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:

• Foam

• Gel

• Cream

• Film

• Suppository

• Tablet

Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.

Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.

All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

How effective is withdrawal as a birth control method?

Not very! Withdrawal is when a man takes his penis out of a woman's vagina (or "pulls out") before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. "Pulling out" can be hard for a man to do. It takes a lot of self-control.

Even if you use withdrawal, sperm can be released before the man pulls out. When a man's penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.

Withdrawal does not protect you from STIs or HIV.

Everyone I know is on the pill. Is it safe?

Today's pills have lower doses of hormones than ever before. This has greatly lowered the risk of side effects. But there are still pros and cons with taking birth control pills. Pros include having:

• More regular and lighter periods

• Fewer menstrual cramps

• A lower risk of ovarian and endometrial cancers, pelvic inflammatory disease (PID), noncancerous ovarian cysts, and iron deficiency anemia

Cons include a higher chance, for some women, of:

• Heart disease, high blood pressure, and blood clots

• Nausea, headaches, sore breasts, and weight gain

• Irregular bleeding

• Depression

Many of these side effects go away after taking the pill for a few months. Women who smoke, are older than 35, or have a history of blood clots or breast or endometrial cancer are more at risk of bad side effects and may not be able to take the pill. Talk with your doctor about whether the pill is right for you.

Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

No, they won't protect you. Birth control pills and most other birth control methods will not protect you from STIs, including HIV (the virus that causes AIDS). They only protect against pregnancy.

The male latex condom is the best birth control method that also can protect you from STIs, including HIV. If you are allergic to latex, polyurethane condoms are a good alternative. If your partner can't or won't use a male condom, female condoms also create a barrier that can help protect you from STIs.

It is important to only use latex or polyurethane condoms to protect you from STIs. "Natural" or "lambskin" condoms have tiny pores that may allow for the passage of viruses like HIV, hepatitis B, and herpes. If you use non-lubricated male condoms for vaginal or anal sex, you can add lubrication with water-based lubricants (like K-Y jelly) that you can buy at a drug store. Never use oil-based products, such as massage oils, baby oil, lotions, or petroleum jelly, to lubricate a male condom. These will weaken the condom, causing it to tear or break. Use a new condom with each sex act.

I've heard my girlfriends talking about dental dams — what are they?

The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STIs, including HIV, during oral-vaginal or oral-anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores.

More information on birth control methods

• American College of Obstetricians and Gynecologists
  Phone: 800-762-2264 x 349 (for publications requests only)

• Food and Drug Administration
  Phone: 888-463-6332

• Planned Parenthood Federation of America
  Phone: 800-230-7526

• Population Council
  Phone: 212-339-0500

Source: Office on Women's Health, HHS