Understanding Pregnancy

Pregnancy: Overview

Pregnancy is a period of up to 41 weeks typically in which a woman carries a fetus inside of her. In support of its goal to improve the health of women and children, the NICHD leads and supports research and training to promote healthy pregnancies, focusing on the important events that occur before, during, and after pregnancy. 

Common Name

Medical or Scientific Terms

Pregnancy: Condition Information

What is pregnancy?

Pregnancy is the term used to describe the period in which a woman carries a fetus inside of her. In most cases, the fetus grows in the uterus.

Pregnancy usually lasts about 40 weeks, or just over 9 months, as measured from the last menstrual period to childbirth. Pregnancy is divided into three trimesters. The major events in each trimester are described below.

First Trimester (Week 1 to Week 12)

The events that lead to pregnancy begin with conception, in which the sperm penetrates the egg produced by an ovary. The zygote (fertilized egg) then travels through the woman's fallopian tube to the uterus, where it implants itself in the uterine wall. The zygote is made up of a cluster of cells formed from the egg and sperm. These cells form the fetus and the placenta. The placenta provides nutrients and oxygen to the fetus.

Second Trimester (Week 13 to Week 28)

Third Trimester (Week 29 to Week 40)

What are some common signs of pregnancy?

consecutive periods, but many women experience other symptoms of pregnancy before they notice a missed period.

Missing a period does not always mean a woman is pregnant. Menstrual irregularities are common and can have a variety of causes, including taking birth control pills, conditions such as diabetes and polycystic ovary syndrome, eating disorders, excessive exercise, and certain medications. Women who miss a period should see their health care provider to find out whether they are pregnant or whether they have a specific health problem.

Pregnancy symptoms vary from woman to woman. A woman may experience every common symptom, just a few, or none at all. Some signs of early pregnancy include:

Many of these symptoms can also be a sign of another condition, the result of changing birth control pills, or stress, and thus they do not always mean that a woman is pregnant. Women should see their health care provider if they suspect they are pregnant.

How do I know if I’m pregnant?

If you have missed one or more menstrual periods or have one or more of the early signs of pregnancy, you may wonder whether you are pregnant. Home pregnancy tests, which can be purchased without a prescription and are considered highly accurate, can be the first way women determine if they are pregnant. If a home pregnancy test is positive, a woman should call her health care provider to schedule an appointment.

Home pregnancy tests measure the amount of human chorionic gonadotropin (hCG) in a woman's urine. Small amounts of this hormone are present even before the first missed period, and they increase as pregnancy continues.

NICHD research in the 1970s led to the development of the home pregnancy test. Researchers were studying the role of hCG in tracking the success of a cancer treatment. During this study, researchers discovered that high levels of hCG in the urine were associated with pregnancy. Manufacturers used this research to create home pregnancy tests that detect hCG levels in urine with up to 97% accuracy.

What is prenatal care and why is it important?

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular prenatal care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a preconception care visit to a health care provider.

Preconception Care

A preconception care visit can help women take steps for a safe and healthy pregnancy before they get pregnant.

Women can help to promote a healthy pregnancy and birth of a healthy infant by taking the following steps before they become pregnant:

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother's health, the infant's health, and any questions about the pregnancy.

Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

What are some common complications of pregnancy?

Some women experience health problems during pregnancy. These complications can involve the mother's health, the fetus, or both. Even women who were healthy before getting pregnant can experience complications. These complications make the pregnancy a high-risk pregnancy.

Getting early and regular prenatal care can help decrease the risk for problems by enabling health care providers to diagnose, treat, or manage conditions before they become serious.

Some common complications of pregnancy include, but are not limited to:

High Blood Pressure

High blood pressure, also called hypertension, occurs when arteries carrying blood from the heart to the body organs are narrowed. This causes pressure to increase in the arteries. In pregnancy, this can make it hard for blood to reach the placenta, which provides nutrients and oxygen to the fetus. Reduced blood flow can slow the growth of the fetus and place the mother at greater risk of preterm labor and preeclampsia.

Women who have high blood pressure before they get pregnant will continue to have to monitor and control it with medications throughout their pregnancy. High blood pressure that develops in pregnancy is called gestational hypertension. According to the Centers for Disease Control and Prevention (CDC), in 2009, the latest year for which information is available, more than 4% of pregnant American women developed this condition during their pregnancy. Typically, gestational hypertension occurs during the second half of pregnancy and goes away after delivery. 

Gestational Diabetes

Gestational diabetes occurs when a woman who didn't have diabetes before pregnancy develops the condition during pregnancy.

Normally, the body digests parts of your food into a sugar called glucose. Glucose is your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.

To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin. In gestational diabetes, hormonal changes from pregnancy cause the body to either not make enough insulin, or not use it normally. Instead, the glucose builds up in your blood, causing diabetes, otherwise known as high blood sugar.

Over time, high glucose levels can cause serious health problems, such as heart disease, vision problems, and kidney disease.

Managing gestational diabetes, by following a treatment plan outlined by a health care provider, is the best way to reduce or prevent problems associated with high blood sugar during pregnancy. If not controlled, it can lead to high blood pressure from preeclampsia and having a large infant, which increases the risk for cesarean delivery.

Preeclampsia

Preeclampsia is a serious medical condition that can lead to premature delivery. Its cause is unknown, but some women are at an increased risk. Risk factors include:

Preterm Labor

Preterm labor is labor that begins before 37 weeks of gestation. Any infant born before 37 weeks is at an increased risk for health problems, in most cases because organs such as the lungs and brain finish their development in the final weeks before a full-term delivery (39 to 41 weeks).

Certain conditions increase the risk for preterm labor, including infections, having a shortened cervix (for unknown reasons, in some women the cervix is shorter than normal), or previous preterm births. Sometimes preterm labor can be slowed or stopped by medication.

Progesterone, a hormone produced naturally during pregnancy, may be used to help prevent preterm birth. A 2003 study led by NICHD researchers found that progesterone supplementation to women at high risk for preterm delivery due to a prior preterm birth reduces the risk of a subsequent preterm birth by one-third.

 Pregnancy Loss/Miscarriage

Miscarriage is the term used to describe a pregnancy loss from natural causes before 20 weeks. According to the American College of Obstetricians and Gynecologists (ACOG), as many as 20% of pregnancies end in miscarriage. Signs can include vaginal spotting or bleeding, cramping, or fluid or tissue passing from the vagina. However, bleeding from the vagina does not mean that a miscarriage will happen or is happening. Women experiencing this sign at any point in their pregnancy should contact their health care provider.

The loss of pregnancy after the 20th week of gestation is called a stillbirth. In approximately half of all reported cases, health care providers can find no cause for the loss. However, health conditions that can contribute to stillbirth include chromosomal abnormalities, placental problems, poor fetal growth, chronic health issues of the mother, and infection.

 Other Complications

Other complications of pregnancy, which are not as common, include the following:

What is a high-risk pregnancy?

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus.

For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complications. But some women are at an increased risk for complications even before they get pregnant for a variety of reasons.

Risk factors for a high-risk pregnancy can include:

Women with high-risk pregnancies should receive care from a special team of health care providers to ensure that their pregnancies are healthy and that they can carry their infant or infants to term.

What is labor?

Labor is the process by which the fetus and the placenta leave the uterus. Delivery can occur in two ways, vaginally or by a cesarean delivery.

Labor occurs in three stages and can actually begin weeks before a woman delivers her infant. The first stage begins with the woman's first contractions and continues until she is dilated fully (10 centimeters, or 4 inches), which means the cervix has stretched to prepare for birth. The second stage is the active stage, in which the pregnant woman begins to push downward. It begins with complete dilation of the cervix and ends with the actual birth. The third stage, or placental stage, begins with the birth and ends with the completed delivery of the placenta and afterbirth.

Just as pregnancy is different for every woman, the signs of labor and the length of time it can take to go through the three stages will vary from woman to woman. Some signs indicating that labor may be close (although in fact it might still be weeks away) may include:

If you experience any of the following signs of labor at any point in your pregnancy you should contact your health care provider:

Sometimes a woman's health care provider will recommend inducing labor (using medically supervised methods, such as medication, to bring on labor) if the health of the mother or the fetus is at risk. Unless delivery is medically necessary, a woman should wait until at least 39 weeks before delivering her infant to give her/him the best chance for healthy outcomes. During the last few weeks of pregnancy, the fetus is still developing its lungs, brain, and liver.

The NICHD's National Child and Maternal Health Education Program currently focuses on raising awareness of the importance of waiting until 39 weeks to deliver a baby, unless medically necessary. The website and materials are designed for health care professionals, but resources on preterm birth are also included.

What is a Cesarean delivery?

A cesarean delivery is a surgical procedure in which a fetus is delivered through an incision in the mother's abdomen and uterus. According to the CDC, in 2010, almost 33% of births were by cesarean delivery. According to the Agency for Healthcare Research and Quality, the number of cesarean deliveries between 1997 and 2008 increased by 72%.

A cesarean delivery may be necessary if:

Women who have a cesarean delivery may be given pain medication with an epidural block, a spinal block, or general anesthesia. An epidural block numbs the lower part of the body through an injection in the spine. A spinal block also numbs the lower part of the body but through an injection directly into the spinal fluid. Women who receive general anesthesia, often used for emergency cesarean deliveries, will not be awake during the surgery.

During the procedure, the infant is delivered through cuts in the mother's abdomen and uterus. The uterus is then closed with stitches that later dissolve. Stitches or staples also close the skin on the belly.

Cesarean delivery is safe, but it is still surgery, with risks and complications to consider. Recovery from a cesarean also often takes longer than from a vaginal delivery. Some women may request a cesarean birth even if vaginal delivery is an option. However, cesarean births can raise the risk of medical problems and having difficulties with future pregnancies.1 Also, infants delivered by cesarean delivery may experience more breathing problems than infants born by vaginal delivery. More information on this topic can be found in the final statement from a 2006 NIH State-of-the-Science Conference on Cesarean Delivery by Maternal Request.

If a woman has had a cesarean delivery in a past pregnancy, in many cases she can still attempt a vaginal delivery (called a VBAC [vaginal birth after cesarean]) in future pregnancies. According to NICHD research, 75% of deliveries are successful for women who attempt a VBAC in future pregnancies.

A 2010 NIH Consensus Development Conference on Vaginal Birth After Cesarean evaluated current data on VBAC and issued a statement determining it as a reasonable option for many women.

Pregnancy: 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.

How much weight should I gain during pregnancy?

The amount of weight you should gain during pregnancy depends on your weight before you got pregnant. Your health care provider will advise you on a healthy weight gain based on your current weight, diet, and activity level. Typically, weight gain should be gradual throughout pregnancy, with a total of about 1 to 4 pounds in the first trimester and 2 to 4 pounds each month in the second and third trimesters.

In 2009, the Institute of Medicine released new recommendations for total weight gain during pregnancy, based on pre-pregnancy body mass index (BMI), a measure that combines height and weight. According to these recommendations:

New recommendations issued by the American Congress of Obstetricians and Gynecologists suggest that overweight and obese women may be able to gain even less than what is recommended and still have a healthy infant. It's important for women to discuss with their health care provider how to maintain a healthy weight during pregnancy, as being overweight or obese can affect pregnancy outcomes and the long-term health of the mother and infant. An NICHD study found that women who were obese before pregnancy were more likely to have infants born with congenital malformations such as heart problems and neural tube defects.

 What can I do during pregnancy to help make sure my child is a healthy weight?

Research is starting to improve our understanding of the epidemic of obesity in the United States. Unfortunately, even young children are at risk for becoming obese, making them vulnerable to diabetes, heart disease, and other conditions throughout their life course.

The good news is that with better knowledge, actions can be taken to prevent the development of overweight and obesity—starting even before pregnancy. For example, the following steps can help ensure a healthy pregnancy and reduce the chance that a child will be overweight or obese:

 Is it safe to take medications or supplements during pregnancy?

Medication use during pregnancy is common. In a study by the CDC, during the first trimester of pregnancy, 70% to 80% of women reported taking at least one medication, and as many as 50% took four or more medications.

Certain medications can be unsafe, however. Talk to your health care provider about the medications you currently take. Tell him or her about prescription and over-the-counter medications as well as dietary or herbal supplements. Certain types of medications for treating acne as well as herbal and dietary supplements can harm the developing fetus. Even ibuprofen or aspirin can cause problems in pregnancy, particularly during the last three months.

Many women take medications to treat health problems during pregnancy like diabetes, asthma, heartburn, and morning sickness. Other women take medications to treat conditions they had before they became pregnant. Often, your health care provider will encourage you to continue taking your medication. However, in some cases, a safer alternative may be available. Read more about medication safety during pregnancy at the FDA Medicine and Pregnancy page.

Medicine and Pregnancy

Get the facts before you take any medicines during pregnancy.

Many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, heartburn, and morning sickness. Other women take medicines before they realize they are pregnant.

Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. Follow these four tips to help keep you and your baby safe.

  1. Ask questions. Always talk to your health care provider before you take any medicines, herbs, or vitamins. Don’t stop taking your medicines until your doctor says that it is OK.

  2. Read the drug label. Drug labels list the risks for women who are pregnant or breast feeding.

The labels tell what is known about how the drugs might affect or have affected other pregnant women.

  1. Report problems. Contact the FDA to report any serious problems you have after taking a medicine.

  2. Sign up for a Pregnancy Registry. Pregnancy Exposure Registries are research studies that collect information from women who take prescription medicines or vaccines during pregnancy.

Pregnancy registries help women and their doctors learn more about which medicines are safe to take during pregnancy.

The FDA does not run pregnancy studies, but it keeps a list of all registries. See if there is a registry for your medicine. Go to: www.fda.gov/pregnancyregistries

(Source:FDA)

What unique challenges do pregnant women with disabilities face?

According to the U.S. Census Bureau, an estimated one in five American women have a disability. Most women with disabilities can have healthy pregnancies and deliver healthy babies, especially if they have a health care team that is knowledgeable about their disability. However, in a national study, many women reported difficulty finding health care providers and hospitals that had experience managing pregnancies with their disability

Women with disabilities face many of the same health problems, including weight gain and fatigue, as other pregnant women. However, these problems can be more serious or lead to other complications in women with disabilities. Other challenges faced by women with disabilities may include:

Preconception care and prenatal care from health care providers experienced in managing pregnancies with women with disabilities can improve the health of the mother and the infant. To find a health care provider, visit the American Congress of Obstetricians and Gynecologists resources for women with disabilities

Preconception Care and Prenatal Care

Preconception care is the care a woman gets before she becomes pregnant. Prenatal care is the care a woman gets during pregnancy. Early and regular prenatal visits with a health care provider are important for the health of both the mother and the fetus. Preconception care from a health care provider is also important to prepare a woman for pregnancy.

The NICHD supports research to promote a healthy pregnancy and improve the lives of the mother and her infant. This research seeks to better understand the health complications that sometimes occur during pregnancy, such as premature labor and birth, gestational diabetes, and preeclampsia. In addition, NICHD-supported research is increasing understanding and raising awareness of factors before pregnancy that increase risk of congenital abnormalities and other complications of pregnancy.

Preconception Care and Prenatal Care: Condition Information

What is preconception care?

Preconception care is the care a woman receives before she gets pregnant to help promote a healthy pregnancy.

Taking steps to make sure you are healthy and avoiding exposure to harmful behaviors and toxins before you conceive can decrease the chance of problems during pregnancy and improve the health of your child.

What is prenatal care?

Prenatal care is the care a woman gets during pregnancy. Prenatal care should begin as soon as a woman knows or suspects she is pregnant. Early and regular prenatal visits with a health care provider are important for the health of both the mother and the fetus.

Prenatal care is important to help promote a healthy pregnancy. Women who do not seek prenatal care are three times as likely to deliver a low birth weight infant. Lack of prenatal care can also increase the risk of infant death

What can a woman do to promote a healthy pregnancy before she gets pregnant?

For women who are considering getting pregnant, following a health care provider’s advice can reduce the risk of problems during pregnancy or after the child’s birth. A health care provider can recommend ways to get the proper nutrition and avoid habits whose lasting effects could harm a fetus. For example, exposure to alcohol and tobacco early in pregnancy can increase the risk of Sudden Infant Death Syndrome (SIDS). Taking a supplement containing at least 400 micrograms of folic acid before getting pregnant can reduce the risk of complications such as neural tube defects (NTDs)—abnormalities that can occur in the brain, spine, or spinal column of a developing fetus and are present at birth.,

Scheduling a preconception care visit with your health care provider can improve the chances of a healthy pregnancy. A health care provider will likely recommend the following steps:

Develop a plan for your reproductive life.

This plan includes your and your partner’s plans for the number and timing of pregnancies based on your values and life goals. Sharing your life plan with your health care provider can help address any potential problems before you conceive.2

Increase your intake of folic acid.

Folic acid is a B vitamin (B9). It helps produce and maintain new cells. This is especially important during times when the cells are dividing and growing rapidly such as infancy and pregnancy. The United States Public Health Service recommends that all pregnant women and “women of childbearing age [15 to 44 years] in the United States who are capable of becoming pregnant should consume [a supplement containing] 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs.” Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid. Studies show that taking folic acid for 3 months before getting pregnant and 3 months after conceiving can reduce the risk of NTDs, such as spina bifida by up to 70%.

Get up to date on vaccines.

Ask your health care provider if you need a booster for any vaccines. Some vaccines can be given during pregnancy, but the rubella (German measles) and varicella (chicken pox) vaccines are recommended before you get pregnant.

Talk to your health care provider about your diabetes or other medical conditions.

Getting health problems such as diabetes, hypertension (high blood pressure), asthma, seizure disorders, maternal phenylketonuria (a condition in which the pregnant woman’s blood level of a certain amino acid—phenylalanine—is too high) under control before and during pregnancy reduces the risk of miscarriage and stillbirth as well as other health problems for the infant.

Avoid smoking, drinking alcohol, or taking drugs.

These substances can increase the risk for SIDS, preterm birth, fetal alcohol spectrum disorders, and NTDs. If you are trying to quit smoking, drinking, or doing drugs and you need help, talk to your health care provider about support groups or about medications to help quit smoking.

Strive to reach a healthy weight.

Obesity may make it more difficult to become pregnant. Being overweight or obese also puts you at risk for complications during pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, stillbirth, and increases the chances of cesarean delivery. NICHD researchers have found that obesity can increase your child’s risk of a congenital (pronounced kon-JEN-ih-tal) heart defect (a problem with the heart that is present at birth) by 15%. Research has also uncovered a link between obesity and NTDs.12 Talk to your health care provider about what a healthy weight is for you and about a plan to help you achieve it.

Learn your family's health history.

Your health care provider will ask for information about your family’s genetic and health history. You may be referred for genetic counseling if certain conditions run in your family or if a family member was born with a physical abnormality.

Get mentally healthy.

Good mental health means you feel good about your life and value yourself. It’s natural to worry or feel sad, anxious, or stressed at times. However, if these feelings do not go away and they interfere with your daily life, it’s important to seek help before you get pregnant. The hormonal changes during pregnancy can contribute to depression. Women who are depressed may have trouble eating or sleeping or may turn to tobacco, alcohol, or drugs, all of which can harm the fetus

What can I do to promote a healthy pregnancy?

Getting early and regular prenatal care is the best thing you can do to keep yourself and your developing infant healthy while you are pregnant.

During your first prenatal visit, your health care provider will probably talk to you about the following steps you can take to help ensure a healthy pregnancy:

Take folic acid.

Begin or continue to get at least 400 micrograms of folic acid by taking vitamin supplements every day to reduce your child’s risk of neural tube defects. In the United States, enriched grain products such as bread, cereal, pasta, and other grain-based foods are fortified with folic acid. A related form, called folate, occurs naturally in leafy, green vegetables and orange juice, but folate is not absorbed as well as folic acid. Also, it can be difficult to get all the folic acid you need from food alone. Most prenatal vitamins contain 400 micrograms of folic acid. If you have had a child with an NTD before, taking a larger daily dose of folic acid (4 mg) before and during early pregnancy can reduce the risk for recurrence in a subsequent pregnancy.

Avoid alcohol and tobacco.

Drinking alcohol and smoking during pregnancy can increase your child’s risk for problems such as fetal alcohol spectrum disorders (FASDs) and Sudden Infant Death Syndrome (SIDS).

FASDs are a variety of effects on the fetus that result from the mother drinking alcohol during pregnancy. The effects range from mild to severe, and they include intellectual and developmental disabilities; behavior problems; abnormal facial features; and disorders of the heart, kidneys, bones, and hearing. FASDs last a lifetime although early intervention services can help improve a child’s development. FASDs are completely preventable. If a woman does not drink alcohol while she is pregnant, her child will not have an FASD. Currently, research shows that there is no safe amount of alcohol to drink while pregnant. According to one recent study supported by the NIH, infants can suffer long-term developmental problems even with low levels of prenatal alcohol exposure.

SIDS is the sudden, unexplained death of an infant younger than 1 year old. It is the leading cause of death in children between 1 month and 1 year of age. Most SIDS deaths happen when babies are between 1 month and 4 months of age. Drinking or smoking during pregnancy increases the risk of SIDS; also, infants exposed to secondhand smoke are at greater risk for SIDS.

Your health care provider can be a source of help if you find it hard to quit smoking or drinking on your own. You can also visit http://smokefree.gov/ for plans and information about quitting smoking. In addition, http://www.publichealth.org/smoking-in-america/ provides historical and other information about cigarettes and quitting smoking. The Rethinking Drinking website provides resources and information related to quitting alcohol use.

Talk to your health care provider about medications.

As many as half of women take four or more medications during pregnancy. Although many are safe, talk to your health care provider before taking any over-the-counter or prescription medication or herbal supplement. Certain medications to treat acne and epilepsy and some dietary or herbal supplements are not safe during pregnancy.

Avoid exposure to toxic substances.

During pregnancy, exposure to radiation, pesticides, some metals, and certain chemicals can cause birth defects, premature birth, and miscarriage. If you’re not sure if something might be harmful to you or your fetus, avoid contact with it until you check with your health care provider.

If you work in a job on a farm, a dry cleaner, a factory, a nail or hair salon, you might be around or come into contact with potentially harmful substances. Talk to your health care provider and your employer about how you can protect yourself before and during pregnancy. You may need extra protection at work or a change in your job duties to stay safe.

A few examples of exposures that are known to be toxic to the developing fetus are:

Many chemicals are commonly found in the blood and body fluids of pregnant women and their infants. However, much remains unknown about the effects of fetal exposure to chemicals. It’s best to be cautious about chemical exposure when you are planning to get pregnant or if you are pregnant. Talk to your health care provider if you live or work in or near a toxic environment.

Follow a healthy diet.

Choose a variety of fruits, vegetables, whole grains, and low-fat dairy products to help ensure the developing fetus gets all the nutrients it needs. Make sure you also drink plenty of water. An online tool called the Daily Food Plan for Momscan help you plan your meals so that you get the right foods in the right amounts according to your personal characteristics and your stage of pregnancy.

Read Nutrition During Pregnancy FAQs(PDF – 253 KB) from the American College of Obstetricians and Gynecologists to learn more about how much you should eat during pregnancy, the nutrients you need, and how much caffeine is safe to drink.

Maintain a safe diet.

Avoid certain foods such as raw fish, undercooked meat, deli meat, and unpasteurized cheeses (for example, certain types of feta, bleu cheese, and Mexican-style soft cheeses). Always check the label to make sure the cheese is pasteurized.

Some pregnant women are concerned about the amount of fish they can safely consume. Certain fish contain methylmercury, when certain bacteria cause a chemical change in metallic mercury. Methylmercury is found in foods that fish eat, and it remains in the fish’s body after it is eaten. Methylmercury in fish eaten by pregnant women can harm a fetus’s developing nervous system. According to the U.S. Food and Drug Administration (FDA), pregnant women can eat up to 12 ounces a week of fish and shellfish that have low levels of methylmercury (salmon, canned light tuna, and shrimp). Albacore (“white”) tuna has more methylmercury than canned light tuna; pregnant women should consume 6 ounces or fewer in a week. Avoid fish with high levels of methylmercury (swordfish, king mackerel, and shark). For more information on methylmercury and pregnancy, see the FDA Food Safety for Moms-to-Be.

Limit caffeine intake.

Some studies suggest that too much caffeine can increase the risk of miscarriage. Talk to your health care provider about the amount of caffeine you get from coffee, tea, or soda. Your health care provider might limit you to 200 milligrams (the amount in about one 12-ounce cup of coffee) per day. Keep in mind, though, that some of the foods you eat, including chocolate, also contain caffeine and contribute to the total amount you consume each day.

Talk to your health care provider about physical activity.

Most women can continue regular levels of physical activity throughout pregnancy. Regular physical activity can help you feel better, sleep better, and prepare your body for birth. After your child is born, it can help get you back to your pre-pregnancy shape more quickly. Talk to your health care provider about the amount and type of physical activity that is safe for you.

Maintain a healthy weight.

Gaining too much or too little weight during pregnancy increases the risk of problems for both the mother and the infant. Following a healthy diet and getting regular physical activity can help you stay within the recommended weight gain guidelines set by the Institute of Medicine.

The amount of weight you should gain during pregnancy depends on your pre-pregnancy weight and body mass index (BMI), which is your weight in kilograms divided by the square of your height in meters (kg/m2). According to the 2009 guidelines released by the Institute of Medicine:

In a recent NICHD study of more than 8,000 pregnant women, 73% gained more than the recommended amount of weight. The study found that excessive weight gain during pregnancy increases the risk for gestational high blood pressure, cesarean section, and large-for-gestational-age infants.

Talk to your health care provider about the right amount of weight gain for you based on your pre-pregnancy weight.

Talk to your health care provider about taking vitamin B12 and iron supplements.

Iron supplements can help reduce your risk for anemia resulting from iron deficiency, which is common during pregnancy. Your health care provider may also recommend a vitamin B12 supplement if you are a vegetarian or vegan.

Get regular dental checkups.

Your gums are more likely to become inflamed or infected because of hormonal changes and increased blood flow during pregnancy. Make sure you tell your dentist if you think you could be pregnant, but keeping up your regularly scheduled checkups is important. Some women may fear getting dental work during pregnancy, but a 2006 study and 2011 follow-up study showed no increase in preterm births or other adverse outcomes for pregnant women who received dental care.

What happens during prenatal visits?

What happens during prenatal visits varies depending on how far along you are in your pregnancy.

Schedule your first prenatal visit as soon as you think you are pregnant, even if you have confirmed your pregnancy with a home pregnancy test. Early and regular prenatal visits help your health care provider monitor your health and the growth of the fetus.

The First Visit

Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won’t schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting.

Because your first visit will be one of your longest, allow plenty of time.

During the visit, you can expect your health care provider to do the following:

Prenatal Visit Schedule

If your pregnancy is healthy, your health care provider will set up a regular schedule for visits that will probably look about like this:

Before 28 weeks:

Monthly

Weeks 28 to 36:

Every 2 weeks

Week 36 to birth:

Weekly

Later Prenatal Visits

As your pregnancy progresses, your prenatal visits will vary greatly. During most visits, you can expect your health care provider to do the following:

Several of these visits will include special tests to check for gestational diabetes (between 24 and 28 weeks) and other conditions, depending on your age and family history.

In addition, the Centers for Disease Control and Prevention and the American Academy of Pediatrics released new vaccine guidelines for 2013, including a recommendation for pregnant women to receive a booster of whooping cough (pertussis) vaccine. The guidelines recommend the shot be given between 27 and 36 weeks of pregnancy.

What preconception tests might I need?

Talking to your health care provider about your health history and lifestyle habits is important. This information may prompt your health care provider to give you certain tests to find out if you have problems that could harm you or your infant.

Your health care provider may test you for the following:

Rubella

A blood test can determine whether you are vaccinated against rubella (also called German measles). Getting rubella while you are pregnant can harm the fetus. You should be vaccinated against rubella before you get pregnant.1

Sexually transmitted infections (STIs)

STIs such as gonorrhea, syphilis, chlamydia, and HIV can make it hard for you to get pregnant and can also harm you or your infant. HIV can be passed from a woman to her infant during pregnancy or delivery. This risk is less than 2% if certain HIV medications are taken during pregnancy.

Genetic Disorders

Depending on your or your partner’s health history, your health care provider may refer you to a genetic counselor to help you determine if you are at an increased risk for passing on a genetic disorder, such as cystic fibrosis, Fragile X syndrome, or sickle cell disease, You can request preconception carrier screening, which involves a sample of blood or saliva.2 Find a genetic counselorthrough the National Society of Genetic Counselors.

Other problems

Your doctor may want to perform other tests depending on your risk for other problems such as anemia (a condition that causes a low red blood cell count) or hepatitis (a liver infection that can be passed on to your infant).

What tests might I need during pregnancy?

Every woman has certain tests during pregnancy. Some women, depending on their age, family history, or ethnicity, may undergo additional testing.

Some tests are screening tests, and others are diagnostic tests. If your health care provider orders a screening test, keep in mind that such tests do not diagnose problems. They evaluate risk. So a screening test result that comes back abnormal does not mean there is a problem with your infant. It means that more information is needed. Your health care provider can explain what the test results mean and possible next steps.

The types of tests you may have during pregnancy include:

Routine Tests

Screening for Chromosomal and Neural Tube Defects (NTDs) and Other Conditions

Additional Testing that Your Health Care Provider May Recommend

What health problems can develop during pregnancy?

Regular prenatal visits help the health care provider identify potential health problems early and take steps to manage them, to protect the health of the mother and the developing fetus. These problems include:

Iron Deficiency Anemia

Anemia occurs when your red blood cell count (hemoglobin or hematocrit) is low. Iron deficiency anemia is the most common type of anemia. Iron is part of the hemoglobin that allows blood to carry oxygen. Pregnant women need more iron than normal for the increased amount of blood in their body and for their developing child. Symptoms of iron deficiency include feeling tired or weak, looking pale, feeling faint, or experiencing shortness of breath. Your health care provider may recommend iron and folic acid supplements.

Gestational Diabetes

Gestational diabetes occurs when blood sugar levels get too high during pregnancy. Between 5% and 6% of pregnant women are diagnosed with the condition every year in the United States. Most often the condition is discovered using a two-step procedure: screening with the glucose challenge screening test around 24 to 28 weeks of pregnancy, followed by a diagnostic test called the Oral Glucose Tolerance Test. Gestational diabetes increases the risk of a baby that is too large (macrosomia), preeclampsia (pronounced pree-i-KLAMP-see-uh, a condition marked by a sudden increase in a pregnant woman’s blood pressure along with the presence of protein in the urine after the 20th week of pregnancy), and cesarean birth. Treatment includes controlling blood sugar levels through a healthy diet and exercise, and through medication if blood sugar values remain high.

Depression

Some women experience extreme sadness during pregnancy. There is no single cause of depression, but it may result from hormonal changes, stress, family history, or changes in brain chemistry or structure. Depression can harm your developing infant if you do not take care of yourself during pregnancy, including attending regular prenatal visits and avoiding alcohol and tobacco smoke. Talk to your health care provider about treatment options.

High Blood Pressure Related to Pregnancy

Women with high blood pressure that starts after 20 weeks of pregnancy will need to be monitored closely because of the risk of preeclampsia.

Fetal Problems

Possible problems in the fetus include decreased movement after 28 weeks of pregnancy and being measured as smaller than normal. These pregnancies often require closer follow-up including more testing such as ultrasound exams, non-stress testing and biophysical profiles as well as possible early delivery.

Hyperemesis Gravidarum

(Pronounced HEYE-pur-EM-uh-suhss grav-uh-DAR-uhm). Some women experience severe, persistent nausea and vomiting during pregnancy beyond the typical "morning sickness." Medication may be prescribed to help with the nausea. Women with hyperemesis gravidarum may need hospitalization to get the fluids and nutrients they need through a tube in their veins. Often, the condition lessens by the 20th week of pregnancy.

Miscarriage

Pregnancy loss from natural causes before the 20th week is considered miscarriage. As many as 20% of known pregnancies end in miscarriage. The most common cause of first trimester miscarriage is chromosomal problems. Symptoms can include cramping or bleeding. Spotting early in pregnancy is common and does not mean that a miscarriage will occur.

Placenta Previa

This condition occurs when the placenta covers part of the opening of the cervix inside the uterus. It can cause painless bleeding during the second and third trimesters. The health care provider may recommend bed rest. Hospitalization may be required if bleeding is heavy or if it keeps happening.

Placental Abruption

In some women, the placenta separates from the inner uterine wall. This separation, or abruption, can be mild, moderate, or severe. If severe, the fetus cannot get the oxygen and nutrients needed to survive. Placental abruption can cause bleeding, cramping, or uterine tenderness. Treatment depends on the severity of the abruption and how far along the pregnancy is. Severe cases may require early delivery.

Preeclampsia

Preeclampsia starts after the 20th week of pregnancy. This condition causes high blood pressure, swelling of the hands and face, abdominal pain, blurred vision, dizziness, and headaches. In some cases, seizures can occur—this is called eclampsia (pronounced ih-KLAMP-see-uh). The only definite cure for preeclampsia and eclampsia is to deliver the baby. If this would result in a premature birth, then the maternal and fetal risks and benefits of delivery need to be balanced with the risks associated with the infant being born prematurely.

Preterm Labor

Going into labor before the fetus is term (37 weeks) is a major risk factor for complications for the infant and future preterm births.

Being aware of the symptoms of these conditions and getting regular prenatal care can prevent health problems and help you get treatment as early as possible.

Who is at increased risk of health problems during pregnancy?

Some women are at increased risk for health problems during pregnancy. Important risk factors include the following:

Women with high-risk pregnancies may need more frequent care and may need care from a team of health care providers to help promote healthy pregnancy and birth.

Will stress during pregnancy affect my baby?

many changes, and as your hormones change, so do your moods. Too much stress can cause you to have trouble sleeping, headaches, loss of appetite, or a tendency to overeat—all of which can be harmful to you and your developing baby.

High levels of stress can also cause high blood pressure, which increases your chance of having preterm labor or a low-birth-weight infant.

You should talk about stress with your health care provider and loved ones. If you are feeling stress because of uncertainty or fear about becoming a mother, experiencing work-related stress, or worrying about miscarriage, talk to your health care provider during your prenatal visits.

Posttraumatic Stress Disorder (PTSD) and Pregnancy

PTSD is a more serious type of stress that can negatively affect your baby. PTSD occurs when you have problems after seeing or going through a painful event, such as rape, abuse, a natural disaster, or the death of a loved one. You may experience:

PTSD occurs in as many as 8% of women during pregnancy, increasing their infant’s risk of preterm birth or low birth weight. PTSD also increases the risk for behaviors such as smoking and drinking, which contribute to other problems.

Reducing stress is important for preventing problems during your pregnancy and for reducing your risk for health problems that may affect your developing child. Identify the source of your stress and take steps to remove it or lessen it. Make sure you get enough exercise (under a doctor’s supervision), eat healthy foods, and get lots of sleep.

If you think you may be depressed, talk to your health care provider. Getting treatment and counseling can help.

Source: NICHD, NIH, HHS

High-Risk Pregnancy

A high-risk pregnancy is one of greater risk to the mother or her fetus than an uncomplicated pregnancy. Pregnancy places additional physical and emotional stress on a woman’s body. Health problems that occur before a woman becomes pregnant or during pregnancy may also increase the likelihood for a high-risk pregnancy. The NICHD is one of many federal agencies working to improve pregnancy outcome, prevent high-risk pregnancy, and improve health outcomes for pregnant women who are at high risk. The NICHD supports and conducts research on the causes and optimal management of high-risk pregnancy.

Common Name

High-Risk Pregnancy: Condition Information

A high-risk pregnancy refers to anything that puts the mother or fetus at increased risk for poor health during pregnancy or childbirth. A pregnancy is considered high risk if the mother has chronic health conditions such as high blood pressure or diabetes, or if she weighs too much or too little. Any pregnancy where complications are more likely than normal is considered a high-risk pregnancy.

What are the factors that put a pregnancy at risk?

The factors that place a pregnancy at risk can be divided into four categories:

Existing Health Conditions

Age

Lifestyle Factors

Conditions of Pregnancy

How many people are at risk of having a high-risk pregnancy?

The more risk factors a woman has, the more likely she and her fetus will be at risk during pregnancy and birth. Statistics are available for some risk factors:

How is high-risk pregnancy diagnosed?

Good prenatal care will help to identify the potential for high-risk pregnancy. Health care providers will ask a woman about her medical history and will perform assessments to determine whether she is likely to experience a high-risk pregnancy based on her risk factors. Ongoing monitoring of physical health and personal habits will help a health care provider identify problems that develop during pregnancy.

A woman with a high-risk pregnancy will also likely receive care from a special team of health care providers throughout the pregnancy to ensure that she carries the fetus or fetuses to term.

Can a high-risk pregnancy be prevented?

Staying healthy is one of the best ways to lower the risk of having a difficult pregnancy. Many health care providers recommend that women who are thinking about becoming pregnant get evaluated to make sure they are in good preconception health. During pregnancy, there are also steps a woman can take to reduce the risk of certain problems1:

What are common treatments for high-risk pregnancy?

For women who are diagnosed with a high-risk pregnancy, treatment varies depending on the risk factors.

High Blood Pressure

Some changes to high blood pressure medication may be necessary during pregnancy. A health care provider can also offer advice about the best way to keep blood pressure under control. Suggestions may include recommendations to limit salt intake and get regular exercise.

Gestational Diabetes

Gestational diabetes, or developing diabetes during pregnancy, increases the risk of pregnancy complications. However, many women have healthy pregnancies and healthy infants because they follow a health care provider’s recommended diet and treatment plan. A woman diagnosed with gestational diabetes should:

Some women with gestational diabetes will also need to take medicine, such as an oral hypoglycemic tablet or insulin to help manage their diabetes.

HIV Treatment

HIV infection can be passed from a mother to her fetus as well as during childbirth and breastfeeding, but treatment can prevent transmission.

High-Risk Pregnancy: 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.

How do I know if I have or will have a high-risk pregnancy?

If you are thinking about getting pregnant or are already pregnant, visit your health care provider. He or she will check your medical history and run tests to determine whether you are likely to have a high-risk pregnancy. Your health care provider will help you come up with a plan for reducing the risks while you are pregnant.

How can I best take care of myself and my fetus during my pregnancy?

You can take care of yourself and your fetus during pregnancy by eating healthy; avoiding drugs, smoking, and alcohol; exercising regularly; getting good prenatal care; and following your health care provider’s recommendations.

If I get gestational diabetes, will I still have diabetes after the infant is born?

If you develop diabetes during pregnancy, typically, you do not continue to have diabetes after delivery. However, gestational diabetes can raise a woman’s risk of developing diabetes later in life. A recent NICHD-led study found that, among women who have had gestational diabetes, following a healthy diet after pregnancy may help prevent type 2 diabetes from developing. Read more about what to expect if you develop gestational diabetes.

As an older first-time mom, am I more likely to have a cesarean section?

Just because a woman is older, it does not mean she will have a cesarean delivery. However, older woman are more likely to have high-risk pregnancies, so if you are an older first-time mom, it is possible that you will have complications that require a cesarean.

Prenatal care fact sheet

Did you know?

Several types of health care professionals can help pregnant women and deliver babies. They include obstetricians, family physicians, midwives, and nurse-midwives. This fact sheet calls all health care professionals "doctor" only to keep the information as easy to read as possible.

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. Take care of yourself and your baby by:

Why do I need prenatal care?

Prenatal care can help keep you and your baby healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.

I am thinking about getting pregnant. How can I take care of myself?

You should start taking care of yourself before you start trying to get pregnant. This is called preconception health. It means knowing how health conditions and risk factors could affect you or your unborn baby if you become pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems also can affect pregnancy.

Talk to your doctor before pregnancy to learn what you can do to prepare your body. Women should prepare for pregnancy before becoming sexually active. Ideally, women should give themselves at least 3 months to prepare before getting pregnant.

The five most important things you can do before becoming pregnant are:

  1. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day for at least 3 months before getting pregnant to lower your risk of some birth defects of the brain and spine. You can get folic acid from some foods. But it's hard to get all the folic acid you need from foods alone. Taking a vitamin with folic acid is the best and easiest way to be sure you're getting enough.

  2. Stop smoking and drinking alcohol. Ask your doctor for help.

  3. If you have a medical condition, be sure it is under control. Some conditions include asthma, diabetes, depression, high blood pressure, obesity, thyroid disease, or epilepsy. Be sure your vaccinations are up to date.

  4. Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Some medicines are not safe during pregnancy. At the same time, stopping medicines you need also can be harmful.

  5. Avoid contact with toxic substances or materials at work and at home that could be harmful. Stay away from chemicals and cat or rodent feces.

I'm pregnant. What should I do — or not do — to take care of myself and my unborn baby?

Follow these do's and don’ts to take care of yourself and the precious life growing inside you:

Health care do's and don’ts

Food do's and don’ts

Lifestyle do's and don’ts

Environmental do's and don’ts

Check out our more detailed tips on Pregnancy do's and don'ts (PDF, 176 KB).

I don't want to get pregnant right now. But should I still take folic acid every day?

Yes! Birth defects of the brain and spine happen in the very early stages of pregnancy, often before a woman knows she is pregnant. By the time she finds out she is pregnant, it might be too late to prevent those birth defects. Also, half of all pregnancies in the United States are not planned. For these reasons, all women who are able to get pregnant need 400 to 800 mcg of folic acid every day.

How often should I see my doctor during pregnancy?

Your doctor will give you a schedule of all the doctor's visits you should have while pregnant. Most experts suggest you see your doctor:

If you are older than 35 or your pregnancy is high risk, you'll probably see your doctor more often.

What happens during prenatal visits?

During the first prenatal visit, you can expect your doctor to:

At the first visit, you should ask questions and discuss any issues related to your pregnancy. Find out all you can about how to stay healthy.

Later prenatal visits will probably be shorter. Your doctor will check on your health and make sure the baby is growing as expected.  Most prenatal visits will include:

While you're pregnant, you also will have some routine tests. Some tests are suggested for all women, such as blood work to check for anemia, your blood type, HIV, and other factors. Other tests might be offered based on your age, personal or family health history, your ethnic background, or the results of routine tests you have had. Visit the pregnancy section of our website for more details on prenatal care and tests.

I am in my late 30s and I want to get pregnant. Should I do anything special?

As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.

During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.

More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation. 

Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it’s also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.

Where can I go to get free or reduced-cost prenatal care?

Women in every state can get help to pay for medical care during their pregnancies. This prenatal care can help you have a healthy baby. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

To find out about the program in your state:

More information on prenatal care

For more information about prenatal care, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Prenatal care fact sheet was reviewed by:

John W. Schmitt, M.D.
Associate Professor of Clinical Obstetrics and Gynecology
University of Virginia Medical School

Source: Office on Women's Health, HHS

Preterm Labor and Birth: Overview

In general, a normal human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth. Labor that begins before 37 weeks is called preterm labor (or premature labor). A birth that occurs before 37 weeks is considered a preterm birth.

Preterm birth is the most common cause of infant death and is the leading cause of long-term disability related to the nervous system in children.

The NICHD is working both on its own and in collaboration with other agencies and organizations to learn more about the causes of preterm labor and birth, improve ways to predict which women are at risk for preterm delivery, and identify prevention methods to reduce the number of infants born early.

The NICHD also is studying ways to improve care for infants born too early in order to reduce death and disability associated with preterm birth.

Common Names

Medical or Scientific Name

Preterm Labor and Birth

What is preterm labor and birth?

In general, a normal human pregnancy is about 40 weeks long (9.2 months). Health care providers now define “full-term” birth as birth that occurs between 39 weeks and 40 weeks and 6 days of pregnancy. Infants born during this time are considered full-term infants.

Infants born in the 37th and 38th weeks of pregnancy—previously called term but now referred to as “early term”—face more health risks than do those born at 39 or 40 weeks.

Deliveries before 37 weeks of pregnancy are considered “preterm” or premature:

“Late preterm” refers to 34 weeks through 36 weeks of pregnancy. Infants born during this time are considered late-preterm infants, but they face many of the same health challenges as preterm infants. More than 70% of preterm infants are born during the late-preterm time frame.

Preterm birth is the most common cause of infant death and is the leading cause of long-term disability in children. Many organs, including the brain, lungs, and liver, are still developing in the final weeks of pregnancy. The earlier the delivery, the higher the risk of serious disability or death.

Infants born prematurely are at risk for cerebral palsy (a group of nervous system disorders that affect control of movement and posture and limit activity), developmental delays, and vision and hearing problems.

Late-preterm infants typically have better health outcomes than those born earlier, but they are still three times more likely to die in the first year of life than are full-term infants. Preterm births can also take a heavy emotional and economic toll on families.

What are the symptoms of preterm labor?

Preterm labor is any labor that occurs from 20 weeks through 36 weeks of pregnancy. Here are the symptoms:

It is normal for pregnant women to have some uterine contractions throughout the day. It is not normal to have frequent uterine contractions, such as six or more in one hour. Frequent uterine contractions, or tightenings, may cause the cervix to begin to open.

If a woman thinks that she might be having preterm labor, she should call her doctor or go to the hospital to be evaluated.

How many people are affected by preterm labor and birth?

According to the Centers for Disease Control and Prevention, each year, preterm birth affects more than 500,000 infants—that's one nearly 1 of every 9 infants born in the United States.

The rate of preterm births peaked in 2006 at nearly 13%, which was more than one-third higher than rates during the early 1980s. But in the past 5 years, the rates of preterm births have been falling. Between 2009 and 2010 (the latest year for which data are available), the rate declined to less than 12% of births.

Going into preterm labor does not always mean that a pregnant woman will deliver the baby prematurely. Up to one-half of women who experience preterm labor eventually deliver at 37 weeks of pregnancy or later.

In some cases, intervention from a health care provider is needed to stop preterm labor. In other cases, the labor may stop on its own. A woman who thinks she is experiencing preterm labor should contact a health care provider immediately.

How many women are at risk for preterm labor and delivery?

Any pregnant woman could experience preterm labor and delivery. But there are some factors that increase a woman’s risk of going into labor or giving birth prematurely. Please visit the section What are the risk factors for preterm labor and birth? for more details on risk factors.

What causes preterm labor and birth?

The causes of preterm labor and premature birth are numerous, complex, and only partly understood. Medical, psychosocial, and biological factors may all play a role in preterm labor and birth.

There are three main situations in which preterm labor and premature birth may occur:

What are the risk factors for preterm labor and birth?

There are several risk factors for preterm labor and premature birth, including ones that researchers have not yet identified. Some of these risk factors are “modifiable,” meaning they can be changed to help reduce the risk. Other factors cannot be changed.

Health care providers consider the following factors to put women at high risk for preterm labor or birth:

Certain medical conditions, including some that occur only during pregnancy, also place a woman at higher risk for preterm labor and delivery. Some of these conditions include:

Other factors that may increase risk for preterm labor and premature birth include:

Is it possible to predict which women are more likely to have preterm labor and birth?

Currently, there is no definitive way to predict preterm labor or premature birth. Many research studies are focusing on this important issue. By identifying which women are at increased risk, health care providers may be able to provide early interventions, treatments, and close monitoring of these pregnancies to prevent preterm delivery or to improve health outcomes.

However, in some situations, health care providers know that a preterm delivery is very likely. Some of these situations are described below.

Shortened Cervix

As a preparation for birth, the cervix (the lower part of the uterus) naturally shortens late in pregnancy. However, in some women, the cervix shortens prematurely, around the fourth or fifth month of pregnancy, increasing the risk for preterm delivery.

In some cases, a health care provider may recommend measuring a pregnant woman’s cervical length, especially if she previously had preterm labor or a preterm birth. Ultrasound scans may be used to measure cervical length and identify women with a shortened cervix.

"Incompetent" Cervix

The cervix normally remains closed during pregnancy. In some cases, the cervix starts to open early, before a fetus is ready to be born. Health care providers may refer to a cervix that begins to open as an "incompetent" cervix. The process of cervical opening is painless and unnoticeable, without labor contractions or cramping.

Approximately 5 to 10 out of 1,000 pregnant women are diagnosed as having an incompetent cervix.

To try to prevent preterm birth, a doctor may place a stitch around the cervix to keep it closed. This procedure is called cervical cerclage (pronounced sair-KLAZH). NICHD-supported research has found that, in women with a prior preterm birth who have a short cervix, cerclage may improve the likelihood of a full-term delivery.

How do health care providers diagnose preterm labor?

If a woman is concerned that she could be showing signs of preterm labor, she should call her health care provider or go to the hospital to be evaluated. In particular, a woman should call if she has more than six contractions in an hour or if fluid or blood is leaking from the vagina.

Physical Exam

If a woman is experiencing signs of labor, the health care provider may perform a pelvic exam to see if:

Any of these situations could mean the woman is in preterm labor.
Providers may also do an ultrasound exam and use a monitor to electronically record contractions and the fetal heart rate.

Fetal Fibronectin (fFN) Test

This test is used to detect whether the protein fetal fibronectin (pronounced fy-broh-NEK-tun) is being produced. fFN is like a biological “glue” between the uterine lining and the membrane that surrounds the fetus.1

Normally fFN is detectable in the pregnant woman's secretions from the vagina and cervix early in the pregnancy (up to 22 weeks, or about 5 months) and again toward the end of the pregnancy (1 to 3 weeks before labor begins). It is usually not present between 24 and 34 weeks of pregnancy (5½ to 8½ months). If fFN is detected during this time, it may be a sign that the woman may be at risk of preterm labor and birth.

In most cases, the fFN test is performed on women who are showing signs of preterm labor. Testing for fFN can predict with about 50% accuracy which pregnant women showing signs of preterm labor are likely to have a preterm delivery.2 It is typically used for its negative predictive value, meaning that if it is negative, it is unlikely that a woman will deliver within the next 7 days.

What treatments are used to prevent preterm labor and birth?

Currently, treatment options for preventing preterm labor or birth are somewhat limited, in part because the cause of preterm labor or birth is often unknown. But there are a few options, described below.

Hormone treatment. The only preventive drug therapy is progesterone (pronounced proh-JES-tuh-rohn), a hormone produced by the body during pregnancy, which is given to women at risk of preterm birth, such as those with a prior preterm birth. The NICHD’s Maternal-Fetal Medicine Units Network found that progesterone given to women at risk of preterm birth due to a prior preterm birth reduces chances of a subsequent preterm birth by one-third. This preventive therapy is given beginning at 16 weeks of gestation and continues to 37 weeks of gestation. The treatment works among all ethnic groups and can improve outcomes for infants.

Cerclage. A surgical procedure called cervical cerclage (pronounced sair-KLAZH) is sometimes used to try to prevent early labor in women who have an incompetent (weak) cervix and have experienced early pregnancy loss accompanied by a painless opening (dilation) of the cervix (the bottom part of the uterus). In the cerclage procedure, a doctor stitches the cervix closed. The stitch is then removed closer to the woman's due date.

Bed rest. Contrary to expectations, confining the mother to bed rest does not help to prevent preterm birth. In fact, bed rest can make preterm birth even more likely among some women.

Women should discuss all of their treatment options—including the risks and benefits—with their health care providers. If possible, these discussions should occur during regular prenatal care  visits, before there is any urgency, to allow for a complete discussion of all the issues.

What treatments can reduce the chances of preterm labor & birth?

If a pregnant woman is showing signs of preterm labor, her doctor will often try treatments to stop labor and prolong the pregnancy until the fetus is more fully developed. Treatments include therapies to try to stop labor (tocolytics) and medications administered before birth to improve outcomes for the infant if born preterm (antenatal steroids to improve the respiratory outcomes and neuroprotective medications such as magnesium sulfate).

Medications to Delay Labor

Drugs called tocolytics (pronounced toh-coh-LIT-iks) can be given to many women with symptoms of preterm labor. These drugs can slow or stop contractions of the uterus and may prevent labor for 2 to 7 days. One common treatment for delaying labor is magnesium sulfate (pronounced mag-NEEZ-ee-um SUL-fate), given to the pregnant woman intravenously through a needle inserted in an arm vein.

Medications to Speed Development of the Fetus

Tocolytics may provide the extra time for treatment with corticosteroids (pronounced kohr-tuh-koh-STER-oids) to speed up development of the fetus's lungs and some other organs or for the pregnant woman to get to a hospital that offers specialized care for preterm infants. Corticosteroids can be particularly effective if the pregnancy is between 24 and 34 weeks (between 5½ and 7¾ months) and the woman's health care provider suspects that the birth may occur within the next week. Intravenously delivered magnesium sulfate may also reduce the risk of cerebral palsy if the child is born early.

What methods do not work to prevent preterm labor?

Researchers have found that some methods for trying to stop preterm labor are not as effective as once thought. These include:

Preterm Labor and Birth: 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.

What health problems and conditions are common among infants born preterm?

What are the effects of preterm birth on families?

What health problems and conditions are common among infants born preterm?

Premature infants are at increased risk for many health complications, such as breathing problems, and even death. In addition to regular infant health care needs, premature infants often require special care for these problems. The earlier in pregnancy a birth occurs, the higher the risk for long-term health problems and the greater the likelihood of long-term disability.

Among the health challenges faced by premature infants are:

Most preterm infants need to stay in the hospital for several weeks or more, often in a neonatal (pronounced nee-oh-NATE-ahl) intensive care unit (NICU).

Surfactant (pronounced sir-FAK-tant) therapy may be used for infants born very early. Surfactant is a substance that helps the air sacs stay inflated in the lungs. The lungs begin making surfactant at around 23 weeks of pregnancy. Lack of surfactant is the main cause of respiratory distress syndrome (breathing problems) in preterm infants. Infants who need surfactant replacement therapy often are very sick and need highly specialized care.

Preterm infants also face an increased risk of lasting disabilities, such as IDD, learning difficulties, behavioral problems, cerebral palsy (a group of disorders that affect a person's ability to move and maintain balance and posture), lung problems, and vision and hearing loss. Infants born too early may be at increased risk of symptoms associated with autism spectrum disorder (such as social, behavioral, and other problems). Studies also suggest that infants born at low birth weight, which is common in infants born preterm, are at increased risk of certain adult health problems, such as diabetes, high blood pressure, and heart disease. 

What are the effects of preterm birth on families?

Preterm birth can have profound effects on families, both emotionally and financially. In addition to the time spent in the NICU, preterm infants spend an average of 13 days in the hospital, compared to a little more than 1 day for full-term infants. Parents of preterm infants also may miss more work than those of full-term infants.
Having a preterm infant can cause hardships and emotional challenges for families. Preterm infants sometimes die, and those that survive may have long-term disabilities.
For resources families can use, visit the Resources and Publications section.

Before you get pregnant: Information for all women

Why preconception health matters

Preconception health is a woman's health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy.

Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.

Five most important things to boost your preconception health

Women and men should prepare for pregnancy before becoming sexually active — or at least three months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines you are using, should start even earlier. The five most important things you can do for preconception health are:

  1. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida. All women need folic acid every day. Talk to your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.

  2. Stop smoking and drinking alcohol.

  3. If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.

  4. Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Be sure your vaccinations are up to date.

  5. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces.

Talk to your doctor before you become pregnant

Did you know?

It's best to be at a healthy weight when you become pregnant. Being overweight or underweight puts you at increased risk for problems during pregnancy. Learn how healthy food choices and physical fitness, together, can help you reach or maintain a healthy weight. Visit our Fitness and nutrition section.

Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby. If you are sexually active, talk to your doctor about your preconception health now. Preconception care should begin at least three months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner's health too. Ask your doctor about:

Bring a list of talking points (PDF, 182 KB) to be sure you don't forget anything. If you run out of time at your visit, schedule a follow-up visit to make sure everything is covered.

Your partner's role in preparing for pregnancy

Your partner can do a lot to support and encourage you in every aspect of preparing for pregnancy. Here are some ways:

Genetic counseling

Did you know?

Some companies offer genetic tests that you can do yourself through the mail. These tests may not provide true or meaningful information. These tests might provide harmful information. Talk to your doctor before using this type of test.

The genes your baby is born with can affect your baby's health in these ways:

Talk to your doctor about your and your partner's family health histories before becoming pregnant. This information can help your doctor find out any genetic risks you might have.

Depending on your genetic risk factors, your doctor might suggest you meet with a genetic professional. Some reasons a person or couple might seek genetic counseling are:

During a consultation, the genetics professional meets with a person or couple to discuss genetic risks or to diagnose, confirm, or rule out a genetic condition. Sometimes, a couple chooses to have genetic testing. Some tests can help couples to know the chances that a person will get or pass on a genetic disorder. The genetics professional can help couples decide if genetic testing is the right choice for them.

Trying to conceive

How do you figure out when you're fertile and when you're not? Wondering if you or your partner is infertile? Read on to boost your chances of conception and get help for fertility problems.

Fertility awareness

The menstrual cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can help you know when you are most likely to get pregnant. See how the menstrual cycle works below.

The average menstrual cycle lasts 28 days. But normal cycles can vary from 21 to 35 days. The amount of time before ovulation occurs is different in every woman and even can be different from month to month in the same woman, varying from 13 to 20 days long. Learning about this part of the cycle is important because it is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods or becomes pregnant) will have a period within 14 to 16 days.

Charting your fertility pattern

Knowing when you're most fertile will help you plan pregnancy. There are three ways you can keep track of your fertile times. They are:

Did you know?

The cervical mucus method is less reliable for some women. Women who are breastfeeding, taking hormonal birth control (like the pill), using feminine hygiene products, have vaginitis or sexually transmitted infections (STIs), or have had surgery on the cervix should not rely on this method.

Infertility

Some women want children but either cannot conceive or keep miscarrying. This is called infertility. Lots of couples have infertility problems. About one-third of the time, it is a female problem. In another one-third of cases, it is the man with the fertility problem. For the remaining one-third, both partners have fertility challenges or no cause is found.

Causes of infertility

Some common reasons for infertility in women include:

Age – Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35. As a woman ages, normal changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality. As a woman nears menopause, the ovaries may not release an egg each month, which also can make it harder to get pregnant. Also, as a woman and her eggs age, she is more likely to miscarry, as well as have a baby with genetic problems, such as Down syndrome.

Health problems – Some women have diseases or conditions that affect their hormone levels, which can cause infertility.

Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus.

Lifestyle factors – Certain lifestyle factors also can have a negative effect on a woman's fertility. Examples include smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Stress also can affect fertility.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. They also have a slightly higher risk of sperm gene defects. Or they might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted infections (STIs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem.

When to see your doctor

You should talk to your doctor about your fertility if:

Happily, doctors are able to help many infertile couples go on to have babies.

Options for infertile couples

If you are having fertility issues, your doctor can refer you to a fertility specialist, a doctor who treats infertility. The doctor will need to test both you and your partner to find out what the problem is. Depending on the problem, your doctor might recommend treatment. About 9 in 10 cases of infertility are treated with drugs or surgery. Don't delay seeing your doctor as age also affects the success rates of these treatments. For some couples, adoption or foster care offers a way to share their love with a child and to build a family.

Infertility treatment

Some treatments include:

Finding the cause of infertility is often a long, complex, and emotional process. And treatment can be expensive. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Some states have laws that mandate health insurance policies to provide infertility coverage.

Adoption

If infertility is a problem for you, another option may be adoption. Adopting a baby or child can be one of the most rewarding experiences of your life. So many babies, children, and adolescents in the United States and around the world need a family. Some of these are healthy infants, and many are children with special needs, including physical, emotional, or mental disabilities. If you do adopt a child with special needs, there are both federal and state sources of financial assistance available to help you afford the child's care.

There are two types of adoptions:

The laws of each state differ on whether, after a period of time, the files of a closed adoption can be opened later to reveal this information. State laws also differ on whether adoptions can be handled by an adoption agency or independently (such as through a doctor, lawyer, counselor or independent organization). Most adoption agencies carefully screen and study the adoptive parents. You can learn more about adoption through the resources at the end of this section.

Foster care

Another option for couples who have a lot of love to share with a child is foster care. Unlike adoption, foster care is a temporary service that responds to crises in the lives of children and families. But it also can be the first step to adopting a child. Many foster children have been abused or neglected, or removed by a court order. Foster families are people who take these children into their homes to provide day-to-day care and nurturing. Children in foster care may live with unrelated foster parents, with relatives, with families who plan to adopt them, or in group homes or residential treatment centers. Even though foster care is viewed as a temporary service, many children have to stay in foster care for long periods of time.

Each child in foster care should have a plan that will let him or her grow up in a permanent family. For many children, the plan is to return to the birth parents. In these cases, foster families may work with the birth parents and the child to help them both learn the skills they need to live together again. Foster parents need to be able to love the children who live in their home, and let go of them when it is time to send them back to their parents. For other children, going back to their parents will not be possible, and the foster parents may become adoptive parents. Or they can keep other kinds of formal or informal ties with the children they parent.

Every state has its own rules about foster parenting. But, the chances are good that you can be a foster parent in your state. There are many more children in need of care than there are foster parents available. To fill this gap, states are looking for people who want to help children and can share their time and their homes. States also give foster parents many different forms of support, like training and financial assistance.

Counseling and support groups

If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counseling and support groups can help you and your partner talk about your feelings and help you meet other couples struggling with the same issues. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process. Ask your doctor for the names of counselors or therapists with an interest in fertility.

Knowing if you are pregnant

A missed period is often the first clue that a woman might be pregnant. Sometimes, a woman might suspect she is pregnant even sooner. Symptoms such as headache, fatigue, and breast tenderness, can occur even before a missed period. The wait to know can be emotional. These days, many women first use home pregnancy tests (HPT) to find out. Your doctor also can test you.

All pregnancy tests work by detecting a special hormone in the urine or blood that is only there when a woman is pregnant. It is called human chorionic gonadotropin (kohr-ee-ON-ihk goh-NAD-uh-TROH-puhn), or hCG. hCG is made when a fertilized egg implants in the uterus. hCG rapidly builds up in your body with each passing day you are pregnant. Read on to learn when and how to test for pregnancy.

Home pregnancy tests

Reading a home pregnancy test

This pregnancy test shows a positive result because you can see a pink line in the results window. The pink line in the control window shows that the test is working.

HPTs are inexpensive, private, and easy to use. Most drugstores sell HPTs over the counter. The cost depends on the brand and how many tests come in the box. They work by detecting hCG in your urine. HPTs are highly accurate. But their accuracy depends on many things. These include:

The most important part of using any HPT is to follow the directions exactly as written. Most tests also have toll-free phone numbers to call in case of questions about use or results.

If a HPT says you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy can help you and your baby stay healthy.

Blood tests

Blood tests are done in a doctor's office. They can pick up hCG earlier in a pregnancy than urine tests can. Blood tests can tell if you are pregnant about six to eight days after you ovulate. Doctors use two types of blood tests to check for pregnancy:

Unplanned Pregnancy

divider line

Unplanned pregnancy is common. About 1 in 2 pregnancies in America are unplanned. Ideally, a woman who is surprised by an unplanned pregnancy is in good preconception health and is ready and able to care for a new child. But this sometimes isn't the case. If you have an unplanned pregnancy, you might not know what to do next. You might worry that the father won't welcome the news. You might not be sure you can afford to care for a baby. You might worry if past choices you have made, such as drinking or drug use, will affect your unborn baby's health. You might be concerned that having a baby will keep you from finishing school or pursuing a career. If you are pregnant after being raped, you might feel ashamed, numb, or afraid. You might wonder what options you have. Here are some next steps to help you move forward:

Partner abuse and unplanned pregnancy

Unplanned pregnancy is common among abused women. Research has found that some abusers force their partners to have sex without birth control and/or sabotage the birth control their partners are using, leading to unplanned pregnancy. If you have an abusive partner, get help now. Violence can hurt you and your pregnancy and have long-lasting effects on your children. About 1 in 2 men who abuse their wives also abuse their children. And children who grow up with violence in the home are more likely to become abusers as adults and have physical and emotional problems. To get help right now, call the National Domestic Violence Hotline at 800-799-SAFE (7233) and 800-787-3224 (TTY). Spanish speakers are available.

Pregnancy: You're pregnant: Now what?

divider line

Are you a father-to-be?

A father's presence is as important to a child's healthy development as the mother's. Your role as a father can begin now by supporting the baby's mother during the pregnancy. Being involved in the pregnancy also will help you to adjust to the idea of parenthood. Learn more about the importance of fathers.

Did you know?

Several types of health care professionals can help pregnant women and deliver babies. They include obstetricians, family physicians, midwives, and nurse-midwives. In this section of womenshealth.gov, we call all health care professionals "doctor" only to keep the information as easy to read as possible.

So — you're pregnant! What's next? What should you eat? What kinds of tests will you and your baby need? What happens if problems come up? Get answers to these questions and more.

Pregnancy: Stages of pregnancy

divider line

Pregnancy Stages

divider line

Stages of pregnancy

Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters. Find out what's happening with you and your baby in these three stages.

First trimester (week 1–week 12)

During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:

  • Extreme tiredness

  • Tender, swollen breasts. Your nipples might also stick out.

  • Upset stomach with or without throwing up (morning sickness)

  • Cravings or distaste for certain foods

  • Mood swings

  • Constipation (trouble having bowel movements)

  • Need to pass urine more often

  • Headache

  • Heartburn

  • Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

Second trimester (week 13–week 28)

Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have:

  • Body aches, such as back, abdomen, groin, or thigh pain

  • Stretch marks on your abdomen, breasts, thighs, or buttocks

  • Darkening of the skin around your nipples

  • A line on the skin running from belly button to pubic hairline

  • Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.

  • Numb or tingling hands, called carpal tunnel syndrome

  • Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)

  • Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Third trimester (week 29–week 40)

You're in the home stretch! Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs. Don't worry, your baby is fine and these problems will lessen once you give birth.

Some new body changes you might notice in the third trimester include:

  • Shortness of breath

  • Heartburn

  • Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

  • Hemorrhoids

  • Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)

  • Your belly button may stick out

  • Trouble sleeping

  • The baby "dropping", or moving lower in your abdomen

  • Contractions, which can be a sign of real or false labor

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date. Get excited — the final countdown has begun!

Your developing baby

First trimester (week 1-week 12)

diagram of a fetus at 4 weeks

At four to five weeks:

  • Your baby's brain and spinal cord have begun to form.

  • The heart begins to form.

  • Arm and leg buds appear.

  • Your baby is now an embryo and one-twenty-fifth inch long.

diagram of a fetus at 8 weeks

At eight weeks:

  • All major organs and external body structures have begun to form.

  • Your baby's heart beats with a regular rhythm.

  • The arms and legs grow longer, and fingers and toes have begun to form.

  • The sex organs begin to form.

  • The eyes have moved forward on the face and eyelids have formed.

  • The umbilical cord is clearly visible.

  • At the end of eight weeks, your baby is a fetus and looks more like a human. Your baby is nearly 1 inch long and weighs less than one-eighth ounce.

diagram of a fetus at 12 weeks

At 12 weeks:

  • The nerves and muscles begin to work together. Your baby can make a fist.

  • The external sex organs show if your baby is a boy or girl. A woman who has an ultrasound in the second trimester or later might be able to find out the baby's sex.

  • Eyelids close to protect the developing eyes. They will not open again until the 28th week.

  • Head growth has slowed, and your baby is much longer. Now, at about 3 inches long, your baby weighs almost an ounce.

Second trimester (week 13-week 28)

diagram of a fetus at 16 weeks

At 16 weeks:

  • Muscle tissue and bone continue to form, creating a more complete skeleton.

  • Skin begins to form. You can nearly see through it.

  • Meconium (mih-KOH-nee-uhm) develops in your baby's intestinal tract. This will be your baby's first bowel movement.

  • Your baby makes sucking motions with the mouth (sucking reflex).

  • Your baby reaches a length of about 4 to 5 inches and weighs almost 3 ounces.

diagram of a fetus at 20 weeks

At 20 weeks:

  • Your baby is more active. You might feel slight fluttering.

  • Your baby is covered by fine, downy hair called lanugo (luh-NOO-goh) and a waxy coating called vernix. This protects the forming skin underneath.

  • Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself.

  • Your baby can hear and swallow.

  • Now halfway through your pregnancy, your baby is about 6 inches long and weighs about 9 ounces.

diagram of a fetus at 24 weeks

At 24 weeks:

  • Bone marrow begins to make blood cells.

  • Taste buds form on your baby's tongue.

  • Footprints and fingerprints have formed.

  • Real hair begins to grow on your baby's head.

  • The lungs are formed, but do not work.

  • The hand and startle reflex develop.

  • Your baby sleeps and wakes regularly.

  • If your baby is a boy, his testicles begin to move from the abdomen into the scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs have formed in the ovaries.

  • Your baby stores fat and has gained quite a bit of weight. Now at about 12 inches long, your baby weighs about 1½ pounds.

Third trimester (week 29-week 40)

diagram of a fetus at 32 weeks

At 32 weeks:

  • Your baby's bones are fully formed, but still soft.

  • Your baby's kicks and jabs are forceful.

  • The eyes can open and close and sense changes in light.

  • Lungs are not fully formed, but practice "breathing" movements occur.

  • Your baby's body begins to store vital minerals, such as iron and calcium.

  • Lanugo begins to fall off.

  • Your baby is gaining weight quickly, about one-half pound a week. Now, your baby is about 15 to 17 inches long and weighs about 4 to 4½ pounds.

diagram of a fetus at 36 weeks

At 36 weeks:

  • The protective waxy coating called vernix gets thicker.

  • Body fat increases. Your baby is getting bigger and bigger and has less space to move around. Movements are less forceful, but you will feel stretches and wiggles.

  • Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.

diagram of a fetus at Weeks 37-40

Weeks 37-40:

  • At 39 weeks, your baby is considered full-term. Your baby's organs are ready to function on their own.

  • As you near your due date, your baby may turn into a head-down position for birth. Most babies "present" head down.

  • At birth, your baby may weigh somewhere between 6 pounds 2 ounces and 9 pounds 2 ounces and be 19 to 21 inches long. Most full-term babies fall within these ranges. But healthy babies come in many different sizes.

Pregnancy: Prenatal care and tests

divider line

Prenatal care and tests

Medical checkups and screening tests help keep you and your baby healthy during pregnancy. This is called prenatal care. It also involves education and counseling about how to handle different aspects of your pregnancy. During your visits, your doctor may discuss many issues, such as healthy eating and physical activity, screening tests you might need, and what to expect during labor and delivery.

Choosing a prenatal care provider

You will see your prenatal care provider many times before you have your baby. So you want to be sure that the person you choose has a good reputation, and listens to and respects you. You will want to find out if the doctor or midwife can deliver your baby in the place you want to give birth, such as a specific hospital or birthing center. Your provider also should be willing and able to give you the information and support you need to make an informed choice about whether to breastfeed or bottle-feed.

What is a doula?

A doula (DOO-luh) is a professional labor coach, who gives physical and emotional support to women during labor and delivery. They offer advice on breathing, relaxation, movement, and positioning. Doulas also give emotional support and comfort to women and their partners during labor and birth. Doulas and midwives often work together during a woman's labor. A recent study showed that continuous doula support during labor was linked to shorter labors and much lower use of.

Check with your health insurance company to find out if they will cover the cost of a doula. When choosing a doula, find out if she is certified by Doulas of North America (DONA) or another professional group.

Health care providers that care for women during pregnancy include:

Ask your primary care doctor, friends, and family members for provider recommendations. When making your choice, think about:

Places to deliver your baby

Many women have strong views about where and how they'd like to deliver their babies. In general, women can choose to deliver at a hospital, birth center, or at home. You will need to contact your health insurance provider to find out what options are available. Also, find out if the doctor or midwife you are considering can deliver your baby in the place you want to give birth.

Did you know?

Some hospitals and birth centers have taken special steps to create the best possible environment for successful breastfeeding. They are called Baby-Friendly Hospitals and Birth Centers. Women who deliver in a baby-friendly facility are promised the information and support they need to breastfeed their infants. Learn more about Baby-friendly hospitals and birth centers from the Baby-Friendly Hospital Initiative.

Prenatal checkups

During pregnancy, regular checkups are very important. This consistent care can help keep you and your baby healthy, spot problems if they occur, and prevent problems during delivery. Typically, routine checkups occur:

Women with high-risk pregnancies need to see their doctors more often.

At your first visit your doctor will perform a full physical exam, take your blood for lab tests, and calculate your due date. Your doctor might also do a breast exam, a pelvic exam to check your uterus (womb), and a cervical exam, including a Pap test. During this first visit, your doctor will ask you lots of questions about your lifestyle, relationships, and health habits. It's important to be honest with your doctor.

After the first visit, most prenatal visits will include:

You also will have some routine tests throughout your pregnancy, such as tests to look for anemia, tests to measure risk of gestational diabetes, and tests to look for harmful infections.

Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important! Ask questions and read to educate yourself about this exciting time.

Monitor your baby's activity

After 28 weeks, keep track of your baby's movement. This will help you to notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor's care. An easy way to do this is the "count-to-10" approach. Count your baby's movements in the evening — the time of day when the fetus tends to be most active. Lie down if you have trouble feeling your baby move. Most women count 10 movements within about 20 minutes. But it is rare for a woman to count less than 10 movements within two hours at times when the baby is active. Count your baby's movements every day so you know what is normal for you. Call your doctor if you count less than 10 movements within two hours or if you notice your baby is moving less than normal. If your baby is not moving at all, call your doctor right away.

Prenatal tests

Avoid keepsake ultrasounds

You might think a keepsake ultrasound is a must-have for your scrapbook. But, doctors advise against ultrasound when there is no medical need to do so. Some companies sell "keepsake" ultrasound videos and images. Although ultrasound is considered safe for medical purposes, exposure to ultrasound energy for a keepsake video or image may put a mother and her unborn baby at risk. Don't take that chance.

Tests are used during pregnancy to check your and your baby's health. At your fist prenatal visit, your doctor will use tests to check for a number of things, such as:

Throughout your pregnancy, your doctor or midwife may suggest a number of other tests, too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV. Other tests might be offered based on your:

Some tests are screening tests. They detect risks for or signs of possible health problems in you or your baby. Based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby.

The following chart describes some of the most common prenatal tests:

Common prenatal tests

Test

What it is

How it is done

Amniocentesis (AM-nee-oh-sen-TEE-suhss)

This test can diagnosis certain birth defects, including:

  • Down syndrome

  • Cystic fibrosis

  • Spina bifida

It is performed at 14 to 20 weeks.

It may be suggested for couples at higher risk for genetic disorders. It also provides DNA for paternity testing.

A thin needle is used to draw out a small amount of amniotic fluid and cells from the sac surrounding the fetus. The sample is sent to a lab for testing.

Biophysical profile (BPP)

This test is used in the third trimester to monitor the overall health of the baby and to help decide if the baby should be delivered early.

BPP involves an ultrasound exam along with a nonstress test. The BPP looks at the baby's breathing, movement, muscle tone, heart rate, and the amount of amniotic fluid.

Chorionic villus (KOR-ee-ON-ihk VIL-uhss) sampling (CVS)

A test done at 10 to 13 weeks to diagnose certain birth defects, including:

  • Chromosomal disorders, including Down syndrome

  • Genetic disorders, such as cystic fibrosis

CVS may be suggested for couples at higher risk for genetic disorders. It also provides DNA for paternity testing.

A needle removes a small sample of cells from the placenta to be tested.

First trimester screen

A screening test done at 11 to 14 weeks to detect higher risk of:

  • Chromosomal disorders, including Down syndrome and trisomy 18

  • Other problems, such as heart defects

It also can reveal multiple births. Based on test results, your doctor may suggest other tests to diagnose a disorder.

This test involves both a blood test and an ultrasound exam called nuchal translucency (NOO-kuhl trans-LOO-sent-see) screening. The blood test measures the levels of certain substances in the mother's blood. The ultrasound exam measures the thickness at the back of the baby's neck. This information, combined with the mother's age, help doctors determine risk to the fetus.

Glucose challenge screening

A screening test done at 26 to 28 weeks to determine the mother's risk of gestational diabetes.

Based on test results, your doctor may suggest a glucose tolerance test.

First, you consume a special sugary drink from your doctor. A blood sample is taken one hour later to look for high blood sugar levels.

Glucose tolerance test

This test is done at 26 to 28 weeks to diagnose gestational diabetes.

Your doctor will tell you what to eat a few days before the test. Then, you cannot eat or drink anything but sips of water for 14 hours before the test. Your blood is drawn to test your "fasting blood glucose level." Then, you will consume a sugary drink. Your blood will be tested every hour for three hours to see how well your body processes sugar.

Group B streptococcus (STREP-tuh-KOK-uhss) infection

This test is done at 36 to 37 weeks to look for bacteria that can cause pneumonia or serious infection in newborn.

A swab is used to take cells from your vagina and rectum to be tested.

Maternal serum screen (also called quad screen, triple test, triple screen, multiple marker screen, or AFP)

A screening test done at 15 to 20 weeks to detect higher risk of:

  • Chromosomal disorders, including Down syndrome and trisomy 18

  • Neural tube defects, such as spina bifida

Based on test results, your doctor may suggest other tests to diagnose a disorder.

Blood is drawn to measure the levels of certain substances in the mother's blood.

Nonstress test (NST)

This test is performed after 28 weeks to monitor your baby's health. It can show signs of fetal distress, such as your baby not getting enough oxygen.

A belt is placed around the mother's belly to measure the baby's heart rate in response to its own movements.

Ultrasound exam

An ultrasound exam can be performed at any point during the pregnancy. Ultrasound exams are not routine. But it is not uncommon for women to have a standard ultrasound exam between 18 and 20 weeks to look for signs of problems with the baby's organs and body systems and confirm the age of the fetus and proper growth. It also might be able to tell the sex of your baby.

Ultrasound exam is also used as part of the first trimester screen and biophysical profile (BPP).

Based on exam results, your doctor may suggest other tests or other types of ultrasound to help detect a problem.

Ultrasound uses sound waves to create a "picture" of your baby on a monitor. With a standard ultrasound, a gel is spread on your abdomen. A special tool is moved over your abdomen, which allows your doctor and you to view the baby on a monitor.

Urine test

A urine sample can look for signs of health problems, such as:

  • Urinary tract infection

  • Diabetes

  • Preeclampsia

If your doctor suspects a problem, the sample might be sent to a lab for more in-depth testing.

You will collect a small sample of clean, midstream urine in a sterile plastic cup. Testing strips that look for certain substances in your urine are dipped in the sample. The sample also can be looked at under a microscope.

Understanding prenatal tests and test results

If your doctor suggests certain prenatal tests, don't be afraid to ask lots of questions. Learning about the test, why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries or fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes back abnormal, this doesn't mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.

High-risk pregnancy

Pregnancies with a greater chance of complications are called "high-risk." But this doesn't mean there will be problems. The following factors may increase the risk of problems during pregnancy:

Health problems also may develop during a pregnancy that make it high-risk, such as gestational diabetes or preeclampsia. See Pregnancy complications to learn more.

Women with high-risk pregnancies need prenatal care more often and sometimes from a specially trained doctor. A maternal-fetal medicine specialist is a medical doctor that cares for high-risk pregnancies.

If your pregnancy is considered high risk, you might worry about your unborn baby's health and have trouble enjoying your pregnancy. Share your concerns with your doctor. Your doctor can explain your risks and the chances of a real problem. Also, be sure to follow your doctor's advice. For example, if your doctor tells you to take it easy, then ask your partner, family members, and friends to help you out in the months ahead. You will feel better knowing that you are doing all you can to care for your unborn baby.

Paying for prenatal care

Did you know?

The Affordable Care Act offers pregnant women more protections and options. Learn more from healthcare.gov.

Pregnancy can be stressful if you are worried about affording health care for you and your unborn baby. For many women, the extra expenses of prenatal care and preparing for the new baby are overwhelming. The good news is that women in every state can get help to pay for medical care during their pregnancies. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

To find out about the program in your state:

You may also find help through these places:

More information on Prenatal care and tests

Pregnancy: Twins, triplets, and other multiples

divider line

Twins, triplets, and other multiples

If you are pregnant with more than one baby, you are far from alone. In the past two decades, the number of multiple births has climbed way up in the United States.

Information about multiples

In 2005, 133,122 twin babies and 6,208 triplet babies were born in the United States. In 1980, there were only 69,339 twin and 1,337 triplet births.

Why the increase? For one, more women are having babies after age 30. Women in their 30s are more likely than younger women to conceive more than one baby naturally. Another reason is that more women are using fertility treatments to help them conceive.

How twins are formed

Twins form in one of two ways:

diagram of a single fertilized egg spliting into two

Identical twins occur when a single fertilized egg splits into two. Identical twins look almost exactly alike and share the exact same genes. Most identical twins happen by chance.

diagram of two, separate eggs are fertilized by two, separate sperm

Fraternal twins occur when two, separate eggs are fertilized by two, separate sperm. Fraternal twins do not share the exact same genes — they are no more alike than they are to their siblings from different pregnancies. Fraternal twins tend to run in some families.

Multiple births can be fraternal, identical, or a combination. Multiples associated with fertility treatments are mainly fraternal.

Pregnancy with multiples

Years ago, most twins came as a surprise. Now, thanks to advances in prenatal care, most women learn about a multiple pregnancy early. You might suspect you are pregnant with multiples if you have more severe body changes, including:

  • Rapid weight gain in the first trimester

  • Intense nausea and vomiting

  • Extreme breast tenderness

Your doctor can confirm whether you are carrying more than one baby through ultrasound. If you are pregnant with twins or other multiples, you will need to see your doctor more often than women who are carrying only one baby because your risk of complications is greater. Women carrying more than one baby are at higher risk of:

More frequent prenatal visits help your doctor to monitor your and your babies' health. Your doctor will also tell you how much weight to gain, if you need to take extra vitamins, and how much activity is safe. With close monitoring, your babies will have the best chance of being born near term and at a healthy weight.

After delivery and once your babies come home, you may feel overwhelmed and exhausted. Ask for help from your partner, family, and friends. Volunteer help and support groups for parents of multiples also can ease the transition.

Pregnancy: Staying healthy and safe

 divider line

Treating for Two. Safer Medication Use in Pregnancy

Eat this. Don't eat that. Do this. Don't do that. Pregnant women are bombarded with do's and don'ts. Here is help to keep it all straight.

Eating for two

Eating healthy foods is more important now than ever! You need more protein, iron, calcium, and folic acid than you did before pregnancy. You also need more calories. But "eating for two" doesn't mean eating twice as much. Rather, it means that the foods you eat are the main source of nutrients for your baby. Sensible, balanced meals combined with regular physical fitness is still the best recipe for good health during your pregnancy.

Weight gain

The amount of weight you should gain during pregnancy depends on your body mass index (BMI) before you became pregnant. The Institute of Medicine provides these guidelines:

Check with your doctor to find out how much weight gain during pregnancy is healthy for you.

You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester. Generally, doctors suggest women gain weight at the following rate:

Where does the added weight go?

Recent research shows that women who gain more than the recommended amount during pregnancy and who fail to lose this weight within six months after giving birth are at much higher risk of being obese nearly 10 years later. Findings from another large study suggest that gaining more weight than the recommended amount during pregnancy may raise your child's odds of being overweight in the future. If you find that you are gaining weight too quickly, try to cut back on foods with added sugars and solid fats. If you are not gaining enough weight, you can eat a little more from each food group.

Calorie needs

Your calorie needs will depend on your weight gain goals. Most women need 300 calories a day more during at least the last six months of pregnancy than they do pre-pregnancy. Keep in mind that not all calories are equal. Your baby needs healthy foods that are packed with nutrients — not "empty calories" such as those found in soft drinks, candies, and desserts.

Although you want to be careful not to eat more than you need for a healthy pregnancy, make sure not to restrict your diet during pregnancy either. If you don't get the calories you need, your baby might not get the right amounts of protein, vitamins, and minerals. Low-calorie diets can break down a pregnant woman's stored fat. This can cause your body to make substances called ketones. Ketones can be found in the mother's blood and urine and are a sign of starvation. Constant production of ketones can result in a child with mental deficiencies.

Foods good for mom and baby

A pregnant woman needs more of many important vitamins, minerals, and nutrients than she did before pregnancy. Making healthy food choices every day will help you give your baby what he or she needs to develop. The MyPyramid for pregnant and breastfeeding women can show you what to eat as well as how much you need to eat from each food group based on your pre-pregnancy BMI and activity level. Use your personal MyPyramid plan to guide your daily food choices. Here are some foods to choose often:

the food pyramid

  • Grains – fortified, cooked or ready-to-eat cereals; wheat germ

  • Vegetables – carrots, sweet potatoes, pumpkin, spinach, cooked greens, winter squash, tomatoes, red pepper

  • Fruits – cantaloupe, honeydew melon, mangoes, prunes or prune juice, bananas, apricots, oranges or orange juice, grapefruit, avocado

  • Dairy – nonfat or low-fat yogurt; nonfat milk (skim milk); low-fat milk (1 percent milk)

  • Meat and beans – cooked beans and peas; nuts and seeds; lean beef, lamb, and pork; shrimp, clams, oysters, and crab; cod, salmon, polluck, and catfish

Talk to your doctor if you have special diet needs for these reasons:

Food safety

Most foods are safe for pregnant women and their babies. But you will need to use caution or avoid eating certain foods. Follow these guidelines:

Clean, handle, cook, and chill food properly to prevent foodborne illness, including listeria and toxoplasmosis.

Do not eat:

Fish facts

Fish and shellfish can be an important part of a healthy diet. They are a great source of protein and heart-healthy omega-3 fatty acids. What’s more, some researchers believe low fish intake may be linked to depression in women during and after pregnancy. Research also suggests that omega-3 fatty acids consumed by pregnant women may aid in babies’ brain and eye development.

Women who are or may become pregnant and nursing mothers need 12 ounces of fish per week to reap the health benefits. Unfortunately, some pregnant and nursing women do not eat any fish because they worry about mercury in seafood. Mercury is a metal that at high levels can harm the brain of your unborn baby — even before it is conceived. Mercury mainly gets into our bodies by eating large, predatory fish. Yet many types of seafood have little or no mercury at all. So the risk of mercury exposure depends on the amount and type of seafood you eat.

Women who are nursing, pregnant, or who may become pregnant can safely eat a variety of cooked seafood, but should steer clear of fish with high levels of mercury. Keep in mind that removing all fish from your diet will rob you of important omega-3 fatty acids. To reach 12 ounces while limiting exposure to mercury, follow these tips:

Foods supplemented with DHA/EPA (such as “omega-3 eggs”) and prenatal vitamins supplemented with DHA are other sources of the type of omega-3 fatty acids found in seafood.

Vitamins and minerals

In addition to making healthy food choices, ask your doctor about taking a prenatal vitamin and mineral supplement every day to be sure you are getting enough of the nutrients your baby needs. You also can check the label on the foods you buy to see how much of a certain nutrient the product contains. Women who are pregnant need more of these nutrients than women who are not pregnant:

Nutrients and pregnancy

Nutrient

How much pregnant women need each day

Folic acid

400 to 800 micrograms (mcg) (0.4 to 0.8 mg) in the early stages of pregnancy, which is why all women who are capable of pregnancy should take a daily multivitamin that contains 400 to 800 mcg of folic acid. Pregnant women should continue taking folic acid throughout pregnancy.

Iron

27 milligrams (mg)

Calcium

1,000 milligrams (mg); 1,300 mg if 18 or younger

Vitamin A

770 micrograms (mcg); 750 mcg if 18 or younger

Vitamin B12

2.6 micrograms (mcg)

Women who are pregnant also need to be sure to get enough vitamin D. The current recommendation for all adults younger than 71 (including pregnant and breastfeeding women) is 600 international units (IU) of vitamin D each day. Talk to your doctor about how you can be sure to get enough vitamin D and other important vitamins and nutrients.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. For this reason, your daily prenatal vitamin should contain no more than 5,000 IU (International Units) of vitamin A. Some supplements contain much more. Only take vitamins and mineral supplements that your doctor recommends.

Don't forget fluids

All of your body's systems need water. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. Water also helps prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Not getting enough water can lead to premature or early labor.

Your body gets the water it needs through the fluids you drink and the foods you eat. How much fluid you need to drink each day depends on many factors, such as your activity level, the weather, and your size. Your body needs more fluids when it is hot and when you are physically active. It also needs more water if you have a fever or if you are vomiting or have diarrhea.

The Institute of Medicine recommends that pregnant women drink about 10 cups of fluids daily. Water, juices, coffee, tea, and soft drinks all count toward your fluid needs. But keep in mind that some beverages are high in sugar and "empty" calories. A good way to tell if your fluid intake is okay is if your urine is pale yellow or colorless and you rarely feel thirsty. Thirst is a sign that your body is on its way to dehydration. Don't wait until you feel thirsty to drink.

Alcohol

There is no known safe amount of alcohol a woman can drink while pregnant. When you are pregnant and you drink beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into your blood. The alcohol in your blood gets into your baby's body through the umbilical cord. Alcohol can slow down the baby's growth, affect the baby's brain, and cause birth defects.

Find out more about the dangers of drinking alcohol during pregnancy in our section on Substance abuse.

Caffeine

Moderate amounts of caffeine appear to be safe during pregnancy. Moderate means less than 200 mg of caffeine per day, which is the amount in about 12 ounces of coffee. Most caffeinated teas and soft drinks have much less caffeine. Some studies have shown a link between higher amounts of caffeine and miscarriage and preterm birth. But there is no solid proof that caffeine causes these problems. The effects of too much caffeine are unclear. Ask your doctor whether drinking a limited amount of caffeine is okay for you.

Cravings

Many women have strong desires for specific foods during pregnancy. The desire for "pickles and ice cream" and other cravings might be caused by changes in nutritional needs during pregnancy. The fetus needs nourishment. And a woman's body absorbs and processes nutrients differently while pregnant. These changes help ensure normal development of the baby and fill the demands of breastfeeding once the baby is born.

Some women crave nonfood items such as clay, ice, laundry starch, or cornstarch. A desire to eat nonfood items is called pica (PYE-KUH). Eating nonfood items can be harmful to your pregnancy. Talk to your doctor if you have these urges.

Keeping fit

Fitness goes hand in hand with eating right to maintain your physical health and well-being during pregnancy. Pregnant or not, physical fitness helps keep the heart, bones, and mind healthy. Healthy pregnant women should get at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week. It's best to spread your workouts throughout the week. If you regularly engage in vigorous-intensity aerobic activity or high amounts of activity, you can keep up your activity level as long as your health doesn't change and you talk to your doctor about your activity level throughout your pregnancy.

Special benefits of physical activity during pregnancy:

Getting started

For most healthy moms-to-be who do not have any pregnancy-related problems, exercise is a safe and valuable habit. Even so, talk to your doctor or midwife before exercising during pregnancy. She or he will be able to suggest a fitness plan that is safe for you. Getting a doctor's advice before starting a fitness routine is important for both inactive women and women who exercised before pregnancy.

If you have one of these conditions, your doctor will advise you not to exercise:

Best activity for moms-to-be

Low-impact activities at a moderate level of effort are comfortable and enjoyable for many pregnant women. Walking, swimming, dancing, cycling, and low-impact aerobics are some examples. These sports also are easy to take up, even if you are new to physical fitness.

Some higher intensity sports are safe for some pregnant women who were already doing them before becoming pregnant. If you jog, play racquet sports, or lift weights, you may continue with your doctor's okay.

Keep these points in mind when choosing a fitness plan:

Tips for safe and healthy physical activity

Follow these tips for safe and healthy fitness:

Stop exercising and call your doctor as soon as possible if you have any of the following:

Work out your pelvic floor (Kegel exercises)

Your pelvic floor muscles support the rectum, vagina, and urethra in the pelvis. Toning these muscles with Kegel exercises will help you push during delivery and recover from birth. It also will help control bladder leakage and lower your chance of getting hemorrhoids.

Pelvic muscles are the same ones used to stop the flow of urine. Still, it can be hard to find the right muscles to squeeze. You can be sure you are exercising the right muscles if when you squeeze them you stop urinating. Or you can put a finger into the vagina and squeeze. If you feel pressure around the finger, you've found the pelvic floor muscles. Try not to tighten your stomach, legs, or other muscles.

Kegel exercises

  1. Tighten the pelvic floor muscles for a count of three, then relax for a count of three.

  2. Repeat 10 to 15 times, three times a day.

  3. Start Kegel exercises lying down. This is the easiest position. When your muscles get stronger, you can do Kegel exercises sitting or standing as you like.

Oral health

Before you become pregnant, it is best to have dental checkups routinely to keep your teeth and gums healthy. If you are pregnant and have not had regular checkups, consider the following:

After you give birth, maintain good oral hygiene to protect your baby's oral health. Bacteria that cause cavities can transfer from you to your child by:

You also should find a dentist for your child by age 1.

Using medicine and herbs

You and your baby are connected. The medicines you use, including over-the-counter, herbal, and prescription drugs or supplements, might get into your baby's body, too. Many medicines and herbs are known to cause problems during pregnancy, including birth defects. For some medicines, we don't know that much about how they might affect pregnancy or the developing fetus. This is because medicines are rarely tested on pregnant women for fear of harming the fetus.

Mothers-to-be might wonder if it's safe to use medicines during pregnancy. There is no clear-cut answer to this question. Your doctor can help you make the choice whether to use a medicine. Labels on prescription and over-the-counter drugs have information to help you and your doctor make this choice. In the future, a new prescription drug label will make it easier for women and their doctors to weigh the benefits and risks of using prescription medicines during pregnancy.

Always speak with your doctor before you start or stop any medicine. Not using medicine that you need may be more harmful to you and your baby than using the medicine.

Weighing benefits and risks

When deciding whether to use a medicine in pregnancy, you and your doctor need to talk about the medicine's benefits and the risks.

There may be times during pregnancy when using medicine is a choice. For example, if you get a cold, you may decide to "live with" your stuffy nose instead of using the "stuffy nose" medicine you use when you are not pregnant.

Other times during pregnancy, using medicine is not a choice — it is needed. For example, you might need to use medicine to control an existing health problem like asthma, diabetes, depression, or seizures. Or, you might need a medicine for a few days, such as an antibiotic to treat a bladder infection or strep throat. Also, some women have a pregnancy problem that needs medicine treatment. These problems include severe nausea and vomiting, earlier pregnancy losses, or preterm labor.

Using herbal or dietary supplements and other "natural" products

You might think herbs are safe because they are "natural." But, except for some vitamins, little is known about using herbal or dietary supplements while pregnant. Some herbal remedy labels claim they will help with pregnancy. But, most often there are no good studies to show if these claims are true or if the herb can cause harm to you or your baby. Also, some herbs that are safe when used in small amounts as food might be harmful when used in large amounts as medicines. So, talk with your doctor before using any herbal or dietary supplement or natural product. These products may contain things that could harm you or your growing baby.

Having sex

Unless your doctor tells you otherwise, sex is safe. You may find that your interest in sex changes during pregnancy. Talk to your partner about other positions if the way you usually have sex is awkward or no longer feels good. Call your doctor if sex causes:

Travel

Buckle up!

Wearing a seatbelt during car and air travel is safe while pregnant. The lap strap should go under your belly, across your hips. The shoulder strap should go between your breasts and to the side of your belly. Make sure it fits snugly.

Everyday life doesn't stop once you are pregnant. Most healthy pregnant women are able to continue with their usual routine and activity level. That means going to work, running errands, and for some, traveling away from home. To take care of yourself and help keep your baby safe, consider these points before taking a long trip or traveling far from home:

Environmental risks

The environment is everything around us wherever we are — at home, at work, or outdoors. Although you don't need to worry about every little thing you breathe in or eat, it's smart to avoid exposure to substances that might put your pregnancy or unborn baby's health at risk.

During pregnancy, avoid exposure to:

Keep in mind: We don't know how much exposure can lead to problems, such as miscarriage or birth defects. That is why it's best to avoid or limit your exposure as much as possible. Here are some simple, day-to-day precautions you can take:

If you are exposed to chemicals in the workplace, talk to your doctor and your employer about what you can do to lower your exposure. Certain industries, such as dry cleaning, manufacturing, printing, and agriculture, involve use of toxins that could be harmful. If you are concerned about the safety of your drinking water, call your health department or water supplier to ask about the quality of your tap water or how to have your water tested. Or, call the Environmental Protection Agency's Safe Drinking Water Hotline at (800) 426-4791. Don't assume that bottled water is better or safer. Usually, bottle water offers no health benefits over tap water.

Quitting smoking

Smoking cigarettes is very harmful to your health and could also affect the health of your baby. Not only does smoking cause cancer and heart disease in people who smoke, smoking during pregnancy increases the risk of low birth weight. low birth weight babies are at higher risk of health problems shortly after birth. Also, some studies have linked low birth weight with a higher risk of health problems later in life, such as high blood pressure and diabetes. Women who smoke during pregnancy are more likely than other women to have a miscarriage and to have a baby born with cleft lip or palate, types of birth defects. Also, mothers who smoke during or after pregnancy put their babies at greater risk of sudden infant death syndrome (SIDS).

Mothers who smoke have many reasons to quit smoking. Take care of your health and your unborn baby's health: Ask your doctor about ways to help you quit during pregnancy. Intensive counseling has been shown to increase a pregnant woman’s chances of quitting success. We don’t know whether the drugs used to help people quit are safe to use during pregnancy. But we do know that continuing to smoke during pregnancy threatens your and your baby’s health. Quitting smoking is hard, but you can do it with help!

Substance abuse

Using alcohol and illegal drugs during pregnancy threatens the health of your unborn baby. So does using legal drugs in an inappropriate way. When you use alcohol or drugs, the chemicals you ingest or breathe into your lungs cross the placenta and enter your baby. This puts your baby at risk for such problems as stillbirth, low birth weight, birth defects, behavioral problems, and developmental delays.

Alcohol

When you drink alcohol, so does your baby. Pregnant women should not drink alcohol to eliminate the chance of giving birth to a baby with fetal alcohol spectrum disorder (FASD). FASD involves a range of harmful effects that can occur when a fetus is exposed to alcohol. The effects can be mild to severe. Children born with a severe form of FASD can have abnormal facial features, severe learning disabilities, behavioral problems, and other problems.

You might think a drink now and then won't hurt your baby. But we don't know how much alcohol it takes to cause harm. We do know that the risk of FASD, and the likely severity, goes up with the amount of alcohol consumed during pregnancy. Also, damage from alcohol can occur in the earliest stages of pregnancy — often before a woman knows she is pregnant. For this reason, women who may become pregnant also should not drink.

Illegal drugs

Many women who use illegal drugs also use tobacco and alcohol. So, it's not always easy to tell the effects of one drug from that of alcohol, tobacco, or other drugs. We do know that using illegal drugs during pregnancy is very dangerous. Babies born to women who use drugs such as cocaine, heroine, and methamphetamine are likely to be born addicted and must go through withdrawal. Mothers who inject drugs are at higher risk of getting HIV, which can be passed to an unborn baby. Some studies suggest that the effects of drug use during pregnancy might not be seen until later in childhood.

Getting help for alcohol or drug use

If you drink alcohol or use drugs and cannot quit, talk to your doctor right away. Treatment programs can help pregnant women with addiction and abuse. To find help near you, go to the Substance abuse treatment facility locator. You can quit using and give your baby a good start to life.

Abusive relationships

Related information

It's hard to be excited about the new life growing inside of you if you're afraid of your partner. Abuse from a partner can begin or increase during pregnancy and can harm you and your unborn baby. Women who are abused often don't get the prenatal care their babies need. Abuse from a partner also can lead to preterm birth and low birth weight babies, stillbirth and newborn death, and homicide. If you are abused, you might turn to alcohol, cigarettes, or drugs to help you cope. This can be even more harmful to you and your baby.

You may think that a new baby will change your situation for the better. But the cycle of abuse is complex, and a baby introduces new stress to people and relationships. Now is a good time to think about your safety and the safety and wellbeing of your baby. About 50 percent of men who abuse their wives also abuse their children. Think about the home environment you want for your baby. Studies show that children who witness or experience violence at home may have long-term physical, emotional, and social problems. They are also more likely to experience or commit violence themselves in the future.

Prenatal exams offer a good chance to reach out for help. It's possible to take control and leave an abusive partner. But for your and your baby's safety, talk to your doctor first. Let motherhood prompt you to take action now.

If you're a victim of abuse or violence at the hands of someone you know or love, or you are recovering from an assault by a stranger, you and your baby can get immediate help and support.

The National Domestic Violence Hotline can be reached 24 hours a day, 7 days a week at 800-799-SAFE (7233) and 800-787-3224 (TTY). Spanish speakers are available. When you call, you will first hear a recording and may have to hold. Hotline staff offer crisis intervention and referrals. If requested, they connect women to shelters and can send out written information.

The National Sexual Assault Hotline can be reached 24 hours a day, 7 days a week at 800-656-4673. When you call, you will hear a menu and can choose #1 to talk to a counselor. You will then be connected to a counselor in your area who can help you. You can also visit the National Sexual Assault Online Hotline.

When to call the doctor

When you are pregnant, do not hesitate to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem.

Call your doctor or midwife as soon as you can if you:

Labor and Delivery

Additional Information on Labor and Delivery

 Labor and delivery describe the process of childbirth. With regular contractions of the uterus and changes of the cervix (the opening of the uterus), a woman’s body prepares for childbirth, the baby is born, and the placenta follows.

NICHD research addresses many aspects of labor and delivery: the basic biology of labor and delivery; the efficacy, safety, and health outcomes of childbirth practices; and prevention and management of complications related to labor and delivery.

Preterm labor and delivery, also called premature labor and birth, share many features with regular labor and delivery. But they also have specific features all their own. For this reason, preterm labor and birth are addressed in a separate topic.

Common Name

Medical or Scientific Name

What are labor and delivery?

Labor and delivery are the process by which a baby is born.

Early labor prepares the body for delivery. This is a period of hours or days when the uterus regularly contracts and the cervix gradually thins out (called effacing) and opens (called dilation) to allow the baby to pass through.


Once the cervix has opened completely, pushing begins. If the baby and placenta come out through the vagina, this is known as a vaginal delivery.

To view the original video, please go to http://youtu.be/samWyTjFmS8

What are the stages of labor?

When does labor usually start?

The due date is 40 weeks after the first day of the last menstrual period, although sometimes it is determined by an ultrasound. For most women, labor occurs sometime between week 37 and week 42 of pregnancy. Labor that occurs before 37 weeks of pregnancy is considered premature, or preterm labor. Labor that occurs at 37 or 38 weeks is now considered early term because babies born at that gestational age are still immature.

Just as pregnancy is different for every woman, the start of labor, the signs of labor, and the length of time it takes to go through labor will vary from woman to woman and even from pregnancy to pregnancy.

Signs of Labor

Some signs that labor may be close (although, in fact, it still might be weeks away) can include1:

If a woman experiences any of the following signs of labor at any point in pregnancy, she should contact her health care provider:

Sometimes, if the health of the mother or the fetus is at risk, a woman’s health care provider will recommend inducing labor, using medically supervised methods, such as medication, to bring on labor.

Unless earlier delivery is medically necessary, waiting until at least 39 weeks before delivering gives mother and baby the best chance for healthy outcomes. During the last few weeks of pregnancy, the fetus’s lungs, brain, and liver are still developing.

The Is It Worth It? Initiative, from the NICHD’s National Child and Maternal Health Education Program, focuses on raising awareness of the importance of waiting until at least 39 weeks to deliver a baby, unless it is medically necessary to deliver earlier.

What are the stages of labor?

To view the original video, please go to http://youtu.be/samWyTjFmS8

Video/Graphics

Audio

TITLE SLIDE:

Stages of Labor

Logo of the Eunice Kennedy Shriver National Institute of Child Health and Human Development

 

GRAPHIC SLIDE:

Stage 1 Early Phase

Computer-generated diagram of a fetus in the womb. The vagina and uterus are labeled with text, followed by a label pointing to the cervix reading “Cervix softens and thins.”

Narrator: Labor has three stages. In the first stage of labor, the body prepares to give birth. There are two phases: early and active.

Early labor can last from hours to days. First-time moms may spend more time in this phase.

The cervix, or the opening to the uterus, begins to soften; efface, or thin out; and dilate, or open. The cervical changes are necessary so the baby can pass through. Usually a woman’s water breaks during the first stage of labor. Contractions—or tightening of the uterus—become strong and regular. Typically, the woman will have a 30- to 70-second long contraction every 5 to 20 minutes.

There may also be a stringy, bloody discharge from the vagina, called “bloody show.” This is considered normal.

GRAPHIC SLIDE:

Stage 1 Active Phase

A similar diagram as in the previous slide, but with the fetus turned slightly and pressed against the dilating cervix. The vagina and uterus are labeled with text, followed by a label pointing to the cervix reading “Dilated cervix.”

Narrator: Active labor occurs when the cervix starts to dilate more quickly. Contractions get stronger, last longer, and occur more often. The cervix continues to open wider, to about 10 centimeters. Then, pushing can start.

GRAPHIC SLIDE:

Stage 2

A similar diagram as in the previous slide, but with the baby’s head past the cervix and crowning. The vagina, uterus, and umbilical cord are labeled with text, followed by a label pointing to the baby’s head reading “Infant’s head crowning.”

Narrator: In the second stage of labor, the child is born. A health care provider usually encourages the woman to “push” to help the baby move down the vagina. She might push for minutes or hours.

Once the baby’s head starts to come out—called crowning—a provider guides the rest of the baby out. Childbirth is finished when the baby is completely out of the vagina.

The provider then cuts and clamps the umbilical cord, which connected mom and baby during pregnancy.

GRAPHIC SLIDE:

Stage 3

A similar diagram as in the previous slide, but without the fetus. The cut umbilical cord sticks out of the vagina and is still connected to the placenta inside of the uterus.

The vagina and cervix are labeled with text, followed by the placenta and umbilical cord.

Narrator: The last stage of labor involves delivery of the placenta, or afterbirth. During pregnancy, the placenta supplies food and oxygen to the fetus. Once the umbilical cord is cut, the placenta has to come out.

Contractions typically begin 5 to 10 minutes after the baby’s birth. During this time, the placenta detaches from the uterus. A provider may encourage the woman to “push” just as she did to deliver the baby.

After 5 to 30 minutes, the placenta comes completely out of the vagina. Then, the process is complete.

 

Last Updated Date: 08/22/2014
Last Reviewed Date: 08/22/2014

Stage 1

The first stage of labor happens in two phases: early labor and active labor.

During early labor:

  • The cervix starts to open or dilate.

  • Strong and regular contractions last 30 to 60 seconds and come every 5 to 20 minutes.

  • The woman may have a bloody show.

A woman may experience this phase for a few hours or days, especially if she is giving birth for the first time.

During active labor:

  • Contractions become stronger, longer, and more painful.

  • Contractions come closer together.

  • The woman may not have much time to relax between contractions.

  • The woman may feel pressure in her lower back.

  • The cervix fully dilates to 10 centimeters.

Stage 2

During this stage, the cervix is fully dilated and ready for delivery. The woman will begin to push (or is sometimes told to “bear down”) to allow the baby to move through the birth canal.

During stage 2:

  • The woman may feel pressure on her rectum as the baby’s head moves through the vagina.

  • She may feel the urge to push, as if having a bowel movement.

  • The baby’s head starts to show (called “crowning”).

  • The health care provider guides the baby out of the vagina.

  • Once the baby comes out, the health care provider cuts the umbilical cord, which connected mother and fetus during pregnancy.

This stage can last between 20 minutes and several hours. It usually lasts longer for first-time mothers.

Stage 3

During this stage, the placenta is delivered. The placenta is the organ that gave the fetus food and oxygen through the umbilical cord during the pregnancy.

During stage 3:

  • Contractions begin 5 to 10 minutes after the baby is delivered.

  • The woman may have chills or feel shaky.

It may take 5 to 30 minutes for the placenta to exit the vagina.

What are the options for pain relief during labor and delivery?

The amount of pain felt during labor and delivery is different for every woman. The level of pain can depend on many factors, including the size and position of the baby and the strength of contractions. Some women learn breathing and relaxation techniques to help them cope with the pain. These techniques can be used along with one or more pain-relieving drugs.

A woman should discuss the many aspects of labor with her health care provider well before labor begins to ensure that she understands all of the options, risks, and benefits of pain relief during labor and delivery. It might also be helpful to put all the decisions in writing to clarify the options chosen.

Types of Pain-Relieving Medications

Pain-relief drugs fall into two categories: analgesics (pronounced an-l-JEE-ziks) and anesthetics (pronounced an-uhs-THET-iks).

There are different forms of each.

Analgesics

Analgesics relieve pain without causing total loss of feeling or muscle movement. These drugs do not always stop pain completely, but they reduce it.

Anesthetics

Anesthetics block all feeling, including pain.

What is natural childbirth?

Natural childbirth can refer to many different ways of giving birth without using pain medication, either in the home or at the hospital or birthing center.

Natural Forms of Pain Relief

Women who choose natural childbirth can use a number of natural ways to ease pain. These include:

A woman should discuss the many aspects of labor with her health care provider well before labor begins to ensure that she understands all of the options, risks, and benefits of pain relief during labor and delivery. It might also be helpful to put all the decisions in writing to clarify the options chosen.

What is a C-section?

A C-section, short for cesarean section, is also called cesarean birth. Cesarean birth is the delivery of a baby through surgical cuts in a woman’s abdomen and uterus. The uterus is then closed with stitches that later dissolve. Stitches or staples also close the skin on the belly.

According to the U.S. Centers for Disease Control and Prevention, in 2011, almost 33% of births were by cesarean delivery. According to the Agency for Healthcare Research and Quality, the number of cesarean deliveries increased by 72% between 1997 and 2008.

When is cesarean delivery needed?

Cesarean delivery may be necessary in the following circumstances:

  • A pregnancy with two or more fetuses (multiple pregnancy). A cesarean delivery may be needed if labor has started too early (preterm labor), if the fetuses are not in good positions in the uterus for natural delivery, or if there are other problems.

  • Labor is not progressing. Contractions may not open the cervix enough for the baby to move into the vagina.

  • The infant’s health is in danger. The umbilical cord, which connects the fetus to the uterus, may become pinched, or the fetus may have an abnormal heart rate. In these cases, a C-section allows the baby to be delivered quickly to address and resolve the baby’s health problems.

  • Problems with the placenta. Sometimes the placenta is not formed or working correctly, is in the wrong place in the uterus, or is implanted too deeply or firmly in the uterine wall. This can cause problems, such as depriving the fetus of needed oxygen and nutrients or vaginal bleeding.

  • The baby is too large. Women with gestational diabetes, especially if their blood sugar levels are not well controlled, are at increased risk for having large infants. And larger infants are at risk for complications during delivery. These include shoulder dystocia, when the infant’s head is delivered through the vagina but the shoulders are stuck.

  • The baby is breech, or in a breech presentation, meaning the baby is coming out feet first instead of head first.

  • The mother has an infection, such as HIV or herpes, that could be passed to the baby during vaginal birth. Cesarean delivery could help prevent transmission of the virus to the infant.

  • The mother has a medical condition. A C-section enables the health care provider to better manage the mother’s health issues.

Women who have a cesarean delivery may be given pain medication with an epidural block, a spinal block, or general anesthesia. An epidural block numbs the lower part of the body through an injection in the spine. A spinal block also numbs the lower part of the body but through an injection directly into the spinal fluid. Women who receive general anesthesia, often used for emergency cesarean deliveries, will not be awake during the surgery.

What are the risks of a C-section?

Cesarean birth is a type of surgery, meaning it has risks and possible complications for both mother and infant.

Possible risks from a C-section (which are also associated with vaginal birth) include:

  • Infection

  • Blood loss

  • Blood clots in the legs, pelvic organs, or lungs

  • Injury to surrounding structures, such as the bowel or bladder

  • Reaction to medication or anesthesia used

A woman who has a C-section also may have to stay in the hospital longer. The more C-sections a woman has, the greater her risk for certain medical problems and problems with future pregnancies, such as uterine rupture and problems with the placenta.

Can a C-section be requested?

Some women may want to have a cesarean birth even if vaginal delivery is an option. Women should discuss this option in detail with their health care provider before making a final decision about a C-section.

As is true for vaginal births, unless there is a medical necessity, delivery should not occur before 39 weeks of pregnancy (called full term). Watch this video to learn why it is important for the mother’s and infant’s health to wait until at least 39 weeks to deliver unless there is a medical reason to do so earlier.

What is induction of labor?

Labor induction is the use of medications or other methods to cause, or induce, labor. This practice is used to make contractions start.

When would a provider induce labor?

Induction is usually limited to situations when there is a problem with the pregnancy, or when a baby is overdue.

Several weeks before labor begins, the cervix begins to soften (called “ripening”), thin out, and open to prepare for delivery. If the cervix is not ready, especially if labor has not started 2 weeks or more after your due date, your health care provider may recommend labor induction.

A health care provider may also recommend labor induction if there is a health risk to mother or fetus.

Health care providers use a scoring system, called the Bishop score, to determine how ready the cervix is for labor. The scoring system ranges from 0 to 13. A score of less than 6 means the cervix may need a procedure to prepare it for labor.

Preparing the Cervix for Labor

If the cervix is not ready for labor, a health care provider may suggest one of the following to ripen the cervix:

How is labor induced?

Once the cervix is ripe, a health care provider may recommend one of the following techniques to start contractions or make them stronger:

Can induction be requested?

In most cases, induction is limited to situations when there is a problem with the pregnancy, or when a baby is overdue. But sometimes labor induction is requested for reasons other than a problem with the pregnancy.

A woman might want labor induction for several reasons, including:

It is best not to induce labor before 39 weeks of pregnancy (full term) unless there is a medical reason. Preterm infants (born before 37 weeks) and early term infants (born in the 37th and 38th weeks of pregnancy) are at increased risk of illness and even death.

What is vaginal birth after cesarean (VBAC)?

VBAC refers to successful vaginal delivery of a baby after a woman has delivered a baby by C-section in a previous pregnancy.

In the past, pregnant women who had a prior cesarean delivery would automatically have another C-section. But research shows that, for many women who had prior C-sections, attempting to give birth vaginally—called a trial of labor after cesarean delivery (TOLAC)—should be considered.

When is VBAC appropriate?

VBAC may be a safe and appropriate choice for some women, including those:

Benefits of VBAC include:

NICHD research has shown that among appropriate candidates, about 75% of VBAC attempts are successful. A 2010 NIH Consensus Development Conference on Vaginal Birth After Cesarean evaluated current data on VBAC and issued a statement determining that it is a reasonable option for many women.

In addition, NICHD-supported researchers developed a way to calculate a woman's chances of a VBAC. Access the calculator. Please note that this calculator only determines the likelihood of VBAC; it does not guarantee success.

But it is still possible that a woman will have to have a cesarean after having a trial of labor. Most risks associated with TOLAC are similar to those associated with choosing a repeat cesarean. They include:

A woman considering VBAC should discuss the issue with her health care provider.

What are some common complications during labor and delivery?

Labor and delivery are different for everyone. Complications sometimes happen. Possible complications include (but are not limited to):

Labor and Delivery: Other FAQs

Basic information for topics, such as "What is it?" is available in the Topic Information section. In addition, Frequently Asked Questions (FAQs) that are specific to a certain topic are answered in this section.

What is false labor, and what are Braxton Hicks contractions?

False labor describes irregular contractions that sometimes happen before true labor begins. These contractions are also called Braxton Hicks contractions. It can be hard to tell the difference between Braxton Hicks contractions and true labor contractions.

The chart below, from the American Congress of Obstetricians and Gynecologists, shows some ways that Braxton Hicks contractions differ from true contractions.

Type of Change

False Labor

True Labor

Timing of contractions

Do not come regularly and do not get closer together

Come at regular times and get closer together over time. Each lasts about 30 to 70 seconds.

Change with movement

Contractions may stop when walking or resting, or they may stop with a change of position.

Contractions continue despite movement.

Strength of contractions

Usually weak and do not get much stronger, or may start strong and get weaker

Get steadily stronger

Pain of contractions

Usually felt only in the front

Usually starts in the back and moves to the front

How are labor and delivery different for a woman having multiple babies?

Women having multiples¯twins, triplets, or quadruplets, for example¯are more likely to have certain complications during labor and delivery. The most common complications are preterm labor and preterm birth.

Preterm labor is labor that starts before 37 weeks of pregnancy. Preterm labor can result in preterm birth. More than half of all twins are born preterm. Preterm infants can have problems with breathing and eating and may have to stay in the hospital longer than other infants.

Women having multiples are also more likely to need a cesarean delivery. 

What is the APGAR test?

An APGAR test, performed 1 minute and 5 minutes after birth, determines whether a newborn infant needs help breathing or is having heart problems. A health care provider assesses the following aspects of an infant's health:

Based on this examination, the health care provider gives the infant an APGAR score of 1 to 10. The higher the score, the better the infant is doing.

Are there added risks for older women during labor and delivery?

Women older than 35 are at higher risk for preterm labor and preterm birth. Preterm infants can have serious short- and long-term health problems.

Older women are also more likely to have a stillbirth, which is when a fetus dies in the uterus after 20 weeks of pregnancy.

Women in their 30s are also more likely than younger women to need a cesarean delivery. 

What should women consider when choosing to deliver outside a hospital setting?

Although most women give birth in hospitals, some families choose a home birth or birth in an out-of-hospital birthing center. The American Academy of Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) state that births in hospitals or birthing centers are the safest options.

If you are thinking about giving birth outside a hospital, you should talk to your health care provider about the risks and benefits.

Women who are good candidates for home birth6:

Planned home births should have the following resources in place:

Is giving birth in water beneficial?

Being immersed in water during early labor may help with pain. However, there are no proven health benefits to giving birth in water for either mother or baby, according to the AAP and ACOG. Water births have serious risks, including infections and drowning. ACOG recommends that women give birth in water only as part of a well-designed clinical trial. 

What are preterm labor and birth?

Labor and birth are considered preterm, also called premature, if they occur before 37 weeks. Preterm labor and birth share many features with regular labor and delivery, but they also have specific features all their own. For this reason, preterm labor and preterm birth are addressed in a separate topic.

Pregnancy Loss

Pregnancy loss or miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. The NICHD supports and conducts research on the causes of pregnancy loss and other related topics that affect maternal health, fertility, and the likelihood of a successful pregnancy. NICHD research on normal pregnancy and those with complications has made great progress in improving prenatal care. Ongoing investigations seek to find ways to prevent these problems and help women have healthier pregnancies and healthier fetuses. 

Common Names

Medical or Scientific Name

Condition Information

A miscarriage, also called pregnancy loss or spontaneous abortion, is the unexpected loss of a fetus before the 20th week of pregnancy, or gestation. (Gestation is the period of pregnancy from conception to birth.) The loss of a pregnancy after the 20th week of gestation is called a stillbirth and can occur before or during delivery.

What are the symptoms of pregnancy loss/miscarriage?

Symptoms of miscarriage may include vaginal spotting or bleeding; abdominal pain or abdominal cramps; low back pain; or fluid, tissue, or clot-like material passing from the vagina. Although vaginal bleeding is a common symptom when a woman has a miscarriage, many pregnant women have spotting early during their pregnancy because of other factors but do not miscarry. Regardless, pregnant women who have any of the symptoms of miscarriage should contact their health care providers immediately.

How many people are affected by or at risk for pregnancy loss or miscarriage?

The estimated rate of miscarriage is 15% to 20% in women who know they are pregnant, but as many as half of all fertilized eggs may spontaneously abort, often before the women realize they are pregnant. Women who have had previous miscarriages are at a higher risk for miscarriage. The risk of miscarriage also increases with maternal age beginning at age 30 and becoming greater after age 35.

What causes pregnancy loss/miscarriage?

Miscarriage occurs due to many different causes, some of them known and others unknown. Frequently, miscarriages occur when a pregnancy is not developing normally. More than half of all miscarriages are caused by a chromosomal abnormality in the fetus (typically due to the wrong number of chromosomes, the structures in a cell that contain the genetic information), which is more common with increasing age of the parents, particularly among women who are older than age 35.

Other possible causes of pregnancy loss or miscarriage are maternal health issues or exposure to chemicals. Maternal health issues include chronic disease, such as diabetes, thyroid disease, or polycystic ovary syndrome (PCOS), or problems associated with the immune system, such as an autoimmune disorder. Other maternal health issues that can increase the risk of miscarriage include infection, hormone problems, obesity, or problems of the placenta, cervix, or uterus. Exposure to environmental toxins, drug use or alcohol use, smoking, or the consumption of 200 milligrams or more of caffeine per day (equal to about one 12-ounce cup of coffee) also can increase the risk of miscarriage.

How do health care providers diagnose pregnancy loss or miscarriage?

If a pregnant woman experiences any of the symptoms of miscarriage, such as crampy abdominal or back pain, light spotting, or bleeding, she should contact her health care provider immediately. For diagnosis, the woman may need to undergo a blood test to check for the level of hCG, the pregnancy hormone, or an internal pelvic examination to determine if her cervix is dilated or thinned, which can be a sign of a miscarriage; or depending on the length of time since her last menstrual period, and the level of pregnancy hormone in the blood, she may need to have an ultrasound test so that her health care provider can observe the pregnancy and the maternal reproductive organs, such as the uterus and placenta. If a woman has had more than one miscarriage, she may choose to have blood tests performed to check for chromosome abnormalities or hormone problems, or to detect immune system disorders that may interfere with a healthy pregnancy.

What are the treatments for pregnancy loss/miscarriage?

In most cases, no treatment is necessary for women who miscarry early in their pregnancy, because the bleeding associated with miscarriage usually empties the uterus of pregnancy-associated tissue. In some cases, however, a woman may need to undergo a surgical procedure called a dilation and curettage (D&C) to remove any pregnancy-associated tissue remaining in the uterus. A D&C is performed if the woman is bleeding heavily or if an ultrasound test detects any remaining tissue in the uterus.

An alternative to a D&C is the use of a medication called misoprostol that helps the tissue pass out of the uterus. The use of misoprostol has proven to be effective in 84% of the cases studied. Other treatments after a woman miscarries may include control of mild to moderate bleeding, prevention of infection, pain relief, and emotional support. If heavy bleeding occurs, the woman should contact her health care provider immediately.

Is there a cure for pregnancy loss/miscarriage?

In many cases, a woman can do little to prevent a miscarriage. However, having pre-conception and prenatal care (before becoming pregnant and during pregnancy) is the best prevention available for all complications associated with pregnancy. Miscarriages caused by systemic disease often can be prevented by detection and treatment of the disease before pregnancy occurs. A woman also can decrease her risk of miscarriage by avoiding environmental hazards, such as infectious diseases, X-rays, drugs and alcohol, and high levels of caffeine.

Pregnancy Loss: 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.

Is there anything a woman can do to prevent a pregnancy loss?

Most of the time, a woman cannot do anything to prevent a miscarriage.

Getting preconception care and prenatal care before becoming pregnant and during pregnancy can help prevent some complications before they occur. 

What health conditions contribute to pregnancy loss or stillbirth?

There are many different causes for miscarriage. In more than half of miscarriages, the developing fetus had a chromosomal abnormality that occurred randomly and was not inherited from the parents. These kinds of genetic errors are more likely as the mother gets older, especially after age 35.1

However, there are some health conditions that may contribute to pregnancy loss, too. These are high blood pressure, diabetes, thyroid disease, inherited blood clotting disorders, certain disorders of the immune system, uterine or cervical abnormalities, abnormal levels of hormones, obesity, and maternal or fetal infection.

Fetal death that occurs after the 20th week of gestation is called a stillbirth. In approximately one-half of all stillbirth cases reported, health care providers can find no cause for the loss. However, health conditions that may contribute to stillbirth are chromosomal abnormalities of the fetus; placental problems, such as placental abruption; poor fetal growth due to smoking or maternal high blood pressure; chronic health issues of the mother; umbilical cord accidents; and infection of the mother, fetus, or placenta. Other causes of stillbirth that are less common include Rh disease (caused by an incompatibility between mother and fetus when Rh protein is on the surface of the fetus's red blood cells and not the mother's), trauma of the fetus, a pregnancy lasting longer than 42 weeks, or a difficult delivery that results in a lack of oxygen to the fetus. 

What lifestyle factors can increase risk for pregnancy loss or stillbirth?

Pregnant women who use illicit drugs, smoke, drink alcohol, or have more than 200 milligrams of caffeine every day (about the amount in a 12-ounce cup of coffee)5 may increase their risk of miscarriage. The consumption of less than 200 milligrams of caffeine per day does not seem to be related to risk of miscarriage or preterm birth.

Additionally, pregnant women who use illicit drugs, smoke, or drink alcohol increase their risk of stillbirth. The risk of stillbirth is increased in women who are obese. Women who are obese should discuss losing weight with their health care provider before attempting to conceive. 

How soon after a pregnancy loss can a woman try again for another infant?

It is typically safe for a woman to conceive after one normal menstrual cycle has occurred following a pregnancy loss. However, it is best to wait until she is physically and emotionally ready to become pregnant again and until any tests recommended by a health care provider to determine the cause of the miscarriage have been completed. 

If a woman loses a pregnancy, is she at higher risk for another pregnancy loss?

Miscarriage is typically a one-time occurrence. However, roughly 1% of women experience more than one miscarriage in a row, or repeated miscarriages. In some cases, an underlying problem causes repeated miscarriages. A health care provider may suggest a series of tests to determine, and treat if possible, the cause of repeated miscarriages. (See What is repeated miscarriage? for more information.)

What is repeated miscarriage?

For every 100 women who have a miscarriage, one of them will have more than one miscarriage in a row. This is called repeated, or recurrent, miscarriage. Although most miscarriages are caused by a random genetic mistake in the egg or sperm that isn't likely to happen again, repeated miscarriages can sometimes have an underlying cause.

After about three repeated miscarriages, a woman's health care provider might suggest tests to try to find a cause. The provider will also ask detailed questions about the parents' medical histories. Potential causes of repeated miscarriage might include rearrangements in the parents' genetic material; structural problems, scarring, or fibroids in the uterus; or certain medical conditions in the mother. Some of these problems can be treated, which might improve the couple's chance of getting pregnant.

However, in about half to three-quarters of women with repeated miscarriages, doctors won't be able to find out a reason.

Even if there's no apparent cause, the woman is still likely to be able to get pregnant and deliver a baby in the future: Almost two of every three women with recurrent miscarriage go on to give birth without any special treatment. 

If a woman was diagnosed with preeclampsia in a previous pregnancy, does she have an increased risk for miscarriage in a subsequent pregnancy?

Preeclampsia is a potentially serious condition that occurs only in pregnancy when a pregnant woman develops high blood pressure (also called hypertension) and protein in the urine. Research shows that a history of preeclampsia is not associated with an increase in the risk of miscarriage.

Women diagnosed with preeclampsia during a previous pregnancy should work with their health care provider to get their blood pressure under control before becoming pregnant again.

Although preeclampsia is not associated with an increased risk of miscarriage, pregnancy complications as a result of high blood pressure include low birth weight, premature birth (before 37 weeks), and problems with the placenta.

 Source: NICHD, NIH, HHS

Newborn screening tests

Newborn screening tests look for developmental, genetic, and metabolic disorders in the newborn baby. This allows steps to be taken before symptoms develop. Most of these illnesses are very rare, but can be treated if caught early.

The types of newborn screening tests that are done vary from state to state. Most states require three to eight tests. Some organizations such as the March of Dimes and the American College of Medical Genetics suggest more than two dozen additional tests.

The most thorough screening panel checks for about 40 disorders. All 50 states screen for congenital hypothyroidism, galactosemia, and phenylketonuria (PKU).

In addition to the newborn screening blood test, a hearing screen is recommended for all newborns.

How the Test is Performed

Screenings are done using the following methods:

How to Prepare for the Test

There is no preparation needed for newborn screening tests. The tests are done when the baby is between 24 hours and 7 days old. Most of the time, screens are done before the baby goes home from the hospital.

How the Test Will Feel

The baby will most likely cry when his or her heel is pricked to get the blood sample. Studies have shown that babies whose mothers hold them skin-to-skin or breastfeed them during the procedure show less distress. Wrapping the baby tightly in a blanket, or offering a pacifier dipped in sugar water, may also help ease pain and calm the baby.

The hearing test should not cause the baby to feel pain, cry, or respond.

Why the Test is Performed

Screening tests do not diagnose illnesses. They show which babies need more testing to confirm or rule out illnesses.

If follow-up testing confirms that the child has a disease, treatment can be started, before symptoms appear.

Screening tests are used to detect a number of disorders. Some of these include:

Normal Results

Normal values for each screening test may vary depending on how the test is performed.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal result means that the child should have additional testing to confirm or rule out the condition.

What the Risks Are

Risks for the newborn heel prick blood sample include pain and possible bruising at the site where the blood was obtained.

Special Considerations

Newborn testing is critical for the baby to receive treatment. Treatment may be lifesaving. However, not all disorders that can be detected can be treated.

Although states do not perform all screening tests, parents can have other tests done at large medical centers. Private labs also offer newborn screening. Parents can find out about extra newborn screening tests from their doctor or the hospital where the baby is born. Groups like the March of Dimes also offer screening test resources.

Alternative Names

Infant screening tests; Neonatal screening tests; The PKU test

Source: NLM, NIH

Pregnancy: Your baby's first hours of life

divider line

After months of waiting, finally, your new baby has arrived! Mothers-to-be often spend so much time in anticipation of labor, they don't think about or even know what to expect during the first hours after delivery. Read on so you will be ready to bond with your new bundle of joy.

What newborns look like

You might be surprised by how your newborn looks at birth. If you had a vaginal delivery, your baby entered this world through a narrow and boney passage. It's not uncommon for newborns to be born bluish, bruised, and with a misshapen head. An ear might be folded over. Your baby may have a complete head of hair or be bald. Your baby also will have a thick, pasty, whitish coating, which protected the skin in the womb. This will wash away during the first bathing.

Once your baby is placed into your arms, your gaze will go right to his or her eyes. Most newborns open their eyes soon after birth. Eyes will be brown or bluish-gray at first. Looking over your baby, you might notice that the face is a little puffy. You might notice small white bumps inside your baby's mouth or on his or her tongue. Your baby might be very wrinkly. Some babies, especially those born early, are covered in soft, fine hair, which will come off in a couple of weeks. Your baby's skin might have various colored marks, blotches, or rashes, and fingernails could be long. You might also notice that your baby's breasts and penis or vulva are a bit swollen.

How your baby looks will change from day to day, and many of the early marks of childbirth go away with time. If you have any concerns about something you see, talk to your doctor. After a few weeks, your newborn will look more and more like the baby you pictured in your dreams.

Bonding with your baby

Spending time with your baby in those first hours of life is very special. Although you might be tired, your newborn could be quite alert after birth. Cuddle your baby skin-to-skin. Let your baby get to know your voice and study your face. Your baby can see up to about two feet away. You might notice that your baby throws his or her arms out if someone turns on a light or makes a sudden noise. This is called the startle response. Babies also are born with grasp and sucking reflexes. Put your finger in your baby's palm and watch how she or he knows to squeeze it. Feed your baby when she or he shows signs of hunger. You can visit our section on breastfeeding for tips to make these first feedings go well.

Medical care for your newborn

Right after birth babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle. So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests. At the same time, please don't assume “everything is being taken care of.” As a parent, it's your job to make sure your newborn gets all the necessary and appropriate vaccines and tests in a timely manner.

The following tests and procedures are recommended or required in most hospitals in the United States:

Apgar evaluation

The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure five signs of the baby's condition. These are:

Apgar scores range from zero to 10. A baby who scores seven or more is considered very healthy. But a lower score doesn't always mean there is something wrong. Perfectly healthy babies often have low Apgar scores in the first minute of life.

In more than 98 percent of cases, the Apgar score reaches seven after five minutes of life. When it does not, the baby needs medical care and close monitoring.

Eye care

Your baby may receive eye drops or ointment to prevent eye infections they can get during delivery. Sexually transmitted infections (STIs) including gonorrhea and chlamydia are a main cause of newborn eye infections. These infections can cause blindness if not treated.

Medicines used can sting and/or blur the baby's vision. So you may want to postpone this treatment for a little while.

Some parents question whether this treatment is really necessary. Many women at low risk for STIs do not want their newborns to receive eye medicine. But there is no evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STIs may get an infection by the time of delivery. Plus, most women with gonorrhea and/or chlamydia don't know it because they have no symptoms.

Vitamin K shot

The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborns probably feel pain when the shot is given. But afterwards babies don't seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.

Newborn metabolic screening

Doctors or nurses prick your baby's heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems. If found right away, serious problems like developmental disabilities, organ damage, blindness, and even death might be prevented.

All 50 states and U.S. territories screen newborns for phenylketonuria (fee-nuhl-kee-toh-NUR-ee-uh) (PKU), hypothyroidism, galactosemia (guh-LAK-tuh-SEE-mee-uh), and sickle cell disease. But many states routinely test for up to 30 different diseases. The March of Dimes recommends that all newborns be tested for at least 29 diseases.

You can find out what tests are offered in your state by contacting your state's health department or newborn screening program. Or, you can contact the National Newborn Screening and Genetics Resource Center.

Hearing test

Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children. When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby's doctor about newborn hearing screening.

Hepatitis B vaccine

All newborns should get a vaccine to protect against the hepatitis B virus (HBV) before leaving the hospital. Sadly, 1 in 5 babies at risk of HBV infection leaves the hospital without receiving the vaccine and treatment shown to protect newborns, even if exposed to HBV at birth. HBV can cause a lifelong infection, serious liver damage, and even death.

The hepatitis B vaccine (HepB) is a series of three different shots. The American Academy of Pediatrics and the Centers for Disease Control (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG shot within 12 hours of birth. The second HepB shot should be given one to two months after birth. The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.

Complete checkup

Soon after delivery most doctors or nurses also:

Source: Office on Women's Health, HHS 

Pregnancy: Recovering from birth

divider line

Related information

Right now, you are focused on caring for your new baby. But new mothers must take special care of their bodies after giving birth and while breastfeeding, too. Doing so will help you to regain your energy and strength. When you take care of yourself, you are able to best care for and enjoy your baby.

Getting rest

The first few days at home after having your baby are a time for rest and recovery — physically and emotionally. You need to focus your energy on yourself and on getting to know your new baby. Even though you may be very excited and have requests for lots of visits from family and friends, try to limit visitors and get as much rest as possible. Don't expect to keep your house perfect. You may find that all you can do is eat, sleep, and care for your baby. And that is perfectly okay. Learn to pace yourself from the first day that you arrive back home. Try to lie down or nap while the baby naps. Don't try to do too much around the house. Allow others to help you and don't be afraid to ask for help with cleaning, laundry, meals, or with caring for the baby.

Physical changes

After the birth of your baby, your doctor will talk with you about things you will experience as your body starts to recover.

Your doctor will check your recovery at your postpartum visit, about six weeks after birth. Ask about resuming normal activities, as well as eating and fitness plans to help you return to a healthy weight. Also ask our doctor about having sex and birth control. Your period could return in six to eight weeks, or sooner if you do not breastfeed. If you breastfeed, your period might not resume for many months. Still, using reliable birth control is the best way to prevent pregnancy until you want to have another baby.

Some women develop thyroid problems in the first year after giving birth. This is called postpartum thyroiditis (theye-royd-EYET-uhss). It often begins with overactive thyroid, which lasts two to four months. Most women then develop symptoms of an underactive thyroid, which can last up to a year. Thyroid problems are easy to overlook as many symptoms, such as fatigue, sleep problems, low energy, and changes in weight, are common after having a baby. Talk to your doctor if you have symptoms that do not go away. An underactive thyroid needs to be treated. In most cases, thyroid function returns to normal as the thyroid heals. But some women develop permanent underactive thyroid disease, called Hashimoto's disease, and need lifelong treatment.

Regaining a healthy weight and shape


The USDA’s online, interactive tool MyPyramid Plan for Moms can help you choose foods based on your baby’s nursing habits and your energy needs. You can learn how to:

Both pregnancy and labor can affect a woman's body. After giving birth you will lose about 10 pounds right away and a little more as body fluid levels decrease. Don't expect or try to lose additional pregnancy weight right away. Gradual weight loss over several months is the safest way, especially if you are breastfeeding. Nursing mothers can safely lose a moderate amount of weight without affecting their milk supply or their babies’ growth.

A healthy eating plan along with regular physical fitness might be all you need to return to a healthy weight. If you are not losing weight or losing weight too slowly, cut back on foods with added sugars and fats, like soft drinks, desserts, fried foods, fatty meats, and alcohol. Keep in mind, nursing mothers should avoid alcohol. By cutting back on “extras,” you can focus on healthy, well-balanced food choices that will keep your energy level up and help you get the nutrients you and your baby need for good health. Make sure to talk to your doctor before you start any type of diet or exercise plan.

Feeling blue

After childbirth you may feel sad, weepy, and overwhelmed for a few days. Many new mothers have the "baby blues" after giving birth. Changing hormones, anxiety about caring for the baby, and lack of sleep all affect your emotions.

Be patient with yourself. These feelings are normal and usually go away quickly. But if sadness lasts more than two weeks, go see your doctor. Don't wait until you postpartum visit to do so. You might have a serious but treatable condition called postpartum depression. Postpartum depression can happen any time within the first year after birth.

Don't wait!

Call 911 or your doctor if you have thoughts of harming yourself or your baby.

Signs of postpartum depression include:

Some women don't tell anyone about their symptoms because they feel embarrassed or guilty about having these feelings at a time when they think they should be happy. Don't let this happen to you! Postpartum depression can make it hard to take care of your baby. Infants with mothers with postpartum depression can have delays in learning how to talk. They can have problems with emotional bonding. Your doctor can help you feel better and get back to enjoying your new baby. Therapy and/or medicine can treat postpartum depression. Get more details on postpartum depression in our Depression during and after pregnancy fact sheet.

Emerging research suggests that 1 in 10 new fathers may experience depression during or after pregnancy. Although more research is needed, having depression may make it harder to be a good father and perhaps affect the baby's development. Having depression may also be related to a mother's depression. Expecting or new fathers with emotional problems or symptoms of depression should talk to their doctors. Depression is a treatable illness.

More information on Recovering from birth

Explore other publications and websites

Source: Office on Women's Health, HHS

Pregnancy: Newborn care and safety

 divider line

Related information

Newborn care

If this is your first baby, you might worry that you are not ready to take care of a newborn. You're not alone. Lots of new parents feel unprepared when it's time to bring their new babies home from the hospital. You can take steps to help yourself get ready for the transition home.

Taking a newborn care class during your pregnancy can prepare you for the real thing. But feeding and diapering a baby doll isn't quite the same. During your hospital stay, make sure to ask the nurses for help with basic baby care. Don't hesitate to ask the nurse to show you how to do something more than once! Remember, practice makes perfect. Before discharge, make sure you — and your partner — are comfortable with these newborn care basics:

Before leaving the hospital, ask about home visits by a nurse or health care worker. Many new parents appreciate somebody checking in with them and their baby a few days after coming home. If you are breastfeeding, ask whether a lactation consultant can come to your home to provide follow-up support, as well as other resources in your community, such as peer support groups.

Many first-time parents also welcome the help of a family member or friend who has "been there." Having a support person stay with you for a few days can give you the confidence to go at it alone in the weeks ahead. Try to arrange this before delivery.

Your baby's first doctor's visit is another good time to ask about any infant care questions you might have. Ask about reasons to call the doctor. Also ask about what vaccines your baby needs and when. Infants and young children need vaccines because the diseases they protect against can strike at an early age and can be very dangerous in childhood. This includes rare diseases and more common ones, such as the flu.

Sudden infant death syndrome (SIDS)

Since 1992, the American Academy of Pediatrics has recommended that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS), also called crib death. SIDS is the sudden and unexplained death of a baby under 1 year of age. Even though there is no way to know which babies might die of SIDS, there are some things that you can do to make your baby safer:

Some mothers worry if the baby rolls over during the night. However, by the time your baby is able to roll over by herself, the risk for SIDS is much lower. During the time of greatest risk, 2 to 4 months of age, most babies are not able to turn over from their backs to their stomachs.

More information on Newborn care and safety

Explore other publications and websites

Depression during and after Pregnancy

What is depression?

Depression is more than just feeling "blue" or "down in the dumps" for a few days. It's a serious illness that involves the brain. With depression, sad, anxious, or "empty" feelings don't go away and interfere with day-to-day life and routines. These feelings can be mild to severe. The good news is that most people with depression get better with treatment.

How common is depression during and after pregnancy?

Depression is a common problem during and after pregnancy. About 13 percent of pregnant women and new mothers have depression.

How do I know if I have depression?

When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:

Your doctor can figure out if your symptoms are caused by depression or something else.

What causes depression? What about postpartum depression?

There is no single cause. Rather, depression likely results from a combination of factors:

Depression after childbirth is called postpartum depression. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen (ESS-truh-jen) and progesterone (proh-JESS-tur-ohn) increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman's moods before she gets her period.

Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.

Other factors may play a role in postpartum depression. You may feel:

Are some women more at risk for depression during and after pregnancy?

Certain factors may increase your risk of depression during and after pregnancy:

Did you know?

If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.

Women who are depressed during pregnancy have a greater risk of depression after giving birth.

What is the difference between "baby blues," postpartum depression, and postpartum psychosis?

Many women have the baby blues in the days after childbirth. If you have the baby blues, you may:

The baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment.

The symptoms of postpartum depression last longer and are more severe. Postpartum depression can begin anytime within the first year after childbirth. If you have postpartum depression, you may have any of the symptoms of depression listed above. Symptoms may also include:

Postpartum depression needs to be treated by a doctor.

Postpartum psychosis (seye-KOH-suhss) is rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective (SKIT-soh-uh-FEK-tiv) disorder have a higher risk for postpartum psychosis. Symptoms may include:

What should I do if I have symptoms of depression during or after pregnancy?

Call your doctor if:

Your doctor can ask you questions to test for depression. Your doctor can also refer you to a mental health professional who specializes in treating depression.

Some women don't tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.

Any woman may become depressed during pregnancy or after having a baby. It doesn't mean you are a bad or "not together" mom. You and your baby don't have to suffer. There is help.

Here are some other helpful tips:

How is depression treated?

The two common types of treatment for depression are:

These treatment methods can be used alone or together. If you are depressed, your depression can affect your baby. Getting treatment is important for you and your baby. Talk with your doctor about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.

What can happen if depression is not treated?

Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:

Depression during pregnancy can raise the risk of:

Untreated postpartum depression can affect your ability to parent. You may:

As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.

Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:

It helps if your partner or another caregiver can help meet the baby's needs while you are depressed.

All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don't suffer alone. Please tell a loved one and call your doctor right away.

More information on depression during and after pregnancy

Source: NIH, HHS

Pregnancy: Getting pregnant again

divider line

Having another baby might be the last thing on your mind right now. But getting pregnant too soon after giving birth can be risky for both you and your baby. Becoming pregnant again within a year of giving birth increases the chance that your new baby will be born too soon.  Babies that are born too soon can have health problems.

Planning your next pregnancy if you want more children — or preventing a pregnancy if you don't — is important. Spacing pregnancies at least 12 months apart will give your body time to fully recover. In the meantime, using reliable birth control is the best way to prevent pregnancy until you decide if and when to have another baby. Women who have just given birth should wait three weeks before using birth control that contains both estrogen and progestin. This includes the pill, the patch, and vaginal ring. Using these methods in the early weeks after giving birth increases the risk of dangerous blood clots. Wait six weeks to use birth control with both estrogen and progestin if you delivered by c-section or have other risk factors for blood clots. These risk factors include obesity, history of blood clots, smoking, or preeclampsia. Women have many good choices for birth control after giving birth. Keep in mind that breastfeeding alone isn't a foolproof way to prevent pregnancy. Talk to your doctor about your birth control options.

Pregnancy: Babysitters and child care

Related information

Finding the right person to take care of your baby can be difficult and stressful. Our tips and resources can help

Choosing and using a babysitter

Planning time away from your new baby means that you will need to find a trusted babysitter to care for your baby like you would. That may seem impossible. But knowing what qualities you need in a babysitter will help you to find the best person to take care of your child. Womenshealth.gov recommends taking the following steps to help a new babysitter get to know you, your baby, and your home. Also, we have provided a
Babysitter information form (PDF, 181 KB) that you can fill out for babysitters caring for your child. It provides the sitter with important information, such as numbers where you can be reached in an emergency.

Tips for familiarizing a new babysitter with child safety and your home

Safety/first aid:

Familiarity with your house:

The following online resources have more information on first aid for babysitters:

Choosing and using child care

Many moms go back to work after having a baby and rely on child care for their children. Relatives or family members sometimes take on child-care duties, or children are enrolled in child-care programs. All parents wish the best start for their children. Child care is more than just a service that allows parents to work. It is a world that will affect a child's development in many ways — physically, emotionally, intellectually, and socially. Finding quality child care that is affordable can be challenging. Many parents need inexpensive or cost-free day care where they know their children are safe and are being helped to grow and develop. Parents can contact their local social service agency (listed in the phone book) for information about government-sponsored programs such as Head Start and Early Head Start and other community programs. Womenshealth.gov recommends taking the following steps to choosing quality child care. Also, we have provided a Child care provider checklist (PDF, 197 KB) for help in choosing child care providers.

Steps to choosing quality child care

Visit the websites of the following organizations for more guidelines on choosing child care.

divider line

Share your story

Nowadays, more than half of all mothers with infants work. And even more mothers with older babies and children are working. How did you navigate the transition? Help other new mothers by sharing your story on womenshealth.gov!

Share Your Story submissions are currently unavailable. Please check back soon.

Community stories

Please note: Posted stories do not necessarily represent the views of womenshealth.gov. Please view our comment policy.

Jamie from NY (US)

May 03, 2012 14:28 PM

My pregnancy was unplanned, and soon my life as a workaholic came to a screeching halt with the birth of my beautiful son. I have only been to work for about two months, and I am still struggling to find a balance. Most mornings it is near impossible to leave my son and head into the office, however making the choice to become a single mom I knew that I would have to return back to work soon. Even tho i work for a local government, if I had not been a workaholic with little to no social life and never went on vacation, I would not have been able to spend the 3 months home that I was able to. It is time to have a real, merit-based discussion about providing all mothers with protected PAID maternity leave. I know if I did not have my vacation days, I would have been forced to either go back to work 2 or 3 weeks after giving birth or, face the consequences of not getting any compensation or healthcare benefits during my "protected" FMLA leave.

Jane (CA)

October 31, 2011 13:22 PM

I'm a 57 year old mother of 4. My "children" are now 32, 30, 21, and 18. Memories are still pretty vivid. When my daughters were born, I was privileged to stay at home. My circumstances changed later, with a second marriage, and I had 2 boys. After maternity leave of 6 months, I had to go back to work and it broke my heart. I did a gradual return to work, working part-time for the first month. I chose to have in-home care for them, which made life easier for the first year. The transition was emotionally difficult. I missed my babies so much. With changes to maternity benefits in Canada, women are now able to stay home for the first year.

I'm now a grandmother, but it seems that pregnancy is a passion of mine. I've attended and assisted with childbirth with 12 women. I use great sites like womenshealth.gov to do my research and provide accurate, informative and up to date content at http://letstalkpregnancy.com Hope you'll come by and visit, share your stories and comments.

amber from NY

April 13, 2011 14:17 PM

All my life I wanted a baby. When I was a child, I would stuff my stomach to make believe I was pregnant. Later on in my life, those fantasies turned into reality ... I was a teen mom. I was so shocked by my pregnancy that I didn’t even want the baby. But as soon as I pushed out a living and breathing human being, all those bad thoughts just went away. I felt so much happier and so blessed to be a mom. Even if I wasn’t a total grown-up, I was still a mother :)

Dejoie from CA

February 25, 2011 19:57 PM

After having my second child, I returned to work after 6 weeks of postnatal care and bonding with my baby. I felt a need to go back to work because, at the time, I thought it was needed and necessary. My husband was in the military and was sent oversees to do a tour while I stayed stateside. I was not surrounded by family, but I did have newly found military wives that later became my friends. I found a babysitter where I lived, and I felt I could trust her. She was wonderful. I not only worked one job, but I worked a second job three nights a week. I stopped after two months. When my husband returned after 12 months, I felt the crunch of time lost with my children. I felt I lost the first year of my youngest child’s life. My husband reassured me that I was a good mom and that I did the best I could. From that time on, if my husband worked days, then I worked nights and vice versa. We were always there for our kids. We only used babysitters when we had date night. Now my first oldest daughter is married and has my granddaughter. She also has a degree in art history and art administration. My second oldest has a Masters degree in psychology and is engaged to be married. Our relationship couldn't be better.

Chichona from VA

October 19, 2010 13:38 PM

I was unemployed when I became pregnant. It was an unplanned pregnancy, which added to the stress of the situation. I am a single mother, and I am currently going to school online. Once my daughter arrived, I never stopped going to school, but my personality type does better with a schedule. So, once I started working, I had more energy and wanted to make sure that I did certain activities with her every day. I graduated with my associate degree, and I am still in school. I think that my daycare is the one thing that gives me piece of mind. She is safe, and she loves her teachers. I still feel like it is my responsibility to make sure she gets what she needs development wise. So, I must say it is hard to leave her, but it makes me want to get back to her that much more. From this experience I want two more kids. What helps me is being prepared, getting in some “me time,” and keeping track of my short- and long-term goals.

Share your story

Nowadays, more than half of all mothers with infants work. And even more mothers with older babies and children are working. How did you navigate the transition? Help other new mothers by sharing your story on womenshealth.gov!

Share Your Story submissions are currently unavailable. Please check back soon.

 Community stories

Please note: Posted stories do not necessarily represent the views of womenshealth.gov. Please view our comment policy.

Rebecca from AL

October 16, 2010 01:24 AM

I used to be a workaholic, and I did not notice time passing by. I worked so hard to make it to the top of the corporate ladder, but there was something missing. At the age of 39, I still had no baby. I was quite frustrated that I had all the money in the world and I had fulfilled my dreams, but I was not happy.

Quitting my job was the best decision of my life. I became a housewife, and after 2 years I had baby. It was very difficult to adapt at first, but it's about setting priorities and goals. I am a full-time housewife now, and I spend my time with my baby and making a blog to share my story.

I hope that my story will inspire you and change the way you live. Life is short, and it is not only our dreams and money that makes us happy. It is our loved ones that most of the time we don't notice. Cheers

Jen from IL

March 30, 2010 11:11 AM

I had twelve weeks of maternity leave, so I went back when my daughter was almost three months old. She went to her grandparents' home while I was at work. Many days, I would try to leave around lunchtime so that I could go see her and nurse her, but that wasn't always possible. I missed her terribly, though it was good to get out and do something besides just being a parent. I wished, and still wish, I could have worked half-time for the first year or so. Just saying the words "I missed her" doesn't really convey how grief-stricken I felt when I started going back to work. We'd spent those first three months together for almost every waking moment, and the idea that I was going to start missing large parts of her life was heartbreaking. It does get better, though. Being with her grandparents (and later, in a good day care) has been a great experience for her -- she's happy and healthy and learning a lot, and is her own person. I don't need to be with her every second to love her or know her or be her mom, just as I don't need to be with my husband every second. Don't let anyone tell you you're not your child's mother if you work outside the home. Believe me, you are, and your child knows it and loves you.

Kim from SC

March 18, 2010 10:45 AM

Returning to work was a little difficult for a while, especially dropping off a 6-week old at daycare. Had a really hard time with it. Now, she's almost 2 years old. Getting everything done at home after work is nearly impossible sometimes. Honestly, I just don't feel the same about working. Need to make money to support my family but would like to spend more time with the little one also

Christine from VA

October 14, 2008 11:16 AM

Before I had my baby, the 8-week maternity leave I had arranged with my employer seemed like an eternity. But after giving birth to my beautiful son, that time flew by in a blink of an eye. Although I only had to take care of myself and my new son, it took me at least 6 weeks to feel somewhat human again. No one can prepare a new mother for the exhaustion she will feel in those first few weeks. Once I felt well-rested enough to enjoy my new baby, I only had a couple weeks more before I needed to be back on the job. Thankfully, I already had daycare arranged. So I used this time to practice pumping (I was breastfeeding) and feeding my baby with a bottle. To be honest, I was looking forward to going back to work. But I felt guilty for feeling this way. And I was scared that I couldn't handle the demands of my job and the demands of a new baby — especially with limited sleep. Even so, I knew that we couldn't afford to have me stay home full-time. I also knew that I liked working and that it was an important source of personal fulfillment. So, now, when I feel guilty about leaving my son and heading off to work in the morning (and I still do sometimes), I remind myself that all his basic needs are being met. He is in a safe and loving environment. And it turns out, I have more energy to give to him at the end of the workday then I did when I was at home with him all day long. I think that's better for both of us.

Source: Office on Women's Health, HHS

Pregnancy: Mom-to-be tools

divider line

Related information

  • National Center of Birth Defects and Developmental Disabilities – Learn the Signs. Act Early.

Before you get pregnant: Information for all women

You're pregnant: Now what?

Getting ready for baby

Childbirth and beyond

Related information

  • Baby wish list – Print-and-go guide (PDF, 105 KB)

  • Hospital pack list – Print-and-go guide (PDF, 156 KB)

divider line

THIS INFORMATION ON PREGNANCY WAS PREPARED BY THE OFFICE ON WOMEN'S HEALTH, HHS.

Source: Office on Women's Health, HHS

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

Medical or Scientific Names

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:

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:

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:

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:

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:

Eclampsia

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

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:

Severe preeclampsia occurs when a pregnant woman has:

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:

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:

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:

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?

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

While You are Pregnant

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

Medical or Scientific Name

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:

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:

Economic Benefits

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

What are the recommendations for breastfeeding?

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

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

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:

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.

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:

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.

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?

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:

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

Females

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

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:

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

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.

How do I pump & store 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:

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:

Do breastfed infants need other nutrition?

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:

In the Infant:

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:

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:

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:

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.

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)?

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:

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

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

Continuous abstinence

This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

Natural family planning/rhythm method

This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart.

A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation.

To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or "unsafe." To learn about your cycle, keep a written record of:

  • When you get your period

  • What it is like (heavy or light blood flow)

  • How you feel (sore breasts, cramps)

This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

Barrier methods — Put up a block, or barrier, to keep sperm from reaching the egg

Contraceptive sponge

This barrier method is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane (pah-lee-YUR-uh-thayn) foam and contains the spermicide (SPUR-muh-syd) nonoxynol-9. Spermicide kills sperm.

Before having sex, you wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted.

Only one kind of contraceptive sponge is sold in the United States. It is called the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

Diaphragm, cervical cap, and cervical shield

These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg.

  • The diaphragm is a shallow latex cup.

  • The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap.

  • The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea's Shield.

The diaphragm and cervical cap come in different sizes, and you need a doctor to "fit" you for one. The cervical shield comes in one size, and you will not need a fitting.

Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.

All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.

Female condom

This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex.  Use a new condom each time you have intercourse. And don't use it and a male condom at the same time.

Male condom

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And you need to use a new condom with each sex act.

Condoms are either:

  • Lubricated, which can make sexual intercourse more comfortable

  • Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.

Keep condoms in a cool, dry place. If you keep them in a hot place (like a wallet or glove compartment), the latex breaks down. Then the condom can tear or break.

Hormonal methods — Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg

Oral contraceptives — combined pill ("The pill")

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the "extended cycle" pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don't contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

Your doctor may advise you not to take the pill if you:

  • Are older than 35 and smoke

  • Have a history of blood clots

  • Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Shot/injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.  

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.

It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Implantable devices — Devices that are inserted into the body and left in place for a few years.

Implantable rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a "T" that goes in your uterus. There are two types:

  • Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.

  • Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Permanent birth control methods — For people who are sure they never want to have a child or they do not want more children

Sterilization implant (essure)

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining.

It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.

For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis.

Emergency contraception — Used if a woman's primary method of birth control fails. It should not be used as a regular method of birth control.

Emergency contraception (Plan B One-Step or Next Choice. It is also called the "morning after pill.")

Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but it was used incorrectly, or did not work (like a condom breaking). Or, a woman may have forgotten to take her birth control pills. She also may have been abused or forced to have sex. These are just some of the reasons women may need emergency contraception.

Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within 72 hours after having unprotected sex.

A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and older.

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.

Birth control methods, failure rates, and side effects

Method

Failure rate (the number of pregnancies expected per 100 women)

Some side effects and risks

Sterilization surgery for women

Less than 1 pregnancy

  • Pain

  • Bleeding

  • Complications from surgery

  • Ectopic (tubal) pregnancy

Sterilization implant for women
(Essure)

Less than 1 pregnancy

  • Pain

  • Ectopic (tubal) pregnancy

Sterilization surgery for men

Less than 1 pregnancy

  • Pain

  • Bleeding

  • Complications from surgery

Implantable rod
(Implanon)

Less than 1 pregnancy

Might not work as well for women who are overweight or obese.

  • Acne

  • Weight gain

  • Ovarian cysts

  • Mood changes

  • Depression

  • Hair loss

  • Headache

  • Upset stomach

  • Dizziness

  • Sore breasts

  • Changes in period

  • Lower interest in sex

Intrauterine device
(ParaGard, Mirena)

Less than 1 pregnancy

  • Cramps

  • Bleeding between periods

  • Pelvic inflammatory disease

  • Infertility

  • Tear or hole in the uterus

Shot/injection
(Depo-Provera)

Less than 1 pregnancy

  • Bleeding between periods

  • Weight gain

  • Sore breasts

  • Headaches

  • Bone loss with long-term use

Oral contraceptives (combination pill, or "the pill") 

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

 

  • Dizziness

  • Upset stomach

  • Changes in your period

  • Changes in mood

  • Weight gain

  • High blood pressure

  • Blood clots

  • Heart attack

  • Stroke

  • New vision problems

Oral contraceptives (continuous/extended use, or "no-period pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

  • Same as combination pill

  • Spotting or bleeding between periods

  • Hard to know if pregnant

Oral contraceptives (progestin-only pill, or "mini-pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

  • Spotting or bleeding between periods

  • Weight gain

  • Sore breasts

Skin patch
(Ortho Evra)

5 pregnancies

May not work as well in women weighing more than 198 pounds.

  • Similar to side effects for the combination pill

  • Greater exposure to estrogen than with other methods

Vaginal ring (NuvaRing)

5 pregnancies

  • Similar to side effects for the combination pill

  • Swelling of the vagina

  • Irritation

  • Vaginal discharge

Male condom

11-16 pregnancies

  • Allergic reactions

Diaphragm with spermicide

15 pregnancies

  • Irritation

  • Allergic reactions

  • Urinary tract infection

  • Toxic shock if left in too long

Sponge with spermicide (Today Sponge)

16-32 pregnancies

  • Irritation

  • Allergic reactions

  • Hard time taking it out

  • Toxic shock if left in too long

Cervical cap with spermicide

17-23 pregnancies

  • Irritation

  • Allergic reactions

  • Abnormal Pap smear

  • Toxic shock if left in too long

Female condom

20 pregnancies

  • Irritation

  • Allergic reactions

Natural family planning (rhythm method)

25 pregnancies

None

 

Spermicide alone

30 pregnancies

It works best if used along with a barrier method, such as a condom.

  • Irritation

  • Allergic reactions

  • Urinary tract infection

Emergency contraception ("morning-after pill," "Plan B One-Step," "Next Choice")

1 pregnancy

It must be used within 72 hours of having unprotected sex.

Should not be used as regular birth control; only in emergencies.

  • Upset stomach

  • Vomiting

  • Lower stomach pain

  • Fatigue

  • Headache and dizziness

  • Irregular bleeding

  • Breast tenderness

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:

You need a prescription for these forms:

You will need surgery or a medical procedure for:

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:

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:

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

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

Source: Office on Women's Health, HHS

Pregnancy_Resource:

  1. All Pregnancy Information
  2. Health Tips for Pregnant Women
  3. All Pregnancy Information
  4. PregSource

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PageEnd