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There are few events in anyone’s life that rival the significance and the joy of childbirth. This new person you’re bringing into the world will become so important to you that you’ll do anything to nurture and protect him or her. Your interest in this book reflects your eagerness to form this unbreakable bond right from the start — to do all you can to help ensure a healthy pregnancy and a wonderful beginning to your child’s life.

‘Mayo Clinic Guide to a Healthy Pregnancy’ is an authoritative reference manual that you can trust. And in this second edition, you’ll find new and updated information to answer your questions about everything from the basics to newer trends, recommendations and technologies in prenatal care and childbirth.

This book is the work of a team of pregnancy experts who find nothing in medicine more exciting to experience than the development and birth of a child. It’s our sincere wish that you find this book helpful and meaningful as you anticipate your new baby.

Myra J. Wick, M.D., Ph.D., is a specialist in the Department of Obstetrics and Gynecology and the Department of Clinical Genomics at Mayo Clinic in Rochester, Minn. She is also an associate professor at Mayo Clinic College of Medicine and Science. As a mother of four children, Dr. Wick can relate to pregnancy from both a doctor’s and a mother’s perspective.

PART 1 Enjoying a healthy pregnancy
Chapter 1 Preparing to become pregnant
Is the time right?
Questions to ask
Is your body ready?
Contraception · Immunizations · Chronic medical condition · Medications and supplements · Prenatal vitamins · Sexually transmitted infections · Family history · Previous pregnancies · Lifestyle · Additional nutrients
How to get pregnant
When you’re most fertile · Maximizing your fertility · Healthy sperm · If you’re having trouble
Are you pregnant?
Early symptoms · Home pregnancy tests
Choosing a care provider
Obstetrician-gynecologists · Midwives · Giving birth in a hospital · Family physicians · Considering an out-of-hospital birth · Maternal-fetal medicine specialists · How to decide
Delayed pregnancy and fertility
Issues to consider · Making healthy choices
Chapter 2 Healthy choices during pregnancy
Pregnancy diet
Making every bite count · Foods to avoid · Vegetarian tips · The good stuff · Taking supplements · Folate and folic acid · Calcium · Protein · Iron · Getting your D
Gaining weight
What’s healthy? · If you’re overweight · If you’re underweight · If you’ve had an eating disorder · Slow and steady · Your weight goal · Determining your BMI · Where the weight goes
Staying active
Baby, let’s move! · Working in workouts · When extra caution is needed · Listen to your body · Athletes and pregnancy · Activities to approach with care · Pregnancy exercises
Playing it smart
Caffeine counter · Caffeine · Alcohol · Tobacco · Illicit drugs
Making sense of medications
What’s safe? · What’s not safe? · A medication guide · Birth control pills and pregnancy · Opioid use during pregnancy · What about herbal products?
Working while pregnant
Proper way to lift · Handling fatigue · Sitting, standing, bending and lifting · Avoiding harmful substances
Travelling wisely
Airplane travel · Destinations to avoid · Proper seat belt use · A few travel tips · Sea travel · Car travel
Common questions
Falls · Flu shot and other vaccinations · Colds and allergies · Acne · lactose intolerance · Hair coloring · Hot tubs and saunas · X-rays · Cellphones, computers and microwaves · Airport scanners · Mosquito bites · Household cleaners · Paint fumes · Litter boxes · Pregnancy and cavities · Water parks and theme park rides
Chapter 3 For dads and partners
How to take part
Getting through the first trimester together
Minimize nausea triggers · Your symptoms (you get ’em too) · Help combat fatigue · Ride out the mood swings · Remember it will pass
Sex during pregnancy
Staying intimate
Labor and delivery worries
Educate yourself about childbirth · Map your route · Install an infant car seat · Keep a copy of the birth plan · Pack your bags · Manage communications
Helping during labor
After the delivery
Common anxiety
Take action · Stay involved
PART 2 Pregnancy month by month
Introduction
Why 10 months?
Pregnancy calendar
A week-by-week checklist
How to respond
A guide to troublesome signs and symptoms
Chapter 4 Month 1: Weeks 1 to 4
Baby’s growth
Week by week · X and Y
Your body changes
What’s happening and where · Estimating your due dates · Baby’s sex: Can parents choose?
Your emotions
Mixed feelings · Mood swings · Your partner’s reaction · Your relationship with your partner
Scheduling a prenatal checkup
Getting yourself prepped · Exercise of the month
Chapter 5 Month 2: Weeks 5 to 8
Baby’s growth
Week by week · Can stress cause miscarriage? · What to avoid
Your body changes
What’s happening and where · Spotting
Coping with morning sickness
Exercise of the month · Hormones and more · How to ease the queasiness · The ‘warmed up’ effect
Your emotions
Anticipation · Worries and concerns
Prenatal checkup
What’s going to happen? · First appointment checklist
Twins, triplets and more
How multiple are made · Fraternal vs. identical · What it means for you · Possible complications
Chapter 6 Month 3: Weeks 9 to 12
Baby’s growth
Week by week
Your body changes
What’s happening and where · That pregnancy glow
Your emotions
Dealing with body image
Prenatal checkup
Prenatal tests: Yes, no, not sure? · Boy or girl: Do you want to know? · Exercise of the month · Sex during pregnancy
Alternative prenatal care models
Chapter 7 Month 4: Weeks 13 to 16
Baby’s growth
Week by week
Your body changes
What’s happening and where · Congestion problems · Exercise of the month
Your emotions
Feeling productive
Time to go shopping
Prenatal checkup
Thinking ahead to child care
Child care options · Making your decision · Work and family balance
Chapter 8 Month 5: Weeks 17 to 20
Baby’s growth
Week by week
Your body changes
What’s happening and where · Exercise of the month
Your motions
Baby on the move! · ‘Baby brain’
Prenatal checkup
Chapter 9 Month 6: Weeks 21 to 24
Baby’s growth
Week by week
Your body changes
What’s happening and where · Is it false labor or true labor? · Exercise of the month
Your emotions
Confronting your fears · Being intimate
Prenatal checkup
Childbirth classes
Different types · What to look for · Thinking ahead: Finding a care provider for your baby
Chapter 10 Month 7: Weeks 25 to 28
Baby’s growth
Week by week
Your body changes
What’s happening and where
Your emotions
Enjoy a little break
Prenatal checkup
Exercise of the month · Losing your personal space · Glucose challenge testing · Rh antibodies testing · Tdap vaccine
The breast or bottle question
A tough decision for some women · Sagging breasts
Chapter 11 Month 8: Weeks 29 to 32
Baby’s growth
Week by week
Your body changes
What’s happening and where · Changes in baby’s movement · Exercise of the month · Watching out for preterm labor · Finding a comfortable sleep position
Your emotions
Handling anxiety
Prenatal checkup
Cord blood banking
Public vs. private · Should you consider it?
Baby gear essentials
Buying a car seat · Buying a crib · Buying a baby carrier
Chapter 12 Month 9: Weeks 33 to 36
Baby’s growth
Week by week
Your body changes
What’s happening and where · Exercise of the month
Preparing your body for labor
Kegel exercises · Perineal massage
Your emotions
Preparing yourself for labor
Prenatal checkup
Strep test · Checking baby’s position
Your birth plan
Birth plan checklist · Pain management
Chapter 13 Month 10: Weeks 37 to 40
Baby’s growth
Week by week · How baby comes out
Your body changes
What’s happening and where
Your emotions
Time to relax
Techniques to keep you calm
Prenatal checkup
When to call · Exercise of the month · What to do when baby’s overdue · Placentophagy
Chapter 14 Labor and childbirth
While you wait
Review your birth plan · Preregister at the hospital · Pack your bag · Try to relax · Common questions
How your body prepares
Early signals · Signs you’re in labor · Presentation, position and station · Can you kick-start labor?
It’s time! – Or is it?
Ready; set; not yet! · What’s that for?
Sages of labor and childbirth
What does labor feel like? · Stage 1 · Cervix dilation · Labor positions · Factors that can speed or slow labor · Back labor · How baby comes out · What exactly triggers labor? · Stage 2 · Stage 3
If you’re the labor coach
During early labor · During active labor · During transition · During pushing and delivery
Chapter 15 Cesarean birth
When is a C-section done?
Reasons why · What about elective C-sections?
The risks
Risks for you · Is there a limit? · Risks for your baby · Dealing with the unexpected
What you can expect
Preparation · The operating room · The recovery room
After surgery
Vaginal seeding · Recovery · Your partner’s involvement · Restrictions · Possible complications · Welcome, little one
PART 3 Baby is finally here
Chapter 16 Your newborn
Your baby’s appearance
Head · Jennifer’s story · Skin · Hair · Eyes
Newborn care
Examinations · Treatments and vaccinations · Screening tests
Circumcision
Issues to consider · How it’s done · Circumcision care
Newborn issues
Jaundice · Infection · Learning to eat
The premature newborn
The setting · The neonatal intensive care until team · What baby may look like · Getting involved · Complications of prematurity · When your baby is hospitalized
Chapter 17 Taking baby home
Your baby’s world
Reflexes · Senses · Crying · Swaddling baby · Eating and sleeping · Coping with colic · Developing good sleep habits · Safe sleep · Peeing and pooping · First bowel movements
Baby care basics
Holding your baby · Changing diapers · Diaper rash · Cradle cap · Bathing · Umbilical cord care · Skin care · Nail care · Clothing
Twins, triplets or more
Getting through the first weeks
Chapter 18 Postpartum issues for mom
Breast care
Engorgement · Leaking milk · Score or cracked nipples · Breast self-awareness · Blocked ducts
Bowel and urination problems
Bowel movements · Hemorrhoids · Urine leakage · Difficulty urinating
Healing
Uterine cramping · Episiotomies and tears · Vaginal discharge
Getting back into shape
Fatigue · Hair and skin · Weight loss · Exercise
The baby blues
Dealing with the blues · Causes · Signs and symptoms · Is it more than the blues?
Baby bonding
Give it time
Chapter 19 Managing as parents
Early survival tips
Tackling transitional stress · Getting enough sleep · When sleep becomes a struggle · Negotiating household chores · Paying for baby · Introducing your pet to a new baby
Parenting as a team
The transition to parenthood · The importance of support · Setting the tone · What makes a strong, healthy family?
Finding time for yourself and each other
Getting away on your own · Getting away together · Sex after pregnancy
Single parenthood
Hang in there
PART 4 Important decisions of pregnancy
Chapter 20 Genetic screening
What is it?
Different types of genetic tests
Issues to consider
9 key questions
Types of genetic disorders
Family history screening
Ethnic-based screening · Genetic diseases
Expanded carrier screening
How it’s done
Understanding the results
Chapter 21 Prenatal testing
Issues to consider
6 key questions
Ultrasound imaging
Prenatal screening
First trimester combines screening · Second trimester quadruple screening · Screening tests combines across first and second trimesters · Cell-free DNA (cfDNA) screening
Prenatal diagnostic tests
Chorionic villus sampling · Amniocentesis · When the results indicate a problem · Genetic studies after CVS or amniocentesis · Fetal blood sampling
Fetal surveillance or late pregnancy tests
Fetal nonstress and stress tests · Biophysical profile testing · Doppler ultrasound
Chapter 22 Breast-feeding
Breast-feeding
Milk production · Benefits for baby · Benefits for you · Pros vs. cons · When breast-feeding may not be an option · Vitamin D · Getting started · Feeding positions · Nursing basics · Keeping yourself healthy · Breast care · Pumping your breasts · Storing breast milk · Breast-feeding multiples · Going back to work · Introducing a bottle · Donor milk
Bottle-feeding
Breast of bottle: Feeding tips · Pros vs. cons · Bottle-feeding basics · Be flexible · Getting started · Preparing formula · Getting into position
Chapter 23 Pain relief during childbirth
Issues to consider
Your options
Pain medications · Natural methods · What’s a doula?
Pain medications
Epidural block · Spinal block · Combined spinal epidural · Receiving an epidural block · Opioids · Local anesthetic · Nitrous oxide
Natural methods
Breathing techniques · Relaxation techniques · Other techniques
Chapter 24 Elective cesarean birth
Issues to consider
Benefits vs. risks
Maternal benefits · Maternal risks · Fetal risks
Making your decision
Chapter 25 Vaginal birth after a cesarean birth
Benefits of VBAC · Risks of VBAC
Issues to consider
Previous incision · Reason for previous C-section · Who might not be a candidate
Tips for planning a VBAC
Chapter 26 Contraception after delivery
Issues to consider
Breast-feeding and contraception
Fertility · Hormones and breast milk · Vaginal dryness
Options
Hormonal methods · Barrier methods · Intrauterine devices · Permanent methods · Natural family planning methods · Emergency methods
Making your decision
PART 5 Symptoms guide
Abdominal discomfort · Abdominal pressure · Abdominal tenderness · Acne · Allergies · Baby’s hiccups · Baby’s kicks · Backache · Blurry vision · Breast discharge · Breast enlargement · Breast tenderness · Buttock and leg pain · Carpal tunnel syndrome · Clumsiness · Constipation · Contractions · Cramping · Dizziness and faintness · Dreams · Enlarged veins · Excessive salivation · Eye changes · Facial skin darkening · Fatigue · Feeling warm · Fluid leakage · Food aversions · Food cravings · Forgetfulness · Gas and bloating · Gum disease and bleeding · Headaches · Heartburn · Hemorrhoids · Hip pain · Hunger · Increased heart rate · Insomnia · Irrational fears · Itchiness · Leg cramps · Linea nigra · Mood swings · Morning sickness · Mucous discharge · Navel soreness · Nesting · Nipple darkening · Nosebleeds · Pelvic pressure · Perineal aching · Perspiration · Public bone pain · Rashes · Rectal bleeding · Red palms and soles · Rib tenderness · Round ligament pain · Sensitivity to smells · Shortness of breath · Skin tags · Snoring · Stretch marks · Stuffy nose · Swelling · Swollen feet · Thirst · Urinary tract infections · Urinating frequently · Urine leakage · Vaginal bleeding · Vaginal discharge · Varicose veins · Vomiting · Yeast infections
PART 6 Complications of pregnancy and childbirth
Chapter 27 Issues during pregnancy
Blood concerns
Rhesus factor incompatibility · Iron deficiency anemia
Cervical incompetence
Depression
Early labor
Bed rest and activity restriction
Excessive vomiting
Fetal growth restriction
Gestational diabetes
Infection
Chickenpox · Cytomegalovirus · Fifth disease · Flu · German measles · Group B streptococcus · Listeriosis · Toxoplasmosis · Tuberculosis · Zika virus
Placental problems
Placental abruption · Placenta previa
Preeclampsia and hypertension
Chapter 28 Problems of labor and childbirth
Labor that fails to start
Inducing labor · Oxytocin
Labor that fails to progress
Prolonged early labor · Assisted birth · Prolonged active labor · Prolonged pushing
Baby in an abnormal position
Facing up · Abnormal angle · Head too big · Breech · Lying sideways
Intolerance of labor
Umbilical cord prolapse · Umbilical cord compression · Decreased fetal heart rate
Chapter 29 Managing mom’s health concerns
Pre-existing health issues
Asthma · Cancer · Depression · Diabetes · Epilepsy · Heart disease · Hepatitis B · High blood pressure · Immune thrombocytopenic purpura · Inflammatory bowel disease · Lupus · Phenylketonuria · Rheumatoid arthritis · Sexually transmitted infections · Sickle cell disease · Thyroid disease · Uterine fibroids
Postpartum concerns
Blood clots · Excessive bleeding · Infection · Postpartum depression · Self-care for postpartum depression
Chapter 30 Pregnancy loss
Miscarriage
Signs and symptoms · Causes · What doesn’t cause miscarriage? · Types of miscarriages · Seeing a doctor · Treatment · Recovery · Recurrent pregnancy loss
Ectopic pregnancy
Signs and symptoms · Treatment · Future pregnancies
Molar pregnancy
Signs and symptoms · Treatment · Future pregnancies
Stillbirth
Signs and symptoms · Causes · Treatment · Future pregnancies · Coping with pregnancy loss
Trying again
Emotional recovery · Your partner · Physical recovery · Tips for future pregnancies
Additional resources
Glossary
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