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Tag: Prenatal Care

Labor And Delivery

Pregnancy & Prenatal Care

There are two ways a baby may be born:

* Through the vagina (vaginal birth). Contractions of the uterus push the baby out through the cervix into the vagina. The baby passes through the vagina to enter the world.

* Cesarean section (C-section). This is a surgical method. The baby is taken directly from the uterus.

The type of delivery you have will depend on your needs. Discuss the options with your health care provider.

Vaginal Births

Natural childbirth means that no medication is given to induce (bring on) labor. Little or no medicine is given to relieve pain. The mother uses various methods to aid the delivery process, like special breathing. Her “coach” provides support.

Vaginal births can also involve medicines. Some of these are:

* Misoprostal. This tablet is put in through the vagina to help dilate the cervix.

* Pitocin. This is a hormone that causes the uterus to contract. It helps to start or speed up labor. It is given through an IV (intravenous drip).

* Prostaglandin gel. This is a gel that is put in through the vagina. It goes right on the cervix. It can help dilate the cervix. It also causes the uterus to contract. This helps to start labor.

* Narcotic pain relievers. Example: Demerol. These can be given with a shot or an IV. They take the edge off pain. But they can also cause you to feel drowsy or dizzy. They can cause an upset stomach or throwing up. Other medicines may be given with narcotic pain relievers. These help them have a stronger effect.

* Tranquilizers. These relax you if you are tense and anxious. They can be given in pills or with a shot. Tranquilizers are sometimes used with pain relievers.

* Anesthetics. Anesthetics cause a loss of feeling. They are usually given after labor has been in progress. There are two main types:

* General anesthesia. This puts the mother to sleep. It is used most often for emergency C-sections. But it can be used in a vaginal birth when the baby is in a breech position. That’s when the baby’s bottom or one or both feet reach the cervix before the head does.

* Local anesthetics. These affect only the area where they are applied. Common examples:

– Pudendal block. A shot numbs the nerves in the vaginal area. It is usually given when the cervix is fully dilated (opened). It may be used with a pain reliever or tranquilizer.

– Epidural block. This is the most popular anesthetic used for labor. The mother lies on her left side or she sits up and leans forward. A shot is given in the back to numb the area. A thin plastic tube is put into the epidural space of the spine. Medicine is given through the tube. This causes some loss of feeling from the waist down. How much numbness occurs depends on the drug and dose used. An epidural block can have other effects. It can lower the mother’s blood pressure. It can make her unable to pass urine on her own. In that case, a tube called a Foley catheter is used to empty urine from the bladder. An epidural block can also increase the chance that forceps will be used at delivery. {Note: Just pain medicine can be given through the tube. It does not cause a loss of feeling from the waist down. If this is done, the mother may be able to get out of bed and walk. But an adult should be with her.}

Whether or not pain medicine is used is not what matters most. The goal in labor and delivery is to have a healthy baby and a healthy mother.

Cesarean Births

A C-section requires anesthetics. Either an epidural block or spinal is used. General anesthesia is rarely used. C-sections are usually done with a low, left-to-right incision (cut) near the line of pubic hair. This is called a lower-segment incision or a “bikini” cut. An up-and-down incision is rare these days. But it may be used in an emergency. The type of incision in the skin may be different from the one made in the uterus.

C-sections may or may not be planned. Here are some reasons for doing one:

* The baby (or babies) or mother is not doing well

* The baby is too big for the mother’s pelvis

* The mother has placenta previa or placenta abruptio.

* The mother had a past C-section with an up-and-down incision on the uterus.

* The baby is lying in a way that makes it hard to deliver.

* The mother has an active outbreak of genital herpes.

* Labor does not progress the way it should.

* The umbilical cord is wedged between the cervix and the baby. This cuts off blood flow to the baby.

* The mother is not strong enough for a vaginal delivery.

* The mother has health problems, like diabetes, high blood pressure, kidney disease, or preeclampsia.

* The baby is more than 2 weeks late and the placenta does not nourish the baby well.

Vaginal Births after C-Section (VBAC)

Some pregnant women have already had a C-section delivery. Of this group, some might be able to have a safe vaginal delivery. Some might not for the next baby.

A vaginal delivery after a C-section may be possible if:

* The incision for the C-section was the left-to-right, lower-segment type.

* Your pelvis is normal size.

* Reasons for the past C-section are not present now. Examples:

– Breech baby

– Separation of the placenta (placenta abruptio)

– More than one baby

– Baby in distress

Signs of Prelabor

Prelabor is the period just before labor begins. Call your health care provider if any of these signs of prelabor happen more than one month before your due date:

* The baby begins to settle into your pelvis. It looks and feels as if the baby has “dropped.” This process is called lightening and engagement. It’s easier for you to breathe after it happens.

* You feel more pressure on the pelvis and rectum (rear end). The pressure can cause a dull ache in the pelvic area or lower back. It feels like menstrual cramps.

* Vaginal discharge may increase and thicken.

* Your energy level changes. Some women feel less energy. Others feel more. They want to clean the whole house. The “nesting instinct” is a way of getting ready for the new baby.

* You lose the mucus plug. That’s a blob of thick stuff that blocks the cervix. You can lose it several days before labor starts. Or you can lose it just as labor starts.

* You may see the bloody show. When the cervix opens, small blood vessels often break. The blood colors the mucus plug pink. Or it may streak the mucus plug with red. When the mucus plug falls out, you may see the blood. You may pass a big clump that looks like a wet cotton ball. Some women don’t notice the bloody show. Bloody show usually means that labor will start within 24 hours. But sometimes labor could still be a few days away.

* You have diarrhea. Some women get this just before labor starts.

* The “bag of waters” (or your “water”) breaks. That’s the sac inside the uterus. It holds the amniotic fluid. The baby grows there. About 15 percent of the time, the water breaks before labor starts. More often, this happens during labor. The fluid can come out in a gush or a slow trickle. Call your provider right away if this happens.

1st Stage of Childbirth

The First Stage of Childbirth: Labor

Labor has three parts:

* The first part is called early or latent labor. This is usually the longest part. It’s usually the least painful, too.

– Real contractions begin. Contractions are when the muscles of the uterus tighten and then relax. The feelings usually start in the lower back and travel to the belly. Some contractions are felt only in your back. Others are felt only in your belly. Contractions usually start about 15 to 20 minutes apart and last 30 to 45 seconds.

– The cervix dilates to open 3 centimeters across. That’s about the size of a silver 50¢ piece. It gets thinner. This can happen over a period of days or weeks. You may not even be aware of it. Or it can happen with stronger contractions over a period of 2 to 6 hours. Rarely, it could take up to 24 hours with the stronger contractions.

– Call your health care provider during the first part of labor. Your provider may tell you to go to the hospital or birthing center. Make sure you’re packed!

* The second part is called active labor. This part of labor is usually shorter than the first part. On average, it lasts 2 to 3 hours. But its length can vary greatly. If you’re not already at the hospital or birthing center, you should get there early in this part of labor. Signs of this part of labor:

– Contractions are stronger. They come more often, usually every 3 to 4 minutes. They last longer, from 40 to 60 seconds each.

– The cervix dilates to 7 centimeters. That’s about the size of the rim of a coffee mug.

* The third part is called advanced active labor or transition. It is the most tiring part. But it is also the shortest. The average length is 15 to 60 minutes. Here are signs that you are in transition:

– Contractions are even stronger. They come every 2 to 3 minutes. Each lasts 60 to 90 seconds.

– The cervix dilates fully. It opens 7 to 10 centimeters. That’s about the size of a small grapefruit.

2nd Stage of Childbirth

The Second Stage of Childbirth: Delivery

During delivery, you push the baby down the birth canal and out into the world.

* Contractions continue. They are usually more regular than before. They come less than two minutes apart. Each lasts about 60 to 90 seconds. You only push when you have contractions. Your health care provider will tell you when to push.

* Most babies come out head first. Then the shoulders. After this, the rest of the baby’s body slips out with ease. Your baby may be placed on your tummy.

* The umbilical cord is clamped and cut.

* The time for this stage varies greatly. It can take from 10 minutes to 3 hours or more.

3rd Stage of Childbirth

The Third Stage of Childbirth: Delivery of the Placenta

Delivery of the placenta usually lasts from about 5 to 30 minutes. Delivery takes place through mild contractions. You might not even feel them. One more push from you can help the placenta come out. Or a nurse or your health care provider may gently press down on your abdomen. This, too, can help the placenta come out.

{Note: The total time for labor varies from woman to woman. It also varies from pregnancy to pregnancy for the same woman. First babies tend to take longer than later ones. This is not always the case, though.}

During Labor

Things Your Health Care Provider May Do During Labor

Your health care provider and his or her staff may do any of the things below during labor. What they will do depends on your special needs. But find out ahead of time which ones the provider is sure to do.

* Do a physical exam.

– Your provider feels your belly. This helps the provider know how big the baby is. It helps the provider to know how the baby is lying.

– Your provider gives you a pelvic exam. This shows how open and thin your cervix is. Your “bag of waters” could break by itself during this exam.

* Put an IV (intravenous drip) in a hand or arm vein. Here are reasons why this may be done:

– To give you fluids. This keeps you from getting dehydrated (dried out or without enough body fluids).

– To give you glucose. Glucose is a type of sugar. It gives you energy. This will help if you have a long labor.

– To provide a way to give you medicine quickly, if you need it.

* Use a fetal monitor to check the baby. This small machine can check your baby’s heartbeat before the baby is born. It can also record your contractions. There are 2 kinds of fetal monitors:

– External monitor. This kind has two wide straps. The straps go over your belly. One strap picks up your baby’s heartbeat by ultrasound. The other connects to a pressure gauge. The gauge records your contractions on a printout.

– Internal monitor. This kind has a small tube that goes inside the uterus. The “bag of waters” must be broken before this monitor can be used. It gets there through the vagina and cervix. A small electrode goes on the baby’s head. This monitor gives more detail than the external one. It is used when the baby doesn’t seem to be doing well. It may also be used when the external monitor is not giving an accurate reading. This can happen if the baby is very active. It can happen when the mother is obese.

* Break your “bag of waters.” Your provider pricks the “bag of waters” with a small tool. The tool enters through the opened cervix. The provider looks at the color of the fluid. Clear is a good sign. Yellow or green could signal a problem.

* Use forceps to help the delivery. Forceps are metal tongs. They are cradled around the baby’s head. They help ease the baby out of the birth canal if the mother can’t push.

* Use vacuum extraction to help the delivery. A suction cup is put on the baby’s head in the birth canal. This helps the baby come out if the mother can’t push. The suction cup is attached to a vacuum pump. Your doctor uses this to pull the baby gently with each contraction. Many doctors prefer this method to forceps. {Note: Forceps and vacuum extraction are not used until the baby’s head can be seen at the vaginal opening.}

* Do an episiotomy. This is a surgical cut. It is made in the skin between the vagina and the anus just before the baby is born. The purpose is to widen the vaginal opening. That helps the baby come out. It also helps keep the skin in the vaginal area from tearing. After the baby is born, the cut is stitched.

How long you stay in the hospital or birthing center will depend on:

* The type of delivery you have and where you give birth. You may go home within 12 to 24 hours in a birthing center. You may be able to stay in a hospital for up to two days. Both of these are with normal vaginal deliveries without problems. C-section stays vary. They usually last 2 to 3 days.

* Your health insurance. Find out what your insurance pays for.

* Your medical needs. You or your baby may need to stay in the hospital longer than usual if you have special medical needs. Sometimes you and your baby get home health care. Your hospital or health insurance may provide this.

© American Institute for Preventive Medicine

January 23, 2026
More Than One Baby

Pregnancy & Prenatal Care

Causes

Having more than one baby may happen more often if:

* There is a family history of it.

* The mother is taking medicine or having treatment to get pregnant.

* She is an older mother.

More than one baby can happen in two ways. The most common way is when two or more eggs are fertilized by two or more sperm. These babies can be either boys or girls. They may or may not look alike. They are called fraternal twins or triplets, etc.

Less common is when an egg is fertilized by a sperm as usual. Then, for some reason, the egg splits apart. Two or more babies grow. They are the same sex. Their hair, eyes, and skin will be the same color. They are called identical twins or triplets, etc.

In rare cases, the egg doesn’t split apart all the way. The twins stay joined together at the head or back. Or they may be joined at some other part of the body. They are called conjoined twins. Sometimes surgery can separate them after they are born. This can be very risky.

Signs

At first, a woman may not know she is carrying more than one baby. Her health care provider can usually tell within 8 weeks, though. Signs include:

* Severe nausea and vomiting

* The uterus is growing faster than usual.

* There are two or more heartbeats.

* An ultrasound picture of the uterus shows more than one baby.

Risks

The health care provider watches for risks that come with carrying more than one baby.

* Low iron and oxygen in mother’s blood.

* Less and less blood flows to the baby.

* High blood pressure and preeclampsia.

* Gestational diabetes.

* Difficult labor

* Preterm labor and preterm birth. Preterm birth happens 3 weeks or more before the due date.

* Low birth weights. A low birth weight is less than 5-1/2 pounds.

Some mothers can have a vaginal birth with more than one baby. Others may need a Cesarean section (C-section) for a safe delivery.

Questions to Ask

Self-Care / Prevention

* You will need more prenatal health care visits than with just one baby. You will need extra blood tests and blood pressure checks. Your provider will need to make sure each baby is doing well. Call your provider whenever you have questions during your pregnancy.

* Eat healthy foods.

* Eat smaller meals more often. This helps ease things as your growing uterus presses on your stomach.

* Take your prenatal vitamins (vitamin pills) every day. They should include iron and folic acid. They will supply other needed vitamins and minerals, too.

* Don’t smoke, drink alcohol, or take drugs.

* Exercise only with your health care provider’s consent. Women carrying more than one baby tire more easily. In later pregnancy, avoid any activity that takes a lot of energy. Avoid any activity that could injure you or your babies.

* Lie on your left side. This helps blood flow to the babies. It may help keep blood pressure down, too. It also makes you more comfortable. Don’t lie on your back.

* Reduce stress in your life. Stress can lead to early labor.

* Get enough sleep. Learn and use methods to relax.

* Follow your health care provider’s advice on rest during the day.

* Get help with daily tasks, like caring for other children. If you can, take time off from your job after the 24th week.

* Watch for signs of preterm labor. Your provider may have you wear an electronic monitor. It senses contractions of the uterus.

* Choose a well-equipped hospital. Do this with your health care provider’s help. The hospital should be well suited for births of more than one baby. Choose one with a neonatal intensive care unit (NICU). This has special staff and equipment for babies born too early.

© American Institute for Preventive Medicine

January 23, 2026
Nausea And Vomiting

Pregnancy & Prenatal Care

Nausea is when you feel like throwing up. Vomiting is when you do throw up. They are both signs of morning sickness. It is usually due to changes in hormones. Low blood sugar levels also cause it.

Despite its name, morning sickness can happen any time of day. It can even happen in the evening. Morning sickness usually begins around the 6th week. For most women, it ends after the first trimester. For some, it lasts longer. For a few, it can last the whole pregnancy.

Upset stomach and throwing up can also be caused by:

* A virus in the intestines. Diarrhea can go along with this.

* Spoiled food

* Eating or drinking too much

Questions to Ask

Self-Care / Prevention

* Keep crackers or dry cereal by your bed. Eat a few crackers or a handful of dry cereal in bed. Do this before you lift your head up in the morning.

* Get up and out of bed slowly. If you can, sit in bed for a half-hour before you get up.

* Use these tips to keep your blood sugar from getting too low:

– Eat small regular meals and snacks through the day. Focus on foods high in carbohydrates. Examples: whole grain breads and cereals, potatoes, pasta. More examples: rice, beans and other legumes, vegetables, fruits.

– Have a good source of protein at each meal. Examples: low-fat milk, yogurt, low-fat cheese, dry beans, dry peas.

– Have a snack before you go to bed at night. Have one if you wake up at night.

– Avoid foods with high sugar content.

– Don’t drink alcohol.

* Don’t smoke.

* Don’t eat fried or greasy foods. These foods have a lot of fat. Fat stays in the stomach for a long time. This can lead to nausea.

* Don’t eat spicy foods.

* Don’t take any medicine without your health care provider’s okay.

* Take your prenatal vitamins (vitamin pills) with meals. This helps prevent stomach upset. Your doctor may prescribe PremesisRx®. This is a vitamin that helps nausea.

* Ask your health care provider about taking ginger and in what form.

* Write down the times when your stomach is upset and when you throw up. These may happen only after you eat certain foods. Or they may happen with certain smells. Once you know what they are, you can avoid them.

* Stay away from smoke and smoky rooms. Even stay away from cooking smells.

* Get plenty of rest.

* Discuss any home remedies with your health care provider. Do this to make sure they are safe.

* Ask your health care provider about a relief band. That’s a wrist band that helps with an upset stomach and throwing up.

* If the Self-Care Tips bring no relief, call your health care provider. He or she can prescribe medicines. Sometimes, IV fluids are needed.

* To get rid of cooking smells and odors:

– Open the windows.

– Run fans in the house. Use the exhaust fan on the stove.

– Use a portable air cleaner or air purifier.

© American Institute for Preventive Medicine

January 23, 2026
Pregnancy Tests

Pregnancy & Prenatal Care

How can you find out for sure if you are pregnant? Do a home pregnancy urine test. You can do one yourself. Facts about these tests:

* They test for a hormone called HCG. HCG is present in the urine only during pregnancy.

* You can buy them over-the-counter. Look for them at the drug store or supermarket.

* They are 95 to 100% error-free. But you have to do what the label says.

* They come in many brands. Some brands include a second test in the package.

* They are not all used the same way. Read the label to find out what to do. Some can be used the day after you miss a period. That’s about 14 days after conception. Some have you wait 3 to 5 days after you miss a period. Some have you use your first morning urine sample.

{Note: If your test is positive, call your health care provider. Make a date to be seen. Ask what prenatal vitamins (vitamin pills) you should take. Do this if you are not already taking them. It is a good idea to start taking prenatal vitamins before you get pregnant and right at the start of pregnancy. Doing this, especially getting enough folic acid, may prevent some birth defects. Prenatal vitamins will supply the minerals you need, too.}

* Get a lab or in-office urine test. Ask your health care provider to order one. Facts about these tests:

– They test for HCG in the urine.

– They are nearly 100% error-free.

– They can confirm pregnancy 7 to 10 days after conception.

* Get a blood test. Ask your health care provider to order it. Facts about these tests:

– They test for HCG in the blood.

– They are 100% error-free.

– They can confirm pregnancy 7 days after conception. That’s even before you miss a period.

Always follow up your pregnancy test with a medical exam. Your health care provider can see signs of pregnancy by or even before the 6th week!

© American Institute for Preventive Medicine

January 23, 2026
Signs Of Pregnancy

Pregnancy & Prenatal Care

What to Look For

Do you think you might be pregnant? Here are some signs to look for:

* You have missed a menstrual period. You are at least 2 weeks late. {Note: Stress or illness can cause your period to be late, too. And, some women do not have regular periods. It may be hard for them to know if their period is 2 weeks late. Other women can have a light menstrual period or spotting and still be pregnant. So watch for other signs also listed here.}

* You feel tired. This is the most common sign.

* You feel sick to your stomach. You may even throw up. This is called “morning sickness.” But it can occur any time of day or night.

* You need to pass urine more often.

* You have food cravings.

* Your taste for certain foods changes.

* You have a metallic taste in your mouth.

* There are changes in your breasts.

– They feel tender.

– They feel tingly.

– They are swollen.

– The dark areas around your nipples are darker than before.

– The tiny glands around your nipples stick up.

© American Institute for Preventive Medicine

January 23, 2026
Backaches

Pregnancy & Prenatal Care

Causes

Pregnant women get backaches because:

* The growing uterus and extra weight pull the body forward. Standing this way can strain the back muscles.

* Hormones are released during pregnancy. These make the ligaments soften and stretch. Ligaments are tissues that surround and support the joints.

* Joints in the lower back get sore from pressure. This happens to joints in the pelvic area, too. The baby is growing in size and weight.

* The baby presses against the tailbone.

Prevention

Do exercises your health care provider tells you to do. Use good posture, too. Keep your spine straight when you are standing. Have a friend check your back for curving: Stand with your heels against a wall. Ask your friend to look at your back. Tell him or her to let you know if it curves. Center your weight over the pelvic area. Be careful when you bend over, too. Bending wrong can give you a backache.

Back Labor

Most women have some back pain during labor. Some women have it through their whole labor. This is called back labor. It is caused by the way the baby is lying. The back of the baby’s head presses against the tailbone. Or it may press slightly to one side of it. Back labor can occur in preterm labor, too.

Questions to Ask

Self-Care

Tips for Good Posture

When you stand:

* Stand straight.

* Tuck in your bottom.

* Don’t hollow your back.

* Don’t tighten your shoulders or hold them back. Keep them dropped.

* If you have to stand for a long time: Stretch your feet and shift your weight. Rest one foot and then the other on a footstool or telephone book.

When you sit:

* Sit on a straight chair with a high back.

* Rest your back against the chair’s back.

* Put a pillow at the small of your back.

* Rest one or both feet on a footstool.

* Don’t sit too long. It strains your lower back. Get up and walk around.

When you bend:

* To pick something up, squat down on your heels and bend your knees. Keep your upper body straight. Don’t lean over from the waist. Use the strength from your legs, not your back.

* To do something down low, kneel or squat. Or get down on all fours. That way, you help take the baby’s weight off your spine.

When you lie down or sleep:

* Use a firm mattress. If you don’t have one, have someone help you place a board under your mattress. Or have someone put your mattress on the floor.

* Lie on your left side with your knees bent. Bend the upper knee more than the lower knee. Leave a lot of space between your legs.

* Put a pillow under your upper knee and leg.

Other Self-Care Tips

* Don’t gain too much weight.

* Wear shoes with low (but not flat) heels.

* On a long car ride, stop every two hours. Get out and walk around.

* Don’t take medicine for pain. Ask your health care provider first.

* Don’t lift objects over 15 pounds.

* Don’t do exercises where you lift both legs at the same time.

* Do exercises for stronger back and belly muscles. Ask your health care provider for these.

* Do relaxation and deep breathing exercises. Do yoga.

* Have someone massage your lower back. Massage won’t cure a backache. It can loosen tight muscles, though.

* Apply warm, moist heat to your back. Use a hot water bottle or warm wash cloth.

* Ask your health care provider if you should wear a back support girdle, a back brace, or a special elastic sling.

* Do an exercise called the “pelvic rock”. This exercise helps your lower back be more flexible. It helps make the muscles in your belly stronger.

You can stand to do the pelvic rock.

Step 1

* Stand 2 feet away from the back of a chair.

* Put your hands on the chair’s back. Keep your elbows straight.

* Bend a little forward from your hips.

Step 2

* Push your hips backward and relax the muscles in your belly. Relax your back.

* Bend your knees a little.

Step 3

* Slowly pull your hips forward.

* Tuck your buttocks under as if someone were pushing you from behind.

Step 4

* Repeat steps 1, 2, and 3.

You can do the pelvic rock on your hands and knees.

Step 1

Get down on all fours. Have your knees slightly apart. Have your back and elbows straight.

Step 2

Breathe in. As you breathe in, relax your back. Use the muscles in your lower belly.

Step 3

Breathe out. As you breath out, let your back relax down to a flat position. Do not let your back sag.

Step 4

Repeat steps 1, 2, and 3.

{Note: Tell your health care provider if you get pain when you do the pelvic rock. Ask for help if you have a problem doing the pelvic rock.}

© American Institute for Preventive Medicine

January 23, 2026
Bleeding

Pregnancy & Prenatal Care

Pregnant women sometimes have light spotting. That’s when a tiny bit of blood leaks from the vagina or the surface of the cervix. It may happen after a vaginal exam. It may also happen after sex. If the blood starts out pink or red and turns dark brown, it is not active bleeding. This is not usually a problem. But let your health care provider know when there is any bleeding. He or she will decide what to do. Bleeding can be a sign of a problem if:

* The blood is bright red.

* Pain or cramps are present, too.

* The bleeding is heavy. Heavy means the bleeding soaks a sanitary pad.

* The spotting keeps going on.

Causes

Before the 20th week, bleeding could be, but is not always, a sign of miscarriage. Other causes of bleeding include:

* Loss of the mucus plug

* Kidney infection

* Preterm labor

* Placenta previa and other problems called vasa previa and marginal previa

* Placenta abruptio

* Swollen cervix

Placenta Previa

The placenta carries oxygen and food to the baby. In most pregnancies, the placenta attaches high in the uterus. In placenta previa, it attaches low, over the cervix. The lower uterus stretches during late pregnancy. Parts of the placenta tear from the wall. That causes bleeding.

Placenta previa is rare. It happens in only 1 in 200 pregnancies. Its cause is not known. Falls and injuries are not factors. Symptoms of placenta previa are:

* Bright red vaginal bleeding. This could start as early as the 24th week. Often, it starts during the 34th or 35th week.

* Usually, there is no pain or cramping.

A woman may not know that she has placenta previa until bleeding happens. Then an ultrasound test can show the problem.

Women with placenta previa have to spend a lot of time in bed. Bed rest may last late into the pregnancy. Bed rest gives the baby time to grow. It prevents stress to the uterus. The goal is to keep blood loss down. A lot of blood loss means danger for both mother and baby. In severe cases, the mother may have to go to the hospital for treatment.

In some cases, the bleeding stops, but the placenta blocks the cervix. The mother will need a Cesarean section (C-section) delivery if the placenta completely blocks the cervix. The mother may need a C-section if the placenta only partly blocks the cervix. When this happens, the mother may have more bleeding after she delivers the baby.

{Note: Some pregnant women may have a “low lying placenta.” This means the placenta lies at the bottom of the uterus (not higher where it should be). An ultrasound can show a “low lying” placenta. If it is found before the 24th week, the placenta can move upward and out of the way of the cervix. If so, there is no longer a problem.}

Placenta Abruptio

There is a right time for delivery of the placenta. That’s after the baby is born. But sometimes it happens another way. The placenta starts to leave the wall of the uterus too early. It starts before the baby is born. This can happen whether the placenta is attached high or low.

Placenta abruptio happens in about 1 in 200 pregnancies. Some cases are more serious than others. Causes might be high blood pressure or a serious blow to the belly. An older mother may be more apt to have placenta abruptio. So are women who use cocaine during pregnancy. Symptoms of placenta abruptio are:

* Bright red vaginal bleeding

* Severe pain in the abdomen. The pain lasts. It doesn’t come and go.

There are no tests for placenta abruptio. Even ultrasound may not show it. Regular prenatal visits help. The health care provider looks for blood in the mother’s vagina. The provider finds out if the uterus is tender.

Women with placenta abruptio need to go to the hospital right away. Some women can have a vaginal delivery. That’s if labor begins on its own and the baby is healthy. Otherwise, a C-section is done. The mother may be given blood.

Questions to Ask

Self-Care / Prevention

* Watch closely for bleeding. If you see any, call your health care provider.

* Rest in bed for light bleeding.

* Avoid doing things that could injure you. Examples: heavy lifting, hard exercise. Don’t do work, sports, or exercises that could give you a blow to the belly.

* Wear a special seat belt when you drive. You can get one that protects a pregnant woman’s belly.

* Don’t smoke.

* Don’t be exposed to other people’s smoke.

* Follow your health care provider’s advice about sex. You may be told to:

– Avoid sex.

– Use extra caution during sex:

– Your partner can focus on more gentle touching.

– Limit how deeply the penis enters the vagina. Use positions that help control the depth.

© American Institute for Preventive Medicine

January 23, 2026
Bleeding 2

First Aid

Most adults can donate a pint of blood without harmful side effects, but losing a quart of blood, quickly, can lead to shock and even death. In a child, losing a pint (or less depending on the child’s size) can put the child in extreme danger.

Signs & Symptoms

For External Bleeding

* A skin wound.

* Dark red blood gushes or flows from veins.

* Bright red blood spurts from arteries.

* Blood oozes from capillaries. The bleeding usually clots off by itself.

For Internal Bleeding

* Vomiting or coughing up true, red blood. This includes blood-tinged sputum.

* A bruise on the skin of the chest or abdomen, especially if it is in a place where no blow was struck.

* Fractured ribs.

* Dizziness. Fainting. Weakness.

* Lethargy. Excessive sleepiness. Mental status changes. These can occur with trauma to the head, even if it is mild.

* Fast pulse. Cold, moist skin.

* Stools contain bright red blood or are black (not due to taking iron).

Causes

For External Bleeding

* Abrasions (scraped skin). Lacerations (cut skin with jagged edges). Punctures.

* Knife, gunshot, or other wounds can graze or penetrate the skin. These can damage internal blood vessels and body organs.

* Injury wounds.

For Internal Bleeding

* A bruise. This is bleeding from and damage to tissues beneath the skin.

* Damage to blood vessels and/or internal structures. This includes a blunt injury that does not break the skin, a bleeding ulcer, and an aneurysm.

* Bleeding disorders.

Taking blood-thinning drugs can result in both internal and external bleeding.

Treatment

When bleeding occurs, the goal is to find the source, stop or lessen the bleeding, and help the body cope with the loss of blood.

* For severe bleeding, treatment includes first aid measures and emergency medical care.

* For minor bleeding, treatment depends on the cause and other medical conditions present.

* Bleeding disorders need to be treated by a doctor.

Questions to Ask

Self-Care / First Aid

For Severe Bleeding

* Without delay, apply direct pressure to the wound using a sterile dressing or clean cloths. {Note: If the cut is large and the edges of it gape open, pinch the edges of the wound while you apply pressure.}

* Call 9-1-1 or take the person to nearest hospital emergency department.

* Do not remove an object that is stuck in a wound. Pack it in place with padding. Put tape around the padding so it doesn’t move.

* If bleeding continues before getting medical help, put extra cloths, etc. on top of existing ones. Keep putting pressure on the wound until bleeding stops or until medical help takes over.

* The most important thing to do is to apply direct pressure on the bleeding site. Some health experts advise to do these things, too, if needed:

– Elevate the wounded area higher than heart level while applying pressure. Do this if no bone is broken.

– Apply pressure to a “pressure point” if bleeding still continues after 15 to 20 minutes of direct pressure. Use the pressure point closest to the bleeding site that is between the wound and the heart. (See Pressure Points.)

* Don’t apply a tourniquet except to save a life.

* While giving first aid for bleeding, keep looking for signs of shock.

For an Amputation

* Control bleeding.

* Wrap the severed part in a clean, dry (not wet) cloth or sterile gauze. Place the wrapped part in a plastic bag or other waterproof container. Put these on a bed of ice. Do not submerge the severed part in cold water or ice.

For Bleeding from the Scalp

* Use a ring pad to apply pressure around the edges of the wound, not on the wound. Make a ring pad (shaped like a doughnut) with a bandage of narrow, long strips of cloth. Start with one end of the narrow bandage and wrap it around all four fingers on one hand until you form a loop. Leave a long strip of the bandage material to weave in and around the loop so it doesn’t unravel.

© American Institute for Preventive Medicine

January 23, 2026
How Your Body Changes, How Your Baby Grows

Pregnancy & Prenatal Care

A full-term pregnancy lasts about 40 weeks. You begin counting from the start of your last menstrual period. That’s about 9 calendar months. The 9 months are divided into 3 parts. Each part is called a trimester. The trimester charts that follow show changes in your body. They show how your baby grows.

First Trimester

(Months 1-3, Weeks 1-13)

Changes in Your Body

* Your hormones change.

* Your body makes more blood and body fluids.

* You may feel very tired.

* You pass urine more often.

* You may have an upset stomach, or throw up (morning sickness). This can happen any time of the day.

* You may feel light-headed or dizzy.

* You gain a few pounds. The average is 3 or 4 pounds. Your clothes begin to feel a little tight.

* Your moods can vary. You may feel happy and elated. You may also feel sad, cross, or anxious.

* Your breasts may change.

– They may get bigger.

– They may get sore and tender.

– Your nipples get darker. They may stick up more.

How Your Baby Grows

Your baby starts out as a single cell. The cell is formed when your egg and your male partner’s sperm meet. That one cell divides into many cells. These attach to the wall of your uterus. Some of the cells form the placenta. The rest become the embryo. That’s what the unborn baby is called from week 4 to week 8. After 8 weeks, it is called a fetus. By the end of the first trimester, your baby:

* Is about 3 to 4 inches long

* Weighs about 1 ounce

* Has all its internal organs and limbs. Its heart beats.

* Has a large head compared to the rest of its body. Its eyes are closed.

* Begins to develop sex organs

* Has well-formed fingers and toes. Fingernails and toenails are forming.

* Can move in the uterus. You can’t feel that yet, though.

Second Trimester

(Months 4-6, Weeks 14-27)

Changes in Your Body

* You probably feel really good during this trimester. Most women do.

* You start to look pregnant as your belly expands. You gain about a pound a week. Loose or maternity clothes feel best.

* Your heart beats stronger. This helps push the extra body fluids around your body. It helps push them into the placenta, too.

* You start to feel your baby move. This usually starts between weeks 15 and 20 with a first baby. It may come earlier than that with babies after the first one. First you feel flutters. Then you feel kicks.

* Your breasts get ready to make milk.

* Your uterus starts to stretch out and get thinner.

* You may notice that you have:

– Backache

– Constipation

– Headache

– Mood swings

– Braxton-Hicks contractions

– Mild swelling of the ankles and feet

– Less morning sickness or none at all

– Less need to pass urine

– Bigger appetite

– Heartburn

– Larger veins in your hands and arms

– Stretch marks on your breasts and belly

– Leg cramps at night

None of these is apt to change your sense of well-being, though.

How Your Baby Grows

Your baby begins to grow fast. Its organs mature. By the end of the second trimester, your baby:

* Is about 11 to 14 inches long

* Weighs about 2 to 2-1/2 pounds

* Swallows

* Sucks its thumb

* Moves and kicks

* Has wrinkly skin. Its skin is covered by a thick, white coating called vernix.

* Has hair growing on its head

* Has teeth forming in the jawbone

* Can open and close its eyelids

* Has eyes that are almost fully developed. Eyebrows and eyelashes start to grow.

Third Trimester

(Months 7-9, Weeks 28-40)

Changes in Your Body

You gain about a pound a week until the final few weeks. Then you may stop gaining weight or lose a pound or two. As the baby grows, your uterus and belly expand. You feel lots of pressure on your bladder. You need to pass urine more often.

The baby pushes up on the bottom of your rib cage. The baby pushes up on the diaphragm. This can cause you to feel short of breath.

The baby makes stronger movements and moves more often. You can feel its head, elbows, and feet as they push against your belly. You may be able to see the baby’s kicks! You may notice that:

* You feel hot and you sweat more than usual.

* A yellow liquid leaks from your breasts.

* Your hands and feet swell.

* Your navel may look flat or stick out.

* You feel tired.

* You have mood swings.

Toward the very end of this trimester (near your due date):

* You may feel your uterus getting tight and hard.

* You may have “practice” contractions. These stop when you move your body or walk around.

* The baby “drops” into your pelvis. It is easier for you to breathe. It also makes you need to pass urine more often.

* You lose the mucus plug. You usually lose it shortly before delivery. It’s called bloody show then. You may notice it as a thick, stringy discharge for days. Or you may pass a big clump that looks like a wet cotton ball. Some women never notice the bloody show.

How Your Baby Grows

Your baby keeps growing and gaining weight. During this trimester, your baby:

* Grows to about 20 inches long

* Gains weight to 7 pounds or more

* Fills the uterus

* Opens and closes its eyes

* Responds to light and sound

* Moves a lot. Its movements are more like rolls and turns instead of kicks. These may slow down close to labor. But the baby does not stop moving before birth. Tell your health care provider if you notice a big decrease in your baby’s activity.

* Settles further down into your pelvis. Your baby is getting ready to be born!

© American Institute for Preventive Medicine

January 23, 2026
Choosing Your Health Care Provider

Pregnancy & Prenatal Care

Read the options below. Discuss them with your health insurance carrier. Do this before you get pregnant. Who you choose will partly depend on:

* Your health insurance coverage.

* You may need to choose from a certain list. Find out who is on it. Ask if there is a waiting period for maternity coverage.

* The health care providers in your area

Your personal wishes are important, too. For example, do you prefer a female or a male provider? Do you want a provider who works alone? Or do you want one in a group practice?

Where You Can Give Birth

Where do you want to have your baby? These are places to think about:

* Hospitals. There may also be choices within hospitals. These could be:

– Regular delivery room. Your family may be able to be with you here.

– Birthing center or birthing room. Your family can be with you here.

– Special high-risk pregnancy section. Sometimes mothers and newborns need high-risk care. Some hospitals offer high-risk care. Find out what services local hospitals can offer.

* Birthing centers not inside hospitals. These are sometimes called alternative birthing centers. They are for low-risk pregnancies. Find out what hospital is used when special needs arise.

{Note: Your special needs during pregnancy may determine where you can have your baby. Do not plan a home birth. It is not safe for you and your baby.}

Types of Providers

* OB/GYN (obstetrician/gynecologist). This doctor gives prenatal and delivery care. That care ends 6 weeks after delivery. The OB/GYN treats women when they’re not pregnant, too. You may already have an OB/GYN. If you do, you could choose this provider for your pregnancy. Most women choose an OB/GYN. If you belong to an HMO, you may need a referral for an OB/GYN. A referral is when your primary care provider says you need a special doctor. You don’t need a referral if the OB/GYN is your primary care provider. You also don’t need a referral if your HMO lets you pick an OB/GYN plus a primary care provider.

* Family practice doctor. A family practice doctor can act as an OB/GYN, an internist, and a pediatrician. That means the provider can give you prenatal care and deliver your baby. You and your child can both go on seeing this same provider afterward. But if you need a cesarean section (c-section), you will need an OB/GYN.

* Maternal and fetal medicine specialist. This provider may be needed to help with high-risk pregnancies. Your primary care doctor or your OB/GYN would give you a referral if he or she can’t provide the care needed for your high-risk problems.

* Infertility specialist. This provider helps persons who want to get pregnant, but haven’t been able to after trying for a year. You may want to see this doctor if your regular OB/GYN cannot help you with your needs.

* Certified nurse-midwife. This provider cares for women with low-risk pregnancies. The nurse-midwife is trained to handle low-risk births. Be sure he or she works with a medical doctor. A lay midwife cannot provide total care. Find out if your insurance will pay for a nurse-midwife. Be sure the midwife is certified. Call the American Midwifery Certification Board (AMCB) at 866.366.9632 or go to its Web site:www.amcbmidwife.org.

How to Find a Provider

There are a lot of ways to find providers who might suit you:

* Look in the directory of providers from your health insurance carrier.

* Ask your regular doctor or specialist.

* Do you have any friends who had a baby recently? Are their ideas about having babies like yours? Ask them.

* Call information at the hospital you want. Ask for the name and phone number of the nurse in charge of the maternity section. Ask for the name and phone number of a resident in obstetrics who works at that hospital. A resident is a doctor who is in training. Ask for the “Physician Referral Service.” Call any or all of them and ask what doctor(s) they recommend.

* Call the medical school closest to you. Ask which obstetricians it recommends.

* Ask your county medical society.

* Look in the Directory of the American Medical Association. Ask for this at your doctor’s office or library.

* Look in the Directory of Medical Specialties for OB/GYNs. Your doctor’s office or library should have this, too.

* Look for a doctor who can take care of special needs you may have.

* Do you want a doctor with a high interest in prepared childbirth? Prepared childbirth is a special approach. The pregnant mother goes to classes. Her partner or other childbirth “coach” goes with her. They both learn ways of helping the birth happen, like special breathing. The doctor works with the mother in this approach to childbirth.

How to Follow Up with a Provider

Have you found some likely prospects? Now you can:

* Call the American Board of Medical Specialties at 866.275.2267 or go to its Web site:www.abms.org. Find out if the provider is properly trained and licensed.

* Ask yourself some questions.

– Do you think you could work well with the provider?

– Does the provider’s office seem to be managed well?

* Ask the provider some questions. You may be able to do this on the phone. (You may be charged an office visit for the phone call.) Or you may need to make a date to meet in person. Here are some questions to ask. You will think of others.

– Does the provider accept your health insurance? What do services cost? How must payment be made? How much do you have to pay?

– What hospital(s) does the provider use?

– Is the hospital accredited? The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does this.

– Does the hospital have a birthing center or birthing room?

– Does it have a Level III neonatal intensive care unit (NICU)?

– Can fathers and other persons be with you in the delivery room? In the operating room?

– Will the provider be the one who delivers your baby?

– Does the provider have partners who share the practice? If so, what would their roles be?

– Would a resident deliver your baby? A resident is a doctor in training.

– How would you reach your OB/GYN or health care provider? Would this differ at certain times of day or night? For emergencies?

– Who would take care of you when your health care provider is away?

– What is the provider’s Cesarean section (C-section) rate? If the rate is more than 35%, ask why.

– For what reasons does the provider do a C-section?

– Does the provider prefer a certain form of pain relief? If so, what and why?

– At the place you will deliver, can you get anesthetics for an epidural any time of the day or night? An epidural is an anesthesia that can block most of the pain during labor and delivery.

– What else can be given for pain?

You can talk to two or more providers. Compare the answers you get. Then you can decide who will give you care and deliver your baby.

© American Institute for Preventive Medicine

January 23, 2026