PRENATAL MANUAL
written by
The Residents and Staff Physicians
Mercy Family Medicine Center
 
Having a baby can be one of life's most enriching and rewarding experiences. You may be experiencing a variety of feelings about this pregnancy. Perhaps you are very happy and excited; on the other hand you may have fears, doubts, or mixed emotions. We believe that you will find it helpful to know more about the physical changes taking place within your body, your changing emotions, and your new life as a parent.
We have designed this page to discuss some of the events of your pregnancy, labor, and delivery. We encourage you to discuss any problems or questions you have with your physician.

Special thanks to Peter Keenan MD, Cecelia Redmond-Norris MD and Peter Danis MD

TABLE OF CONTENTS

PRENATAL CARE Your First Prenatal Visit Additional Prenatal Visits Prenatal Classes Suggested Reading Material FIRST TRIMESTER Your Physical Changes Physical Discomforts Baby Development Working During Pregnancy Nutrition During Pregnancy Weight Gain Drugs During Pregnancy X-rays Exercise Emotional Development in the First Trimester SECOND TRIMESTER Your Physical Changes Physical Discomforts Baby Development Advantages of Breast Feeding Preparation for Breast Feeding Emotional Development in the Second Trimester

THIRD TRIMESTER Your Physical Changes Physical Discomforts Baby Development Travel Family Planning Preparing to Bring the Baby Home Emotional Development in the Third Trimester Car Seat LABOR AND DELIVERY Signs of the Beginning of Labor When to Call Your Doctor Stages of Labor and Delivery Anesthesia/Analgesia Stage One of Labor Stage Two of Labor Stage Three of Labor After the Baby is Born

PRENATAL CARE
 
Your pregnancy was confirmed by a laboratory test detecting the presence of a hormone called chorionic gonadotropin in your urine or blood. This hormone is produced in greater amounts in your body during pregnancy. The test is able to detect this hormone in your urine approximately 2-3 weeks after conception has occurred.
 
YOUR FIRST PRENATAL VISIT
 
We prefer you start your prenatal care no later than after the second missed menstrual period. Your first prenatal visit may take up to one hour and begins with a discussion of your medical health history. Specifically, you will be asked about:
 
1. Past or present health problems -- physical or mental

2. Allergies

3. Past surgeries

4. Use of drugs, alcohol, or tobacco

5. Past pregnancies

6. Family health: parents, brothers, sisters

You will then have a thorough physical examination which includes a pelvic examination to check the size of your uterus. This allows your physician to estimate when your baby will be due.
At the end of the first prenatal visit, you will have a series of laboratory tests that includes:

1. Urine check for infection of the urinary tract

2. Test for immunity to German measles (Rubella)

3. Test for syphilis

4. Tests for anemia (low iron in blood)

5. Blood type and Rh factor

6. Test for Hepatitis B infection

7. Pap smear -- screening test for cervical cancer

At this and all other prenatal visits, your doctor will talk with you about various topics surrounding your pregnancy, such as nutrition, emotional changes, parenthood, etc.

ADDITIONAL PRENATAL VISITS
Regular prenatal appointments are very important -- good prenatal care contributes to the health of mothers and their babies. Your prenatal appointments will follow this general schedule (although variations may occur:)

First 28 weeks -- one visit every four weeks

28-36 weeks -- one visit every two weeks

36 weeks to delivery -- one visit each week

At each prenatal visit, your urine will be screened for protein and sugar. Your blood pressure and weight will be recorded. Your doctor will measure the size of your uterus to check the baby's growth. By about the 12th week of your pregnancy, you and your physician will be able to listen to your baby's heartbeat with a small instrument called a "doppler." Do not be concerned if the heartbeat is not heard on the first attempt.

Be sure to discuss questions and concerns with your physician during these visits. Feel free to write down questions at home and bring them with you to your prenatal visit. We also encourage you to bring your partner with you to your prenatal appointments.
 
PRENATAL CLASSES
Childbirth Education classes are provided at St. John's Mercy Medical Center to prepare couples for the process of labor and delivery. These classes are designed for you and your coach (husband, friend, or family member). The coach is encouraged to be with you during labor and delivery. These classes begin in the latter months of your pregnancy, and there is a minimal charge. Most women and their coaches have found the classes to be very helpful, and we encourage you to attend. Call 961-BABY to sign up for classes. It is best to sign up about the time you are 5-6 months into your pregnancy.
 
SUGGESTED READING MATERIALS:
PREGNANCY:
Eisenberg, Arlene, What to Expect When You're Expecting

PRENATAL CLASSES:
Ewy, Donna and Roger, Preparation for Childbirth
Bradley, Robert, Husband-Coached Childbirth
Karmel, Marjorie, Thank You Dr. Lamaze

DIET:
Eisenberg, Arlene, What to Eat When You're Expecting

EXERCISE DURING PREGNANCY:
Bing, Elisabeth, Moving Through Pregnancy
Simkin, Diana, The Complete Pregnancy Exercise Program

BREAST FEEDING:
LaLeche League International, The Womanly Art of Breast Feeding
Eiger and Olds, The Complete Book for Breast Feeding

CHILDBIRTH:
Kitzinger, Sheila, Experience of Childbirth
Bing, Elisabeth, Six Practical Lessons for an Easier Childbirth

NEW PARENTS:
Brazelton, Berry, Infants and Mothers, Differences in Development
Brazelton, Berry, Toddlers and Parents, A Declaration of Independence
Caplan, Frank, The First Twelve Months of Life
Beebe, Brooke McKamy, Best Bets for Babies
 
SUPPORT GROUPS:
 
New Moms Network, St. John's Mercy Medical Center, 961-BABY
Parents as Teachers, 432-4330

Table of contents
 
FIRST TRIMESTER
(First 3 Months of Pregnancy)
 
YOUR PHYSICAL CHANGES
 
During the first three months of your pregnancy, many changes are taking place within your body. Your uterus becomes three times its normal size in this first trimester. Your breasts will probably swell and become tender. You will notice that your nipples and the area around them (areola) may darken and become broader.
 
PHYSICAL DISCOMFORTS
 
Nausea and Vomiting ("morning sickness")
Cause? One theory is that your body is producing a higher level of hormones. These may
upset your stomach.
Relief?
1. Eat six small meals instead of three larger meals
2. Eat a few dry crackers before getting our of bed
3. Avoid greasy, spiced foods
4. Wait to drink fluids until after mealtime
5. Emetrol or antacids can be safely taken
 
Fatigue (tiredness)
Cause? There are more demands on your entire body during pregnancy.
Relief?
1. Try to rest during the daytime
2. Continue to exercise (discuss types of exercise with your physician)
 
Frequent Urination (especially at night)
Cause? You may need to urinate more often because increased hormones change the
water balance in your body and cause you to retain more fluid. Also, as the uterus
becomes larger, it presses on your bladder.
Relief?
1. Avoid drinking too many fluids before bedtime
2. Avoid heavy use of salt
3. Avoid caffeine
 
ALWAYS CALL YOUR DOCTOR IF YOU HAVE
- VAGINAL BLEEDING
- ABDOMINAL PAIN
- PERSISTENT VOMITING
- FEVER
- PAIN ON URINATION
 
DEVELOPMENT OF YOUR BABY
1st Month - The baby becomes visible. The first heartbeats occur though they can't be heard by your physician yet.

2nd Month - The baby is a little over one inch long. The face is formed and the limbs are partially formed. It has the definite appearance of a baby.

3rd Month - The baby is about 3 inches long and weighs one ounce. The arms, legs, fingers, toes, and ears are fully formed. Even tiny fingernails are beginning to appear.
 
WORKING DURING PREGNANCY
Many women continue working throughout their pregnancy. Your decision regarding work should depend on how you feel physically and emotionally. If you continue to work until your delivery, you may find that you need more rest. Try to plan your time efficiently to allow for plenty of sleep. Also, don't hesitate to ask friends and family members to help you with other children and household responsibilities.
 
NUTRITION DURING PREGNANCY
"During the prenatal period . . . a human being is more susceptible to the environment than ever again in life. What happens then can help in development, or it can hinder it; it can promote growth or it can interrupt it."
Ashley Montagu

During pregnancy, your baby is totally dependent upon you to provide a healthy environment. Eating a good, nutritious diet is one way to give your baby the best possible start in life. Not only does eating well increase your chances of having a healthy baby, but it increases your chances of enjoying a healthy pregnancy and an uncomplicated labor and delivery.

To get all the nutrients you need, meals, and snacks should include a wide variety of foods from the following groups as well as your daily prenatal vitamin:
1. Protein foods
2. Milk and milk products
3. Breads and cereals (grain products)
4. Vitamin C rich foods
5. Leafy green vegetables
6. Other fruits and vegetables

Pregnant women who are 19 years old or younger have a greater need for nutritious food because their own bodies are still growing. Therefore, we have provided a separate chart for teenage women.

WEIGHT GAIN
The healthiest babies are born to women who allow themselves a natural weight gain during pregnancy (usually 20-35 pounds). You will need additional calories to support the needs of your own changing body, plus the needs of your growing baby.

More important that total weight gain is your pattern of gain. During the first three months of pregnancy, weight gain should be minimal (2 to 4 pounds). From the fourth month until delivery, you should add about 3/4 pound per week. More than 6 pounds in a month may mean you are choosing high calorie rather than nutritious foods.
This is approximately what your pregnancy weight adds up to just before delivery.

Pounds
Placenta Uterus Blood Baby Amniotic Fluid Breast Tissue Tissue Fluid Fat in Tissue	1 1/2 2 4 7 1/2 1 1/2 2 2 1/2 3
Total	24

DRUGS DURING PREGNANCY
Any drugs or medications taken by a pregnant woman may affect the unborn baby. The risk to your baby is greatest during the first trimester (the first three months of your pregnancy). Drugs taken during this time can impair the normal development of your baby. The safest approach is to avoid all medication, (prescribed and over-the-counter) during pregnancy unless prescribed by a doctor who knows you are pregnant. Tylenol, nose spray, antacid, and plain Robitussin are okay to use in needed. Avoid all alcohol, cigarette smoking, and other "drugs". These can harm your baby. Caffeine should be limited to 1-2 servings a day.
 
X-RAYS
Avoid having routine x-rays (chest, dental, etc.) during your pregnancy. These also may be harmful to the baby. If you must have an x-ray due to injury or illness, be sure to tell the doctor you are pregnant.
 
GUIDELINES FOR EXERCISE DURING PREGNANCY
Although there is still much to be learned, evidence increasingly demonstrates the beneficial effects of exercise during pregnancy for you, and potentially for your baby. A few of the known and potential benefits include: better sleep, improved appetite and weight control, decreased back pain, and a possibly improved course of labor. If you exercised before you became pregnant, pregnancy is no reason to stop. And, if you haven't exercised before and are at the beginning of your pregnancy, this is a great time to start.

Read through the guidelines below and discuss any questions you might have, as well as your exercise plan, with your doctor.

General information:

Your body goes through many changes during pregnancy, and these changes influence your ability to exercise. The ligaments (tissue connecting bone to bone) start to soften, which can lead to increased sprains. Your center of gravity changes as the baby grows and your uterus expands, causing problems with balance. Increased weight puts increased stress on your joints. Although these and other changes are important, if you are aware of them and modify your exercise appropriately, you can avoid most problems.

1. Choose exercises that involve rhythmic movements of large muscles, and don't require fine balance. Walking is an excellent exercise.

2. Make sure you spend at least 10 minutes warming up before you begin exercise, and then cool down afterwards, doing the same kind of activity. This will help you to avoid injuries. Warm up exercises can include slow walking, or any gentle rhythmic movements.

3. Take frequent rest breaks if you become short of breath or tired.

4. Avoid exercises that require you to lie on your back after the fourth month of pregnancy.

5. Check your pulse after exercise. It should be back to your normal (resting) rate within 15 minutes.

6. Regular exercise (at least three times a week) is better that infrequent activity.

7. Avoid exercise if you are feeling ill or have a temperature.

8. Make sure that you drink plenty of fluids before, during, and after exercise, especially if you sweat a lot.

9. Measure your heart rate (pulse) at the peak of your activity (see guidelines below), and then every 15 minutes.
 
If you are a new exerciser:

1. Pick a simple exercise to start with. Walking, swimming, and stationary bike riding are all excellent choices. Don't try to learn a new sport, as the changes in your body mentioned above could make learning and performing the sport both difficult and frustrating.

2. To start with, keep your maximum pulse at no greater than 140 beats per minute, or approximately 60-70% of your maximum predicted heart rate (ask your doctor to help you calculate this). Exercise for about 15 minutes, three times a week (not counting warm-up and cool-down time). A simple test of your exertion is the "walk-talk" test. If you cannot walk and talk at the same time, you are exercising too hard.

3. As your level of fitness increases, you can slowly increase your amount of exercise.

If you have exercised before:

1. If the exercise involves lots of jumping or bouncing, you should try to decrease the amount of impact (for example, change from high impact to low impact aerobics).

2. If you are already in good condition, your body and baby can tolerate a faster heart rate -- up to about 160 beats per minute or 75-85% of your maximum predicted heart rate.

3. Remember that as your pregnancy advances, you might have to decrease the intensity of your work-outs.

If you are a competitive athlete, and want to continue competition during pregnancy, make sure you discuss your training and plans with your doctor.

When to stop:

1. If the particular exercise that you are doing becomes uncomfortable, consider changing to a different one. As your body changes, consider changing to a simpler exercise like walking or swimming. If, especially in late pregnancy, you are uncomfortable even with walking, it is time to stop.

2. If you ever become light-headed or dizzy during exercise, stop, and inform your doctor.

3. If you develop any complications during your pregnancy, discuss their implications for your exercise program. For some problems, like diabetes, exercise might be of help. For other problems, like poor weight gain or elevated blood pressure, you might need to stop exercise.

4. If you develop any injuries because of your exercise, make sure you inform your doctor so that they can be appropriately treated.

Exercises to avoid:

Horse back riding, scuba diving, water-skiing, contact sports. If you have questions about any other exercises, make sure you discuss them with your doctor.

After your baby is born, don't forget to ask when and how you may resume your exercise program.

Finally, if you have any questions about a specific exercise or your exercise plan ask your doctor.
 
EMOTIONAL DEVELOPMENT IN THE FIRST TRIMESTER
This is usually a period of very mixed emotions. You may have both happy and sad periods, and even question whether you want to be or whether you really are pregnant. Your feelings toward many things may be surprisingly intense, changeable, and unpredictable. You may begin to think about what kind of parent you will be. The father of the baby may experience similar emotional changes as well.

Your desire for sexual relations may increase or decrease, either of which is quite normal during this time. As long as you feel well, there is no reason to stop havingintercourse during pregnancy.

As a couple the best thing to do at this time is to openly share your thoughts and feelings with each other, as this will help both of you grow. Support each other as you both try to cope with some of these unfamiliar feelings. You may want to spend more time with friends and relatives who are already parents. We suggest that you talk with your doctor about any problems or concerns you have.

Table of contents

SECOND TRIMESTER
(4th-6th Months of Pregnancy)
 
YOUR PHYSICAL CHANGES
 
During the second three months of pregnancy, your body will make a number of noticeable changes. By the 6th month of pregnancy, your uterus will have increased 20 times its normal size. Your waist will thicken and your stomach will begin to protrude below your waist. As your abdomen grows larger, the skin often will stretch and cause pink or reddish marks to appear. Rubbing lotion over this skin will keep it soft and supple but probably won't prevent these stretch marks. You may notice a darkened line between the naval and the pubic area. Some women notice that the skin on their face darkens below their eyes. Your breasts may leak a yellowish fluid called colostrum. This is a normal function as your body prepares for breast feeding. Finally, you will begin to feel movements of your baby (usually during the 5th month). Your physician will be very interested in the date you first felt movement. This is important for determining how many weeks you are pregnant. An ultrasound may be done around this time to "date the baby" and assess it's growth. This usually gives you your first picture for your baby book!
 
 
PHYSICAL DISCOMFORTS

1.Heartburn or Indigestion
Cause? As your baby grows larger, the uterus pushes up on the stomach. Acid from the stomach is brought up into the lower esophagus.
Relief?
1. Avoid eating greasy or spiced foods
2. Eat smaller meals more often
3. Breathe slowly and deeply
4. Sleep propped up on pillows at night or prop the head of your bed up 6-8 inches (in a semi-sitting position)
5. Ask your physician for an antacid
6. DO NOT USE ANY OTHER MEDICINES WITHOUT CONSULTING YOUR PHYSICIAN.
 
2.Hemorrhoids (enlarged blood vessels of the lower intestine and/or rectum)
Cause? The veins in the rectum become dilated and swollen from the pressure of the
enlarged uterus. Also, constipation and straining when you have a bowel
movement can lead to hemorrhoids.
Relief?
1. Eat a good diet with plenty of raw vegetables, fresh fruits, and whole grain
cereals and breads
2. Drink plenty of water and juices -- at least 8 glasses a day
3. Sit in a warm bath and then apply Preparation H to the area
4. Avoid straining to have a bowel movement
 
3.Varicose Veins in Legs
Cause? The heavy uterus presses on the veins and blood vessels in the legs and cause poor
circulation. As these veins work harder to circulate blood, they become larger.
Also, hormonal changes are responsible for varicosities.
Relief?
1. Wear support stockings a size larger than your ordinary stockings
2. Rest and elevate your legs each day
3. Exercise regularly
 
ALWAYS CALL YOUR DOCTOR IF YOU HAVE
-VAGINAL BLEEDING
-ABDOMINAL PAIN
-PERSISTENT VOMITING
-FEVER
-PAIN ON URINATION
 
DEVELOPMENT OF YOUR BABY
 
4th Month - The baby is about 8 inches long and weighs nearly one half pound. Movement
can be felt and heart sounds may be heard by your physician. The eyelashes and
eyebrows are formed. The skin is covered with fine hair.
5th Month - The baby is about 12 inches long and weighs about one pound. There will be hair
on the head at this stage.
6th Month - The baby is about 14 inches long and weighs almost two pounds. The skin is very
wrinkled. Some very active movements may be felt during this time.
 
 WHY SHOULD YOU NURSE YOUR BABY?
Among the many decisions you will make during your pregnancy is "How will I feed my baby?" You will want to give this some thought and choose what is best for you, your baby, and your family.
Did you know that the American Academy of Family Physicians recommends that moms breast fed their babies as much as possible during the babies' first year of life? The reason for this is, breast milk is the ideal food for the healthy growth and development of infants.

Other reasons why you should consider breast feeding are:
1. Human breast milk is made with just the right things your baby needs.
2. Mother's milk is easily digested by the baby and the baby is less likely to be constipated or colicky.
3. Breast fed babies have fewer allergies than a bottle fed baby.
4. Breast feeding promotes a special closeness between mom and baby.
5. Babies receive special antibodies through the breast milk that protects them against infections such as ear infections and diarrhea.
6. Breast feeding is economical. You don't have to buy formula and since breast fed babies are not sick as often there are fewer doctor bills.
7. Nursing the baby will help your body return to its normal state faster by helping your uterus contract; this can help you stop bleeding sooner. Also, making milk uses a lot of calories which helps you loose weight.
8. Breast fed babies are portable, you can take them wherever you go. No need to worry about keeping formula cold or warming it up.

When you decide to nurse, your physician, childbirth educator, lactation consultant can be a good source for learning how to breast feed.

Remember that breast milk is a wonderful gift that only you can give your baby!!!

PREPARATION FOR BREAST FEEDING
From the beginning of pregnancy, the breasts become larger and more tender. This is especially true during the first and last months of pregnancy. To preserve the normal shape of the breast, wear a supportive bra during pregnancy and following pregnancy if you breast feed your baby.
If the nipples are protruding, it will be easier to breast feed. If the nipples are inverted (turned in), flat, or small, it is essential to prepare them by drawing them out between the thumb and index finger. A cream can be used to make this procedure more comfortable. Continue this throughout your pregnancy. The nipples should become elastic and better prepared for the baby to suck.
Gently massage your breasts throughout pregnancy to keep the skin supple and to avoid stretch marks. Later in pregnancy, there may be slight leaks of fluid from the nipple. This is a normal process as your mammary glands are preparing to produce milk.
 
EMOTIONAL DEVELOPMENT IN THE SECOND TRIMESTER
For most women, this is usually a calm, peaceful, and happy period. You may experience great delight in feeling your baby move. This may give you a sense of attachment to your baby. In this stage, you may begin outwardly preparing for the baby. (Choosing a name, clothes, furniture, etc.) Fathers may also begin to have strong feelings toward the baby as it begins to move. The parenting may become more real to him at this point. This is an excellent time to enjoy each other and build a stronger relationship by sharing feelings and plans for the future.

There is no medical reason to stop having intercourse during this time, as long as you are comfortable.

Table of contents

THIRD TRIMESTER
(7th Month Until Delivery)
 
YOUR PHYSICAL CHANGES
In this final stage of pregnancy, you may feel your uterus tighten every now and then. These contractions are called Braxton-Hicks and are believed to strengthen the muscles of your uterus in preparation for labor. During this last stage of pregnancy, the baby's head usually settles into the pelvis. This is called "dropping" or "engagement." This will take much of the pressure off your lungs.
 
PHYSICAL DISCOMFORTS
1.Hemorrhoids (enlarged blood vessels of the lower intestine and/or rectum)
Cause? The veins in the rectum become dilated and swollen from the pressure of the enlarged uterus. Also, constipation and straining when you have a bowel movement can lead to hemorrhoids.
Relief?
1. Eat a good diet with plenty of raw vegetables, fresh fruits, and whole grain cereals and breads.
2. Drink plenty of water and juices -- at least 8 glasses a day
3. Sit in a warm bath and then apply Preparation H to the area
4. Avoid straining to have a bowel movement
 
2.Constipation and Gas
Cause? When the baby drops or becomes engaged in the pelvis, there is pressure on your bowels. Also, in these last months of pregnancy, your exercise and activity usually decrease, causing constipation.
Relief?
1. Eat fresh fruits, raw vegetables, 100% bran cereals, and drink plenty of water
and juices
2. Avoid foods such as beans, cabbage, fried foods, or any food that produces gas
3. Lie on your left side in bed with your knee raised toward your chest. This will help you get rid of gas
4. Do not take laxatives without consulting your physician
5. Continue to be active (walking, etc.)
 
3.Backache and Aches in Hips and Thighs
Cause? The baby presses on nerves in your backbone and pelvis bones causing discomfort. Also, you may walk differently for balance, often leaning back to counteract a heavier front.
Relief?
1. Stand up straight with your tummy tucked in
2. Sleep on a firm mattress
3. Ask someone to give you a back rub
4. Take a warm bath
5. Rest
6. Wear low heeled, supporting shoes
7. If you have been doing prenatal exercises, backache will be less bothersome

4.Leg Cramps
Cause? Muscle tightens, often while you're resting, the reason is unknown.
Relief?
1. Stretch before going to bed. to stretch calf muscles with leg straight, flex your foot to about a 90' angle
2. If cramps occur, repeat stretching and use heat and massage on the affected muscle
 
5.Sleep Problems (restless, difficulty getting to sleep and staying asleep)
Cause? Your sleep may be disturbed due to the baby's increased movements, backache, dreams, and generally being uncomfortable toward the end of the pregnancy.
Relief?
1. Rest during the daytime
2. Take a warm bath before bed
3. Put a heating pad or hot water bottle on the aching parts (turn the pad on low heat and never lie on it since this can cause a severe burn)
4. Drink milk before bedtime
5. Avoid sleeping pills of any kind -- they can be harmful to your baby
6. Lay in bed on your left side with your stomach supported by the mattress with a pillow between your legs.
 
ALWAYS CALL YOUR DOCTOR IF YOU HAVE:
 
-VAGINAL BLEEDING
-SWELLING OF THE FACE OR FINGERS/
SUDDEN LARGE WEIGHT GAIN
-SEVERE OR CONTINUOUS HEADACHE
-DIMNESS OR BLURRING OF VISION
-ABDOMINAL PAIN
-BACK PAIN THAT IS MORE THAN MILD
-PERSISTENT VOMITING
-FEVER
-PAIN ON URINATION
-GUSH OR LEAKAGE OF FLUID FROM VAGINA
-THE BABY STOPS MOVING
 
DEVELOPMENT OF YOUR BABY
From the 7th month until delivery, your baby continues to grow. By the 9th month, the average baby is about 20 inches long and weighs approximately 7 pounds.
 
TRAVEL
Try not to travel for 4 weeks prior to your due date (earlier if you have a history of preterm labor). Take frequent breaks if driving. Get up to walk frequently if travelling by plane, train, or bus.
 
FAMILY PLANNING
As you near the end of your pregnancy, it is important for you to begin thinking about your future family planning needs. There are many options available. Discuss with your doctor and your partner these issues now so that after delivery you may make an informed decision.
 
PREPARING TO BRING THE BABY HOME
Take to the hospital only enough clothing to dress the baby for the trip home. An approved car seat is essential for safe transport of a baby in the car -- even on this short trip.

Clothing for the baby in the home should include:
3-6 dozen diapers (cloth or disposable)
4-6 shirts (cotton)
3-6 sleepers
4-6 receiving blankets
4-6 plastic pants (if using cloth diapers)
2 carrying blankets
1 sweater
booties or socks

Bedding:
firm mattress for the baby's bed
2-4 quilted crib pads (optional)
water resistant mattress protector
2-3 crib blankets
2-4 fitted crib sheets
1 heavy blanket

Bathing supplies:
mild soap
2-3 bath towels
bottle of lotion or oil fingernail scissors or nail file
cotton balls
8 diaper safety pins (if using cloth diapers)
2-3 washcloths
 
EMOTIONAL DEVELOPMENT IN THE THIRD TRIMESTER
Naturally, these last few months are a time of great anticipation. You may also have some fears about the coming delivery. (Keep in mind that the baby's father is undoubtedly experiencing some of these same fears.) As your "due date" approaches, you will probably begin to feel impatient and tired of being pregnant. In these final weeks of pregnancy, intercourse may be awkward. You may need to experiment with different positions to be comfortable. In these last month of pregnancy, you need to finalize your roles as parents. Continue to share your feelings and concerns with each other. Discuss your questions and fears about delivery with your doctor.

Table of contents

LABOR AND DELIVERY
 
SIGNS OF THE BEGINNING OF LABOR
1. Regular uterine contractions occurring every 5-20 minutes and lasting from about 45 seconds to a minute.
2. Rupture of the membranes or "bag of waters."
3. Passage of a small amount of blood-stained mucus called the "bloody show." This is the mucus plug that has been formed to close off the cervix (the mouth of the uterus) to prevent infection. The mucus plug is passed as the cervix gradually begins to open. (There is no need to call your doctor when this happens.)
 
WHEN TO CALL YOUR DOCTOR
Call your doctor when any of the following occur:
1. A sudden gush of fluid from the vagina
2. The contractions are lasting for about one minute
3. Contractions are occurring about every 3-5 minutes for 2 hours (or every 5-10 minutes for 1 hour if this is not your first baby).
 
STAGES OF LABOR AND DELIVERY
The process of labor and delivery is divided into 3 stages:

Stage I - From the onset of labor to the complete opening (dilation) of the cervix (the mouth of the uterus) generally 10 cm.
Stage II - Begins when the cervix is completely dilated or opened and ends with the birth of the baby.
Stage III - From the completion of the delivery of the baby to the delivery of the after-birth (placenta).
 
ANESTHESIA/ANALGESIA
 
Anesthesia/Analgesia (medicines to relieve discomfort) will be available during your labor and delivery and used appropriately as needed. Your desires and expectations should be discussed with your physician during the last trimester of your pregnancy. Your doctor may want you to attend an anesthesia class that discusses all types of anesthesia. If you deliver at St. John's Mercy Medical Center and think you may want epidural anesthesia you MUST view an anesthesia video prior to your delivery.
 
STAGE ONE OF LABOR

Before labor begins, the wall of uterus is thin and the cervix is long and thick. During the first stage of labor, your cervix is being thinned out (effaced) and opened (dilated) by the contractions of your uterus.

The opening of the cervix is measured in centimeters. It is completely dilated when the opening measures 10 centimeters (about 4 inches).

Your doctor may say you are in early labor, active labor, or transition. These are terms used to describe the stages of cervical dilation you are going through.

Early labor is the period of time when your cervix dilates from 1-3 centimeters. In a first pregnancy, early labor takes an average 9 hours. Contractions are approximately 30-60 seconds long and occur every 5-20 minutes. Early labor often feels like menstrual cramps with mild backache.

Active labor is the period of time when your cervix dilates from 4-7 centimeters. Contractions are approximately 45-75 seconds long and occur every 2-5 minutes.

Transition is the period of time when your cervix dilates from 8-10 centimeters. This is the most uncomfortable but the shortest stage of labor. Transition lasts between 20-45 minutes. Many women find this stage most discouraging and feel they cannot continue. There is an intense urge to push or bear down. As soon as your cervix is dilated 10 centimeters, you will be ready to push the baby out.
 
STAGE TWO OF LABOR

In the second stage of labor, the contractions are further apart than in transition. Usually they will be about 4-5 minutes apart, lasting approximately 60-90 seconds. It is DURING a contraction that you will push.

When the whole top of the baby's head is visible, it is called crowning and the next few contractions will bring the baby's head into the world. The baby is usually born facing your backbone, but as soon as its head is out, it turns toward one of your thighs. This turning puts the baby in a position to be born easily with the next contraction or two.

An episiotomy, a cut between your vaginal opening and rectum, may be made to prevent a jagged tear in that area. Not all women need or want episiotomies, so discuss this with your doctor. You will need some form of anesthesia (local or epidural) if this is done.

After the baby is delivered and the umbilical cord stops pulsating, it is clamped and cut. Some babies will take their first breath and begin to cry immediately, but often the baby won't begin to cry until the mucus is suctioned out of his/her nose and mouth.
 
WHAT THE BABY WILL LOOK LIKE AT BIRTH

The baby will be wet looking and may be covered with a white creamy substance called vernix. This material protected the baby's skin while in the uterus. It also served as a lubricating agent as the baby moved along the birth canal. Some babies are covered with very fine hair called lanugo. This disappears within a few days. Don't be alarmed if your baby's head looks unusually oblong! His/her head may have been flattened as it came through the birth canal. But it will take on a more normal, rounded appearance within a day or two.
 
STAGE THREE OF LABOR

After the baby is born, the uterus stops contracting and becomes smaller. After a few minutes of rest, it will begin contracting again to free the placenta (afterbirth) from the wall of the uterus. Within a matter of minutes, the placenta will be expelled from the uterus. Occasionally, it must be removed by the doctor. With the delivery completed, if you have an episiotomy it will be closed with stitches. The stitches don't have to be taken out because they absorb in 15-20 days.

By this time, the baby will have been cleaned off and wrapped in a warm blanket. You and your partner will be able to spend a few minutes admiring your new baby!

AFTER THE BABY IS BORN . . .
Following the delivery, your baby will "room-in" with you. You will be in charge of feeding, diapering, and caring for the baby; however, the nurses will assist you when you wish. If you need some time alone to rest, the baby can return to the nursery during this period.

The birth of your baby begins a whole new adventure -- parenthood. As your baby grows and develops, you, like many other new parents, will probably have many questions about your child's health and development. Do not hesitate to discuss these questions and concerns with your family practitioner. We look forward to providing complete care for you and your new family. Congratulations and good luck!

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