Your pregnancy week by week header

10 to 15 weeks

At 10 weeks of pregnancy:

Fingers and toes continue to grow and soft nails begin to form. The eyelids begin to form. All of the organs are formed but not fully developed.

At 12 weeks of pregnancy:

Your baby weighs just a little over an ounce and is about 3 ½ inches long. The facial features are starting to take shape. The head still makes up about half the body. Your baby moves on his own now but is still too small for you to feel the movement.

At 14 and 15 weeks of pregnancy:

Your baby’s organs are fully formed and the arms and legs can now flex. The heart is pumping about 100 pints of blood per day and the kidneys are now producing urine. The hands will soon open and close into fists. The organs of taste and smell are developing and the skin is starting to become thicker.

Sources for weight gain chart

Exercise

Staying active and exercising (even just walking) for 30 minutes a day most days can benefit your pregnancy by: 

  • boosting your mood and energy level
  • helping you sleep better
  • reducing backache, constipation, bloating and swelling
  • promoting muscle tone, strength and endurance

If you have not been active before pregnancy, start with a few minutes each day and build up to 30 minutes on most days. This can be broken up into smaller time periods throughout your day. If you’ve been very active before pregnancy, most women can continue with the activities they enjoy. Just remember to avoid contact sports, exercises that could injure your abdomen and not to start a new sport during pregnancy. Some changes in your body may require you to modify your routine somewhat. Discuss any questions with your doctor. Stop exercising and call your doctor if you experience dizziness, shortness of breath, chest pain, trouble walking, calf pain or swelling, vaginal bleeding or uterine contractions that continue after rest.

Nasal Congestion & Nose Bleeds

Many women feel as if they have a stuffy nose and/or experience nose bleeds during pregnancy. This is because the increased blood volume (nearly 45%) during pregnancy causes the membranes in your nose to swell. Your nose may feel dry and raw which may lead to nose bleeds. Try increasing your fluid intake, using a saline only nasal spray, or using a cold steam humidifier in your home to alleviate these symptoms.

Constipation & Hemorrhoids

Hormone changes during pregnancy cause your digestive system to slow down which can lead to constipation. Vitamin supplements containing iron are often recommended during pregnancy and this too can increase the likelihood of becoming constipated. Many women may develop hemorrhoids during pregnancy or notice increased problems with existing hemorrhoids due to difficulty with bowel movements. Hemorrhoids are swollen veins in the rectum that typically itch or burn but may sometimes bleed as well.

Remember to drink plenty of fluids and increase your fiber intake to help avoid constipation. Fiber can be found in fruits, vegetables and whole grains. For some women a warm cup of decaffeinated coffee or tea may stimulate a bowel movement. If you continue to experience constipation, your doctor may recommend an over the counter stool softener.

Additional treatment recommendations for constipation and hemorrhoids can be found in the information you received at your first obstetrical appointment on the sheet “Physician Approved Medications for the Pregnant Patient”.

16 to 19 weeks

At 16 weeks of pregnancy:

Your baby is now able to hear sounds and the digestive system is working. Your baby weighs about five ounces and is about six to seven inches long. The baby has eyelids, ears and an upper lip.

At 17 weeks of pregnancy:

Your baby weighs about eight ounces. The skin begins to produce a protective covering called vernix that acts as a waterproof barrier and will eventually completely cover the baby’s skin until it is born.

At 18 weeks of pregnancy:

Your baby now sleeps and wakes regularly and may be awakened by noises or your movements. Your baby is growing quickly between 17 and 20 weeks so that the proportion of the head to the body more closely resembles that of a newborn. Soft, downy hair starts to cover the baby’s body to keep the baby warm inside the womb.

At 19 weeks of pregnancy:

If your baby’s hand floats to the mouth it may suck it’s thumb now. This sucking reflex is the one the baby will later depend on for nursing. Movements and turns are stronger now. The bones and spleen are starting to make red blood cells. The arms and legs are now long enough to touch each other.

Anatomical Survey

Your physician will order an ultrasound evaluation of the baby at an upcoming visit (usually around 20 to 22 weeks of pregnancy). This ultrasound looks at the general anatomy of the baby and is generally referred to as an anatomical survey. During the ultrasound, all the major organ systems will be looked at and fetal growth will be assessed. In many cases, if you choose to find out, the sex of your baby can be determined provided that the position of the baby allows the ultrasound technicians to view the genital region. If the position of the baby does not allow good imaging of certain major organ systems, it may be necessary to have further images taken at a later visit. This will be the last routinely scheduled ultrasound of your pregnancy unless further studies are medically necessary.

Feeling baby's movements

The time when you can expect to feel your baby move for the first time is referred to as “quickening” and varies a great deal. For women that have had another child, they may feel movement as early as 16 weeks, however, it is not unusual to not be able to feel the baby’s movements until at least 18 weeks of pregnancy or even later. You may notice a “flutter” one day and then not again for several days—your baby is suspended in amniotic fluid so you may not be able to feel all movements. You may also experience days where you feel several movements followed by days where you do not. Don’t worry—this is due to your baby having very active periods followed by long periods of rest.

CAUTION:

Use of saunas and hot tubs:

The temperatures of saunas and hot tubs may increase your core body temperature. Some studies suggest this may adversely affect the baby’s development. The American College of Obstetricians and Gynecologists suggests that a pregnant woman spends no longer than 10 minutes in a hot tub and avoid submerging their head, arms and shoulders. Pregnant women should spend no longer than 15 minutes in a sauna.

Use of tanning beds or over-exposure to the sun is generally discouraged due to increased risk of skin damage and higher incidence of skin cancers for anyone, but there are additional concerns during pregnancy. Just as with saunas or hot tubs, increasing core body temperature should be avoided. During pregnancy, many women develop what is commonly referred to as the “mask of pregnancy.” This refers to dark blotches that appear on the face but usually fade after pregnancy. Sun exposure can make this discoloration of the skin worse. Many physicians approve spray tanning in a well-ventilated area as an alternative.

20 to 24 Weeks

At 20 weeks of pregnancy:

Your baby may weigh up to one pound and is about ten inches long. The baby’s digestive system now starts producing a dark, sticky substance called meconium. Some babies will start to pass this during delivery and you will see this in the first soiled diapers after the baby is born. The fingernails continue to grow to the ends of the fingertips.

At 21-22 weeks of pregnancy:

Your baby has formed fingerprints now. If you notice jerking movements—it’s likely the baby hiccupping! Loud sounds may startle the baby. Tear ducts are developing and the baby’s eyes are moving behind the still-closed eyelids. 

At 23-24 weeks of pregnancy:

Your baby’s bones are starting to store calcium and grow harder, and more muscle tone is starting to develop. You may start to be able to distinguish the feel of a tiny arm or leg that may even push back if pushed gently. By the 24th week the baby may weigh up to a pound and a half and is about 12 inches long. The lungs are now fully formed but not yet ready to be able to breath outside the womb.

Forgetfulness:

Many women find it harder to concentrate during pregnancy. You may find yourself experiencing moments of forgetfulness that you've never had before. Lists and other memory prompts are sometimes helpful.

Dizziness:

Some women experience dizziness as a result of the circulation changes in their bodies during pregnancy. This is often because of less blood flow to your head and upper body. It may help to drink plenty of water and remember to stand up or change positions slowly. Standing for long periods or getting too hot may make dizziness worse. 

Testing

Gestational Diabetes
During your pregnancy, you will be tested for a condition called gestational diabetes. This test usually takes place between 24 and 28 weeks of pregnancy and is often referred to as “one hour glucose”or “glucose tolerance test.” You will be given a sugary drink and your blood will be drawn one hour later to test your blood sugar.

Gestational diabetes is a condition that allows glucose to build up in your blood rather than being absorbed by your cells as it normally would be. This condition is caused by a hormone made by the placenta during pregnancy and will resolve for most women after the baby is born. If your blood sugar level is higher than expected with this screening, further testing will be done later to determine if you have gestational diabetes. You should not fast on the day of your testing. It is recommended that you eat a well-balanced diet as you normally would, but you should avoid eating concentrated sweets like candy or regular soda immediately before your test.

Determining if a woman has gestational diabetes is important for the health of your baby. Managing blood sugar with appropriate diet, exercise and sometimes medication during your pregnancy can help ensure that your baby grows appropriately and does not produce too much insulin after delivery. A screening test for antibodies will be drawn and done for all pregnant women at the time of the glucose tolerance test.

Rh Factor

At one of your first obstetrical visits your blood was drawn for several tests. One of these tests was to determine your blood type (O, A, B, or AB) and if you have a positive (Rh positive) or negative (Rh negative) blood type. If you have a negative blood type and the baby’s father has a positive blood type, the baby may inherit the positive Rh factor. If your baby has an Rh positive blood type it is possible for your immune system to develop antibodies because the baby’s cells are different from yours. These cells may not be a problem during your current pregnancy but could cause serious problems during future pregnancies. To prevent this, women with Rh negative blood are given an injection of Rhogam (a type of gamma globulin) at the time they have testing for gestational diabetes (usually 28 weeks of pregnancy). This injection is often given if a pregnant woman experiences bleeding, has certain types of procedures done during pregnancy and after delivery if the newborn has a positive blood type.

25 to 28 weeks

At 25-26 weeks of pregnancy:

Your baby’s nervous system and brain are rapidly growing during this time. The surface of the brain is becoming more folded and wrinkled to provide more space for nerves to grow. The skin has taken on color due to the production of melanin and begins to appear smoother and less wrinkled as more fat is added to the body.

At 27-28 weeks of pregnancy:

Your baby is now longer and often curled into a fetal position but can still move and flex. You may notice your whole stomach appearing to move when the baby changes position. The baby’s heart rate may decrease at the sound of familiar voices. The eyes open, close and sense changes in light. The baby can make grasping motions and may even smile during sleep. Your baby likely weighs about 2 ½ pounds and is about 14 inches long.

Prenatal classes

Now is the perfect time to contact the hospital where you plan to deliver to pre-register. You may have received materials and contact information at your first prenatal visit, but if this has been misplaced, feel free to ask any of the nursing staff for another packet. Both Memorial Medical Center Family Maternity Suites and St. John’s Birth Center offer tours of the facilities and a wide range of prenatal classes for you to choose from.

Participating in classes and being familiar with where the birth of your baby will take place can add to the comfort and enjoyment of your birth experience. Discuss the different options that may be available to you throughout your delivery for pain control and comfort with your physician. Childbirth classes at Memorial Medical Center and St. John’s Hospital offer information on pain control, common childbirth procedures, relaxation and breathing techniques. 

Sleeping positions

It is often difficult to find a comfortable sleeping position during pregnancy. Trust your body. Some women find that their bodies automatically find the best positions for sleep. Most women find sleeping on their side the most comfortable during this time. A pillow positioned between the knees and another under the abdomen (or a full length body pillow) helps to provide support. Although sleeping on your back will not harm your baby, it does put the weight of the uterus on your spine and back muscles, which may cause discomfort. Lying on your back may also compress a major blood vessel. This will often cause you to feel dizzy.

Swelling and varicose veins

Even during the first part of pregnancy, some women notice their feet getting bigger. This is due to both the extra fluid your body retains during pregnancy and relaxin, the hormone that causes ligaments in the feet to loosen and allows bones to spread. During the latter months of pregnancy, and especially in hot months, most women experience some swelling of the feet and legs. The added weight of pregnancy causes circulation to be slower in returning fluid, especially from the feet and lower legs. This type of swelling is often referred to as edema.

The weight of the uterus pressing on a major vein can also slow blood flow from your lower body. For some women this will result in varicose veins. Varicose veins appear as sore, itchy, blue bulges. These can occur not only on the legs but also near the vagina, vulva or rectum. (Varicose veins of the rectum are commonly known as hemorrhoids.)

To reduce swelling and the appearance of varicose veins, prop up your legs as often as you can while seated and elevate legs on a pillow when lying down or lying on your side. Avoid crossing your legs when seated, and if you must either sit or stand for long periods, be sure to move around often. Avoid wearing knee high or thigh high stockings or nylons with any tight elastic bands. It may be helpful to wear support hose that do not constrict at the knee or thigh.

It is very important that if you experience excessive swelling in your legs, hands or face that you let your physician know. Excessive swelling could indicate a much more serious condition such as preeclampsia and needs to be evaluated to determine if other symptoms are present.

Vaccinations and pregnancy

Vaccines can help keep you and your growing family healthy. Here are some guidelines for the vaccines you need before, during, and after pregnancy.

Tdap Vaccine

It is recommended that every pregnant woman get a dose of Tdap to protect the newborn from pertussis (whooping cough). Infants are most at risk for severe, life-threating complications from pertussis. The ideal time for vaccination is during the third trimester of pregnancy. This allows time for your body to create antibodies to the disease that are then passed along to your baby, and helps to protect your infant until they begin to receive the vaccines against pertussis at about two months of age.

If the vaccine was already given during the first or second trimester of pregnancy then you should not receive another vaccine during the same pregnancy. All caregivers and family members should also make sure they are up to date on their vaccines and if not, they should be vaccinated at least two weeks before having contact with the baby.

More Vaccination Resources

29 to 30 weeks

At 29-30 weeks of pregnancy:

Your baby is gaining weight very quickly now. During the last two and a half months, half of your baby’s birth weight will be added. The limbs are becoming smooth and plump. The fine hair that covers your baby’s body (lanugo) begins to disappear although many babies will be born with patches of it still on their shoulders, back and ears. The hair on your baby’s head is beginning to grow and thicken, although this will normally be lost within the first six months of life. Your baby is beginning to acquire immunity from many infections as your antibodies are passed along through the placenta to the baby’s blood.

Skin changes:

Some women will notice an increase in acne or skin break-outs caused by the hormones of pregnancy. Try washing a few times a day with a mild cleanser. Do not use acne products or take oral medications for acne without first discussing this with your doctor as many of these products may be unsafe to take during pregnancy.

You may notice changes in skin coloration. Your body produces more melanin (the pigment that gives color to your skin) during pregnancy. The “mask of pregnancy,” known as chloasma, gives some women brownish marks around the eyes or on the nose or cheeks. Sunblock, wearing a hat, and limiting exposure to direct sunlight can help avoid the worsening of this condition. You may also notice the appearance of a dark line running up and down your abdomen, called the linea nigra, getting darker. These conditions are not harmful nor will they cause permanent scarring or damage to the skin. Both of these will fade postpartum as your hormone levels return to normal.

Stretch marks can be found not only on the abdomen but also on the breasts, thighs and upper arms. Using cocoa butter or other moisturizers may help with the itchiness that occurs over the expanding abdomen and breasts, although it will not prevent stretch marks from occurring. Some stretch marks may have a very red-looking appearance. These will fade postpartum to become silvery in color.

Insomnia and fatigue

Feeling tired is normal at this time. Your body is working to support your baby’s development while at the same time it is often difficult to find a comfortable sleeping position. Insomnia is not uncommon during the third trimester of pregnancy for many reasons, not the least of which is often anxiety.

Don’t take any over-the-counter sleep medications unless approved by your physician. It may help to avoid exercise or caffeine immediately before bed, and to try a relaxing, warm shower or a good book before bed. If you are having difficulty sleeping, sometimes a change of rooms from the bedroom may help. Whenever possible, listen to your body and rest when it says you are tired, even if this is a short, 15-minute nap during the day. 

Heartburn or indigestion

It is very common for women to experience frequent heartburn or indigestion during pregnancy. This happens for two reasons: 1.) The hormones of pregnancy relax the valve between your stomach and your esophagus which makes it easier for stomach acid to be pushed upwards into the esophagus. 2.) The growing size of your uterus pushes on the stomach so that it is not able to hold as much as it did before pregnancy.

There are a few things that you can do to lessen the frequency or severity of the heartburn. Avoid consuming large amounts of food or liquid in a short period of time. Instead, drink fluids between meals and have five or six small meals throughout your day instead of three large meals. Avoid eating or drinking large amounts right before bedtime or lying down right after a meal. Not eating for a few hours before bedtime will allow your body to digest your food before lying down. Do not over-indulge in carbonated beverages or spicy, greasy, hot or fried food. You may use a few extra pillows to prop up your head and shoulders or try raising the head of your bed since lying flat will allow the stomach acid to leak more easily.

Physician recommended over-the-counter medications for heartburn are listed on your Physician Approved Medications for the Pregnant Patient handout and can also be accessed under the Pregnancy Facts Sheets found in our Resource Library.

Round ligament pain

Your uterus is supported by fibrous bands of tissue on both sides of the abdomen and running along the pelvic floor. As your uterus grows, these bands are pulled and stretched like a rubber band. You may feel this as a dull ache at times or all of sudden feel a “knife stabbing” pain that can take your breath away.

Any sudden movement, position change, coughing or sneezing may cause these ligaments to spasm. Changing position or not moving for a short time may help relieve the pain. If abdominal pain continues or gets worse as time goes on you should consult your physician immediately.

31 to 32 weeks

At 31 to 32 weeks of pregnancy:

Your baby begins to have some ability to control its body temperature, so that it does not have to rely entirely on the temperature of the amniotic fluid as the brain continues to rapidly grow and develop. Many of the bones begin to harden, although the skull will remain soft and flexible to allow for growth. The skin loses the “see-through” appearance as more fat accumulates. At 32 weeks gestation your baby is approximately 18 inches long and weighs around five pounds.

Kick counts:

Kick counts are a test you are able to do at home to monitor your baby’s movement and well-being. Your doctor may recommend that you begin doing these and will instruct you on how often to do them. Often the best time to do kick counts is late afternoon or early evening. Your baby is often most active following a meal or snack. 

To perform kick counts, lie in a quiet place on your left side. With your hands on your abdomen, fully concentrate on your baby’s movements. Keep track of how many times you feel your baby move in one hour. Be sure not to count things such as feeling your baby hiccup. If you have not felt 10 movements one hour, drink 8 ounces of orange juice, lie down and monitor again for one hour. 

If you do not feel 10 movements in the second hour of monitoring, you should call your physician or, if this occurs after office hours, go to the hospital for monitoring. If your doctor instructs you to begin doing kick counts you may be provided with instructions and a chart that can assist you in keeping track of movements.

Fetal movement

You should continue to feel your baby move several times every day. Each baby has its own level of activity and most have a sleep cycle of 20-40 minutes. Your baby will often be most active after you have eaten a meal. You are more likely to notice your baby’s movements while resting or sitting quietly than while active and engaged in other activities. The feeling of your baby’s movement will often feel differently during the later stages of your pregnancy. This is due to the baby having less room to move in the uterus. It is normal for the movements to feel different but the rate of movement should actually be the same. 

33 to 34 weeks

At 33-34 weeks of pregnancy:

Your baby is continuing to gain weight quickly. Now about 20 inches long, the baby won’t likely get too much longer but may gain about ½ pound a week. As fat continues to be added underneath the skin it becomes less wrinkled in appearance. Your baby is developing definite sleeping patterns. Your baby likely weighs about 5 ½ pounds.

Back pain:

Many women will experience lower back pain during their pregnancy and this is especially true during the later stages of pregnancy. The growing uterus changes your center of gravity and your posture, which puts strain on the lower back. The hormones of pregnancy cause the ligaments of the strong, weight-bearing joints in the pelvis to loosen in order to make your baby’s passage through the pelvis easier at delivery. Pain may occur from this loosening of joints during activities like exiting a car, walking up stairs or even standing from a chair.

This problem will usually go away after delivery. To help lessen the stress on your joints from the added weight you may find it helpful to:

  • Wear low-heeled shoes with good arch support such as athletic or walking shoes and avoid high heels, which will tilt your body forward and increase the strain on your lower back.
  • Avoid standing for long periods of time. If you must do so, try resting one foot on a stool or box to take the strain off of your back.
  • Sit in chairs with good back support or try tucking a small pillow behind your lower back.
  • Always keep your back straight and bend at the knees to pick up objects. Do not bend at the waist to pick something up.
  • Maternity support garments can be worn. These appear similar to a girdle and help to take the weight of your belly off of your back muscles.

Sciatica

Pressure from the growing uterus on the sciatic nerve may also cause symptoms during pregnancy. The sciatic nerve branches from the lower back, down the buttocks and legs. Women may experience tingling, numbness and pain in these areas. Sometimes simply changing position may help to alleviate the symptoms by shifting the weight of the uterus. This discomfort often resolves on its own after the birth of your baby. If you experience weakness in your leg, severe calf pain or tenderness, call your physician and let them know so that they can evaluate these symptoms.

Braxton Hicks contractions

Uterine muscles contract occasionally throughout pregnancy. As you get closer to your due date, Braxton Hicks contractions (pre-labor contractions) may get stronger and more frequent. Sometimes these contractions may be barely felt or feel like a slight tightening in the abdomen, but they may also be painful and feel like true labor contractions. This type of contraction does not change your cervix.

Braxton Hicks contractions are more likely to occur in the afternoon or evening, after physical activity, after intercourse or when you are tired. You may time your contractions from the beginning of one contraction to the beginning of the next to determine if they become more regular and more frequent. Often walking or changing position may lessen or stop Braxton Hicks contractions. Be sure to drink plenty of fluid since Braxton Hicks contractions also tend to occur more if you are dehydrated. 

Group B streptococcus (GBS)

GBS is a bacteria that lives in the body and does not usually cause harm. In about 10-30% of women it can be found in the vagina and rectum. Most pregnant women with GBS have no symptoms or health effects although some women may develop a urinary tract infection from this bacteria. 

If present, the bacteria has the possibility of causing serious infection in your newborn baby by being passed to your baby as it travels down the birth canal during delivery. The risk of infection to your baby can be dramatically decreased by the administration of antibiotics through your IV during labor.

Your doctor will test for GBS between 35 and 37 weeks of pregnancy. If you have been diagnosed with a urinary tract infection earlier in pregnancy then this culture will not be needed and your doctor will plan for you to receive the antibiotics during labor. The antibiotics only help get rid of some of the bacteria that can harm the baby when given during labor. If given earlier in the pregnancy, the bacteria may regrow and be present during labor. 

Postpartum birth control

If you plan to use birth control after your baby is born, now may be a good time to discuss the options with your physician. There are a wide variety of options available including permanent sterilization, implantable devices, oral contraceptives and injectable contraceptives.

Breastfeeding mothers are able to use both non-hormonal and progesterone-only options safely while breastfeeding. It is important to remember that breastfeeding alone is not an effective form of contraception despite many women not having periods while exclusively breast feeding.

35 to 36 weeks

At 35-36 weeks of pregnancy:

Your baby’s lungs are maturing now and getting ready to breathe after birth. The circulatory system and musculoskeletal system are now complete. Your baby may weigh as much as 6 pounds so there is much less room for movement. You may feel less rolling around or somersaults, but should continue to feel kicks and frequent movement.

Reminder: Your 35 to 36 week visit is when you may typically expect to have your culture done to test for Group B strep bacteria unless you have been told earlier in the pregnancy that this bacteria was the cause of a bladder infection. If you have an allergy to Penicillin, please tell the nurse or physician during your visit today.

Cervical checks

As you near the end of your pregnancy, your physician will often begin to do vaginal exams during your routine visits to determine if your cervix is changing. This may occur any time you report contractions or symptoms that may indicate labor, or routinely during the last month of your pregnancy. The physician may report changes in your cervix to you as effacement (how much your cervix has thinned) and dilatation (how much your cervix has opened).

The cervix is normally 1 ½ to 2 inches long and will become paper thin as it stretches and pulls over the baby’s head. Zero percent effaced means no change to the thickness of the cervix while 100% effaced means the cervix is completely thinned out. The cervix gradually opens zero centimeters to ten centimeters (completely open). It is very common to have a small amount of vaginal bleeding following a vaginal exam. Spotting may be brown, pink or a small amount of bright red. If you experience bright red, heavy bleeding at any time, you should go to the labor and delivery unit of your hospital.

Car seat

You must have a car seat safely installed in your car to take the baby home from the hospital. All infants must, by law, ride in a rear-facing car seat until they reach at least one year of age and weigh at least 20-22 pounds. The American Academy of Pediatrics recommends that children should ride in rear-facing car seats as long as possible—until they reach the maximum height and weight limit for a rear-facing convertible car seat or at least until age two.

It is important for you to know and execute the proper installation of the car seat and base you choose. You can locate your nearest child safety inspection station by visiting the National Highway and Traffic Safety website at www.nhtsa.dot.gov and visit one of these locations to have the car seat checked for proper installation.

An infant should never be placed in front of an active airbag and generally, the safest place for the child is the middle of the back seat (depending on the car). If using a second-hand or used car seat, be very cautious to check everything. Never use a car seat that has been in a crash, is missing the instructions, does not have a label with the date of manufacture, seat name, and model number or has any cracks or missing parts. Do not use a car seat that is over five years old. Use the information provided on the label to check for recalls.

Feeding your baby

Before delivery, you will want to decide rather you plan to breast feed or give your baby formula. Breast feeding your infant has many benefits for both the baby and the mother. Breast milk is the most complete and easiest to digest form of nutrition for infants. Exclusively breast feeding for the first six months of an infant’s life is recommended by the World Health Organization and UNICEF. For mothers who are unable or choose not to breast feed, commercially prepared formulas are a nutritious alternative.

Bottle-feeding is convenient because any caregiver can feed the baby a bottle at any time, however, it is important to keep in mind that breast milk can be pumped and stored for bottle-feeding as well. It is recommended that all babies get 400 international units of vitamin D a day to ensure strong, healthy bone growth. Vitamin D is available in liquid form that you can give your baby with a dropper. Most formula-fed babies are likely getting the recommended amount of vitamin D daily, but be sure to check the label to make sure. Your pediatrician can help you choose the best formula for your infant.

If you have decided to breastfeed it may be a good idea to take a breastfeeding class from a certified lactation consultant before your baby is born. This can help you avoid some common problems many mothers face when they first start to breastfeed and make you more comfortable with the learning process of both you and your baby. Help and support will be available to you after your delivery to assist you with feeding your baby.

Choosing a pediatrician

It is very important for you to feel confident in the physician you choose to care for your baby. For many parents, the choices available to you will be determined, at least in part, by your insurance carrier. Many parents ask friends and family members about the health care providers they use for their children, and often you may request an appointment with the provider to interview them.

Choosing a provider close to your home is often best since this is the distance you will have to travel when your child is ill. If you choose a pediatrician or family physician that does not travel to the hospital at which you plan to deliver your baby, the hospital will have pediatricians available to examine and care for your baby while in the hospital after delivery. The care of your baby can then be transferred to your chosen physician once your baby is discharged from the hospital.

 Springfield Clinic Pediatric Care Options

37 weeks

At 37 weeks of pregnancy:

The body hair that has covered your baby to keep him or her warm throughout your pregnancy (lanugo) has been mostly shed. Your baby’s body fat has now increased to about 16% and your baby will continue to add fat over the elbows, knees and shoulders.

Reminder: If a culture for Group B strep was performed at your last visit, your physician will discuss these results with you at your 37 week visit and let you know if you will require antibiotics during your labor. If you have an allergy to Penicillin, be sure to mention this during your visit.

Lightening and show

During the latter part of pregnancy, changes take place as your body begins to prepare for labor. These changes may occur anywhere from a few weeks to a few hours before labor begins. The baby’s head settles deeper into the pelvis. This is often referred to as the “baby dropping” or lightening. The top of the uterus (or fundus) is positioned high in your abdomen, just underneath your breasts, until this occurs. Once lightening occurs the fundus will often drop 2 to 3 inches away from your ribs. This may make it now easier to breathe but you may also feel more pressure in your pelvis and on your bladder, causing you to make more frequent trips to the bathroom. It is not unusual for a woman to never notice the “baby dropping” or lightening. This is not an indication that everything is not progressing normally, so don’t be discouraged if this has not yet happened for you.

During pregnancy, a thick mucus plug accumulates at the cervix. When the cervix begins to dilate the plug is pushed into the vagina. When this happens you will notice increased vaginal discharge which may be clear, pink or even slightly bloody. This may occur several days or longer before actual labor begins. As with lightening, this increased discharge may not occur for every mother-to-be. If at any time you notice leakage of clear, watery fluid in either a trickle or a gush call your doctor or if after hours, go to labor and delivery to be evaluated.

Labor precautions

It can be very difficult to tell the difference between true labor and “false” labor (Braxton Hicks contractions). When a woman experiences Braxton Hicks contractions they are often irregular and do not get closer together. They may stop when you walk, rest or change position and they do not usually get stronger. Many women only feel Braxton Hicks contractions in the front as a tightening of the abdomen. During true labor the contractions usually start in the back and move to the front. True contractions will continue despite movement, come at regular intervals, get closer together and increase steadily in strength as time goes on. Sometimes the only way to tell the difference is to have a vaginal exam to find out if your cervix has changed.

You should always call your doctor or go to the labor and delivery unit of the hospital if your “water breaks” (clear, odorless, watery fluid gushes or trickles from the vagina) or you have bright red vaginal bleeding (other than bloody mucus or light spotting following a vaginal exam or intercourse) regardless of whether or not you are having contractions. Call your doctor or go to the hospital if you have severe pain with no relief between contractions or any time you notice the baby is moving less often.

Preeclampsia

Preeclampsia is a condition that occurs only during pregnancy. Symptoms of preeclampsia include headaches, vision problems, upper abdominal pain and rapid weight gain of more than 2 pounds per week. Your doctor would detect preeclampsia based on elevated blood pressure above a certain point and high levels of protein in your urine.

This condition causes stress on the kidneys and can also affect the liver, the brain and the placenta. Women with preeclampsia must be closely monitored with frequent visits and tests to monitor the health of both you and your baby. Sometimes hospitalization is necessary, and depending on the severity of the condition and the gestational age of the baby, a decision may be made about whether to deliver the baby.

Packing for the hospital

It is a good idea to pack a small bag to take with you to the hospital in case labor begins a few weeks in advance. Pack things in advance and leave the bag in a convenient spot so that you don’t have to throw things in a bag at the last minute. Make a list of items that you want to take with you but are unable to pack ahead of time, and keep it in a place that will trigger your memory to take these items with you. Don’t panic if you forget items. If a friend or relative is unable to bring you something you need, the hospital may have these items. Your partner or coach may also want to have a similar bag packed in advance to make their stay more comfortable.

38 weeks

At 38 weeks of pregnancy:

Eighty-five percent of babies are born within 2 weeks of their due date so your baby could be born any day now.

Nesting

As you approach your due date, you may suddenly feel the urge to complete projects, organize, clean or do other things to prepare for the birth of your baby. This is called “nesting,” and many women report feeling better than they have through the whole pregnancy. Do whatever you feel you need to do to satisfy this urge but be sure not to overdo it. It is important to conserve your energy for labor, delivery and caring for your new baby. Try to avoid lack of sleep and fatigue.

Hospital admission

When you arrive at the hospital to have your baby someone will verify your name and date of birth before taking you to your room. A hospital identification band will be placed on your wrist and a nurse will review your health history, any medications you may be taking and what you are currently experiencing. The hospital you have chosen will likely already have the information from your prenatal visits with your physician and will obtain the most updated records when you arrive.

Simple laboratory tests are often ordered when you are admitted to the hospital and these will be collected. You will be given a hospital gown to change into and an IV line will be inserted. You will be examined to determine the stage of labor you are in, to allow your progress to be monitored and to determine the position of the baby. Your contractions and your baby’s heartbeat will be monitored to assure your baby’s well-being. This monitoring may be intermittent or continuous depending on the condition of the baby, the stage of labor and a number of other factors.

Circumcision

If you have a boy, you will need to decide whether to have him circumcised after birth. Circumcision is the cutting away of the foreskin (a layer of skin that covers the tip of the penis). Studies show that there are some medical benefits of circumcision, including a slight decreased risk of urinary tract infections, lower risk of infection of the foreskin, lower risk of getting cancer of the penis and a slightly lower risk of getting a sexually transmitted disease. These medical reasons alone are not sufficient to recommend that all infant boys be circumcised. This personal decision is entirely up to the parents. If you decide to have your son circumcised this procedure will be performed by your obstetrician, usually before your baby is discharged from the hospital.

Safe sleep for your baby

You have likely heard about the “Back to Sleep” efforts to educate parents and caregivers on ways to decrease the risk of your baby being lost to SIDS (sudden infant death syndrome).

As you begin to plan for your baby’s homecoming remember the following tips:

  • All babies should be placed on their back on a firm sleep surface for every
  • sleep time—nighttime and naptime.
  • The baby should not sleep in the same bed with you. Room sharing is
  • encouraged, but not bed sharing.
  • Keep soft objects or loose bedding out of the crib or bassinet. This includes
  • toys, bumper pads, pillows and blankets. Use sleep clothing with no other covering over the baby to keep the head and face uncovered during sleep.
  • Don’t let your baby become overheated during sleep. Keep the
  • temperature so that it feels comfortable for an adult. Dress your baby in as much or as little clothing as you would wear.
  • Devices to maintain sleep position such as wedges and positioners are not
  • recommended since many have not been sufficiently tested for safety.

Postpartum birth control

If you plan to use birth control after your baby is born, now may be a good time to discuss the options with your physician. There are a wide variety of options available including permanent sterilization, implantable devices, oral contraceptives and injectable contraceptives. Breastfeeding mothers are able to use both non-hormonal and progesterone only options safely while breastfeeding. It is important to remember that breastfeeding alone is not an effective form of contraception despite many women not having periods while exclusively breast feeding.

39 to 40 weeks

At 39 to 40 weeks:

Your baby’s head may have already dropped into position in your lower pelvis. At 40 weeks most babies will weigh somewhere between 6 and 9 pounds and be 18-20 inches long. At birth, the brain will weigh about 14 ounces and will continue to increase in size and weight. 

Induction of labor

In some cases your physician may recommend that steps be taken to begin labor rather than waiting for it to begin naturally. Before labor induction, your physician will review the baby’s gestational age, how your pregnancy is going and possible risks for you and your baby.

If labor induction is decided upon, several different methods may be used. If the cervix has not begun to thin or open on its own, your provider may choose to use medications or special dilators to help soften or widen the cervix the evening before beginning labor induction. A hormone called oxytocin (Pitocin) may be given through your IV site to stimulate contractions.

Your contractions and your baby’s heartbeat will be monitored while this medication is being administered to ensure that contractions do not begin to come too close together or cause too much stress to your baby. If your water has not broken already, your doctor may make a small hole in the amniotic sac. This may then increase the contractions or make them stronger.

There are some risks associated with induction of labor, which your doctor will discuss with you in advance of making this decision with you.

What to expect after your baby is born

Immediately following the birth of your baby, both you and your baby will be closely monitored. Both of you will have your vital signs checked frequently for the first couple of hours after delivery. The hospital staff will frequently assess the amount of bleeding you have to make sure it is not unexpectedly heavy, and will press on and massage your uterus. This may be uncomfortable, however, it is important to help keep your uterus in a contracted state after delivery.

Sometimes medication is given to keep the uterus firm. If your uterus does not remain firm and contracted, bleeding may become heavy and require other treatment measures. You may experience shaking of your whole body that comes and goes the first few hours after birth. This is normal, and although you may not be cold, you may be offered a warm blanket to help with this. Your baby will be assessed immediately after being born. If special medical treatments are needed for your baby it may be taken to the nursery, but most often your baby will be able to stay with you. Hospital staff will continue to check the baby’s temperature and heart rate. You will be given the opportunity to breastfeed for the first time and assistance will be provided if needed.

The length of your hospital stay will depend on the type of delivery you experience as well as other factors, including your preference. Most insurance coverage allows for a two-day hospital stay following a vaginal delivery and a three-day hospital stay following a cesarean birth. Some parents prefer to leave the hospital in just 24 hours after having their baby. If your delivery has been without complications and your pediatrician does not feel that your baby needs to be monitored closely for the full two days, this may be an option for you. Be sure to let the physician for both you and your baby know if this is what you wish to do.

Post-term pregnancy

A post-term pregnancy is defined as one that lasts longer than 42 weeks. A pregnancy often lasts longer than expected because the exact time when you became pregnant is not known. If your due date has passed, your doctor will do testing to check your baby’s health and your visits will likely be more frequent. Your physician will discuss options with you based on the well-being of both you and your baby, including induction of labor if appropriate.

Special test to monitor the health of your baby

Your physician may order special testing to monitor the health of your baby. Two of these tests that may be performed in the office are called non-stress test (NST) and biophysical profile (BPP).

During a non-stress test two belts will be placed around your abdomen. Ultrasound devices monitor the baby’s heartbeat and any uterine contractions you may have. You will be given a button to push when you feel the baby move. When the baby moves, the heart rate increases. This increase in the heart rate is a sign of your baby’s good health.

A biophysical profile is a test performed by ultrasound. It assesses four areas: the baby’s breathing movements, body movements, muscle tone and the amount of amniotic fluid (referred to as the amniotic fluid index or AFI). Each area is given a score from 0 to 2. Sometimes these tests are done on the same day and the NST is given a score of 0 to 2 as well. When this is done a score of 8 to 10 is considered normal and a sign of your baby’s good health.

Baby Blues

Seventy to eighty percent of mothers will experience what is commonly known as the “baby blues” after having a baby. Usually about 2 to 3 days after birth, you may notice feelings you never expected to have at this time in your life. You may cry for no reason, have trouble sleeping or making choices, and even question if you can handle caring for this new baby. You may feel angry, alone, anxious and weak. These feelings often go away in anywhere from a few hours to a couple of weeks. If these feelings do not start to fade after about a week or begin to worsen rather than get better, you should contact your physician.