Healthy Pregnancy

Editor in Chief

Associate Medical Editors

mm HarperCollins e-books

About this book

To use Mayo Clinic Guide to a Healthy Pregnancy, you may find it helpful to understand how the information is arranged. The book is divided into four parts:

Part 1: Pregnancy, Childbirth and Your Newborn

This section offers month-by-month insights into your baby's development as well as your own physical and emotional changes. It also gives detailed information on labor, childbirth, and newborn and postpartum care.

Part 2: Decision Guides for Pregnancy, Childbirth and Parenthood

Each guide is designed to help you reach a decision that's best for you and your situation.

Part 3: Pregnancy Reference Guide

Here, you'll find helpful self-care tips for heartburn, nausea, back pain, fatigue and many more of the common concerns of pregnancy.

Part 4: Complications of Pregnancy and Childbirth

This section provides details on complications that can occur with pregnancy, along with information on being pregnant when you have a health condition.

Throughout this book, the term health care provider covers the many kinds of medical professionals who provide pregnancy care. When the term doctor is used, it indicates that a doctor of medicine (M.D.) is likely the best type of health care professional to provide this type of care.

About Mayo Clinic

Mayo Clinic evolved from the frontier practice of Dr. William Worrall Mayo and the partnership of his two sons, William J. and Charles H. Mayo, in the early 1900s. Pressed by the demands of their busy practice in Rochester, Minn., the Mayo brothers invited other physicians to join them, pioneering the private group practice of medicine. Today, with more than 2,000 physicians and scientists at its three major locations in Rochester, Minn., Jacksonville, Fla., and Scottsdale, Ariz., Mayo Clinic is dedicated to providing comprehensive diagnoses, accurate answers and effective treatments.

With this depth of medical knowledge, experience and expertise, Mayo Clinic occupies an unparalleled position as a health information resource. Since 1983 Mayo Clinic has published reliable health information for millions of consumers through award-winning newsletters, books and online services. Revenue from the publishing activities supports Mayo Clinic programs, including medical education and research.

Editorial Staff

Editor in Chief

Associate Medical Editors

Managing Editor

Paula Marlow Limbeck

Contributing Medical Editors

Kristi Boldt, M.D.

Abimbola Famuyide, M.D.

Jennifer Friedmann, M.D.

Sasikala Hemkumar, M.D.

Keith Johansen, M.D.

Bruce Johnston, M.D.

Thomas Kastner, M.D.

Mary Marnach, M.D.

Margaret Pfeifer, M.D.

Petra Polasek, M.D.

Susan Sobolewski, R.N.

Catherine Walsh Vockley, M.S., C.G.C.

Creative Director

Daniel Brevick

Art Director

Stewart Koski

Editorial Research

Anthony Cook Danielle Gerberi Deirdre Herman Michelle Hewlett Stephen Johnson

Contributing Writers

Rachel Bartony Lee Engfer Julie Freeman Kelly Kershner Jennifer Koski Amy Michenfelder

Copy Editor

Mary Duerson

Proofreading

Miranda Attlesey Louise Hutter Filipic Donna Hanson

Illustration

Michael A. King Kent McDaniel M. Alice McKinney James D. Postier Chris Srnka

Indexing

Larry Harrison

Editor in Chief, Books/Newsletters Christopher Frye

Editorial Director

Sara Gilliland

HarperCollins Publishers

Stephen W. Hanselman,

Senior Vice President, Publisher, HarperResource Leah Carlson-Stanisic, Design Manager Karen Lumley,

Senior Production Manager Donna Ruvituso,

Executive Managing Editor Toni Sciarra, Senior Editor

Advisors

Anita DeAngelis Daniel Goldman, J.D. James Hale Sr. Jacqueline Heying Vicki Moore

Mayo Medical Ventures

Gregory Anderson, M.D. Michael Casey Marne Gade Laura Long S. Rebecca Roberts Gayle Rock Richard Van Ert John Schmidt

Literary Agent

Arthur Klebanoff

Media Support Services Nancy Moltaji preface

This book is for people who will soon be having a baby. If that is you, please accept our warmest congratulations! There are few events in anyone's life that rival the importance — and the joy — of childbirth. This new person will be so important to you as a parent that you will do anything to nurture, protect and give love to this special baby. Undoubtedly, your desire to start that care is reflected in your interest in this book, a guide to starting out a new life in good health for both mother and baby.

Although pregnancy is a normal event, it is marvelously complex, involving changes in mother's anatomy and physiology and in the entire family's relationships. These changes are tiny compared to the miracle of development of a single cell formed from the sperm and egg to a brand-new, one-of-a-kind, important human being. I know of nothing in medicine that is more exciting, fascinating or satisfying to observe.

There has never been a time when there was a better opportunity to start a life in good health, and wisdom dictates that you should seek information from people you can trust. This book is a compilation of expertise from many viewpoints and approaches to care. Mayo Clinic has at the core of its greatness an approach to every medical issue by a team of caregivers, each with special insight and gifts. This book reflects that philosophy. Not only does it come to you from a team of obstetricians with specialized medical knowledge related to problems of pregnancy, but Mary Murry, C.N.M., is the principal co-editor, lending the wisdom and experience of a scientifically grounded midwife to its pages. This team has brought its multiple skills to bear to help you have a healthier, happier pregnancy.

It is our sincere wish that you find this book informative, helpful and meaningful as you anticipate your new baby. It is our hope that your need for solid information is met in its pages. It is also our hope that your pregnancy will be a wonderful experience, and your new baby will have the blessing of good health.

Roger W. Harms, M.D. Editor in Chief

contents

Part 1: Pregnancy, childbirth and your newborn 1

Introduction Preparing to have a baby 3

Before pregnancy: Giving baby the best 3

Nutrition: Make every bite count 4

Exercise: Pace it for pregnancy 17

Lifestyle: Living for two 20

Medications: Take with care 25

Work: Plan ahead 27

Pregnancy timing: Does age matter? 35

Chapter 1 Month 1: Weeks 1 to 4 43

Your baby's growth 43

Your body 48

Your emotions 52

Appointments with your health care provider 54

When to call a health care professional 56

Chapter 2 Month 2: Weeks 5 to 8 57

Your baby's growth 57

Your body 60

Your emotions 63

Appointments with your health care provider 65

When to call a health care professional 70

Chapter 3 Month 3: Weeks 9 to 12 71

Your baby's growth 71

Your body 73

Your emotions 75

Appointments with your health care provider 76

When to call a health care professional 77

Chapter 4 Month 4: Weeks 13 to 16 79

Your baby's growth 79

Your body 81

Your emotions 86

Appointments with your health care provider 86

When to call a health care professional 88

Chapter 5 Month 5: Weeks 17 to 20 93

Your baby's growth 93

Your body 95

Your emotions 98

Appointments with your health care provider 99

When to call a health care professional 100

Chapter 6 Month 6: Weeks 21 to 24 103

Your baby's growth 103

Your body 105

Your emotions 108

Appointments with your health care provider 109

When to call a health care professional 110

Chapter 7 Month 7: Weeks 25 to 28 113

Your baby's growth 113

Your body 114

Your emotions 117

Appointments with your health care provider 117

When to call a health care professional 120

Chapter 8 Month 8: Weeks 29 to 32 123

Your baby's growth 123

Your body 124

Your emotions 128

Appointments with your health care provider 129

When to call a health care professional 130

Chapter 9 Month 9: Weeks 33 to 36 133

Your baby's growth 133

Your body 134

Your emotions 140

Appointments with your health care provider 141

When to call a health care professional 143

Chapter 10 Month 10: Weeks 37 to 40 145

Your baby's growth 145

Your body 147

Your emotions 150

Appointments with your health care provider 151

When to call a health care professional 152

Chapter 11 Labor and childbirth 155

Making those final preparations 155

How your body prepares for labor 160

Is it time to go to the hospital? 166

The stages of labor and childbirth 167

What you can do as the labor coach 180

Chapter 12 Caesarean birth 187

Why a Caesarean birth might be necessary 187

Risks of Caesarean birth 192

Managing anxiety about Caesarean birth 194

What you can expect during a Caesarean birth 195

Recovery from Caesarean birth 200

Post-Caesarean restrictions 204

Possible post-Caesarean complications 205

Chapter 13 Your newborn 207

Your baby's appearance 208

Initial health care for the newborn 212

Common newborn problems 215

The premature newborn 217

Chapter 14 Taking your baby home 225

Your baby's world 225

Baby-care basics 235

Bringing home babies: Twins or more 250

Chapter 15 Postpartum care for moms 251

Breast care 251

Healing from an episiotomy or tear 253

Fatigue 254

Bowel and urination problems 254

Afterpains 256

Other postpartum changes 257

Weight loss 258

The postpartum checkup 259

Emotional and lifestyle changes 260

Part 2: Decision guides for pregnancy, childbirth and parenthood 267

Understanding genetic carrier screening for prospective parents 269

Choosing your health care provider for pregnancy 277

Understanding prenatal testing 289

Trying again after a pregnancy loss 315

Managing travel during pregnancy 321

Understanding pain relief choices in childbirth 325

Considering vaginal birth after Caesarean birth 345

Exploring elective Caesarean birth 351

Considering circumcision for your son 355

Choosing your baby's health care provider 359

The breast or the bottle? 363

Contraceptive choices after delivery 389

Returning to work 401

Thinking about when to have another child 407

Part 3: Pregnancy reference guide 413

Alphabetical listing of the common concerns and questions of pregnancy, including self-care tips and advice on when to seek medical help 415

Part 4: Complications of pregnancy and childbirth 505

Maternal health problems and pregnancy

Asthma 507

Cancer 508

High blood pressure 511

Depression 512

Diabetes 513

Epilepsy 515

Gallstones 517

Heart disease 518

Hepatitis B 519

Herpes 520

hiv/aids 521

Hyperthyroidism 522

Hypothyroidism 523

Immune thrombocytopenic purpura 524

Inflammatory bowel disease 525

Lupus erythematosus 526

Phenylketonuria 527

Rheumatoid arthritis 528

Sexually transmitted diseases 528

Sickle cell disease 530

Uterine fibroids 531

Problems during pregnancy

Preterm labor 533

Pregnancy loss 537

Depression 545

Gestational diabetes 547

Hyperemesis gravidarum 550

Intrauterine growth restriction 550

Iron deficiency anemia 553

Placental abruption 554

Placenta previa 555

Preeclampsia 557

Rhesus factor incompatibility 559

Infections during pregnancy

Chickenpox 561

Cytomegalovirus 562

Fifth disease 563

Group B streptococcus 563

Listeriosis 564

German measles (rubella) 565

Toxoplasmosis 565

Problems of labor and childbirth

Labor that fails to start 567

Labor that fails to progress 570

Assisted birth 570

Complications with the baby 573

Fetal intolerance of labor 577

Postpartum conditions

Deep vein thrombophlebitis 579

Endometritis 580

Mastitis 581

Post-Caesarean wound infection 582

Postpartum bleeding 582

Postpartum depression 585

Urinary tract infection 587

Glossary 589

Index 595

contents

Part 1: Pregnancy, childbirth and your newborn 1

Introduction Preparing to have a baby 3

Before pregnancy: Giving baby the best 3

Nutrition: Make every bite count 4

Exercise: Pace it for pregnancy 17

Lifestyle: Living for two 20

Medications: Take with care 25

Work: Plan ahead 27

Pregnancy timing: Does age matter? 35

Chapter 1 Month 1: Weeks 1 to 4 43

Your baby's growth 43

Your body 48

Your emotions 52

Appointments with your health care provider 54

When to call a health care professional 56

Chapter 2 Month 2: Weeks 5 to 8 57

Your baby's growth 57

Your body 60

Your emotions 63

Appointments with your health care provider 65

When to call a health care professional 70

Chapter 3 Month 3: Weeks 9 to 12 71

Your baby's growth 71

Your body 73

Your emotions 75

Appointments with your health care provider 76

When to call a health care professional 77

Chapter 4 Month 4: Weeks 13 to 16 79

Your baby's growth 79

Your body 81

Your emotions 86

Appointments with your health care provider 86

When to call a health care professional 88

Chapter 5 Month 5: Weeks 17 to 20 93

Your baby's growth 93

Your body 95

Your emotions 98

Appointments with your health care provider 99

When to call a health care professional 100

Chapter 6 Month 6: Weeks 21 to 24 103

Your baby's growth 103

Your body 105

Your emotions 108

Appointments with your health care provider 109

When to call a health care professional 110

Chapter 7 Month 7: Weeks 25 to 28 113

Your baby's growth 113

Your body 114

Your emotions 117

Appointments with your health care provider 117

When to call a health care professional 120

Chapter 8 Month 8: Weeks 29 to 32 123

Your baby's growth 123

Your body 124

Your emotions 128

Appointments with your health care provider 129

When to call a health care professional 130

Chapter 9 Month 9: Weeks 33 to 36 133

Your baby's growth 133

Your body 134

Your emotions 140

Appointments with your health care provider 141

When to call a health care professional 143

Chapter 10 Month 10: Weeks 37 to 40 145

Your baby's growth 145

Your body 147

Your emotions 150

Appointments with your health care provider 151

When to call a health care professional 152

Chapter 11 Labor and childbirth 155

Making those final preparations 155

How your body prepares for labor 160

Is it time to go to the hospital? 166

The stages of labor and childbirth 167

What you can do as the labor coach 180

Chapter 12 Caesarean birth 187

Why a Caesarean birth might be necessary 187

Risks of Caesarean birth 192

Managing anxiety about Caesarean birth 194

What you can expect during a Caesarean birth 195

Recovery from Caesarean birth 200

Post-Caesarean restrictions 204

Possible post-Caesarean complications 205

Chapter 13 Your newborn 207

Your baby's appearance 208

Initial health care for the newborn 212

Common newborn problems 215

The premature newborn 217

Chapter 14 Taking your baby home 225

Your baby's world 225

Baby-care basics 235

Bringing home babies: Twins or more 250

Chapter 15 Postpartum care for moms 251

Breast care 251

Healing from an episiotomy or tear 253

Fatigue 254

Bowel and urination problems 254

Afterpains 256

Other postpartum changes 257

Weight loss 258

The postpartum checkup 259

Emotional and lifestyle changes 260

Part 2: Decision guides for pregnancy, childbirth and parenthood 267

Understanding genetic carrier screening for prospective parents 269

Choosing your health care provider for pregnancy 277

Understanding prenatal testing 289

Trying again after a pregnancy loss 315

Managing travel during pregnancy 321

Understanding pain relief choices in childbirth 325

Considering vaginal birth after Caesarean birth 345

Exploring elective Caesarean birth 351

Considering circumcision for your son 355

Choosing your baby's health care provider 359

The breast or the bottle? 363

Contraceptive choices after delivery 389

Returning to work 401

Thinking about when to have another child 407

Part 3: Pregnancy reference guide 413

Alphabetical listing of the common concerns and questions of pregnancy, including self-care tips and advice on when to seek medical help 415

Part 4: Complications of pregnancy and childbirth 505

Maternal health problems and pregnancy

Asthma 507

Cancer 508

High blood pressure 511

Depression 512

Diabetes 513

Epilepsy 515

Gallstones 517

Heart disease 518

Hepatitis B 519

Herpes 520

hiv/aids 521

Hyperthyroidism 522

Hypothyroidism 523

Immune thrombocytopenic purpura 524

Inflammatory bowel disease 525

Lupus erythematosus 526

Phenylketonuria 527

Rheumatoid arthritis 528

Sexually transmitted diseases 528

Sickle cell disease 530

Uterine fibroids 531

Problems during pregnancy

Preterm labor 533

Pregnancy loss 537

Depression 545

Gestational diabetes 547

Hyperemesis gravidarum 550

Intrauterine growth restriction 550

Iron deficiency anemia 553

Placental abruption 554

Placenta previa 555

Preeclampsia 557

Rhesus factor incompatibility 559

Infections during pregnancy

Chickenpox 561

Cytomegalovirus 562

Fifth disease 563

Group B streptococcus 563

Listeriosis 564

German measles (rubella) 565

Toxoplasmosis 565

Problems of labor and childbirth

Labor that fails to start 567

Labor that fails to progress 570

Assisted birth 570

Complications with the baby 573

Fetal intolerance of labor 577

Postpartum conditions

Deep vein thrombophlebitis 579

Endometritis 580

Mastitis 581

Post-Caesarean wound infection 582

Postpartum bleeding 582

Postpartum depression 585

Urinary tract infection 587

Glossary 589

Index 595

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