Becoming a Mother

If you'’re not already immune, get a measles-mumps-rubella vaccination at least three months before becoming pregnant, the chickenpox vaccine one month before. Get a flu shot if you'’ll be in your second or third trimester during flu season.

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Pregnancy changes everything. In this first installment of our three-part series, we provide a head-to-toe look at the pregnant body, starting with how you need to nurture it even before you conceive.

So sit back, put your feet up and learn how to take good care of your baby’s first home: your own body.

How to get pregnant

Have sex every other day beginning four days before you’re due to ovulate, advises Abraham Shashoua, M.D., chairman of the division of obstetrics and gynecology at Women’s Hospital at Weiss Memorial in Chicago.

Ovulation occurs 14 days before your period starts, so if your menstrual cycle is 28 days long, you ovulate on day 14 (the first day of your period is day 1). You should have intercourse on days 10, 12 and 14. Resist the temptation to have sex every day: Sperm count may decline with daily intercourse. Also, sperm survive in cervical mucus for up to two days. If your cycle is highly irregular, a gynecologist can perform tests to determine whether you’re ovulating. Ovulation-predictor kits (available at drugstores) can help you time intercourse more exactly.

Building a Healthy Baby

Increasing the odds that you give birth to a healthy baby starts several months before you conceive. Siobhan M. Dolan, M.D., assistant medical director of the March of Dimes, recommends the following:

Take folic acid} Women who begin taking 400 micrograms of folic acid supplements daily starting one month before they conceive reduce their risk of having a baby with neural-tube defects, such as spina bifida, by 50 percent to 70 percent.

Treat infections before conceiving} Common health conditions like gum infections and bacterial vaginosis can increase the risk of prematurity and other problems. All infections should be treated and other health issues, such as diabetes, anemia and high blood pressure, should be brought under control before you get pregnant.

Start out at a healthy weight} Weighing either too much or too little can impair fertility and increase your risk of developing pregnancy complications. “The goal is to be neither too heavy nor too light,” Dolan says. Aim for a body-mass index (BMI) of between 20 and 25 before you become pregnant. (A 5-foot-4-inch woman who weighs 145 pounds has a BMI of 25.)

Schedule a preconception visit} Your OB-GYN or midwife will make sure you’re healthy enough to get pregnant and review any prescription drugs you take. If there’s a chance you are at risk for having a baby with sickle-cell anemia, cystic fibrosis or other genetically linked disease, get a referral to a genetic counselor to learn more about your risk and whether there are ways to reduce it.

Clean up your act} Don’t use tobacco (avoid secondhand smoke, too), alcohol or recreational drugs, all of which can contribute to prematurity, low birth weight and birth defects, including mental retardation. Stop using over-the-counter remedies, including herbal supplements, unless they’re approved by your doctor.

Seek support} It’s easier to meet the demands of motherhood when you have a support system in place long before you deliver. Enlist the help of family and friends, meet other women who are considering pregnancy, start practicing stress-relief strategies such as meditation or yoga and get professional help, if needed, for emotional problems.

Exercise Do’s & Don’ts

Exercise strengthens your cardiovascular system; helps control weight gain; reduces stress and fatigue; relieves backaches and other discomforts; helps prevent constipation; makes for better sleep; and tones your muscles, including those needed to push the baby out. “Exercise helps with labor and delivery,” says Edward Jew, M.D., director of the division of obstetrics/gynecology at St. Luke’s Roosevelt Hospital in New York. Most doctors agree that exercise is safe during pregnancy as long as you’re free of certain complications, including bleeding, a history of premature labor or an incompetent cervix. Pregnant women do need to take some precautions, however. Jew offers the following suggestions:

>Don’t overexert yourself During aerobic exercise, work out hard enough to boost your heart rate but not so hard that you’re out of breath for very long. You should be able to carry on a conversation.

>Stick with safe activities Risky types include skiing, outdoor cycling, horseback riding and in-line or ice skating, any of which can cause you to fall, particularly as you get bigger. Landing on your abdomen could dislodge the placenta

and trigger premature labor. Instead, choose activities like walking, jogging, riding a stationary bike, swimming, water aerobics, weight lifting and yoga (for a great prenatal-yoga workout, see “Strength & Serenity” on pg. 88).

>Stay off your back Exercises that require you to lie flat on your back can restrict blood flow to the baby.

>Work with a qualified trainer If you lift weights or start a new activity during pregnancy, find a trainer with special expertise in prenatal exercise.

>Don’t get overheated A too-high temperature will trigger your body to direct blood away from your abdomen, and from the baby, as it works to cool down.

>Stay hydrated Drink plenty of water before, during and after your workout.

>Listen to your body If you feel sore, achy or crampy during exercise, take a break. “Your body will tell you when it’s time to slow down,” Jew says.

Eating & Weight Gain

Pregnancy isn’t a free pass that allows you to eat whatever you want. True, you’re eating for two, but you need only about 300 extra calories a day, says Heidi Reichenberger, R.D., a spokeswoman for the American Dietetic Association. She suggests getting those extra calories from a glass of milk for calcium, some lean protein such as white-meat chicken and an extra fruit or vegetable for fiber.

Aim to gain 25 to 35 pounds if you are beginning your pregnancy at a healthy weight. Try to gain no more than 15 to 25 pounds if you are overweight (you have a BMI, or body-mass index, of 25 or higher); and aim to gain 28 to 40 pounds if you’re underweight (a BMI of 18 or lower).

Things that Happen in Bed

let’s talk about sex} Sex during pregnancy is generally safe, says Mary Herlihy, M.D., an assistant professor of obstetrics and gynecology at the University of Massachusetts Medical School in Worcester. The fetus is well protected from pokes and germs. However, your doctor may want you to abstain if you had a miscarriage in the first or second trimester of an earlier pregnancy, or if you have a history of premature delivery or ruptured membranes, are pregnant with twins or more, or have unexplained bleeding or placenta previa (a condition in which the placenta covers all or part of the cervical opening).

You can keep having sex until you go into labor unless your doctor has told you not to; however, your interest in it may vary widely over the course of your pregnancy. In the first trimester, nausea, hormonal changes, fatigue and breast tenderness can contribute to a decreased libido. Fortunately, it often rebounds with vigor in the second trimester, a time often referred to as the “honeymoon period” of pregnancy. Lovemaking may become more difficult later on as your growing belly gets in the way. Try different positions—on top, on your hands and knees, on your side—or have oral sex. When desire wanes, opt for sensual mutual massages or cuddling instead.

Getting your zzzz’s} One of the first physical changes you may notice after you become pregnant is exhaustion. That extreme fatigue generally subsides somewhat in the second trimester, when, for most women, sleep comes easily and energy increases.

A good night’s rest often proves elusive during the third trimester, however. “You may have a lot of aches and pains that you didn’t have before,” says Joan McCarthy, M.D., assistant professor of obstetrics and gynecology at the University of South Florida College of Medicine in Tampa. And as your belly grows, you’ll find it difficult to lie on your stomach. At the same time, it’s best not to sleep on your back because your uterus can press on the vein that returns blood from your lower body to your heart (the inferior vena cava). Heartburn may wake you up and, thanks to pressure on your bladder from your growing uterus, you’ll likely need to urinate several times a night.

To get more comfortable, lie on your left side with a pillow under your belly and another one between your knees. Or try using either a large body pillow or a “maternity pillow” that supports your back and belly at the same time. Both types are sold online at sites such as www.maternityshoppe.com and www.bigvpillow.com.

How your body changes

Here’s a guide to some of the most common physical changes of pregnancy. Not only are they normal, but most will go away after your baby is born.

Face and head

Changes} Brownish, blotchy patches (melasma, or “the mask of pregnancy”) develop around your eyes, nose and cheeks. Your face may look puffy, particularly in the last trimester (tell your doctor if you have severe swelling). You may become lightheaded as blood volume and vessel size increase and blood pressure decreases.

Relief} Avoid exposure to sunlight. Lie on your left side (so the fetus doesn’t press on a major blood vessel); drink plenty of water and avoid salty foods. Stand up slowly after you’ve been sitting or lying down.

Breasts

Changes} Breast tenderness often is the earliest noticeable change and can continue throughout pregnancy. Breasts may grow two or three cup sizes bigger. Your nipples and areolas may get

darker, veins and stretch marks may appear and skin may feel tight and itchy.

Relief} Wear a soft, supportive bra. Apply moisturizer to damp skin after showering.

Belly

Changes} Nausea and vomiting are common in the first trimester. Acid reflux (heartburn) may start midpregnancy. A dark line (linea nigra) often develops from navel to pubic bone. Skin becomes tight.

Relief} Nibble on crackers or toast before rising from bed; eat smaller, more frequent meals; try acupressure bands and ginger. Take antacids (with doctor’s approval); don’t eat just before bedtime.

Back

Changes} As your uterus grows and your center of gravity shifts, added strain is placed on your lower back, causing pain.

Releif} Get massages from a prenatal-massage therapist; take daily walks; apply heat or ice;

wear low-heeled (not flat), supportive shoes; sleep on your left side; try wearing an abdominal-support garment.

Legs & feet

Changes} Swelling and pain may occur, particularly as your uterus expands. Varicose veins can

develop in the second or third trimester. Painful leg cramps may wake you up at night.

Relief} Limit salty foods; rest with your legs elevated. Avoid sitting or standing for long periods; try support stockings. Stretch legs before going to bed; avoid pointing your toes.

Butt & lower belly

Changes} Constipation can start in the first trimester. Hemorrhoids (swollen veins in the rectum) may develop, particularly if you’re constipated. The need to urinate increases in the first trimester, subsides in the second, then increases again during the third.

Relief} Exercise; drink lots of water; eat foods high in fiber. Take warm baths and use doctor-approved, over-the-counter hemorrhoid creams or pads. Avoid drinking large amounts of water just before bedtime.

What can go wrong Call your doctor if the baby’s movements decrease markedly or if you have any signs of preterm labor. Also call if you experience bleeding or leaking of fluid from your vagina, severe headache, excessive swelling in your face or hands, sudden weight gain, blurred vision or constant and/or severe abdominal pain.

Countdown to delivery

Signs that labor may be starting soon:>Lightening (“dropping”) The baby usually descends into the pelvis two to four weeks before you go into labor. You’ll

typically need to urinate more frequently and will feel pressure on your rectum.

>Expulsion of the mucous plug This can occur anywhere from one to two weeks or just hours before labor—or not at all. When tinged with blood, it’s called “bloody show.”

>Braxton Hicks contractions (aka false labor) This mild, irregular cramping and tightness lasts a few seconds and often starts three to four weeks or more before delivery.

>Water breaking The amniotic-

fluid sac (aka membranes, or “bag of waters”) sometimes ruptures on its own before labor starts, releasing a trickle or gush of warm fluid.

Signs that labor really

is beginning:

>Regular contractions They start occurring closer together; changing positions doesn’t stop them.

>Increase in pain You have difficulty talking.

Call your doctor if:

>Your contractions occur every five to 10 minutes Be sure to time them when they begin so you can be certain.

>Your membranes rupture Have pads handy for your trip to the hospital.

Now you know what to expect of your body while pregnant. In Part 2, learn how your emotions and interactions with others evolve.

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