40 weeks: Your baby's development in depth and what to do to keep him healthy.
From the minute you have a positive pregnancy test, you're counting the days until you meet your baby. All the while, there's a lot happening behind the scenes. This timeline will provide you with a week-by-week look at what's going on with you and your baby, as well as reminders about what you can do at every stage to have the healthiest pregnancy possible.
Weeks 1-3 First things first
If you even think you might be pregnant, quit any risky behaviors, such as using recreational drugs, smoking or drinking alcohol, and start limiting your caffeine intake to no more than 200 milligrams daily (about two cups of regular coffee). But perhaps the most important thing you can do is start taking a daily prenatal vitamin with at least 400 micrograms of folic acid (many experts recommend 600 micrograms or even more; check with your doctor). Ideally, you should take it for at least a month before you conceive; doing so will help protect your baby against neural-tube defects such as spina bifida. (Here's expert advice to help you choose a good one fitpregnancy.com/prenatalvitamins.)
If you're using any prescription medications, do not stop them without talking to your doctor or midwife; many conditions, such as asthma and diabetes, require treatment throughout pregnancy. Otherwise, don't take any meds, prescription or over-the-counter, without checking with your caregiver. (That includes herbal remedies.) Exception: Very high doses of vitamin A can cause severe birth defects, so as soon as you find out you're pregnant (and preferably before you get pregnant), discontinue all treatments that contain vitamin A or its derivatives, such as Retin-A. Also avoid chemicals, including your pet's flea treatments, and secondhand smoke from here on out.
A note about folate and folic acid Folate is the naturally occurring form of folic acid that's found in foods; folic acid is the synthetic form added to vitamins and fortified foods. It can be hard to get the full requirement of folate from foods alone, which is why folic acid is included in prenatal vitamins. Regardless of form, this B vitamin is one of the most important nutrients for pregnancy, especially early on. (Learn more at fitpregnancy.com/findingfolate.)
Develop an exercise habit Experts recommend that pregnant women exercise for at least 30 minutes on most, if not all, days of the week. Doing so can help reduce backaches, swelling and constipation and help you avoid excessive weight gain; it may also help prevent gestational diabetes. The children of women who exercised during their pregnancies enjoy lifelong benefits, too. Whatever kind of exercise you choose, work out only so hard that you can carry on a conversation without being winded. Also be sure to stop immediately and call your doctor if you become dizzy, experience calf pain or swelling, develop a headache, leak amniotic fluid or have vaginal bleeding. (Essential exercise information and weight-gain guidance for pregnant women fitpregnancy.com/exerciseguidelines.)
Weeks 4 -7 Welcome to pregnancy!
Fatigue? Sore breasts? Nausea? Bloating? A frequent need to pee? Any of these may be your earliest pregnancy symptoms. While there's not much you can do about most of these unpleasantries, an extra-supportive bra may help your burgeoning breasts (they may grow by a full cup size within the first few weeks).
If you develop morning sickness, don't worry about it affecting your baby—the majority of cases are completely harmless. In fact, there is some evidence that nausea may actually be a good thing, as it may indicate higher levels of pregnancy hormones and a lower risk of miscarriage. The condition usually lessens or disappears by the beginning of the second trimester; in the meantime, try eating several small meals throughout the day instead of three large ones. Also avoid spicy and fatty foods and smells that bother you. Although scientific evidence is lacking, many women also say they get relief from acupuncture, motion-sickness bands and hypnosis; ginger and lemon also may be helpful. If you suffer from severe or persistent nausea and vomiting, you may become dangerously dehydrated; be sure to alert your doctor or midwife.
[ ] Make an appointment with an OB or midwife now; most want to see you for the first time during weeks eight to 10.
[ ] Start doing Kegel exercises: They help with urinary incontinence, a common problem during and after pregnancy, while preparing your pelvic floor for delivery. Squeeze the muscles around your vagina as if you're stopping the flow of urine. Do several at a time, a few times a day, for the duration of your pregnancy.
Don't forget! Toxoplasmosis is a disease caused by a parasite that can be transferred to the baby and cause lifelong problems with the brain, eyes and heart. The parasite can be passed to pregnant women through the feces of infected cats, though the more typical transmission is through eating undercooked meat. So make sure all meat you eat is well-cooked, and either hand off the litter box duties or wear gloves while cleaning it. (10 top tips on what to eat now to better your baby's future health fitpregnancy.com/rulestoeatby.)
Weeks 8-13 Testing, testing
Your doctor or midwife may look or listen for the fetal heartbeat with ultrasound at your first appointment. In addition to being an exciting milestone, it can be a reassuring one: Once you see or hear the heartbeat, your risk of miscarriage drops to about 2 percent. Your caregiver will also give you your official due date, though very few women actually deliver on that day. Sometime between weeks eight to 10:
[ ] Make an appointment if you're having chorionic villus sampling (CVS), a test that can diagnose Down syndrome and certain other chromosomal defects. Done in weeks 10 to 13, CVS involves removing a small piece of placental tissue via a tube inserted through the cervix or a needle inserted through the uterine wall.
[ ] Make an appointment if you're having first-trimester screening, which assesses your baby's risk for Down syndrome and trisomy 18 (an extra copy of chromosome 18). The test must be done between 11 and 14 weeks and involves taking a blood sample from you and performing a detailed ultrasound, called the nuchal translucency, that measures the distance between the soft tissue and the skin in the fetus's neck. The results of the blood work are then combined with the results of the ultrasound.
Here's an in-depth look at the screening and diagnostic tests you might undergo, and how some real couples dealt with the decisions and emotional issues involved fitpregnancy.com/prenataltesting.
Starting at around week 12, your uterus is growing rapidly and has begun to expand outside the protective pelvic bones. In other words, you're probably "showing." From now on, steer clear of any activities that pose the risk of a fall or abdominal trauma (always wear your seat belt!), and avoid lying flat on your back when exercising: The growing fetus can place too much weight on a major vein, risking reduced blood flow to your uterus.
Weeks 14 -22 Second trimester decisions
[ ] Around week 14, make an appointment if you're having second-trimester screening, which assesses your risk for having a baby with Down syndrome, trisomy 18 and neural-tube defects. It consists of a blood test and must be done between 15 and 20 weeks.
[ ] At the same time, make an appointment if you're having amniocentesis, which is most commonly performed between weeks 15 and 22. This test can diagnose chromosomal abnormalities such as Down syndrome, as well as structural abnormalities such as neural-tube defects.
[ ] Start researching what type of childbirth education you're interested in—Lamaze, Bradley, HypnoBirthing and ICEA (the International Childbirth Education Association) are some common types. Classes fill up fast, so sign up early.
[ ] Decide whether you want to find out your baby's sex. Many doctors do a detailed ultrasound between weeks 16 and 20, at which time the gender often can be determined.
Sometime from 16 to 22 weeks you'll start to feel your baby move. It usually takes first-time moms longer to recognize the movements, while women who have been pregnant before typically notice them earlier. Movements are fluttery in the beginning (many moms say they feel like butterfly wings) and progress to full-fledged kicks as your baby grows. (Here's how some moms describe that miraculous moment fitpregnancy.com/firstkick.)
Don't forget! Know the signs of preterm labor. Call your doctor immediately if you notice any of these symptoms:
➜ A change in vaginal discharge, either leaking fluid or bleeding.
➜ A low, dull backache.
➜ Menstrual-like or abdominal cramps, with or without diarrhea.
➜ Uterine contractions that occur every 10 minutes or less. These sometimes can be hard to detect; a good way to tell is if your abdomen hardens and tightens rhythmically.
➜ A feeling of pressure in your lower abdomen or pelvis.
Weeks 23 -28 Pesky problems
Vivid, bizarre dreams may be starting to disturb your sleep. Many experts speculate it's your mind's way of processing the enormity of what it means to become a parent. Don't worry: Dreaming that you've left your newborn in his car seat on the roof of your car indicates you're going to be a conscientious mom.
You may be afflicted with heartburn and leg cramps, both of which are most common at night. Avoid eating late in the evening, and make friends with Maalox or Mylanta. They won't harm your baby, and they can work wonders on the burning in your throat and chest. (Just to be safe, talk to your doctor or midwife first.) To help prevent sleep-disturbing leg cramps, stretch your legs, especially your calves, before going to bed. Also avoid standing or sitting in one position for too long and be sure to load up on fluids, particularly water, throughout the day. If you do get a cramp, straighten your leg, heel first, and wiggle your toes. Better yet, have your partner do it—and ask him to throw in a foot rub while he's at it! (Our trimester-by-trimester sleep guide will help you get the rest you need now fitpregnancy.com/sleepguide.)
Hemorrhoids and constipation may also be setting in. Lucky you! Keep downing the fluids and load up on fiber-rich foods. Talk to your doc about using Preparation H or other products if hemorrhoids are really bothering you. Ditto for stool softeners. Between 2 percent and 10 percent of women develop gestational diabetes, a condition that causes high levels of glucose (sugar) in the blood. Gaining too much weight may be a contributing factor. Your doctor will screen you for it via a simple blood test in weeks 24 to 28 weeks of pregnancy.
[ ] Believe it or not, it's not too early to start looking into child care if you plan to return to work after your baby is born: Day-care centers fill up fast, and nannies can be hard to find.
How much weight should you gain? The American College of Obstetricians and Gynecologists advises most women of normal prepregnancy weight (a body mass index, or BMI, of 18.5-24.9) to gain 25 to 35 pounds; underweight women (BMI below 18.5), 28 to 40 pounds; and overweight women (BMI 25-29.9), 15 to 25 pounds. If your BMI is 30+, talk to your doctor. (Use our tool to calculate your pre-pregnancy BMI. This will give you a starting point for recommended weight gain fitpregnancy.com/bmi.)
Weeks 29-32 Welcome to the third trimester
Start being on the lookout for signs of preeclampsia, a common complication that can lead to serious, even deadly, complications for you and your baby. It can develop any time after the 20th week, though it's most common after week 28, which is why your OB or midwife might want to start seeing you every two weeks around that time. Call immediately if you notice any of the following possible symptoms: changes in vision, including temporary loss of vision, blurred vision or sensitivity to light; decreased urination; dizziness; nausea or vomiting; pain in the upper right abdomen; severe headaches; or sudden weight gain of more than 4 pounds a week.
Braxton Hicks ("practice") contractions often start about now. Unlike true contractions, these do not indicate that labor has started; they usually happen sporadically and do not get closer together. (The lowdown on different types and what they mean fitpregnancy.com/contractions.)
[ ] Ask your doctor about doing fetal kick counts, which help assess your baby's well-being. (Learn how to do them at fitpregnancy.com/kickcounts.)
[ ] Interview labor and/or postpartum doulas, if you'll be using one.
[ ] Call your health insurance provider and find out any requirements it may have about adding a baby to your policy.
] Get a life insurance policy and write a will, if you haven't already.
Be alert for signs of depression: Contrary to popular belief, pregnancy doesn't protect against it. In fact, the rate is the same among pregnant and nonpregnant women: approximately 12 percent. If you suspect you might be depressed (symptoms include fatigue, difficulty sleeping, change in appetite, feelings of despair or hopelessness or crying that won't stop), get help; untreated depression during pregnancy almost always leads to full-fledged postpartum depression. For resources, go to postpartum.net.
Weeks 33-37 Hang in there
Pregnancy may be starting to lose some of its glow. Having your baby shower right about now may give you just the boost you need. When you register, keep it in perspective: All you really need is a car seat, a safe place for the baby to sleep, diapers and some basic baby clothes. Don't go overboard with newborn-size clothing; you don't know how big your baby may be, and tiny outfits are quickly outgrown.
Any time after week 35, the baby may drop lower into your pelvis in preparation for delivery. This should make it easier to breathe, yet your pee breaks will become even more frequent due to the increased pressure on your bladder. Don't cut back on fluids during the day; dehydration can lead to uterine contractions, but do limit your intake in the evening. Your breasts may also start leaking colostrum—your baby's first food—so load up on nursing pads. Plan on weekly OB visits from now on.
[ ] Tour your hospital's maternity floor.
[ ] Look into maternity leave benefits at work.
[ ] Interview lactation consultants and take a breastfeeding class.
[ ] Choose a pediatrician. She'll need to check your baby while still in the hospital.
[ ] Consider doing perineal massage daily. This may reduce the need for an episiotomy.
[ ] Choose a cord-blood bank if you're planning to store your baby's cord blood.
[ ] Organize a support system of friends, family members and/or neighbors to help out when you're home with your new baby.
[ ] Buy several nursing bras and have them professionally fitted, if possible.
[ ] Think about leaving a status sheet at work in case you go into labor unexpectedly.
Weeks 38-40 Home stretch!
A pregnancy is considered full-term beginning at 38 weeks, so pack your hospital bag. Hint: Ask your experienced mom friends what to bring and what to leave home; you might be surprised (and enlightened) by what they have to say. (The 10 must-have items you'll want to be sure to pack fitpregnancy.com/hospitalbag.) Call your doctor or midwife or head to the hospital when your contractions occur every five to 10 minutes or if your water breaks. It's finally time to meet your baby!