A person is considered obese when their body mass index (BMI) is 30 or higher. For people who become pregnant, being obese can increase the risk of many health conditions and complications. You can still have a healthy pregnancy if you are obese. There are things you need to do to manage risks for you and your baby.

Path to improved wellness

Many people who are obese have healthy pregnancies and give birth to healthy babies. However, there are risks to both you and your baby, including:

• Gestational diabetes. This type of diabetes only develops during pregnancy.
• Infection. This can include urinary tract and postpartum infections.
• Preeclampsia. This condition can cause high blood pressure and damage to organs, such as the kidneys.

You may also be at a higher risk for problems during labor and delivery, such as:

• C-section. Obesity during pregnancy can result in more elective and emergency C-sections.
• Labor problems. You are more likely to need to have your labor induced if you are obese. Obesity can also interfere with the use of certain types of pain medication. This can include epidural blocks.
• Overdue pregnancy. Obesity increases the risk that pregnancy will continue beyond your expected due date.
• Pregnancy loss. Obesity can increase the risk of miscarriage.

There is also a higher risk for health problems for your baby when you are obese during pregnancy. These can include birth defects and chronic conditions. Your baby may have an increased risk of developing diabetes or heart disease later in life.

It is important to take steps to manage the health of both you and your baby. If you are obese and pregnant or planning to be pregnant, make sure you:

• Schedule a preconception appointment. Talk to your doctor if you are obese and are planning to get pregnant. They may have you start taking prenatal vitamins. They can also work with you on a plan to reach a healthy weight before becoming pregnant.
• Receive regular prenatal care. See your doctor regularly to monitor for complications. Discuss any medical conditions you may have and ways to manage them during pregnancy.
• Carefully manage your weight. Ask him or her what a healthy weight gain would be during your pregnancy.
• Focus on eating a healthy diet and working physical activity into your day. During pregnancy, you’ll need more calcium, folic acid, iron, and other essential nutrients. A daily prenatal vitamin can help fill any gaps.
• Discuss special labor and delivery needs with your doctor before giving birth.

Things to consider

If you’re obese, your doctor will closely monitor your pregnancy. They might recommend:

• Early testing for gestational diabetes. Women at average risk of gestational diabetes are usually given a screening test called the glucose challenge test between weeks 24 and 28 of pregnancy. If you’re obese, your doctor might recommend the screening test earlier.
• Delayed fetal ultrasound. Fetal ultrasound evaluates a baby’s growth and development. It is typically done between weeks 18 and 20 of pregnancy. Ultrasound waves don’t easily penetrate abdominal fat tissue. This means that obesity during pregnancy can interfere with the effectiveness of a fetal ultrasound. Ultrasound results might be more detailed if the test is done a few weeks later.
• Fetal echocardiography. Your doctor might recommend a fetal ultrasound that provides a detailed picture of your baby’s heart (called fetal echocardiography) between weeks 22 and 24 of pregnancy. This test is used to check for a congenital heart defect.
• Frequent prenatal visits. Your doctor might recommend more frequent prenatal visits than is typical. This will help them monitor your and your baby’s health.

Questions to ask your doctor

• What are some ways I can manage my weight gain during pregnancy?
• What are the health benefits of losing weight before I get pregnant?
• Am I at risk for any complications after giving birth?

Resources

Centers for Disease Control and Prevention: Pregnancy Complications

ChooseMyPlate.gov: Moms – Pregnancy and Breastfeeding

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What is hepatitis?

Hepatitis is a group of viral infections. It affects your liver and causes swelling. There are three main forms: hepatitis A, B, and C. Though related, each form has its own specific virus. People can get hepatitis from diseases, drug use, alcohol abuse, and poisons.

Hepatitis A is mainly an acute (short-term) disease. People can be cured with or without treatment. Hepatitis B and C often are chronic (long-term) diseases. Hepatitis A and B can be prevented with vaccines. There is no vaccine for hepatitis C.

Path to improved health

Because hepatitis is a viral infection, it is contagious. It is most often transferred through blood or body fluids. It also can be passed from mother to baby at birth. The risk is higher for women who have hepatitis B and C. If you are pregnant and have hepatitis, you should tell your doctor.

The American Academy of Family Physicians (AAFP) recommends that all pregnant women be screened for hepatitis B at their first prenatal appointment. Although the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend screening for hepatitis C in pregnancy, currently the AAFP does not. The AAFP only recommends hepatitis C screening for people who have a high risk of the infection. This includes women who have:

• Used drugs
• Been exposed to needles
• Received a blood transfusion
• Have HIV (human immunodeficiency virus)

A pregnant woman who tests positive for hep B should get a dose of immune globulin (IG). This injection helps to treat the virus and protect your baby. After delivery, the baby should get a dose of IG, as well as the hep B vaccine. The Centers for Disease Control and Prevention (CDC) recommends that all babies receive the hep B vaccine at birth.

Unlike hep B, there is no medicine to help prevent a pregnant woman from passing hep C to her baby. Pregnant women who have hep B or C will receive extra prenatal care. This may include blood tests, liver tests, and medicine to reduce symptoms.

Things to consider

Women who have hep B or C while pregnant can have several problems. One is acute fatty liver. This is a rare disease that affects the liver’s ability to process fatty acids. It often occurs in late pregnancy and can be severe. In these cases, the doctor may want to deliver the baby right away. This allows treatment to start and helps prevent the baby from getting the virus.

Another potential problem is gallstones. These can occur if fluids from your liver build up in your gallbladder. The stones can cause pain, swelling, and jaundice, which is when your skin and eyes turn yellow. If the gallstones are severe, you may need surgery.

Pregnant women who have hep B or C should contact their doctor right away if they have any complications.

Women who use the medicine Rebetron (a combination of the medicines Rebetrol and Intron A) should not try to become pregnant. If you use this medicine and become pregnant, stop taking it and see your doctor. It can cause severe birth defects. It also should not be used by women who breastfeed. Talk to your doctor about other medicines that may be harmful. These include prescriptions and over-the-counter drugs.

Questions to ask your doctor

• How do I know if I have hep B or C?
• What is the cause of my hepatitis?
• If I have hep B or C and am pregnant, what is the best form of treatment?
• Are there any lifestyle changes I should make?
• What is the risk that I will pass the virus to my baby at birth?

Resources

American College of Obstetricians and Gynecologists, Hepatitis B and Hepatitis C in Pregnancy

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There are many things to think about when you’re going to have a baby. One of those is where you’ll go through labor and delivery. A hospital used to be your only choice. Today, women have more options.

Path to improved health

According to the National Institutes of Health, more than 98% of women give birth in hospitals. The rest either give birth at home or in freestanding birth centers. There are advantages and disadvantages to each location.

Hospital

A hospital is the safest place to deliver your baby. Sometimes there can be complications with the birth. A hospital has everything you or your baby might need if this happens.

Different hospitals offer different experiences for labor and delivery. In a traditional hospital birth, you may go through several different rooms. This could include one for labor, one for delivery, and one for recovery. Usually, the babies are brought to your room for feedings and visits. The rest of the time, they stay in a nursery.

Other hospitals have developed more family-centered care. You stay in one room for labor, delivery, and recovery. The rooms are larger to accommodate family members. They are usually furnished more like a home. Your partner can usually stay with you in these rooms. Your baby stays with you, as well. These types of settings are more popular in hospitals today.

You should have your baby in a hospital if:

• You or your baby has problems during the pregnancy
• You have had a premature birth, a cesarean delivery (c-section), or other complicated delivery before
• You have an existing issue, such as gestational diabetes, that makes your pregnancy more complicated
• You are pregnant with twins or multiples
• The baby is in a position that will make delivery more difficult
• You go into labor early
• You are 35 years or older
• You have not gone into labor by 41 weeks

Advantages

• A team of experts is available right away in case something goes wrong.
• You can have pain relief if you need it.
• Emergency services are available for your baby if they are distress after birth.

Disadvantages

• It may be more stressful and less comfortable.
• You’ll have fewer options for delivery.
• You may have more medical interventions that you’d like.
• You might not know the doctor who delivers your baby.
• You will probably have to move rooms or be discharged quickly after birth.

Birth Center

These centers are set up to provide you with more options in your delivery and less medical intervention. Certified nurse-midwives deliver your baby instead of an obstetrician or a physician. They offer more natural options for labor and delivery. They are designed to make you feel more at home. That way your delivery is more of a natural event than a medical one.

You should look for a center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Make sure the center has agreements with a local hospital in case problems come up in labor or delivery.

Birth centers often allow as many people as you wish to attend your delivery. They offer options like Jacuzzi tubs or water births. They also don’t interfere as much with your labor process. You are monitored occasionally instead of being hooked up to machines for constant monitoring. Some women prefer this more natural experience of childbirth.

Advantages

• The surroundings are usually more comfortable than a hospital.
• You’re more likely to know the midwife or doctor delivering your baby.
• You won’t have to move rooms.
• If something goes wrong, you’re still close to a hospital or a team of medical experts.

Disadvantages

• You might have to be transferred to a hospital if there are complications.
• There might not be as many pain relief options. This could include an epidural, which can only be done in a hospital.

Home

Less than 1% of women deliver their baby at home. But it is a trend that has been increasing in recent years. Some women want the comfort of their own home. They also want more control over their childbirth experience. Giving birth at home lowers a woman’s stress, as she is surrounded by everything that is familiar to her. She is free to do what she wants when she wants. A certified nurse-midwife attends to her and delivers the baby.

Advantages

• There will be fewer delivery interventions.
• There will be a greater chance for natural childbirth, and less chance of a c-section.
• You’ll be more comfortable in familiar surroundings.
• You may have a close relationship with your midwife.
• You don’t have to worry about moving rooms or being discharged quickly.

Disadvantages

• If anything goes wrong, you’ll need to be transferred to a hospital. If the maternity ward is full, you might have to go further from home.
• There is increased risk of complications happening, especially if it is your first baby.

Things to consider

There are factors that influence where you can have your baby. These include:

• Where your doctor delivers. Many women choose their provider and then deliver their baby wherever that doctor practices. If you want a birthing center or home birth, you’ll need to find out what providers will deliver in those locations. Then you can choose your doctor.
• What your insurance covers. Some insurance policies may not cover a birthing center or a home delivery. You’ll need to find out what your insurance will cover early in your pregnancy so you can make plans accordingly.
• If your pregnancy is high-risk. This means you are at greater risk of something going wrong during your pregnancy or delivery. Women with high-risk pregnancies should deliver at a hospital. This will ensure there will be back-up services and medical intervention available if something goes wrong.
• Where you live. Some states are friendlier to birthing center or home births than others. Check your state regulations before you decide where to deliver your baby. You may also be limited based on what hospitals or birthing centers are nearby.

Questions to ask your doctor

• Where is the best place for me to have my baby?
• Is a birthing center or home birth safe for me and my baby?
• What facilities do you deliver at?
• Will I have a say in how much monitoring or intervention is done?
• Will I have to change rooms?
• Can my partner stay with me?
• Can my baby stay with me all the time?
• Will I have to share a room with another new mother?

Resources

American Academy of Family Physicians: Having a Baby Outside of a Hospital: What you Need to Know

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If you are pregnant, it’s important to take precautions against viral infections. A viral infection is a contagious illness. Most viruses will not hurt your baby. However, some viruses can cause miscarriage or birth defects. A virus can affect your respiratory tract (breathing) and can cause other symptoms. The flu and the common cold are examples of viral infections. Other examples are:

• Chickenpox (varicella)
• Fifth disease
• Cytomegalovirus
• Rubella (also called German measles)
• Zika virus
• COVID-19

Pregnant women can be exposed to people with viral infections. They spread directly through touching, kissing, or sexual activity. You can also get them indirectly, through coughing or sneezing. They can spread through contact with infected surfaces, food, and water. Just being exposed doesn’t mean you will become sick.

Path to improved health

Contact your doctor right away if you are pregnant and exposed to someone who has a viral infection. The doctor will want to know which virus and what type of contact you had. They also may ask about your symptoms.

Here are some questions your doctor may ask:

• Did you touch or kiss the infected person?
• How long were you in contact with the infected person?
• When did the infected person get sick?
• Did a doctor diagnose the infected person’s illness? Were any tests done?

What if I’m exposed to influenza?

Influenza can be more serious for pregnant women. You may get very sick. However, it hardly ever causes birth defects in the baby. If you are pregnant during flu season (October through March), you should get a flu shot.

What should I do if I’m exposed to chickenpox?

Chickenpox is caused by the varicella virus and is highly contagious. It can be serious during pregnancy. Sometimes, chickenpox can cause birth defects. If you have had chickenpox in the past, it is unlikely you will catch it again. If you have not had it or if you are not sure, see your doctor. Your doctor will test your blood to see if you are immune.

Many people who don’t remember having chickenpox are immune. If your blood test shows that you are not immune, you can take medicines to make your illness less severe and help protect your baby from chickenpox.

What should I do if I’m exposed to fifth disease?

Fifth disease is a common virus in children. About half of all adults are sensitive to fifth disease and can catch it from children.

Children who have fifth disease often get a rash on their body and have cold-like symptoms. Their cheeks may be red and look like they’ve been slapped or pinched. Adults who get fifth disease do not usually have the “slapped cheek” rash. Adults will often have very sore joints.

If you get fifth disease early in your pregnancy, you could have a miscarriage. It also can cause birth defects in your baby, such as severe anemia. Call your doctor if you are exposed to fifth disease. Your doctor may have you take a blood test to see if you’re immune. You also may need an ultrasound exam to see if the baby has been infected.

What if I’m exposed to cytomegalovirus?

Cytomegalovirus usually doesn’t cause any symptoms. This makes it hard to know if you have it. It is the most common infection that can be passed from mother to baby. Cytomegalovirus affects 1 of every 100 pregnant women. It can cause birth defects, such as hearing loss, development disabilities, or even death of the fetus.

It’s important to prevent cytomegalovirus because there is no way to treat it. Women who work in day care centers or a health care setting have the highest risk of getting infected. Pregnant women with these jobs should wash their hands after handling diapers and avoid snuggling or kissing the babies. If you think you’ve been exposed to a person who has cytomegalovirus, see your doctor right away.

What if I’m exposed to rubella?

Since 1969, almost all children have had the rubella vaccine, so it is a rare disease today. At the first prenatal visit, all pregnant women should be tested to see if they are immune to rubella. Women who are not immune should get the vaccine after the baby is born. Talk to your doctor if you are trying to become pregnant. Then you can get the vaccine in advance if you are not immune.

Symptoms of rubella in adults are joint pain and a possible ear infection. The virus can cause severe birth defects or death of the fetus. Talk to your doctor if you have these symptoms or have been exposed.

What if I’m exposed to measles?

Measles (also called rubeola) is a serious respiratory illness that affects the lungs and breathing tubes. It also causes a rash and a fever. It is one of the most contagious diseases there is, and it can be spread to others very easily. In rare cases, it can be deadly. If you are thinking of becoming pregnant or are pregnant, talk to your doctor about a measles vaccination. If you are traveling, you are at a higher risk of getting measles. One person infected by measles can infect 9 out of 10 of their unvaccinated close contacts. Many countries and popular travel destinations have experienced measles outbreaks in recent years. Most were among children who had not received measles-mumps-rubella (MMR) vaccine. To prevent measles infection and prevent its spread, all U.S. residents should be up to date on their MMR vaccinations, especially prior to international travel regardless of the destination.

What if I’m exposed to Zika virus?

The Zika virus is a travel-related virus that can cause birth defects if a woman is exposed during pregnancy. Zika outbreaks have been reported in South America, Central America, and North America. The virus can cause microcephaly (the baby’s head and brain are smaller than normal. This causes an intellectual disability).

The infection is transmitted through an infected mosquito bite or is passed to a woman through sexual contact. Women who are pregnant or hope to become pregnant should avoid travel to these regions and use a condom during sex if your partner has traveled to the area. Your doctor will tell you how long you must wait before trying to become pregnant if your partner has been exposed to the virus.

Things to consider

Most other viruses do not seem to increase the natural risk for birth defects. This includes viruses such as regular measles, mumps, roseola, mononucleosis, and bronchiolitis. In normal pregnancies, the risk of serious birth defects is 2% to 3%.

To protect yourself from all infectious viruses:

• Wash your hands frequently, especially after using the restroom or before a meal.
• Avoid contact with people who are sick, infected or in close contact with others who are.
• Get a flu shot and other vaccines either before or during pregnancy, as needed.

Contact your doctor right away if you have been exposed to an infected person or have symptoms of a virus. They can provide treatment, if possible, and monitor your baby for signs of infection.

Questions to ask your doctor

• How do I know if I’ve been exposed to someone infected with a virus?
• What can I do to prevent exposure?
• How do I know if I’m immune to certain viruses?
• At what point should I get a flu shot?
• Are there any other vaccines I should get before or during pregnancy?

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Some people choose to pump and store their breast milk. You may decide to do this when you return to work after maternity leave. Or you may want to pump so that your partner can feed the baby breast milk. Whatever the reason, pumping allows you to continue to feed your baby breast milk through a bottle. You can buy or rent an electric or hand-operated breast pump to use. Some hospitals and insurance plans provide one for free.

Path to improved health

Pumping breast milk

When should I start to pump?

If you plan to pump when you return to work, start practicing 1 or 2 weeks in advance. This helps you learn how your pump works. You can pump right after your baby eats or between feedings. Or you may prefer to pump from one breast while you feed your baby from the other.

Starting at home also helps you build a collection of breast milk. You can store it for your baby’s feedings when you return to work.

How much milk will I get when I pump?

You may not get much milk when you first start pumping. This will change as you continue to pump regularly. Your breasts will begin to make more milk. The more often you pump, the more milk your breasts make. Drink lots of fluids to stay hydrated. This will also help your milk supply.

How long should I pump each time?

It takes about the same time to pump milk as it does to breastfeed. With practice, you may be able to pump in as little as 10 to 15 minutes. While you are at work, try to pump as often as your baby usually feeds. This may be every 3 to 4 hours for 15 minutes each time. To keep up your milk supply, give your baby extra feedings when you are together. You also can pump right after your baby feeds to help your breasts make more milk.

Will there be times that my baby needs more milk than I have ready?

Yes, your baby needs more milk during growth spurts. These occur at about 2 weeks and 6 weeks of age and again at about 3 months and 6 months of age. The best way to increase your milk supply for a growth spurt is to breastfeed or pump more often.

Storing breast milk

How should I store my breast milk?

There are a couple of ways you can store breast milk. You can use a plastic or glass bottle with a sealable top. Or you can use a sterile, sealable bag. Store your breast milk in the amount your baby consumes in a feeding. This way, you don’t waste any milk. For example, if your baby eats 4 ounces in a feeding, put 4 ounces of breast milk in the storage container. Always put a date on the container of breast milk so you know how long to keep it.

Where should I store my breast milk?

Store your pumped breast milk in a refrigerator or cooler with ice as soon as possible. You also can freeze the milk if you aren’t going to use it right away.

How long can I store my breast milk?

The life of breast milk varies based on how it is stored.

• At room temperature (less than 77°F), it lasts up to 6 hours.
• In a cooler with ice packs, it lasts up to 24 hours.
• In the refrigerator, it lasts for 3 to 8 days.
• In the freezer, it lasts up to 6 months.

Things to consider

Stored breast milk can vary in color. It can be bluish, yellowish, or brownish. It is normal for breast milk to separate (the fatty part of the milk goes to the top). Shake the bottle or sealed bag and the fat should go back into the milk. If it does not, then the breast milk may be bad. You should smell the milk before feeding it to your baby. Bad milk smells sour. If you still aren’t sure, try tasting the milk. If it tastes sour, then it is bad and needs to be thrown away.

If you choose to freeze breast milk, you need to thaw it before giving it to your baby. There are 2 ways you can thaw the milk:

• Put the container of milk in warm water. Swirl the container around in the water until the milk thaws.
• Put the container of milk in the refrigerator the day before it is to be used.

Thawed breast milk can be refrigerated for up to 24 hours, but it should not be refrozen. Do not use hot water to thaw breast milk. The milk could get too hot and burn your baby’s mouth. Do not thaw frozen breast milk in a microwave. This can damage valuable proteins in breast milk.

Questions to ask your doctor

• How early after birth can I start pumping breast milk?
• How long can I pump and store breast milk?
• What type of bottles should I use to store breast milk?
• What should I do if my baby prefers bottle-feeding to breastfeeding?
• What happens if I accidentally give my baby bad breast milk?
• Can drugs or medicines I take get in my breast milk?

Resources

American Academy of Family Physicians: Breastfeeding: Returning to Work

Office on Women’s Health: Pumping and storing breastmilk

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Lupus is an autoimmune disease. This means your immune system attacks healthy cells and tissue by mistake. Systemic lupus erythemotosus (SLE) is the most common type. If you have lupus and are pregnant or trying to get pregnant, you may worry about how it will affect you and your baby. Most people who have lupus can have normal pregnancies and healthy babies. However, anyone who has lupus and is pregnant is considered to have a “high risk” pregnancy. It is important to plan ahead and get adequate medical care before, during, and after your pregnancy.

Path to improved health

If you have lupus, the best time to get pregnant is when your disease is under control or in remission (for at least 6 months). Tell your doctor that you are interested in trying to get pregnant. Your doctor may want to do blood and urine tests. These tests can help your doctor know what to watch for during your pregnancy.

Talk to your doctor about any medicines you are taking before you get pregnant. Some medicines used to treat lupus are safe during pregnancy. Some are not. Your doctor may change some of your medicines. Your doctor may also recommend that you take new medicines that can help prevent problems during pregnancy.

After you get pregnant, be sure to get regular prenatal care. Tell your doctor about any lupus symptoms you may have. Your doctor will want to monitor you very closely during pregnancy so that any problems can be identified and treated early.

Most people who have lupus deliver healthy babies. However, lupus can increase your risk of certain problems during pregnancy, including:

• Elevated blood pressure. This could lead to gestational hypertension or pre-eclampsia. Symptoms may include a sudden increase in blood pressure, fluid retention with leg swelling, or large amounts of protein in the urine.
• Blood clots. Blood clots can interfere with the supply of oxygen and nutrition that the placenta delivers to the baby. Blood clots can also put your health at risk.
• Early delivery (premature birth). Pregnancy-induced hypertension or blood clots that affect the placenta can increase the risk for premature birth.
• People who have lupus while pregnant are at higher risk of miscarriage (about 10%).

If you get pregnant while you have symptoms of lupus, you may be at greater risk of having problems. You may need additional monitoring if:

• Your kidneys, heart, or lungs are affected by lupus
• You have high blood pressure
• You had problems during a previous pregnancy
• You have certain proteins in your blood that could cause complications

Lupus is not hereditary, or passed down in genes. However, lupus does seem to appear in certain families. A very small number (about 3%) of babies born to individuals who have lupus have neonatal lupus. Neonatal lupus is not the same as lupus in adults. It appears to be caused by proteins in your blood that pass to the baby at birth.

Most of the symptoms of neonatal lupus go away during the first few months of a baby’s life. These symptoms may include a rash on the face, head, and chest, liver problems, or abnormal blood cell counts. Rarely, babies who have neonatal lupus may have a heart problem that affects the heartbeat. This problem can be serious, but it is treatable.

Things to consider

Pregnancy is considered high risk for people who have lupus. Individuals who have high blood pressure, lung disease, heart failure, chronic kidney failure, kidney disease, a history of stroke, or a history of preeclampsia may be at higher risk. People who have lupus and are pregnant are more likely to develop high blood pressure, diabetes, or kidney problems, especially if they take corticosteroids during the pregnancy.

Flares (when symptoms get worse, or “flare up”) of lupus are uncommon during pregnancy. They can occur anytime during pregnancy and are typically mild. Flares are often easily treated with steroids. The most common signs and symptoms of flares include arthritis, rashes, and fatigue.

Your doctor will monitor your lupus symptoms and progress during labor and delivery. They may want you to have a cesarean section (C-section) if you or your baby are having any problems that could worsen during the stress of a vaginal birth.

If you are pregnant and have lupus, you should also plan for support after the birth. It’s hard to tell how you might feel after delivering your baby. Some people may experience a flare of symptoms during pregnancy or in the weeks or months after delivery. Put a plan into place just in case you need it. Ask your spouse or partner, family members, and friends for help and support.

Questions to ask your doctor

• Are the medicines I’m taking safe during pregnancy?
• Are there new medicines I should be taking?
• Will my lupus medicines be safe to take while breastfeeding?
• Are there any symptoms that may get worse during or after pregnancy?

Resources

Centers for Disease Control and Prevention: Having a Healthy Pregnancy with Lupus

March of Dimes: Chronic Health Conditions and Pregnancy

U.S. Department of Health & Human Services, Office on Women’s Health: Pregnancy and lupus

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Your body has just done one of the most remarkable things it will ever do: grow another human being. After 9 months of waiting, you are probably excited to finally be home with your new baby. Much of your focus and energy during the coming weeks and months will be on baby but remember that you also need to take care of yourself, too.

Your delivery may have been complicated or easy. You may have had a cesarean birth (C-section) or vaginal delivery. You may have labored for a few hours or a few days. No matter what your delivery looked like, your body has been through a trauma. It is going to need time to recover.

Your postpartum recovery won’t be just a few days. Fully recovering from pregnancy and childbirth can take months. Although many women feel mostly recovered by 6-8 weeks, it may take longer than this to feel like yourself again. During this time, you may feel as though your body has turned against you. Try not to get frustrated. Remember that your body is not aware of your timelines and expectations. The best thing you can do for it is rest, eat well, and give yourself a break.

During this time, your hormones also will be fluctuating. You may not be thinking clearly and will be more emotional. Again, give yourself time for this to pass. However, if at any time you think about hurting yourself or your baby, tell someone. Or call 988, the Suicide and Crisis Lifeline.

Path to improved health

It took the better part of a year to grow and have a baby. Take comfort in knowing that, for the most part, you will begin to feel like yourself much sooner than that. In a few months, you should be well on your way to recovery.

That is not to say that postpartum recovery won’t have its challenges. It is very common to feel as though your body is not healing as quickly as you’d like. Remember, the more you can rest your body and let it fully recover, the better you’ll be for it. Even if you can only manage to eat, sleep, and care for your baby, that is enough.

During the first six weeks, pay attention to your body. You’ll be tired and focused on your baby but try to notice changes with your own body. This is very important as you heal.

As you begin to feel better, resist the temptation to do more. Overdoing things at this point can set you back in your recovery. Concentrate on nourishing your body with good foods, drinking plenty of water (especially if you are breastfeeding), and getting enough rest.

If you’ve had a C-section, you’ll have more restrictions about what you can do in the days and weeks following childbirth. Common don’ts include driving and lifting anything heavier than your baby. Your doctor will let you know when you can resume normal activities.

Here is more of what you can expect during your postpartum recovery.

Abdominal pain. As your uterus shrinks back into its normal size and shape, you will feel pain in your abdomen (lower belly). These pains are called “afterpains.” Most of these pains will be dull, but some will be sharp. You may feel more of these pains as you breastfeed your baby. That is because breastfeeding stimulates a chemical in your body that causes the uterus to contract (tighten). For many women, applying heat to the area helps control the pain. Consider using a heating pad or hot water bottle. Your abdominal pain should ease up over time. If these pains get worse or don’t let up, you should call your doctor.

Baby blues. You are so excited and happy to bring baby home. The next minute, though, you are sad. It can be confusing, especially to new moms. Know that many women (70-80%) struggle with feeling sad the first few weeks after having a baby. It is commonly called the “baby blues” and is caused by hormone changes. It is nothing to be ashamed of. In fact, confiding in a friend of family member can often make you feel better. If these feelings last more than a few weeks or you are not able to function because of them, you could have postpartum depression. Postpartum depression is more serious than baby blues. If you have severe feelings of sadness or hopelessness or you have thoughts of hurting yourself or others, you should call your doctor immediately.

Constipation. It is very common to be constipated in the days following childbirth. There are several things that could cause this. If you received any pain-relieving drugs in the hospital, they could slow down your bowels. If you had anesthesia (a pain blocker) for any reason, that also can cause it. Sometimes, postpartum constipation is brought on simply by fear. This is true especially if you have stitches because you had an episiotomy (a surgical cut between the vagina and anus to widen the vaginal opening for childbirth) or tore this area during delivery. You may be afraid of damaging the stitches or be afraid that a bowel movement will cause even more pain in that area. To help ease constipation, drink plenty of water and try to eat foods that offer a lot of fiber. In many cases, you may want to talk to your doctor about prescribing a stool softener (such as Colace or Docusoft). If you haven’t had a bowel movement by four days postpartum, call your doctor.

Hemorrhoids. You may have developed hemorrhoids (painful swelling of a vein in the rectum) during your pregnancy. If not, you may have gotten them from the strain and pushing during delivery. They can cause pain and bleed after a bowel movement. They also itch. You can get some relief from the pain and itching by applying witch hazel to your hemorrhoids. This is especially effective if you keep the witch hazel in the refrigerator. Your hemorrhoids should shrink over time. If not, contact your doctor.

Hormonal shifts. Besides fueling your mood swings (see “Baby blues,” above), hormones are also responsible for other postpartum symptoms. You may be sweating more, especially at night when you sleep. Just make sure that your sweating is not accompanied by a fever. That could be a sign of infection. Hormonal changes also cause hair loss for many new moms. This is only temporary. When your estrogen levels increase, your hair will return to its normal thickness.

Perineum soreness. The perineum is the area between your vagina and anus. Many times, this area will tear during childbirth. Other times, your doctor may have to make a small cut in this area to widen your vagina for childbirth. Even if neither of these things happened during your vaginal birth, your perineum will be sore and possibly swollen postpartum. You may feel discomfort in this area for several weeks. While you recover, sitting on an icepack several times a day for 10 minutes will help relieve the pain. This is especially good to do after going to the bathroom. During the first week postpartum, also use a squirt bottle to rinse the perineum with warm water after using the toilet. Notify your doctor if your perineum area does not get less sore each day or you have any sign of infection.

Sore nipples and breasts. The first few days of breastfeeding, it is normal for women to have sore nipples and breasts. If the soreness continues beyond a few days, it could be that the baby isn’t latching correctly. Try changing positions or consult a lactation expert (breastfeeding expert) for help. Do this before your nipples develop painful cracks, which could sideline your breastfeeding. The American Academy of Family Physicians (AAFP) recommends that all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for the first 6 months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year. However, not all women are able to breastfeed for a number of reasons and using formula is fine in those instances.

Stitches or staples. If you have stitches due to a torn or cut perineum (see “Perineum soreness,” above), it will take 7-10 days to heal. The stitches will absorb over time. It is important that you keep the stitches from getting infected by gently cleaning them with warm water after each time you use the toilet. Do this by using a squirt bottle to rinse the area and pat it dry. Do not wipe the area with toilet paper or you could irritate the stitched area. No matter how eager you are to check the healing progress, try to keep your hands off the stitches. If the area begins to hurt worse or the stitches seem weepy, contact your doctor. It could be a sign of infection.

If you have stitches from a cesarean birth (C-section), these heal in varying degrees. The stitches in the skin should heal in 5-10 days. The underlying stitches in your muscle layer will take longer to heal. These won’t completely heal for 12 weeks. For the stitches that you can see, make sure to watch for any signs of infection. These signs include if the incision area is red, swollen, or weeping pus; or if you have a fever. You may have staples on the skin instead of stitches. These can be removed anywhere from a few days to a week after delivery.

Vaginal bleeding and discharge. After giving birth it is common that you will have vaginal bleeding and discharge (this is called lochia), even if you had a C-section. This is your body’s way of eliminating the extra blood and tissue that was used to grow and nourish your baby. Expect for this to be heavier at first (up to 10 days), but then taper off. Light bleeding and spotting can last up to six weeks after delivery. It is important that you use only sanitary pads during this time. Using tampons can introduce bacteria and lead to infection. Also expect to pass some clots, especially the first week. If clots are bigger than a quarter, you should contact your doctor.

Water retention. You may be eager for that swelling you noticed during your pregnancy to go away. It won’t, though, for a while longer. Also known as postpartum edema (swelling), your body will continue to hold on to water because of an increase in a hormone called progesterone. You may notice the swelling in your hands, legs, and feet. It shouldn’t last much longer than a week after delivery. If it does or if it seems to get worse over time, tell your doctor.

Weight loss. If you were hoping for immediate weight loss after your baby was born, you were probably very disappointed. No mother is that lucky, no matter what you read in the tabloids. You can expect to lose about 6-12 pounds (depending on the size of your baby) during the birth. After that, your weight loss will slow considerably. Depending on how much weight you gained during pregnancy (the average is 25-35 pounds), it may take several months to lose the baby weight. For many women, breastfeeding seems to help promote weight loss. Other moms don’t see weight loss associated with breastfeeding. Try to keep your nutrition consistent while you are breastfeeding and do not get frustrated if it takes longer than you’d hoped to lose the weight.

Things to consider

Pay attention to your body after giving birth. If something doesn’t seem right, it probably isn’t. Soreness is to be expected, but too much pain could mean something is seriously wrong. Don’t be so wrapped up in caring for your baby that you ignore your own health.

Just because you’ve made it through delivery, you are not necessarily out of danger for health complications. There are life-threatening problems related to childbirth that can happen days or weeks after delivery.

• Postpartum hemorrhage is rare but can happen. If your postpartum bleeding is filling more than a pad every hour, you should contact your doctor immediately. Without treatment, postpartum hemorrhage can be fatal.
• Headaches that are severe and don’t go away can also signal an underlying problem, especially coupled with high blood pressure. You could be in danger of having a stroke.
• Deep vein thrombosis (a blood clot in a deep vein) is a somewhat uncommon problem (1 in every 1,000 pregnancies) that can occur during or after pregnancy. Symptoms include leg pain or feeling like you have a pulled muscle. Your leg may also be red and hot to the touch. Left untreated, these clots can break away and travel to your lungs. When this happens, it can be life-threatening.
• Postpartum preeclampsia is rare and can develop within 48 hours after childbirth or as late as six weeks after childbirth. It is similar to preeclampsia (also called toxemia), which can occur while you’re pregnant. Both preeclampsia and postpartum preeclampsia cause your blood vessels to constrict (get smaller). This results in high blood pressure and also distresses your internal organs. Sometimes there are no obvious symptoms unless you are monitoring your blood pressure. When you do have symptoms, they may include severe headache, swelling of your hands and feet, blurred vision, pain in the upper right portion of your body, and sudden weight gain. If you suspect you may have postpartum preeclampsia, call your doctor immediately.

When you are recovering from delivery, it is best to err on the side of caution if you feel that something is not right with you or with the baby. You should expect to have some discomfort as you heal. You should not begin to feel worse.

In general, if you have any of these postpartum symptoms, call your doctor.

• Heavy vaginal bleeding that soaks more than one pad per hour or vaginal bleeding that increases each day instead of decreasing
• Passing large clots (bigger than a quarter)
• Chills and/or a fever of more than 100.4°F
• Fainting or dizziness
• Changes to your vision or a severe headache (persistent)
• Painful urination or difficulty urinating
• Vaginal discharge with a strong odor
• Heart palpitations, chest pain or difficulty breathing
• Vomiting
• Incision from C-section or episiotomy is red, weepy (with pus), or swollen
• Abdominal (lower belly) pain that is getting worse or new abdominal pain
• Sore breasts that are red or feel hot to the touch
• Pain in your legs with redness or swelling
• Increase in swelling

Questions to ask your doctor

• How long until I will feel like myself again?
• Why am I still retaining water?
• How many calories should I eat while I’m breastfeeding?
• When can I begin exercising?
• How long should I wait before having sex again?
• Can I get pregnant while I’m breastfeeding?
• Why is my hair falling out?
• Are there foods I shouldn’t eat while breastfeeding?
• Why aren’t I losing weight?
• What are my options for birth control?
• Will my breasts go back to normal?
• Why do I have no interest in sex?

Resources

Centers for Disease Control and Prevention (CDC): Depression Among Women

National Institutes of Health, MedlinePlus: Postpartum Care

Office on Women’s Health: Recovering from birth

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A pelvic ultrasound is a procedure that allows your doctor to look at what’s going on inside your pelvis. This is the space between your hip bones that contains the large triangle-shaped bone at the bottom of your spine (sacrum), your tailbone, bladder, sex organs, and rectum.

Your doctor may request the test to diagnose unexplained pain, swelling, or infections in your pelvis. A pelvic ultrasound is the best test to examine a growth in your pelvis. It helps your doctor determine if the growth is a fluid-filled cyst, a solid tumor, or another kind of lump.

A pelvic ultrasound is a safe procedure that can be a little uncomfortable. The test is performed on men and women of all ages. The ultrasound looks at different things for men and women.

During the test, a trained medical technician will squirt a small amount of warm gel on your skin over your pelvic area. The technician will move a handheld device (called a wand) through the gel and across your pelvis. The technician will monitor the images on a nearby screen and record the images for the doctor. The probe is connected to an ultrasound machine. As the device moves across your pelvis, it produces high-frequency sound waves. Those sound waves create real-time photos and video of the inside of your pelvis. The images look like an X-ray. However, ultrasound technology picks up things that aren’t seen by an X-ray.

Path to improved health

A pelvic ultrasound can be done one of three ways:

• Abdominally (the outer stomach)
• Vaginally (inside a woman’s vagina)
• Rectally (the area between the bottom of your large intestine and your anus).

The approach your doctor recommends for your ultrasound depends on the reason for your test and whether you are a man or a woman. A pelvic ultrasound can be used to look at the bladder for both men and women. Your doctor may recommend a pelvic ultrasound of your bladder if you are having difficulty going to the bathroom. It is used on men and women to guide a doctor during a biopsy procedure (inserting a needle into the pelvis to take samples of fluid or tissue).

A transabdominal ultrasound is commonly used to monitor the development of a baby in pregnant women at or before 14 weeks in their pregnancy. For this type of ultrasound, the technician will squirt a small amount of warm gel onto your stomach and move the probe or wand back and forth over your stomach. It will check the baby’s growth, such as height, the length of the baby’s arms and legs, head size, and more.

This type of ultrasound can check several factors during pregnancy, including:

• How far along the pregnancy is
• The baby’s position in the uterus
• The number of babies the mother is carrying
• The amount of amniotic fluid that surrounds the baby
• The baby’s heart

In some cases, it may be used to screen for certain conditions, such as Down syndrome. A transabdominal ultrasound also can be used to look for tumors in your uterus and other issues related to the female body, whether you are pregnant or not.

A transvaginal ultrasound is only used on women. It uses a specially shaped probe that can fit inside a woman’s vagina. The probe is covered with a latex condom. If you are allergic to latex, tell your doctor. The probe will be inserted into your vagina. If it makes you more comfortable, you can ask to insert it yourself.

This kind of ultrasound is used in early pregnancy to determine how far along a mother is and a due date. This method brings the probe closer to the uterus. This provides a clearer view of a fetus during a mother’s first trimester.

Your doctor may recommend a transvaginal ultrasound for other reasons, including:

• Locating an intrauterine device used for birth control
• Determining the cause of infertility (or to guide your doctor during a fertility treatment or procedure)
• Looking for (ovarian) cysts or other growths in your pelvis
• Determining the cause of abnormal vaginal bleeding or problems with your menstrual period
• Diagnosing unexplained pelvic pain
• Looking for an ectopic pregnancy (when a fertilized egg begins to develop outside of the uterus)

A transrectal ultrasound is used on men. The end of the probe for this type of ultrasound is shaped to partially fit inside a man’s rectum. The end of the probe is covered with a latex condom. This can be used to examine problems with the prostate (the gland that makes semen). It can also look at the glands that secrete some of a man’s semen (seminal vesicles).

Depending upon the type of pelvic ultrasound you are having, preparing may be different. For example, a transabdominal ultrasound to view your bladder requires a full bladder. Your doctor will tell you to drink four to six glasses of water one hour before your test. A full bladder moves your intestines aside to give the technician a better view.

If you are a woman, your only preparation for a transvaginal ultrasound is to let your doctor and technician know if you are allergic to latex. The same applies to transrectal ultrasounds for men.

Men also may need to take an enema one hour before a transrectal ultrasound to empty their bowels or intestines. This will improve the quality of the ultrasound pictures. For a prostate biopsy, men may be required to take an antibiotic to protect against an infection.

Tell your doctor if you had an X-ray that included a dye two days before the pelvic ultrasound. The dye will remain in your intestines and prevent the technician from getting quality photos and videos.

In all pelvic ultrasounds, you will be asked to put on a light hospital gown. This makes it easy for the technician to access your pelvis. You will lie on your back unless the technician needs you to turn to get a better picture. The procedure usually takes about 30 minutes. Your doctor or doctor’s office will call you with the results one to two days after the procedure. You might have mild discomfort from the pressure of the probe on your belly or near where the probe was inserted. Your body is not exposed to radiation during a pelvic ultrasound.

Things to consider

A pelvic ultrasound involves time and expense. It’s possible you may have to repeat the procedure because the first test didn’t produce clear photos. This can happen for several reasons:

• Being severely overweight may prevent the ultrasound from seeing deep enough into your pelvis
• Not having a full bladder
• Not having empty bowels, intestines, or rectum
• Having excess gas in your intestines (which blocks the view of your pelvic organs)
• Moving too much during the procedure
• Having an open wound in your belly

You may also have to repeat the procedure if you are undergoing fertility tests and treatment, which requires regular ultrasounds.

Repeat ultrasounds may also be needed if your doctor discovers a lump in your pelvis that requires further testing. Your doctor may require you to repeat the test in six to eight weeks to see if the lump has changed in size or appearance.

If you are a man, you may have to repeat a pelvic ultrasound of your prostate if your prostate is larger than normal. In that case, an ultrasound may not be an option. You may have to undergo a digital rectal exam (when your doctor inserts his glove-covered finger into your rectum), a blood test, or a biopsy.

Because they are done inside your body, there is a slight risk of infection with transvaginal and transrectal ultrasounds. See your doctor if you have abnormal discharge or fever after your ultrasound.

Questions for your doctor

• Will the probe from a transvaginal ultrasound harm my pregnancy?
• Should I take an over-the-counter pain reliever before I have a transvaginal or transrectal ultrasound to ease the discomfort?
• What else do I need to know to prepare for the test?

Resources

National Institutes of Health, MedlinePlus: Pregnancy Ultrasound

National Institutes of Health, MedlinePlus: Transvaginal Ultrasound

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Genes are found in chromosomes and are made up of DNA. We inherit genes from our parents. Our gene structure dictates how our body grows and regulates. When genes are normal, they work properly. When genes are abnormal or damaged, they can lead to disease. These are called gene mutations, or changes. Some changes run in families. These happen by chance and are called hereditary or inherited diseases and conditions. A gene mutation can be the sole cause of disease. However, most diseases occur from a mix of genetic and environmental factors.

Genetic testing looks at your genes to check for any mutations. The test is done with a blood, saliva, or tissue sample. There are several reasons why you might do genetic testing.

• To diagnose a disease or a type of disease
• To determine the cause of a disease
• To determine treatment options for a disease
• To find your risk of getting a certain disease that possibly can be prevented
• To find your risk of passing a disease to your children
• To screen your embryo, fetus, or baby

Path to well being

Talk to your doctor if you think you are at risk for an inherited disease. They may refer you to a genetic counselor, who can review your family history and provide advice. They will ask you questions about your health and the health of your blood relatives. This information can calculate what your risk may be. It can help you decide whether you want to get testing. It also may determine if your insurance will pay for the testing.

If one of your family members already has the disease, they should get genetic testing first. This will show if their disease was passed down or occurred by chance. People from different ethnic groups are often more at risk of certain diseases.

A positive test result means that you have the gene mutation. This increases your risk of the disease. However, it does not guarantee you will get the disease. It does mean you could pass the mutation to your children.

A negative test result means that you don’t have the gene change. This may mean the disease doesn’t run in your family or wasn’t passed down to you. A negative result does not guarantee you won’t get the disease. It means that your risk of the disease is the same as it is for other people.

Common conditions and diseases that benefit from genetic testing include:

• Colon cancer (Lynch syndrome)
• Breast cancer (BRCA gene)
• Down syndrome
• Cystic fibrosis
• Tay-Sachs disease
• Sickle cell disease
• Spina bifida
• Turner syndrome
• Von Willebrand Disease
• Albinism
• Duchenne muscular dystrophy

There are others and more are becoming available as research advances.

Things to consider

Genetic testing has pros and cons. These can change depending on your situation. Keep in mind that genetic testing is a voluntary choice. You should not feel forced to do it.

Some benefits of genetic testing include:

• You might be less worried about getting a certain disease.
• You might be able to change your lifestyle to reduce your risk.
• You might know how to move forward with family planning.
• You might be able to get treatment to prevent the disease. This could include medicine or surgery.
• Your doctor will know how often to screen for the disease.

There also are reasons you might not want genetic testing done. These are mainly emotional or financial.

• You might be more worried about getting a certain disease.
• You might feel angry, guilty, or depressed.
• It could lead to problems with your employer or insurance company.

Questions to ask your doctor

• How do I know if I should see a genetic counselor?
• If my genetic testing result is positive, what is my risk of getting the disease? What can I do to prevent or treat it?
• Should my genetic testing be done in a clinical setting or can I do it from home?

Resources

Centers for Disease Control and Prevention: Genetic Testing
National Cancer Institute: Genetic Testing for Inherited Cancer Susceptibility Syndromes
National Human Genome Research Institute: Genetic Testing FAQ

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