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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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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Whether you’re actively planning to become pregnant or not, preconception care during your childbearing years is essential. About half of all pregnancies in this country are unplanned. Unplanned pregnancies are at higher risk for preterm birth and low-birth-weight babies.

Preconception care means taking good care of your body and mind during the period when you can have a child. Everybody can benefit from this healthy living lifestyle. So if you’re trying to have a baby or just have an inkling you might want to in the future, here are some things you should focus on.

Path to improved health

The following are important steps to help you get ready for the healthiest pregnancy possible.

Up your folic acid. Folic acid is a B vitamin that our bodies use to make new cells. Folic acid is especially important at times like pregnancy when the cells are dividing and growing rapidly. Getting adequate folic acid can help prevent two common and very serious defects: spina bifida and anencephaly. Both occur as early as 3 to 4 weeks after conception, which is before many women even know they’re pregnant.

• Anencephaly is when a baby is born without the front part of the brain (forebrain) and the thinking and coordinating part of the brain (cerebrum). The remaining parts of the brain are often not covered by bone or skin.
• Spina bifida can happen if the backbone that protects the spinal cord does not form and close properly. This often results in damage to the spinal cord and nerves. It might cause physical and intellectual disabilities that range from mild to severe.

The U.S. Public Health Service and Centers for Disease Control and Prevention recommend that all women of childbearing age (between 15 and 45 years of age) consume 0.4 mg (400 micrograms) of folic acid every day.

Schedule a preconception checkup. It’s important to get any chronic conditions under control before you become pregnant. Identifying them now can help up your chances of having a healthy pregnancy for both you and your baby. Your visit should include discussions of:

• Your medical and family history. If you have certain conditions, such as diabetes, hypertension, asthma, seizure disorders, or maternal phenylketonuria, you’ll need to learn how to manage them during your pregnancy.
• Any vaccines or boosters you may need. Some vaccines can be given during pregnancy, but the rubella (German measles) and varicella (chicken pox) vaccines should be given before you get pregnant.
• All over-the-counter and prescription medicines you take. This includes vitamins, dietary and herbal supplements. Certain medications can cause serious birth defects, so be sure to mention everything you’re taking.

Stop smoking, vaping, using marijuana, and drinking alcohol. All of these can increase the risk for preterm birth, NTDs, fetal alcohol spectrum disorders, and sudden infant death syndrome (SIDS). If you need help to stop, speak to your healthcare provider about what types of support is in your area. You can also call 1-800-QUIT-NOW (784-8669) to be connected to your state’s “quit line.” For help with drug abuse, 1-800-662-HELP (4357) provides referrals to local treatment facilities, support groups, and community-based organizations. Having supports in place will increase your chances of quitting successfully.

Get to a healthy weight. Being overweight can make it more difficult to conceive. It also increases your risk of certain issues during pregnancy, including high blood pressure, gestational diabetes, having a stillbirth, and increasing the chances of needing a cesarean delivery. Shedding the weight before becoming pregnant can help improve your chances of conceiving and delivering a healthy baby.

The Centers for Disease Control and Prevention’s adult body mass index (BMI) calculator can help you determine your BMI and figure out whether you’re in the healthy range. Always talk with your doctor about the best way to achieve your weight loss goals.

Stay away from certain fish. Some fish, including swordfish, tilefish, king mackerel, and shark, contain a metal called methylmercury. Exposure can be harmful to a developing fetus. If you regularly eat these fish, methylmercury can build up in your bloodstream. Stay away from these four fish while you’re thinking of getting pregnant.

Other cooked fish and seafood are fine if you eat a variety of different kinds of fish. Choose up to 12 ounces (2 average meals) a week of fish and shellfish that are lower in methylmercury. These include shrimp, canned light tuna, salmon, pollock, and catfish. Keep in mind, albacore (“white”) tuna has more methylmercury than canned “light” tuna. So, when choosing your 2 meals, you may eat up to 6 ounces of albacore tuna per week.

Things to consider

Genetic counseling may be something you want to think about if certain conditions run in your family or your partner’s family. You also will want to know if a member of your family was born with a genetic condition, birth defect, chromosomal disorder, or cancer. Other reasons to see a genetic counselor include having had trouble getting pregnant, experiencing several miscarriages, infant deaths, or a birth defect with a previous pregnancy. Or if you or your partner are older than age 35.

A genetic counselor can meet with you to discuss potential genetic risks. At your appointment, you’ll discuss your medical, family, and pregnancy history. The counselor will explain what genetic conditions your future children may be at risk for depending on your history and recommend tests that can help diagnose any conditions. Once you gather all the information, you and your partner can make an informed decision about whether genetic testing is right for you.

Questions for your doctor

• What kinds of vitamins should I take that include enough folic acid?
• Are there any foods I shouldn’t be eating while trying to get pregnant?
• Are there any activities I shouldn’t be doing while trying to get pregnant?
• Could any of my current health conditions affect my pregnancy?
• Could any of my history (STDs, miscarriages, abortions) affect my future pregnancy?
• When should I stop using birth control?

Resources

Centers for Disease Control and Prevention: Planning for Pregnancy

National Institutes of Health, MedlinePlus: Steps to Take Before You Get Pregnant

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Finding out you’re pregnant is a life-changing event. You find yourself faced with many new questions and situations you’ve never had to deal with before. There are many decisions you’ll need to make. It can be hard to know what to do.

Path to improved health

Here are some of the questions you’ll face during pregnancy, and some information to help you make decisions.

Will I have the baby?

The first decision you need to make when you find out you’re pregnant is whether you are going to have the baby. This can be a difficult decision. There is a lot to think about. You must make the decision that is right for you. Consider your personal situation and your beliefs. You have several options:

• Continue the pregnancy and raise the baby
• Create an adoption plan to allow someone else to raise the baby
• End the pregnancy

If you’re not sure what to do, talk to someone you trust. This could be your baby’s father, a family member, a friend, your doctor, or a minister or rabbi. Learn about all your options. Getting more information can help you make your decision. It can also help you feel more confident about your decision.

What doctor will I use?

If you decide to continue your pregnancy, the first thing you need to do is find a doctor. There are several types of doctors who can take care of you when you’re pregnant. These include:

• Family doctor. Family doctors provide care for the whole family. Some will provide care for pregnant people, while others may refer pregnant patients to an OB/GYN.
• Obstetrician-gynecologist (OB/GYN). OB/GYNs are medical doctors specially trained to take care of pregnant people and people’s reproductive health.
• Certified nurse midwife. Midwives are trained and licensed professionals who provide comprehensive, family-centered maternity care. They are registered nurses who work with obstetricians.

What kind of doctor you choose may depend on how much risk you have in your pregnancy. If you are at low risk for complications, a family doctor or midwife might be right for you. However, if you have a high-risk pregnancy, you will probably need to see an OB/GYN or other specialist. Problems in high-risk pregnancies include high blood pressure, diabetes, and a history of previous pregnancy complications.

Where will I give birth?

Early in your pregnancy, you’ll want to think about where you want to deliver your baby. A large majority of people deliver their babies in a hospital. This is the safest place to deliver. Several factors will influence where you decide to have your baby. These include:

• Where your doctor delivers. Many people choose their provider and then deliver their baby wherever that doctor practices.
• What your insurance covers. Some insurance policies may not cover a birthing center or a home delivery.
• If your pregnancy is high-risk. People with high-risk pregnancies should deliver at a hospital. This ensures there will be back-up services and medical interventions 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. You may also be limited based on what hospitals or birthing centers are nearby.

Where you want to give birth may also determine who your doctor will be. For example, if you want to use a birthing center or your home to give birth, you’ll need to find a doctor willing to deliver there.

Will I go to all my prenatal appointments?

The best thing you can do for yourself and your baby when you are pregnant is to go to all your prenatal doctor appointments. At these visits, your doctor will check your weight, your blood pressure, and your urine. They will listen to the baby’s heartbeat and measure the baby’s growth. These appointments give your doctor the chance to find out early if there is anything wrong that could endanger you or your pregnancy. It is very important that you go to all your scheduled visits. If your pregnancy is considered high risk because of your age or other health factors, you will likely be required to attend more prenatal appointments.

Will I have prenatal screenings or prenatal diagnosis tests done?

Prenatal screenings and diagnostic tests are tests your doctor performs while you are pregnant. They are done to check for any health problems with the baby before it is born. Problems could include birth defects, genetic disorders such as Down syndrome, or diseases such as cystic fibrosis. Screenings are usually done early in the pregnancy with blood tests or ultrasound. They detect risks for or signs of a possible health problem. Diagnostic tests can confirm or rule out specific health problems in you or your baby.

Most genetic testing is now done through cell-free fetal DNA (cfDNA). For this test, the mother’s blood is taken and the small amounts of fetal DNA found in it are amplified. Then, that genetic material is analyzed to test for fetal genetic disorders. If this test reveals a disorder, your doctor may then want to confirm the diagnosis by doing an amniocentesis. For this test, your doctor will collect a sample of your amniotic fluid.

Screenings and diagnostic tests can be helpful to let you know if your baby might have problems when it is born. But sometimes they can cause added worry or concern. In many cases, prenatal screening is a choice. For example, if your doctor suggests your baby be screened for Down syndrome during your pregnancy, that is a choice. Some screening tests can increase your chance of miscarriage or other problems. Talk to your doctor about the risks and benefits of the tests.

What will I eat while I’m pregnant?

It is important to make healthy choices when you’re pregnant. What you put in your body directly affects your growing baby. You should eat a balanced diet with plenty of lean protein, fruits, vegetables, whole grains, and low-fat dairy. This will ensure that your baby is getting the nutrients it needs to grow. You should also take a prenatal vitamin that contains folic acid. This will help supplement nutrients you may be missing. There are also certain foods you should avoid when you’re pregnant. These include raw fish, raw eggs, unpasteurized milk or soft cheeses, and lunch meat.

It is important that you eat the right number of calories. Too few calories could result in low birth weight and have a negative impact on your baby’s development. Too many calories could result in high birth weight and a more complicated delivery for the baby and you. Talk to your doctor about how many calories you should have each day and how much weight you should gain during your pregnancy.

Don’t drink alcohol or use tobacco or drugs while you are pregnant. Even minor use carries risks for health issues in your baby. These include miscarriage, preterm birth, low birth weight, birth defects, and brain damage. No amount of these substances is safe during pregnancy.

Will I exercise while I’m pregnant?

Exercise is important when you are pregnant. It promotes a healthy lifestyle and can ease some of the discomforts that come with pregnancy. Some people say exercising while you are pregnant makes labor and delivery easier. It does not increase your risk of miscarriage or of delivering your baby early.

Try to get at least 30 minutes of exercise every day. If you were not active before getting pregnant, talk to your doctor before you start. When you do start, start slowly. Drink plenty of water. Avoid playing contact sports or any exercise that could cause you to fall, such as skiing or rock climbing.

Will I take birthing classes?

Taking birthing classes is an important part of preparing for the birth of your baby. They help you develop a birth plan. They can ease your anxiety about the unknowns of labor and delivery. They cover many topics, including the different methods of delivery, how to know if you are in labor, strategies for pain management, breastfeeding basics, and how to care for your newborn at home. Attending these classes is a great way for you and your partner to gain more confidence going into childbirth. Ask your doctor or midwife about classes in your area.

How will I manage my pain during labor?

Pain is often part of the labor and childbirth process. How you want to deal with this pain is an important decision.

You can deal with childbirth pain in a natural way or by using medicine. Most people use a mixture of both. Natural methods of managing your pain include activities such as breathing exercises, relaxation, massage, and forms of distraction. There are also popular methods such as Lamaze and Bradley that can help you deal with your pain without medicine.

Many people who choose to use medicine to help manage their pain get an epidural block. It is the most common form of medicine used in childbirth. It helps numb the lower half of your body so that you don’t feel the strong pain of labor or delivery. There are other forms of pain medicine that can be given in some situations, as well.

Talk with your doctor and create a pain management plan with them early on. This will help you be prepared and know what to expect. But remember that a plan is what you want to happen in a best-case scenario. Sometimes different factors can change the plan. For example, if your labor is progressing rapidly, you might not have time to get the pain medicine you had planned on.

Do I want to breastfeed?

Breastfeeding is a natural process that has many benefits for your baby. It is rich in nutrients. It has antibodies that help protect your baby against infections. It can help prevent sudden infant death syndrome (SIDS). And babies who are breastfed are less likely to have allergies, asthma, diabetes, or become overweight. Breastfeeding also benefits you. It can help you lose weight faster. It can delay the return of your periods. And people who breastfeed have lower risk of type 2 diabetes, breast cancer, ovarian cancer, high blood pressure, and heart disease. Breastfeeding is often the best thing you can do for yourself and your baby.

Do I want my baby boy to be circumcised?

During a circumcision, the foreskin (skin that covers the tip of the penis) is removed. It is usually done 1 to 2 days after birth. Deciding whether to have your newborn son circumcised may be difficult. You will need to consider the benefits and the risks of circumcision. Factors such as your culture, religion, and personal preference may also affect your decision.

It is a good idea to decide before your son is born whether you want him to be circumcised. The American Academy of Family Physicians (AAFP) recommends that parents talk to their family doctor about the potential benefits and risks when making their decision. The American Academy of Pediatrics (AAP) says the health benefits of circumcision outweigh the risks, but not enough to recommend the procedure in all male newborns.

Will I bank my newborn’s cord blood?

One choice that can be confusing in pregnancy is whether you should save your baby’s umbilical cord blood. Researchers have found that the blood in your baby’s umbilical cord is rich in blood-forming cells. These can be used as treatment for people with life-threatening illnesses such as leukemia, lymphoma, or some inherited metabolic or immune system disorders. So instead of throwing that cord blood away, parents can choose to:

• Donate it to a public cord blood bank. This option can help someone you don’t know. Your baby’s cord blood will be stored and listed on a public donation registry. It doesn’t cost anything and can help save lives.
• Save it for a family member who needs it. This is for people who have family members with a disease that may be treated with a cord blood transplant. It is called directed donation. It is usually offered at little to no cost to eligible families.
• Store it in a private bank. This option is like an insurance policy. If your child or any other family member gets sick and needs those cells, you have them stored and available. There are collection and yearly storage fees involved.

Talk with your doctor early on in your pregnancy about saving your baby’s cord blood. There are some steps you’ll need to go through ahead of time if you choose to do it.

Things to consider

You have many decisions to make when you are pregnant. Some of them are relatively simple. Others are more complicated and are harder to make. That is why it is important to know all your options. Do research to make sure you know the pros and cons of each choice. There are many pregnancy books and websites available that can help you learn about your options. It can also help to have a support network. Surround yourself with friends and family members who will support you no matter what you decide. And of course, always talk to your doctor if you have questions or are unsure about what to do.

Questions to ask your doctor

• I have so many questions. Who can I turn to for help?
• Can you recommend any books or websites that might answer some of my questions?
• Can I call your office if I have a question?

Resources

National Institutes of Health, News in Health: Pregnancy and Beyond, Making Healthy Choices for Yourself and Your Baby

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

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Right before birth, most babies are in a headfirst position in the mother’s uterus. Sometimes, the baby is in a bottom-first (or feet-first) position. This is called a breech birth or breech baby. Babies can be breech early in pregnancy. Most of them turn on their own to be headfirst by the time of delivery. As you get closer to your due date, your doctor will be able to tell if your baby is breech. They can check by a physical exam, ultrasound, or both.

Breech babies are more likely in these cases:

• Early, or premature births
• Multiple births (two or more babies)
• An abnormal level of amniotic fluid
• An abnormal shaped uterus

Path to improved health

It’s important to see your doctor regularly throughout your pregnancy. Your doctor can tell if your baby is breech and help plan what to do. There are several ways to try and turn your baby. Your doctor may suggest methods to help turn the baby naturally. These could be the first attempt if it is still early and there are no health problems or concerns. Another option is to do a procedure called external cephalic version (ECV). Or your doctor may want to schedule a cesarean delivery (C-section).

External cephalic version

ECV is one way to turn a baby from breech position to head down position while it’s still in the uterus. The doctor will apply pressure to your stomach to turn the baby from the outside. Sometimes, they use ultrasound as well.

Many women who have normal pregnancies can have ECV. You should not have ECV if you have:

• Vaginal bleeding
• A placenta that is near or covering the opening of the uterus
• A low level of fluid in the sac that surrounds and protects the baby
• An abnormal fetal heart
• Premature rupture of the membranes
• Twins or other multiples pregnancy

ECV usually is done in a hospital toward the end of pregnancy, around 37 weeks. Before the procedure, the doctor will do an ultrasound to confirm that your baby is breech. They also will monitor your baby’s heart rate to make sure it is normal. The doctor may give you medicine to relax the muscles in your uterus. This can help decrease discomfort and increase the success of turning your baby. The medicine may be given as a shot or through a vein (IV). It is very safe, with no risk to your baby.

During the ECV, you will lie down and the doctor will place their hands on your stomach. After locating the baby’s head, the doctor will gently try to turn the baby to the headfirst position.

After the procedure, your doctor will monitor your baby’s heart rate again. If the procedure is successful, you shouldn’t have to stay in the hospital. Your chance of having a normal vaginal delivery is high. However, there is a chance that the baby can turn back around to the breech position. The success rate of ECV depends on several factors:

• How close you are to your due date
• The amount of fluid around your baby
• How many pregnancies you have had
• The weight of your baby
• How the placenta is positioned
• The position of your baby

If the procedure is not successful, your doctor will talk to you about delivery. They will discuss the pros and cons of having a vaginal delivery or a C- section. The doctor may suggest repeating the ECV.

The risks of ECV are small, but include:

• Early onset labor
• Premature rupture of the membranes
• Minor blood loss for either the baby or the mother
• Fetal distress leading to an emergency C-section

Natural methods

Some people look to natural ways to try and turn their baby. These methods include exercise positions, certain stimulants, and alternative medicine. They may help but there is no scientific evidence that they work.

• Breech tilt, or pelvic tilt: Lie on the floor with your legs bent and your feet flat on the ground. Raise your hips and pelvis into a bridge position. Stay in the tilt for about 10 to 20 minutes. You can do this exercise three times a day. It may help to do it at a time when your baby is actively moving in your uterus.
• Inversion: There are a few moves you can do that use gravity to try and turn the baby. They help relax your pelvic muscles and uterus. One option is to rest in the child’s pose for 10 to 15 minutes. A second option is to gently rock back and forth on your hands and knees. You also can make circles with your pelvis to promote activity.
• Music: Certain sounds may appeal to your baby. Place headphones or a speaker at the bottom of your uterus to encourage them to turn.
• Temperature: Like music, your baby may respond to temperature. Try placing something cold at the top of your stomach where your baby’s head is. Then, place something warm (not hot) at the bottom of your stomach.
• Webster technique: This is a chiropractic approach. It is meant to align your pelvis and hips and relax your uterus. The goal is to encourage your baby to turn.
• Acupuncture: This is a form of Chinese medicine. It involves placing needles at pressure points to balance your body’s energy. It may help relax your uterus and stimulate your baby’s movement.

Things to consider

It is not always possible to turn your baby from being breech. Some breech babies can be safely delivered through the vagina, but usually doctors deliver them by C-section. Risks involved with a C-section include bleeding and infection. There also can be a longer hospital stay for both the mother and her baby.

Other risks can occur for breech babies who are born vaginally. These include:

• Injuries during or after delivery
• Separation of the baby’s hip socket and thigh bone
• Problems with the umbilical cord. For example, the umbilical cord can be flattened during delivery. This can cause nerve and brain damage due to a lack of oxygen.

Questions to ask your doctor

• How can I tell if my baby is breech?
• If my baby is breech, does it mean there is something wrong with them?
• What are the benefits and risks of ECV?
• What are my options for delivery if my baby remains in the breech position?
• What are the health risks to my baby and me if they are born breech?

Resources

Medline Plus: Breech Birth

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What is diethylstilbestrol?

Diethylstilbestrol, or DES, is a synthetic (man-made) form of estrogen. Estrogen is a female hormone. DES was given to millions of pregnant women between 1938 and 1971. It was discontinued in the United States in 1971. That is when researchers discovered that it increased some women’s chances of developing cancer. DES was used in other countries until at least the early 1980s.

DES was given to pregnant women to prevent complications during pregnancy. These could include having a miscarriage or giving birth too early. Researchers found that the daughters of the women who used DES were more likely to get a certain kind of cancer of the vagina and cervix (called clear cell adenocarcinoma, or CCA). These women are sometimes called “DES daughters.”

Has DES caused any other problems?

Yes. Women who took DES during pregnancy have a slightly increased risk of getting breast cancer. Daughters of women who took DES during pregnancy also may have a higher risk of breast cancer.

Up to one-third of DES daughters have reproductive tract problems. These problems increase their risk of not being able to get pregnant. They also raise the risk of having a miscarriage or having a baby too early. Even with the increased risk, however, most of these women have no problem getting pregnant and delivering healthy babies.

The sons of women who took DES during pregnancy (sometimes called “DES sons”) have a higher risk of some reproductive tract problems, as well. These can include abnormally small or undescended testicles. However, these men seem to have normal fertility.

Path to improved health

How do I know if I was exposed to DES?

If you were pregnant between 1938 and 1971, try to remember if you may have taken a prescription medicine during your pregnancy. If you did, try to get your medical records from the doctors who took care of you. Remember, DES was used in other countries until the early 1980s.

If you were born between 1938 and 1971, ask your mother if she remembers taking any prescription medicine during her pregnancy.

Things to consider

I took DES during pregnancy. What should I do?

The increase in your risk of getting breast cancer is small. But you should still tell your doctor that you took DES during pregnancy. They will discuss this risk factor with you. They will most likely recommend regular breast screenings and medical exams.

Be sure to tell your children that you took DES during your pregnancy. Encourage them to tell their doctors.

I am a DES daughter. What special health care needs do I have?

Be sure to tell your family doctor that you were exposed to DES.

If you have never had a pelvic exam, your doctor will want you to have one. Your doctor will check your vagina, uterus, cervix, and ovaries for lumps. Your exam may also include a colposcopy. This is an exam in which your doctor uses an instrument (called a colposcope) to magnify the view of the tissues in your vagina and cervix.

It is important to have pelvic exams and Pap smears every year.

I am a DES son. What special health care needs do I have?

Tell your family doctor that you were exposed to DES. Your doctor will recommend that you follow routine health screenings. You also should report any urinary or genital problems to your doctor.

Questions to ask your doctor

• I took DES when I was pregnant. What is my risk of developing cancer?
• I was exposed to DES before I was born. What is my risk of developing cancer?
• How common are these types of cancer?
• What other reproductive problems might I have because of my exposure to DES?
• Can a woman’s use of DES affect future generations beyond sons and daughters?

Resources

National Cancer Institute: Diethylstilbestrol (DES) and Cancer

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Epilepsy is a central nervous system (neurological) disorder. It causes abnormal brain activity and can lead to seizures, unusual behaviors, and loss of awareness. It can usually be managed with medicine. Women who have epilepsy are at higher risk for complications during pregnancy. Regular medical care before, during, and after your pregnancy is important for monitoring these risks.

Path to improved health

Talk to your doctor if you have epilepsy and are planning to get pregnant. They may want to make sure that your symptoms have been well controlled for at least six months before you get pregnant.

It’s very important that you take your antiseizure medicine just as your doctor tells you. If you haven’t had any seizures for 2 years or more, your doctor may want to slowly stop your seizure medicine before you become pregnant or while you are pregnant. However, you should not stop taking this medicine on your own. Your doctor can help you find the right medicine that will have the fewest potential effects on your baby.

As with all pregnant women, it’s also very important for you to take prenatal vitamin supplements and folic acid. It can help prevent certain kinds of birth defects. Start taking these vitamins before you get pregnant to get the most benefit. Your antiseizure medicine may change how your body absorbs folic acid. Your doctor may recommend a type of prenatal vitamin with a higher dose of folic acid.

It is also very important to get adequate sleep to decrease the chances for seizures during pregnancy.

Pregnancy affects each woman who has epilepsy differently. Some women actually experience fewer seizures than normal while pregnant.

However, women who have epilepsy and become pregnant have a higher risk for pregnancy-related complications than pregnant women who don’t have epilepsy. These complications include:

• Vaginal bleeding
• The possibility that your seizures may occur more often
• Preeclampsia (a condition during pregnancy that is a combination of high blood pressure and the presence of protein in the urine after 20 weeks of pregnancy)
• Separation of the placenta (the organ that provides nourishment for the baby during pregnancy) from the uterus (womb) that can occur with a seizure

The majority of women who have epilepsy deliver normal, healthy babies. But there are some risks. Babies of mothers who have epilepsy have a higher risk of the following:

• Developing seizure disorders as they get older
• Developmental and growth delays
• Bleeding problems after birth (related to the mother’s seizure medicines)
• Being born prematurely or stillborn
• Birth defects caused by the medicine you take
  • It is important that you follow your doctor’s directions for taking your medicine. The risks of not taking your medicine are much higher for you and your baby. These include physical injury, developmental delay, and even death from your seizures.

Tell your doctor about any family history of brain or spinal defects. Eating a healthy diet, getting enough sleep, and exercising regularly are other things you can do to have a safe and healthy pregnancy.

Things to consider

During your pregnancy, you will see your doctor often. Your doctor will perform frequent blood tests to be sure that you’re getting enough antiseizure medicine. It’s very common for your doctor to change the dose of your medicine during your pregnancy.

They may also want you to have several ultrasound exams during your pregnancy. Your doctor may even want you to have an amniocentesis. In this procedure, a small amount of fluid is removed from your uterus. This fluid gives your doctor some information about the health of your unborn baby. These extra precautions are a way for your doctor to monitor your pregnancy and your unborn baby’s development.

Questions to ask your doctor

• What happens if I have a seizure during pregnancy?
• How do I know when vaginal bleeding could be a sign of something serious?
• Will my medicines affect my baby?
• What are the chances that my baby could be born with epilepsy?
• Are there foods that I can eat to help my body better absorb folic acid?

Resources

U.S. National Library of Medicine, Medline Plus: Epilepsy

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Cystic fibrosis (CF) is a genetic disorder. It causes thick mucus to collect in your lungs and intestines. This causes problems with breathing and digestion. The damage is permanent. CF gets worse over time. People who have CF have a shorter life expectancy. However, thanks to modern medicine, people who have CF are living longer, healthier lives than ever before.

Two parents who have the CF gene can pass it on to their baby. Children have a 25% chance of having CF if both parents have one copy of the gene. Your doctor may perform a prenatal screening to test for CF if both parents know they carry the gene. This is performed while you are pregnant. It checks for any health problems with your baby before they are born. The screening also can detect other genetic disorders. This includes birth defects, and neural tube defects.

Path to improved well being

At your first prenatal visit, your doctor will talk to you about screening and tests. Although they may offer suggestions, it is your choice to do the screenings or not.

Carrier screening

If you don’t know if you have or carry CF and would like to find out, you may choose to do carrier screening test first. This is a simple method to test you or your partner for the CF gene.

Your doctor will collect a blood, saliva, or tissue sample from inside your cheek. Carrier screening is done one person at a time. It can be done before or during pregnancy. The possible results are:

• You (or your partner) test negative as a carrier. The other person does not need to be tested.
• You (or your partner) test positive as a carrier. The other person should be tested.
• You and your partner both test positive as carriers. If you are pregnant, you should consider the prenatal testing to see if your baby has CF. If you are not pregnant but are trying, talk to your doctor about your options. You may consider adopting or using fertility treatment to avoid the CF gene.

Prenatal screening

Screening for CF in a baby can be done one of two ways.

• Chorionic villus sampling (CVS). Your doctor collects a sample of tissue from your placenta. This test is done between 10 and 13 weeks of pregnancy.
• Your doctor collects a sample from your amniotic fluid. This test is done between 15 and 20 weeks of pregnancy.

Diagnosis

If the prenatal screening is positive for CF, you have two options.

• You can continue with your pregnancy. The diagnosis does not affect ongoing prenatal care. In the remaining months, do research to learn more about CF. Talk to your doctor about treatment options. You may consider joining a support group.
• You can end your pregnancy. This decision consists of legal and moral considerations.

At your first prenatal visit, your doctor will talk to you about screening and tests. Although they may offer suggestions, it is your choice if you want to do the screenings or not.

Things to consider

Although screening can be helpful, it also can create added worry or concern. If you choose not to screen during pregnancy, most states check for CF during newborn screening. This is a series of tests your baby undergoes in the hospital after birth. These include blood, hearing, and heart tests. Talk to your doctor to see what your state’s testing includes.

Keep in mind that no screening is 100% effective. Carrier and prenatal screenings cannot check for all gene mutations. If the tests are negative, there still is a rare chance you carry CF or your baby could have CF.  Talk to your doctor if:

• You and your partner both have CF.
• You and your partner are known carriers for CF.
• You and your partner have a family history of CF.
• You and your partner are pregnant or trying to become pregnant and want to learn more about genetic testing.

Questions to ask your doctor

• What are the risks and benefits of CF prenatal screening?
• Does my state test for CF during the newborn baby screening?
• If my partner or I test negative in the carrier screening, what is the chance our baby could still have CF?
• If we have a child with CF, what are the chances our other children will have CF?
• Are there other prenatal screening tests that I should consider?

Resources

American College of Obstetricians and Gynecologists: Cystic Fibrosis: Prenatal Screening

March of Dimes: Cystic Fibrosis and Pregnancy

National Institutes of Health, MedlinePlus: Cystic Fibrosis

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