Family Planning


 
Bleeding During Pregnancy

Vaginal bleeding in pregnancy has many causes. Some are serious and some are not.

Early Pregnancy Many women have vaginal spotting or bleeding in the first 12 weeks of pregnancy.

If you have bleeding during pregnancy, you may need special care.

Miscarriage

Bleeding doesn’t mean that miscarriage is certain, but it can occur. About half of the women who bleed do not have miscarriages.

Miscarriage can occur at any time during the first half of pregnancy. Most occur during the first 12 weeks. Miscarriage occurs in about 15 percent to 20 percent of pregnancies.

If you think you have passed fetal tissue, take it to the doctor’s office so it can be examined.

Most miscarriages cannot be prevented. They are often the body’s way of dealing with a pregnancy that was not normal. There is no proof that exercise or sex causes miscarriage.

Ectopic Pregnancy

Another problem that may cause pain and bleeding in early pregnancy is ectopic pregnancy. If pregnancy occurs in a fallopian tube, it may burst.

Ectopic pregnancies are much less common than miscarriages. They occur in about one in 60 pregnancies.

Molar Pregnancy

A rare cause of early bleeding is molar pregnancy. It is also called gestational trophoblastic disease (GTD) or simply a “mole.” It is the growth of abnormal tissue instead of an embryo.

Late Pregnancy The causes of bleeding in the second half of pregnancy differ from those in early pregnancy. Common conditions that cause minor bleeding include an inflamed cervix or growths on the cervix.

Late bleeding may pose a threat to the health of the woman or the fetus. It may require treatment in a hospital. Heavy vaginal bleeding usually involves a problem with the placenta. The two most common causes of bleeding in late pregnancy are placental abruption and placenta previa. Preterm labor can also cause vaginal bleeding.

Placental Abruption

The placenta may detach from the uterine wall before or during labor. This may cause vaginal bleeding. Only 1 percent of pregnant women have this problem. It usually occurs during the last 12 weeks of pregnancy. Stomach pain often occurs, even if there is no obvious bleeding.

Placenta Previa

When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa. It may cause vaginal bleeding. Placenta previa is serious and requires prompt care.

Placenta previa occurs in one woman in 200.

Labor Late in pregnancy, vaginal bleeding may be a sign of labor. A plug that covers the opening of the uterus during pregnancy is passed just before or at the start of labor. A small amount of mucus and blood is passed from the cervix. This is called “bloody show.” It is common. It is not a problem if it happens within a few weeks of your due date.

Taking Action

Call your doctor if you have bleeding in late pregnancy. You may need to be admitted to the hospital to find its cause. Ultrasound may be advised.

Conditions that cause bleeding in late pregnancy pose a risk to both mother and fetus.

Finally … Many women with bleeding in pregnancy have minor conditions that need no treatment. At other times, bleeding can be a sign of a serious problem. Bleeding anytime in pregnancy — early or late — should be reported to your doctor.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright April 1999 The American College of Obstetricians and Gynecologists

Maternal Serum Screening For Birth Defects

Abstract

Second trimester maternal serum screening provides a method to identify pregnancies at high risk for fetal Down’s syndrome, trisomy 18, open neural tube defects, and a variety of other chromosomal and nonchromosomal fetal anomalies. Results are presented for a regional program to identify high-risk pregnancies using alpha feto-protein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) analyses (triple marker testing). A total of 27,140 women received screening. Using a midtrimester Down’s syndrome risk of 1:270 to define the high-risk group, 5.26% of women of all ages were screen-positive for Down’s syndrome resulting in the eventual detection of approximately 72% of the affected fetuses. The detection rate for patients under 35 at estimated date of delivery was 61% and for women 35, or older, the detection rate was 100%. A separate protocol to screen for trisomy 18 identified 0.2% of pregnancies, with 38% of the trisomy 18 cases present in this group. Over 3% of women screen-positive for Down’s syndrome or trisomy 18 had a serious fetal chromosome anomaly. In addition, 2.89% of women had an elevated AFP (greater or equal to 2.0 multiples of median). This component of the screening resulted in the identification of 86% of the neural tube defects, 75% of the ventral wall defects, and also some of the other various fetal anomalies present in the screened population. Since both laboratory and clinical data are combined to generate patient-specific risks, there is a need for quality control elements that go beyond that normally required for a clinical laboratory alone. We stress the need for comprehensive follow-up programs to evaluate screening programs and maintain high quality.

PMID:

8706425

[PubMed – indexed for MEDLINE]The intrauterine device (IUD) is a type of birth control. It is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy.

Breastfeeding Your Baby

One of the most special times in a mother’s life is when she is breastfeeding her baby. Experts agree that breastfeeding is best.

Benefits Breast milk is nature’s perfect baby food. Your milk has just the right nutrients, in just the right amounts, to nourish your baby fully.

Baby

There are many reasons why breastfeeding is best for your baby:

The colostrums — a yellow, watery pre-milk — that your breasts make for the first few days after birth helps your newborn’s digestive system grow and function.

Breast milk has antibodies that help your baby’s immune system fight off sickness.

The protein and fat in breast milk are better used by the baby’s body than the protein and fat in formula.

Babies who are breastfed have less gas, fewer feeding problems, and often less constipation than those given formulas.

Breastfed babies are at lower risk for sudden infant death syndrome (SIDS).

Mothers

Breastfeeding isn’t just good for babies. It’s good for mothers, too.

Breastfeeding:

Is convenient.

Releases the hormone oxytocin. This makes the uterus contract and helps it return to its normal size more quickly.

May lower your risk of osteoporosis and some forms of cancer.

Burns calories.

Is cheaper than bottle feeding.

Creates a special bond between you and your baby.

Facts About Breastfeeding 

During pregnancy, your nipples may start to drip a little colostrum. After you give birth, your body sends a signal to your breasts to start making milk. Within a few days, colostrum is replaced by milk.

Once feeding is established, the first milk that flows out of your breasts is watery and sweet. This quenches the baby’s thirst and provides sugar, proteins, minerals and fluid. As the feeding goes on, the milk becomes thick and creamy. This milk will give your baby the nutrients he or she needs to grow.

Getting Started 

Although breastfeeding is a natural process, it may take some practice and patience to master. Mothers and babies have to learn together.

To help give you a good start, during pregnancy tell your doctor that you plan to breastfeed.

During labor, remind the doctor and nurses that you plan to breastfeed. They can help you get started right after delivery.

How to Breastfeed 

Babies are born with the instincts they need to nurse, such as the rooting reflex.

Cup your breast in your hand and stroke your baby’s lower lip with your nipple. The baby will open his or her mouth wide (like a yawn). Quickly center your nipple in the baby’s mouth, making sure the tongue is down, and pull the baby close to you. Bring your baby to your breast — not your breast to your baby.

Let your baby set his or her own nursing pattern. Many newborns nurse for 10 to 15 minutes on each breast.

Nurse on demand

When babies are hungry, they will nuzzle against your breast, make sucking motions, or put their hands to their mouth. Crying is a late sign of hunger.

When your baby empties one breast, offer the other. Don’t worry if your baby doesn’t continue to nurse, though.

Diet 

When you are pregnant, your body stores extra nutrients and fat to prepare you for breastfeeding. When you are nursing:

Eat a well-balanced diet.

Make sure you get 1,000 mg of calcium a day.

Avoid foods that bother the baby.

Drink at least eight glasses of liquid a day.

Sex and Birth Control 

When you are ready to resume having sex, think about birth control. Even though you may not have menstrual periods while you are breastfeeding, you can still get pregnant. Talk with your doctor about what form of birth control is right for you.

Barrier methods such as latex condoms or a copper intrauterine device (IUD) are good options because they do not affect your milk supply.

Work 

Many mothers keep nursing their babies after they return to work. If you want to breastfeed when you go back to work, you may want to look into buying or renting a breast pump.

Any breast milk is better than no breast milk. Try to breastfeed without supplementation for at least the first 6 months of your baby’s life if you can.

Breast Health 

As they start to breastfeed, some women may have a few minor problems. Problems that may occur include:

Engorgement

Sore nipples

Blocked ducts

Mastitis (an infection of the breast caused by bacteria in the milk ducts)

Most often problems are easy to treat. If you have any of these signs of a problem, contact your doctor:

Fever

Pain

Bleeding

Rash

Lumps

Redness

To keep your breasts healthy and to increase the chances of breastfeeding success, try these tips:

Learn proper nursing technique.

Use your finger to break the suction before you remove your breast from your baby’s mouth.

Gently pat your nipples dry with a clean cloth after feedings.

Use only cotton bra pads.

Apply 100 percent pure lanolin to your nipples after feeding.

Don’t wash your nipples with harsh soaps or use perfumed creams.

If one nipple is tender, offer the other breast first.

Finally… Breastfeeding is a special gift of love and health only you can give your baby. Breastfeeding is natural, but it takes practice. You and your baby can learn together.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright July 2001 The American College of Obstetricians and Gynecologists

Easing Back Pain During Pregnancy

Back pain is one of the most common discomforts during pregnancy.

What Causes Back Pain

Back pain in pregnancy has many possible causes. It usually is caused by strain on the back muscles.

Weakness of the abdominal muscles also can cause back pain.

What You Can Do

To help prevent or ease back pain, try to be aware of how you stand, sit and move. Here are some tips that may help:

Wear low-heeled (but not flat) shoes with good arch support.

Ask for help when lifting heavy objects.

When standing for long periods, place one foot on a stool or box.

If your bed is too soft, have someone help you place a board between the mattress and box spring.

Don’t bend over from the waist to pick things up — squat down, bend your knees, and keep your back straight.

Sit in chairs with good back support, or use a small pillow behind the low part of your back.

Try to sleep on your side with one or two pillows between your legs for support.

Apply heat or cold to the painful area or massage it.

Doing special exercises for the back also can help lessen backache.

If back pain continues to be a problem, your doctor may suggest that you wear a maternity girdle, special elastic sling, or back brace.

Don’t try to treat yourself. Back pain also can be caused by other problems. Back pain is one of the main symptoms of preterm labor.

Finally … During pregnancy your body will go through many changes. Some of these changes may cause discomfort. This is normal. Backache is one of the most common complaints during pregnancy.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright October 1997 The American College of Obstetricians and Gynecologists

Pain Relief During Labor and Delivery

Each woman’s labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby and the strength of contractions.

Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications.

Types of Pain Relief 

There are 2 types of pain-relieving drugs — analgesics and anesthetics. Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.

Systemic Analgesics

Systemic analgesics are often given as injections into a muscle or vein. They lessen pain but will not cause you to lose consciousness. They act on the whole nervous system rather than a specific area.

Local Anesthesia

Local anesthesia provides numbness or loss of sensation in a small area. It does not, however, lessen the pain of contractions.

Regional Analgesia

Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks, and combined spinal-epidural blocks are all types of regional analgesia that are used to decrease labor pain.

General Anesthesia

General anesthetics are medications that put you to sleep (make you lose consciousness). If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons.

Anesthesia for Cesarean Births

Whether you have general, spinal, or epidural anesthesia for a cesarean birth will depend on your health and that of your baby. It also depends on why the cesarean delivery is being done. In emergencies or when bleeding occurs, general anesthesia may be needed.

Finally… Many women worry that receiving pain relief during labor will somehow make the experience less ‘natural’. The fact is, no two labors are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © July 2004 The American College of Obstetricians and Gynecologists

Exercise During Pregnancy

Regular exercise builds bones and muscles, gives you energy, and keeps you healthy. It is just as important when you are pregnant.

Benefits of Exercise

Becoming active and exercising at least 30 minutes on most, if not all, days of the week can benefit your health in the following ways:

Helps reduce backaches, constipation, bloating and swelling

May help prevent or treat gestational diabetes

Increases your energy

Improves your mood

Improves your posture

Promotes muscle tone, strength and endurance

Helps you sleep better

Changes in Your Body

Pregnancy causes many changes in your body. Some of these changes will affect your ability to exercise.

Joints

The hormones produced during pregnancy cause the ligaments that support your joints to become relaxed.

Balance

Remember that during pregnancy you are carrying extra pounds — as much as 25 to 40 pounds at the end of pregnancy. The extra weight in the front of your body shifts your center of gravity and places stress on joints and muscles, especially those in the pelvis and lower back.

Heart Rate

The extra weight you are carrying will make your body work harder than before you were pregnant. Exercise increases the flow of oxygen and blood to the muscles being worked and away from other parts of your body. So, it’s important not to overdo it.

Getting Started

Before beginning your exercise program, talk with your doctor to make sure you do not have any obstetric or health condition that would limit your activity.

Choosing Safe Exercises

Most forms of exercise are safe during pregnancy. However, some types of exercise involve positions and movements that may be uncomfortable, tiring or harmful for pregnant women. For instance, after the first trimester of pregnancy, women should not do exercises that require them to lie flat on their backs.

Certain sports are safe during pregnancy, even for beginners:

Walking is a good exercise for anyone.

Swimming is great for your body.

Cycling provides a good aerobic workout.

Aerobics is a good way to keep your heart and lungs strong.

Other exercises, if done in moderation, are safe for women who have done them for a while before pregnancy:

Running

Racquet sports

Strength training

The following activities should be avoided during pregnancy:

Downhill snow skiing

Contact sports

Scuba diving

Your Routine

Exercise during pregnancy is most practical during the first 24 weeks. During the last three months, it can be difficult to do many exercises that once seemed easy. This is normal.

If it has been some time since you’ve exercised, it is a good idea to start slowly. Begin with as little as five minutes of exercise a day and add five minutes each week until you can stay active for 30 minutes a day.

Always begin each exercise session with a warm-up period for five to 10 minutes.

Things to Watch

The changes your body is going through can make certain positions and activities risky for you and your baby. While exercising, try to avoid activities that call for jumping, jarring motions, or quick changes in direction that may strain your joints and cause injury.

While you exercise, pay attention to your body. Do not exercise to the point that you are exhausted.

After the Baby’s Born

Having a baby and taking care of a newborn is hard work. It will take a while to regain your strength after the strain of pregnancy and childbirth. Taking care of yourself physically and allowing your body time to recover is important. If you had a cesarean delivery, difficult childbirth or complications, your recovery time may be longer. Check with your doctor before starting or resuming an exercise program.

Finally … Exercise during pregnancy can help prepare you for labor and childbirth. Exercising afterward can help get you back in shape. Before you begin an exercise program, talk to your doctor. Follow this guide to help maintain a safe and healthy exercise program during pregnancy.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © June 2003 The American College of Obstetricians and Gynecologists

Postpartum Depression

Having a baby is a joyous time for most women. After childbirth, though, many mothers feel sad, afraid, angry or anxious. Most new mothers have these feelings in a mild form called postpartum blues. Sometimes these feelings are called “baby blues.” Postpartum blues almost always go away in a few days.

About 10 percent of new mothers have a greater problem called postpartum depression. Postpartum depression lasts longer and is more intense. It often requires counseling and treatment. Postpartum depression can occur after any birth, not just the first.

Baby Blues 

Many new mothers are surprised at how weak, alone and upset they feel after giving birth. Their feelings don’t seem to match the feelings they thought they would have. They wonder, “What have I got to be depressed about?”

In fact, about 70 percent to 80 percent of women have baby blues after childbirth. About two to three days after birth, they begin to feel depressed, anxious and upset. For no clear reason, they may feel angry with the new baby, their partners or their other children.

These feelings may come and go in the first few days after childbirth.

Postpartum Depression 

Women with postpartum depression have such strong feelings of sadness, anxiety or despair that they have trouble coping with their daily tasks. Without treatment, postpartum depression may become worse or may last longer.

Postpartum depression is more likely to happen in women who lack the support of a partner or who have had:

Postpartum depression before

A psychiatric illness

Recent stress, such as losing a loved one, family illness or moving to a new city

Reasons for Postpartum Depression 

Postpartum depression is likely to result from body, mind and lifestyle factors combined. No two women have the same biologic makeup or life experiences. This may be why some women have postpartum depression and others don’t.

Body Changes

The postpartum period is a time of great changes in the body. These changes can affect a woman’s mood and behavior for days or weeks.

Levels of the hormones estrogen and progesterone drop sharply in the hours after childbirth. This change may trigger depression in the same way that much smaller changes in hormone levels can trigger mood swings and tension before menstrual periods.

Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength. Some women have their babies by cesarean birth. Because this is major surgery, it will take them longer to feel strong again.

Emotional Aspects

Many emotional factors can affect a woman’s self-esteem and the way she deals with stress. This can add to postpartum depression.

Feelings of doubt about the pregnancy are common

The baby may be born early. This can cause stressful changes in home and work routines that the parents did not expect.

Lifestyle Factors

A major factor in postpartum depression is lack of support from others. The steady support of a new mother’s partner is a comfort during pregnancy and after the birth.

Breastfeeding problems can make a new mother feel depressed. New mothers need not feel guilty if they cannot breastfeed or if they decide to stop.

The Role of Myths

Women who have an idea of the “perfect mother” are more likely to feel let down and depressed when faced with the needs of day-to-day mothering. Three myths about being a mother are common:

Myth #1: Motherhood Is Instinctive. First-time mothers often believe that they should just know how to care for a newborn. In fact, new mothers need to learn mothering skills just as they learn any other life skill.

Myth #2: The Perfect Baby. Most women dream about what their newborn will look like. When the baby arrives, it may not match the baby of their dreams.

Also, babies have distinct personalities right from birth. A new mother may find it hard to adjust to the baby.

Myth #3: The Perfect Mother. For some women, being perfect is a never-ending goal. A mother may think she is not living up to the ideal. She may feel that she is a failure.

What You Can Do

If you are feeling depressed after the birth of your child, there are some things you can do to take care of yourself and your baby:

Get plenty of rest.

Ask for help from family and friends.

Take special care of yourself.

Spend time with your partner.

Call your doctor if your feelings do not lessen after a few weeks and you have trouble coping. Blues that don’t go away after a few weeks may be a sign of a more severe depression.

Finally… Many new mothers feel sadness, fear, anger and anxiety after having a baby. This is normal. It does not mean that you are a failure as a woman or mother or that you have a mental illness. Having these feelings means that you are adjusting to the many changes that follow the birth of a child.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 1999 The American College of Obstetricians and Gynecologists

Getting in Shape After Your Baby is Born

A healthy diet and daily exercise will increase your energy level and help you get in shape at any time of life. Having a baby and taking care of a newborn are hard work. It will take a while to regain your strength after the strain of pregnancy and birth. You should allow your body time to recover.

Benefits of Exercise 

Daily exercise can help restore muscle strength and firm up your body. Exercise can make you less tired because it raises your energy level and improves your sense of well-being.

When Can I Start? 

Check with your doctor before starting an exercise program. You should start when you feel up to it and know you will keep it up.

If you didn’t exercise during pregnancy, start with easy exercises and slowly build up to harder ones.

Getting Started 

Walking is a good way to get back in shape. Brisk walks will prepare you for more vigorous exercise when you feel up to it.

As you feel stronger, think about trying more vigorous exercise. You will want to decide on exercises that meet your needs.

Your Exercise Program

Your workout should always include time for you to warm up and cool down.

Warm Up

Before you begin each exercise session, always warm up for five to 10 minutes.

Target Heart Rate

You should exercise so that your heart beats at the level that gives you the best workout. This is called your target heart rate.

Cool Down

After exercising, cool down by slowing your activity. This allows your heart rate to return to normal levels. Cooling down is like warming up. Cooling down for five to 10 minutes and stretching again also helps prevent sore muscles.

Finally… Exercising after you have your baby can help you get back in shape. It can improve your physical and mental well-being. Before you begin your exercise program, talk to your doctor.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © January 2000 The American College of Obstetricians and Gynecologists

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