Family Planning

Pregnancy, Breast-Feeding and Travel

Factors Affecting the Decision to Travel Although pregnancy is a normal state rather than a disabled condition, pregnant women need to consider the potential problems associated with international travel, as well as the quality of medical care available at the destination and during transit. According to the American College of Obstetricians and Gynecologists, the safest time for a pregnant woman to travel is during the second trimester (18-24 weeks) when she usually feels best and is in least danger of experiencing a spontaneous abortion or premature labor. Women in the third trimester (25-36 weeks) may be asked by their physicians to stay within 300 miles of home because of concerns about access to medical care in case of problems such as hypertension, phlebitis, or false or premature labor. The final decision to travel should be based on consultation with the woman’s health care provider.

General Recommendations for Travel

Once a pregnant woman has decided to travel, a number of issues need clarification prior to departure (see Table 1). It is advisable for pregnant women to travel with a companion; in addition, attention to comfort becomes more important. The checklist (Table 2) provides a guideline for planning with regard to medical considerations.

Motor vehicle accidents are a major cause of morbidity and mortality. When available, seat belts should be fastened at the pelvic area. Lap and shoulder restraints are best; in most accidents, the fetus recovers quickly from the seat belt pressure. However, even after seemingly blunt, mild trauma, a physician should be consulted.

Typical problems of pregnant travelers are the same as those experienced at home: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination and hemorrhoids. Signs and symptoms that indicate the need for immediate medical attention are bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling, headaches or visual problems.

Table 1. Relative Contraindications to International Travel during Pregnancy

Patients with Obstetrical Risk Factors:

History of miscarriage

Incompetent cervix

History of ectopic pregnancy (ectopic with present pregnancy should be ruled out prior to travel)

History of premature labor or premature rupture of membranes

History of or present placental abnormalities

Threatened abortion or vaginal bleeding during present pregnancy

Multiple gestation (more than one fetus) in present pregnancy

History of toxemia, hypertension or diabetes with any pregnancy

History of infertility or difficulty becoming pregnant

Primigravida (woman who is pregnant for the first time) older than 35 years or younger than 15 years

Patients with General Medical Risk Factors:

Valvular heart disease or congestive heart failure

History of thromboembolic disease

Severe anemia

Chronic organ system dysfunction requiring frequent medical interventions

Patients Contemplating Travel to Destinations That May Be Hazardous

High altitudes

Areas endemic for or with ongoing outbreaks of life-threatening food- or insect-borne infections

Areas where chloroquine-resistant Plasmodium falciparum is endemic

Areas where live-virus vaccines are required and recommended

Table 2. Checklist for the Pregnant Traveler

Make sure health insurance is valid while abroad and during pregnancy. Check to see if the policy covers a newborn should delivery take place. Obtain a supplemental travel insurance policy and a prepaid medical evacuation insurance policy.

Check medical facilities at the destination. For women in the last trimester, medical facilities should be able to manage complications of pregnancy, toxemia and cesarean sections.

Determine beforehand whether prenatal care will be required abroad and, if so, who will provide it. Make sure prenatal visits requiring specific timing are not missed.

Check ahead of time whether blood is screened for HIV and hepatitis B at the destination. Pregnant travelers and their companions should know their blood types.

Check facilities at the destination for availability of safe food and beverages, including bottled water and pasteurized milk.

Breast-Feeding and Travel 

The decision to travel internationally while nursing brings another set of challenges. However, breast-feeding has nutritional and anti-infective advantages that serve an infant well while traveling. Supplements usually are not needed by breast-fed infants younger than 6 months, and breast-feeding should be maintained as long as possible. If supplementation is considered necessary, powdered formula that requires reconstitution with boiled water should be carried. For short trips, it may be feasible to carry an adequate supply of pre-prepared canned formula. Exclusive breast-feeding relieves concerns about sterilizing bottles and about availability of clean water.

Nursing women may be immunized for maximum protection, depending on the travel itinerary, but consideration needs to be given to the neonate who cannot be immunized at birth and who would not gain protection against many of these infections (e.g., yellow fever, measles, and meningococcal meningitis) through breast-feeding.

Neither inactivated nor live-virus vaccines affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication to the administration of any vaccines, including live-virus vaccines, to the breast-feeding woman. Although rubella vaccine virus may be transmitted in breast milk, the virus usually does not infect the infant, and if it does, the infection is well tolerated. Breast-fed infants should be vaccinated according to routine recommended schedules.

Nursing women need to realize that their eating and sleeping patterns, as well as stress, will inevitably affect their milk output. They need to increase their fluid intake, avoid excess alcohol and caffeine, and, as much as possible, avoid exposure to smoke.

Specific Recommendations for Pregnancy and Travel


Because of the theoretical risks to the fetus from maternal vaccination, the risks and benefits of each immunization should be carefully reviewed. Ideally, all women who are pregnant should be up to date on their routine immunizations. In general, pregnant women should avoid live vaccines and women should avoid becoming pregnant within three months of having received one; however, no harm to the fetus has been reported from the accidental administration of these vaccines during pregnancy.


The combination diphtheria/tetanus immunization should be given if the traveler has not been immunized in the past 10 years, although preference would be for its administration during the second or third trimesters.


Immunity to measles is essential for all travelers. Many young adults require immunization (and in some cases, reimmunization) for protection. The specific recommendations for different age groups depend on the traveler’s country of origin, itinerary, and the epidemiology of measles in the country to be visited. The measles vaccine as well as the MMR (measles, mumps, and rubella combination) are live-virus vaccines and are contraindicated in pregnancy. Because of the increased incidence of measles in children in developing countries, its communicability, and its potential for causing serious consequences in adults, some authorities recommend delaying travel for nonimmune women until after delivery, when immunization can be given safely. However, in cases in which the rubella vaccine was accidentally administered, no complications were reported. If a pregnant woman has a documented exposure to measles, immune globulin should be given within a six-day period to prevent illness.


It is important for the pregnant traveler to be protected against polio. Paralytic disease may occur with greater frequency when infection develops during pregnancy. Anoxic fetal damage has also been reported, with up to 50 percent mortality in neonatal infection. If not previously immunized, a pregnant woman should have at least two doses of vaccine before travel (day 0 and at one month). Despite being a live-virus vaccine, the oral preparation (OPV) is recommended when immediate protection is needed. The recommendation for the nonimmune pregnant traveler is 1 dose of OPV prior to travel followed by completion of the regimen after delivery. However, for routine boosting or for when immediate protection is not required, the inactivated vaccine (IPV) is preferred. There is no convincing evidence of adverse effects of either OPV or IPV in pregnant women or a developing fetus. However, it is prudent to avoid polio vaccination of pregnant women unless immediate protection is needed. In this case, OPV is the vaccine of choice.

Breast-feeding does not interfere with successful immunization against poliomyelitis with IPV or OPV. IPV may be administered to a child with diarrhea, and OPV may be administered to a child with mild diarrhea. Minor upper respiratory illnesses with or without fever, mild to moderate local reactions to a previous dose of vaccine, current antimicrobial therapy, and the convalescent phase of an acute illness are not contraindications for vaccination.


The hepatitis B vaccine may be administered during pregnancy. For tourists or business travelers, it is not routinely recommended unless the woman will be working in a health care setting, is sexually active with new partners, is planning delivery overseas, or will be a long-term traveler. It is desirable, however, for everyone to be protected against hepatitis B.


The pneumococcal and influenza vaccines should be given to all who would otherwise qualify for special protection against these diseases: pregnant women with chronic diseases or pulmonary problems. In general, women with serious underlying illnesses should not travel to developing countries when pregnant.

Travel-Related Immunizations During Pregnancy


The yellow fever vaccine should not be given to a pregnant woman unless travel to an endemic or epidemic area is unavoidable. In these instances, the vaccine can be administered. Although concerns exist, no congenital abnormalities have been reported after administration of this vaccine to pregnant women.

If traveling to or transiting regions within a country where the disease is not a current threat but where policy requires a yellow fever certificate, a physician waiver should be carried, along with documentation on the immunization record. In general, travel to areas where yellow fever is a risk should be postponed until after delivery, when the vaccine can be administered without concern of fetal toxicity. A nursing mother should also delay travel, as the neonate cannot be immunized because of the risk of vaccine-associated encephalitis. Breast-feeding is not a contraindication to the vaccine for the mother.


Pegnant women without immunity to hepatitis A need protection before traveling to developing countries. Hepatitis A is usually no more severe during pregnancy than at other times and does not affect the outcome of pregnancy. There have been reports, however, of acute fulminant disease in pregnant women during the third trimester, when there is also an increased risk of premature labor and fetal death. These events have occurred in women from developing countries and may have been related to underlying malnutrition. The hepatitis A virus is rarely transmitted to the fetus, but this can occur during viremia or from fecal contamination at delivery. Immune globulin is a safe and effective means of preventing hepatitis A, but immunization with one of the hepatitis A vaccines gives a more complete and prolonged protection. The effect of these inactivated virus vaccines on fetal development is unknown, but the production methods for the vaccines are similar to that for IPV, which is considered safe during pregnancy.


The older injectable typhoid vaccine is not recommended during pregnancy because of febrile reactions, which can result in spontaneous abortions. It can be administered intradermally with less risk of systemic symptoms. The safety of the oral typhoid vaccine in pregnancy is not known. Nonetheless, neither of these is absolutely contraindicated during pregnancy, according to the Advisory Committee on Immunization Practices (ACIP). The Vi injectable preparation may be the vaccine of choice because it is inactivated and requires only one injection. With any of these, the vaccine efficacy (about 70 percent) needs to be weighed against the risk of disease.


The polyvalent meningococcal meningitis vaccine may be administered during pregnancy if the woman is entering an area where the disease is endemic. The vaccine’s safety during pregnancy has not been conclusively determined.


The cell-culture rabies vaccines may be given during pregnancy for either pre- or postexposure prophylaxis.


No information is available on the safety of Japanese encephalitis vaccine during pregnancy. It should not be routinely administered during pregnancy, except when a woman must stay in a high-risk area. If not mandatory, travel to such areas should be delayed.


There are no data available on the use of plague vaccine for pregnant women. BCG (Bacillus Calmette-Gurin) vaccine for the prevention of tuberculosis can theoretically cause disseminated disease and thus affect the fetus; skin testing for tuberculosis exposure before and after travel is preferable when the risk is high. Therefore, neither of these vaccines is recommended.

Malaria During Pregnancy 

Malaria in pregnancy carries significant morbidity and mortality for both the mother and the fetus. Because no antimalarial agent is 100 percent effective, it is imperative that pregnant women use personal protective measures when traveling through a malaria-endemic area. Pregnant women should remain indoors between dusk and dawn, but if outdoors at night, should wear light-colored clothing, long sleeves, long pants, and shoes and socks. Pregnant women should sleep in air-conditioned quarters or use screens and permethrin-impregnated bed nets.

Pyrethrum-containing house sprays or coils also should be used indoors if insects are a problem. Insect repellents containing a low percentage of DEET (recommendations vary from 10 percent to 35 percent) can be used on the skin. Nursing mothers should be careful to wash repellents off hands and breast skin prior to handling infants.

Chloroquine and proguanil have been used by pregnant women for malaria chemoprophylaxis for decades with no documented increase in birth defects. Mefloquine has been recommended for chemoprophylaxis during the second and third trimesters. Women in the first trimester should be discouraged from visiting areas where chloroquine-resistant malaria occurs. However, if they do travel to these areas, experience suggests that mefloquine causes no significant increase in spontaneous abortions (miscarriages) or congenital malformations (birth defects) among women who have inadvertently taken the drug during this period.

Nursing mothers should take the usual adult dose of antimalarial appropriate for the country to be visited. The amount of medication in the breast milk will not be helpful or harmful to the infant. Therefore, the breast-feeding child needs his or her own prophylaxis.

Any pregnant traveler returning with malaria from an area where chloroquine-resistant Plasmodium falciparum is endemic should be treated as a medical emergency and as if she had illness due to chloroquine-resistant organisms. Because of the serious nature of malaria, quinine or intravenous quinidine should be used and should be followed by Fansidar, or even doxycycline, despite concerns regarding potential fetal problems. Frequent glucose levels and careful fluid monitoring often require intensive care supervision.

Travelers’ Diarrhea 

During Pregnancy Dietary vigilance should be adhered to while traveling during pregnancy because dehydration due to travelers’ diarrhea (TD) can lead to inadequate placental blood flow. Potentially contaminated water should be boiled. Iodine-containing purification systems should not be used long term. Iodine tablets can probably be used for short-term travel up to several weeks, but congenital goiters have been reported in association with administration of iodine-containing drugs during pregnancy. Eating only well-cooked meats and pasteurized dairy products, as well as avoiding pre-prepared salads, should help avoid diarrheal disease, as well as infections such as toxoplasmosis and listeria, which can have serious sequelae in pregnancy. It is not recommended that pregnant women use prophylactic antibiotics for the prevention of TD.

Oral rehydration is the mainstay of TD therapy. Bismuth subsalicylate compounds are contraindicated due to the theoretical risks of fetal bleeding from salicylates and teratogenicity from the bismuth. The combination of kaolin-pectin may be used, and loperamide should be used only when necessary. The antibiotic treatment of TD during pregnancy can be complicated. An oral third-generation cephalosporin may be the best option for treatment if an antibiotic is needed.

Breast-feeding is desirable during travel and should be continued as long as possible because of its safety and its lower incidence of infant diarrhea. A nursing mother with TD should not stop breast-feeding but should increase her fluid intake.

Air Travel During Pregnancy 

Commercial air travel poses no special risks to a healthy pregnant woman or her fetus. The lowered cabin pressures (kept at the equivalent of 5,000 to 8,000 feet or 1,524 to 2,438 meters) affect fetal oxygenation minimally because of the fetal hemoglobin dissociation curve. Severe anemia (Hgb 0.5 g/dL), sickle-cell disease or trait, a history of thrombophlebitis, or placental problems are relative contraindications to flying; however, supplemental oxygen may be ordered in advance. Each airline has policies regarding pregnancy and flying; it is always safest to check with the airline when booking reservations, as some will require medical forms to be completed. Domestic travel is usually permitted until 36 weeks gestation, and international travel may be curtailed after the 32nd week. Pregnant women should always carry documentation stating their expected date of delivery.

An aisle seat at the bulkhead will provide the most space and comfort, but a seat over the wing in the midplane region will give the smoothest ride. A pregnant woman should walk every half hour during a smooth flight and flex and extend the ankles frequently to prevent phlebitis. The seat belt should always be fastened at the pelvic level. Fluids should be taken liberally because of the dehydrating effect of the low humidity in aircraft cabins.

Women traveling with infants should keep in mind that newborns (younger than 6 weeks old) should not fly because their alveoli are not completely functional. Infants are particularly susceptible to pain with eustachian tube collapse during pressure changes, and breast-feeding during ascent and descent relieves this discomfort.

The Travel Health Kit 

During Pregnancy Additions and substitutions to the usual travel health kit need to be made during pregnancy and nursing. Talcum powder, a thermometer, oral rehydration packets, multivitamins, an antifungal agent for vaginal yeast, acetaminophen, insect repellent containing a low percentage of DEET, and sunscreen with a high SPF (sun protection factor) should be carried. Women in their third trimester may want to carry a blood pressure cuff and urine dipsticks to check for proteinuria and glucosuria, both of which would require attention. Antimalarial and antidiarrheal self-treatment medications should be evaluated individually, depending on the traveler, her trimester, the itinerary, and her health history. Most medications should be avoided, if possible.


Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention

This page last reviewed July 10, 2000

Group B Streptococcus and Pregnancy

Group B streptococcus (GBS) is a type of bacteria that can be found in 10 percent to 30 percent of pregnant women. A woman with GBS can pass it to her baby during delivery. Most babies who get GBS from their mothers do not have any problems. A few, however, will become sick.

What Is GBS?

GBS is one of the many bacteria that usually do not cause serious illness. It may be found in the digestive, urinary, and reproductive tracts of men and women. In women, it is most often found in the vagina and rectum. GBS is not a sexually transmitted disease.

Effects on the Baby

If the bacteria is passed from a woman to her baby, the baby may develop GBS infection. This happens to only one or two of every 100 babies whose mothers have GBS. Babies who do become infected may have early or late infections.

Early infections develop right after delivery when the baby passes through the birth canal colonized with GBS.

Late infections occur after the first seven days of life. About one-half of late infections are passed from the mother to the baby during birth. The other half result from other sources of infection, such as contact with other people who are GBS carriers.

These infections can cause inflammation of the baby’s blood, lungs, brain or spinal cord. Both early and late GBS infections lead to death in about 5 percent of infected babies.

Testing for GBS

A culture is the most accurate way to test for GBS. This is a simple procedure and should not be painful. With cultures, a swab is placed in the woman’s vagina and rectum to obtain a sample.

The results of cultures are most useful between 35 and 37 weeks of pregnancy.


To reduce the risk of GBS infection in newborns, all women who test positive for GBS must be treated with antibiotics during labor. Babies of women who are carriers of GBS and do not get treatment have more than 20 times the risk of getting infected than those who do receive treatment.

Penicillin is the antibiotic that is most often given to prevent GBS in newborns. Another antibiotic may be given if you are allergic to penicillin.

In women who have planned a cesarean birth, it is not necessary for them to be given antibiotics during delivery, whether or not they are GBS carriers. However, these women should still be tested for GBS because preterm labor may occur before the planned cesarean birth.

Finally … GBS is fairly common in pregnant women. Yet, very few babies actually become sick from GBS infection. Treatment during labor and delivery may help prevent infection in your baby.


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 2003 The American College of Obstetricians and Gynecologists

High Blood Pressure During Pregnancy

Normal blood pressure levels are key to good health. When blood pressure becomes too high, it is known as hypertension. This can pose health risks at any time. During pregnancy, hypertension can cause added problems. In some cases, preeclampsia, a serious disorder that affects pregnancy, may develop. If you are pregnant and have any of the risk factors that may lead to high blood pressure, you may need special care.

Effects of Pregnancy

In a healthy pregnancy, the fetus receives from the woman all of the nutrients and oxygen it needs for normal growth. This happens when the correct amount of the woman�s blood flows through the placenta and the nutrients and oxygen pass through the umbilical cord to the baby.

High blood pressure can cause problems during pregnancy. For instance, when a woman has high blood pressure in pregnancy, it may cause less blood to flow to the placenta. This means that the fetus receives less of the oxygen and nutrients it needs. This can cause the growth of the fetus to slow down.

Types of High Blood Pressure:

Chronic Hypertension

When high blood pressure has been present for some time before pregnancy, it is known as chronic, or essential, hypertension. This condition remains during pregnancy and after the birth of the baby. It is vital that chronic hypertension be controlled because it can lead to health problems such as heart failure or stroke.

Gestational Hypertension

When high blood pressure first occurs during the second half of pregnancy, it is known as gestational hypertension. This type of high blood pressure goes away soon after the baby is born.


Although gestational hypertension is the most common sign of preeclampsia, preeclampsia is a serious medical condition affecting all organs of the body. For example, preeclampsia causes stress on the kidneys, which results in increased amounts of protein in the woman’s urine. Other signs of preeclampsia may include:


Visual problems

Rapid weight gain

Swelling (edema) of the hands and face

Doctors do not know why some women get preeclampsia. They do know that some women are at higher risk than others.

Prenatal Care 

If a woman knows she has high blood pressure before pregnancy, there are steps she and her doctor can take to reduce the chance of severe effects to herself or her baby. For this reason, the best thing a woman can do is to see her doctor before pregnancy and get regular prenatal care.


When blood pressure increases slightly and the woman is not near the end of her pregnancy, bed rest may help reduce the pressure. Bed rest at home or in the hospital may be prescribed. If the blood pressure does not increase to dangerous levels, pregnancy may be allowed to continue until labor begins naturally.

If preeclampsia develops, the only real cure is having the baby.

Finally High blood pressure during pregnancy can place the woman and baby at risk for severe problems. If you have chronic hypertension or are at risk for developing preeclampsia, take steps to reduce the risks to your baby. You will need special care and may have to see your doctor more often. Working with your doctor to control your blood pressure level will help improve your chances of having a healthy baby.


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 2004 The American College of Obstetricians and Gynecologists

The Rh Factor: How It Can Affect Your Pregnancy

During pregnancy, you will have a blood test to find out your blood type. If your blood lacks the Rh antigen, it is called Rh negative. If it has the antigen, it is called Rh positive. More than 85 percent of people in the world are Rh positive. Problems can arise when the fetus’ blood has the Rh factor and the mother’s blood does not.

What Is the Rh Factor? 

Just as there are different major blood groups, such as A and B type blood, there also is an Rh factor. The Rh factor is the type of protein on the red blood cells. Most people have the Rh factor — they are Rh positive. Others do not have the Rh factor — they are Rh negative.

When Does the Rh Factor Cause Problems? 

The Rh factor causes problems when an Rh-negative person’s blood comes in contact with Rh-positive blood.

An Rh-negative woman can become sensitized if she is pregnant with an Rh-positive fetus. If a pregnant woman’s blood group is Rh negative, knowing whether the father is Rh positive or Rh negative will help find the risk of Rh sensitization.

During pregnancy, mother and fetus do not share blood systems. Blood from the fetus can cross the placenta into the mother’s system, though. When this occurs, a small number of pregnant women with Rh-negative blood who carry an Rh-positive fetus will react as if it were allergic to the fetal blood. Then, they become sensitized by making antibodies. These antibodies go back to the fetus and attack the fetal blood. They break down the red blood cells and produce anemia (lack of iron in the blood). This condition is called hemolytic disease.

In a second pregnancy with an Rh-positive fetus, the antibodies are more likely to cause hemolytic disease in the fetus.

Sensitization can occur any time the fetus’ blood mixes with the mother’s blood.

How Can Problems Be Prevented? 

A simple blood test can tell a woman’s blood type and Rh factor. Another blood test, called an antibody screen, can show if an Rh-negative woman has developed antibodies to Rh-positive blood.

Rh immunoglobulin (RhIg) is a blood product that can prevent sensitization of an Rh-negative mother.

RhIg, first used in 1968, is safe and easily obtained. Its use can prevent sensitization in almost all cases.

When Is RhIg Used? 

During Pregnancy and After Delivery

If a woman with Rh-negative blood has not been sensitized, her doctor may suggest that she receive RhIg around the 28th week of pregnancy to prevent sensitization for the rest of the pregnancy.

Shortly after birth, if the child has Rh-positive blood, the mother should be given another dose of RhIg. In almost all cases, this treatment prevents the woman from making antibodies to the Rh-positive cells she may have received from her fetus before and during delivery. No treatment is needed if the father or baby is also Rh negative.

Other Reasons RhIg May Be Given

Amniocentesis. Amniocentesis is a procedure in which a small amount of amniotic fluid (the fluid in the sac that surrounds the fetus) is withdrawn from the mother’s uterus through a needle for testing. If and when this is done, fetal Rh-positive red blood cells could mix with a mother’s Rh-negative blood. This would cause her to produce antibodies. Thus, RhIg is given.

Postpartum Sterilization. An Rh-negative mother may receive RhIg after a birth even if she decides to have her fallopian tubes tied and cut to prevent future pregnancies.

What Happens If Antibodies Develop? 

Once a woman develops antibodies, RhIg treatment does not help. Doctors are finding ways to save infants who get hemolytic disease. A mother who is Rh-sensitized will be checked during her pregnancy to see if the fetus is developing the disease.

Finally . . . To protect against Rh sensitization, all pregnant women should have a blood test done at an early stage of pregnancy.


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 © November 1999 The American College of Obstetricians and Gynecologists

How to Tell When Labor Begins

Awaiting the birth of a baby is an exciting and anxious time. Most women give birth between 38 and 42 weeks of pregnancy. However, there is no way to know exactly when you will go into labor. Birth often occurs within two weeks before or after your expected due date.

Making Plans 

As you plan for the birth of your baby, you can take steps to help your labor go more smoothly. It is best to discuss your questions about labor with your health care team before the time comes:

When should I call my doctor?

How can I reach the doctor or nurse after office hours?

Should I go directly to the hospital or call the office first?

Are there any special steps I should follow when I think I’m in labor?

Before it’s time to go to the hospital, there are many things to think about.



Time of day

Home arrangements

Work arrangements

How Labor Begins 

No one knows exactly what causes labor to start, although changes in hormones may play a role. Sometimes, it is hard to tell when labor begins.

True Versus False Labor 

You may have periods of “false” labor, or irregular contractions of your uterus, before “true” labor begins. These are called Braxton Hicks contractions. They are normal but can be painful at times.

One good way to tell the difference is to time the contractions. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. If you think you’re in labor, call your doctor’s office or hospital.

Finally… You are nearing a special, exciting time. Although it’s not possible to know exactly when labor will begin, you can be ready by knowing what to expect. Being prepared can make it easier for you to relax and focus on the arrival of your baby when the time comes.


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 1999 The American College of Obstetricians and Gynecologists

Caffeine and Pregnancy

Caffeine is a drug found in many foods, drinks, chocolate and some medicines. It’s a stimulant, which means it can keep you awake. Most adults get caffeine mainly from coffee.

The March of Dimes recommends that women who are pregnant or trying to get pregnant get no more than 200 milligrams (mg) of caffeine per day. This is the amount of caffeine in about one 12-ounce cup of coffee.

How does caffeine affect your body?

Caffeine helps keep you awake. It slightly increases your blood pressure and heart rate and the amount of urine your body makes. Caffeine causes some people to feel jittery, have indigestion or have trouble sleeping.

Some people are more sensitive to caffeine than others. During pregnancy, you may be especially sensitive to caffeine because it may take you longer to clear it from your body than someone who’s not pregnant.

Does caffeine during pregnancy affect your baby?

Yes. During pregnancy, caffeine passes through the placenta and reaches your baby. Caffeine may decrease blood flow to the placenta, which may cause problems for your baby.

You may have heard that too much caffeine can cause miscarriage (when a baby dies in the womb before 20 weeks of pregnancy). Some studies say this is true and some say it’s not. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day.

Is caffeine safe during breastfeeding?

The American Academy of Pediatrics (AAP) says it’s safe for breastfeeding moms to have caffeine. A small amount of caffeine does get into breast milk, so limit caffeine if you’re breastfeeding. Breastfed babies of women who drink more than 2 to 3 cups of coffee a day may become irritable or have trouble sleeping.

What foods and drinks contain caffeine?

Caffeine is found in:

Coffee and coffee-flavored products, like yogurt and ice cream


Some soft drinks

Chocolate and chocolate products, like chocolate syrup and hot cocoa

The amount of caffeine in foods and drinks varies a lot. For coffee and tea, the brand, how it’s prepared, the type of beans or leaves used, and the way it’s served (espresso, latte and others) can affect the amount of caffeine.

What medicines contain caffeine?

Some medicines used for pain relief, migraines, colds and to help keep you awake contain caffeine. The Food and Drug Administration (FDA) requires that label on medicine lists the amount of caffeine in the medicine.

If you’re pregnant, talk to your health care provider before taking any medicine that contains caffeine. This includes prescription and over-the-counter medicine. A prescription is an order for medicine given by a health care provider. Over-the-counter means medicine, like pain relievers and cough syrup, you can buy without a prescription.

Some herbal products contain caffeine. These include guarana, yerba mate, kola nut and green tea extract. Herbal products are made from herbs, which are plants that are used in cooking and for medicine. The FDA does not require that herbal products have a label saying how much caffeine they contain. Some herbal products have as much caffeine as 8 cups of coffee! If you’re pregnant, don’t use herbal products because we don’t know how much caffeine they contain.

Last reviewed June 2012

About Birth Defects

About 3 percent of babies born in the United States have some type of major birth defect. A baby may be born with more than one birth defect. In most cases, there is no known reason for a birth defect. In some cases, birth defects are inherited. Others can occur if the fetus is exposed to certain drugs (including alcohol), chemicals or viruses during key stages of growth during pregnancy.

Heartfelt Obstetrics & Gynecology
2640 Biehn St, Suite 1
Klamath Falls, OR 97601
Phone: 541-204-1061
Fax: 541-205-6899
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