Joanne Stone

Article / Updated 09-29-2022

More and more women are expressing interest in nontraditional or alternative birthing methods, and more and more possibilities are becoming available. Certainly, the following options aren’t for everyone, but knowing what’s possible can be helpful. Delivering without anesthesia Natural childbirth usually refers to giving birth without any medications or anesthesia. (It’s probably not the best terminology, because using pain medication doesn’t make the birthing process unnatural.) The theory behind natural birth is that childbirth is an inherently healthy and natural process, and that women’s bodies are made to handle childbirth without the need for medications. Natural childbirth allows women to have a great deal of control over the childbirth process and their own bodies. It emphasizes having the woman choose which positions are comfortable, how mobile she wants to be, and which techniques she wants to use to be as comfortable as possible. Natural childbirth can be practiced in a hospital setting, birthing center, or even at home. Some practitioners aren’t comfortable with every aspect of natural childbirth because they don’t want to be limited in doing what they feel is medically necessary and important. Discuss with your practitioner what he feels comfortable with, so your delivery can be as great an experience as possible. Giving birth at home Home births are still relatively uncommon in the United States, with fewer than 1 percent of women choosing to deliver at home. This rate is similar to other industrialized countries, except that England has a rate of about 2.4 percent, and the Netherlands about 23 percent! Although the American College of Obstetricians and Gynecologists, in agreement with the American Academy of Pediatrics, believe that hospitals and birthing centers are the safest setting for births, they respect the right of women to make medically informed decisions about where they want to deliver. For some women, a home birth provides an ideal environment to deliver their baby. Common reasons for choosing a home birth are the desire for a low-intervention birth; a desire for control over the birth process; a desire to give birth in a familiar and comfortable environment, surrounded by family and friends; living in a rural area with lack of access to a hospital; and economic, cultural, or religious issues. Typically, a midwife usually attends a home birth, and an obstetrician is on call in case problems arise. Home births are certainly more appropriate for women who are at very low risk for complications. Although some studies demonstrate that home births are associated with greater risks for both the mother and baby, others show that home births are at least as safe as hospital births for healthy, low-risk women. The American College of Obstetricians and Gynecologists recently published the minimum criteria for planning a home birth, which include informed consent, a singleton pregnancy with the fetus’s head down, no medical or obstetrical conditions, no contraindications to vaginal birth, and the prenatal care, labor, birth, and postpartum care administered by a licensed obstetrical caregiver. The backup hospital should also be within 15 minutes of the home. In addition, and of prime importance, is that women completely understand that while the absolute risk of home births is low, it is still associated with a two- to threefold increase in neonatal death when compared with planned hospital births. Using a doula A doula may be a friend, relative, or trained companion who is there to provide nonmedical continuous support during labor and delivery. Doulas often meet with prospective moms before delivery so they get to know each other. During labor, they provide both emotional support and physical support — helping to get moms into comfortable positions, massaging their back or legs, getting water or ice chips, and so forth. Some studies have shown that labors attended with doulas may actually be shorter in length, although there is no effect on cesarean delivery rates. Women who used doulas also seemed to have a slightly better overall birth experience and were more likely to rate their labor and delivery as “very good.” Some women choose doulas because they may not have someone there (like a partner or friend) who can be of emotional support. Others may be at a hospital without one-on-one nursing care and want the additional help. Others just like having a helping hand, and others believe it will enhance the birthing experience. Immersing yourself in a water birth Water births refer to spending much of labor immersed in water, with the option of even delivering the baby in the water. Water births usually take place in a birthing center with the help of a midwife, although some hospitals may provide birthing pools or baths. The water temperature is kept about the same as the body temperature, and the woman’s temperature should be monitored throughout labor. A recent review of randomized trials found a somewhat lower rate of anesthesia when water immersion was used in the first stage of labor. Interesting, prolonged immersion for more than two hours may actually slow down labor by decreasing the production of oxytocin. Although some professionals in the medical community feel that a water birth is a safe procedure, others have more serious concerns about its safety for both the patient and newborn. Water immersion during the second stage is not well studied. There have been a few cases reported of water aspiration and snapped umbilical cords, difficulty regulating body temperature, and infections in the newborn.

Cheat Sheet / Updated 09-13-2021

Once you find out you’re pregnant, follow a recommended schedule of prenatal visits and review the tests you can expect for each doctor’s visit. Learning a few medical abbreviations used by your doctors and hospital staff will help you keep up with what's going on all the way through your delivery. Keeping tabs on your baby’s growth is exciting, especially when you have a helpful growth chart to follow. Keep a bag packed towards the end of your pregnancy and have important phone numbers handy ahead of time.

Article / Updated 04-24-2017

On or about the fifth day of development, the blastocyst attaches to the blood-rich lining of the uterus during a process called implantation. Part of the blastocyst grows to become the embryo (the baby in the first eight weeks of development), and the other part becomes the placenta (the organ that implants into the uterus to provide oxygen and nourishment to the fetus and eliminate its waste products). From the blastocyst, the embryo develops into three different tissue layers: the endoderm, mesoderm, and ectoderm. These three layers ultimately give rise to all of the structures of the body and are initially organized into a flat disk. Around the beginning of the fourth week of embryonic development, the flat disk begins to fold and form a cylinder. At this point, the embryo begins to take on the form of the general body plan, with a mouth region and an anal region. Between weeks four and eight, all of the organ systems that you find in an adult will be forming. After the eighth week of your pregnancy, the developing embryo is referred to as a fetus. Amazingly, by this time almost all the baby’s major organs and structures are already formed. The remaining 32 weeks allow the fetus’s structures to grow and mature. On the other hand, the brain, although also formed very early, isn’t mature at birth; rather it continues to develop into early childhood. Your baby grows within the amniotic sac in the uterus. The amniotic sac is full of clear fluid, known as amniotic fluid. This water balloon-like structure actually comprises two thin layers of membrane called the chorion and amnion (which together are known as the membranes). When people talk about water “breaking,” they’re referring to the rupturing of those membranes that line the uterus’s inner walls. The baby “swims” in this fluid and is attached to the placenta by the umbilical cord. The figure shows a diagram of an early pregnancy, including a developing fetus and the cervix, which is the uterus’s opening. The cervix opens up, or dilates, when you’re in labor. Credit: Kathryn Born, MA The placenta begins to form soon after the embryo implants in the uterus. Maternal and fetal blood vessels lie very close to one another inside the placenta, which allows various substances (such as nutrients, oxygen, and waste) to transfer back and forth. The mother’s blood and the baby’s blood are in close contact, but they don’t actually mix. The placenta grows like a tree, forming branches that in turn divide into smaller and smaller ones. The tiniest buds of the placenta are called the chorionic villi, and it’s within these villi that small fetal blood vessels form. About three weeks after fertilization, these blood vessels join to form the baby’s circulatory system, and the heart begins to beat. Menstrual weeks are weeks from the last menstrual period, not weeks from conception. So at eight weeks, the baby is really six weeks from conception. By the end of the eighth week, arms, legs, fingers, and toes begin to form. In fact, the embryo begins to perform small, spontaneous movements. If you have an ultrasound examination performed in the first trimester, you can see these spontaneous movements on the screen. The brain enlarges rapidly, and ears and eyes appear. The external genitalia also emerge and can be differentiated as male or female by the end of the 12th week, although sex differences are not yet detectable by ultrasound. By the end of the 12th week, the fetus is about 4 inches long and weighs about 1 ounce. The head looks large and round, and the eyelids are fused shut. The intestines, which protruded slightly into the umbilical cord at about week 10, are by this time well inside the abdomen. Fingernails appear, and hair begins to grow on the baby’s head. The kidneys start working during the third month. Between 9 and 12 weeks, the fetus begins to produce urine, which you can see within the small fetal bladder on ultrasound.

Article / Updated 03-08-2017

Your positive pregnancy test marks a new beginning. The time has come to start thinking about what lies ahead. After you decide who your practitioner will be, give the office a call to find out how to proceed. Some practices want you to come in for a visit with the office nurse to give a medical history and confirm your good news with either a blood or urine test, whereas others schedule a first visit with the practitioner. How soon your first visit will be scheduled depends in part on your past or current history. If you didn’t have a preconceptional visit beforehand, and you haven’t been on prenatal vitamins or other vitamins containing folic acid, let the office know. A prescription for prenatal vitamins can be called in so you can start taking them even before your first prenatal visit. All over-the-counter adult multi- and prenatal vitamins should have the correct dose of folic acid so the typical patient doesn’t need a prescription for them, but ask the pharmacist if you’re not sure. Also, some insurance companies may cover prescription vitamins but not over-the-counter ones, and some women just simply prefer one particular type of vitamin. Some things are consistent from trimester to trimester — like checking your blood pressure, urine, and the baby’s heartbeat. See the table for an overview of a typical schedule for prenatal visits. Typical Prenatal Visit Schedule Stage of Pregnancy Frequency of Doctor Visits First visit to 28 weeks Every four weeks 28 to 36 weeks Every two to three weeks 36 weeks to delivery Weekly If you develop problems during pregnancy or if your pregnancy is considered “high risk,” your practitioner may suggest that you come in more frequently. This schedule of prenatal visits isn’t set in stone. If you’re planning a vacation or need to miss a prenatal visit, tell your practitioner and reschedule your appointment. If your pregnancy is going smoothly, rescheduling usually isn’t a big deal. However, because some prenatal tests have to be performed at specific times during pregnancy, just make sure that missing an appointment won’t affect any of these tests. Prenatal visits vary a bit according to each woman’s personal needs and each practitioner’s style. Some women need particular laboratory tests or physical examinations. However, the following procedures are standard during your prenatal visits: A nurse checks your weight and blood pressure. You give a urine sample (usually an easy job for most pregnant women!). Your practitioner checks for the presence of protein or glucose, which may be a sign of preeclampsia or diabetes. Some urine tests also enable your doctor to look for any indications of a urinary tract infection. Starting sometime after 14 to 16 weeks, a nurse or doctor measures your fundal height. The practitioner uses either a tape measure or her hands to measure your uterus. This gives her a rough idea of how the baby is growing and whether you have an adequate amount of amniotic fluid. Credit: Kathryn Born, MA The nurse or doctor is measuring the fundal height, the distance from the top of the pubic bone to the top of the uterus (the fundus). By 20 weeks, the fundus usually reaches the level of the navel. After 20 weeks, the height in centimeters roughly equals the number of weeks pregnant you are. (Being above or below by 2 centimeters is usually within acceptable norms as long as you’re consistent from visit to visit.) The fundal height measurement may not be useful in women who are expecting two or more babies or in women who have large fibroids (in both cases, the uterus is much bigger than normal) or in women who are very obese (because it can be difficult to feel the top of the uterus). A nurse or doctor listens for and counts the baby’s heartbeat. Typically, the heartbeat ranges between 120 and 160 beats per minute. Most offices use an electronic Doppler device to check the baby’s heartbeat. With this method, the baby’s heartbeat sounds sort of like horses galloping inside the womb. Sometimes, you can hear the heartbeat as early as 8 or 9 weeks using this method, but often it isn’t clearly discernible until 10 to 12 weeks. Prior to the availability of Doppler, a special stethoscope called a fetoscope was used to hear the baby’s heartbeat. Using this method, the doctor can hear the heartbeat around 20 weeks. A third way of checking the baby’s heartbeat is by seeing it on ultrasound. The heart beating away can frequently be seen at around 6 weeks. In some practices, a medical assistant or nurse performs tasks such as checking your blood pressure; in other practices, a doctor may perform this task. No matter who performs the technical components of the prenatal visit, you should always have the opportunity to ask a practitioner questions before leaving the office.

Step by Step / Updated 03-27-2016

If you’ve ever had a parent-to-be show you an ultrasound picture of the baby, you know determining what you’re looking at, let alone detecting a family resemblance, isn’t always easy! But ultrasound pictures can be amazingly clear and useful — if you know what you’re looking for. Following are some of the items that doctors and sonographers try to pick out on ultrasound to find out whether the baby is growing and developing well.

Article / Updated 03-26-2016

So you know what’s going on throughout your pregnancy while at doctor’s visits, touring the hospital, and during labor and delivery, learn these medical abbreviations and what they mean. Abbreviation What It Stands For AFP Alpha-fetoprotein AMA/APA Advanced Maternal/Paternal Age CNM Certified Nurse Midwife CRL Crown-Rump Length CVS Chorionic Villus Sampling EDC or EDD Estimated Date of Confinement or Estimated Due Date EFW Estimated Fetal Weight EGA Estimated Gestational Age IUGR Intrauterine Growth Restriction LGA Large-for-Gestational Age LMP Last Menstrual Period MFM Maternal-Fetal Medicine SGA Small-for-Gestational Age

Article / Updated 03-26-2016

During your pregnancy, pack portable items you’ll need for your labor and delivery and hospital stay in a bag and keep it in a handy place or in your car. For your trip to the hospital you’ll need: Your partner/labor coach A bathrobe and nightgown Toiletries Sturdy underwear that you don’t mind soiling with blood A change of clothes to wear home, including comfortable, roomy shoes Baby clothes Infant car seat (your partner can bring this item on the day of discharge) Sanitary napkins (if you don’t want to use the archaic ones that most hospitals provide) A camera Telephone numbers of family and friends you may want to call Insurance information Lollipops or sucking candies Any device with the ability to play music Change for parking, or vending machines Cell phone

Article / Updated 03-26-2016

To ensure the health of you and your baby, you’ll need to schedule regular visits to your doctor during your pregnancy. Use this guideline for making your appointments and understanding common procedures for each visit: Weeks Possible Tests 6–8 Blood type, rubella titer, blood counts, hepatitis screen, ultrasound. 10–12 Doppler detection of fetal heart, CVS, if planned. 11–14 First trimester screen/Nuchal translucency (11–12 weeks is best) cell-free fetal DNA test is appropriate. 15–18 Second trimester serum screen (sometimes called quad screen); amniocentesis (if planned). 18–22 Ultrasound to evaluate fetal anatomy. 24–28 Glucose screen to check for gestational diabetes. 28–36 Every-other-week visits to check blood pressure, weight, urine protein, and fetal growth. 36–40 Weekly visits to check all the above and to assess fetal position. Some practitioners do internal exams to check the cervix; some do a vaginal/rectal culture for group B streptococcus. 40–?? Twice-weekly visits to assure fetal well-being.

Article / Updated 03-26-2016

At the eighth week of pregnancy (date of last menstrual period) the embryo is now referred to as a fetus. All organs are formed and the remaining 32 weeks of pregnancy is a time for the fetus to grow and mature. Take a look at this chart to see how your baby’s body weight and length changes during your pregnancy: Weeks Pregnant (measured from LMP) Average Weight Average Length 8 0.035 oz (1 g) 1.5 in (3.81 cm) 10 0.175 oz (5 g) 2.4 in (6.10 cm) 12 0.7 oz (20 g) 3.5 in (8.89 cm) 14 2.1 oz (60 g) 4.1 in (10.41 cm) 16 4.2 oz (0.12 kg) 6.25 in (15.88 cm) 18 8.0 oz (0.23 kg) 7.8 in (19.81 cm) 20 12.0 oz (0.34 kg) 9.75 in (24.77 cm) 22 1 lb (0.45 kg) 11.0 in (27.94 cm) 24 1 lb 8 oz (0.68 kg) 11.7 in (29.72 cm) 26 2 lb (0.91 kg) 12.5 in (31.75 cm) 28 2 lb 12 oz (1.25 kg) 13.7 in (34.80 cm) 30 3 lb 10 oz (1.65 kg) 14.8 in (37.60 cm) 32 4 lb 6 oz (2.00 kg) 15.6 in (39.62 cm) 34 5 lb 3 oz (2.35 kg) 16.4 in (41.66 cm) 36 6 lb (2.72 kg) 17.5 in (44.45 cm) 38 6 lb 12 oz (3.10 kg) 18.7 in (47.50 cm) 40 7 lb 8 oz (3.40 kg) 19.5 in (49.53 cm) lb = pounds cm = centimetersoz = ounces g = gramsin = inches kg = kilograms

Article / Updated 03-26-2016

Be prepared for your baby’s arrival (or in case you have questions or concerns during your pregnancy) by printing this list and filling out the information. Keep this list in your purse or on the fridge for easy access Your practitioner: Name ______________________ Phone number ________ Address ________________________________________________________ ______________________________________________________________________ Your pediatrician: Name ______________________ Phone number ________ Address ________________________________________________________ ______________________________________________________________________ Hospital or birthing center: Name ______________________ Phone number ________ Address ________________________________________________________ ______________________________________________________________________ Consultant (ultrasound, internist, maternal-fetal medicine, and so on): Name ______________________ Phone number ________ Address ________________________________________________________ ______________________________________________________________________