What to Expect When You're Expecting

What to Expect When You're Expecting

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Now with over 9.9 million copies in print, What To Expect When You're Expecting is America's pregnancy bible. Featuring an easy-to-follow month-by-month format, this indispensable book reassuringly leads readers through a wealth of information. Here is what parents-to-be need to know about choosing a caregiver, prenatal diagnosis, exercise, childbirth options, second pregnancies, twins, making love during pregnancy, having a cesarean, and coping with common and not-so-common pregnancy symptoms. Also included are step-by-step guides through labor and delivery, postpartum care, and breastfeeding, a full section just for fathers-to-be, and a 24-page of Pregnancy Notes" insert for keeping detailed records of prenatal test results, weight gain, doctor As visits, observations, and more. Updated with each printing, What To Expect When You're Expecting incorporates the most recent developments in medical science and responds to the many letters and queries received from readers. Selection of the Book-of-the-Month Club, the Better Homes & Gardens Family Book Service, and ABA Basic Booklist. Winner of the Parent's Choice Foundation's 1991 Parenting Shelf Award.

Product Details

ISBN-13: 9780761187486
Publisher: Workman Publishing Company, Inc.
Publication date: 05/31/2016
Edition description: Fifth Edition, Revised
Pages: 656
Sales rank: 173
Product dimensions: 5.90(w) x 8.60(h) x 1.30(d)

About the Author

Heidi Murkoff is the co-author of the What to Expect series with her mother Arlene Eisenberg and sister Sandee Hathaway. In addition, she runs the What to Expect Foundation, which she co-founded with her mother, Arlene Eisenberg. The Foundation promote pre-natal health in low-income areas and recently published a free low-literacy pregnancy guide. Heidi writes monthly "\" columns for Baby Talk and Parenting magazines and lectures nationwide on parenting and pregnancy issues. She lives in Santa Barbara, California, with her husband and two children.

Arlene Eisenberg worked on all three editions of What to Expect When You're Expecting and remained active in the What To Expect Foundation until her death in February 2001. She was also co-author, with Heidi Murkoff, of the "What to Expect" magazine columns.

Sandee Hathaway holds a Bachelor of Science in Nursing degree from Boston University. An experience RN with a specialty in obstetrics and neonatal care, Sandee lives in Waban, Massachussets with her husband and three children.

Read an Excerpt

Excerpt from:

What to Expect When You're Expecting

WHat You Can Expect At Your First Prenatal Visit

The first prenatal visit is the most comprehensive of all the prenatal visits. (See the Appendix for an explanation of the procedures and tests performed.) A complete medical history will be taken, and certain tests an procedures will be performed only at this exam. One practitioner's routine may vary slightly from another's. In general, the examination will include:

Confirmation of Your Pregnancy.

Your practitioner will want to check the following: the pregnancy symptoms you are experiencing; the date of your last normal menstrual period, to determine your estimated date of delivery (EDD), or due date (see page 6); your cervix and uterus, for signs and approximate age of the pregnancy. If there's any question, a pregnancy test may be ordered if you haven't already had one.

A Complete History.

To give you the best care, your practitioner will want to know a great deal about you. Come prepared by checking home records and refreshing your memory, as necessary, on the following: your personal medical history (chronic illness, previous major illness or surgery, medications you are presently taking or have taken since conception, known allergies, including drug allergies); your family medical history (genetic disorders and chronic illnesses); your social history (age, occupation, and habits, such as smoking, drinking, exercising, diet); your gynecological and obstetrical history (age at first menstrual period, usual length of menstrual cycle, duration and regularity of menstrual periods, past abortions, miscarriages, and live births; course of past pregnancies, labors and deliveries); and factors in your personal life that might affect your pregnancy.

A Complete Physical Examination.

This may include: assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at subsequent visits; notation of your height and weight, usual and present; inspection of extremities for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; inspection and palpation of external genitalia; internal examination of your vagina and cervix (with a speculum in place); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also through the rectum and vagina; assessment of the size and shape of your bony pelvis.

A Battery of Tests.

Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include:

  • A blood test to determine blood type and check for anemia.
  • Urinalysis to screen for sugar, protein, white blood cells, blood, and bacteria.
  • Blood screens to determine immunity to such diseases as rubella.
  • Tests to disclose the presence of such infections as syphilis, gonorrhea, hepatitis, chlamydia, and in some cases, AIDS).
  • Genetic tests for sickle-cell anemia or Tay-Sachs disease.
  • A Pap smear for the detection of cervical cancer.
  • A gestational diabetic screening test to check for any tendency toward diabetes, particularly for women who have previously had an excessively large baby or gained excessive weight with an earlier pregnancy.
An Opportunity for Discussion.

Come prepared with a list of questions, problems, and symptoms you would like to talk about. This is also a good time to bring up any special concerns that weren't addressed at an earlier consultation.

What You May Look Like

By the end of the first month, your baby is a tiny, tadpole-like embryo, smaller than a grain of rice. In the next two weeks, the neural tube (which becomes the brain and spinal cord), heart digestive tract, sensory organs, an arm and leg buds will begin to form.

What You Might Be Feeling

You may experience all of these symptoms at one time or another, or only one or two.


  • Absence of menstruation (though you may stain slightly when your period would have been expected or when the fertilized egg implants in the uterus)
  • Fatigue and sleepiness
  • Frequent urination
  • Nausea, with or without vomiting, and/or excessive salivation (ptyalism)
  • Heartburn, indigestion, flatulence, bloating
  • Food aversions and cravings
  • Breast changes (most pronounced in women who have breast changes prior to menstruation): fullness, heaviness, tenderness, tingling; darkening of the areola (the pigmented area surrounding the nipple). Sweat glands in the areola become prominent (Montgomery's tubercles), looking like large goose bumps; a network of bluish lines appear under the skin as blood supply to the breasts increases (though these lines may not appear until later)

  • Instability comparable to premenstrual syndrome, which may include irritability, mood swings, irrationality, weepiness
  • Misgivings, fear, joy, elation
  • any or all of these
What You May Be Concerned About


"I'm tired all the time. I'm worried that I won't be able to continue working."

It would be surprising if you weren't tired. In some ways, your pregnant body is working harder even when you're resting than a nonpregnant body is when mountain-climbing; you just can't see its efforts. For one thing, it's manufacturing your baby's life-support system, the placenta, which won't be completed until the end of the first trimester. For another, it's adjusting to the many other physical and emotional demands of pregnancy, which are considerable. Once your body has adjusted and the placenta is complete (around the fourth month), you should have more energy. Until then, you may need to work fewer hours or take a few days off if you're really dragging. But if your pregnancy continues normally, there is absolutely no reason why you shouldn't stay at your job (assuming your doctor hasn't restricted your activity and/or the work isn't overly strenuous or hazardous; see page 72). Most pregnant women are happier and less anxious if they keep busy.

Since your fatigue is legitimate, don't fight it. Consider it a sensible signal from your body that you need more rest. That, of course, is more easily suggested than done. But it's worth a try.

Baby Yourself.

If you're a first-time expectant mother, enjoy what will probably be your last chance for a long while to focus on taking care of yourself without feeling guilty. If you already have one or more children at home, you will have to divide your focus. But either way, this is not a time to strive for Super-Mom-to-Be status. Getting adequate rest is more important than keeping your house white-glove-test clean or serving dinners worthy of four-star ratings. Keep evenings free of unessential activities. Spend them off your feet when you can, reading, watching TV, or scouring baby-name books. If you have older children, read to them, play quiet games with them, or watch classic children's videos with them rather than traipsing off to the playground. (Fatigue may be more pronounced when there are older children at home, simply because there are so many more physical demands and so much less time to rest. On the other hand, it may be less noticed, since a mother of young children is usually accustomed to exhaustion and/or too busy to mind.)

And don't wait until nightfall to take it easy

  • if you can afford the luxury of an afternoon nap, by all means indulge. If you can't sleep, lie down with a good book. A nap at the office isn't a reasonable goal, of course, unless you have a flexible schedule and access to a comfortable sofa, but putting your feet up at your desk or on the sofa in the ladies room during breaks and lunch hours may be. (If you choose to rest at lunch hour, don't forget to eat, too.) Napping when you're mothering may also be difficult, but if you can time your rest with the children's nap-time (if they still nap), you may be able to get away with it
  • assuming you can tolerate the unwashed dishes and the dust balls under the bed.
Let Others Baby You.

Accept your mother-in-law's offer to vacuum and dust the house when she's visiting. Let your dad take the older kids to the zoo on Sunday. Enlist your husband for chores like laundry and marketing.

Get an Hour or Two More Sleep Each Night.

Skip the 11 o'clock news and turn in earlier; ask your husband to fix breakfast so you can turn out later.

Be Sure That Your Diet Isn't Deficient.

First-trimester fatigue is often aggravated by a deficiency in iron, protein, or just plain calories. Double-check to make certain you're filling all of your requirements (see the Best-Odds Diet, page 80). And no matter how tired you're feeling, don't be tempted to rev up your body with caffeine and candy bars, and cake. It won't be fooled for long, and after the temporary lift, your blood sugar will plummet, leaving you more fatigued than ever.

Check Your Environment.

Inadequate lighting, poor air quality ("sick building" syndrome), or excessive noise in your home or workplace can contribute to fatigue. Be alert to these problems and try to get them corrected.

Take a Hike.

Or a slow jog. Or a stroll to the grocery store. Or the time to do a pregnancy exercise routine. Paradoxically, fatigue can he heightened by too much rest and not enough activity. But don't overdo the exercise. Stop before that exercise high dissolves into a low, and be sure to follow the precautionary guidelines on page 195.

Though fatigue will probably ease up by month four, you can expect it to return in the last trimester -probably as nature's way of preparing you for the long sleepless nights once the baby has arrived.

When fatigue is severe, especially if it is accompanied by fainting, pallor, breathlessness, and/or palpitations, it's wise to report it to your practitioner...

Table of Contents

Forword to the Second Edition: Another Word From the Doctor ..... XV11
Forword: A word from the Doctor ..... XV111
Introduction to the Second Edition: Why This Book Was Reborn ..... XX
What's in a Month?
Introduction: How This Book Was Born ..... XXII

Part 1: In The Beginning

Chapter 1: Are You Pregnant? ..... 2

What You May Be Concerned About ..... 2
Signs of Pregnancy
Pregnancy Tests
Possible Signs of Pregnancy
Probable Signs of Pregnancy
Positive Signs of Pregnancy
Testing Smart
Due Date
What It's Important to Know: Choosing (and Working with) Your Practitioner ..... 8
A Look Back
What Kind of Patient Are You?
Obstetrician? Family Practitioner? Nurse-Midwife?
Type of Practice
Finding a Candidate
Birthing Alternatives
Making Your Selection
Making the Most of the Patient-Practitioner Partnership
Protecting Yourself Against Malpractice
So You Won't Forget

Chapter 2 : Now That You Are Pregnant ..... 18

What You May Be Concerned About ..... 18
Your Gynecological History
Previous Abortions
Fibroids Incompetent Cervix
Your Obstetrical History Repeating Itself
Repeat Cesareans
Your Family History
Pregnancies too Close Together
Tempting Fate the Second Time Around
Having a Big Family
Being a Single
Mother Having a Baby After 35
Age and Testing for Down Syndrome
The Father's Age
In-Vitro Fertilization (IVF)
Living at a High Altitude
Religious Objections to Medical Care
RH Incompatibility
Signs and Symptoms of Genital Herpes
Other STDs (Sexually Transmitted Diseases)
Fear of Aids
Hepatitis B
An IUD Still in Place
Birth Control Pills in Pregnancy
Genetic Problems
Your Opposition to Abortion
What It's Important to Know: About Prenatal Diagnosis ..... 42 Amniocentesis
Amnio Complication
Maternal-Serum Alpha-Fetoprotein Screening
Chorionic Villus Sampling (CVS)
Reducing the Risk in Any Pregnancy
Other Types of Prenatal Diagnosis

Chapter 3: Throughout Your Pregnancy ..... 52

What You May Be Concerned About ..... 52
Cigarette Smoking
Breaking the Smoking Habit
When Other People Smoke
Marijuana Use
Cocaine and Other Drug Use
Perils in Perspective
Caffeine Sugar Substitutes
Your Pregnancy Lifestyle
The Family Cat
Hot Tubs and Saunas
Microwave Exposure
Electric Blankets and Heating Pads
Household Hazards
Let Your House Breathe
The Green Solution
Air Pollution
Occupational Hazards
Getting all the Facts
Quiet Please
What It's Important to Know: Playing Baby Roulette ..... 76
Weighing Risk vs. Benefit

Chapter 4: The Best-Odds Diet ..... 80

Nine Basic Principles for Nine Months of Healthy Eating
The Best-Odds Daily Dozen
What's in a Pill?
The Best Odds Diet Food Selection Groups ..... 89
Protein Foods
High-Protein Snacks
Vitamin C Foods
Calcium-Rich Foods
Calcium-Rich Snacks
Green Leafy and Yellow Vegetables and Yellow Fruits
Other Fruits and Vegetables
Whole Grains and Legumes
Iron-Rich Foods
High-Fat Foods BEST ODDS RECIPES ..... 93
Cream of Tomato Soup
Best-Odds Fries
Power-Packed Oatmeal
Bran Muffins
Buttermilk Pancakes
Double-the-Milk Shake
Fig Bars
Fruity Oatmeal Cookies
Complete Protein Combinations
Dairy Complete Protein Combinations
Fruited Yogurt
Mock Strawberry Daiquiri
Virgin Sangria

Part 2: Months and Counting: From Conception to Delivery

Chapter 5: The First Month ..... l00
What You Can Expect at Your First Prenatal Visit ..... 100
Wbat You May Look Like
What You May Be Feeling ..... 102
What You May Be Concerned About ..... 102
Morning Sickness
Excessive Saliva
Frequent Urination
Breast Changes
Vitamin Supplements
Ectopic Pregnancy'
The Condition of Your Baby
Possible Signs of Miscarriage
Stress in Your Life
Relaxation Made Easy
Overwhelming Fear About Baby's Health
Picking Up Other Children
What It's Important to Know Getting Regular Medical Care ..... 116
A Schedule of Prenatal Visits
Wben to Call the Practitioner
Taking Care of the Rest of You

Chapter 6: The Second Month ..... 119
What You Can Expect at This Month's Check-up ..... 119
What You May Be Feeling ..... 119
What You May Be Concerned About ..... 120
Venous Changes
What You May Look Like
Complexion Problems
Waistline Expansion
Losing Your Figure Heartburn and Indigestion
Food Aversions and Cravings
Milk Aversion or Intolerance
A Meatless Diet
A Vegetarian Diet
Junk-Food Junkie
Eating Fast Food
Best-Odds Cheating
Chemicals in Food
Reading Labels
Eating Safe
What It's Important to Know: Playing It Safe ..... 133

Chapter 7 : The Third Month ..... 134
What You Can Expect At This Month's Checkup ..... 134
What You May Be Feeling ..... 134
What You May Look Like
What You May Be Concerned About ..... 135
Flatulence (Gas)
Weight Gain
Trouble Sleeping
Stretch Marks
Baby's Heartbeat
Sexual Desire
Oral Sex
Cramp After Orgasm
Twins and More
A Corpus Luteum Cyst
What It's Important to Know: Weight Gain During Pregnancy .... 47
Breakdown of Your Weight Gain

Chapter 8: The Fourth Month ..... 150
What You Can Expect At This Month's Checkup ..... 150
What You May Be Feeling ..... 150
What You May Look Like
What You May Be Concerned About ..... 152
Elevated Blood Pressure
Sugar in the Urine
Hair Dyes and Permanents
Nosebleeds and Nasal Stuffiness
Vaginal Discharge
Fetal Movement
Maternity Clothes
Reality of Pregnancy
Unwanted Advice
What It's Important to Know MAKING LOVE DURING PREGNANCY ..... 164
Understanding Sexuality During Pregnancy
When Sexual Relations May Be Limited
Enjoying It More, Even if You're Doing It Less

Chapter 9: The Fifth Month ..... 170
What You Can Expect At This Month's Checkup ..... 1 70
What You May Be Feeling ..... 1 70
What You May Look Like
What You May Be Concerned About ..... 1 7 1
Faintness and Dizziness
Hepatitis Testing
Sleeping Position
Carrying Older Children
Foot Problems
Fast-Growing Hair and Nails
Late Miscarriage
Abdominal Pain
Changes in Skin Pigmentation
Other Strange Skin Symptoms
Dental Problems
Eating Out
Eating Out, Best-Odds Style
Wearing a Seat Belt
A Low-Lying Placenta
Outside Influences in the Womb
Carrying Baby, Fifth Month
What It's Important to Know: Exercise During Pregnancy ..... 189
The Benefits of Exercise
Developing a Good Exercise Program
Don't Just Sit There...
Playing It Safe
Choosing the Right Pregnancy Exercise
If You Don't Exercise

Chapter 10: The Sixth Month ..... 199
What You Can Expect At This Month's Checkup ..... 199
What You May Be Feeling ..... 199
What You May Look Like
What You May Be Concerned About ...... 200
Pain and Numbness in the Hand
Pins and Needles
Baby Kicking
Leg Cramps
Rectal Bleeding and Hemorrhoids
Itchy Abdomen
Toxemia, or Preeclampsia
Staying on the job
The Pain of Childbirth
Labor and Delivery
What It's Important to Know: Childbirth Education . . . . . . .209
Benefits of Taking a Childbirth Class
Choosing a Childbirth Class
For Information on Childbirth Classes
The Most Common Schools of Thought

Chapter 11: The Seventh Month ..... 214
What You Can Expect At This Month's Checkup ..... 214
What You May Be Feeling ..... 214
What You May Look Like
What You May Be Concerned About ..... 215
Increasing Fatigue
Concern About the Baby's Well-Being
Edema (Swelling) of the Ankles and Feet
Orgasm and the Baby
Premature Labor
Don't Hold It In
Approaching Responsibility
Lower Back and Leg Pain (Sciatica)
Skin Eruptions
Fetal Hiccups
Dreams and Fantasies
A Low-Birthweight Baby
A Birthing Plan
What It's Important to Know: All About Childbirth Medication ..... 226
What Kinds of Pain Relief Are Most Commonly Used?
Making the Decision

Chapter 12: The Eighth Month ..... 233
What You Can Expect At This Month's CheckupS ..... 233
What You May Be Feeling ..... 233
What You May Look Like
What You May Be Concerned About ..... 234
Shortness of Breath
Not So Funny Rib Tickling
Stress Incontinence
Your Weight Gain and the Baby's Size
How You're Carrying
Presentation and Position of the Baby
Hospitals and Cesarean Rates
Making the Cesarean Birth a Family Affair
Travel Safety
Braxton Hicks
Relationship With Your Spouse
Making Love Now
What It's Important to Know: Facts About Breastfeeding ..... 251
Why Breast Is Best
Why Some Prefer the Bottle
Making the Choice
When You Can't or Shouldn't Breastfeed
Making Bottle-Feeding Work

Chapter 13: The Ninth Month ..... 256
What You Can Expect At This Month's CheckupS ..... 256
What You May Be Feeling ..... 257
What You May Look Like
What You May Be Concerned About ..... 258
Changes in Fetal Movements
Fear of Another
Long Labor
Bleeding or Spotting
Lightning and Engagement
When You Will Deliver
Do-It- Yourself Labor Induction?
Labor and Delivery Rooms
The Overdue Baby
How Is Baby Doing?
What to Take to the Hospital
Membrane Rupturing in Public
What It's Important to Know: Pre Labor, False Labor, Real Labor ..... 268
Prelabor Symptoms
False Labor Symptoms
Real Labor Symptoms
When to Call the Doctor
Best Medicine for Labor?

Chapter 14: Labor and Delivery ..... 2 7 1
What You May Be Concerned About ..... 2 7 1
Bloody Show
Rupture of Membranes
Darkened Amniotic Fluid (Meconium Staining)
Induction of Labor
Having a Short Labor
Calling Your Practitioner
Back Labor
Irregular Contractions
Not Getting to the Hospital in Time
Emergency Delivery En Route to the Hospital
Shaving the Pubic Area
Emergency Delivery If You're Alone
Fetal Monitoring
Emergency Home (or Office) Delivery
The Sight of Blood
Being Stretched by Childbirth
Being Strapped to the Delivery Table
The Use of Forceps
Apgar Table
The Baby's Condition
What It's Important to Know: The Stages of Childbirth ..... 288
Labor Positions
The First Stage Of Childbirth: Labor ..... 290
The First Phase: Early or Latent Labor
If You Aren't Making Progress
The Second Phase: Active Labor
On to the Hospital
The Third Phase: Advanced Active or Transitional Labor
Pain Risk Factors
The Second Stage Of Childbirth: Pushing and Delivery ...... 299
A Baby Is Born 1 A First Look at Baby
The Third Stage Of Childbirth: Delivery of The Placenta, Or Afterbirth ...... .305
Breech Delivery ..... 306
Cesarean Section: Surgical Delivery ..... 307

Part 3: Of Special Concern

Chapter 15: If You Get Sick ..... 310
What You May Be Concerned About ..... 310
Coming Down With a Cold or Flu
Gastrointestinal Ills
German Measles (Rubella)
Cytomega- lovirus (CMV)
Fifth Disease
Group B Strep
Lyme Disease
Urinary Tract Infection
Hepatitis 1XIV
Chicken Pox (Varicella)
Taking Aspirin and Nonaspirin
Taking Medications
Herbal Cures
What It's Important to Know: Staying Well ..... 323

Chapter 16: Coping With a Chronic Condition ..... 325
What You May Be Concerned About ..... 325
Safe Exercise
Heart Rate for Diabetic Pregnan-cies
Chronic Hypertension
Multiple Sclerosis (MS)
An Eating Disorder
Physical Disability
Phenylketonuria (PKU)
Coronary Artery Disease (CAD)
Sickle-Cell Anemia
Systemic Lupus Erythematosus (SLE)
What It's Important to Know: Living With The High-Risk Or Problem Pregnancy ..... 339
Moms Helping Moms

Chapter 17 : When Something Goes Wrong ..... 342
Conditions that May Cause Concern During Pregnancy ..... 343
Hyperemesis Gravidarum
Ectopic Pregnancy
Bleeding in Early Pregnancy
Bleeding,In Mid- or Late Pregnancy
If You've Had a Miscarri4ge
Early Miscarriage, or Spontaneous Abortion
Late Miscarriage
Trophoblastic Disease (Hydatidiform Mole
When a Serious Fetal Defect Is Detected
Partial Molar Pregnancy
Preeclampsia (Pregnancy-Induced Hypertension)
Lowering the Risks for the Baby at Risk
Intrauterine Growth Retar-dation (IUGR)
Repeat Low-Birthweight Babies
Placenta Previa
Placenta Accreta
Abruptio Placenta
Premature Rupture of the Membranes (PROM)
Cord Prolapse
Ve-nous Thrombosis
Preterm or Premature Labor
Conditions that May Cause Concern During Childbirth ..... 362
Uterine Inversion
Uterine Rupture
Shoulder Dystocia
First Aid for the Fetus
Fetal Distress V
aginal and Cervical Lacerations
Postpartum-Hemorrhage 1
Postpartum Infection

Chapter 17: When Something Goes Wrong ..... 342
Conditions That May Cause Concern During Pregnancy ..... 343
Hyperemesis Gravidarum
Ectopic Pregnancy
Bleeding in Early Pregnancy
Bleeding in Mid-or Late Pregnancy
If You've Had a Miscarriage
Early Miscarriage, or Spontaneous Abortion
Late Miscarriage
Trophoblastic Disease (Hydatidiform Mole)
When a Serious Fetal Defect is Detected
Partial Molar Pregnancy
Gestational Diabetes
Preeclampsia (Pregnancy Induced Hypertension)
Lowering the Risks for the Baby at Risk
Intrauterine Growth Retardation (IUGR)
Repeat Low-Birthweight Babies
Placenta Previa
Placenta Accreta
Abruptio Placenta
Premature Rupture of the Membranes (PROM)
Cord Prolapse
Venous Thrombosis
Preterm or Premature Labor
Conditions That May Cause Concern During Childbirth ..... 362
Uterine Inversion
Uterine Rupture
Shoulder Dystocia
Fist Aid for the Fetus
Fetal Distress
Vaginal and Cervical Lacerations
Postpartum Hemorrhage
Postpartum Infection
Coping With Pregnancy Loss .....366
When Multiple Fetuses Aren't Thriving?
Loss of One Twin

Part4: Last But Not Least: Postpartum, Fathers, and the Next Baby

Chapter 18: Postpartum: The First Week ..... 374
What You May Be Feeling ..... 374
What You May Be Concerned About ..... 375
Your Postpartum Condition
Pain in the Perineal Area
Difficulty with Urination
Having a Bowel Movement
Excessive Perspiration
Adequacy of Your Milk Supply
Engorged Breasts
When to Call Your Practioner
Engorgement If You're Not Breastfeeding
Going Home
Recovery from a Cesarean Section
What It's Important To Know: Getting Started: BreastFeeding ..... 388
Breastfeeding Basics
Baby and Breast
A Perfect Feeding Team
When the Milk Comes In
Best-Odds Nursing Diet
Sore Nipples
Occasional Complications
Medication and Breastfeeding
Breastfeeding After a Cesarean
Breastfeeding Twins

Chapter 19: Postpartum: The First Six Weeks ..... 396
What You May Be Feeling ..... 396
What You Can Expect At Your Postpardom Chechup ..... 397
What You May Be Concerned About ..... 397 Fever
Returning to Prepregnancy Weight and Shape
Breast Milk
Long-Term Cesarean Recovery
Resuming Sexual Relations
Lack of Interest in Making Love
Easing Back into Sex
Becoming Pregnant Again
Hair Loss
Taking Tub Baths
What It's Impotant To Know: Getting Back Into Shape ..... 408
Ground Rules
Phase One: 24 Hours After Delivery
Phase Two: Three Days After Delivery
Phase Three: After Your Postpartum Checkup

Chapter 20: Fathers Are Expectant, Too ..... 412
What You May Be Concerned About ..... 412
Feeling Left Out
Fear of Sex
Impatience With Your Wife's Mood Swings
Sympathy Symptoms
Anxiety Over Your Wife's Health
Anxiety Over the Baby's Health
Anxiety Over Life Changes
Your Wife's Looks
Falling Apart During Labor
Exclusion During Breastfeeding
Feeling Unsexy After Delivery

Chapter 21: Preparing for the Next Baby ..... 424

Appendix ..... 429
Common Tests During Pregnancy
Non-Drug Treatments During Pregnancy
Keeping Moist
Best-Odds Calorie and Fat Requirements
Sources and Resources

Pregnancy Notes ..... 439
Index ..... 462
Afterword ..... 479


Exclusive Author Essay
Some things about pregnancy never change. When the first edition of What to Expect when You're Expecting hit bookstores in 1985, pregnant women suffered from morning sickness, constipation, and leg cramps. In 2002 -- sorry, no good news here -- they still do. They experienced symptoms they'd never have associated with pregnancy, like forgetfulness and red palms; growth in places they'd never expected, like in their feet; and a range of emotions, from happiness to anxiety to apprehension to excitement, often within the same five minutes, that often made them doubt their sanity. They still do. They worried about their weight gain, their diet, the changing dynamics of their relationships, about labor and delivery, and most of all, about the health of their babies. They still do. They craved answers to their thousands of questions and reassurance for their thousands of worries. Guess what? They still do.

But as many things about pregnancy stay the same, at least as many don't.

In the nearly 19 years since I delivered a proposal for What to Expect when You're Expecting and a first baby (within about four hours of each other…it was a busy day), I've seen hundreds of changes. Changes not only in obstetrical practice but in the lifestyles of pregnant women and their partners (an important one being: those partners aren't necessarily their husbands anymore).

Most changes have been for the better. For instance, practitioners and their pregnant patients are getting along a lot better than they used to (or, as it's called it in the sandbox, they're "playing nicely"). Back in the late 1970s and early '80s, the climate in obstetrics was combative, often adversarial. Practitioners, usually obstetricians, tended to be inflexible in their practice, patients intractable in their birthing plans. Today, practitioners are for the most part far more responsive; patients, much more open-minded and better educated. The relationship is more likely to be a partnership -- a partnership that works together toward a shared goal (a healthy mother, a healthy baby), a partnership in which each partner contributes knowledge and insight based on what he or she knows best (practitioner: medicine; patient: her body). Another change is the fact that more of those partnerships are likely to be with midwives, who now deliver 9 percent of the babies born in the United States.

Recommendations about everything from prenatal diagnosis to sex to diet to exercise have changed. Take weight gain: When I was pregnant for the first time, gains of 70 pounds and more were the vogue. Sure, they still happen, but not usually with the practitioner's blessing. The majority of today's practitioners routinely recommend a more reasonable gain of 25 to 35 pounds for most women.

And because obstetrics, like all areas of medicine, is an ever-evolving science, the use of interventions during labor and delivery has evolved with it. Some procedures that were routine at hospital admission a generation ago, such as enemas and shaving of the pubic hair, have been pretty much abandoned; women today can wear their pubic hair any way they care to at delivery. Pain medication, which fell out of favor with the (re)popularization of natural childbirth, is back in style with a vengeance -- more than half of all delivering women now ask for an epidural by name. At the same time, complementary and alternative treatments -- from biofeedback for morning sickness to hypnosis and acupuncture for pain relief during labor -- once the province of fringe practitioners, have entered the mainstream of obstetrical practice. Cesarean rates are down from their all-time high in the 1980s, but they are creeping up once again (and are still considered way too high); vaginal birth after cesarean (VBAC) is now on its way down after becoming almost standard; induction was down, now it's up again, though a backlash may soon bring it back down; and (dizzy yet?) episiotomies and fetal monitoring, routine when I was birthing babies (I had both procedures), are now used only when deemed necessary, which doesn't turn out to be all that often. Further reducing the need for interventions with their special brand of comfort, support, and care are doulas, birth attendants-for-hire who coach both mothers and fathers during delivery and who are showing up at more and more births.

Not only has how women given birth changed, but where. Birthing centers that cater to low-risk deliveries by midwives continue to proliferate, but the most dramatic differences are in hospital deliveries. Family-centered care is the norm -- big brothers and sisters are welcomed with fanfare and sibling classes; fathers aren't just coaching the birth but spending the night. While I had to fight for my birthing room (there were only one or two in many hospitals, offered on a first-come-first-served basis, and none at all in others) today's low-risk expectant mothers can expect to deliver in LDRs (labor-delivery-recovery) or LDRP (labor-delivery-recovery-postpartum) rooms that rival some hotel suites in luxury and convenience (except the room service isn't nearly as good). Jacuzzi, anyone?

Visit a maternity store, and you'll notice one of the most obvious changes: Pregnancy style is no longer an oxymoron. I spent my pregnancies, unhappily, in tentlike dresses that could sleep a family of four beneath their enormous pitch. Today's expectant mothers celebrate their swollen silhouettes in clothes designed to cling, not conceal. They flaunt their bellies proudly in bikinis and in baby tees that reveal more than a glimpse of baby-to-be. Even the expectant mother on the cover of What to Expect when You're Expecting has benefited from this revolution in maternity wear -- besides trading in her '80s perm for a sleek new bob for the third edition, she's retired her shapeless muumuu for a twin set and slacks. Even her shoes, though still sensible, are cuter. Now, that's progress!

Yes, a lot has changed -- in pregnancy and in What to Expect when You're Expecting -- in the 19 years since I first delivered a baby and a book proposal. Great changes, most of them. In fact, every once in a while, I start wondering if I should give pregnancy another chance again, fill up that nearly empty nest, just so I'd be able to experience all those changes for myself. Then I remember about the morning sickness. And the constipation. And the leg cramps. And the sleepless nights. And I think maybe I'll just keep writing about pregnancy instead. After all, some things never change. (Heidi Murkoff)

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What to Expect When You're Expecting 4.5 out of 5 based on 0 ratings. 4 reviews.
Anonymous More than 1 year ago
Love this new edition!
Anonymous More than 1 year ago
KanakaLele More than 1 year ago
This book has a ton of information on nearly every pregnancy-related subject you can think of. It is, however, firmly in the "if it's not proven safe, it's not good for you and you shouldn't do it" category - for example, things like telling you not to eat deli meats. (Research on this has shown that the risk is quite low, and these days things like frozen organic vegetables are just as prone to carrying listeria as deli meat.) Overall, a good place to start - but take the advice with a grain of salt and do some of your own research. Very easy to read.
dibbylodd More than 1 year ago
As a grandmother to be, I find this book amazingly informative. It is exhaustively research and updated and written in an informed, while accessible style.