healthy babies book

8/8/2019 Healthy Babies Book

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Having Healthy BabieT

h e S ci

en c e

In s i d e

H E A L T H Y P E O P L E L I B R A R Y P R O J E C TAmerican Association for the Advancement of Science


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Having Healthy Babies: TheScience Inside

HEALTHY PEOPLE LIBRARY PROJECTAmerican Association for the Advancement of Science


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INTRODUCTION: NATURE PLUS KNOWLEDGE . . . . . . . . . . . . . . . . . 1

PART 1: WHOS AT RISK IN PREGNANCY? . . . . . . . . . . . . . . . . . . . . 3Risk factors and risk disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3How risk factors cause harm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Reducing risks: Maternal health before pregnancy. . . . . . . . . . . . . 8

PART 2: WHAT IS A HEALTHY BABY? . . . . . . . . . . . . . . . . . . . . . . . 11Healthy conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Healthy development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Healthy birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Healthy infancy and early childhood . . . . . . . . . . . . . . . . . . . . . . . 13

PART 3: HEALTH CARE DURING PREGNANCY AND CHILDBIRTH . . 17Recognizing pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Nutrition, exercise, and environment . . . . . . . . . . . . . . . . . . . . . . 20Labor and delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Postnatal care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

PART 4: COMPLICATIONS OF PREGNANCY. . . . . . . . . . . . . . . . . . . 27Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Miscarriage and other pregnancy loss . . . . . . . . . . . . . . . . . . . . . . 28Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29High blood pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Stress, anxiety, and depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Premature labor and childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Neonatal intensive care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

PART 5: HEALTH CARE OF INFANTS AND TODDLERS . . . . . . . . . . . 37Caring for an infant at home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Postnatal medical care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Risks to infant health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Health in infancy and early childhood. . . . . . . . . . . . . . . . . . . . . . 39Smart babies: learning through play . . . . . . . . . . . . . . . . . . . . . . . 41

T A B L E O F C O N T E N T S


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PART 6: NEW RESEARCH ABOUT MOTHERS AND BABIES . . . . . . . 45Identifying risk factors and risk disparities . . . . . . . . . . . . . . . . . . 45Discovering causes for pregnancy complications . . . . . . . . . . . . . . 46Evaluating prenatal and postnatal care. . . . . . . . . . . . . . . . . . . . . 47The vital role of volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

CONCLUSION: MAKING MOTHERS AND BABIES HEALTHIER . . . . . 49

RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

APPENDIX 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Questions to Ask Your Doctor About Pregnancy and Childbirth

APPENDIX 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Taking Part in Research StudiesQuestions To Ask

APPENDIX 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Recommended Early Childhood Immunization Schedule

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

PHOTO CREDITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72


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ost people think that humanreproduction just comes naturally.It is certainly true that women hadbeen giving birth for thousands of years before reproduction wasunderstood by science. But for mostof those centuries, pregnancy andchildbirth were highly dangerousfor both mothers and babies. Today,because of advances in science, weknow more than ever before abouthow to have healthy babies and howto keep them healthy.

Science and technology have givenus tools that would have been hardto imagine just 50 years ago. Now, amother can actually see a picture of her unborn baby in the womb.Infants who are born too early havea much greater chance of survivingthan ever before. Doctors can per-form tests that show parents, evenbefore the mother becomes preg-nant, where they might have trou-ble having a healthy baby. Scientificresearch shows which risk factorscan lead to an unhealthy pregnancyand how to avoid these risks.

Many scientific studies have shown

that mothers who receive good pre-natal care are at lower risk forhaving health problems in preg-nancy. A mother and her baby arehealthier when the mother seeks

prenatal care early in her preg-nancy. Nurses, doctors, and otherprofessionals monitor the health of the mother and the growth of thebaby in the womb. They treat thenormal discomforts of pregnancyand help mothers reduce the risksof the complications of pregnancy.

Every parent needs to have knowl-edge about the natural process of reproduction. They need to knowthat a babys health begins with theparents healththat mothers andfathers with healthy lifestyles have

better chances of producing infantswho are born healthy and who stayhealthy. Parents need to know howthe process of childbirth can bemade safer for both mothers and

INTRODUCTION: NATUREPLUS KNOWLEDGE

M


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H a v i n g H e a l t h y B a b i e s : T h e S c i e n c e I n s i d e

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babies. They also need to know howthe proper care of newborn infantshelps them grow up healthy andstrong.

This book summarizes what healthprofessionals know about healthybabies and mothers. It also directsreaders to more sources of informa-tion and to the latest scientificresearch. Most of that researchdelivers a positive message: pregnan-

cy, childbirth, and infant care can besafe, happy, and healthy experiences.Doctors can identify risk factors forunhealthy pregnancy. Parents canchange their lifestyles to avoid theserisks and give infants the best possi-ble start in life. Armed with knowl-edge, mothers can look forward withpeace of mind to the joy of childbirthand of having healthy children andfamilies.

Health Professionals for Mothers and Babiesprimary doctor: monitors the patients overall health, directs medical treatment, and coordinates care

gynecologist: specializes in womens health

obstetrician: specializes in care of pregnantwomen and their developing babies

nurse-midwife: advises mothers on labor anddelivery; delivers babies with physician

emergency backup

pediatrician: specializes in childrens health

lactation consultant: helps women learn tobreastfeed their newborns

dietician, nutritionist: matches the patient withan eating plan and provides training and supportso the patient eats properly

dentist: regularly checks the mothers mouth to prevent or treat gum disease

pharmacist: dispenses prescriptions, helps the patient keep track of medications, and offers advice on toolsand supplements


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Risk factors and riskdisparitiesPregnancy always carries somehealth risks, because the needs of the growing baby make extrademands on the mothers body.

Mothers who are not healthy aremore likely to have unhealthybabies. Scientists have identifiedmany risk factors that increase thechances that a mother and her babywill have health problems. A riskfactor for pregnancy is any behav-ior or condition that might harm themothers or babys health.

Researchers often identify riskfactors by counting how often theyoccur at the same time as certainmedical problems. For example,smoking is a risk factor for anunhealthy pregnancy. According tothe Office of the Surgeon General,smoking is probably the mostimportant risk factor of poorpregnancy outcomes among womenin the United States. Women who

smoke during pregnancy subjectthemselves and their developingfetus and newborn to special risks,including an increased risk of miscarriage, pregnancy complica-tions, premature birth, low birth

weight infants, infections, still-birth, and infant death.

The data on smoking do not providea scientific explanation of howsmoking harms the fetus. Nor dothe numbers allow for other risk

factors that often go along withsmoking, such as alcohol abuse orobesity. The findings are, however,strong evidence that smoking is oneof the causes of low-birth-weightbabies.

A risk disparity is a noticeable dif-ference in risk data between mem-bers of one racial, ethnic, or othersocial group and the population as awhole. For example, researcherscounted the incidence of variousrisk factors in mothers of differentracial origins. The results showedthat the percentage of health risksin pregnancy is significantly higheramong African Americans thanamong other racial groups.

Like the smoking data, thesestatistics have some limitations.For example, the table includes nocategories for mixed races. A motherwith one Asian-American parentand one African-American parentwould have to be assigned to just

PART 1: Whos at risk

in pregnancy? Smokingand Pregnanc Women who smok

have increased risfor conception deand for bothprimary andsecondary infertil

Women who smok

during pregnancyrisk pregnancycomplications,premature birth,low birth weightinfants, infectionsstill birth, and infdeath.

Women who smokmay have a modeincrease in risks fectopic pregnancy(fallopian tube orperitoneal cavitypregnancy) andspontaneousabortion.

Studies show a linbetween smokingand the risk ofsudden infant dea

syndrome (SIDS)among the offspriof women whosmoke duringpregnancy.


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one of the groups for reporting pur-poses. However, for all their limita-tions, risk disparities can be cluesto the causes of health problems andcan guide researchers in their searchfor cures.

Identifying a risk disparity is not thesame as identifying what causes thedisparity. Risk disparities can be theresult of social conditions (such aslower incomes and less access tohealth care), as well as medicalconditions (such as personal andfamily medical problems).

How risk factors cause harmIf a woman understands how riskfactors can harm her health, shemight be motivated to lower herhealth risks by getting better healthcare, changing bad habits, and paying

attention to her own and her familyshealth histories.

Listed below are just a few examplesof risk factors in pregnancy and whatmedical science knows about theircauses. These causes include those

that relate to diet, genetics, viruses,bacteria, smoking, substance abuse,and teenage pregnancy. More factsabout the health problems of preg-nant women and infantsand aboutthe risk factors for those problems appear in Parts 3, 4, and 5 of thisbook.

Diet. Folic acid deficiency is anexample of a risk factor related todietspecifically to folic acid, one of the B vitamins. Folic acid is foundin green, leafy vegetables and citrusfruits. It can also be obtained frommost multiple vitamins or other vita-min supplements. Folic acid contains

Low and Very Low Birthweight Birthsby Maternal Race, United States 2000

Low birthweight is less than2500 grams (51/ 2 pounds)Very low birthweight is lessthan 1500 grams (31/ 3 pounds)

White Black Native Asian orPacific

Islander

All Races

Percent

8

4

0

13.0

Source: National Center foHealth Statistics, 2000 finanatality dataPrepared by March of DimPerinatal Data Center, 2002


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chemicals that help build normalred blood cells and healthy nervecells. Without folic acid, the motherruns a risk of anemia (a shortageof red blood cells) and other prob-lems. The unborn baby is also atrisk because it needs folic acid todevelop a healthy nervous system.The most critical time for theembryo to get folic acid is duringthe first few weeks of pregnancy,when its nerve cells are first beingformed.

Folic acid deficiency is a leadingcause of spina bifida and otherbirth defects of the brain andspinal cord. Spina bifida, alsocalled open spine, affects thebackbone and the spinal cord andcan cause paralysis of the legs, aswell as problems with bladder andbowel control. Folic acid deficiencycauses another neural tube defectcalled anencephaly. Babies withthis deadly condition are born with

severely undeveloped brains andskulls. Low levels of folic acid havealso been related to miscarriages,premature (early) deliveries, andlow birth weight babies.

Genetics. Sickle cell disease isan example of a risk factor thatis genetic, or inherited. Thisdisease is caused by a defective

form of hemoglobin, which isfound in all red blood cells. Redblood cells with normal hemoglo-bin are round, flexible, and moveeasily through the blood vesselsto deliver oxygen throughout the

body. Red blood cells with sicklecell hemoglobin, however, canbecome rigid and bent into a C (orsickle) shape. Sickled red bloodcells are sticky and can clumptogether, forming temporary plugsin small blood vessels that stopblood flow and cause pain. Whilenormal blood cells live about 120days, sickled cells die after about10 to 20 days. Because they cannotbe replaced fast enough, the bloodbecomes short of red blood cells, acondition called anemia. Pregnantwomen with sickle cell diseasemay suffer more pain and infec-tions during pregnancy thanwomen without the disease. Theyare also at increased risk for heartproblems, miscarriage, andpreterm (early) labor.

Sickle cell disease is also danger-ous because the genetic trait forthe disease can be passed on to the

unborn baby. If both parents carrythe sickle cell gene, there is a 50/50chance that their baby will alsocarry the sickle cell gene. Mostcases of sickle cell disease in the

Part 1: Whos at risk in pregnancy?

Currently, roughly one in eight or morethan 500,000 women

smoke during preg-nancy in the United States. Birth compli-cations caused by

smoking during pregnancy or pre-natal exposure to

secondhand smoke

result in as much as$2 billion in addi-tional health carecosts in the U.S.each year.

According to theU.S. Agency for Healthcare Researchand Quality, infant respiratory distress

syndrome and pre-maturity/low birthweight, which canboth be caused by maternal smok-ing, are two of thethree most expensivconditions requiringhospital care.


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United States occur among African Americans and Hispanic Americansfrom the Caribbean. Scientists esti-mate that about 1 in 12 African

Americans in the United States

carries the sickle cell trait. About 1in every 400 African Americans actu-ally gets sickle cell disease.

Viruses. Rubella (German measles)is an example of a risk factor that iscarried by a virus. A virus is a tinyorganism that invades the cells of living things. Once inside a body, avirus becomes a parasite, living off the cells of its host, reproducingitself, and spreading disease. Thevirus that causes rubella is carriedthrough the mothers bloodstreamand into the bloodstream of the fetus.

Infection by the rubella virus cancause miscarriages or stillbirths, oreven congenital rubella syndrome(CRS). CRS is a group of severebirth defects, including mental retar-dation, heart disease, deafness, andcataracts.

Bacteria. Chlamydia is an exampleof a sexually transmitted infec-

tion (STI). Chlamydia is caused bybacteria. The bacteria enter the vagi-na during sexual intercourse, wherethey multiply and spread to theuterus, fallopian tubes, and ovaries.Unless it is treated, chlamydia canlead to inflammation throughout thewomans reproductive system. Pelvicinflammatory disease (PID)damages the fallopian tubes, whichcan lead to ectopic pregnancy(tubal pregnancy) or infertility.Pregnant women with chlamydia areat greater risk for miscarriage andpreterm deliveries. Mothers withchlamydia also risk passing the

Why Does Sickle Cell Disease Occur Only within Certain Ethnic Groups?

Does it seem odd that some diseases only occur withincertain ethnic groups? In the case of sickle cell disease,only people whose ancestors came from areas of theworld troubled by a deadly disease called malaria caninherit the condition. And whats more, although sicklecell anemia is a serious medical condition, it oncehelped keep people alive!

Hundreds of thousands ofyears ago, malaria sweptthrough parts of Africa,the Mediterranean, theMiddle East, and India.Although many peoplewere killed, some sur-vived. Those who did hada genetic mutation (analteration in a gene) thatcaused some of their redblood cells to form into asickle shape. Sickled redblood cells did not allowthe parasite that causesmalaria to spreadthroughout the body.

Some of the malaria sur-vivors with the mutated

hemoglobin gene had children with other survivors, andpassed the gene on to some of their children. Genera-tion after generation, the gene was passed on ascarriers had children with other carriers. Over time, aspeople migrated throughout the world, so did the sicklecell gene. Unfortunately, the gene that once helpedpeople survive malaria can also cause great harm in theform of sickle cell disease.


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infection on to their babies duringdelivery. Babies born with chlamy-

dia can develop eye infections andpneumonia.

Smoking. Smoking is an exampleof a risk factor caused by addictivebehavior. It can cause damage inseveral different ways. First, smok-ing is dangerous because it depositsnicotine, carbon, sulfur, and otherharmful chemicals into the lungs.

These harmful chemicals penetratedeep into the smallest branches of the lungsthe tiny air sacs. Insidethe air sacs, oxygen breathed infrom the air is supposed to passinto the bloodstream. Air sacs thatare clogged from smoking cannotdeliver enough oxygen to the blood.Damage to the mothers blood inturn causes damage to the fetus.Through the bloodstream, the dam-age from smoking spreads through-out the bodys systems. Each systembecomes less able to produce thesubstances it needs. For example,smoking weakens the immune sys-

tem, making it harder for the bodyto produce antibodies to fight off

viruses and infections. Becausesmoking damages so many parts of the body, it is not always possible totrace every path by which dangerfrom smoking reaches the unborninfant. But statistics link smokingto many of the worst health prob-lems of pregnancy: miscarriage,ectopic pregnancy, placental compli-cations, low birth weight, and even

birth defects.

Substance Abuse. Alcohol,cocaine, and other substance abuse,like smoking, are risk factorscaused by addictive behavior.

Addictions have complex causesthat include home environment andsocial pressures, in addition tochemical reactions. For pregnantwomen, the risks of substanceabuse extend to the unborn child.For example, babies born to moth-ers who used cocaine during preg-nancy can be born addicted to thedrug. Mothers who drink alcohol


A woman should get healthy before

she gets pregnant.She should see

a doctor as early in pregnancy as possible.


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during pregnancy put their babies atrisk for fetal alcohol syndrome.This is a combination of mental andphysical birth defects, including men-tal retardation, heart problems, andabnormal brain development

Teenage pregnancy. Teenage preg-nancy is a risk factor with manyphysical and social causes. Scientistsknow that younger mothers are atrisk because so many health problemsoccur more often among them. Womenunder 20 are at greater risk for highblood pressure, anemia, and prema-

ture labor during pregnancy. Teenagemothers also have a higher chance of having low birth weight babies. Theyounger a mother is, the greaterthe chance that her baby will notweigh enough at birth.

It is not always possible to pinpointthe causes of health problems amongteenage mothers. Studies show that

teenagers are more likely to have pooreating habits and are less likely toreceive early prenatal care than oldermothers. Teenage mothers also tendto gain less weight during pregnancy.(A healthy, non-overweight womanshould gain between 25 and 35pounds.)

Reducing risks: maternalhealth before pregnancyFortunately, there are steps womencan take to reduce many of the riskfactors of pregnancy and childbirth.For the best health, doctors recom-

mend these steps for all womenof childbearing age.

Take at least 400 micrograms(400mg) of folic acid every day. For

most women, this means taking amultiple vitamin to supplement thefolic acid received from food. Since ahuman embryo needs folic acid evenbefore the mother knows she ispregnant, the USDA recommendsthat all women of childbearing agetake folic acid.

Eat a healthy, well-balanced dietthat is high in fiber and low in salt

and sugar. Learn your personal and family

medical histories. A womans med-ical history can help predict andprevent problems she might havein pregnancy. The medical history of the father can also be important.Many risk factors for pregnancy aremedical conditions like heart dis-ease and high blood pressure, which

can be passed down through bothsides of the family.

Refrain from smoking, drinkingalcohol, and using cocaine and otherchemical substances.

Refrain from having sex with multi-ple partners and from other behav-iors that spread sexually transmit-ted diseases.

Get regular medical and dentalcheckups.

Make sure you are immunizedagainst mumps and rubella andkeep other immunizations up todate.


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For Wendy Hilliard, PrenatalExercise Scores a Perfect 10

Wendy Hilliard is as comfort-able stretching on mats in agym as she is sitting on a sofain her living room. After yearsof triumphing in world-classcompetitions in rhythmic gym-nastics, she knows the rewardsof a steady exercise regimenare more than gold medalsand cheers from an apprecia-

tive audience. Thats why,when she became pregnant forthe first time at age 41, sheimmediately began to thinkabout ways in which exercisecould continue to promote herown good health and that ofher unborn child. Ive beenan athlete my entire life, buthaving a baby changes every-thing. I wanted to be sure

that I did exercise that wasgood for me and for my baby,said Hilliard.

As it turns out, I did have to make adjustments to my routine, both interms of exercise and work.

Before becoming pregnant, Hilliard engaged three to five times a week inBikram yoga, a demanding method in which a heated exercise area bol-sters the difficulty of the workout. After years of training and competi-tion, she loved the intensity of the workout; however, it was that intensitythat caused concern among her doctors. After considering the many exer-cise options available to pregnant women, she switched to a weekly rou-tine of prenatal yoga at the Prenatal Yoga Center in New York City, sup-plemented by 3-mile walks.

Prenatal yoga, with its focus on Kegel exercises and proper breathingtechniques, is aimed at making pregnancy and childbirth easier on the

Hilliard, continued on next page


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bodysomething any mom-to-be can appreciate. It also helps to reduce stress,to boost energy, and to teach self-discipline.

For Hilliard, being disciplined has never been a problem. From first-handexperience, she knows that hard work and training yield results. In 1978, she

became the first African American to represent the United States in rhythmicgymnastics and she remained on the National Team a record-setting ninetimes. A national and international gold medalist, Hilliard represented the U.S.in more than 15 foreign countries and at three world championships.

Her personal and professional lives still reflect the energy and intensity level ofthe city she calls home, New York, where she serves as managing director ofsports for NYC2012, an organization committed to bringing the Olympics to theBig Apple.

As if that isnt enough, she is also founder and president of the Wendy HilliardFoundation, an organization that has helped more than 5,000 New York inner-city youth enjoy rhythmic gymnastics programs and its associated disciplines.Yet, no matter how busy her schedule, Hilliard always makes time for exercise.

Like so many moms-to-be across the country and the world, she is enthusiasticabout her new form of exercise. I love it. Its a healthy, life-long activity thatreally has a calming influence, and I am able to bond with the other moms-to-be in my class.

For Hilliard and other moms-to-be, prenatal exercise scores a perfect 10.


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Healthy conceptionConception takes place when amale sperm cell fertilizes a femaleegg. A woman is born with thou-sands of eggs in her ovaries, andusually only one of those eggsmatures per menstrual cycle. Afterthe egg is released, it travelsthrough the fallopian tube towardthe uterus. Sperm cells meet theegg in the fallopian tube and fertil-ize it. The fertilized egg then entersthe uterus and is implanted in itswall, which begins a pregnancy.(Sometimes, more than one eggmature and become fertilized, whichleads to twins or other multiple

births.)

Conception can take place onlywithin a very short amount of time each month. A womans mostfertile time is in the middle of hermonthly cycle. This occurs abouttwo weeks from the first day of themenstrual period, or between 12and 14 days before the next men-

strual period is due. Once the sin-gle-celled egg is fertilized, it imme-diately begins to divide.

Healthy developmentMost babies are born between 38and 42 weeks after conception.Obstetricians use the first day of the last menstrual period plus 40weeks as a formula for estimatingthe expected delivery date. Medicalscience divides a pregnancy bytrimesters periods of about threemonths each.

The first trimester. In a healthypregnancy, the fertilized egg movesdown the fallopian tube into theuterus. The egg implants itself intothe wall of the uterus. This causescertain hormones to be released,

Part 2: What is a

healthy baby?


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which signal the uterus to begin itsgradual change into a womb. Bythree to four weeks after conception,the fertilized egg has developed intoan embryo. The cells of the embryovery rapidly divide into specializedcells that will become the bodysmajor systems. By nine or ten weeksafter conception, the embryo hasgrown into a fetus.

Meanwhile, the mothers body hasbeen changing to provide the fetuswith what it needs. By the end of thefirst trimester, the place in the

uterus where the egg was implantedhas developed into the placenta.For the rest of the pregnancy, theplacenta will nourish the fetus andeliminate its wastes. A mucous plugdevelops to seal off the motherscervix, which creates a secure womb.

The second trimester. During thesecond trimester, the baby further

develops the complex systems it willneed to survive on its own. Healthybabies call more and more attentionto themselves during their fourth,fifth, and sixth months in the womb.Mothers and their doctors can hearthe babys heartbeat and determineits sex and age.

Second-trimester babies begin mov-ing their muscles, stretching, andkicking. The skeletal, muscular, andother systems grow stronger at anever-increasing rate. By the end of month five, a healthy baby weighsabout one pound. It weighs two

pounds or more by the end of monthsix. By the end of the secondtrimester, the fetus still almost com-pletely relies on the placenta fornourishment and waste disposal. Butthe baby has begun swallowing,digesting, and breathing on its own.

The third trimester. During theseventh month of pregnancy, thefetus moves ten or more times everyhour. The mother feels most of thesemotions. During the seventh andeighth month, the baby will get intobirth position. The baby may move

around considerably before settlingdown. The usual position is with thehead pointing down toward the birthcanal.

The unborn baby gains most of itsweight during the third trimester.

A healthy baby reaches about fourpounds by week 30 of pregnancy andfive pounds or more by week 35. The

baby is considered full term by week37. The healthy baby will weighabout 7.5 pounds at birth.

Healthy birthIn a healthy birth, the baby is bornwith no complications in labor anddelivery and no harm to the baby.The birth process is described in

detail in Part 3: Health care duringpregnancy and childbirth.To first-time parents, a newbornbaby may not look especially healthy.Its skin may have spots or patches of waxy, flaky substances. Its head may


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Part 2: What is a healthy baby?

have a funny shape. The baby mayvery well be red and wrinkled.These are normal effects of child-birth and need not cause alarm.Birth attendants begin cleaning thebaby as soon as it is born. Babiescannot see well at birth. An infantsvision takes some time to adjust tothe world.

These ordinary conditions of child-birth usually clear up within a veryfew days.

Healthy infancy and earlychildhoodDuring its first month, the infantwill gradually stretch itself outafter being cramped so long in thefetal position. After stretching out,the infant becomes ever more inter-active. Gradually the baby learns tohold up its head, roll over, squirmalong, crawl, stand up, and then

finally walk. A babys skills developquickly in early childhood.

For more information about healthybabies, see Part 3, Health care dur-ing pregnancy and childbirth, Part5, Health care for infants and tod-dlers, and Part 6, New researchon mothers and babies.

These illustrations show how the baby posi-tions itself during labor for a routine vaginal birth. The baby descends headfirst into themother's pelvis and shifts its head so the

smallest part will go through the birth canal first.Then the baby turns from a sideways position to one where its head faces its moth-er's back. Finally the baby flexes its neck sothat doctors or medical attendants can guidefirst the baby's head and later the rest of itsbody out of the mother's womb.


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Part 2: What is a healthy baby?

Recipe, continued on next page

Mothers Milk A Recipe for Success

Morena Parada, a mother of three girls, understands that breastfeedingcan be a complicated issue for new moms. On one hand, researcherspoint to a wide range of benefits that breastfeeding affords a babyfrom a stronger immune system to a higher I.Q. But for some women,nursing can be difficult or even painful at first. Some women may alsoworry about how people will react if they nurse their babyespeciallyif they are the first person in their family or the only one amongfriends who decides to breastfeed.

For me, it came down to doing the best thing for my baby, saysParada, a 31-year-old mother from Alexandria, Virginia. I think nursinghas helped my girls be healthier. They rarely get sick, and I think thatnursing is one of the reasons.

Parada first made the decision to breastfeed eleven years ago when hereldest daughter, Vicky, was born. Initially, the decision was made basedon convenience: Parada liked not having to worry about warming milkin the middle of the night, toting bottles whenever she went out, orpaying for expensive formula. But there was an intangible benefit thatoutweighed all others: the time spent nursing made her feel especially

close to her baby.It was our special time, Parada said. I would sing to her in Spanish,and hold her as close to me as I could.

When her second baby, Karina, now 4 1 / 2 years old, was born Paradaknew she would again breastfeed. And she did for 2 1 / 2 years.

Currently nursing her third child, Diana, age 1, Parada is a veteran ofbreastfeeding and a vocal advocate. As part of her commitment tokeep her children healthy, Parada visits the clinic sponsored by the

Alexandria Neighborhood Health Services, Inc., a neighborhood-basedcenter that is geared toward the Hispanic population and dedicated tomaking sure that women and children in need receive basic health care.While at the clinic, Parada encourages expectant mothers to give nurs-


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ing a try, and for new mothers who are having a difficult time, she urges per-severance.

Breastfeeding came easy to Parada, but she knows that is not the case foreveryone. It is not always easy for new mothers. They complain about sore-ness and sometimes the baby doesnt take to it right away. It can be frustrat-ing. I just tell the moms to give it a chance, but I understand that for somemothers its really hard, especially when they dont get support from others.

Support is something Parada feels blessed to have. Her husband, Nicholas,understands and appreciates what she is doing for their baby, and she findscomfort in knowing that so many of her friends and relatives have made thesame choice.

In fact, research shows that Parada has a lot of company. A recent nationalsurvey found that breastfeeding in the United States is at a record high, with69.5 percent of new mothers starting out breastfeeding. Equally impressive isthat 32.5 percent are still nursing six months later.

For a variety of reasons, breastfeeding is not for every mother, but clearlymore and more women like Parada are viewing breast milk as a recipe fortheir childrens success.


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Part 3: Health careduring pregnancyand childbirthRecognizing pregnancy

As soon as conception begins, themothers body begins to change. Thefirst unmistakable sign of pregnancyis missing a menstrual period. A sexually active woman who misses aperiod should suspect pregnancyfirst, even though there may beother causes. Other early warningsigns include sore breasts, more fre-quent urination, nausea and vomit-ing ( morning sickness ), andfatigue. A woman who suspects sheis pregnant might want to use ahome pregnancy test to confirmher suspicions.

By the time the mother recognizesthe pregnancy, the embryo has prob-ably been alive for two to four weeksor more. A woman who thinks she ispregnant should immediatelybehave as if pregnantstop smok-ing, stop drinking alcohol and tak-ing drugs, start eating right, and soforth. She should seek prenatal care

as soon as possible.

Prenatal careThe first trimester. The first pre-natal care consultation should takeplace soon after the first signs of

pregnancy, preferably by theend of the second month. A mother will profit most fromthe visit if she comes pre-pared with the medical his-tories of both herself and

the childs father.

At the first visit, healthcare professionals will ask questionsabout the mother and fathers gener-al health and lifestyles. If necessary,they will recommend changes.The mother might be asked tostop smoking, drinking alcohol,and abusing drugs. The doctorwill ask what prescription andover-the-counter drugs she is tak-ing. Often the doctor will recom-mend that she stop taking thedrugs and suggest alternativetreatments during pregnancy.

The doctor will also review themothers medical history for dis-eases or conditions that might berisk factors in the pregnancy. When

the mother has a medical conditionsuch as obesity, diabetes , or highblood pressure, the doctor willadvise her on how to control diseaseduring this critical time. The doctorwill test the mother for rubella(German measles), HIV , and hepa-

A mother receiveshealthcounseling.

Babies need prenata

care during pregnanand postnatal care athey are born.


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18

titis B diseases that are especiallyharmful to the embryo. A hemoglobintest establishes how healthy themothers blood is.

Whenever possible, the fathers med-ical history is reviewed as well.Looking at the genetic history helpsparents and their doctors decidewhether to perform genetic testing.Some genetic conditions have a muchhigher incidence among certain ethnicgroups. For example, people of European descent have a higher rateof cystic fibrosis . Tay-Sachs ,Canavan , and Gauchers diseases

are more common among Jewish peo-ple. Sickle cell disease has a higherincidence among African Americans.Thalassemia occurs more oftenamong Asian Americans and thoseof Mediterranean descent.

Prenatal health care professionalswill also advise mothers about diet,nutrition, exercise, health environ-ments, and other aspects of pregnan-cy. They will set up a prenatal careschedule for the rest of the pregnancy,usually with monthly visits.

During the first trimester of pregnan-cy, many women suffer discomfortssuch as nausea, backaches, andfatigue. Health care professionalscan help women alleviate these dis-comforts. Good nutrition, exercise,and other good health habits can alsohelp the mother feel better.

The second trimester. This is usu-

ally the most comfortable trimesterfor both healthy babies and healthymothers. The discomforts of earlypregnancy usually go away. The babybegins to grow, and the mother beginsgaining weight. A healthy amount togain during the second trimester is 3to 4 pounds per month. Regular pre-natal care should continue, with visitsto the doctor at least once a month.By this time, the baby will havegrown enough for the mother and doc-tor to hear the babys heartbeat. Themother also feels the baby movinginside her womb.

HIV/AIDS and Pregnancy HIV (human immunodeficiency virus) causesAIDS (acquired immune deficiency syndrome). AIDSis passed on through sexual intercourse or exposure

to infected blood. Being infected with HIV (being HIV positive)and having AIDS are risk factors for pregnancy.They are associated with premature births andother complications in pregnancy and with low-birth-weight babies.

Mothers can pass on HIV and AIDS to theirunborn infants. Without treatment, babies areinfected in 1 out of every 4 cases.

The risk of infection to infants can be greatlyreduced by treating the mother with the drug AZT(zidovudine) during pregnancy.

To avoid blood exchange and contamination ofthe baby during delivery, the doctor might recom-mend delivery by caesarean section (c-section).

Babies of mothers who have HIV or AIDS shouldbe tested soon after birth. New tests can identifymost infected babies by one month.

Babies of mothers who have HIV or AIDS are atcontinued risk from the virus during their first yearof life.


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Warning SignduringPregnancy The AmericanMedical Associationrecommends that apregnant woman seeher doctor if sheexperiences anyof the followingsymptoms:

Abdominal crampcontractions, orother pain

Persistent, dullbackache

Pressure in thepelvis

Leaks of blood orother fluid fromthe vagina

Pain or burningupon urination

Headaches andblurred vision

A fever with atemperatureover 100F

A lower fever thatlasts for more thana few days

Extreme or suddenswelling of thehands or feet

1

In normal, healthy pregnancies,health care providers can easilymonitor the babys progress withouthigh technology. They measure themothers expanding body and checkthe position of the fetus and theshape of the uterus. Vaginal exami-nation also shows how a pregnancyis progressing. Doctors and nursesask questions about abnormal spot-ting or other symptoms the moth-er might be experiencing. Additionalblood and urine testing might alsobe used to monitor health.

Under special circumstances, thedoctor might also order moreadvanced tests of the babys health.Ultrasound tests , amniocentesis ,chorionic villus sampling (CVS) ,and alpha-fetoprotein screeninghelp health care professionals moni-tor the health of both the motherand the baby. These tests are notroutine. They are done if the mother

asks for them, or if the doctorthinks they are medically necessary. At least two of the procedures amniocentesis and CVShave somepossible harmful side effects.Women and their doctors or mid-wives must weigh these risks whendeciding on this testing.

The third trimester. The lasttrimester can get increasinglyuncomfortable for both the baby andthe mother. The baby moves aroundless, but restricts the movements of the mother more. It might becomenecessary to have more frequentprenatal care visits. The mothershould be careful to eat properly

and to gain the right amount of weight. The total weight gain dur-ing pregnancy should be 25 to 35pounds (for mothers of normalweight).

During the third trimester themother might experience more dis-

comfortsuch as frequent urinationand constipation as a directresult of the growing baby.Backaches, swollen veins, and otherproblems might also develop. Themother should watch herself closely,keep track of her symptoms, anddiscuss them with her obstetrician.This is especially true for high-riskpregnancies .

This is the time when the womanand her doctor or midwife will bemaking decisions about how andwhen the baby will be delivered.The medical condition of the motheror baby might lead the doctor toadvise a caesarean section

Part 3: Health care during pregnancy and childbirth

Ultrasound scanning is often performed during pregnancy as a routine check-up.The size of the fetus is assessed and any abnormalities in growth or development can be discovered.


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(c-section) . In a c-section, the babyis delivered through a surgical inci-sion of the uterus. For routine vagi-nal birth , the mother might electto give birth without medications.The mother might want to attend achildbirth class to prepare for laborand delivery. The father is alsoencouraged to attend these classes.Parenting classes help parents pre-pare for feeding, changing, and clean-

ing the newborn infant. Healthexperts recommend that parents getas much training as possible whilethey await the babys birth.

Nutrition, exercise,and environmentGood prenatal care is up to the moth-er as well as her doctors. The mother

20


These conditions are usually not dangerousand can be treated by changing your diet,behavior patterns, or medications. However,your doctor should monitor any of these con-ditions, since they can lead to more seriouscomplications.

Morning sickness. Nausea and vomiting,which usually occur during the first trimester.Affects about half of all pregnant women.Recommended treatments include eatingcrackers or other bland food before gettingout of bed, eating several small meals a day,avoiding foods that trigger nausea, drinkingplenty of fluids, and drinking tea or eatingfoods that contain ginger.

Anemia. An inadequate level of hemoglobinin the blood that is caused by too little iron orfolic acid in the diet. Symptoms includefatigue, fainting, pale skin, heart palpitations,and breathlessness. Treatment includes addingiron-rich foods (leafy green vegetables, lentils,cooked dry beans, and citrus fruits) to yourdiet. This condition must be monitored careful-ly to avoid more serious problems.

Edema. Swelling caused by extra fluid in themothers body that is often brought on bywarm weather. Treatment includes puttingcold-water compresses on the affected areas,avoiding salt, and elevating the legs and feet.Sudden swelling of the face, legs, or feetrequires immediate medical attention.

Varicose veins. Painful and swollen veins,especially in the legs, due to an increased vol-ume of blood in the body. Afflicts about 20

percent of pregnant women. Treatmentincludes staying off your feet and wearing sup-port stockings and loose clothing.

Constipation. Slowed bowel activity, oftencaused by pressure from the growing baby.Treatment includes drinking 23 quarts of flu-ids per day; getting moderate daily exercise;eating fruits, whole grains, and vegetables;and taking fiber formers or laxatives under adoctors supervision.

Hemorrhoids. Enlarged veins in the anus,often due to the increased pressure of consti-pation. Treatment includes avoiding constipa-tion, avoiding strain during bowel movements,

taking warm baths, and applying witch hazelcream.

Heartburn. Burning sensation in the stomach,often caused by the expanding uterus pushingon the stomach. Treatment includes eatingsmaller meals more often, eating more slowly,avoiding greasy foods and coffee, raising thehead slightly during sleep, and taking simpleantacids under a doctors supervision.

Backache. Low-level pain in the lower back orligaments, caused by the weight of the grow-ing baby. Treatment includes controllingweight, eliminating strain, and getting moder-ate exercise.

Disturbed sleep. Can be caused by all of theabove discomforts, as well as by stress, anxiety,or depression. Treatment includes avoiding caf-feine, avoiding large meals before bedtime,and getting more exercise.

Common Medical Conditions during Pregnancy


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will also need the cooperation of everyone in her household.

Nutrition. A pregnant womanshould stop smoking or inhaling

second-hand smoke. She shouldstop drinking alcohol. She shouldstop using illegal drugs. She shouldcut down on or eliminate sugar,

junk foods, fatty and salty foods,and caffeine. Instead, she shouldfollow a well-balanced diet that isrich in whole grains, fruits, andvegetables.

Variety in nutrition is important inorder to make sure the mother andbaby get all the nutrients theyneed. Pregnant women need proteinfor cell growth and blood produc-tion; carbohydrates for daily energy;calcium for strong bones and teethas well as for muscle contractionand nerve functions; iron for redblood cell production; and fat forstored body energy.

The role of vitamins in promotinghealth is also well known. Pregnantwomen need vitamin A for healthyskin, good eyesight, and strongbones; vitamin C for healthy gums,teeth, and bones and for healthyabsorption of iron; vitamin B6 forhealthy blood cell formation and tohelp the body use proteins, fats, andcarbohydrates; vitamin B12 for redblood cell formation and maintain-ing nervous system health; vitaminD for healthy bones and to aid inabsorbing calcium; and folic acid forblood and protein production. Most

pregnant women should take vita-min supplements to make sure alltheir needs are met.

Exercise. Research shows that

exercise is not just safe for pregnantwomen but beneficial. A womanshould consult her doctor, however,before beginning her exercise pro-gram. If she already exercisesregularly, she should clear herroutine with her doctor during herfirst prenatal care visit. Jogging,running, horseback riding, andother exercises that require jerky,

bouncy movements are not recom-mended for pregnant women.

Exercises to strengthen the pelvicmuscles are especially recommend-ed for pregnant women. Kegelexercises strengthen the musclesthat support the uterus, bladder,



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urethra, and rectum. During the lasttrimester of pregnancy, mothersshould undertake exercise plans toprepare for labor. Mothers can learnsuch exercises at Lamaze or otherchildbirth classes.

Safe environments. Clean house-hold and work environments protectthe mother and baby from bacterialinfections during pregnancy andearly infancy. These are the mostcritical times for the babys health.The mother and other householdmembers should take extra care to

use high standards of hygiene.Changing cat litter is unsafe for apregnant woman because cat fecescarry the bacteria toxoplasmosis .

Pregnant women and their babiesare more vulnerable to listeriosisand other forms of food contamina-tion. According to the Center forDisease Control, pregnant women

are 20 times more likely than other

healthy adults to get listeriosis.Changes caused by hormones arethought to make pregnant womenmore susceptible. Greater care thanusual should go into keeping kitchensurfaces clean, washing food, andcooking food thoroughly.

Health care experts are also becom-ing more concerned about unsafework environments during pregnan-cy. Pregnant women who workshould examine the hygiene stan-dards in their workplace restroomsand kitchen areas. Women should

also check for potential health haz-ards, such as harmful chemicals,that are used in the process of theirwork. Women should discuss theirenvironmental safety concerns withhealth care professionals.

Labor and deliveryIn most pregnancies, labor begins

with a series of noticeable changes.

Pain Relief during Delivery Each of these methods has advantages and drawbacks. The mother and her doctor ormidwife should discuss available options and make decisions as pregnancy advances.

Epidural. Insertion of a needle into the epidural space at the end of the spine.This numbs the lower body.

Intravenous analgesic. Pain-relieving drug administered through a tube inserted

into a vein.Lamaze (natural childbirth). Series of techniques for breathing and for stretching andrelaxing the muscles to aid in labor and delivery without medications.

Local analgesic. Pain-relieving drug administered locally through a needle insertedinto a muscle.

Pudendal block. A procedure that numbs the area around the vulva.


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The mother feels the baby descend-ing into the pelvis. The mothermight begin to feel small, irregularcontractions of her uterus. Crampsin the lower back are another signlabor is approaching.

When these signs appear, the moth-er and her health care providersshould make final plans for thedelivery. One important decisionto be made is what kind of painrelief, if any, will be used duringthe delivery.

The unmistakable signs of labor areregular labor pains and breakingwater . A womans water sometimesbreaks first, but it usually happensafter labor pains have begun. Thepains come more frequently andstrongly as labor progresses. A woman who has begun labor shouldimmediately set the delivery plan inmotioncall the doctor or midwife,or get to the hospital or birth cen-ter . The mother will be examined

and then admitted or sent home toremain on close watch, with emer-gency plans in place.

Most births are healthy. The moth-ers uterus contracts, which widensthe cervix. When the cervix is wideenough, the mother begins to push.The baby is thrust downward witheach contraction, and then finallyslides down into the birth canal andemerges head-first. The doctor andmedical attendants guide the babygently into the world. Attendantsquickly remove the mucus from thebabys mouth and nose, and thebaby makes its first cry. Often thebaby is placed immediately on itsmothers stomach. The umbilicalcord is cut.

Several quick screening tests areperformed on the baby immediatelyafter birth, usually right in thedelivery room. Attendants weighand measure the baby. They per-form a simple visual test and give


The mothers womband birth canal

prepare for delivery and the fetus movesinto position for birth when the

pregnancy hasreached termin approximately 9 months.

Daily Food Portions duriPregnancy According to theMarch of Dimes, apregnant womansdaily diet shouldinclude the following

6 to 11 servings ofbreads and otherwhole grains

3 to 5 servingsof vegetables

2 to 4 servingsof fruits

4 to 6 servings ofmilk and milkproducts

3 to 4 servings ofmeat and proteinfoods

6 to 8 glasses ofwater, and no morethan one soft drinkor cup of coffee peday to limit caffein


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Snuffing out SIDS

It seems like children have beentagging around after Amanda Sue

Bordeaux all her life and Bordeauxcouldnt be happier about it. As thethird-oldest in a family of nine kids,Bordeaux learned at a young age howto comfort and care for babies. Whenshe was in high school, she ran a tutor-ing and nutrition program for youngerchildren after school. Now that shes agrandmother, Bordeaux isnt slowingdown; she runs an in-home daycareprogram with 12 to 15 children.

I think my daycare career really startedwhen I was 10 years old, laughed Bordeaux as she chased her two-year-old grandson around her home in Rosebud, South Dakota.

But a moment later, she turned serious. Bordeaux, who is Native American,has become increasingly worried about the number of babies on her reser-vation who have died in their sleep from Sudden Infant Death Syndrome,or SIDS.

Recently there have been a lot of baby deaths, and Im kind of baffledabout it, Bordeaux said. Because I take care of a lot of kids I hear aboutit from different people. Fortunately Ive never had anything happen to achild in my care, but one of my fellow daycare providers had taken care ofa child who passed away from SIDS recently.

Thats why Bordeaux, who is a member of the Comanche tribe, attended arecent two-day conference on SIDS held in Rosebud, which drew expertsfrom as far away as Washington, D.C. The conference was both scary andreassuring, said Bordeaux. It frightened her to realize that South Dakota isin the region of the country that has the highest rate of SIDS. But she feltbetter knowing that parents and caregivers can do many things todecrease the chance that SIDS will strike their babies.

The conference was really a brainstorming session, said Bordeaux. Themain objective was how we can get the word out to the Native American

SIDS, continued on next page


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people about SIDS being at the highest rate in our area and how we can pro-mote awareness of ways to prevent it.

Although Bordeaux already knew the importance of putting babies to sleepon their backs, rather than on their stomachs, and of keeping soft beddingand stuffed animals out of the crib until a child turns one year old, other tipsshe learned at the conference came as a surprise.

I didnt realize there was an association with cigarette smoking and SIDS,she said. Everybody talks about how you shouldnt smoke around kids, butI never realized smoking could be so bad for kids even before theyre born.

So now Bordeaux warns pregnant women on her reservation not to smokeand not to stand too close to anyone else who is smoking either.

My own daughter is due with her baby in July, and she didnt even knowthat, said Bordeaux.

When that baby arrives, itll be grandchild number three for Bordeaux butshe sometimes feels as though shes a grandmother to hundreds of kids. Justrecently, a young woman who once attended Bordeauxs in-home daycaretelephoned and asked Bordeaux to come with her to the hospital: It was timefor her to deliver her own baby.

Bordeaux cant wait to sing that new little baby girl a lullaby before she putsthe baby down to sleep on her back, of course.


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InfertilityInfertility is the inability to con-ceive children. Doctors think of cou-ples as infertile if they are not ableto conceive children after a year of sexual intercourse without birthcontrol .

Infertility has many causes.Problems with the male reproduc-tive system occur in about 30 per-cent of infertility cases. Up to 70percent of infertility problems origi-nate in the female reproductive sys-tem. Known causes of infertility forboth men and women include emo-tional stress, malnutrition, obesity,cancer, abuse of alcohol and drugs,smoking, and certain medical condi-tions (diabetes, thyroid disease,HIV/AIDS , and others). Femaleinfertility is most often caused bydiseases of the reproductive system,such as pelvic inflammatorydisease and endometriosis .

Medications and treatments forinfertility are as varied as the caus-

es. Intense screening and diagnostictests might be necessary to estab-lish the source of the problem.The woman might be treated withfertility drugs . These are medica-

tions, often hormones, whichregulate or bring about ovulation .When a disease such as endo-metriosis has caused permanentdamage to the reproductive system,in vitro fertilization might beused. In this procedure, the egg

Part 4: Complications

of pregnancy

Common Pregnancy ComplicationsThe Centers for Disease Control lists the mostcommon complications of pregnancy, whichinclude:

ectopic pregnancy depression high blood pressure infection complicated delivery

diabetes premature labor hemorrhage miscarriage excessive vomiting need for a caesarean delivery

The CDC also lists the leading causes of maternaldeath: hemorrhage blood clots

high blood pressure infection strokes amniotic fluid in the bloodstream heart muscle disease


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and sperm are joined in the laborato-ry and then transferred to the uterus.

Miscarriage and otherpregnancy lossMiscarriage. A miscarriage is theloss of an unborn child during thefirst 20 weeks of a pregnancy. It oftenoccurs before the mother learns she ispregnant. Between 15 and 20 percentof known pregnancies end in miscar-riage. Its medical term is sponta-neous abortion .

Miscarriage is almost never caused byexercise or sexual intercourse. Inmost miscarriages, the fertilized eggdoes not develop normally. The abnor-mal development is due to genetic fac-tors. Miscarriages are also associatedwith risk factors in the mothershealth, such as smoking, alcohol andillegal drug use, chronic disease, and

older age. A condition called anincompetent cervix is responsiblefor some repeated miscarriages.Women who have already had severalpregnancy losses are at greater riskfor miscarriage in the future.However, miscarriages also take placein low-risk pregnancies. They are usu-ally not preventable.

Warning signs of a miscarriageinclude vaginal spotting or bleeding,losing fluid or tissues from the vagi-na, abdominal pain, and cramping. A woman with those symptoms shouldcall her health care providers andseek help immediately.

Ectopic pregnancy. An ectopicpregnancy , also called a tubal preg-nancy, is one in which the fertilizedegg develops outside the uterus. Most

of the time (about 95 percent), the eggsettles in the fallopian tube. The eggmight also become implanted in thecervix, abdomen, or ovaries. As anectopic pregnancy goes on, the grow-ing embryo or fetus can burst theorgan that contains it. The rupturecauses internal bleeding and puts themother in danger of her life. Mostectopic pregnancies do not developinto live births.

Ectopic pregnancies occur in about 2percent of all pregnancies. Earlydetection of an ectopic pregnancy cansave the mothers life. The warningsigns include vaginal bleeding, fol-lowed by worsening pain in the lowerabdomen. There might also be shoul-der pain, dizziness, nausea, andvomiting.

Molar pregnancy. A molar preg-nancy is one in which the placentagrows abnormally. The baby may notform at all, or be unformed andunable to survive. The rate of frequency is about 1 in 1,000pregnancies.

Ultrasound technology (sonograms)

can help detect molar pregnanciesearly. Surgery is needed to remove themolar tissue. After the surgery, thewoman is monitored for a year forchoriocarcinoma , a cancer thatcan develop in any remaining molartissue.


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Warning signs of molar pregnancyinclude vaginal bleeding a weekafter a missed period, abdominalcramping, severe nausea and vomit-

ing, and high blood pressure.

Stillbirth. A stillbirth takes placewhen a baby dies in the womb afterthe 20th week of pregnancy. Thishappens in about 1 in 200 pregnan-cies. Only about 1 in 7 stillbirthstakes place during labor and deliv-ery. Many stillbirths happen with-out warning in an otherwisehealthy pregnancy. Women withhigh blood pressure and diabetesare at higher risk.

A mothers first notice of a stillbirthis that the baby stops kicking andmoving around. Bleeding from thevagina is another sign. A stillbirthis often diagnosed by ultrasound.Doctors induce labor after the diag-nosis in order to save the health of the mother. The baby and placentaare examined. However, the causeof death in a stillbirth cannotalways be determined.

DiabetesDiabetes is a disease that preventsthe body from digesting sugarsand starches properly. Women whohave diabetes before they arepregnant have more risk factorsfor pregnancy.

Type 1 and Type 2 diabetes.Type 1, or insulin-dependent, dia-betes is caused by the failure of thepancreas to produce the hormoneinsulin . Young people usuallydevelop this form of diabetes beforeage 20. Patients with Type 1 dia-betes require daily insulin shots.Type 2, or noninsulin-dependentdiabetes, is brought on by overeat-ing and poor diet and is associatedwith obesity. This type of diabetescan often be brought under control

with proper diet, weight loss, andoral medication. Both Type 1 andType 2 diabetes are risk factors forpregnancy. Pregnant women whoare diabetic may need to discontin-ue or change their medications toavoid harm to the baby.

Part 4: Complications of pregnancy

In vitro implantation of embryo into uterus.


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Gestational diabetes. Gestationaldiabetes occurs during pregnancyand goes away after the pregnancy isover. Between 3 and 5 percent of preg-nant women in the United Statesexperience this complication. In gesta-tional diabetes, the pregnant womanssystem is unable to properly regulatethe release of insulin. As the placentaand fetus grow, more insulin is need-ed, until the pancreas can no longermake enough insulin to keep up withdemands.

There are many risk factors associat-

ed with gestational diabetes, such asobesity, a family history of diabetes,having too little amniotic fluid , orhaving a history of very large births,stillbirths, or births with birthdefects. Older mothers are also atgreater risk. But many women with-out those risk factors also developgestational diabetes.

Doctors recommend that all pregnantwomen be tested for gestational dia-betes. Women who are diagnosed withthis condition will be asked to helpcontrol their blood sugar levels withdiet. The health of the fetus andmother will be monitored to reducecomplications during later pregnancyand childbirth. Health problems dueto gestational diabetes are manage-able and preventable.

High blood pressureHigh blood pressure (or hyperten-sion ) can exist before pregnancy ordevelop during pregnancy ( gestation-

al hypertension ). Both types canlead to health problems and complica-tions during pregnancy. Hypertensioncan damage the mothers kidneysand other organs. A disease associatedwith high blood pressure is pree-clampsia . Preeclampsia can lead toan even more serious condition,eclampsia . Problems related to highblood pressure occur in 6 to 8 percent

of pregnancies in the United States.

Doctors may advise a pregnantwoman with high blood pressure tocontrol her weight, increase exercise,and make other dietary and lifestylechanges. Pregnant women should telltheir doctors about blood pressuremedications they are taking.Preeclampsia is characterized by acombination of high blood pressureand increased protein in the mothersurine. Increased protein in the urinemight be the result of kidney prob-lems. The kidney problems could bethe result of the mother having highblood pressure or diabetes beforepregnancy.

Preeclampsia occurs more frequentlyin mothers over 40 and under 20,obese mothers, and mothers withdiabetes, kidney disease, rheuma-toid arthritis , lupus , or scleroder-ma . It is also more commonduring multiple births.


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Preeclampsia prevents the placentafrom getting enough blood. The pla-centa therefore cannot nourish thebaby adequately. This can cause lowbirth weight and other problems.Warning signs of preeclampsiainclude severe headaches, excessiveswelling of hands and feet, dimin-ishing urine, blood in the urine,vomiting, double or blurred vision,fever, pain in the abdomen, rapidheartbeat, and dizziness. Specialprenatal care is needed.

Fortunately, only a small percent-age of women with preeclampsiadevelop eclampsia, a serious condi-tion characterized by seizures .Hospitalization late in pregnancymight also be required if the doctorfeels that eclampsia is a threat.

Stress, anxiety,and depressionMental health during pregnancy isanother issue that concerns healthcare professionals. Recent studieshave shown that depression, stress,anxiety, and other mood disordersstrike many mothers, both duringand after pregnancy.

Stress can contribute to emotionaland mental problems during preg-nancy. Normal worries of parents,such as where to find the extra

income to care for the new baby, canput stress on the mother. The dis-comforts of pregnancy can also leadto stress. Research suggests thatstress is harmful because it releasesa hormone that can trigger contrac-tions of the uterus. Stress also caus-es higher blood pressure, elevated


Symptoms of Postpartum DepressionThe U. S. governments Office on Womens Health recommends that mothers whoexhibit these symptoms seek professional help:

Restlessness, irritability, or excessive crying

Headaches, chest pains, heart palpitations, numbness, or hyperventilation

Inability to sleep, extreme exhaustion, or both

Loss of appetite and weight loss

Overeating and weight gain

Difficulty concentrating, remembering, or making decisions

Excessive concern or disinterest with the new baby

Feelings of inadequacy, guilt, and worthlessness

Fear of harming the baby or oneself

Loss of interest in sex and other normal activities


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heart rate, and other negative physi-cal reactions. Indirectly, stress cancause harm by leading to smoking,drinking, or not eating well.Mood swings and feelings of depres-sion also trouble many pregnantwomen. Changes in the bodyshormones are the cause of someof these emotional changes. Healthcare professionals can recommend

a variety of techniques for reducingstress and improving mental health.

Deep breathing, meditation, andother relaxation techniques helpmany women. Support groups andchildcare classes relieve anxietiesabout pregnancy.

Postpartum depression amongmothers who have just given birthranges from mild to severe. About 10percent of pregnancies result in post-partum depression. An even moreserious mental illness, postpartumpsychosis , may affect as many as1 in 1,000 new mothers. Women whosuffer postpartum depression exhibita wide variety of physical symptoms.Studies have linked these symptoms

to hormonal changes and to drops inthyroid levels. There are significantlinks between postpartum depressionand pre-existing mental disorders, aswell as to extreme stress and abuseat home. Although the exact causesof postpartum depression are not yetknown, health care professionals doknow about medications and othertreatments that alleviate the condi-tion. Pregnant women and newmothers are urged to seek profession-al help and to discuss their feelingsopenly with their nurses and doctors.Postpartum depression, like all forms

of depression, is treated with combi-nations of counseling and drugtherapy.

Premature laborand childbirthThe best chance for a healthy baby isa full-term pregnancy. The baby needsthose last weeks in the womb todevelop its lungs for breathing ontheir own. Important brain growthalso occurs during the last weeks of pregnancy. A full-term delivery hap-pens about 40 weeks after the moth-ers last menstrual period. Ten toeleven percent of babies are born prmature they are delivered 3or more weeks before the due date.

Premature labor. Prematurelabor can take place at any time dur-ing the last four months of pregnancy.Early labor poses some health risks tothe mother. But doctors sometimesinduce early labor in mothers, in


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cases where the health dangers aregreater if the pregnancy continues.In general, the later in the pregnan-cy the mother gives birth, the betterher babys chances will be forhealthy survival.

Not all premature labor ends inimmediate delivery. In many cases,doctors are able to stop prematurecontractions. Extra fluids, bed rest,and medications such as musclerelaxants are used to stop contrac-tions. Extra care, even hospitaliza-tion, may be required for the rest of

the pregnancy. If premature laborcannot be stopped, doctors givemothers medications that preparethe baby for birth. They might alsogive mothers medications that stoplabor briefly, to make a safer pre-mature delivery possible.

Premature delivery. Risks to themother during premature delivery

are higher than for full-term births.The higher risks are partly due todifferences in procedure. For exam-ple, premature births are oftenmedical emergencies. Early birthsmore often involve c-sections andother extra procedures. Medicationsthat stop contractions can alsocause fluid to build up in the lungs,which can complicate delivery.In spite of the higher risk, however,most premature deliveries are phys-ically safe for the mother.

Babies are at much higher riskthan mothers during and after

premature delivery. Prematurebabies usually need perinatalcare to survive.

Very premature babies will requiremonths in intensive care in thehospital. Mothers who give birthprematurely are at high risk forpostpartum depression and mayneed medication, counseling, orboth.

Premature Labor: Signs and CausesPregnant women should stay alert for these warning signsof premature labor: vaginal spotting or bleeding abdominal cramps like menstrual cramps low back pain feeling pressure on the pelvisA woman should seek medical help as soon as she experiencesany of the above warning signs.

Medical emergencies that require a doctor immediately are: regular contractions of the uterus watery discharge from the vagina

Only about half of the cases of premature labor can beexplained. Known causes of premature labor include: a rupture in the amniotic sac infections and disorders of the uterus, cervix, or urinary

tract certain chronic diseases, including high blood pressure,

kidney disease, diabetes, and hyperthyroidism previous premature deliveries smoking, alcohol, and drug use by the mother malnutrition in the mother congenital defects in the baby


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Neonatalintensive carePerinatal care isthe medical care of premature infantswho cannot surviveon their own. Suchcare takes place in thehospital, in neonatalintensive care units(NICUs) . ( Neonatalmeans newborn.)NICUs also care forfull-term babies who

develop problemsafter birth.

Most babies in NICUs are kept inincubators . The incubator serves asan artificial womb for the prematurechild. It keeps the baby warm andfree of infections. Depending on itsage, the baby will receive intra-venous feeding , be fed through

a tube in the nose, or be fed witha bottle. The babys blood pressure,heart rate, breathing, and tempera-ture are carefully monitored.

Infants stay in NICUs until they nolonger need continuous hospital care.To go home, a baby must have a sta-ble temperature, be able to nurse,and be gaining weight. Such infantswill need special care at home. Theyoften cannot breastfeed. Infants bornprematurely need closer monitoring,more frequent doctors visits, andmore medications than full-terminfants.

NICUs are increasingly successful inkeeping even very premature babiesalive. However, very young prematurebabies (between 23 and 25 weeks old)have higher death rates and higherrisks of serious medical problems.Only 30 to 50 percent of babies bornat 23 weeks survive. Babies 25 weeksold have a 60 to 90 percent survivalrate.

Very young premature babies whosurvive are at high risk. About two-thirds of premature babies who weighless than 2 pounds at birth have

developmental problems. Half of those(one-third of the total) are seriousmedical problems, such as cerebralpalsy , seizures, and hydrocephalus(too much fluid in the brain). Theremay also be lasting nerve damage.The other half (one-third of the total)are less serious chronic health prob-lems, including slower growth rates,increased incidence of infections,

vision and hearing problems, andslower rates of learning.

Older premature babies have higherchances of surviving and growing uphealthy. However, all prematurebabies are at high risk for low birthweight . Babies who weigh less than5 pounds, 8 ounces are at higher riskfor medical complications than babieswho are born at normal weight(78 pounds).

Knowingthe risk

factors canhelp predict and prevent

complicationsof pregnancy

and childbirth.


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The Root Cause of Better Learning

Barbara Bowman knew shed found herlifes calling when she walked into a nurs-ery school and looked into the bright eyesof young children.

At the time, Bowman was a college stu-dent, and visiting the nursery school was arequirement for a school course. ButBowman discovered that even after shedcompleted the class, she didnt want to saygood-bye to the kids.

I was fascinated with how interestingyoung children were, even babies, she says. I was pretty good at talkingto them, responding to them. They liked me and I liked them.

Now Bowman stands as one of the nations foremost experts in earlychildhood education. During her 50-year career, she has served on WhiteHouse panels, national science advisory boards and she even has a streetnamed after her in her hometown, Chicago. But ask her about her mostimportant achievement, and you can hear the pride in her voice shinethrough as she talks about her own daughter and 17-year-old grand-daughter.

As a parent and an educator, Bowman knows every mother and fathercan take simple steps to set the stage for a lifetime of better learning fortheir children. Just because babies dont yet talk doesnt mean theyre notcapable of learning. In fact, research shows the most rapid and significantgrowth of a persons brain occurs during the first year of life.

Parents dont need flashcards or special kinds of music to stimulate their

babies brains. In fact, the most important thing they can do is spend timeplaying with and talking to their children, Bowman says.

We know when infants are stimulated pleasantly not too much, nottoo little it does make them smarter, Bowman says. Letting babies

BETTER LEARNING, continued on next page


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handle things, playing with them, and giving them body rubs are examplesof things that children get pleasure from that are good for them and helpmake them smart.

Bowman says that while reading to children is important, parents who areunable to read well themselves might shy away from books. Theres a simplesolution, she says: Take your children to story time at the local library andencourage them to retell stories they have heard.

Bowman has seen firsthand how the challenges of preparing children tolearn are felt around the world. After she married, she traveled with her hus-band to Iran and worked with children in orphanages and public schools andspent time with tribes. After returning to Chicago, she helped form theErikson Institute, which trains daycare directors, teachers of young children,and other child-centered professionals to enter the workforce.

Bowman knows that just as strong, healthy roots allow a tree to stretchtoward the sky, giving young children the things they need early on letsthem soar to their full potential. And to a child, love is just as important asfood to eat and air to breathe.

The early experience of being well taken care of and having somebodyenjoy being with you and all those very simple things are what builds achilds capacity to love, Bowman says.

With those kinds of roots, the sky can be the limit for any child.


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Part 5: Health care of

infants and toddlersCaring for an infantat homeFeeding the new baby. Breastmilk or infant formula is the mainsource of nutrition for a baby in itsfirst year of life. The advantages of breastfeeding infants are wellestablished. Breast milk from ahealthy mother strengthens thebabys immune system, provides thebaby with complete nutrition, and iseasier than formula for the infant todigest.

The alternative to breast milk is aninfant formula . The mothershould consult health care profes-sionals in choosing the best typeand brand for the babys specificneeds. Infant formulas must be pre-pared and stored safely to protectthe babys health.

Babies can start eating solid foodwhen they are 4 to 6 months old.Solid food should be introduced lit-tle by little. The babys specific diet

should be planned with the help of health care professionals. Doctorsmight recommend vitamin supple-ments or dietary changes for under-weight or overweight infants.

Babys Milk For most babies, the healthiest food is their mothers milk.Here are some of the advantages of breast milk from a healthymother:

Strengthens the infants immune system Provides complete nutrition for the infant Is easier for the infant to digest Helps low birth weight babies gain weight faster Costs much less than infant formula

Infant formula is also healthy for infants when it is preparedand stored correctly. Here are some rules for safe bottlefeeding.

Sterilize all bottles and nipples before use. Formula should be mixed only with water that has been

boiled. Boil the water for at least two minutes. After thewater has cooled to warm, mix with the formula.

Mix the formula in the correct proportions. Keep prepared formula in the refrigerator. Use within 48

hours. Warm the refrigerated formula before feeding the baby.

Whole milk is not good for infants. It should not be part of ababys diet until sometime around the first birthday.


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Keeping clean. Newborn babiesshould get warm sponge baths untilthe umbilical cord falls off and thebaby is otherwise recovered fromchildbirth. Cleanup after each diaperuse and daily sponge baths remainthe safest forms of bathing until thebaby can hold its head up on its own.Bathing a newborn in a sink or tubshould be done only with extremecare, preferably by two adults.

The babys entire environment shouldbe kept as clean as possible. Peoplewho handle the baby should observe

good hygiene habits, espe-cially washing the handsthoroughly after using thebathroom and after chang-ing the babys diapers.The babys toys should besterilized or washed fre-quently.

Keeping safe. Parents

have the responsibility toprovide a safe home envi-ronment. This is more of achallenge as the babybecomes more able tomove on its own. A houseshould be baby-proofed

to eliminate accident risks, such asopen electrical plugs and householdchemicals (most cleaning products).Playpens and other safe areas canalso reduce danger. Consumerguidelines should be followed in buy-ing car seats, cribs, playpens, walk-ers, and other baby furniture andtoys.

Postnatal medical careRegular visits to doctors and clinicshelp keep babies healthy. It is com-mon for the baby to have two doctors

appointments in the first month of life and one visit a month for the firstyear. High-risk infants may requiremore frequent visits.

During visits, health care profession-als monitor the babys growth anddiscuss any concerns the parentsmay have about the babys health.They can help the parents learn to

recognize common childhood ailmentsand how to treat them. Doctors alsorecommend that infants and toddlersbe immunized against common child-hood diseases.

Risks to infant health A healthy baby is born with a strongimmune system, which gets even

stronger if the baby is breastfed by ahealthy mother. With good nutritionand a healthy, caring environment,most infants stay healthy and growup normally. There are, however,some medical conditions that threateninfants, especially infants who arealready at risk.

Sudden infant death syndrome(SIDS). Sudden infant deathsyndrome (SIDS) is the sudden andunexplained death of a baby underone year of age. The cause is notknown. However, certain risk factorsare known. SIDS occurs more oftenwhen mothers smoke during or after

Babies use all their senses to explorethe world, so it is

important to baby-

proof a house to prevent them from putting dangerous

things in their mouths.


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Part 5: Health care of infants and toddlers

pregnancy, or if the baby is bornprematurely or with low birthweight.

Doctors have an important new

message to spread: babies who sleepon their backs have a significantlylower rate of SIDS than babies whosleep on their stomachs. Putting thebaby to sleep on its back dramati-cally reduces the risk of SIDS.

Failure to thrive. Failure tothrive is the term used when ababy is consistently behind normal

growth for its age group. Prema-ture, low birth weight, and under-nourished babies are most likely tosuffer from it. Failure to thrive canresult from many different causes.The warning signs include beingunderweight and having low levelsof response, a high rate of infectionsand childhood illnesses, and learn-ing disabilities.

Shaken baby syndrome. Shakenbaby syndrome is a severe headinjury that occurs when a baby isshaken hard enough to cause thebabys brain to bounce against hisor her skull. Sometimes, parents orother caregivers may shake a babyout of frustration, thinking that it isharmless. Shaking a baby, however,can be just a dangerous as hittingor other forms of abuse. The bounc-ing of the brain against the skullmay cause bruising, swelling, andbleeding of the brain, which maylead to permanent, severe braindamage or death.

The warning signs of shaken babysyndrome may include changes inbehavior, irritability, tiredness, lossof consciousness, pale or bluishskin, vomiting, and seizures.

It is important for parents to be onthe alert for any signs of illness orunusual behavior in infants andbabies. Even small concerns shouldbe brought to a doctors attentionduring regular medical checkups.

Health in infancy and early

childhoodBabies who are one to three monthsold become ever more interactive.They discover their parents andother familiar faces. They learn tosmile and make noises in responseto other people. They learn to reachfor and grasp objects. They playwith their toes.

New babies continue to kick,stretch, and develop stronger bonesand muscles during their fourththrough seventh months. Graduallythe baby learns to hold up its head,roll over, squirm along, and start tocrawl. He or she responds more andmore to toys, starts to imitate adultmovementsand keeps workingtoward crawling and walking.

Babies make a huge amount of progress in their intelligence, mobil-ity, language skills, and interactionswith others as they approach theirfirst birthdays. Between their

Reducing the

Risk of SIDSThe NationalInstitute of ChildHealth and HumanDevelopment recommends the followingto help lower therisk of sudden infandeath syndrome:

Place the baby on

his or her back tosleep.

Place the baby ona firm mattress.

Remove all pillowfluffy blankets,and stuffed toysfrom the crib.

Keep the babyshead and faceuncovered duringsleep.

Do not smokebefore or after thebirth of the baby.

Keep the babyfrom overheatingduring sleep.


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eighth and twelfth months, babieslearn to crawl. They love doing it andget better and better at it. They alsolearn to pull themselves up.

Most babies start to walk by theirfirst birthday and improve their walk-ing in the months that follow. As thechild masters walking, he or she may

also be learning to climb stairs or tobend over and stand up again withoutfalling.

A babys skills (what the baby can do)develop quickly in early childhood.Health care and early childhoodexperts use skills to mark theprogress of childrens mental and


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The American Medical Association liststhese signs as warnings that a baby is notdeveloping normal skills:

1 to 3 months Cannot support its own head Cannot hold its head up 45 degrees Cannot grasp or hold objects Cannot make fist Does not press down legs when feet are

on a flat surface

4 to 7 months

Has stiff or tight muscles Feels extremely floppy Does not use one side of the body Favors one arm or leg Cannot get objects to his or her mouth Cannot roll over by 5 months Cannot sit when supported by 6 months Cannot control head adequately at 7

months Does not reach for objects by end of 7

months

8 to 12 months Cannot crawl Cannot stand when supported Does not use both sides of the bod

healthy babies book

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