If you're having a normal pregnancy, s.e.x is considered safe during all stages of the pregnancy.

So what's a "normal pregnancy"? It's one that's considered low-risk for complications such as miscarriage or pre-term labor. Talk to your doctor, nurse-midwife, or other pregnancy health care provider if "s.e.x During Pregnancy," October 2007, reprinted with permission from www.kidshealth.org. Copyright 2007 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.

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Pregnancy and Birth Sourcebook, Third Edition you're uncertain about whether you fall into this category. (The next section of this text may help, too.) Of course, just because s.e.x is safe during pregnancy doesn't mean you'll necessarily want to have it! Many expectant mothers find that their desire for s.e.x fluctuates during certain stages in the pregnancy.

Also, many women find that s.e.x becomes uncomfortable as their bodies get larger.

You and your partner need to keep the lines of communication open regarding your s.e.xual relationship. Talk about other ways to satisfy your need for intimacy, such as kissing, caressing, and holding each other. You also may need to experiment with other positions for s.e.x to find those that are the most comfortable.

Many women find that they lose their desire and motivation for s.e.x late in the pregnancy-not only because of their size but also because they're preoccupied with the impending delivery and the excitement of becoming a new parent.

When It's Not Safe There are two types of s.e.xual behavior that aren't safe for any pregnant woman: * If you engage in oral s.e.x, your partner should not blow air into your v.a.g.i.n.a. Blowing air can cause an air embolism (a blockage of a blood vessel by an air bubble), which can be potentially fatal for mother and child.

* You should not have s.e.x with a partner whose s.e.xual history is unknown to you or who may have a s.e.xually transmitted disease, such as herpes, genital warts, chlamydia, or HIV [human immunodeficiency virus]. If you become infected, the disease may be transmitted to your baby, with potentially dangerous consequences.

If your doctor, nurse-midwife, or other pregnancy health care provider antic.i.p.ates or detects certain significant complications with your pregnancy, he or she is likely to advise against s.e.xual intercourse. The most common risk factors include: * a history or threat of miscarriage * a history of pre-term labor (you've previously delivered a baby before 37 weeks) or signs indicating the risk of pre-term labor (such as premature uterine contractions) 214.

s.e.x during Pregnancy * unexplained v.a.g.i.n.al bleeding, discharge, or cramping * leakage of amniotic fluid (the fluid that surrounds the baby) * placenta previa, a condition in which the placenta (the blood-rich structure that nourishes the baby) is situated down so low that it covers the cervix (the opening of the uterus) * incompetent cervix, a condition in which the cervix is weakened and dilates (opens) prematurely, raising the risk for miscarriage or premature delivery * multiple fetuses (you're having twins, triplets, etc.) Common Questions and Concerns The following are some of the most frequently asked questions about s.e.x during pregnancy.

Can s.e.x harm my baby?

No, not directly. Your baby is fully protected by the amniotic sac (a thin-walled bag that holds the fetus and surrounding fluid) and the strong muscles of the uterus. There's also a thick mucus plug that seals the cervix and helps guard against infection. The p.e.n.i.s does not come into contact with the fetus during s.e.x.

Can intercourse or o.r.g.a.s.m cause miscarriage or contrac- tions?

In cases of normal, low-risk pregnancies, the answer is no. The contractions that you may feel during and just after o.r.g.a.s.m are entirely different from the contractions a.s.sociated with labor. However, you should check with your health care provider to make sure that your pregnancy falls into the low-risk category. Some doctors recommend that all women stop having s.e.x during the final weeks of pregnancy, just as a safety precaution, because s.e.m.e.n contains a chemical that may actually stimulate contractions. Check with your health care provider to see what he or she thinks is best.

Is it normal for my s.e.x drive to increase or decrease dur- ing pregnancy?

Actually, both of these possibilities are normal (and so is everything in between). Many pregnant women find that symptoms such as fatigue, 215 Pregnancy and Birth Sourcebook, Third Edition nausea, breast tenderness, and the increased need to urinate make s.e.x too bothersome, especially during the first trimester. Generally, fatigue and nausea subside during the second trimester, and some women find that their desire for s.e.x increases. Also, some women find that freedom from worries about contraception, combined with a renewed sense of closeness with their partner, makes s.e.x more fulfilling. Desire generally subsides again during the third trimester as the uterus grows even larger and the reality of what's about to happen sets in.

Your partner's desire for s.e.x is likely to increase or decrease as well.

Some men feel even closer to their pregnant partner and enjoy the changes in their bodies. Others may experience decreased desire because of anxiety about the burdens of parenthood, or because of concerns about the health of both the mother and their unborn child.

Your partner may have trouble reconciling your ident.i.ty as a s.e.xual partner with your new (and increasingly visible) ident.i.ty as an expectant mother. Again, remember that communication with your partner can be a great help in dealing with these issues.

When to Call Your Doctor Call your health care provider if you're unsure whether s.e.x is safe for you. Also, call if you notice any unusual symptoms after intercourse, such as pain, bleeding, or discharge, or if you experience contractions that seem to continue after s.e.x.

Remember, "normal" is a relative term when it comes to s.e.x during pregnancy. You and your partner need to discuss what feels right for both of you.

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Chapter 26.

Working and Traveling during Pregnancy Chapter Contents.Section 26.1-Work and Travel Considerations for Pregnant Women ................................................. 218 Section 26.2-International Travel during Pregnancy ............ 221 217.

Pregnancy and Birth Sourcebook, Third Edition Section 26.1 Work and Travel Considerations for Pregnant Women "Work and Travel During Pregnancy,"

2009 A.D.A.M., Inc. Reprinted with permission.

Generally, women who are pregnant may continue to work during their pregnancy. Some women are able to work right up until they are ready to deliver, while others may need to cut back on their work schedule or stop completely before their due date. Whether you can work during your pregnancy or not depends on your health, the health of the baby, and the type of job that you have. Here are some factors to consider: * Heavy lifting: Heavy lifting: If your job requires heavy lifting, standing, or walking, your doctor may recommend that you work fewer hours a day. This is especially true as you get closer to your delivery date. If your job requires heavy lifting, standing, or walking, your doctor may recommend that you work fewer hours a day. This is especially true as you get closer to your delivery date.

* Exposure to environmental hazards: Exposure to environmental hazards: If you work in a job where you are exposed to hazardous or poisonous agents, you may need to temporarily change positions until after the baby is born. Some agents that may pose a threat to the health of the baby include: If you work in a job where you are exposed to hazardous or poisonous agents, you may need to temporarily change positions until after the baby is born. Some agents that may pose a threat to the health of the baby include: * chemotherapy medications (may impact health care workers such as nurses and pharmacists); * lead (workers in lead smelting, paint manufacturing, printing, ceramics, gla.s.s manufacturing, pottery glazing and bat-tery manufacturing; toll booth attendants; and people working on heavily traveled roads); * ionizing radiation (X-ray technicians, some physicists and researchers).

Get information on possible toxic substances present at your workplace. Find out if these are at toxic levels and if the workplace is adequately ventilated and workers adequately equipped 218 Working and Traveling during Pregnancy with protective devices. Radiation from computers, color TVs, and microwaves is called non-ionizing radiation and is not harmful.

* Stress: Stress: All people experience mental and physical stress as part of life. Too much stress, however, may cause various symptoms such as headaches, depression, and weight gain. Stress may have an impact on how well your body can fight off infection or disease. While you are pregnant, stress should be minimized to the best of your ability. Depending on how much stress your pregnancy adds to your existing load, you may need to get extra help from your spouse or someone else so you can get the rest you need. All people experience mental and physical stress as part of life. Too much stress, however, may cause various symptoms such as headaches, depression, and weight gain. Stress may have an impact on how well your body can fight off infection or disease. While you are pregnant, stress should be minimized to the best of your ability. Depending on how much stress your pregnancy adds to your existing load, you may need to get extra help from your spouse or someone else so you can get the rest you need.

Travel Traveling is generally considered safe during pregnancy. The key to traveling while pregnant is to make sure you are going to be comfortable and as safe as possible. It is best to notify your doctor of your travel plans and ask for any recommendations specific to your pregnancy.

Whether you are traveling by plane, car, or train it is important to do the following: * Continue to eat regularly.

* Drink plenty of fluids to avoid dehydration.

* Get up and walk around every hour or so to help your circulation and to keep swelling down.

* Wear comfortable shoes and clothing that doesn't bind.

* Take crackers and juice with you to prevent nausea.

Do not take over the counter medicines or any non-prescribed medications without checking with your doctor. This includes medication for motion sickness or bowel problems related to traveling.

Foreign travel: If you are planning a trip out of the country, discuss your trip with your doctor. Plan ahead to allow time for any shots or medications you may need, and be prepared to take a copy of your prenatal record with you. If you are planning a trip out of the country, discuss your trip with your doctor. Plan ahead to allow time for any shots or medications you may need, and be prepared to take a copy of your prenatal record with you.

Traveling to high alt.i.tudes may cause problems during pregnancy, as your body and your fetus adjust to the lower air pressure and lower levels of oxygen. It's generally best to let your body adjust to moderate 219 Pregnancy and Birth Sourcebook, Third Edition alt.i.tudes-6,0008,000 feet-for a few days before going above 8,000 feet. Women with complicated pregnancies may want to avoid moun-tain-top excursions altogether.

The American College of Obstetricians and Gynecologists (ACOG) recommends the following when traveling by land, air, or sea: * Land: Land: Travel no more than 56 hours a day. Always wear your seatbelt. Place the lap belt under your abdomen and across your hips so that it fits snugly and comfortably. Put the shoulder strap between your b.r.e.a.s.t.s and across your shoulder. Always wear the lap shoulder strap when traveling while pregnant. The fluid-filled sac inside the uterus, which is further protected by muscles, organs, and bones, cushions the baby. Unless the mother has a serious injury in an accident, the baby will likely not be harmed. Travel no more than 56 hours a day. Always wear your seatbelt. Place the lap belt under your abdomen and across your hips so that it fits snugly and comfortably. Put the shoulder strap between your b.r.e.a.s.t.s and across your shoulder. Always wear the lap shoulder strap when traveling while pregnant. The fluid-filled sac inside the uterus, which is further protected by muscles, organs, and bones, cushions the baby. Unless the mother has a serious injury in an accident, the baby will likely not be harmed.

However, if you are in an accident you should always check with your doctor to make sure you and your baby are fine.

* Air: Air: Flying during pregnancy is generally safe. In the United States, pregnant women are allowed to fly up to 36 weeks of pregnancy. You should consider getting an aisle seat for more room and to make it easier to walk around and get to the bathroom. Wear layered clothing so you can have some control when there are temperature changes. Be sure to get up and walk at least once an hour, and drink plenty of fluids, to reduce the risk of blood clots forming in your legs. Women with complicated pregnancies-those with high risk of preterm delivery, pre-eclampsia, or signs of poor fetal growth-may need supplemental oxygen when flying. Talk to your health care provider before you travel to see if you need additional oxygen. Air travel also exposes pa.s.sengers to small amounts of cosmic radiation. This is rarely an issue for pa.s.sengers, but flight attendants and pilots may be exposed to inappropriate levels of radiation. Flying during pregnancy is generally safe. In the United States, pregnant women are allowed to fly up to 36 weeks of pregnancy. You should consider getting an aisle seat for more room and to make it easier to walk around and get to the bathroom. Wear layered clothing so you can have some control when there are temperature changes. Be sure to get up and walk at least once an hour, and drink plenty of fluids, to reduce the risk of blood clots forming in your legs. Women with complicated pregnancies-those with high risk of preterm delivery, pre-eclampsia, or signs of poor fetal growth-may need supplemental oxygen when flying. Talk to your health care provider before you travel to see if you need additional oxygen. Air travel also exposes pa.s.sengers to small amounts of cosmic radiation. This is rarely an issue for pa.s.sengers, but flight attendants and pilots may be exposed to inappropriate levels of radiation.

* Sea: Sea: If you have never been on a cruise it may not be the best time to take one. Travel by sea may upset your stomach even if you're not pregnant, and may be more uncomfortable if you are. If you have never been on a cruise it may not be the best time to take one. Travel by sea may upset your stomach even if you're not pregnant, and may be more uncomfortable if you are.

If you do decide to go on a cruise, check what medical care will be available to you and what emergency measures your cruise is prepared to employ.

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Working and Traveling during Pregnancy Section 26.2 International Travel during Pregnancy Excerpted from "Planning for a Healthy Pregnancy and Traveling While Pregnant," Chapter 9, Travelers' Health Yellow Book Yellow Book, by the Centers for Disease Control and Prevention (CDC, www.cdc.gov), June 18, 2007.

Factors Affecting the Decision to Travel before and during Pregnancy Reproductive-aged women who may be planning both pregnancy and international travel should consider preconceptional immunization, when practical, to prevent disease in the offspring. Since as many as 50% of pregnancies are unplanned, reproductive-aged women should consider maintaining current immunizations during routine checkups in case an unplanned pregnancy coincides with a need to travel. Preconceptional immunizations are preferred to vaccination during pregnancy, because they decrease risk to the unborn child. A woman should defer pregnancy for at least 28 days after receiving live vaccines (e.g., MMR [measles, mumps, rubella], yellow fever), because of theoretical risk of transmission to the fetus. However, no harm to the fetus has been reported from the unintentional administration of these vaccines during pregnancy, and pregnancy termination is not recommended after an inadvertent exposure. Vaccination of susceptible women during the postpartum period, especially for rubella and varicella, is another opportunity for prevention, and these vaccines should be encouraged and administered (even for breastfeeding mothers) before discharge from the hospital.

According to the American College of Obstetrics and Gynecology, the safest time for a pregnant woman to travel is during the second trimester (18-24 weeks), when she usually feels best and is in least danger of spontaneous abortion or premature labor. A woman in the third trimester should be advised to stay within 300 miles of home because of concerns about access to medical care in case of problems such as hypertension, phlebitis, or premature labor. Pregnant women should be advised to consult with their health-care providers before making any travel decisions. Collaboration between travel health 221 Pregnancy and Birth Sourcebook, Third Edition experts and obstetricians is helpful in weighing benefits and risks based on destination and recommended preventive and treatment measures. In general, pregnant women with serious underlying illnesses should be advised not to travel to developing countries.

Preparation for Travel during Pregnancy Once a pregnant woman has decided to travel, a number of issues need to be considered before her departure.

* An intrauterine pregnancy should be confirmed by a clinician and ectopic pregnancy excluded before beginning any travel.

* Health insurance should provide coverage while abroad and during pregnancy. In addition, a supplemental travel insurance policy and a prepaid medical evacuation insurance policy should be obtained, although most may not cover pregnancy-related problems.

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

* Determine beforehand whether prenatal care will be required abroad and, if so, who will provide it. The pregnant traveler should also make sure prenatal visits requiring specific timing are not missed.

* Determine, before traveling, whether blood is screened for HIV [human immunodeficiency virus] and hepat.i.tis B at the destination. The pregnant traveler should also be advised to know her blood type, and Rh-negative pregnant women should receive the anti-D immune globulin (a plasma-derived product) prophylacti-cally at about 28 weeks' gestation. The immune globulin dose should be repeated after delivery if the infant is Rh positive.

General Recommendations for Travel A pregnant woman should be advised to travel with at least one companion; she should also be advised that, during her pregnancy, her level of comfort may be adversely affected by traveling. Typical problems of pregnant travelers are the same as those experienced by any pregnant woman: fatigue, heartburn, indigestion, constipation, v.a.g.i.n.al discharge, leg cramps, increased frequency of urination, and hemorrhoids. During travel, pregnant women can take preventive measures 222 Working and Traveling during Pregnancy including avoidance of gas-producing food or drinks before scheduled flights (entrapped gases can expand at higher alt.i.tudes) and periodic movement of the legs (to decrease venous stasis). Pregnant women should always use seatbelts while seated, as air turbulence is not predictable and may cause significant trauma.

Signs and symptoms that indicate the need for immediate medical attention are v.a.g.i.n.al bleeding, pa.s.sing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling or pain, headaches, or visual problems.

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

Hepat.i.tis E, which is not vaccine preventable, can be especially dangerous for pregnant women, for whom the case-fatality rate is 17%33%. Therefore, pregnant women should be advised that the best preventive measures are to avoid potentially contaminated water and food, as with other enteric infections.

Scuba diving should be avoided in pregnancy because of the risk of decompression syndrome in the fetus.

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Chapter 27.

Nicotine, Alcohol, and Drug Use during Pregnancy Chapter Contents.Section 27.1-Smoking and Pregnancy ..................................... 226 Section 27.2-Alcohol Use and Pregnancy ................................ 227 Section 27.3-Fetal Alcohol Spectrum Disorders ..................... 230 Section 27.4-Drug Use during Pregnancy ............................... 235 225.

Pregnancy and Birth Sourcebook, Third Edition Section 27.1 Smoking and Pregnancy Excerpted from "Staying Healthy and Safe," by the Office of Women's Health (www.womenshealth.gov), part of the U.S.

Department of Health and Human Services, March 2009.

Smoking cigarettes is very harmful to your health and could also affect the health of your baby. Not only does smoking cause cancer and heart disease in people who smoke, a recent large study confirmed that smoking during pregnancy increases the risk of low birth weight.

Low-birth-weight babies are at higher risk of health problems shortly after birth. Also, some studies have linked low birth weight with a higher risk of health problems later in life, such as high blood pressure and diabetes. Women who smoke during pregnancy are more likely than other women to have a miscarriage and to have a baby born with cleft lip or palate, types of birth defects. Also, mothers who smoke during or after pregnancy put their babies at greater risk of sudden infant death syndrome (SIDS).

Mothers who smoke have many reasons to quit smoking. Take care of your health and your unborn baby's health by asking your doctor for help quitting smoking. Quitting smoking is hard, but you can do it with help.

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Nicotine, Alcohol, and Drug Use during Pregnancy Section 27.2 Alcohol Use and Pregnancy This section includes text from "Alcohol Use and Pregnancy," by the National Center on Birth Defects and Developmental Disabilities (NCBDDD, www.cdc.gov/ncbddd), part of the Centers for Disease Control and Prevention (CDC), September 15, 2005, and "When You Are Pregnant Drinking Can Hurt Your Baby," by the National Inst.i.tute of Alcohol Abuse and Alcoholism (NIAAA, www.niaaa.nih.gov), part of the National Inst.i.tutes of Health, 2006.

Alcohol Use and Pregnancy A mother's alcohol use during pregnancy is one of the top preventable causes of birth defects and developmental disabilities. There is no known amount of alcohol that is safe to drink while pregnant. There is no time during pregnancy when it is safe to drink. When a pregnant woman drinks alcohol, her baby does, too.

* Drinking alcohol during pregnancy can cause many birth defects and developmental disabilities. These are known as fetal alcohol spectrum disorders (FASDs) and include fetal alcohol syndrome.

* FASDs can cause problems in how a person looks, grows, thinks, and acts. FASDs can also cause birth defects of the heart, brain, and other major organs.

* About 1 in 12 pregnant women in the United States reports alcohol use. And about 1 in 30 pregnant women in the United States reports binge drinking (having five or more drinks at one time).

* Alcohol can harm a baby at any time during pregnancy. It can cause problems in the early weeks of pregnancy, before a woman even knows she is pregnant.

* The good news is that FASDs are 100% preventable-if a woman does not drink alcohol while she is pregnant.

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Pregnancy and Birth Sourcebook, Third Edition * Health professionals should ask all of their female patients of childbearing age about alcohol use. They should tell women about the risks of using alcohol during pregnancy and advise them not to drink alcohol during pregnancy.

The U.S. Surgeon General wants women to know they should not drink alcohol during pregnancy. In a 2005 advisory on alcohol use in pregnancy, he stated: * A pregnant woman should not drink alcohol.

* A pregnant woman who has already used alcohol during her pregnancy should stop right away.

* A woman who is thinking about getting pregnant should stop using alcohol.

* Nearly half of all births in the United States are unplanned.

Therefore, any woman who could become pregnant should talk to her doctor and take steps to lower the chance of exposing her baby to alcohol.

When You Are Pregnant Drinking Can Hurt Your Baby When you are pregnant, your baby grows inside you. Everything you eat and drink while you are pregnant affects your baby. If you drink alcohol, it can hurt your baby's growth. Your baby may have physical and behavioral problems that can last for the rest of his or her life. Children born with the most serious problems caused by alcohol have fetal alcohol syndrome.

Children with fetal alcohol syndrome may: * be born small; * have problems eating and sleeping; * have problems seeing and hearing; * have trouble following directions and learning how to do simple things; * have trouble paying attention and learning in school; * need special teachers and schools; * have trouble getting along with others and controlling their behavior; and * need medical care all their lives.

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Nicotine, Alcohol, and Drug Use during Pregnancy Can I drink alcohol if I am pregnant?

No. Do not drink alcohol when you are pregnant. Why? Because when you drink alcohol, so does your baby. Think about it. Everything you drink, your baby also drinks.

Is any kind of alcohol safe to drink during pregnancy?

No. Drinking any kind of alcohol when you are pregnant can hurt your baby. Alcoholic drinks are beer, wine, wine coolers, liquor, or mixed drinks. A gla.s.s of wine, a can of beer, and a mixed drink all have about the same amount of alcohol.

What if I drank during my last pregnancy and my baby was fine?

Every pregnancy is different. Drinking alcohol may hurt one baby more than another. You could have one child that is born healthy and another child that is born with problems.

Will these problems go away?

No. These problems will last for a child's whole life. People with severe problems may not be able to take care of themselves as adults.