Well, that kind of depends-mostly, on you. The 2 to 4 permanent pounds the average woman puts on with each pregnancy, and the flab that often goes with them, aren't inevitable. In fact, if you gain the right amount of weight, at the right rate, on the right foods, your chances of recovering your prepregnancy shape are really very good, particularly if you team your sensible eating efforts with pregnancy-approved exercise, and especially if you keep your regimen up after your baby arrives. Mind you, that recovery won't happen overnight (think three to six months, minimum).

So fear not your pregnancy weight gain. Remember, it's set to accumulate for the very best reason: the nourishment of your baby now, and, if you choose to breastfeed, later.

Measuring Small "At my last prenatal visit, my midwife told me my uterus is measuring a little small. Does this mean the baby's not growing right?"

Parents rarely wait until their babies are born to begin worrying about their size. But-just as is usually the case after birth-there's rarely anything to worry about before. After all, trying to size up your uterus from the outside isn't an exact science anytime in pregnancy, and especially not this early in the game. Calculating what that size should be isn't easy either (unless you're certain about which day you conceived on), since the date of your pregnancy may be off by as much as several weeks on either side. Chances are your midwife is planning to schedule an ultrasound to pinpoint more precisely the size of your uterus and the date of your pregnancy and to see if there are any discrepancies, which there most likely aren't.

Measuring Big "I was told my uterus is measuring ten weeks, but according to my dates I'm only eight weeks pregnant. Why is my uterus so large?"

There's a good chance that your uterus is bigger than it's supposed to be because you're further along than you think. It's likely that your dates are off, or that your size was miscalulated, both pretty common scenarios. To check this out, and because there are other, much less likely explanations (for example, that you might be carrying twins-though it's unlikely at this early stage that multiples would make a difference in uterine size), your practitioner will probably order an ultrasound.

Difficulty Urinating "The last few days it's been really hard to urinate, even though my bladder seems very full."

It's possible that you might have a stubbornly tilted uterus (about 1 in 5 women has a uterus that tilts toward the back instead of the front) that has refused to right itself and is now pressing on your urethra, the tube leading from the bladder. The pressure of this increasingly heavy load can make urination difficult. There may also be urinary leakage when the bladder becomes very overloaded.

In nearly all cases, the uterus shifts itself back into position by the end of the first trimester without any medical intervention. But if you're really uncomfortable now-or if you're finding it espcially difficult to urinate-put in a call to your practitioner. He or she might be able to manipulate your uterus by hand to move it off the urethra so you can pee easily again. Most of the time that works. In the unlikely event that it doesn't, catheterization (removing the urine through a tube) may become necessary.

One other possibility if you're having trouble urinating (and another good reason to put in that call to your practitioner). a urinary tract infection. See page 498 page 498 for more. for more.

Mood Swings "I know I should feel happy about my pregnancy-and sometimes I am. But other times, I feel so weepy and sad."

They're up-and they're down. The very normal mood swings of pregnancy can take your emotions places they've never gone before, both to exhilarating highs and depressing lows. Moods that can have you over-the-moon one moment, down-in-the-dumps the next-and weeping inexplicably over insurance commercials. Can you blame it on your hormones? You bet. These swings may be more pronounced in the first trimester (when hormonal havoc is at its peak) and, in general, in women who ordinarily suffer from marked emotional ups and downs before their periods (it's sort of like PMS pumped up). Feelings of ambivalence about the pregnancy once it's confirmed, which are common even when a pregnancy is planned, may exaggerate the swings still more. Not to mention all those changes you're experiencing (the physical ones, the emotional ones, the logistical ones, the relationship ones-all of which can overwhelm your moods).

Mood swings tend to moderate somewhat after the first trimester, once hormone levels calm down a little-and once you've adjusted to some of those pregnancy changes (you'll never adjust to all of them). In the meantime, though there's no sure way to hop off that emotional roller coaster, there are several ways to minimize the mood mayhem: [image] Keep your blood sugar up. What does blood sugar have to do with moods? A lot. Dips in blood sugar-caused by long stretches between meals-can lead to mood crashes. Yet another compelling reason to ditch your usual three-meals-a-day (or fewer) eating routine and switch to the Six-Meal Solution (see Keep your blood sugar up. What does blood sugar have to do with moods? A lot. Dips in blood sugar-caused by long stretches between meals-can lead to mood crashes. Yet another compelling reason to ditch your usual three-meals-a-day (or fewer) eating routine and switch to the Six-Meal Solution (see page 91 page 91). Give complex carbs and protein starring roles in your mini meals for the longest lasting blood sugar-and mood-highs.[image] Keep sugar and caffeine down. That candy bar, that doughnut, that Coke will give your blood sugar a quick spike-followed soon after by a downward spiral that can take your mood down with it. Caffeine can have the same effect, adding to mood instability. So limit both, for happier results. Keep sugar and caffeine down. That candy bar, that doughnut, that Coke will give your blood sugar a quick spike-followed soon after by a downward spiral that can take your mood down with it. Caffeine can have the same effect, adding to mood instability. So limit both, for happier results.[image] Eat well. In general, eating well will help you feel your best emotionally (as well as physically), so follow the Pregnancy Diet as best you can. Getting plenty of omega-3 fatty acids in your diet (through walnuts, fish, and enriched eggs, to name a few) may also help with mood moderating (and they're also super important for your baby's brain development). Eat well. In general, eating well will help you feel your best emotionally (as well as physically), so follow the Pregnancy Diet as best you can. Getting plenty of omega-3 fatty acids in your diet (through walnuts, fish, and enriched eggs, to name a few) may also help with mood moderating (and they're also super important for your baby's brain development).[image] Get a move on. The more you move, the better your mood. That's because exercise releases feel-good endorphins, which can send your spirits soaring. With your practitioner's guidance, build exercise into your day-every day. Get a move on. The more you move, the better your mood. That's because exercise releases feel-good endorphins, which can send your spirits soaring. With your practitioner's guidance, build exercise into your day-every day.[image] Get a groove on. If you're in the mood for love (and if you're not too busy puking), making love can turn that frown upside down by releasing happy hormones. It can also bring you closer to your partner at a time when your relationship may be facing new challenges. If sex isn't in the cards, just taking the time for intimacy of any kind (cuddling, pillow talk, hand-holding on the sofa) can help boost your mood. Get a groove on. If you're in the mood for love (and if you're not too busy puking), making love can turn that frown upside down by releasing happy hormones. It can also bring you closer to your partner at a time when your relationship may be facing new challenges. If sex isn't in the cards, just taking the time for intimacy of any kind (cuddling, pillow talk, hand-holding on the sofa) can help boost your mood.[image] Light up your life. Research has shown that sunlight can actually lighten your moods. When the sun's shining, try catching some daily rays (just don't forget to apply sunscreen first). Light up your life. Research has shown that sunlight can actually lighten your moods. When the sun's shining, try catching some daily rays (just don't forget to apply sunscreen first).[image] Talk about it. Worried? Anxious? Feeling unsettled? Feeling unsure? Pregnancy is a time of many mixed emotions, which play themselves out in mood swings. Venting some of those feelings-to your spouse (who's probably feeling plenty of the same things), to friends who can relate, to other expectant moms on online pregnancy message boards (check out the ones on whattoexpect.com)-can help you feel better, or at least help you see that what you're feeling is normal. Talk about it. Worried? Anxious? Feeling unsettled? Feeling unsure? Pregnancy is a time of many mixed emotions, which play themselves out in mood swings. Venting some of those feelings-to your spouse (who's probably feeling plenty of the same things), to friends who can relate, to other expectant moms on online pregnancy message boards (check out the ones on whattoexpect.com)-can help you feel better, or at least help you see that what you're feeling is normal.[image] Rest up. Fatigue can exacerbate normal pregnancy mood swings, so make sure you're getting enough sleep (but not too much, since that can actually increase fatigue and emotional instability). Rest up. Fatigue can exacerbate normal pregnancy mood swings, so make sure you're getting enough sleep (but not too much, since that can actually increase fatigue and emotional instability).[image] Learn to relax. Stress can definitely take your moods down, so find ways of moderating it or coping with it better. See Learn to relax. Stress can definitely take your moods down, so find ways of moderating it or coping with it better. See page 142 page 142 for tips. for tips.

If there's one person in your life who's more affected-and bewildered-by your mood swings than you are, it's your spouse. It'll help for him to understand why you're acting the way you are these days (that surges of pregnancy hormones are holding your emotions hostage), but it'll also help for him to know exactly how he can help you. So tell him what you need (more help around the house? a night out at your favorite restaurant?) and what you don't need (hearing that your rear's looking a little wide; his leaving a trail of socks and underwear down the hallway) right now, what makes you feel better and what makes you feel worse. And be specific: Even the most loving spouse isn't a mind reader. See Chapter 19 for more on coping strategies for fathers-to-be.

Depression "I expected some mood swings with pregnancy, but I'm not just a little down-I'm depressed all the time."

Every pregnant woman has her ups and downs, and that's normal. But if your lows are consistent or frequent, you may be among the 10 to 15 percent of pregnant women who battle mild to moderate depression during pregnancy. Here are some of the factors that can put an expectant mom at risk for such depression: [image] A personal or family history of mood disorder A personal or family history of mood disorder[image] Financial or marital stress Financial or marital stress[image] Lack of emotional support from and communication with the baby's father Lack of emotional support from and communication with the baby's father[image] Hospitalization or bed rest because of pregnancy complications Hospitalization or bed rest because of pregnancy complications[image] Anxiety about her own health, especially if she has a chronic medical condition or has previously experienced complications or illness during pregnancy Anxiety about her own health, especially if she has a chronic medical condition or has previously experienced complications or illness during pregnancy[image] Anxiety about her baby's health, especially if there is a personal or family history of miscarriage, birth defects, or other problems Anxiety about her baby's health, especially if there is a personal or family history of miscarriage, birth defects, or other problems The most common symptoms of true depression, in addition to feeling sad, empty, and emotionally lethargic, include sleep disturbances (you get too much or too little); changed eating habits (not eating at all or eating continually); prolonged or unusual fatigue and/or excessive agitation or restlessness; extended loss of interest in work, play, and other activities or pleasures; reduced ability to concentrate and focus; exaggerated mood swings; and even self-destructive thoughts. There may also be unexplained aches and pains. If that sounds like what you're experiencing, start by trying those tips for dealing with mood swings in the previous question.

If the symptoms continue for longer than two weeks, speak to your practitioner about your depression (he or she may want to test you for a thyroid condition since that can trigger depression) or ask for a referral to a therapist who can offer supportive psychotherapy. Getting the right help is important. Depression can keep you from taking optimum care of yourself and your baby, now and after delivery. In fact, depression during pregnancy can increase risks for complications-much as depression can adversely affect your health when you're not pregnant. Deciding whether antidepressant medication will be part of the treatment plan will require sitting down with your practitioner (and therapist) to weigh possible risks against possible benefits (see page 518 page 518 for a discussion of antidepressants during pregnancy). for a discussion of antidepressants during pregnancy).

Panic Attacks Pregnancy can be a time of high anxiety, especially for those who are expecting for the first time (and consequently don't know what to expect). And a certain amount of worry is normal, and probably unavoidable. But what about when that worry turns to panic?

If you've had panic attacks in the past, you're probably all too aware of the symptoms (and most women who have panic attacks during pregnancy have had them before). They're characterized by intense fear or discomfort accompanied by an accelerated heart rate, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea or abdominal distress, dizziness, numbness or tingling, or chills or hot flashes that appear seemingly out of the blue. They can be incredibly unsettling, of course, particularly when they strike for the first time. But happily, though they definitely affect you, there is no reason to believe that panic attacks affect the development of your baby in any way.

Still, if you do experience such an attack, tell your practitioner. Therapy is always the first choice during pregnancy (and other times, too). But if medications are necessary to ensure your well-being (and your baby's-if anxiety is keeping you from eating or sleeping or otherwise taking care of your precious cargo), your practitioner, together with a qualified therapist, can work with you to decide which medication offers the most benefits for the fewest risks (and how low a dose you can take and still derive those benefits). If you've been on a medication for panic attacks, anxiety, or depression prepregnancy, a change or an adjustment of dose might be necessary, too.

While medication is one solution to extreme anxiety, it certainly isn't the only one. There are many nondrug alternatives that can be used instead of or in conjunction with traditional therapy. These include eating well and regularly (including plenty of omega-3 fatty acids in your diet may be especially helpful); avoiding sugar and caffeine (caffeine, in particular, can trigger anxiety); getting regular exercise; and learning meditation and other relaxation techniques (prenatal yoga can be incredibly calming). Talking your anxieties over with other expectant moms can also provide enormous relief.

Consult your practitioner, too, before turning to any alternative treatments. Over-the-counter supplements, such as SAM-e and St. John's wort, touted for their mood-elevating properties, have not been studied enough to consider them safe for use in pregnancy. But other CAM therapies (see page 85 page 85) might help, and bright light therapy (which increases levels of the mood-regulating hormone serotonin in the brain) cuts depressive symptoms during pregnancy in half. Eating foods rich in omega-3 fatty acids lowers the risk of depression during pregnancy and possibly during the postpartum period as well. You can also ask your practitioner about taking a pregnancy-safe omega-3 supplement.

Being depressed during pregnancy does put you at somewhat greater risk of postpartum depression. The good news is that getting the right treatment during pregnancy-and/or right after delivery-can help prevent postpartum depression. Ask your practitioner about this.

Weight Gain During Pregnancy Put two pregnant women together anywhere-in a doctor's waiting room, on an elevator, at a business meeting-and the questions are certain to start flying. "When are you due?" "Have you felt the baby kicking yet?" "Have you been feeling sick?" And perhaps the most commonly posed of all: "How much weight have you gained?"

Everybody expects to gain weight while they're pregnant (and after spending half a lifetime dieting, lots of women actually look forward to it). And, in fact, gaining the right amount of weight is vital when you're growing a baby. But what is the right amount of weight? How much is too much? How much is too little? How fast should you gain it all? And will you be able to lose it all once your baby's delivered? (Answer: yes-if you gain the right amount of weight at the right rate on the right type of foods.) How Much Should You Gain?

If there were ever a legitimate reason to pile on the pounds, pregnancy is it. After all, when you grow a baby, you've got to do some growing, too. But piling on too many pounds can spell problems for you, your baby, and your pregnancy. Ditto if you pile on too few pounds.

What's the perfect pregnancy weight gain formula? Actually, since every pregnant woman-and every pregnant body-is different, that formula can vary a lot. Just how many pounds you should aim on adding during your 40 weeks of baby growing will depend on how many pounds you were packing before you became pregnant.

Your practitioner will recommend the weight gain target that's right for you and your pregnancy situation (and that's the guideline to follow, no matter what you read here). Generally, weight gain recommendations are based on your prepregnancy BMI (a measurement of body fat calculated by multiplying your weight in pounds by 703, then dividing by your height in inches squared; see What to Expect: Eating Well When You're Expecting What to Expect: Eating Well When You're Expecting for a chart). If your BMI is average (between 18.5 and 26), you'll probably be advised to gain between 25 and 35 pounds, the standard recommendation for the average-weight pregnant woman. If you start out pregnancy overweight (BMI between 26 and 29), your goal will be somewhat scaled back-to somewhere between 15 and 25 pounds. If you're obese (with a BMI greater than 29), you'll likely be told to tally a total of between 11 and 20 pounds, or perhaps even less than that. Super skinny (with a BMI of less than 18.5)? Chances are your target will be higher than average-upward of 28 to 40 pounds. For moms providing room and board for more than one, extra babies require extra pounds (see for a chart). If your BMI is average (between 18.5 and 26), you'll probably be advised to gain between 25 and 35 pounds, the standard recommendation for the average-weight pregnant woman. If you start out pregnancy overweight (BMI between 26 and 29), your goal will be somewhat scaled back-to somewhere between 15 and 25 pounds. If you're obese (with a BMI greater than 29), you'll likely be told to tally a total of between 11 and 20 pounds, or perhaps even less than that. Super skinny (with a BMI of less than 18.5)? Chances are your target will be higher than average-upward of 28 to 40 pounds. For moms providing room and board for more than one, extra babies require extra pounds (see page 407 page 407).

It's one thing to set an ideal weight gain goal; it's another thing to get there. That's because ideals aren't always completely compatible with reality. Piling on the right number of pounds isn't just about piling the right amount of food on your plate. There are other factors at work, too. Your metabolism, your genes, your level of activity, your pregnancy symptoms (the heartburn and nausea that make eating too much like hard work; those cravings for high-calorie foods that make gaining too much too easy)-all play a role in helping you (or keeping you from) packing on the perfect pregnancy poundage. With that in mind, keep an eye on the scale to ensure that you're reaching your weight gain target.

At What Rate Should You Gain?

Slow and steady doesn't only win the race-it's a winner when it comes to pregnancy weight gain, too. A gradual weight gain is best for your body and your baby's body. In fact, the rate at which weight is gained is as important as the total number of pounds you gain. That's because your baby needs a steady supply of nutrients and calories during his or her stay in your womb-deliveries that come in fits and spurts won't cut it once your little one starts doing some significant growing (as will happen during the second and third trimesters). A well-paced weight gain will also do your body good, allowing it to gradually adjust to the increased poundage (and the physical strains that come with it). Gradual gain also allows for gradual skin stretching (think fewer stretch marks). Need more convincing? Pounds put on at a slow and steady rate will come off more easily when the time comes (after you've delivered and you're anxious to get back to your prepregnancy shape).

Does steady mean spreading out those 30 pounds or so evenly over 40 weeks? No-even if that were a possible plan, it wouldn't be the best one. During the first trimester, your baby is only the size of a few poppy seeds, which means that eating for two doesn't require extra eating at all, and only a minimum of weight gain. A good goal for trimester 1 is between 2 and 4pounds-though many women don't end up gaining any at all or even losing a few (thanks to nausea and vomiting), and some gain somewhat more (often because their queasiness is comforted only by starchy, high-calorie foods), and that's fine, too. For those who start slowly, it should be easy to play weight gain catch-up during the next six months (especially once food starts tasting and smelling good again); for those who begin gangbusters, watching the scale a little more closely in the second and third trimester will keep their total close to target.

Why More (or Less) Weight Gain Isn't More What do you have to lose by gaining too much weight when you're expecting? Packing on too many pounds can present a variety of problems in your pregnancy. More padding can make assessing and measuring your baby more difficult, and added pounds can add to pregnancy discomforts (from backache and varicose veins to fatigue and heartburn). Gaining too much weight can also increase your risk of preterm labor, of developing gestational diabetes or hypertension, of ending up with an oversize baby that may be too large to deliver vaginally, of postcesarean complications, of a host of problems for your newborn, and of having more trouble with breastfeeding. Not surprisingly, too, those extra pounds may be extra hard to shed postpartum-and, in fact, many women who gain too much weight during pregnancy end up never shedding them all.

Gaining too little weight can also be a losing proposition during pregnancy, and in some cases it can be more dangerous than gaining too much. Babies whose mothers gain under 20 pounds are more likely to be premature, small for their gestational age, and to suffer growth restriction in the uterus. (The exception: very overweight women, who can safely gain less than 20 pounds under close medical supervision.)

Breakdown of Your Weight Gain (All weights are approximate) Baby 7 pounds 7 pounds Placenta 1 pounds 1 pounds Amniotic fluid 2 pounds 2 pounds Uterine enlargement 2 pounds 2 pounds Maternal breast tissue 2 pounds 2 pounds Maternal blood volume 4 pounds 4 pounds Fluids in maternal tissue 4 pounds 4 pounds Maternal fat stores 7 pounds 7 pounds Total average 30 pounds overall weight gain 30 pounds overall weight gain

During the second trimester, your baby starts to grow in earnest-and so should you. Your weight gain should pick up to an average rate of about 1 to 1 pounds per week during months 4 through 6 (totaling 12 to 14 pounds).

During your final trimester, baby's weight gain will pick up steam, but yours may start to taper off to about a pound a week (for a net gain of about 8 to 10 pounds). Some women find their weight holding steady-or even dropping a pound or two-during the ninth month when ever-tighter abdominal quarters can make finding room for food a struggle.

How closely will you be able to follow this rate of gain formula? Realistically, not that closely. There will be weeks when your appetite will rule and your self-control will waver, and it'll be a rocky road (by the half-gallon) to your weight gain total. And there will be weeks when eating will seem too much of an effort (especially when tummy troubles send whatever you eat right back up). Not to worry or stress over the scale. As long as your overall gain is on target and your rate averages out to that model formula (a half pound one week, 2 pounds the next, 1 the following, and so on), you're right on track.

So for best weight gain results, keep your eye on the scale, since what you don't know can throw your weight gain way off target. Weigh yourself (at the same time of day, wearing the same amount of clothes, on the same scale) once a week (more often and you'll drive yourself crazy with day-to-day fluid fluctuations). If once a week is too much (because you're scale-phobic),. twice a month should do the trick. Waiting until your monthly prenatal is fine, too-though keep in mind that a lot can happen in a month (as in 10 pounds) or not happen (as in no pounds), making it harder for you to stay on track.

Weight Gain Red Flags If you gain more than 3 pounds in any one week in the second trimester, or if you gain more than 2 pounds in any week in the third trimester, especially if it doesn't seem to be related to overeating or excessive intake of sodium, check with your practitioner. Check, too, if you gain no weight for more than two weeks in a row during the fourth to eighth months.

If you find that your weight gain has strayed significantly from what you and your practitioner planned (for instance, you gained 14 pounds in the first trimester instead of 3 or 4, or you packed on 20 pounds in the second instead of 12), take action to see that the gain gets back on a sensible track, but don't try to stop it in its tracks. Dieting to lose weight is never appropriate when you're pregnant, and neither is using appetite-suppressing drinks or pills (these can actually be very dangerous). Instead, with your practitioner's help, readjust your goal to include the excess you've already gained and to accommodate the weight you still have to gain.

CHAPTER 8.

The Third Month Approximately 9 to 13 Weeks AS YOU ENTER THE LAST MONTH of your first trimester (great!), many of those early pregnancy symptoms are probably still going strong (not so great!). Which means it's probably hard to tell whether you're exhausted because of first-trimester fatigue-or because you woke up three times last night to go the bathroom (it's likely a little of both). But chin up, if you have the strength to lift it. There are better days ahead. If morning sickness has had you-and your appetite-down, there's a less queasy day soon to dawn. As energy levels pick up, you'll soon have more get-up-and-go-and as urinary urges ease, you may have to get up and go less often. Even better, you may hear the amazing sound of your baby's heartbeat at this month's checkup, which might make all those uncomfortable symptoms seem much more worthwhile. of your first trimester (great!), many of those early pregnancy symptoms are probably still going strong (not so great!). Which means it's probably hard to tell whether you're exhausted because of first-trimester fatigue-or because you woke up three times last night to go the bathroom (it's likely a little of both). But chin up, if you have the strength to lift it. There are better days ahead. If morning sickness has had you-and your appetite-down, there's a less queasy day soon to dawn. As energy levels pick up, you'll soon have more get-up-and-go-and as urinary urges ease, you may have to get up and go less often. Even better, you may hear the amazing sound of your baby's heartbeat at this month's checkup, which might make all those uncomfortable symptoms seem much more worthwhile.

Your Baby This Month Week 9 Your baby (who has officially graduated now from embryo to fetus) has grown to approximately 1 inch in length, about the size of a medium green olive. His or her head is continuing to develop and take on more baby-like proportions. This week, tiny muscles are starting to form. This will allow your fetus to move his or her arms and legs, though it'll be at least another month before you'll be able to feel those little punches and kicks. While it's way too early to feel anything, it's not too early to hear something (possibly). The glorious sound of your baby's heartbeat might be audible via a Doppler device at your practitioner's office. Take a listen-it's sure to make your heart beat a little faster. Your baby (who has officially graduated now from embryo to fetus) has grown to approximately 1 inch in length, about the size of a medium green olive. His or her head is continuing to develop and take on more baby-like proportions. This week, tiny muscles are starting to form. This will allow your fetus to move his or her arms and legs, though it'll be at least another month before you'll be able to feel those little punches and kicks. While it's way too early to feel anything, it's not too early to hear something (possibly). The glorious sound of your baby's heartbeat might be audible via a Doppler device at your practitioner's office. Take a listen-it's sure to make your heart beat a little faster.

Your Baby, Month 3 Week 10 At nearly 1 inches long (about the size of a prune), your baby is growing by leaps and bounds. And in gearing up for those first leaps and bounds (and baby steps), bones and cartilage are forming-and small indentations on the legs are developing into knees and ankles. Even more unbelievably for someone the size of a prune, the elbows on baby's arms are already working. Tiny buds of baby teeth are forming under the gums. Further down, the stomach is producing digestive juices, the kidneys are producing larger quantities of urine, and, if your baby's a boy, his testes are producing testosterone (boys will be boys-even this early on!). At nearly 1 inches long (about the size of a prune), your baby is growing by leaps and bounds. And in gearing up for those first leaps and bounds (and baby steps), bones and cartilage are forming-and small indentations on the legs are developing into knees and ankles. Even more unbelievably for someone the size of a prune, the elbows on baby's arms are already working. Tiny buds of baby teeth are forming under the gums. Further down, the stomach is producing digestive juices, the kidneys are producing larger quantities of urine, and, if your baby's a boy, his testes are producing testosterone (boys will be boys-even this early on!).

Week 11 Your baby is just over 2 inches long now and weighs about a third of an ounce. His or her body is straightening out and the torso is lengthening. Hair follicles are forming, and fingernail and toenail beds are beginning to develop (nails will actually start to grow within the next few weeks). Those nails are forming on individual fingers and toes, having separated recently from the webbed hands and feet of just a few weeks ago. And though you can't tell baby's gender by looking yet (even with an ultrasound), ovaries are developing if it's a girl. What you would be able to see, if your womb had a view, is that your fetus has distinct human characteristics by now, with hands and feet in the front of the body, ears nearly in their final shape (if not final location), open nasal passages on the tip of the nose, a tongue and palate in the mouth, and visible nipples. Your baby is just over 2 inches long now and weighs about a third of an ounce. His or her body is straightening out and the torso is lengthening. Hair follicles are forming, and fingernail and toenail beds are beginning to develop (nails will actually start to grow within the next few weeks). Those nails are forming on individual fingers and toes, having separated recently from the webbed hands and feet of just a few weeks ago. And though you can't tell baby's gender by looking yet (even with an ultrasound), ovaries are developing if it's a girl. What you would be able to see, if your womb had a view, is that your fetus has distinct human characteristics by now, with hands and feet in the front of the body, ears nearly in their final shape (if not final location), open nasal passages on the tip of the nose, a tongue and palate in the mouth, and visible nipples.

Week 12 Your baby has more than doubled in size during the past three weeks, weighing in now at ounce and measuring (crown to rump. about 2 inches. About the size of a large fresh plum, your baby's body is hard at work in the development department. Though most of his or her systems are fully formed, there's still plenty of maturing to do. The digestive system is beginning to practice contraction movements (so your baby will be able to eat), the bone marrow is making white blood cells (so your baby will be able to fight off all those germs passed around the playgroup), and the pituitary gland at the base of the brain has started producing hormones (so your baby will one day be able to make babies of his or her own). Your baby has more than doubled in size during the past three weeks, weighing in now at ounce and measuring (crown to rump. about 2 inches. About the size of a large fresh plum, your baby's body is hard at work in the development department. Though most of his or her systems are fully formed, there's still plenty of maturing to do. The digestive system is beginning to practice contraction movements (so your baby will be able to eat), the bone marrow is making white blood cells (so your baby will be able to fight off all those germs passed around the playgroup), and the pituitary gland at the base of the brain has started producing hormones (so your baby will one day be able to make babies of his or her own).

Week 13 As your first trimester comes to a close, your fetus (who seems to be working its way through the produce section) has reached the size of a peach, about 3 inches long. Your baby's head is now about half the size of his or her crown to rump length, but that cute little body is picking up steam and will continue growing overtime (at birth, your baby will be one-quarter head, three-quarters body). Meanwhile, your baby's intestines, which have been growing inside the umbilical cord, are now starting their trek to their permanent position in your baby's abdomen. Also developing this week: your baby's vocal cords (the better to cry with ... soon!). As your first trimester comes to a close, your fetus (who seems to be working its way through the produce section) has reached the size of a peach, about 3 inches long. Your baby's head is now about half the size of his or her crown to rump length, but that cute little body is picking up steam and will continue growing overtime (at birth, your baby will be one-quarter head, three-quarters body). Meanwhile, your baby's intestines, which have been growing inside the umbilical cord, are now starting their trek to their permanent position in your baby's abdomen. Also developing this week: your baby's vocal cords (the better to cry with ... soon!).

What You May Be Feeling As always, remember that every pregnancy and every woman is different. You may experience all of these symptoms at one time or another, or only a few of them. Some may have continued from last month; others may be new. Still others may be hardly noticed because you've become so used to them. You may also have other, less common, symptoms. Here's what you might experience this month:

A Look Inside This month, your uterus is a little bigger than a grapefruit and your waist may start to thicken. By the end of the month, your uterus can be felt right above your pubic bone in the lower abdomen.

Physically [image] Fatigue, lack of energy, sleepiness Fatigue, lack of energy, sleepiness[image] Frequent urination Frequent urination[image] Nausea, with or without vomiting Nausea, with or without vomiting[image] Excess saliva Excess saliva[image] Constipation Constipation[image] Heartburn, indigestion, flatulence, bloating Heartburn, indigestion, flatulence, bloating[image] Food aversions and cravings Food aversions and cravings[image] Increasing appetite, especially if morning sickness is easing Increasing appetite, especially if morning sickness is easing[image] Breast changes: fullness, heaviness, tenderness, tingling; darkening of the areolas (the pigmented area around your nipples). lubrication glands in the areolas becoming prominent, like large goose bumps; expanding network of bluish lines under your skin Breast changes: fullness, heaviness, tenderness, tingling; darkening of the areolas (the pigmented area around your nipples). lubrication glands in the areolas becoming prominent, like large goose bumps; expanding network of bluish lines under your skin[image] Visible veins on your abdomen, legs, and elsewhere, as your blood supply pumps up Visible veins on your abdomen, legs, and elsewhere, as your blood supply pumps up[image] Slight increase in vaginal discharge Slight increase in vaginal discharge[image] Occasional headaches Occasional headaches[image] Occasional faintness or dizziness Occasional faintness or dizziness[image] A little more rounding of your belly; your clothes feeling a little snugger A little more rounding of your belly; your clothes feeling a little snugger Emotionally [image] Continued emotional ups and downs, which may include mood swings, irritability, irrationality, weepiness Continued emotional ups and downs, which may include mood swings, irritability, irrationality, weepiness[image] Misgivings, fear, joy, elation-any or all Misgivings, fear, joy, elation-any or all[image] A new sense of calm A new sense of calm[image] Still, a sense of unreality about the pregnancy ("Is there really a baby in there?") Still, a sense of unreality about the pregnancy ("Is there really a baby in there?") What You Can Expect at This Month's Checkup This month, you can expect your practitioner to check the following, though there may be variations depending on your particular needs and your practitioner's style of practice: [image] Weight and blood pressure Weight and blood pressure[image] Urine, for sugar and protein Urine, for sugar and protein[image] Fetal heartbeat Fetal heartbeat[image] Size of uterus, by external palpation (feeling from the outside), to see how it correlates to due date Size of uterus, by external palpation (feeling from the outside), to see how it correlates to due date[image] Height of fundus (the top of the uterus) Height of fundus (the top of the uterus)[image] Hands and feet for swelling, and legs for varicose veins Hands and feet for swelling, and legs for varicose veins[image] Questions or problems you want to discuss-have a list ready Questions or problems you want to discuss-have a list ready What You May Be Wondering About Constipation "I've been terribly constipated for the past few weeks. Is this common?"

Irregularity-that bloated, gassy, clogged-up feeling-is a very regular pregnancy complaint. And there are good reasons why. For one, the high levels of progesterone circulating in your expectant system cause the smooth muscles of the large bowel to relax, making them sluggish-and allowing food to hang around longer in the digestive tract. The upside: There's added time for nutrients to be absorbed into your bloodstream, allowing more of them to reach your baby. The downside: You end up with what amounts to a waste-product traffic jam, with nothing going anywhere anytime soon. Another reason for the clogged-up works. Your growing uterus puts pressure on the bowel, cramping its normal activity. So much for the process of elimination, at least as you once knew it.

But you don't have to accept constipation as inevitable just because you're pregnant. Try these measures to combat your colon congestion (and head off hemorrhoids, a common companion of constipation): Fight back with fiber. You-and your colon-need about 25 to 35 grams of fiber daily. No need to actually keep count. Just focus on fiber-rich selections such as fresh fruit and vegetables (raw or lightly cooked, with skin left on when possible); whole-grain cereals and bread. legumes (beans and peas); and dried fruit. Going for the green can also help get things going-look for it not only in the form of green vegetables, but in the juicy, sweet kiwi, a tiny fruit that packs a potent laxative effect. If you've never been a big fiber fan, add these foods to your diet gradually or you may find your digestive tract protesting loudly. (But since flatulence is a common complaint of pregnancy as well as a frequent, but usually temporary, side effect of a newly fiber-infused diet, you may find your digestive tract protesting for a while anyway.) You-and your colon-need about 25 to 35 grams of fiber daily. No need to actually keep count. Just focus on fiber-rich selections such as fresh fruit and vegetables (raw or lightly cooked, with skin left on when possible); whole-grain cereals and bread. legumes (beans and peas); and dried fruit. Going for the green can also help get things going-look for it not only in the form of green vegetables, but in the juicy, sweet kiwi, a tiny fruit that packs a potent laxative effect. If you've never been a big fiber fan, add these foods to your diet gradually or you may find your digestive tract protesting loudly. (But since flatulence is a common complaint of pregnancy as well as a frequent, but usually temporary, side effect of a newly fiber-infused diet, you may find your digestive tract protesting for a while anyway.) Really plugged up? You can try adding some wheat bran or psyllium to your diet, starting with a sprinkle and working your way up, as needed. Don't overdo these fiber powerhouses, though; as they move speedily through your system, they can carry away important nutrients before they've had the chance to be absorbed.

Another Reason for Being Tired, Moody, and Constipated Have you been tired, moody, and constipated lately? Welcome to the pregnancy club. Surging gestational hormones, of course, trigger those pesky symptoms in most pregnant women. However, a shortage of another hormone, thyroxine, can mimic these common pregnancy complaints, as well as many others-weight gain, skin problems of all kinds, muscle aches and cramps, a decrease in libido, memory loss, and swelling-especially of the hands and feet. (Another common symptom, an increased sensitivity to cold, is more clear-cut during pregnancy, since expectant moms tend to be warmer rather than chillier.) Consequently, hypothyroidism (a deficiency of the thyroid hormone due to an underactive thyroid gland) may be easy for physicians to miss in an expectant mom. Yet the condition, which affects 1 in 50 women, can have an adverse affect on pregnancy (also wreaking havoc in the postpartum period; see page 460 page 460), so proper diagnosis and treatment are vital.Hyperthyroidism (when too much thyroid hormone is produced by an overactive gland) is seen less often in pregnancy, but it can also cause complications if left untreated. Symptoms of hyperthyroidism-many of which may also be hard to distinguish from pregnancy symptoms-include fatigue, insomnia, irritability, warm skin and sensitivity to heat, rapid heartbeat, and weight loss (or trouble gaining weight).If you have ever been diagnosed with any thyroid problems in the past (even if they have since cleared up) or if you currently take medication for a thyroid condition, be sure to let your practitioner know. Because the body's need for thyroid hormone fluctuates during pregnancy, it's possible you may need medication again or need your dose adjusted (see page 531 page 531).If you have never been diagnosed with a thyroid condition, but you're experiencing some or all of the symptoms of hypo- or hyperthyroidism (and especially if you have a family history of thyroid disease), check with your doctor. A simple blood test can determine whether you have a thyroid problem.

Resist the refined. While high-fiber foods can keep things moving, refined foods can clog things up. So steer clear of the refiner things in life, such as white bread (and other baked goods) and white rice. While high-fiber foods can keep things moving, refined foods can clog things up. So steer clear of the refiner things in life, such as white bread (and other baked goods) and white rice.

Drown your opponent. Constipation doesn't stand a chance against an ample fluid intake. Most fluids-particularly water and fruit and vegetable juices-are effective in softening stool and keeping food moving along the digestive tract. Another time-honored way to get things moving: Turn to warm liquids, including that spa staple, hot water and lemon. They'll help stimulate peristalsis, those intestinal contractions that help you go. Truly tough cases may benefit from that geriatric favorite, prune juice. Constipation doesn't stand a chance against an ample fluid intake. Most fluids-particularly water and fruit and vegetable juices-are effective in softening stool and keeping food moving along the digestive tract. Another time-honored way to get things moving: Turn to warm liquids, including that spa staple, hot water and lemon. They'll help stimulate peristalsis, those intestinal contractions that help you go. Truly tough cases may benefit from that geriatric favorite, prune juice.

When you gotta go, go. Holding in bowel movements regularly can weaken muscles that control them and lead to constipation. Timing can help avoid this problem. For example, have your high-fiber breakfast a little earlier than usual, so it will have a chance to kick in before you leave the house-instead of when you're in the car stuck in traffic. Holding in bowel movements regularly can weaken muscles that control them and lead to constipation. Timing can help avoid this problem. For example, have your high-fiber breakfast a little earlier than usual, so it will have a chance to kick in before you leave the house-instead of when you're in the car stuck in traffic.

Don't max out at mealtime. Big meals can overtax your digestive tract, leading to more congestion. Opt for six mini meals a day over three large ones-you'll also experience less gas and bloating. Big meals can overtax your digestive tract, leading to more congestion. Opt for six mini meals a day over three large ones-you'll also experience less gas and bloating.

Check your supplements and medications. Ironically, many of the supplements that do a pregnant body good (prenatal vitamins, calcium, and iron supplements) can also contribute to constipation. Ditto every pregnant woman's best buddy, antacids. So talk to your practitioner about possible alternatives or adjustments in dosages or, in the case of supplements, switching to a slow-release formula. Also ask your practitioner about magnesium supplements that may help fight constipation Ironically, many of the supplements that do a pregnant body good (prenatal vitamins, calcium, and iron supplements) can also contribute to constipation. Ditto every pregnant woman's best buddy, antacids. So talk to your practitioner about possible alternatives or adjustments in dosages or, in the case of supplements, switching to a slow-release formula. Also ask your practitioner about magnesium supplements that may help fight constipation Get some bacteria. Probiotics (aka "good bacteria") may stimulate the intestinal bacteria to break down food better, aiding the digestive tract in its efforts to keep things moving. Enjoy probiotics in yogurt and yogurt drinks that contain active cultures. You can also ask your practitioner to recommend a probiotic supplement-in powder form, it can be easily added to smoothies (and it has no taste of its own). Probiotics (aka "good bacteria") may stimulate the intestinal bacteria to break down food better, aiding the digestive tract in its efforts to keep things moving. Enjoy probiotics in yogurt and yogurt drinks that contain active cultures. You can also ask your practitioner to recommend a probiotic supplement-in powder form, it can be easily added to smoothies (and it has no taste of its own).

Get some exercise. An active body encourages active bowels, so fit a brisk walk of about half an hour into your daily routine (some people find even a 10-minute walk works); supplement it with any exercise you enjoy that is safe during pregnancy (see An active body encourages active bowels, so fit a brisk walk of about half an hour into your daily routine (some people find even a 10-minute walk works); supplement it with any exercise you enjoy that is safe during pregnancy (see page 224 page 224).

If your efforts don't seem to be productive, consult with your practitioner. He or she may prescribe a bulk-forming stool softener for occasional use. Don't use any laxative (including herbal remedies or castor oil) unless your practitioner specifically recommends it.

Lack of Constipation "All my pregnant friends seem to have problems with constipation. I don't-in fact, I've remained very regular. Is my system working right?"

From the sound of things, your system couldn't be working better. Chances are your digestive efficiency is attributable to your lifestyle-one you've been enjoying for a long while or one you've adopted since you learned you were expecting. Stepped-up consumption of fiber-rich foods and fluids, along with regular exercise, are bound to counteract the natural digestive slowdown of pregnancy and keep things moving smoothly. If this dietary style is new to you, the productivity of your digestive tract may decrease a little (and flatulence, which often temporarily accompanies such dietary changes, may ease up) as your system gets used to the rough stuff, but you will probably continue to be "regular."

Diarrhea "I'm not at all constipated. In fact, for the last couple of weeks I've had loose stools-almost diarrhea. Is this normal?"

When it comes to pregnancy symptoms, normal is often what's normal for you. And in your case, more frequent, looser stools may be just that. Every body reacts differently to pregnancy hormones-yours may be reacting by stepping up, not slowing down, on production of bowel movements. It's also possible that this increased bowel activity is due to a positive change in your diet and exercise habits.

You can try cutting back on bowel-stimulating foods, such as dried fruits, and adding bulking foods (such as bananas) until your stool becomes more firm. To compensate for the fluids you're losing through loose stools, make sure you're drinking enough.

If your stools are very frequent (more than three a day) or watery, bloody, or mucousy, check with your practitioner; this kind of diarrhea could require prompt intervention during pregnancy.

Gas "I'm very bloated and I'm passing gas all the time. Will it be like this the whole pregnancy?"

Are you passing gas like a college frat boy (make that more more than a college frat boy)? Sorry, guys, but nobody does gas like a pregnant woman. Fortunately, while the same can't be said for those who work and live within hearing and sniffing distance of you, your baby is oblivious and impervious to your digestive distress. Snug and safe in a uterine cocoon that's protected on all sides by impact-absorbing amniotic fluid, he or she is probably soothed by the bubbling and gurgling of your gastric Muzak. than a college frat boy)? Sorry, guys, but nobody does gas like a pregnant woman. Fortunately, while the same can't be said for those who work and live within hearing and sniffing distance of you, your baby is oblivious and impervious to your digestive distress. Snug and safe in a uterine cocoon that's protected on all sides by impact-absorbing amniotic fluid, he or she is probably soothed by the bubbling and gurgling of your gastric Muzak.

Baby won't be happy, though, if bloating-which often worsens late in the day and, yes, generally persists throughout pregnancy-prevents you from eating regularly and well. To cut down on the sounds and smells from down under and to make sure your nutritional intake doesn't suffer on account of your intestinal outtakes, take the following measures: Stay regular. Constipation is a common cause of gas and bloating. See the tips on Constipation is a common cause of gas and bloating. See the tips on page 173 page 173.

Graze, don't gorge. Large meals just add to that bloated feeling. They also overload your digestive system, which isn't at its most efficient anyway in pregnancy. Instead of those two or three supersize squares, nibble on six mini meals. Large meals just add to that bloated feeling. They also overload your digestive system, which isn't at its most efficient anyway in pregnancy. Instead of those two or three supersize squares, nibble on six mini meals.

Don't gulp. When you rush through meals or eat on the fly, you're bound to swallow as much air as food. This captured air forms painful pockets of gas in your gut, which will seek release the only way they know how. When you rush through meals or eat on the fly, you're bound to swallow as much air as food. This captured air forms painful pockets of gas in your gut, which will seek release the only way they know how.

Keep calm. Particularly during meals. Tension and anxiety can cause you to swallow air, which can give you a full tank of gas. Taking a few deep breaths before meals may help relax you. Particularly during meals. Tension and anxiety can cause you to swallow air, which can give you a full tank of gas. Taking a few deep breaths before meals may help relax you.

Steer clear of gas producers. Your tummy will tell you what they are-they vary from person to person. Common offenders include onions, cabbage, fried foods, rich sauces, sugary sweets, carbonated beverages, and, of course, the notorious beans. Your tummy will tell you what they are-they vary from person to person. Common offenders include onions, cabbage, fried foods, rich sauces, sugary sweets, carbonated beverages, and, of course, the notorious beans.

Don't be quick to pop. Ask your practitioner before popping your usual anti-gas medications (some are safe, others are not recommended) or any remedy, over-the-counter or herbal. Sipping a little chamomile tea, however, may safely soothe all kinds of pregnancy-induced indigestion. Ditto for hot water with lemon, which can cut through gas as well as any medication. Ask your practitioner before popping your usual anti-gas medications (some are safe, others are not recommended) or any remedy, over-the-counter or herbal. Sipping a little chamomile tea, however, may safely soothe all kinds of pregnancy-induced indigestion. Ditto for hot water with lemon, which can cut through gas as well as any medication.

Headaches "I find that I'm getting a lot more headaches than ever before. Can I take something for them?"

That women are more susceptible to headaches during the time they're supposed to stay away from certain pain relievers is one of the ironies of pregnancy. It's an irony you'll have to live with, but it's not necessarily one you'll have to suffer with-at least, not too much. Prevention, teamed with the right remedies (medicinal and non), can offer relief from the normal recurrent headaches of pregnancy.

The best route to headache relief depends on the cause or causes. Pregnancy headaches are most commonly the result of hormonal changes (which are responsible for the increased frequency and severity of many types of headaches, including sinus headaches), fatigue, tension, hunger, physical or emotional stress, or any combination of these.

There are plenty of ways around a headache (and some surprisingly effective ones don't come in capsule form). In many cases you'll be able to fit the probable cause with the possible cure:

What's a Corpus Luteum Cyst?

If your practitioner has told you that you have a corpus luteum cyst, your first question will probably be-what is it? Well, here's all you need to know. Every month of your reproductive life, a small yellowish body of cells forms after you ovulate. Called a corpus luteum (literally "yellow body"), it occupies the space in the follicle formerly occupied by the egg. The corpus luteum produces progesterone and some estrogen, and it is programmed by nature to disintegrate in about 14 days. When it does, diminishing hormone levels trigger your period. When you become pregnant, the corpus luteum hangs around instead of disintegrating, continuing to grow and produce enough hormones to nourish and support your baby-to-be until the placenta takes over. In most pregnancies, the corpus luteum starts to shrink about six or seven weeks after the last menstrual period and stops functioning altogether at about 10 weeks, when its work of providing board for the baby is done. But in about 1. percent of pregnancies, the corpus luteum doesn't regress when it's supposed to. Instead, it develops into a corpus luteum cyst.So now that you know what a corpus luteum cyst is, you're probably wondering-how will it affect my pregnancy? The answer. probably not at all. The cyst is usually nothing to worry about-or do anything about. Chances are it will go away by itself in the second trimester. But just to be sure, your practitioner will keep an eye on your cyst's size and condition regularly via ultrasound (which means you get extra peeks at your baby).

Relax. Pregnancy can be a time of high anxiety, with tension headaches a common result. Some women find relief through meditation and yoga (which also makes a fabulous pregnancy exercise). You can take a class, turn to a DVD or CD, read a book on these or other relaxation techniques, or try the one on Pregnancy can be a time of high anxiety, with tension headaches a common result. Some women find relief through meditation and yoga (which also makes a fabulous pregnancy exercise). You can take a class, turn to a DVD or CD, read a book on these or other relaxation techniques, or try the one on page 142 page 142.