Fear that having an orgasm will stimulate miscarriage or early labor. Athough the uterus does contract following orgasm-and these contractions can be quite powerful in some women, lasting as long as half an hour after intercourse-such contractions are not a sign of labor and aren't harmful in a normal pregnancy. Again, if there's a reason why you should avoid orgasm while you're expecting (because you're at high risk for miscarriage or preterm labor, or have a placenta problem, for instance), your practitioner will let you know. Athough the uterus does contract following orgasm-and these contractions can be quite powerful in some women, lasting as long as half an hour after intercourse-such contractions are not a sign of labor and aren't harmful in a normal pregnancy. Again, if there's a reason why you should avoid orgasm while you're expecting (because you're at high risk for miscarriage or preterm labor, or have a placenta problem, for instance), your practitioner will let you know.

Fear that the fetus is "watching" or "aware." Not possible. Though your baby may enjoy the gentle rocking of uterine contractions during orgasm, he or she can't see what you're doing, has no clue what's happening, and will certainly have no memory of it. Fetal reactions (slowed movement during sex, then furious kicking and squirming and a speeded-up heartbeat after orgasm) are solely responses to uterine activity. Not possible. Though your baby may enjoy the gentle rocking of uterine contractions during orgasm, he or she can't see what you're doing, has no clue what's happening, and will certainly have no memory of it. Fetal reactions (slowed movement during sex, then furious kicking and squirming and a speeded-up heartbeat after orgasm) are solely responses to uterine activity.

Fear of "hitting" the baby on the head. Though your partner may not want to admit it, no penis is big enough to hurt a fetus-or big enough to get close to it. Once again, the baby is well sealed off in a cozy uterine home. Even if your baby's head is engaged in your pelvis, deep penetration can't do any harm (though if it's uncomfortable, avoid it). Though your partner may not want to admit it, no penis is big enough to hurt a fetus-or big enough to get close to it. Once again, the baby is well sealed off in a cozy uterine home. Even if your baby's head is engaged in your pelvis, deep penetration can't do any harm (though if it's uncomfortable, avoid it).

Fear that sex will cause infection. As long as your partner doesn't have a sexually transmittable disease and your cervix is not open, there is no danger of infection to either mother or fetus through intercourse. In the amniotic sac, the baby is safely sealed off from both semen and infectious organisms. As long as your partner doesn't have a sexually transmittable disease and your cervix is not open, there is no danger of infection to either mother or fetus through intercourse. In the amniotic sac, the baby is safely sealed off from both semen and infectious organisms.

Anxiety over the coming attraction. Sure, you're both preoccupied and maybe a little (or a lot) stressed out. You might be experiencing mixed feelings, too, over your baby's imminent arrival. And it's sometimes hard to have sexy thoughts when your mind's cluttered with worries about all those upcoming responsibilities and lifestyle changes, not to mention the financial and emotional cost of bringing up baby. Your best move? Talk about these feelings openly and often-and don't bring them to bed. Sure, you're both preoccupied and maybe a little (or a lot) stressed out. You might be experiencing mixed feelings, too, over your baby's imminent arrival. And it's sometimes hard to have sexy thoughts when your mind's cluttered with worries about all those upcoming responsibilities and lifestyle changes, not to mention the financial and emotional cost of bringing up baby. Your best move? Talk about these feelings openly and often-and don't bring them to bed.

Sexercise There's no better way to mix business with pleasure than performing Kegels during sex. These exercises tone the perineal area in preparation for childbirth, reducing the likelihood that you'll need an episiotomy, as well as minimizing the risk of a tear. Doing Kegels often will also speed postpartum recovery in the area. And though you can perform Kegels anywhere, anytime (see page 295 page 295 for how), doing them during intercourse can double the pleasure for you both. Exercise was never this much fun! for how), doing them during intercourse can double the pleasure for you both. Exercise was never this much fun!

The changing relationship. Maybe you're having trouble adjusting to those impending changes in your family dynamic-the idea that you'll no longer be just lovers, or partners, but mother and father as well. Or you may be discovering that the new dimension in your relationship brings a new intimacy to lovemaking-and with it, a new excitement. Maybe you're having trouble adjusting to those impending changes in your family dynamic-the idea that you'll no longer be just lovers, or partners, but mother and father as well. Or you may be discovering that the new dimension in your relationship brings a new intimacy to lovemaking-and with it, a new excitement.

Resentment. Feelings of resentment-of your partner toward you, perhaps because he is jealous that you and the pregnancy have become the center of attention, or of you toward him because you feel you're doing all the heavy lifting for the baby you both want and will both enjoy-can keep things chilly under the sheets. Such feelings are important to talk out, but again, do your chatting before you hit the sack. Feelings of resentment-of your partner toward you, perhaps because he is jealous that you and the pregnancy have become the center of attention, or of you toward him because you feel you're doing all the heavy lifting for the baby you both want and will both enjoy-can keep things chilly under the sheets. Such feelings are important to talk out, but again, do your chatting before you hit the sack.

Belief that sex later in pregnancy will cause labor to begin. It is true that the uterine contractions triggered by orgasm become stronger as pregnancy proceeds. But unless the cervix is ripe and ready, these contractions do not appear to bring on labor-as many hopeful and eager overdue couples can attest. In fact, studies show that couples who are sexually active during late pregnancy are more likely to carry to term. It is true that the uterine contractions triggered by orgasm become stronger as pregnancy proceeds. But unless the cervix is ripe and ready, these contractions do not appear to bring on labor-as many hopeful and eager overdue couples can attest. In fact, studies show that couples who are sexually active during late pregnancy are more likely to carry to term.

Of course, psychological factors can also add to pregnancy sex pleasure (good news!). For one, some couples who worked hard at becoming pregnant may be happy to switch from procreational to recreational sex. Instead of being slaves to ovulation predictor kits, charts, calendars, and monthly anxiety, they can enjoy spontaneous sex for pleasure's sake. For another, many couples find that creating a baby brings them closer together than ever before, and they find the belly a symbol of that closeness-instead of an awkward obstacle.

When Sex May Be Limited Since lovemaking has so much to offer you and your partner when you're expecting, it would be wonderful if every couple could take advantage of those perks throughout pregnancy. Alas, for some this isn't possible. In high-risk pregnancies, intercourse may be restricted at certain times or even for the full nine months. Or intercourse may be permitted without orgasm for the woman. Or foreplay may be allowed as long as penetration is avoided. Or penetration is permitted but only if a condom is used. Knowing precisely what is safe and when it's safe is essential, so ask for details if your practitioner instructs you to abstain. Find out why sex is off the table and whether that refers to intercourse, orgasm, or both, and whether the restrictions are temporary or apply for the entire pregnancy.

Sex will probably be restricted under the following, and possibly other, circumstances: [image] If you are experiencing signs of preterm labor or, possibly, if you have a history of preterm labor If you are experiencing signs of preterm labor or, possibly, if you have a history of preterm labor[image] If you've been diagnosed with incompetent cervix or placenta previa If you've been diagnosed with incompetent cervix or placenta previa[image] Possibly, if you are experiencing bleeding or if you have a history of miscarriages Possibly, if you are experiencing bleeding or if you have a history of miscarriages If penetration is off-limits, but orgasm's allowed, consider mutual masturbation. If orgasm's taboo for you, you might get pleasure out of pleasuring your partner this way (he certainly won't object). If intercourse has been okayed-but orgasm's prohibited-you could try making love without your reaching climax. Though this definitely won't be completely satisfying for you (and may be impossible if you climax easily), you'll still get some of the intimacy you're both craving while providing pleasure for your partner. If all lovemaking activities have been banned for the duration, try not to let that come between you as a couple. Focus on other ways of getting close-the romantic, G-rated kinds you might not have tapped into since early on in your relationship (like hand-holding, cuddling, and old-fashioned making out).

Getting Comfortable When you're making love at this point in your pregnancy (and later on, too), position matters. Side-lying positions (front-to-front or front-to-back) are often most comfortable because they keep you off your back. Ditto woman on top (which allows you more control over penetration). Rear entry can work well, too. Man on top is fine for quickies (as long as he keeps his weight off you by supporting himself with his arms), but after the fourth month, it's not a good idea to spend too much time flat. on your back.

Enjoying It More, Even If You're Doing It Less Good, lasting sexual relationships are rarely built in a day (or even a really hot night). They grow with practice, patience, understanding, and love. This is true, too, of an already established sexual relationship that undergoes the emotional and physical changes of pregnancy. Here are a few ways to "stay on top": [image] Enjoy your sex life instead of analyzing it. Seize the moment as you seize each other. Don't focus on how frequently or infrequently you're having sex (quality is always more important than quantity, but especially when you're expecting) or compare prepregnancy sex with your sex life now (they're two different animals and, for that matter, so are both of you). Enjoy your sex life instead of analyzing it. Seize the moment as you seize each other. Don't focus on how frequently or infrequently you're having sex (quality is always more important than quantity, but especially when you're expecting) or compare prepregnancy sex with your sex life now (they're two different animals and, for that matter, so are both of you).[image] Accentuate all the positives. Think of making love as good physical preparation for labor and delivery-especially true if you remember to do your Kegels during intercourse. (Not many athletes have this much fun in training.) Think of sex as relaxing-and relaxation is good for all involved (including baby). Think of the roundness of your pregnant body as sensual and sexy. Think of every embrace as a chance to get closer as a couple, not just a chance to get closer to closing the deal. Accentuate all the positives. Think of making love as good physical preparation for labor and delivery-especially true if you remember to do your Kegels during intercourse. (Not many athletes have this much fun in training.) Think of sex as relaxing-and relaxation is good for all involved (including baby). Think of the roundness of your pregnant body as sensual and sexy. Think of every embrace as a chance to get closer as a couple, not just a chance to get closer to closing the deal.[image] Get adventurous. The old positions don't fit anymore? Look at this as an opportunity to try something new (or a lot of somethings new). But give yourselves time to adjust to each position you try. You might even consider a "dry run"-trying out a new position fully clothed first, so that it'll be more familiar (and you'll be more successful) when you try it for real. See the box on the facing page for ideas. Get adventurous. The old positions don't fit anymore? Look at this as an opportunity to try something new (or a lot of somethings new). But give yourselves time to adjust to each position you try. You might even consider a "dry run"-trying out a new position fully clothed first, so that it'll be more familiar (and you'll be more successful) when you try it for real. See the box on the facing page for ideas.[image] Keep your expectations within reality's reach. Pregnant sex presents plenty of challenges, so cut yourself some slack in the sack. Though some women achieve orgasm for the first time during pregnancy, other women find the big "O" more elusive than ever. Your goal doesn't always have to be mutual fireworks. Remind yourself that getting close is sometimes the best, and most satisfying, part of getting it on. Keep your expectations within reality's reach. Pregnant sex presents plenty of challenges, so cut yourself some slack in the sack. Though some women achieve orgasm for the first time during pregnancy, other women find the big "O" more elusive than ever. Your goal doesn't always have to be mutual fireworks. Remind yourself that getting close is sometimes the best, and most satisfying, part of getting it on.[image] Don't forget the other kind of intercourse (talking, that is). Communication is the foundation of every relationship, particularly one that's going through life-changing adjustments. Discuss any problems you're facing as a couple openly instead of trying to sweep them under the bed (and instead of taking them to bed). If any problems seem too big to handle by yourselves, seek professional help. There was never a better time to work on your twosome than now that it's about to become a threesome. Don't forget the other kind of intercourse (talking, that is). Communication is the foundation of every relationship, particularly one that's going through life-changing adjustments. Discuss any problems you're facing as a couple openly instead of trying to sweep them under the bed (and instead of taking them to bed). If any problems seem too big to handle by yourselves, seek professional help. There was never a better time to work on your twosome than now that it's about to become a threesome.

Good, bad, or indifferent, remember, too, that every couple feels differently about sex during pregnancy, both physically and emotionally. The bottom line (whether you're on top, on bottom, side to side, or not doing it at all): What's normal, as is almost always the case when you're expecting, is what's normal for you and your partner. Embrace that, embrace each other-and try not to sweat the rest.

CHAPTER 11.

The Sixth Month Approximately 23 to 27 Weeks NO DOUBT ABOUT THOSE TUMMY moves these days: They're all baby, not gas (though you're probably still having plenty of that, too). And as those little arms and legs start to pack more of a punch, these baby calisthenics-and sometimes bouts of baby hiccups-will become visible from the outside and may even entertain those around you. This month marks the last of the second trimester, which means you're almost two thirds of the way there. Still, you've got a ways to go, and a ways to grow-as does baby, who's a relatively light load compared to what you'll be carrying around in a month or two. Take advantage-and while you can still see your feet (if not touch your toes), kick up your 2-inch heels a little. moves these days: They're all baby, not gas (though you're probably still having plenty of that, too). And as those little arms and legs start to pack more of a punch, these baby calisthenics-and sometimes bouts of baby hiccups-will become visible from the outside and may even entertain those around you. This month marks the last of the second trimester, which means you're almost two thirds of the way there. Still, you've got a ways to go, and a ways to grow-as does baby, who's a relatively light load compared to what you'll be carrying around in a month or two. Take advantage-and while you can still see your feet (if not touch your toes), kick up your 2-inch heels a little.

Your Baby This Month Week 23 A window into your womb would reveal that your baby's skin is a bit saggy, hanging loosely from his or her little body. That's because skin grows faster than fat develops, and there's not much fat to fill that skin out yet. But don't worry-the fat is about to start catching up. Beginning this week, your baby (who is around 8 inches long and just over a pound in weight) begins to pack on the pounds (which means you will, too!). In fact, by month's end, your baby will be double the weight he or she is now (fortunately, you won't be). Once those fat deposits are made, your baby will be less transparent, too. Right now, the organs and bones can still be seen through the skin, which has a red hue thanks to the developing blood veins and arteries just underneath. But by month 8, no more see-through baby! A window into your womb would reveal that your baby's skin is a bit saggy, hanging loosely from his or her little body. That's because skin grows faster than fat develops, and there's not much fat to fill that skin out yet. But don't worry-the fat is about to start catching up. Beginning this week, your baby (who is around 8 inches long and just over a pound in weight) begins to pack on the pounds (which means you will, too!). In fact, by month's end, your baby will be double the weight he or she is now (fortunately, you won't be). Once those fat deposits are made, your baby will be less transparent, too. Right now, the organs and bones can still be seen through the skin, which has a red hue thanks to the developing blood veins and arteries just underneath. But by month 8, no more see-through baby!

Your Baby, Month 6 Week 24 At a weight of 1 pounds and a length of about 8 inches, your baby has outgrown the fruit references and is now the size of a standard letter (but would take a lot more than a standard stamp to mail). Baby's weekly weight gain is now about 6 ounces-not quite as much as you're putting on, but getting a lot closer. Much of that weight is coming from accumulating baby fat, as well as from growing organs, bones, and muscle. By now, your baby's tiny face is almost fully formed, and achingly adorable-complete with a full set of eyelashes and eyebrows and a good sprinkling of hair on that head. Is your baby a brunette, a blond, or a redhead? Actually, right now, he or she's snow white, since there's no pigment in that hair just yet. At a weight of 1 pounds and a length of about 8 inches, your baby has outgrown the fruit references and is now the size of a standard letter (but would take a lot more than a standard stamp to mail). Baby's weekly weight gain is now about 6 ounces-not quite as much as you're putting on, but getting a lot closer. Much of that weight is coming from accumulating baby fat, as well as from growing organs, bones, and muscle. By now, your baby's tiny face is almost fully formed, and achingly adorable-complete with a full set of eyelashes and eyebrows and a good sprinkling of hair on that head. Is your baby a brunette, a blond, or a redhead? Actually, right now, he or she's snow white, since there's no pigment in that hair just yet.

Week 25 Baby's growing by leaps and bounds (and inches and ounces), this week reaching 9 inches in length and more than 1 pounds in weight. And there are exciting developments on the horizon, too. Capillaries are forming under the skin and filling with blood. By week's end, air sacs lined with capillaries will also develop in your baby's lungs, getting them ready for that first breath of fresh air. Mind you, those lungs aren't ready for prime-time breathing yet-and they have a lot of maturing left to do before they will be. Though they're already beginning to develop surfactant, a substance that will help them expand after birth, your baby's lungs are still too undeveloped to sufficiently send oxygen to the bloodstream and release carbon dioxide from the blood (aka breathe). And talking about breathing, your baby's nostrils, which have been plugged up until now, are starting to open up this week. This enables your baby to begin taking practice "breaths." Your baby's vocal cords are functioning now, leading to occasional hiccups (which you'll certainly be feeling). Baby's growing by leaps and bounds (and inches and ounces), this week reaching 9 inches in length and more than 1 pounds in weight. And there are exciting developments on the horizon, too. Capillaries are forming under the skin and filling with blood. By week's end, air sacs lined with capillaries will also develop in your baby's lungs, getting them ready for that first breath of fresh air. Mind you, those lungs aren't ready for prime-time breathing yet-and they have a lot of maturing left to do before they will be. Though they're already beginning to develop surfactant, a substance that will help them expand after birth, your baby's lungs are still too undeveloped to sufficiently send oxygen to the bloodstream and release carbon dioxide from the blood (aka breathe). And talking about breathing, your baby's nostrils, which have been plugged up until now, are starting to open up this week. This enables your baby to begin taking practice "breaths." Your baby's vocal cords are functioning now, leading to occasional hiccups (which you'll certainly be feeling).

Week 26 Next time you're browsing through the meat department, pick up a 2-pound chuck roast. No, not for dinner-just so you can get a sense of how big your baby is this week. That's right-your baby now weighs a full 2 pounds and measures in at 9-plus inches long. Another momentous development this week: Your baby's eyes are beginning to open. The eyelids have been fused for the past few months (so the retina, the part of the eye that allows images to come into focus, could develop). The colored part of the eye (the iris) still doesn't have much pigmentation, so it's too early to start guessing your baby's eye color. Still, your baby is now able to see-though there's not much to see in the dark confines of his or her uterine home. But with the heightened sense of sight and hearing that your baby now possesses, you may notice an increase in activity when your baby sees a bright light or hears a loud noise. In fact, if a loud vibrating noise is brought close to your belly, your baby will respond by blinking and startling. Next time you're browsing through the meat department, pick up a 2-pound chuck roast. No, not for dinner-just so you can get a sense of how big your baby is this week. That's right-your baby now weighs a full 2 pounds and measures in at 9-plus inches long. Another momentous development this week: Your baby's eyes are beginning to open. The eyelids have been fused for the past few months (so the retina, the part of the eye that allows images to come into focus, could develop). The colored part of the eye (the iris) still doesn't have much pigmentation, so it's too early to start guessing your baby's eye color. Still, your baby is now able to see-though there's not much to see in the dark confines of his or her uterine home. But with the heightened sense of sight and hearing that your baby now possesses, you may notice an increase in activity when your baby sees a bright light or hears a loud noise. In fact, if a loud vibrating noise is brought close to your belly, your baby will respond by blinking and startling.

Week 27 Your baby graduates onto a new growth chart this week. No longer will he or she be measured crown to rump, but rather from head to toe. And this week that head-to-toe length is a full 15 inches (more than a foot long)! Your baby's weight is creeping up the charts as well, coming in at just over 2 pounds this week. And here's an interesting fetal factoid: Your baby has more taste buds now than he or she will have at birth (and beyond). Which means that not only is your baby able to taste the difference in the amniotic fluid when you eat different foods, he or she might even react to it. For instance, some babies respond to spicy foods by hiccupping. Or by kicking when they get that spicy kick. Your baby graduates onto a new growth chart this week. No longer will he or she be measured crown to rump, but rather from head to toe. And this week that head-to-toe length is a full 15 inches (more than a foot long)! Your baby's weight is creeping up the charts as well, coming in at just over 2 pounds this week. And here's an interesting fetal factoid: Your baby has more taste buds now than he or she will have at birth (and beyond). Which means that not only is your baby able to taste the difference in the amniotic fluid when you eat different foods, he or she might even react to it. For instance, some babies respond to spicy foods by hiccupping. Or by kicking when they get that spicy kick.

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 At the beginning of this month, your uterus is around 1 inches above your belly button. By the end of the month, your uterus has grown an inch higher and can be felt approximately 2 inches above your belly button. Your uterus is the size of a basketball now, and you might even look like that's what you're carrying around in your belly.

Physically [image] More definite fetal activity More definite fetal activity[image] Continued vaginal discharge Continued vaginal discharge[image] Achiness in the lower abdomen and along the sides (from stretching of ligaments supporting the uterus) Achiness in the lower abdomen and along the sides (from stretching of ligaments supporting the uterus)[image] Constipation Constipation[image] Heartburn, indigestion, flatulence, bloating Heartburn, indigestion, flatulence, bloating[image] Occasional headaches, faintness, or dizziness Occasional headaches, faintness, or dizziness[image] Nasal congestion and occasional nosebleeds; ear stuffiness Nasal congestion and occasional nosebleeds; ear stuffiness[image] Sensitive gums that may bleed when you brush Sensitive gums that may bleed when you brush[image] Hearty appetite Hearty appetite[image] Leg cramps Leg cramps[image] Mild swelling of ankles and feet, and occasionally of hands and face Mild swelling of ankles and feet, and occasionally of hands and face[image] Varicose veins of the legs and/or hemorrhoids Varicose veins of the legs and/or hemorrhoids[image] Itchy abdomen Itchy abdomen[image] A protruding navel A protruding navel[image] Backache Backache[image] Skin pigmentation changes on abdomen and/or face Skin pigmentation changes on abdomen and/or face[image] Stretch marks Stretch marks[image] Enlarged breasts Enlarged breasts Emotionally [image] Fewer mood swings Fewer mood swings[image] Continued absentmindedness Continued absentmindedness[image] Some boredom with the pregnancy ("Can't anyone think about anything else?") Some boredom with the pregnancy ("Can't anyone think about anything else?")[image] Some anxiety about the future Some anxiety about the future[image] Plenty of excitement about the future Plenty of excitement about the future What You Can Expect at This Month's Checkup It will probably be business pretty much as usual at this month's checkup. As you end your second trimester, you can expect your practitioner to check the following, though there may be variations, depending on your particular needs and on 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] Height of fundus (top of uterus) Height of fundus (top of uterus)[image] Size of uterus and position of fetus, by external palpation (feeling from the outside) Size of uterus and position of fetus, by external palpation (feeling from the outside)[image] Feet and hands for swelling, and legs for varicose veins Feet and hands for swelling, and legs for varicose veins[image] Symptoms you may have been experiencing, especially unusual ones Symptoms you may have been experiencing, especially unusual ones[image] Questions and problems you want to discuss-have a list ready Questions and problems you want to discuss-have a list ready What You May Be Wondering About Trouble Sleeping "I've never had a sleep problem in my life-until now. I can't seem to settle down at night."

Between midnight bathroom runs, a racing mind, cramping legs, heartburn that's keeping you upright, a hopped-up metabolism that's keeping the heat on even when it's off, and the impossibility of getting comfortable when you're sporting a basketball in your midsection, it's no wonder that you can't settle in for a good night's sleep. While this insomnia is definitely good preparation for the sleepless nights you'll encounter as a new parent, that doesn't mean you have to take it lying down. Try the following tips for summoning the sandman: [image] Move your body during the day. A body that gets a workout by day will be sleepier at night. But don't exercise too close to bedtime, since the postexercise high could keep you from crashing when your head hits the pillow. Move your body during the day. A body that gets a workout by day will be sleepier at night. But don't exercise too close to bedtime, since the postexercise high could keep you from crashing when your head hits the pillow.[image] Clear your mind. If you've been losing sleep over problems at work or at home, unload them on your spouse or a friend during the early evening so they don't weigh you down at bedtime. If no one's around to talk them over with, write your concerns down. Putting them on paper can be therapeutic, plus it may help you figure out some solutions. As bedtime approaches, put those worries aside, empty your head, and try thinking happy thoughts only. Clear your mind. If you've been losing sleep over problems at work or at home, unload them on your spouse or a friend during the early evening so they don't weigh you down at bedtime. If no one's around to talk them over with, write your concerns down. Putting them on paper can be therapeutic, plus it may help you figure out some solutions. As bedtime approaches, put those worries aside, empty your head, and try thinking happy thoughts only.[image] Take your (dinner)time. Instead of wolfing your dinner down (as hungry as you are by the time it's in front of you), serve up a leisurely approach to your evening meal. Eating slowly and calmly will take a bite out of nighttime heartburn and ideally keep you from tossing and turning when you turn out the light. And don't go straight from dinner to bed, because a full tummy can leave you too energized-and too uncomfortable-to sleep. Take your (dinner)time. Instead of wolfing your dinner down (as hungry as you are by the time it's in front of you), serve up a leisurely approach to your evening meal. Eating slowly and calmly will take a bite out of nighttime heartburn and ideally keep you from tossing and turning when you turn out the light. And don't go straight from dinner to bed, because a full tummy can leave you too energized-and too uncomfortable-to sleep.[image] Top off before you turn in. Too much food right before bed can interfere with sleep, but so can too little. To keep the midnight munchies from waking you, have a light snack as part of your bedtime routine. That old sleepy-time standard, a glass of warm milk, may be especially effective, probably because it reminds you of being tucked in with your teddy bear. You'll get a similar soporific effect by combining any light protein with some complex carbs, so nibble on fruit and cheese or yogurt and raisins, or dunk a muffin or some oatmeal cookies in your milk. Top off before you turn in. Too much food right before bed can interfere with sleep, but so can too little. To keep the midnight munchies from waking you, have a light snack as part of your bedtime routine. That old sleepy-time standard, a glass of warm milk, may be especially effective, probably because it reminds you of being tucked in with your teddy bear. You'll get a similar soporific effect by combining any light protein with some complex carbs, so nibble on fruit and cheese or yogurt and raisins, or dunk a muffin or some oatmeal cookies in your milk.[image] Slow the flow. If frequent trips to the bathroom are standing between you and a good night's sleep, limit fluids after 6 Slow the flow. If frequent trips to the bathroom are standing between you and a good night's sleep, limit fluids after 6 P.M. P.M. (just make sure you get your daily quota of fluids before then). Drink if you're thirsty, but don't guzzle a 16-ounce bottle of water right before bedtime. (just make sure you get your daily quota of fluids before then). Drink if you're thirsty, but don't guzzle a 16-ounce bottle of water right before bedtime.[image] Don't get buzzed. Avoid caffeine in all its forms in the afternoon and evening (its effects can keep you buzzing for up to six hours). Ditto for sugar (especially combined with caffeine, as in chocolate), which will give you an energy boost when you least want one and then leave your blood sugar levels wobbly during the night. Don't get buzzed. Avoid caffeine in all its forms in the afternoon and evening (its effects can keep you buzzing for up to six hours). Ditto for sugar (especially combined with caffeine, as in chocolate), which will give you an energy boost when you least want one and then leave your blood sugar levels wobbly during the night.[image] Give yourself a bedtime routine. It's not just for kids. The relaxing repetition of the right bedtime rituals can help adults settle down for a good night's sleep, too. Easy does it, so focus on activities that slow you down after dinner, preferably practiced in a predictable order. Good options to consider adding to your routine: light reading (but nothing you can't put down) or television (though steer clear of anything that's violent or emotionally wrenching), soothing music, some stretching, serene yoga poses or relaxation exercises, a warm bath, a backrub, some lovemaking. Give yourself a bedtime routine. It's not just for kids. The relaxing repetition of the right bedtime rituals can help adults settle down for a good night's sleep, too. Easy does it, so focus on activities that slow you down after dinner, preferably practiced in a predictable order. Good options to consider adding to your routine: light reading (but nothing you can't put down) or television (though steer clear of anything that's violent or emotionally wrenching), soothing music, some stretching, serene yoga poses or relaxation exercises, a warm bath, a backrub, some lovemaking.[image] Get comfy. There is no such thing as too many pillows when you're pregnant. Use them to prop you up, support you where you need it, or just cozy up to. The sooner in pregnancy you learn to sleep comfortably on your side, the easier it will be for you to do it later on. Be sure, too, that your mattress is comfortable and your bedroom isn't too hot or too cold. Get comfy. There is no such thing as too many pillows when you're pregnant. Use them to prop you up, support you where you need it, or just cozy up to. The sooner in pregnancy you learn to sleep comfortably on your side, the easier it will be for you to do it later on. Be sure, too, that your mattress is comfortable and your bedroom isn't too hot or too cold.[image] Get some air. It's hard to get sleepy when you're stuffy, especially when you're heating for two. So open a window in all but the coldest or hottest weather (when a fan or air-conditioning can help circulate the air). And don't sleep with the covers over your head. This will decrease the oxygen and increase the carbon dioxide you breathe in, which can cause headaches. Get some air. It's hard to get sleepy when you're stuffy, especially when you're heating for two. So open a window in all but the coldest or hottest weather (when a fan or air-conditioning can help circulate the air). And don't sleep with the covers over your head. This will decrease the oxygen and increase the carbon dioxide you breathe in, which can cause headaches.[image] Ask before you pop. While there are sleep aids that are safe for occasional pregnancy use, don't take any sleep aid (prescription, over-the-counter, or herbal) unless it's been prescribed by your practitioner. If your practitioner has recommended that you take a magnesium supplement (or a calcium-magnesium supplement) to combat constipation or leg cramps, it makes sense to take it before bed because magnesium has natural relaxing powers. Ask before you pop. While there are sleep aids that are safe for occasional pregnancy use, don't take any sleep aid (prescription, over-the-counter, or herbal) unless it's been prescribed by your practitioner. If your practitioner has recommended that you take a magnesium supplement (or a calcium-magnesium supplement) to combat constipation or leg cramps, it makes sense to take it before bed because magnesium has natural relaxing powers.[image] Smell your way to sleep. A lavender-scented pillow that you tuck into bed with you or a dried lavender sachet slipped between the pillowcase and pillow can help relax you and bring on sleep faster. Smell your way to sleep. A lavender-scented pillow that you tuck into bed with you or a dried lavender sachet slipped between the pillowcase and pillow can help relax you and bring on sleep faster.[image] Save your bed for sleep (and sex). Don't invite activities you associate with being wide awake and possibly stressed (answering office e-mails on your laptop, paying bills) into your bed. Take care of business in other parts of your home, and reserve your bedroom for its more traditional purposes. Save your bed for sleep (and sex). Don't invite activities you associate with being wide awake and possibly stressed (answering office e-mails on your laptop, paying bills) into your bed. Take care of business in other parts of your home, and reserve your bedroom for its more traditional purposes.[image] Go to bed when you're tired. Climbing into bed before you're sleepy is a recipe for a restless night. Putting off your bedtime may, paradoxically, help you sleep better. But don't wait until you're overtired and less able to settle down. Go to bed when you're tired. Climbing into bed before you're sleepy is a recipe for a restless night. Putting off your bedtime may, paradoxically, help you sleep better. But don't wait until you're overtired and less able to settle down.[image] Avoid clock-watching. Judge whether you're getting enough sleep by how you feel, not by how many hours you stay in bed. Keep in mind that many people who believe they have sleep problems actually get more sleep than they think-and as much as they need. You're getting enough rest if you're not chronically tired (beyond the normal fatigue of pregnancy). And speaking of clocks, if the sight of that glowing dial (and the hours ticking by) stresses you out, turn it so you can't see it. Avoid clock-watching. Judge whether you're getting enough sleep by how you feel, not by how many hours you stay in bed. Keep in mind that many people who believe they have sleep problems actually get more sleep than they think-and as much as they need. You're getting enough rest if you're not chronically tired (beyond the normal fatigue of pregnancy). And speaking of clocks, if the sight of that glowing dial (and the hours ticking by) stresses you out, turn it so you can't see it.[image] Don't just lie there. When sleep's eluding you-and you've run out of sheep to count-get up and do something relaxing (read, watch TV) until you feel sleepy. Don't just lie there. When sleep's eluding you-and you've run out of sheep to count-get up and do something relaxing (read, watch TV) until you feel sleepy.[image] Don't lose sleep over losing sleep. Stressing about your lack of shut-eye will only make it harder to grab any. In fact, sometimes just letting go of that "will I ever fall asleep?" worry is all it takes to drop off into dreamland. Don't lose sleep over losing sleep. Stressing about your lack of shut-eye will only make it harder to grab any. In fact, sometimes just letting go of that "will I ever fall asleep?" worry is all it takes to drop off into dreamland.

Save Time (in a Capsule) Time flies when you're having babies-and raising them. Before it has a chance to fly away, preserve your pregnancy for posterity by making a time capsule. Years from now, your baby (who won't be a baby anymore) will get a kick out of seeing the way things were back in the day, before he or she arrived on the scene. Just take a box (or a capsule) and put in pictures of you (pregnant, of course), your spouse, any pets, and your house and car. Add ultrasound pictures, a menu from the restaurant that always delivers your cravings to the door, a current magazine and newspaper-and any other souvenirs of this expectant era you'd like to hold on to. No need to bury it-just seal it and put it away (don't forget where next time you move) until your baby's old enough to appreciate it.

Protruding Navel "My belly button used to be a perfect 'innie.' Now it's sticking all the way out. Will it stay that way even after I deliver?"

Has your innie been outed? Is it poking straight through your clothes these days? Taking on a life of its own? Don't worry. There's nothing novel about navels that pop during pregnancy. Just about every belly button does at some point. As the swelling uterus pushes forward, even the deepest "innie" is sure to pop like a timer on a turkey (except, on most women, the navel "pops" well before baby's "done"). Your belly button should revert back to its regular position a few months after delivery, though it may bear the mommy mark: that stretched-out, lived-in look. Until then, you can look at the bright side of your protruding navel: It gives you a chance to clean out all the lint that's accumulated there since you were a kid. If you find that the outie look doesn't quite work with the clingy fashion statement you're trying to make, consider taping it down (you can use a Band-Aid, as long as it doesn't irritate, or specially designed belly button tape). But in the meantime, remember, it's just one more pregnancy badge of honor to wear proudly.

Baby Kicking "Some days the baby is kicking all the time; other days he seems very quiet. Is this normal?"

Fetuses are only human. Just like us, they have "up" days, when they feel like kicking up their heels (and elbows and knees), and "down" days, when they'd rather lie back and take it easy. Most often, their activity is related to what you've been doing. Like babies out of the womb, fetuses are lulled by rocking. So when you're on the go all day, your baby is likely to be pacified by the rhythm of your routine, and you're likely not to notice much kicking-partly because baby's slowed down, partly because you're so busy. As soon as you slow down or relax, he or she is bound to start acting up (a pattern babies, unfortunately, tend to continue even after they're born). That's why you're more apt to feel fetal movement in bed at night or when you're resting during the day. Activity may also increase after you've had a meal or snack, perhaps in reaction to the surge of sugar in your blood. You may also notice increased fetal activity when you're excited or nervous-about to give a presentation, for example-possibly because the baby is stimulated by your adrenaline response.

Babies are actually most active between weeks 24 and 28, when they're small enough to belly dance, somersault, kickbox, and do a full aerobic step class in their roomy uterine home. But their movements are erratic and usually brief, so they aren't always felt by a busy mother-to-be, even though they are visible on ultrasound. Fetal activity usually becomes more organized and consistent, with more clearly defined periods of rest and activity, between weeks 28 and 32. It's definitely felt later and less emphatically when there's an anterior placenta getting in the way (see page 246 page 246).

Don't be tempted to compare baby movement notes with other pregnant women. Each fetus, like each newborn, has an individual pattern of activity and development. Some seem always active; others mostly quiet. The activity of some fetuses is so regular their moms could set their watches by it; in others there's no discernible activity pattern at all. As long as there is no radical slowdown or cessation of activity, all variations are normal.

Keeping track of your baby's kicks isn't necessary until week 28 (see page 289 page 289).

"Sometimes the baby kicks so hard it hurts."

As your baby matures in the uterus, he or she becomes stronger and stronger, and those once butterfly-like fetal movements pack more and more punch. Which is why you shouldn't be surprised if you get kicked in the ribs or poked in the abdomen or cervix with such force it hurts. When you seem to be under a particularly fierce attack, try changing your position. It may knock your little linebacker off balance and temporarily stem the assault.

"The baby seems to be kicking all over. Could I be carrying twins?"

At some point in her pregnancy, just about every woman begins to think that she's carrying either twins or a human octopus. That's because until a fetus grows out of room to move (usually at about 34 weeks), it's able to perform numerous acrobatics. So, while it may sometimes feel as if you're being pummeled by a dozen fists (or a litter), it's more likely to be two fists that really get around-along with tiny knees, elbows, and feet. (And if you did have a second passenger on board, you would have likely made that discovery during one of your ultrasounds.) Itchy Belly "My belly itches constantly. It's driving me crazy."

Join the club. Pregnant bellies are itchy bellies, and they can become progressively itchier as the months pass. That's because as your belly grows, the skin stretches rapidly, becoming increasingly moisture-deprived-leaving it itchy and uncomfortable. Try not to scratch, which will only make you itchier and could cause irritation. Moisturizer can temporarily curb the itching. apply a gentle one frequently and liberally. An anti-itching lotion (such as calamine) may provide more relief, as can an oatmeal bath. If you have an all-over itch that's not related to dry or sensitive skin, however, or develop a rash on your abdomen, check with your practitioner.

Clumsiness "Lately I've been dropping everything I pick up. Why am I suddenly so clumsy?"

Like the extra inches on your belly, the extra thumbs on your hands and those two left feet you suddenly feel you're sporting are part of the pregnancy package. This real (and, unfortunately, plain for everyone to see) pregnancy-induced clumsiness is caused by the loosening of joints and ligaments and the retention of water, both of which can make your grasp on objects less firm and sure. Other factors include a lack of concentration as a result of pregnancy forgetfulness (see page 214 page 214) or a lack of dexterity as a result of carpal tunnel syndrome (see next question). And it certainly doesn't help matters that your growing belly has shifted your center of gravity, throwing your balance off-kilter. This uneasiness in balance-whether conscious or not-is most apparent when you're climbing a flight of stairs, walking on a slippery surface (something you really shouldn't be doing anyway), or carrying something heavy (ditto). Not being able to see past your belly to your feet (which, if it hasn't happened yet, definitely will) can also make tripping-over curbs, on steps, on the sneakers your spouse left in front of the bathroom door-a lot easier to do. Finally, pregnancy fatigue can keep you off your game (or knock you off your feet), making it easier to both trip and drop.

Most pregnancy clumsiness is just annoying. Repeatedly retrieving the car keys from the floor, for instance, is merely an ongoing pain in the neck (as well as a pain in the back if you don't remember to bend from the knees). Falls, however, can be a more serious matter, which is why "caution" should be your middle name when you're expecting.

If you're feeling like a bull in a china shop these days, you'll have to make some modifications to your daily activities. Definitely stay out of china shops (and keep your clumsy paws off the good china at home). Leave your favorite crystal on the shelf for the duration and let someone else load and unload the dishwasher, especially when the good stuff's involved. It'll also help to slow down, walk more deliberately and carefully (especially when there's ice or snow underfoot), use extra caution in the tub or shower, keep hallways and stairs clear of objects that might trip you up, refrain from standing on any chairs (no matter what you need to reach), and avoid pushing yourself (the more tired you are, the more clumsy you'll be). Most important, recognize your current limitations and your lack of coordination, and try to have a sense of humor about it.

Numbness in the Hands "I keep waking up in the middle of the night because some of the fingers on my right hand are numb. Is that related to pregnancy?"

Feeling all atingle these days? Chances are it isn't romance or even excitement about the baby-it's the normal numbness and tingling in the fingers and toes that many women experience during pregnancy, probably the result of swelling tissues pressing on nerves. If the numbness and pain are confined to your thumb, index finger, middle finger, and half of your ring finger, you probably have carpal tunnel syndrome (CTS). Though this condition is most common in people who regularly perform tasks that require repetitive motions of the hand (such as piano playing or typing), it is also extremely common in pregnant women-even in those who don't do repetitive hand motions. That's because the carpal tunnel in the wrist, through which the nerve to the affected fingers runs, becomes swollen during pregnancy (as do so many other tissues in the body), with the resultant pressure causing numbness, tingling, burning, and pain. The symptoms can also affect the hand and wrist, and they can radiate up the arm.

Though the pain of CTS can strike at any time of day, you might feel yourself wrestling with wrist pain more at night. That's because fluids that accumulate in your lower extremities during the day are redistributed to the rest of your body (including your hands) when you're lying down. Sleeping on your hands can make the problem worse, so try elevating them on a separate pillow at bedtime. When numbness occurs, shaking your hands may relieve it. If that doesn't do the trick, and the numbness is interfering with your sleep, discuss the problem with your practitioner. Often wearing a wrist splint is helpful. Acupuncture can also bring relief.

The nonsteroidal anti-inflammatory drugs and steroids usually prescribed for CTS may not be recommended during pregnancy. Check with your practitioner. Luckily, when the regular swelling of pregnancy resolves once you've delivered, the carpal tunnel symptoms will diminish, too.

If you think the CTS is related to your work habits (or at-home computer use) as well as your pregnancy, see page 191 page 191.

Leg Cramps "I have leg cramps at night that keep me awake."

Between your overloaded mind and your bulging belly, you probably have enough trouble catching those z's without leg cramps cramping your sleeping style. Unfortunately, these painful spasms that radiate up and down your calves and occur most often at night are very common among the expectant set in the second and third trimesters.

No one's quite sure what causes leg cramps. Various theories blame fatigue from carrying pregnancy weight, compression of the blood vessels in the legs, and possibly diet (an excess of phosphorus and a shortage of calcium or magnesium). You might as well blame hormones, too, since they seem to cause so many pregnancy aches and pains.

Whatever the cause, there are ways of both preventing and alleviating them: [image] When a leg cramp strikes, be sure to straighten your leg and flex your ankle and toes slowly up toward your nose (don't point your toes). This should soon lessen the pain. Doing this several times with each leg before turning in at night may even help ward off the cramps. When a leg cramp strikes, be sure to straighten your leg and flex your ankle and toes slowly up toward your nose (don't point your toes). This should soon lessen the pain. Doing this several times with each leg before turning in at night may even help ward off the cramps.[image] Stretching exercises can also help stop cramps before they strike. Before you head to bed, stand about 2 feet away from a wall and put your palms flat against it. Lean forward, keeping your heels on the floor. Hold the stretch for 10 seconds, then relax for 5. Try this three times. (See the illustration.) Stretching exercises can also help stop cramps before they strike. Before you head to bed, stand about 2 feet away from a wall and put your palms flat against it. Lean forward, keeping your heels on the floor. Hold the stretch for 10 seconds, then relax for 5. Try this three times. (See the illustration.)[image] To ease the daily load on your legs, put your feet up as often as you can, alternate periods of activity with periods of rest, and wear support hose during the day. Flex your feet periodically. To ease the daily load on your legs, put your feet up as often as you can, alternate periods of activity with periods of rest, and wear support hose during the day. Flex your feet periodically.[image] Try standing on a cold surface, which can sometimes stop a spasm. Try standing on a cold surface, which can sometimes stop a spasm.

Stretching Away Leg Cramps

When Something Just Doesn't Feel Right Maybe it's a twinge of abdominal pain that feels too much like a cramp to ignore, a sudden change in your vaginal discharge, an aching in your lower back or in your pelvic floor-or maybe it's something so vague you can't even put your finger on it. Chances are it's just par for the pregnancy course, but to play it safe, check page 138 page 138 to see if a call to your practitioner is in order. If you can't find your symptoms on the list, it's probably a good idea to call anyway. Reporting odd symptoms could help identify early signs of premature labor or other pregnancy complications, which could make a big difference in your pregnancy. Remember, you know your body better than anyone. Listen up when it's trying to tell you something. to see if a call to your practitioner is in order. If you can't find your symptoms on the list, it's probably a good idea to call anyway. Reporting odd symptoms could help identify early signs of premature labor or other pregnancy complications, which could make a big difference in your pregnancy. Remember, you know your body better than anyone. Listen up when it's trying to tell you something.

[image]You can add massage or local heat for added relief, but don't massage or add heat if neither flexing nor cold helps the situation.[image] Make sure you're drinking enough fluids-at least eight glasses a day. Make sure you're drinking enough fluids-at least eight glasses a day.[image] Eat a well-balanced diet that includes plenty of calcium and magnesium. Eat a well-balanced diet that includes plenty of calcium and magnesium.

Really bad cramps (like a charley horse) can cause muscle soreness that lasts a few days. That's nothing to worry about. But if the pain is severe and persists, contact your practitioner because there's a slight possibility that a blood clot may have developed in a vein, making medical treatment necessary (see page 563 page 563).

Hemorrhoids "I'm dreading getting hemorrhoids-I've heard they're common during pregnancy. Is there anything I can do to prevent them?"

It's a big pain in the butt, but more than half of all pregnant women experience hemorrhoids. Just as the veins of the legs are more susceptible to varicosities at this time, so, too, are the veins of the rectum. Pressure from your enlarging uterus, plus increased blood flow to the pelvic area, can cause the veins in your rectal wall to swell, bulge, and itch (how's that for a pleasant thought?).

Constipation can aggravate, or even cause, hemorrhoids (also called piles because of the resemblance these swollen veins sometimes bear to a pile of grapes or marbles), so your best prevention is to avoid constipation in the first place (see page 173 page 173). Doing your Kegels (see page 295 page 295) can also ward off hemorrhoids by improving circulation to the area, as can taking the pressure off by sleeping on your side, not your back; avoiding long hours of standing or sitting; and not lingering on the toilet (keep this book and other reading material out of the bathroom so you aren't tempted to just sit and read). Sitting with your feet on a step stool may make that other stool easier to pass.

To soothe the sting of hemorrhoids, try witch hazel pads or ice packs. A warm bath might reduce discomfort, too. If sitting is a pain, use a doughnut-shaped pillow to ease pressure. Ask your practitioner before using any medication, topical or otherwise. But forget about your grandma's cure-downing a spoonful of mineral oil-which can carry valuable nutrients right out the back door.

Hemorrhoids can sometimes bleed, especially when you're bearing down during a bowel movement, though anal fissures (painful cracks in the skin of the anus caused by straining from constipation) can also be the cause of rectal bleeding. Rectal bleeding should always be evaluated by your physician, but hemorrhoids or fissures are probably the culprits. Hemorrhoids aren't dangerous (just uncomfortable) and usually go away after delivery-though they can also develop postpartum as a result of pushing during delivery.

Breast Lump "I'm worried about a small tender lump on the side of my breast. What could it be?"

Though you're still months away from being able to nurse your baby, it sounds like your breasts are already gearing up. The result: a clogged milk duct. These red, tender-to-the-touch, hard lumps in the breast are very common even this early in pregnancy, especially in second and subsequent pregnancies. Warm compresses (or letting warm water run on it in the shower) and gentle massage will probably clear the duct up in a few days, just as it will during lactation. Some experts suggest that avoiding underwire bras also helps, but make sure you get ample support from the bra you do wear.

Keep in mind that monthly self-exams of your breasts shouldn't stop when you're pregnant. Though checking for lumps is trickier when you're expecting because of the changes in your breasts, it's still important to try. Show any lump to your practitioner at your next visit.

Childbirth Pain

Bleeding in Mid- or Late Pregnancy It's always unsettling to see pink or red on your underwear when you're expecting, but light or spotty bleeding in the second or third trimester is generally not a cause for concern. It's often the result of bruising to the increasingly sensitive cervix during an internal exam or sexual intercourse, or it is sometimes simply triggered by causes unknown and innocuous.

Still, let your practitioner know about any bleeding or spotting in case it's a sign something more serious is going on. If you're bleeding heavily or if the spotting is accompanied by pain or discomfort, give your practitioner a call right away. An ultrasound exam can often determine whether or not there's a problem.

"I'm eager to become a mother, but not so eager to experience childbirth. Mostly, I worry about the pain."

Almost every expectant mother eagerly awaits the birth of her child, but few look forward to labor and delivery-and far fewer still to the pain of labor and delivery. And many, like you, spend much of the months leading up to this momentous event obsessing about the pain. That's not surprising. For those who've never experienced significant discomfort (except maybe a toothache here, a pulled muscle there), the fear of labor pain-which is, after all, an unknown quantity of pain-is very real and very normal.

But it's important to keep in mind the following: Childbirth is a normal life process, which women have been experiencing as long as there have been women. Sure it comes with pain, but it's a pain with a positive purpose (though it won't necessarily feel positive when you're in it): to thin and open your cervix, and bring your baby into your arms. And it's also a pain with a built-in time limit. You might not believe it (especially somewhere around the 5-cm mark), but labor won't last forever. Not only that, but the pain of childbirth is a pain you don't even have to put up with at all. Pain medication is always just a request away, should you end up wanting it or needing it-or both.

So there's no point in dreading the pain (especially because you have the option of avoiding it, or at least, avoiding most of it), but there's a lot to be said for being prepared for it-and for preparing realistically and rationally, with eyes wide open to every option and every eventuality. Preparing now (both your body and mind-since both are involved in how you experience pain) should help reduce the anxiety you're feeling now and the amount of discomfort you'll feel once those contractions kick in.

Diagnosing Preeclampsia Chances are you've heard of (or know) someone who developed preeclampsia (or pregnancy-induced hypertension) during pregnancy. But the reality is that it isn't that common, occurring in only 3 to 7 percent of pregnancies, even in its mildest form. And luckily, in women who are receiving regular prenatal care, preeclampsia can be diagnosed and treated early, preventing needless complications. Though routine office visits sometimes seem a waste of time in a healthy pregnancy ("I have to pee in a cup again?"), the earliest signs of preeclampsia can be picked up at such visits.

Early symptoms of preeclampsia include sudden weight gain apparently unrelated to overeating, severe swelling of the hands and face, unexplained headaches, pain in the stomach or the esophagus, all-over itching, and/or vision disturbances. If you experience any of these, call your practitioner. Otherwise, assuming you are getting regular medical care, there's no reason to worry about preeclampsia. See pages 524 pages 524 and and 548 548 for more information on and tips for dealing with high blood pressure and preeclampsia. for more information on and tips for dealing with high blood pressure and preeclampsia.

Get educated. One reason earlier generations of women found labor so frightening was that they didn't understand what was happening to their bodies or why. They only knew that it hurt. Today, a good childbirth education class can reduce fear (and ultimately pain) by increasing knowledge, preparing women and their coaches, stage by stage and phase by phase, for labor and delivery. If you can't take a class or if you just don't want to, read up as much as you can on the subject of labor and delivery. What you don't know can worry you more than it has to. Taking classes makes sense, by the way, even if you're planning on having an epidural-or even if you have a cesarean delivery scheduled. One reason earlier generations of women found labor so frightening was that they didn't understand what was happening to their bodies or why. They only knew that it hurt. Today, a good childbirth education class can reduce fear (and ultimately pain) by increasing knowledge, preparing women and their coaches, stage by stage and phase by phase, for labor and delivery. If you can't take a class or if you just don't want to, read up as much as you can on the subject of labor and delivery. What you don't know can worry you more than it has to. Taking classes makes sense, by the way, even if you're planning on having an epidural-or even if you have a cesarean delivery scheduled.

Get moving. You wouldn't consider running a marathon without the proper physical training. Neither should you consider signing up for labor (which is no less challenging an event) untrained. Work out with all the breathing, stretching, and toning-up exercises your practitioner and/or childbirth educator recommends, plus plenty of Kegels. You wouldn't consider running a marathon without the proper physical training. Neither should you consider signing up for labor (which is no less challenging an event) untrained. Work out with all the breathing, stretching, and toning-up exercises your practitioner and/or childbirth educator recommends, plus plenty of Kegels.

Team up. Whether you have your partner there to comfort you and feed you ice chips, a doula (see Whether you have your partner there to comfort you and feed you ice chips, a doula (see page 298 page 298) to massage your back, or a friend to wipe your brow-or if you really like company, all three-a little support can go a long way in easing your fears. Even if you end up feeling more tense than chatty during labor, it will be comforting to know that you're not going it alone. And make sure your team is trained, too. Have your coach attend childbirth classes with you, or if that's not possible, suggest that he read the section on labor and delivery beginning on page 380 page 380, so that he'll know what to expect-and how best to help.

Have a plan-and a backup plan. Maybe you've already decided that an epidural has your name on it. Maybe you're hoping to breathe your way through those contractions-or use hypnosis or another CAM approach to pain management. Maybe you're waiting to make that decision until you see how much pain you're facing. Either way, think ahead, and then keep your mind open (because labor has a way of not always following plans). In the end, you'll need to do what's best for you and your baby (even if that's accepting pain relief when you were hoping to tough it out). Remember, you don't have to be a martyr to be a mother. This is one time when you can have the gain without the pain. In fact, sometimes pain relief's absolutely necessary to keep a laboring mom at her most effective. See Maybe you've already decided that an epidural has your name on it. Maybe you're hoping to breathe your way through those contractions-or use hypnosis or another CAM approach to pain management. Maybe you're waiting to make that decision until you see how much pain you're facing. Either way, think ahead, and then keep your mind open (because labor has a way of not always following plans). In the end, you'll need to do what's best for you and your baby (even if that's accepting pain relief when you were hoping to tough it out). Remember, you don't have to be a martyr to be a mother. This is one time when you can have the gain without the pain. In fact, sometimes pain relief's absolutely necessary to keep a laboring mom at her most effective. See page 301 page 301 for more on pain relief during labor and delivery. for more on pain relief during labor and delivery.

Labor Inhibitions "I'm afraid I'll do something embarrassing during labor."

That's because you're not in labor yet. Sure, the idea of screaming, cursing, or involuntarily emptying your bladder or bowel might seem embarrassing now-but during labor, embarrassment will be the furthest thing from your mind. Besides, nothing you can do or say during labor will shock your birth attendants, who've seen and heard it all before-and then some. So check your inhibitions when you check into the hospital or birthing center and feel free to do what comes naturally, as well as what makes you most comfortable. If you are ordinarily a vocal, emotive person, don't try to hold in your moans or hold back your grunts and groans-or even your ear-shattering screams. But if you're normally very soft-spoken or stoic and would prefer to whimper quietly into your pillow, don't feel obligated to out yell the woman next door.

Calling the Labor Shots "I have pretty definite ideas of what I'd like to happen during labor and delivery. I don't like the idea of losing control of the situation."

If you're a take-charge kind of person, the thought of handing control of your labor and delivery over to the medical team can be a little unnerving. Of course you want the doctors, nurses, and midwives to take the best possible care of you and your baby. But you'd still like to call as many shots as possible (including whether or not you get those shots). And chances are you'll be able to, especially if you prepare thoroughly for labor and delivery at your childbirth preparation exercises, become familiar with the birth process, and develop an open and productive rapport with your practitioner, if you haven't already.Setting up a birth plan (see page 294 page 294), specifying what you would like to happen and not happen during a normal labor and delivery, also increases your control.