To be sure that the leak you've sprung is urine (which it almost certainly is) and not amniotic fluid, it's smart to initially give it the sniff test. If the liquid that has leaked doesn't smell like urine (which has an ammonia-like smell; amniotic fluid has a sweet smell), let your practitioner know as soon as possible.

How You're Carrying "Everyone says I seem to be carrying small and low for the eighth month. My midwife says everything's fine, but what if my baby isn't growing the way she should be?"

The truth is, you can't tell a baby by her mom's belly. How you're carrying has much less to do with the bulk of your baby and much more to do with these factors: [image] Your own bulk, shape, and bone structure. Bellies come in all sizes, just like expectant moms do. A petite woman may carry more compactly (small, low, and out in front) than a larger woman. On the other hand, some very overweight moms never seem to pop out much at all. That's because their babies have lots of growing room available in mom's already ample abdomen. Your own bulk, shape, and bone structure. Bellies come in all sizes, just like expectant moms do. A petite woman may carry more compactly (small, low, and out in front) than a larger woman. On the other hand, some very overweight moms never seem to pop out much at all. That's because their babies have lots of growing room available in mom's already ample abdomen.[image] Your muscle tone. A woman with very tight muscles may not pop as soon or as much as a woman with slacker muscles, particularly one who's already had a baby or two. Your muscle tone. A woman with very tight muscles may not pop as soon or as much as a woman with slacker muscles, particularly one who's already had a baby or two.[image] The baby's position. How your fetus is positioned on the inside may also affect how big or small you look on the outside. The baby's position. How your fetus is positioned on the inside may also affect how big or small you look on the outside.[image] Your weight gain. A bigger maternal weight gain doesn't necessarily predict a bigger baby, just a bigger mom. Your weight gain. A bigger maternal weight gain doesn't necessarily predict a bigger baby, just a bigger mom.

The only assessments of a fetus's size that are worth paying attention to are medical ones-the ones you get from your practitioner at your prenatal visits, not the ones you get from your sister-in-law, your colleague at work, or perfect strangers in the supermarket checkout line. To evaluate your baby's progress more accurately at each prenatal visit, your practitioner won't just take a look at your belly. She'll routinely measure the height of your fundus (the top of the uterus) and palpate your abdomen to locate your baby's cute little body parts and estimate her size. Other tests, including ultrasound, may also be used as needed to approximate size.

Carrying Baby, Eighth Month These are just three of the very different ways that a woman may carry near the end of her eighth month. The variations are even greater than earlier in pregnancy. Depending on the size and position of your baby, as well as your own size and weight gain, you may be carrying higher, lower, bigger, smaller, wider, or more compactly.

In other words, it's what's inside that counts-and apparently, what's inside your petite belly is a baby who's plenty big enough.

"Everyone says I'm having a boy because I'm all belly and no hips. I know that's probably an old wives' tale, but is there any truth to it at all?"

Predictions about the baby's sex-by old wives or others-have about a 50 percent chance of coming true. (Actually, a little better than that if a boy is predicted, since 105 boys are born for every 100 girls.) Good odds if you're placing a bet in Las Vegas; not necessarily good odds if you're basing your nursery theme and baby names on it.

That goes for "boy if you're carrying up front, girl if you're carrying wide," "girls make your nose grow, boys don't," and every other prediction not made from the pages of a baby's genetics report or from an ultrasound.

Your Size and Your Delivery "I'm five feet tall and very petite. I'm afraid I'll have trouble delivering my baby."

When it comes to your ability to birth your baby, size matters-but inside size, not outside size. It's the size and shape of your pelvis in relation to the size of your baby's head that determines how difficult (or easy) your labor will be, not your height or your build. And just because you're extra petite doesn't necessarily mean you've got an extra-petite pelvis. A short, slight woman can have a roomier (or more accommodatingly configured) pelvis than a tall, full-figured woman.

How will you know what size your pelvis is (after all, it doesn't come with a label: small, medium, extra-large)? Your practitioner can make an educated guess about its size, usually using rough measurements taken at your first prenatal exam. If there's some concern that your baby's head is too large to fit through your pelvis while you're in labor, ultrasound may be used to get a better view (and measurement).

Of course, in general, the overall size of the pelvis, as of all bony structures, is smaller in people of smaller stature. Luckily, nature doesn't typically present an undersized woman with an oversized baby. Instead, newborns are usually pretty well matched to the size of their moms and their moms' pelvises at birth (though they may be destined for bigger things later on). And chances are, your baby will be just the right size for you.

Your Weight Gain and the Baby's Size "I've gained so much weight that I'm afraid my baby will be very big and difficult to deliver."

Just because you've gained a lot of weight doesn't necessarily mean your baby has. Your baby's weight is determined by a number of variables: genetics, your own birthweight (if you were born large, your baby is more likely to be, too), your prepregnancy weight (heavier women tend to have heavier babies), and the kinds of foods you've gained the weight on. Depending on those variables, a 35- to 40-pound weight gain can yield a 6- or 7-pound baby and a 25-pound weight gain can net an 8-pounder. On average, however, the more substantial the weight gain, the bigger the baby.

By palpating your abdomen and measuring the height of your fundus (the top of the uterus), your practitioner will be able to give you some idea of your baby's size, though such guesstimates can be off by a pound or more. An ultrasound can gauge size more accurately, but it may be off the mark, too.

Even if your baby does turn out to be on the big side, that doesn't automatically predict a difficult delivery. Though a 6- or 7-pound baby often makes its way out faster than a 9- or 10-pounder, most women are able to deliver a large baby (or even an extra-large baby) vaginally and without complications. The determining factor, as in any delivery, is whether your baby's head (the largest part) can fit through your pelvis. See the previous question for more.

Baby's Position "How can I tell which way my baby is facing? I want to make sure he's the right way for delivery."

Playing "name that bump" (trying to figure out which are shoulders, elbows, bottom) may be more entertaining than the best reality TV has to offer, but it's not the most accurate way of figuring out your baby's position. Your practitioner will be able to give you a better idea by palpating your abdomen for recognizable baby parts. The location of the baby's heartbeat is another clue to its position: If the baby's presentation is head first, the heartbeat will usually be heard in the lower half of your abdomen; it will be loudest if the baby's back is toward your front. If there's still some doubt, an ultrasound offers the most reliable view of your baby's position.

Still can't resist a round of your favorite evening pastime (or resist patting those round little parts)? Play away-and to make the game more interesting (and to help clue you in), try looking for these markers next time: [image] The baby's back is usually a smooth, convex contour opposite a bunch of little irregularities, which are the "small parts"-hands, feet, elbows. The baby's back is usually a smooth, convex contour opposite a bunch of little irregularities, which are the "small parts"-hands, feet, elbows.[image] In the eighth month, the head has usually settled near your pelvis; it is round, firm, and when pushed down bounces back without the rest of the body moving. In the eighth month, the head has usually settled near your pelvis; it is round, firm, and when pushed down bounces back without the rest of the body moving.[image] The baby's bottom is a less regular shape, and softer, than the head. The baby's bottom is a less regular shape, and softer, than the head.

Breech Baby "At my last prenatal visit, my doctor said he felt my baby's head up near my ribs. Does that mean she's breech?"

Even as her accommodations become ever more cramped, your baby will still manage to perform some pretty remarkable gymnastics during the last weeks ofgestation. In fact, although most fetuses settle into a head-down position between weeks 32 and 38 (breech presentations occur in fewer than 5 percent of term pregnancies), some don't let on which end will ultimately be up until a few days before birth. Which means that just because your baby is bottoms down now doesn't mean that she will be breech when it comes time for delivery.

Turn, Baby, Turn Some practitioners recommend simple exercises to help turn a breech baby into a delivery-friendly, heads-down position. Ask your practitioner whether you should be trying any of these at home: Rock back and forth a few times on your hands and knees several times a day, with your buttocks higher than your head; do pelvic tilts (see page 224 page 224); get on your knees (keep them slightly apart), and then bend over so your butt's up and your belly's almost touching the floor (stay in that position for 20 minutes three times a day if you can, for best results).

Face Forward It's not just up or down that's important when it comes to the position of your baby-it's also front or back. If baby's facing your back, chin tucked onto his or her chest (as most babies end up positioned come delivery), you're in luck. This so-called occiput anterior position is ideal for birth because your baby's head is lined up to fit through your pelvis as easily and comfortably as possible, smallest head part first. If baby's facing your tummy (called occiput posterior, but also known by the much cuter nickname "sunny-side up"), it's a setup for back labor (see page 367 page 367) because his or her skull will be pressing on your spine. It also means your baby's exit might take a little longer.As delivery day approaches, your practitioner will try to determine which way (front or back) your baby's head is facing-but if you're in a hurry to find out, you can look for these clues. When your baby is anterior (face toward your back), you'll feel your belly hard and smooth (that's your baby's back). If your little one is posterior, your tummy may look flatter and softer because your baby's arms and legs are facing forward, so there's no hard, smooth back to feel.Do you think-or have you been told-that your baby is posterior? Don't worry about back labor yet. Most babies turn accommodatingly to the anterior position during labor. Some midwives recommend giving baby a nudge before labor begins by getting on all fours and doing pelvic rocks; whether these exercises can successfully flip a baby is unclear (research has yet to back it up, so to speak), but it certainly can't hurt. At the very least, it might help relieve any back pain you might be experiencing right now.

If your baby does stubbornly remain a breech as delivery approaches, you and your practitioner will discuss possible ways to attempt to turn your baby head down and the best method of delivery (see below).

"If my baby is breech, can anything be done to turn him?"

There are several ways to try to coax a bottoms-down baby heads up. On the low-tech side, your practitioner may recommend simple exercises, such as the ones described in the box, page 317 page 317. Another option (moxibustion) comes from the CAM camp and uses a form of acupuncture and burning herbs to help turn a stubborn fetus.

If your baby still seems determined not to budge, your practitioner may suggest a somewhat higher-tech, yet hands-on approach to manipulating your baby into the coveted heads-down position: external cephalic version (ECV). ECV is best performed around week 37 or 38 or very early in labor when the uterus is still relatively relaxed; some physicians prefer to attempt the procedure after an epidural has been given. Your practitioner (guided by ultrasound and usually in a hospital) will apply his or her hands to your abdomen (you'll feel some pressure, but probably no pain-especially if you've had an epidural) and try to gently turn your baby downward. Continuous monitoring will ensure that everything's okay while the maneuver's completed.

How Does Your Baby Lie?

Location, location, location-when it comes to delivery, a baby's location matters a lot. Most babies present head first, or in a vertex position. Breech presentations can come in many forms. A frank breech is when the baby is buttocks first, with his or her legs facing straight up and flat against the face. A footling breech is when one or both of the baby's legs are pointing down. A transverse lie is when the baby is lying sideways in the uterus. An oblique lie is when the baby's head is pointing toward mom's hip instead of toward the cervix.

The chances of success are pretty high. About two thirds of all ECV attempts are successful (and the success rate is even higher for those who have delivered before, thanks to those laxer uterine and abdominal muscles). Some babies refuse to turn at all, and a small number of contrary fetuses turn and then flip back into a breech position.

"If my baby stays in a breech position, how will that affect labor and delivery? Will I still be able to try for a vaginal birth?"

Whether you'll be able to give vaginal birth a chance will depend on a variety of factors, including your practitioner's policy and your obstetrical situation. Most obs routinely perform a C-section when a baby's in a breech position (in fact, only 0.5 percent of breech babies end up arriving vaginally) because many studies have suggested it's a safer way to go. There are some doctors and midwives, however, who feel it's reasonable to attempt a vaginal delivery under some circumstances (such as when your baby is in a frank breech position and it's clear your pelvis is roomy enough to accommodate).

The bottom line if your baby remains bottom down: You'll need to be flexible in your childbirth plans. Even if your practitioner green-lights a trial of labor, it's just that-a trial. If your cervix dilates too slowly, if your baby doesn't move down the birth canal steadily, or if other problems come up, you'll likely wind up having a C-section. Talk the options over with your practitioner now so you'll be prepared for any possibility come delivery day.

Other Unusual Presentations "My doctor said that my baby's in an oblique position-what's that and what does it mean for delivery?"

Babies can squirm their way into all kinds of unusual positions, and oblique is one of them. What this means is that your baby's head (though down) is pointed toward either of your hips, rather than squarely on your cervix. An oblique position makes a vaginal exit difficult, so your practitioner might do an external cephalic version (see page 318 page 318) to try to coax your baby's head straight down. Otherwise, he or she will probably opt for a C-section.

Yet another tight spot a baby can get into is a transverse position. This is when your baby's lying sideways, across your uterus, instead of vertically. Again, an ECV will be done to try and turn baby up and down. If that doesn't work, your baby will be delivered via cesarean.

Cesarean Delivery "I was hoping for a vaginal birth, but my doctor just told me I'll probably have to have a cesarean. I'm really disappointed."

Even though it's still considered major surgery (and the happiest kind you can have), a cesarean is a very safe way to deliver, and in some cases, the safest way. It's also a more and more common way. More than 30 percent of women are having C-sections these days, which means the chances that your baby will end up arriving via the surgical route are more than 1 in 3, even if you don't have any predisposing factors.

That said, if you had your heart set on a vaginal delivery, the news that your baby may need to arrive surgically instead can be understandably disappointing. Visions of pushing your baby out the way nature intended-and perhaps the way you'd always pictured-can be displaced by concerns about the surgery, about being stuck in the hospital longer, about the tougher recovery, and about the scar that comes standard issue.

But here are some things to consider if your practitioner ultimately decides that your baby's best exit strategy is through your abdomen: Most hospitals now strive to make a cesarean delivery as family friendly as possible, with mom awake (but appropriately numb), dad in the room by her side, and a chance to take a good look at your baby and even do a little quick kissing and caressing right afterward if there's no medical reason to preclude it. (More serious cuddling and nursing usually have to wait until you're in recovery-after you've been stitched back up.) So a surgical birth experience may be more satisfying than you're imagining. And while the recovery will be longer and the scar unavoidable (though usually placed unobtrusively), you'll also be delivering with your perineum intact and your vaginal muscles unstretched. The plus side for baby in a cesarean delivery is purely cosmetic-and temporary; because there's no tight squeeze through the birth canal, he or she will have an initial edge in appearance over vaginally delivered babies (think round head, not pointy).

But by far the most important thing to keep in mind as your baby's arrival approaches: The best birth is the one that's safest-and when it's medically necessary, a cesarean birth is definitely safest.

And after all, any delivery that brings a healthy baby into the world and into your arms is a perfect delivery.

"Why does it seem everyone I know (my sister, my friends, plus just about every celebrity) is having C-sections these days?"

With cesarean rates in the United States at an all-time high (over 30 percent of women can expect to have a surgical delivery), just about everyone knows somebody who's had one. And if the past few years are any indication of future trends, you can expect those numbers to continue climbing-and to hear more and more C-section birth stories from the recently delivered around you.

Many factors contribute to these rising cesarean rates, including: Safety. Cesarean delivery is extremely safe-for both mom and baby-especially with today's better technology (such as the fetal monitor and a variety of other tests) that can more accurately indicate when a fetus is in trouble. Cesarean delivery is extremely safe-for both mom and baby-especially with today's better technology (such as the fetal monitor and a variety of other tests) that can more accurately indicate when a fetus is in trouble.

Bigger babies. With more expectant mothers exceeding the recommended weight gain of 25 to 35 pounds, and with the rate of gestational diabetes increasing, more large babies, who may be more difficult to deliver vaginally, are arriving.

Bigger moms. The C-section rate has also risen with the obesity rate. Being obese (or gaining too much weight during pregnancy) significantly increases a woman's chance of needing a C-section, partly because of other risk factors that accompany obesity (gestational diabetes, for instance), partly because obese women tend to have longer labors, and longer labors are more likely to end up on the operating table. The C-section rate has also risen with the obesity rate. Being obese (or gaining too much weight during pregnancy) significantly increases a woman's chance of needing a C-section, partly because of other risk factors that accompany obesity (gestational diabetes, for instance), partly because obese women tend to have longer labors, and longer labors are more likely to end up on the operating table.

Older mothers. More and more women in their late 30s (and well into their 40s) are now able to have successful pregnancies, but they are more likely to require cesarean deliveries. The same is true of women with chronic health problems.

Repeat C-sections. Though VBAC (vaginal birth after cesarean; see page 325 page 325) is still considered a viable option in a few cases, fewer doctors and hospitals are allowing women to try one, and more are scheduling surgeries over a trial of labor.

Fewer instrumental deliveries. Fewer babies are being born with the help of vacuum extraction and even fewer with forceps, which means doctors are turning to surgical deliveries more often when they might have turned to instruments for help in the past. Fewer babies are being born with the help of vacuum extraction and even fewer with forceps, which means doctors are turning to surgical deliveries more often when they might have turned to instruments for help in the past.

Requests by moms. Since cesareans are so safe and can prevent the pain of labor while keeping the perineum neatly intact, some women-particularly those who've had one before-prefer them to vaginal deliveries and actually ask ahead for one (see page 323 page 323).

Be in the Know The more you know, the better your birth experience will be. And that goes for a surgical birth experience, too. Here are a few topics you might want to bring up with your practitioner before the first contraction kicks in:[image] If labor isn't progressing, will it be possible to try other alternatives before moving to a C-section-for example, oxytocin to stimulate contractions or squatting to make pushing more effective? If labor isn't progressing, will it be possible to try other alternatives before moving to a C-section-for example, oxytocin to stimulate contractions or squatting to make pushing more effective?[image] If the baby is a breech, will attempts to turn the baby (using ECV or another technique) be tried first? Are there times when a breech vaginal birth might be possible? If the baby is a breech, will attempts to turn the baby (using ECV or another technique) be tried first? Are there times when a breech vaginal birth might be possible?[image] What kind of incision will likely be used? What kind of incision will likely be used?[image] Can your coach be with you if you're awake? If you are asleep? Can your coach be with you if you're awake? If you are asleep?[image] Can your nurse-midwife or doula be with you, too? Can your nurse-midwife or doula be with you, too?[image] Will you and your spouse be able to hold the baby immediately after birth, and will you be able to nurse in the recovery room? Will you and your spouse be able to hold the baby immediately after birth, and will you be able to nurse in the recovery room?[image] If the baby doesn't need special care, can he or she room-in with you? If the baby doesn't need special care, can he or she room-in with you?[image] How much recovery time will you need both in and out of the hospital? What physical discomforts and limitations can you expect? How much recovery time will you need both in and out of the hospital? What physical discomforts and limitations can you expect?To find out what you can expect at a cesarean delivery, see page 398 page 398.

Satisfaction. Family-friendly policies have made for a much more satisfying surgical birth experience. Since mom can be wide awake and alert during a cesarean section and family-friendlier hospital policies allow dad to be right alongside her, baby meet-and-greets can often take place right on the delivery table. What's more, a C-section is very quick, lasting a mere 10 minutes or less for the delivery itself (suturing mom back up takes about another 30 minutes). Family-friendly policies have made for a much more satisfying surgical birth experience. Since mom can be wide awake and alert during a cesarean section and family-friendlier hospital policies allow dad to be right alongside her, baby meet-and-greets can often take place right on the delivery table. What's more, a C-section is very quick, lasting a mere 10 minutes or less for the delivery itself (suturing mom back up takes about another 30 minutes).

Even with C-section rates as high as they are these days (and they're far lower for midwives, who attend only low-risk births), keep in mind that surgical deliveries still comprise the minority of births. After all, two out of three women can expect to deliver their babies vaginally.

"Do you generally know in advance that you are going to have a cesarean delivery, or is it usually last minute? What are the reasons you might have one?"

Some women won't find out whether they're having a C-section until they're well into labor, others will get the heads-up ahead of time. Different doctors follow different protocols when it comes to surgical deliveries. The most common reasons for a scheduled C- section include: [image] A previous cesarean delivery, when the reason for it still exists (Mom has an abnormally-shaped pelvis, for example), or when a vertical incision was used before (instead of the more common low horizontal, which can better withstand the pressure of labor); a C- section is also called for when labor has to be induced in a woman who's already had a cesarean delivery A previous cesarean delivery, when the reason for it still exists (Mom has an abnormally-shaped pelvis, for example), or when a vertical incision was used before (instead of the more common low horizontal, which can better withstand the pressure of labor); a C- section is also called for when labor has to be induced in a woman who's already had a cesarean delivery[image] When a fetus's head is believed to be too large to fit through mom's pelvis (cephalopelvic disproportion) When a fetus's head is believed to be too large to fit through mom's pelvis (cephalopelvic disproportion)[image] Multiple births (almost all triplets or more are delivered by C-section; many twins are delivered by C-section) Multiple births (almost all triplets or more are delivered by C-section; many twins are delivered by C-section)[image] Breech or other unusual fetal presentation Breech or other unusual fetal presentation[image] A fetal condition or illness (heart disease, diabetes, preeclampsia) in the mother that may make labor and vaginal delivery risky A fetal condition or illness (heart disease, diabetes, preeclampsia) in the mother that may make labor and vaginal delivery risky[image] Maternal obesity Maternal obesity[image] An active herpes infection, especially a primary one, or an HIV infection An active herpes infection, especially a primary one, or an HIV infection[image] Placenta previa (when the placenta partially or completely blocks the cervical opening) or placental abruption (when the placenta separates from the uterine wall too soon) Placenta previa (when the placenta partially or completely blocks the cervical opening) or placental abruption (when the placenta separates from the uterine wall too soon) Sometimes the C-section decision isn't made until well into labor for reasons such as: [image] Failure of labor to progress, such as when the cervix hasn't dilated quickly enough, or it's taking too long to push the baby out. (In most cases, physicians will try to give sluggish contractions a boost with oxytocin before resorting to a cesarean.) Failure of labor to progress, such as when the cervix hasn't dilated quickly enough, or it's taking too long to push the baby out. (In most cases, physicians will try to give sluggish contractions a boost with oxytocin before resorting to a cesarean.)[image] Fetal distress Fetal distress[image] A prolapsed umbilical cord A prolapsed umbilical cord[image] A ruptured uterus A ruptured uterus If your practitioner says that a C-section will be necessary-or will probably be necessary-ask for a detailed explanation of the reasons. Ask, too, if any alternatives are open to you.

Elective Cesareans "I've heard some women say they chose to have a C-section-is that something I should consider, too?"

Cesareans on demand may be more in demand than ever these days, but that doesn't mean you should sign up for yours. Opting for a surgical delivery when one isn't medically necessary isn't a decision you should take lightly (and definitely one you shouldn't base on trends). It deserves careful consideration-and plenty of discussion with your practitioner about the potential pros and cons.

Though you might have plenty of reasons for wanting a C-section, make sure you consider both sides of the equation. If you're ...

... scared about the pain of a vaginal birth, keep in mind that electing to have a C-section isn't the only way to deliver without pain. There are many effective pain-relief options available to women having a vaginal birth (see keep in mind that electing to have a C-section isn't the only way to deliver without pain. There are many effective pain-relief options available to women having a vaginal birth (see page 302 page 302).

... worried about the aftereffects of a vaginal birth, like pelvic wear and tear or lax vaginal muscles, remember that regular pelvic floor exercises (aka Kegels) can significantly reduce the risk of those effects. What's more, a vaginal birth isn't any more likely to leave you with urinary incontinence issues than a C-section is (which means your baby's exit route doesn't impact the chances that you'll spring a leak postpartum). vaginal birth, like pelvic wear and tear or lax vaginal muscles, remember that regular pelvic floor exercises (aka Kegels) can significantly reduce the risk of those effects. What's more, a vaginal birth isn't any more likely to leave you with urinary incontinence issues than a C-section is (which means your baby's exit route doesn't impact the chances that you'll spring a leak postpartum).

Scheduled Classes for Scheduled C's Think a scheduled C-section means you won't have to schedule childbirth classes? Not so fast. Sure, you won't need to become an expert on breathing exercises or pushing techniques, but childbirth education classes still have plenty to offer you and your coach (including plenty on what to expect with a C-section-and with an epidural). Most classes also offer invaluable advice on taking care of your baby (which you'll have to master no matter which exit your baby takes), breastfeeding, and possibly getting back into shape postpartum. And don't tune out when the teacher's going over the labor breathing routine with the other students. You might find those skills come in handy postpartum when you're confronted with afterpains (as your uterus contracts back to its original size) or when baby's trying to feed off your painfully engorged breasts. Relaxation techniques also help all new moms (and dads).

... hoping to give birth when it's convenient for you, be sure you also consider the longer recovery time and hospital stay plus the increased risk from surgery for you and your baby if you select a C-section. That's not exactly convenient. for you, be sure you also consider the longer recovery time and hospital stay plus the increased risk from surgery for you and your baby if you select a C-section. That's not exactly convenient.

... going to have another baby, understand that opting for a C-section now may limit your options next time around. Some doctors and hospitals limit VBACs (vaginal births after cesarean) these days, which means you might not be able to choose a vaginal birth for your second baby, if you decide later on that C-sections aren't for you after all. understand that opting for a C-section now may limit your options next time around. Some doctors and hospitals limit VBACs (vaginal births after cesarean) these days, which means you might not be able to choose a vaginal birth for your second baby, if you decide later on that C-sections aren't for you after all.

Something else to consider when contemplating a scheduled cesarean that's not medically necessary: The best time for your baby to make his or her exit from your uterus is when he or she is ready. When an elective delivery is planned, there's always the possibility that the baby will inadvertently be born too soon (particularly if the dates are off to begin with).

If, after careful consideration, you're still interested in signing up for an elective cesarean delivery, talk with your practitioner and decide together whether it's the choice that's right for you and your baby.

Repeat Cesareans "I've had two cesareans and want to go for my third-and maybe my fourth child. Is there a limit on the number of C-sections you can have?"

Thinking of having lots of babies-but not sure whether you'll be allowed to make multiple trips to the hospital's happiest operating room? Chances are you'll be able to. Limits are no longer arbitrarily placed on the number of cesarean deliveries a woman can undergo, and having numerous cesareans is generally considered a much safer option than it once was. Just how safe depends on the type of incision made during the previous surgeries, as well as on the scars that are formed following the procedures, so discuss the particulars in your case with your practitioner.

Depending on how many incisions you've had, where you've had them, and how they've healed, multiple C-sections can put you at somewhat higher risk for certain complications. These include uterine rupture, placenta previa (a low-lying placenta), and placenta accreta (an abnormally attached placenta). So you'll need to be particularly alert for any bright red bleeding during your pregnancies, as well as the signs of oncoming labor (contractions, bloody show, ruptured membranes). If any of these occur, notify your practitioner right away.

Vaginal Birth After Cesarean (VBAC) "I had my last baby by cesarean. I'm pregnant again and I'm wondering if I should try for a vaginal delivery this time."

The answer to your question depends on who you talk to. When it comes to determining whether it's safe for women to try for a VBAC (vaginal birth after cesarean; pronounced vee-back), the pendulum of opinions-expert or otherwise-continues to swing VBAC and forth. At one time, doctors and midwives were routinely encouraging pregnant women who'd had a C-section in the past to at least try for a vaginal birth (a trial of labor). But then came a study that warned of the risks (of uterine rupture or of the incision coming apart) if VBAC was attempted, leaving many pregnant women-and their practitioners-confused and unsure about what to do when it comes to childbirth after a C-section.

Looking at the statistics, though, your chances of having a successful VBAC are still pretty good. More than 60 percent of women who have had C-sections and who are candidates for a trial of labor are able to go through a normal labor and a vaginal delivery in subsequent deliveries. Even women who have had two cesarean deliveries have a good chance of being able to deliver vaginally, as long as the proper precautions are taken. And the study that caused the VBAC backlash actually showed that uterine rupture is really quite rare, happening only 1 percent of the time. What's more, that risk is only higher for certain women in certain circumstances, such as those who have a vertical uterine scar instead of a low transverse (95 percent of incisions are low transverse; check the records of your previous cesarean delivery to find out for sure which type of incision you had), or those whose labors are induced by prostaglandins or other hormonal stimulants (these make contractions stronger). Which means that a VBAC is worth a shot if your practitioner and hospital are willing (many hospitals have strict rules about who can or can't attempt a VBAC and some have stopped allowing VBACs altogether).

If you do decide you'd like to attempt a VBAC, you'll need to find a practitioner who backs you up on your decision (midwives are more open to VBACs and often more successful at making them work). Most important if you're pushing for pushing out your baby is to learn everything you can about VBAC, including what your options will be when it comes to pain relief (some physicians limit pain medications during VBAC, some offer epidurals). Keep in mind, too, that if your labor ends up having to be induced, your practitioner will likely veto VBAC.

If, despite all your best efforts, you end up having a repeat C-section, don't be disappointed. Remember that even the woman who has never had a cesarean before has a nearly 1 in 3 chance of needing one. Don't feel guilty, either, if you decide ahead of delivery (in consultation with your practitioner) that you'd rather schedule an elective second cesarean delivery than attempt VBAC. About a third of all C-sections are repeats, and many are actually performed at the request of the mother. Again, what's best for your baby-and best for you-is what matters.

"My ob is encouraging me to try for a VBAC, but I'm not sure why I should bother."

While your feelings definitely factor into the decision of whether or not to give VBAC a shot, your ob does have a point-and a point you might want to consider. The risks of a VBAC are very low, and a C-section, after all, is still major surgery. A vaginal birth means a shorter hospital stay, a lower risk of infection, no abdominal surgery, and a faster recovery-all good reasons to favor a VBAC. So it makes sense to weigh the pros and cons of VBAC and a repeat cesarean delivery before you make your decision.

If, after you've thought and talked it over, you're still convinced that VBAC's not for you, let your ob know your decision and your reasons-and schedule your cesarean delivery without feeling guilty.

Group B Strep "My doctor is going to test me for group B strep infection. What does this mean?"

It means that your doctor's playing it safe, and when it comes to group B strep, safe is a very good way to play it.

Group B strep (GBS) is a bacterium that can be found in the vaginas of healthy women (and it's not related to group A strep, which causes the throat infection). In carriers (about 10 to 35 percent of all healthy women are carriers), it causes no problems at all. But in a newborn baby, who can pick it up while passing through the vagina during childbirth, GBS can cause very serious infection (though only 1 in every 200 babies born to GBS-positive mothers will be affected).

If you're a GBS carrier, you won't have any symptoms (that's a plus). But that also means you're unlikely to know you're a carrier (that's a minus-one that could potentially spell trouble for your baby come delivery). Which is why expectant moms are routinely tested for GBS between 35 and 37 weeks (testing done before 35 weeks isn't accurate in predicting who will be carrying GBS at the time of delivery). Coming soon to a hospital near you (though not yet widely available) is a rapid GBS test that can screen women during labor and provide results within the hour, which might make a test at 35 to 37 weeks unnecessary.

So how's the test currently done? It's performed like a Pap smear, using vaginal and rectal swabs. If you test positive (meaning you're a carrier), you'll be given IV antibiotics during labor-and this treatment completely eliminates any risk to your baby. (GBS can also show up in your urine during a routine pee-in-cup test at a prenatal checkup. If it does, it'll be treated right away with oral antibiotics.) If your practitioner doesn't offer the GBS test during late pregnancy, you can request it. Even if you weren't tested but end up in labor with certain risk factors that point to GBS, your practitioner will just treat you with IV antibiotics to be sure you don't pass the infection on to your baby. If you've previously delivered a baby with GBS, your practitioner may also opt not to test you at 35 to 37 weeks and merely proceed straight to treatment during labor.

Eat Up Okay, you may be feeling like a cow these days, and that's all the more reason to keep grazing. Fitting your meals-and baby's nutrient shipments-into that uterus-cramped stomach of yours is likely getting more and more challenging. Which means that more than ever, the Six-Meal Solution is for you. So graze on, Mom.

Playing it safe through testing-and, if necessary, treatment-means that your baby will be safe from GBS. And that's a very good thing.

Taking Baths Now "Is it okay for me to take a bath this far along into my pregnancy?"