Keep an Eye on Her Mood Baby blues are one thing (they're normal and self-limiting), but true postpartum depression is another. It's a serious medical condition that requires prompt, professional treatment. If the mom in your life still seems truly overwhelmed several weeks after the baby comes home or experiences bouts of crying, irritability, or sleep disruptions (other than those caused by the baby), or if she's not eating or otherwise functioning normally-as normally as can be expected given her new responsibilities-encourage her to talk to her practitioner about it. Don't leave it up to her if she says no. She may not recognize the signs of depression. Make sure she gets the treatment she needs to feel better. See page 458 page 458 for signs of postpartum depression. for signs of postpartum depression.

If you find your spouse is monopolizing the baby care (she may do this without even being aware of it), let her know you'd like to take on at least your share. Volunteering to spend time alone with the baby whenever possible-while your spouse takes an exercise class, meets a friend for coffee, or just soaks in a tub with a good book-will guarantee that maternal good intentions won't interfere with you and your son getting to know each other. And don't feel you have to spend your quality time with your son at home. Newborns are highly portable, so feel free to pack a diaper bag, strap him into a stroller, car seat, or baby carrier, and take a stroll or run an errand with baby in tow.

Feeling Unsexy After Delivery "The delivery of our baby was absolutely awesome. But seeing her born seems to have turned me off sexually."

Human sexual response, compared to that of other animals, is extremely delicate. It's at the mercy not only of the body but of the mind as well (dogs don't think about it-they just do it). And the mind can, at times, play plenty of tricks. One of those times, as you probably already know, is during pregnancy. Another, as you're discovering, is during the postpartum period.

Postpartum Sex?

Are you experiencing the longest sexual dry spell you've had since freshman year? Think you're exhibiting the symptoms of dreaded DSB (deadly sperm backup)? Be patient: Their time will come, and so will yours. Your spouse is still recovering from a significant shock to her system-not just the birthing, but the nine months preceding. She's been through the wringer physically. The doctor or midwife may have already said that sex is technically okay to start up again, but your partner will be the ultimate decision maker on this one. Once she agrees to give it a try, you'll need to proceed very slowly and extremely gently. Ask her what feels good, what hurts, what you can do to help. And don't even consider laying into the entree until you've served up at least a few foreplay appetizers (she'll need lots of massage, and lubrication will help get her juices going because hormonal changes have left her extra dry). Don't be surprised if you get an accidental eyeful of milk right in the middle of the action (milk happens, especially early on). Share a laugh, and get back to business.

It's very possible that the cause of your sudden sexual ambivalence has nothing to do with having seen your baby delivered. Most brand-new fathers find both the spirit and the flesh somewhat less willing after delivery (although there's nothing abnormal about those who don't) for many very understandable reasons: fatigue; fear that your baby will wake up crying at that first kiss (particularly if she is sharing your room); concern that you may hurt your spouse by having sex before her body is completely healed; and, finally, a general physical and mental preoccupation with your newborn, which sensibly concentrates your energies where they are most needed at this stage of your lives. Your feelings may also be influenced by the temporary increase in female hormones and drop in testosterone that many new fathers experience, because it's the male hormones, in both women and men, that fuel libido. That's probably nature's way of helping you nurture-and nature's way of keeping sex off your mind when there's a new baby in the house.

In other words, it's probably just as well that you aren't feeling sexually motivated, particularly if your wife-like most women in the immediate postpartum period-isn't feeling emotionally or physically up to it, either. Just how long it will take for your interest, and hers, to return is impossible to predict. As with all matters sexual, there is a wide range of normal. For some couples, desire precedes even the practitioner's go-ahead-which, depending on the circumstances, may be anywhere from two to six weeks. For others, six months can pass before sex makes a postpartum comeback. Some women find their libidos lacking until they stop breastfeeding, but that doesn't mean they can't enjoy the closeness of lovemaking.

Some fathers, even if they've been prepared for the childbirth experience, do come out of it feeling as if the special place that's always been meant for pleasure has suddenly taken on a practical purpose. But as the weeks pass, that feeling usually does, too. The vagina, after all, has two really important functions: practical and sexual. Neither excludes the other, and, if you think about it, they're very much interconnected. The vagina is used for childbirth only briefly, but it's a source of pleasure for you and your wife for a lifetime.

While you're waiting for your libido to make its inevitable return (and it will!), make sure you're paying your partner plenty of the attention she's undoubtedly in need of. Women who've just delivered typically don't feel their most desirable, and even if she's not in the mood for love-she's definitely in the mood to hear that you love her (and think she's beautiful and sexy). It can't hurt, either, to try some romantic moves to get you both back into the mood-as hard as that might be to accomplish when you've got a newborn in the house. Light some scented candles once baby's finally asleep to mask that pervasive aroma of dirty diapers; offer her a sensuous no-strings-attached massage; bring on the cuddles while you're both collapsed on the coach. Who knows-you might feel that libido return sooner than you'd think.

Take One for the Team Are your immunizations up to date? Get your TdaP shot as well as seasonal flu vaccine (and other booster shots you may need) to protect the precious baby who's joined the family. Seventy percent of babies who get whooping cough are infected by immediate family members-including dads.

"Now that my wife's breastfeeding, I can't help feeling differently about her breasts. They seem too functional to be sexy."

Like the vagina, breasts were designed to serve both a practical and a sexual purpose (which, from a procreative perspective, is also practical). And though these purposes aren't mutually exclusive in the long run, they can conflict temporarily during lactation.

Some couples find breastfeeding a sexual turn-on, especially if breasts are full for the first time. Others, for aesthetic reasons (leaking milk, for instance) or because they feel uncomfortable about using the baby's source of nourishment for their sexual pleasure, find it a very definite turn-off. They may find this effect wears off, however, as breastfeeding becomes more second nature for all concerned.

Whatever turns you on-or off-is what is normal for you. If you feel your wife's breasts are too functional to be sexy now, focus foreplay elsewhere until you've become more comfortable sharing them with baby (or until baby has been weaned). Be sure, however, to be open and honest with your wife. Taking a sudden, unexplained hands-off approach to her breasts could leave her feeling unappealing. Be careful, also, not to harbor any resentment against the baby for sharing the breasts you love so much; try to think of nursing as a temporary "loan" instead. And enjoy the "interest" that comes with the loan-a healthy, well-fed newborn.

PART 6.

Staying Healthy When You're Expecting

CHAPTER 20.

If You Get Sick.

SO YOU PROBABLY EXPECT TO DEAL with at least a few of the less pleasant pregnancy symptoms during your nine-month stint (a little morning sickness, a few leg cramps, some indigestion and exhaustion), but maybe you weren't planning on coming down with a nasty cold or an ugly (and itchy) infection. The truth is, pregnant women can get sick with the best of them-and even better than the best of them, since suppression of the normal immune system makes expectant moms easier targets for germs of every variety. What's more, being sick for two can make you at least twice as uncomfortable-especially since so many of the remedies you're used to reaching for may need to stay behind medicine cabinet doors for a while. with at least a few of the less pleasant pregnancy symptoms during your nine-month stint (a little morning sickness, a few leg cramps, some indigestion and exhaustion), but maybe you weren't planning on coming down with a nasty cold or an ugly (and itchy) infection. The truth is, pregnant women can get sick with the best of them-and even better than the best of them, since suppression of the normal immune system makes expectant moms easier targets for germs of every variety. What's more, being sick for two can make you at least twice as uncomfortable-especially since so many of the remedies you're used to reaching for may need to stay behind medicine cabinet doors for a while.

Fortunately, such pregnancy- unrelated illnesses won't affect your pregnancy (though they may affect the way you feel). Prevention is, of course, the best way to avoid getting sick in the first place and to keep that healthy glow of pregnancy going strong. But when it fails (as when a coworker brings the flu to the office, your nephew's wet kisses are loaded with cold germs, or you pick up some bacteria with those fresh-picked blueberries), quick treatment, in most cases under the supervision of your practitioner, can help you feel better fast.

What You May Be Wondering About The Common Cold "I'm sneezing, coughing, and my head is killing me. Can this nasty cold affect my baby?"

Common colds are even more common when you're pregnant because your normal immune system is suppressed. The good news is that you're the only one those nasty bugs will be bugging. Your baby can't catch your cold or be affected by it in any way. The not-so-good news: The medications and supplements that you might be used to reaching for to find relief (or to prevent a cold), including aspirin and ibuprofen, megadoses of vitamins, and most herbs, are usually off limits when you're expecting (see page 509 page 509 for information on taking medications during pregnancy). So before you pick the shelves of the drugstore clean, pick up the phone and call your practitioner to ask which remedies are considered safe in pregnancy, as well as those that will work best in your case-there will probably be several you can choose from. (If you've already taken a few doses of a medication that isn't recommended for use during pregnancy, don't worry. But do check with your practitioner for extra reassurance.) for information on taking medications during pregnancy). So before you pick the shelves of the drugstore clean, pick up the phone and call your practitioner to ask which remedies are considered safe in pregnancy, as well as those that will work best in your case-there will probably be several you can choose from. (If you've already taken a few doses of a medication that isn't recommended for use during pregnancy, don't worry. But do check with your practitioner for extra reassurance.) Even if your standard cold medication is shelved for now, you don't have to suffer (or play mother-to-be martyr) when you're laid up in bed with a runny nose and hacking cough-or even if you just feel a cold coming on. Some of the most effective cold remedies don't come in a bottle and are also the safest for both you and your baby. These tips can help nip a cold in the bud, before it blossoms into a nasty case of sinusitis or another secondary infection, while helping you to feel better faster. At the very first sneeze or tickle in the throat: [image] Rest, if you feel the need. Taking a cold to bed doesn't necessarily shorten its duration, but if your body is begging for some rest, be sure to listen. On the other hand, if you feel up to it (and you're not running a fever or coughing), light to moderate exercise can actually help you feel better faster. Rest, if you feel the need. Taking a cold to bed doesn't necessarily shorten its duration, but if your body is begging for some rest, be sure to listen. On the other hand, if you feel up to it (and you're not running a fever or coughing), light to moderate exercise can actually help you feel better faster.[image] Don't starve your cold, fever-or baby. Eat as nutritiously as you can, given how crummy you feel and how little appetite you probably have. Choose foods that appeal to you or at least don't turn you off completely. Try to have some citrus fruit or juice (oranges, tangerines, grapefruit) as well as plenty of other fruits and vegetables rich in vitamin C every day, but don't take extra vitamin C supplements (beyond what comes in your pregnancy vitamin supplement) without medical approval. The same holds true for zinc and echinacea. Don't starve your cold, fever-or baby. Eat as nutritiously as you can, given how crummy you feel and how little appetite you probably have. Choose foods that appeal to you or at least don't turn you off completely. Try to have some citrus fruit or juice (oranges, tangerines, grapefruit) as well as plenty of other fruits and vegetables rich in vitamin C every day, but don't take extra vitamin C supplements (beyond what comes in your pregnancy vitamin supplement) without medical approval. The same holds true for zinc and echinacea.[image] Flood yourself with fluids. Fever, sneezes, and a runny nose will cause your body to lose fluids that you and your baby need. Warm beverages will be particularly soothing, so keep a thermos of a hot drink or hot soup next to your bed and try to drink at least a cupful an hour. Water and cold juices work fine, too, if that's what you're thirsting for. Flood yourself with fluids. Fever, sneezes, and a runny nose will cause your body to lose fluids that you and your baby need. Warm beverages will be particularly soothing, so keep a thermos of a hot drink or hot soup next to your bed and try to drink at least a cupful an hour. Water and cold juices work fine, too, if that's what you're thirsting for.[image] When you're lying down or sleeping, use a couple of pillows to keep your head elevated. This will make it easier for you to breathe through a stuffy nose. Nasal strips (which gently pull your nasal passages open, making breathing easier) may help, too. They're sold over the counter and are completely drug free. When you're lying down or sleeping, use a couple of pillows to keep your head elevated. This will make it easier for you to breathe through a stuffy nose. Nasal strips (which gently pull your nasal passages open, making breathing easier) may help, too. They're sold over the counter and are completely drug free.[image] Keep your nasal passages moist with a humidifier and by squirting the inside of your nose with saline nose drops (which are also drug free and completely safe). Keep your nasal passages moist with a humidifier and by squirting the inside of your nose with saline nose drops (which are also drug free and completely safe).[image] If your throat is sore or scratchy, or if you're coughing, gargle with salt water ( If your throat is sore or scratchy, or if you're coughing, gargle with salt water (1/4 teaspoon of salt to 8 ounces of warm water). teaspoon of salt to 8 ounces of warm water).[image] Try to bring down a fever promptly. For more on fever treatment, see Try to bring down a fever promptly. For more on fever treatment, see page 497 page 497.[image] Don't put off calling the doctor or refuse to take a medication he or she prescribes because you think all drugs are harmful in pregnancy. Many are not. But do be sure the prescribing doctor knows you're expecting. Don't put off calling the doctor or refuse to take a medication he or she prescribes because you think all drugs are harmful in pregnancy. Many are not. But do be sure the prescribing doctor knows you're expecting.

Is It the Flu or a Cold?

Here's how to tell which bug has you down: The cold. A cold, even a bad one, is milder than the flu. It often starts with a sore or scratchy throat (which typically lasts only a day or two) followed by the gradual appearance of cold symptoms. These include a runny, and later stuffy, nose; lots of sneezing; and possibly slight achiness and mild fatigue. There is little or no fever (usually less than 100F). Coughing may develop, particularly near the cold's end, and may continue for a week or more after other symptoms have subsided. A cold, even a bad one, is milder than the flu. It often starts with a sore or scratchy throat (which typically lasts only a day or two) followed by the gradual appearance of cold symptoms. These include a runny, and later stuffy, nose; lots of sneezing; and possibly slight achiness and mild fatigue. There is little or no fever (usually less than 100F). Coughing may develop, particularly near the cold's end, and may continue for a week or more after other symptoms have subsided.

The flu. Influenza (or the flu) is more severe and comes on more suddenly. Symptoms include fever (usually 102F to 104F), headache, sore throat (which generally worsens by the second or third day), often intense muscle soreness, and general weakness and fatigue (which can last a couple of weeks or longer). There may also be occasional sneezing and often a cough that can become severe. In some cases, nausea or vomiting may occur, but don't confuse this with what is often called the "stomach flu" (see Influenza (or the flu) is more severe and comes on more suddenly. Symptoms include fever (usually 102F to 104F), headache, sore throat (which generally worsens by the second or third day), often intense muscle soreness, and general weakness and fatigue (which can last a couple of weeks or longer). There may also be occasional sneezing and often a cough that can become severe. In some cases, nausea or vomiting may occur, but don't confuse this with what is often called the "stomach flu" (see page 501 page 501). You can easily avoid coming down with the flu by getting a flu shot.

If your cold is severe enough to interfere with eating or sleeping, if you're coughing up greenish or yellowish mucus, if you have a cough with chest pain or wheezing, if your sinuses are throbbing (see the next question), or if symptoms last more than a week, call your doctor. It's possible that your cold has settled into a secondary infection and prescribed medication may be needed for your safety and your baby's.

Sinusitis "I've had a cold for about a week. Now my forehead and cheeks are starting to really hurt. What should I do?"

Sounds as though your cold has turned into sinusitis. Signs of sinusitis include pain and often tenderness in the forehead and/or one or both cheeks (beneath the eye), and possibly around the teeth (pain usually worsens when you bend over or shake your head), as well as thickened and darkened (greenish or yellowish) mucus.

Sinusitis following a cold is fairly common, but it is far more common among pregnant women. That's because your hormones tend to swell mucous membranes (including those in and leading to the sinuses), causing blockages that allow germs to build up and multiply in the sinuses. These germs tend to linger longer there, because immune cells, which destroy invading germs, have difficulty reaching the sinuses' deep recesses. As a result, sinus infections that aren't treated can persist for weeks-or even become chronic. Treatment with antibiotics (your practitioner will be able to prescribe one that is safe during pregnancy) can bring relief quickly.

Flu Season "It's fall, and I'm wondering if I should get a flu shot. Is it safe during pregnancy?"

A flu shot is definitely your best line of defense during flu season. Not only is it safe to receive while you're pregnant, it's considered a good move. In fact, the Centers for Disease Control and Prevention (CDC) recommends that any woman who will be pregnant during flu season (generally October through March) be given the flu shot. And since the CDC puts pregnant women at the top of the priority list for getting vaccinated (along with the elderly and children between the ages of 6 months and 5 years), moms-to-be can waddle to the front of the flu-shot line, even if the vaccine is in short supply. Talk to your ob-gyn or midwife about getting a flu shot. If he or she doesn't offer it, make an appointment with your general practitioner to get one. You can also look for flu-shot clinics that are sometimes set up at local drug and grocery stores during flu season.

The flu vaccine must be taken prior to each flu season-or at least early in the season-for best protection. It's not 100 percent effective because it protects only against the flu viruses that are expected to cause the most problems in a particular year. Still, it greatly increases the chance that you will escape the season flu free. And even when it doesn't prevent infection, it usually reduces the severity of symptoms. Side effects occur infrequently and are generally mild.

Flu Shot for Two Getting a flu shot is good for you when you're expecting, but did you know that its benefits carry over to your newborn as well? Researchers have found that babies born to mothers who were given the flu shot during the last trimester of pregnancy appear to be protected against the virus for the first six months of life. Which means that by getting a flu shot now, you'll be keeping your baby protected until it's time for his or her first flu shot.

When going for your flu shot, ask if you can receive thimerosal-free (or -reduced) vaccine. And stick with the needle, not the nasal spray vaccine (FluMist). That vaccine, unlike the flu shot, is made from live flu virus (which means it could actually give you a mild case of the flu) and is not recommended for pregnant women.

If you suspect you might have the flu (see symptoms in box, facing page), call your doctor so that you can be treated (and so that the flu doesn't progress to pneumonia). Treatment is typically symptomatic-aimed at reducing fever (take steps right away to bring down any fever; see next question), aches and pains, and nasal stuffiness. Most important if you've got the flu (or any virus) when you're expecting: Rest and drink plenty of fluids, essential for preventing dehydration.

Fever "I'm running a little fever. What should I do?"

During pregnancy, a low-grade fever (one that's under 100.4F) isn't usually something to be concerned about. But it's also not something to be ignored, which means you should take steps to bring any fever down promptly. Keep a close eye on your temperature, too, to make sure it doesn't start rising.

Any fever over 100.4F while you're expecting is more of a concern and should be reported to your practitioner right away. That's because the cause (such as an infection that should be treated with antibiotics) can pose a pregnancy problem even when the fever doesn't. While you're waiting to speak to your practitioner, take two acetaminophen (Tylenol) to start reducing the fever. Taking a tepid bath or shower, drinking cool beverages, and keeping clothing and covers light will also help bring your temperature down. Aspirin or ibuprofen (Advil or Motrin) should not not be taken when you're expecting unless they've been specifically recommended by your practitioner. be taken when you're expecting unless they've been specifically recommended by your practitioner.

If you had a high fever earlier in pregnancy and did not report it to your practitioner, mention it now.

Strep Throat "My three-year-old came down with strep throat. If I catch it, is there a risk to the baby?"

If there's one thing kids are good at sharing, it's their germs. And the more kids you have at home (particularly of the child-care-attending or school-going variety), the greater your chances of coming down with colds and other infections while you're expecting.

So step up preventive measures (don't share drinks, resist the temptation to finish that peanut-butter-and-germ sandwich, wash your hands frequently) and boost your immune system-which is lowered during pregnancy anyway-by eating well and getting enough rest.

If you do suspect that you've succumbed to strep, go to your practitioner for a throat culture right away. The infection will not harm the baby, as long as it is treated promptly with the right type of antibiotic. Your practitioner will prescribe one that is effective against strep and perfectly safe for use during pregnancy. Don't take medication prescribed for your children or someone else in the family.

Urinary Tract Infection "I'm afraid I have a urinary tract infection."

Your poor battered bladder, which spends months on end being pummeled by your growing uterus and its adorable occupant, is the perfect breeding ground for less welcome visitors: bacteria. These little bugs multiply fast in areas where urine pools or is prevented from moving along, meaning anywhere along a urinary tract that's being squished by the expanding uterus. (It's that same compression that makes you unable to sleep through the night without getting up several times to pee.) That here- and-there compression, added to the muscle-relaxing properties of the hormones flooding your body, makes it much easier for the intestinal bacteria that live quietly on your skin and in your feces to enter your urinary tract and make you miserable. In fact, urinary tract infections (UTIs) are so common in pregnancy that at least 5 percent of pregnant women can expect to develop at least one, and those who have already had one have a 1 in 3 chance of an encore. In some women, a UTI is "silent" (without symptoms) and diagnosed only after a routine urine culture. In others, symptoms can range from mild to quite uncomfortable (an urge to urinate frequently, pain or a burning sensation when urine-sometimes only a drop or two-is passed, pressure or sharp pain in the lower abdominal area). The urine may also be foul smelling and cloudy.

Diagnosing a UTI is as simple as dipping an indicator stick into a urine sample at your practitioner's office; the stick will react to red or white blood cells in the sample. Red blood cells indicate bleeding in the urinary tract; white cells indicate a likely infection. Treating a UTI is as simple as taking a full course of prescribed antibiotics specifically aimed at the type of bacteria found when a lab analyzed that urine sample. (Don't hesitate to take them-your practitioner will prescribe one of the many antibiotics that are safe for use during pregnancy.) Of course, your best bet is to prevent a UTI in the first place. There are a number of steps you can take to reduce your chances of developing one during your pregnancy (or, in conjunction with medical treatment, help speed recovery when infection occurs): [image] Drink plenty of fluids, especially water, which can help flush out any bacteria. Cranberry juice may also be beneficial, possibly because the tannins it contains keep bacteria from sticking to the walls of the urinary tract. Avoid coffee and tea (even decaffeinated varieties) and alcohol, which may increase risk of irritation. Drink plenty of fluids, especially water, which can help flush out any bacteria. Cranberry juice may also be beneficial, possibly because the tannins it contains keep bacteria from sticking to the walls of the urinary tract. Avoid coffee and tea (even decaffeinated varieties) and alcohol, which may increase risk of irritation.[image] Wash your vaginal area well and empty your bladder just before and after sex. Wash your vaginal area well and empty your bladder just before and after sex.[image] Every time you urinate, take the time to empty your bladder thoroughly. Leaning forward on the toilet will help accomplish this. It sometimes also helps to "double void": After you pee, wait five minutes, then try to pee again. And don't put off the urge when you have it; regularly "holding it in" increases susceptibility to infection. Every time you urinate, take the time to empty your bladder thoroughly. Leaning forward on the toilet will help accomplish this. It sometimes also helps to "double void": After you pee, wait five minutes, then try to pee again. And don't put off the urge when you have it; regularly "holding it in" increases susceptibility to infection.[image] To give your perineal area breathing room, wear cotton-crotch underwear and panty hose, avoid wearing tight pants, don't wear panty hose under pants, and sleep without panties or pajama bottoms on if possible (and comfortable). To give your perineal area breathing room, wear cotton-crotch underwear and panty hose, avoid wearing tight pants, don't wear panty hose under pants, and sleep without panties or pajama bottoms on if possible (and comfortable).[image] Keep your vaginal and perineal areas meticulously clean and irritation free. Wipe front to back after using the toilet to keep fecal bacteria from entering your vagina or urethra (the short tube through which urine is excreted from the bladder). Wash daily (showers are better than baths), and avoid bubble bath and perfumed products-powders, shower gels, soaps, sprays, detergents, and toilet paper. Also, stay out of pools that aren't properly chlorinated. Keep your vaginal and perineal areas meticulously clean and irritation free. Wipe front to back after using the toilet to keep fecal bacteria from entering your vagina or urethra (the short tube through which urine is excreted from the bladder). Wash daily (showers are better than baths), and avoid bubble bath and perfumed products-powders, shower gels, soaps, sprays, detergents, and toilet paper. Also, stay out of pools that aren't properly chlorinated.[image] Some practitioners recommend eating yogurt that contains active cultures or taking probiotics while you're on antibiotics to help restore the balance of beneficial bacteria. Ask your practitioner; some probiotics are definitely more potent than others. Some practitioners recommend eating yogurt that contains active cultures or taking probiotics while you're on antibiotics to help restore the balance of beneficial bacteria. Ask your practitioner; some probiotics are definitely more potent than others.[image] Keep your resistance high by eating a nutritious diet, getting enough rest and exercise, and not letting your life get too stressful. Keep your resistance high by eating a nutritious diet, getting enough rest and exercise, and not letting your life get too stressful.

UTIs in the lower part of the urinary tract are no fun, but a more serious potential threat is that bacteria from an untreated UTI will travel up to your kidneys. Kidney infections that aren't treated can be quite dangerous and may lead to premature labor, low-birthweight babies, and more problems. The symptoms are the same as those of UTIs but are frequently accompanied by fever (often as high as 103F), chills, blood in the urine, backache (in the midback on one or both sides), nausea, and vomiting. Should you experience these symptoms, notify your practitioner immediately so you can be treated promptly.

Yeast Infection "I think I have a yeast infection. Should I go get some of the medication I usually use, or do I need to see the doctor?"

Pregnancy is never a time for self- diagnosis or treatment-not even when it comes to something as seemingly simple as a yeast infection. Even if you've had yeast infections a hundred times before, even if you know the symptoms backward and forward (a yellowish, greenish, or thick and cheesy discharge that has a foul odor, accompanied by burning, itching, redness, or soreness), even if you've treated yourself successfully with over-the-counter preparations in the past-this time around, call your practitioner.

Bacterial Vaginosis Bacterial vaginosis (BV) is the most common vaginal condition in women of childbearing age, affecting up to 16 percent of pregnant women. A BV condition, which occurs when certain types of bacteria normally found in the vagina begin to multiply in large numbers, is often accompanied by an abnormal gray or white vaginal discharge with a strong fishlike odor, pain, itching, or burning (though some women with BV report no signs or symptoms at all). Doctors are not exactly sure what causes the normal balance of bacteria in the vagina to be disrupted, though some risk factors have been identified, including having multiple sex partners, douching, or using an IUD. BV is not transmitted during sexual contact but is associated with sexual activity (women who have never had sexual intercourse are rarely affected).

During pregnancy, BV is associated with a slight increase in such complications as premature rupture of the membranes and amniotic fluid infection, which may lead to premature labor. It may also be associated with miscarriage and low birthweight. Some doctors test for BV in women who are at high risk for preterm delivery, but no clear evidence indicates that treating such high-risk women reduces the incidence of prematurity. That said, treating symptomatic BV with antibiotics is effective at relieving symptoms. Some research has also suggested that treatment may reduce the complications associated with preterm births triggered by BV and may decrease the number of days these babies spend in the NICU.

How you will be treated will depend on what kind of infection you have, something only your practitioner can determine via lab tests. If it does turn out to be a yeast infection, which is very common in pregnancy, your practitioner may prescribe vaginal suppositories, gels, ointments, or creams. The oral anti-yeast agent fluconazole (Diflucan) may also be prescribed during pregnancy, but only in low doses and for no longer than two days.

Unfortunately, medication may banish a yeast infection only temporarily; the infection often returns off and on until after delivery and may require repeated treatment.

You may be able to speed your recovery and prevent reinfection by keeping your genital area clean and dry. Do this by practicing meticulous hygiene, especially after going to the bathroom (always wipe from front to back); rinsing your vaginal area thoroughly after soaping during a bath or shower; skipping irritating or perfumed soaps, and bubble baths; wearing cotton underwear; and avoiding tight pants or leggings (especially those that aren't cotton). In general, let the area breathe whenever you can (sleeping without underwear, if possible).

Eating yogurt containing live probiotic cultures may help keep those yeast bugs at bay. You can also ask your practitioner about using an effective probiotic supplement (many on the market aren't effective). Some chronic yeast infection sufferers find that cutting down on the sugar and baked goods made with refined flour helps, too. Do not douche, because it upsets the normal balance of bacteria in the vagina.

Stomach Bugs "I've got a stomach bug, and I can't keep anything down. Will this hurt my baby?"

Just when you thought it was safe to come out of the bathroom, you're back with a bug (good-bye morning sickness, hello stomach flu). And if you're still in your first trimester when the bug hits, it could be hard to differentiate the symptoms from those of morning sickness.

Luckily, having a stomach virus won't hurt your fetus, even while it's hurting your stomach. But just because the virus isn't bugging baby doesn't mean it shouldn't be treated. And whether your tummy is turning from hormones, a virus, or from egg salad that sat on the lunch cart too long, the treatment is the same: Get the rest your body's aching for, and focus on fluids, especially if you're losing them through vomiting or diarrhea. They're much more important in the short term than solids.

If you're not urinating frequently enough or your urine is dark (it should be straw-colored), you may be dehydrated. Fluid needs to be your best buddy now: Try taking frequent small sips of water, diluted juice (white grape is easiest on the tummy), clear broth, weak decaffeinated tea, or hot water with lemon. If you can't manage to sip, suck on ice chips or a Popsicle. Follow your stomach's lead when it comes to adding solids-and when you do, keep it bland, simple, and fat-free (white rice or dry toast, low-fiber cereal, applesauce, bananas). And don't forget that ginger's good for what ails any sick stomach. Take it in tea or in flat ginger ale (best if there's actually ginger in it) or another ginger beverage, or suck or chew on some ginger candies. Remember, too, to supplement when you can. Getting your vitamin insurance is an especially good idea now, so try to take your supplement when it's least likely to come back up. Don't worry, however, if you can't manage to keep it down for a few days or so; no harm done.

If you can't get anything down, talk to your practitioner. Dehydration is a problem for anyone suffering with a stomach bug, but it's especially problematic when you need to stay hydrated for two. You might be advised to take some rehydration fluid (like Pedialyte, which also comes in a soothing freezable form).

Check with your practitioner before you open up your medicine cabinet looking for relief. Antacids like Tums and Rolaids are considered safe to take during pregnancy, and some practitioners may okay gas relievers, but be sure to ask first. Your practitioner may also say you can take certain antidiarrheal medicines, but probably only after your first trimester is safely behind you (see page 511 page 511). As always, check with your practitioner before taking anything, just to play it safe.

And sick tummies, take heart: Most stomach bugs clear up by themselves within a day or so.

Listeriosis "A friend who is pregnant said to stay away from certain dairy products because they can make you sick when you're expecting. Is this true?"

More bad news for adventurous eaters. Unpasteurized milk and cheeses made from unpasteurized milk (including some mozzarella, blue cheese, Mexican cheeses, Brie, Camembert, and feta) can sometimes make you sick, and that extremely unlikely possibility becomes slightly more likely when you're expecting. These foods, along with unpasteurized juices, raw or undercooked meat, fish and shellfish, poultry, eggs, unwashed raw vegetables, and hot dogs and deli meats, can very occasionally contain Listeria. These bacteria can cause serious illness (listeriosis), especially in high-risk individuals, including young children, the elderly, those with compromised immune systems, and pregnant women, whose immune systems are also somewhat suppressed. Though the overall risk of contracting listeriosis is extremely low-even in pregnancy-the potential of its causing problems in pregnancy is higher. Listeria, unlike many other germs, enters the bloodstream directly and therefore can get to the baby quickly through the placenta (other food contaminants generally stay in the digestive tract and may only pose a threat if they get into the amniotic fluid).

Listeriosis is hard to detect-partly because symptoms can appear anytime between 12 hours and 30 days after contaminated food is eaten, and partly because the symptoms (headache, fever, fatigue, muscle aches, and occasionally nausea and diarrhea) are similar to those of flu, and some can even be mistaken for pregnancy side effects. Antibiotics are needed to treat and cure listeriosis. Untreated, the illness can cause serious complications for mom and baby.

So, clearly, it's important to prevent infection in the first place by staying away from the risky foods that might possibly carry Listeria, especially now, even if it means that your taco salad comes without the fresh queso. See page 116 page 116 for more tips on food safety and the prevention of food-borne diseases. Keep in mind, though, that the risk of contracting the infection from day-to-day eating is extremely low, even among expectant diners, so don't stress about the queso you've sprinkled or the smoked turkey you've gobbled up until now. for more tips on food safety and the prevention of food-borne diseases. Keep in mind, though, that the risk of contracting the infection from day-to-day eating is extremely low, even among expectant diners, so don't stress about the queso you've sprinkled or the smoked turkey you've gobbled up until now.

Toxoplasmosis "Though I've given all the cat-care chores over to my husband, just the very fact that I live with cats makes me nervous about toxoplasmosis. How would I know if I came down with it?"

Chances are you wouldn't. Most people who are infected show no symptoms at all, though some do notice mild malaise, slight fever, and swollen glands two or three weeks after exposure, followed by a rash a day or two later.

But chances are, too, that you wouldn't come down with the disease in the first place. If you've lived with cats for a long time, it's very likely that you've already become infected and have developed antibodies to the virus that causes toxoplasmosis.

If you turn out not to be immune, and you do experience the symptoms of toxoplasmosis, you'll probably be tested. (Don't try to test yourself, however, since home tests for toxoplasmosis are highly unreliable.) In the unlikely event that the test comes back positive, you'll probably be treated with antibiotics to reduce the risk of transmitting the infection to your baby.

There is little risk to an expectant mother from toxoplasmosis, and the risk of a fetus becoming infected if mom has contracted the infection and is untreated is only about 15 percent. The earlier in pregnancy a mother is infected, the less likely the illness will be transmitted to her baby but the more serious the consequences will be. The later in the pregnancy, the greater the transmission rate but the less severe the potential consequences. Fortunately, the number of pregnant women who contract toxoplasmosis is small to begin with, and only 1 in 10,000 babies is born with severe congenital toxoplasmosis.

Recent advances have made it possible to test fetal blood and/or amniotic fluid and the fetus's liver via ultrasound to learn whether or not the fetus has actually become infected, though not usually before 20 to 22 weeks. If no infection is detected, the fetus is most likely fine.

The best "treatment" of toxoplasmosis, however, is prevention. See page 79 page 79 for tips on how to avoid infection. for tips on how to avoid infection.

Cytomegalovirus "My son came home from preschool with a note saying that there's an outbreak of CMV at his school. Is this something I should worry about catching during pregnancy?"

Luckily, the chances of picking up cytomegalovirus (CMV) from your son and passing it on to your baby are remote. Why's that? A majority of adults were infected in childhood, and if you're among that majority, you can't "catch" CMV now (though it could become "reactivated"). Even if you did come down with a new CMV infection during pregnancy, the risks to your baby are low. Though half of infected moms give birth to infected infants, only a tiny percentage of them ever show any ill effects. The risks are lower still in a baby whose mom had a reactivated infection during pregnancy.

Still, unless you know for sure that you're immune to CMV because you had the infection before, your best defense is a good offense. Take preventative measures such as washing up carefully after changing your son's diapers or helping him out at the potty, and resist nibbling on your preschooler's leftovers. (And if you work in a child-care or preschool setting, always practice good hygiene protocol.) Though CMV often comes and goes without any obvious symptoms, it's occasionally marked by fever, fatigue, swollen glands, and sore throat. If you notice any of these symptoms, check with your doctor. Whether these symptoms signal CMV or another illness (such as flu or strep throat), you'll need some sort of treatment.

Fifth Disease "I was told that a disease I had never even heard of before-fifth disease-could cause problems in pregnancy."

Fifth disease is the fifth of a group of six diseases that cause fever and rash in children. But unlike its sister diseases (such as measles and chicken pox, the ones that get all the attention), fifth disease isn't widely known because its symptoms are mild and can go unnoticed-or may even be totally absent. Fever is present in only 15 to 30 percent of cases. For the first few days, the rash gives the cheeks the appearance of having been slapped, then spreads in a lacy pattern to trunk, buttocks, and thighs, recurring on and off (usually in response to heat from the sun or a warm bath) for one to three weeks. It is often confused with the rash of rubella and other childhood illnesses or even a sun- or windburn.

Concentrated exposure from caring for a child sick with fifth disease or from teaching at a school where it is epidemic somewhat increases that very small risk of contracting the illness. But half of all women of childbearing age had fifth disease during childhood and are already immune, so infection, happily, isn't common among pregnant women. In the unlikely event that a mom catches fifth disease and her fetus does become infected, the virus can disrupt the developing baby's ability to produce red blood cells, leading to a form of anemia or other complications. If you do contract fifth disease, your practitioner will follow you for signs of fetal anemia with weekly ultrasounds for eight to ten weeks. If the baby is infected during the first half of pregnancy, the risk of miscarriage increases.

Again, the odds that fifth disease will affect you, your pregnancy, or your baby are very remote. Still, as always, it makes sense to take the appropriate steps to avoid any infection while you're expecting (see opposite page).

Measles "I can't remember if I was vaccinated against measles when I was a child. Should I be immunized now?"

No. Measles vaccine (a component of the MMR vaccine) isn't given during pregnancy because of the theoretical risk to the fetus from the vaccine, though there have been no reports of problems among newborns whose mothers were inadvertently vaccinated. Besides, the chances are good that you are already immune to measles, since most women of childbearing age either had the disease or were vaccinated against it as children. If your medical history doesn't include this information and your parents can't recall it, your doctor can run a test to determine whether you are immune. Even if you're not immune, the risk that you might contract measles is extremely remote because the disease has been practically wiped out in the United States (which means it would be highly unlikely that you'd be able to catch it here).