How Conception Happens

Given the number of things that must fall into place in order to start a baby, it's a wonder it ever happens at all. The creation of a human being requires the right environment, the right ingredients, the right timing, and a great deal of luck.

The first step occurs when an egg cell from a woman unites with a sperm cell from a man to form an embryo -- the beginnings of a human being. This process is called conception.

Most women of childbearing age go through a cycle of physical events every month. The cycle is measured by the most obvious of these events: her menstrual period, the few days in which blood and tissue pass from the vagina. Most of the other events involved in the menstrual cycle are harder to track, because they occur internally. The first day of the period is designated day 1 of the cycle. On average, a woman's cycle lasts 28 days, but that can vary widely among individuals.

The steps in the menstrual cycle are triggered by the rise and fall of certain hormones (chemical substances in the body). Several glands -- including the pituitary in the brain annd the ovaries (egg-producing organs) in the reproductive tract -- manufacture and release these hormones. The varying hormone levels signal the organs of the reproductive tract to respond in a particular way at different points in the cycle.

Each month, one of these hormonal signals tells the uterus (womb) to prepare for the possibility of pregnancy. Over the course of the next two weeks, a layer of blood-rich tissue builds up on the inside surface of the uterus. This lining, called the endometrium, is meant to serve as a bed in which a developing baby can grow.

Meanwhile, some of the eggs inside one of the ovaries begin to mature. Each ovary contains many thousands of immature eggs, but only a small proportion respond in any given month. Of these, usually only one egg ultimately reaches maturity. At the midpoint of the cycle -- usually about day 14 -- that egg emerges from the wall of the ovary and makes its way into the nearby fallopian tube, a narrow, hollow structure that carries the egg to the uterus. The release of the egg from the ovary is called ovulation.

Most of the time, conception does not occur. The egg proceeds down the fallopian tube and reaches the uterus with no interruption. In such a case, the uterus eventually sheds its blood-rich lining, causing the menstrual period. The egg passes out of the body along with the blood and tissue.

In order for conception to occur, sperm cells from a man must be present in the woman's reproductive tract at the time the egg enters the fallopian tube. This can happen in several ways. If the woman has intercourse with a man during the week preceding ovulation, then he may deposit semen (a fluid containing sperm cells) into the woman's vagina. Some of the sperm can make their way through the cervix (the opening of the uterus, located at the end of the vagina), into the uterus, and on up into the fallopian tubes. There, one of them may meet with the egg as it travels down one of the tubes toward the uterus.

Intercourse is not the only way to get sperm in position. Another way is for a doctor to place sperm cells directly into the woman's uterus at the right time in her cycle, a technique called intrauterine insemination. These sperm can also swim up the fallopian tubes, seeking the egg.

When sperm meet the egg, they attempt to penetrate the egg's outer layer. When one succeeds, the egg's outer surface forms a barrier to prevent other sperm from penetrating. The union of the sperm and egg is called fertilization.

The fertilized egg is the first cell of a new human being. It contains a complete set of the genetic information necessary for the development of a baby. Half of that genetic material comes from the mother, carried in the egg; the other half comes from the father, carried in the sperm cell. That means the baby will have a combination of characteristics from both parents.

Conception is only the first step; once the egg and sperm unite to create a fertilized cell, that cell must go through many more steps to grow into a baby.

As it floats down the fallopian tube toward the uterus, the cell divides into two. Those two cells then divide to make four, and the division continues. In a week or so after fertilization, the growing cluster contains about 100 cells. It then attaches itself (implants) in the wall of the uterus, where it settles down to grow.

Some of the cells in the cluster form the embryo, the part that will eventually develop into a baby. Other cells multiply to form an organ called the placenta, which connects with the uterine lining to draw nourishment and oxygen from the mother's blood to sustain the developing embryo. The placenta also produces hormones, which enter the mother's bloodstream and spread through the body. These hormones alert the body that a baby is growing in the uterus, and they signal the uterus to maintain its lining rather than shedding it. That means the woman does not have a period that month. This may be her first sign that she is pregnant.

Over the next few weeks, the embryo grows and develops at a rate faster than at any other point in its existence, including all childhood and adulthood. By about seven or eight weeks after conception, the embryo has formed all its vital internal organs and its external structures, and it is called a fetus. Over the remaining months of pregnancy, the fetus grows from less than an ounce to about seven or eight pounds in size, and its organs develop to prepare it for life after birth.

The conception process is hardly foolproof. An ovary might not release an egg successfully. Or the egg might be flawed or damaged -- something that is more likely to occur the older the woman gets, or if she smokes, uses drugs, or is exposed to radiation or other phenomena that can damage immature eggs. A man might have trouble producing sperm, or his sperm may be misshapen or slow-moving. Damaged sperm or eggs may not be able to join successfully, or they may produce a fertilized egg that cannot survive the early stages of growth.

Other problems have to do with the organs and systems in the woman's body. A blocked or bent fallopian tube can prevent an egg from entering the uterus. Problems with the endometrium may keep a fertilized egg from implanting. And levels of hormones that are too high or low can throw off the entire cycle. Fortunately, medical treatment can now fix many of these problems.

Still, even if all the systems are in order, timing must also be right. If the sperm enter the uterus too long before the woman ovulates, they die before the egg arrives. If they come too late, they miss the chance to meet the egg in the fallopian tube.

Although fertilization can occur only when an egg is present, it's important to remember that not all women ovulate regularly. Sometimes an egg emerges earlier or later than usual. This is particularly true for younger women and for women with irregular periods. For that reason, some possibility always exists that a woman in her childbearing years might be fertile at any moment, even during her period.

For this reason, couples who do not want to have a baby should use contraception every time they have sex. The risk of conception at the beginning or end of a woman's cycle may be tiny, but it does exist. Couples that engage in natural family planning (the timing of sex to achieve or avoid pregnancy, based on physical signs of the woman's fertility) can reduce the odds of an unplanned birth by keeping close track of a woman's cycles and other signs over a long term. Even this system, however, can fail, simply due to the unpredictability of a woman's body.

Many couples try to plan their pregnancies so that their baby will arrive at an opportune time -- during a certain season, or before or after some event. Most, however, soon discover that it's nearly impossible to plan conception down to the month.

Contrary to some people's assumptions, only a minority of couples conceive the first time they try to get pregnant. It takes an average of 4-5 months of unprotected intercourse for a woman in her early 20s to conceive. That figure rises to 5-7 months for women in their late 20s, 7-10 months for women in their early 30s, and 10-12 months for women in their late 30s.

Bear in mind that these numbers are only averages. Some women from each age group will conceive in their first month, and some in their 12th. Both extremes are considered normal. Still, months of disappointment can be frustrating -- particularly if you happen to know someone who got pregnant from just one instance of unprotected sex.

Couples who want to maximize their chances of conception can take a few steps to make every attempt count. This becomes especially important for couples who are often separated by travel or work and have limited opportunity for sex, couples in which the woman is over 30, and couples who have a particular need to conceive very soon. For most couples, though, odds are that if they have regular unprotected sex, they'll end up expecting a baby within a year.

Conception occurs when a sperm cell, swimming up through the uterus, meets and joins with an egg cell on its way from the ovary. This generally happens in the fallopian tube, the organ through which the egg travels from the ovary to the uterus.

Normally, a woman ovulates (releases an egg) once a month. About 14 days later, she will have her period. So, for a woman with a 28-day cycle, if you count the first day of the woman's period as day 1, ovulation will typically occur on day 15. For a woman with longer cycles, ovulation will probably occur later.

Some women can tell when they ovulate -- they may notice a slight cramping or a change in the mucus discharge from the vagina. However, by the time you realize you have ovulated, it may be too late to conceive. That's because the sperm already have to be in your reproductive tract by the time the egg arrives. If you wait until the egg is already on its way, the sperm will get there too late. Research suggests that nearly all couples who conceive have had sex during the six days leading up to and including ovulation, but that sex after ovulation makes no difference.

The trick, then, is to know when you are going to ovulate, so you can plan to have sex in advance. You can increase your chances by having intercourse at least every other day starting four to six days before ovulation.

There are several ways to predict ovulation. Women with regular periods may be able to make a good estimate just by counting days on a calendar. If you know when your period is going to come, you need only count backward 14 days. That is probably your day of ovulation. Count back four to six days more to find the day you should start having sex, and continue having sex at least every other day until you have ovulated.

A more thorough method is called BBT charting. BBT stands for "basal body temperature." Body temperature rises slightly around the time you ovulate, but the rise is so small -- about half a degree Fahrenheit -- that it can be hard to notice. The best way to see the change is to take your temperature daily before you get out of bed and start moving around; that is when your temperature is at its lowest. Write down the number each day, and graph the results. You should see a slight peak midway through your cycle each month. After a few months, you can use this information to predict your ovulation days. Bear in mind that even if the chart looks precise, it can only give you a sense of your patterns. Some studies suggest that sometimes ovulation occurs up to three days before or after the temperature rise.

Both of these methods rely on identifying a pattern, so they work best for women with regular periods. If your periods vary in length from month to month, you may not benefit much from calendars and charting. Instead, you may want to try using an ovulation prediction kit. You can buy these kits without a prescription at the drugstore or supermarket. A kit contains a series of test sticks designed to detect the presence of certain hormones in urine. Each morning, you use one of the sticks to test your urine. When a stick changes color, that means ovulation should occur within the next 24-36 hours, and that you and your partner should have sex as soon as possible.

Advice abounds on ways to improve your chances of conceiving. Unfortunately, most of the commonly repeated tips have no grounding in fact. For example, your position during intercourse has no bearing on your likelihood of pregnancy. Nor does it matter whether you really do or don't want to have a baby -- desire has no impact on pregnancy rates. And although there is some logic to the theory that a woman's orgasm might improve the ability of the sperm to enter the uterus, studies have not yet found any connection between female orgasm and conception.

Speaking more generally, healthy lifestyle habits may improve your fertility odds, and will certainly improve the odds of having a healthy baby when you do conceive. In particular, avoid tobacco, drugs, and alcohol; exercise regularly; maintain a healthy weight; and eat a nutritious diet.

Stress -- including stress about conception -- is thought to affect a woman's cycles and may reduce her ability to conceive. If you find you have become so focused on charting days and timing sex that you are no longer enjoying sex, or that you are having sex only when you "need" to, then you may be happier (and less stressed) if you set the charts aside and simply try to improve your opportunities to have sex for fun.

However, if you do not conceive after a year of unprotected sex, it's time to talk with your doctor about a fertility workup. Many common causes of infertility can be corrected. Women over 35 should see a doctor after six months of unsuccessful trying, and women over 40 should seek help after only four months. That's because the older you get, the more likely you are to have a condition that is interfering with your ability to conceive, and also because further lost time can significantly lower your chances of having a baby.

Many couples spend so much time preventing an unplanned pregnancy that they assume that when they are ready for a family all they have to do is stop using birth control. Getting pregnant is not always that fast or automatic â€” it can take up to a year or longer. Rather than taking a "hit or miss" approach, you can monitor two body functions to pinpoint your most fertile times, maximizing your chances of getting pregnant.

The changes in the consistency of your cervical fluid and your body temperature are two indicators of fertility. This article explains how to monitor your cervical fluid and temperature, identify the changes, and learn what they mean. It may sound like a hassle, but the process is really pretty easy.

Cervical fluid plays critical roles in getting pregnant â€” it protects the sperm and helps it move through the cervix toward the uterus and fallopian tubes. Like practically everything else involved with the menstrual cycle, cervical fluid changes in preparation

for ovulation. You will notice clear differences in how it looks and feels over the course of the cycle.

At the beginning of your cycle, you probably will not notice any cervical fluid at all. Then it may become sticky or gummy, and then creamy and white. Finally, as ovulation approaches, it becomes more clear and stretchy, almost like egg white. Your cervical fluid actually gives you advance notice that you are about to ovulate.

Cervical fluid can usually be felt inside the lower end of the vagina, especially on fertile days. Check cervical fluid more than once a day if possible, such as every time you use the bathroom.

Rub your fingers together to evaluate the consistency of the fluid. See the stages listed below. More than one adjective is used because the conditions differ slightly among women:

Take your temperature first thing in the morning before you get out of bed. Try not to move too much, as activity can raise your body temperature slightly. Use a glass basal thermometer or a digital thermometer so that you can get accuracy to the tenth of a degree. Keep the thermometer in your mouth for five minutes. If your temperature is between two marks, record the lower number.

Try to take your temperature at the same time every day if possible. Shake the thermometer down when you are done so that you do not have to shake it in the morning and thus risk raising your temperature from the movement.

After you ovulate, your body temperature will rise and stay at an elevated level for the rest of your ovulation cycle. At the end of your cycle, it falls again. Create a chart and write down your temperature everyday. From one day to the next, your temperature will zigzag a little. These small temperature changes will seem random at first â€” ignore them.

Also, ignore the occasional "fluke" temperature that is obviously way out of alignment with the others â€” this can happen for any number of reasons (like stress) and is not important to finding the pattern. If you look at a complete cycle, you will probably notice a point at which the temperatures become higher than they were in the first part of your cycle. More specifically, the rise is when your temperature increases 0.2 degrees above the previous six days.

The limitation with monitoring your temperature is that by the time you are certain that you have ovulated, it is usually too late! You can still try to get pregnant the morning your temperature rises, but chances are slimmer. The egg is probably gone by that point.

However, temperature is still a very useful indicator of fertility. For one thing, after several cycles you may be able to see a predictable pattern and get a sense for your most fertile days. More reliably, the rise lets you know when trying to get pregnant becomes less likely. And lastly, temperature is an excellent indicator of whether you are pregnant. If your temperature does not go down at the end of the cycle, you probably succeeded!

Starting a family means overwhelming change. By planning ahead, you can begin to prepare emotionally and physically for pregnancy and parenthood. Here are some suggestions that can put you on the path toward a healthy and enjoyable pregnancy.

Start by seeing your health care provider for a preconception physical exam. Ideally, this should occur six months before you try to get pregnant. Tell your provider you want to get pregnant, and together you can discuss your health status and prospects. At your visit, you should:

Address any major health problems. If you have a chronic illness such as high blood pressure, diabetes, asthma, lupus, or epilepsy, discuss how this affects your pregnancy plans.

Discuss the safety of any prescription or nonprescription medications you use. Your provider may advise you to eliminate some drugs now and to plan on stopping or changing others as soon as you know you're pregnant. Don't forget to discuss your vitamins and supplements as well; even "natural" products might impair your fertility or harm an unborn baby.

Ask your provider whether you fall into any high-risk categories for genetic disorders and whether you should see a genetic counselor for advice or testing. If you or your partner are over a certain age, have a family history of disease, have certain ethnic backgrounds, or have been exposed to significant radiation, your children may be at increased risk of disorders.

Update your immunizations. Your provider can test you for immunity against preventable diseases that pose risks to pregnant women or their babies. It's best to update your vaccinations at least three months before conceiving.

Test for and treat other disorders and infections before you conceive. Once you're pregnant, not only do you have to worry about the illness itself, but you're also limited in your choice of treatments.

Talk about your contraception history . If you've been using birth control pills, Norplant, Depo-Provera, or an IUD, ask your provider how long you should wait before trying to conceive.

Evaluate your weight. Both overweight and underweight can affect your fertility and the health of any baby you conceive. If you have a weight problem, ask your provider for guidance on achieving a healthier weight.

Discuss your nutritional needs. Your provider can give you eating guidelines that will ensure proper nourishment of a new embryo. You will probably also be told to take a supplement containing folic acid, which can significantly reduce the risk of certain birth defects. Because you need sufficient levels of this vitamin in your body at the time of conception, you should start taking it as soon as you plan on trying to conceive.

After you schedule your preconception exam, you might consider these additional steps:

Wean yourself from alcohol, recreational drugs, and tobacco. These substances can reduce your fertility and seriously injure a baby. And avoiding them will make you a healthier mom.

Take care of any teeth and gum problems before you conceive. Experts recommend minimizing anesthesia and routine X-rays while pregnant. Also, pregnancy makes the gums sensitive, so dental work is more uncomfortable.

Consider what changes you may need to make in your home and work environment if you become pregnant. Avoid home renovations or hobbies involving chemicals while you are trying to conceive. Does your workplace expose you to illnesses, X rays, paints, solvents, pesticides, cleaning agents, or other possible hazards? Look into precautions, a transfer, or a leave of absence.

Having a baby isn't cheap. Advance planning can help keep the costs manageable. For example:

Check your health care coverage. Does it cover prenatal care, tests, hospital costs, and newborn care? If you have restrictions on providers, facilities, or visits, make appropriate choices -- or consider changing or supplementing your coverage. If you don't have health insurance, do your best to get some, even if it's a bare-bones policy. If you experience any complications, you'll be glad you have coverage.

If you work, investigate your options for maternity leave. Find out whether the Family and Medical Leave Act (FMLA) or the Pregnancy Discrimination Act applies to your company. Check your partner's options as well.

Start thinking about how you will budget and pay for pregnancy and childrearing. Will you need childcare? Can you start saving now?

The first step occurs when an egg cell from a woman unites with a sperm cell from a man to form an embryo -- the beginnings of a human being. This process is called conception.

Conception is only the first step; once the egg and sperm unite to create a fertilized cell, that cell must go through many more steps to grow into a baby.

You should start thinking about health risk factors from the time you are trying to get pregnant all the way through pregnancy. Some considerations are to reduce or preferably eliminate alcohol, drug consumption and smoking; eat a well-balanced diet; and avoid drug use unless approved by your physician.

If you have any chronic medical problems (i.e., high blood pressure, kidney problems, or diabetes), you should discuss pregnancy with your physician before trying to get pregnant.

Possibly, and particularly 2 to 3 months prior to conception. Smoking and alcohol consumption may cause problems with the fetus. Smoking and alcohol or marijuana use has also been shown to lower sperm count.

For over 4000 years, certain human abnormalities have been noted to run in families, but the "WHY" of the observations did not become apparent until the advent of modern genetics and the recognition of how genetic information is transmitted. Before then one only heard the admonition, "it's in the blood" (thought to refer more to bloodline rather than some abnormal element in the blood).

Present day medicine has recognized how genetic diseases are inherited based on an understanding of the nature of DNA, genes, and chromosomes. Scientists are presently trying to "map" the chromosomes, to determine the location and function of all of the thousands of genes in each chromosome. This will ultimately help in diagnosing and treating genetic disorders.

However, until science has the ability to treat some of the more disastrous (and ultimately fatal) genetic disorders, the best remaining recourse is prevention. Prevention of genetically transmitted diseases can consist of major choices: abstinence from pregnancy, egg or sperm donation, preimplantation/prenatal diagnosis and termination or early treatment of affected pregnancies.

Prenatal diagnosis involves testing fetal cells, amniotic fluid, or amniotic membranes to detect fetal abnormalities. Preimplantation diagnosis is a new technique only available in specialized centers. It involves in vitro fertilization and genetic testing of the resulting embryos prior to implanting only those embryos found not to have the abnormal gene(s).

Genetic counseling (and prenatal diagnosis) provides parents with the knowledge to make intelligent, informed decisions regarding possible pregnancy and its outcome. Based on genetic counseling, some parents (in the face of possibly lethal genetic disease) have forgone pregnancy and adopted children while others have opted for egg or sperm donation from an anonymous donor who is not likely to be a carrier of the specific disease.

Many diseases transmitted as a single gene defect can now be diagnosed very early in pregnancy. Because of this some parents have elected to become pregnant and then, early in the pregnancy, had the disease status of the fetus determined. The pregnancy is continued if the fetus is disease-free. Parents who decide to continue the pregnancy with a defective fetus may be able to better prepare to care for the infant by being informed about the disease in advance. For example, genetic diseases where a component of the diet is not tolerated can lead to specialized diets for the mother and newborn baby.

Infertility is the inability of a couple to achieve a pregnancy after 12 months of unprotected intercourse.

Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after a minimum of 1 year of attempting to do so through unprotected intercourse. Secondary infertility is the term used to describe couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.

Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30% to 40% of all infertility is due to a "male" factor, such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. Some factors affecting sperm count are heavy marijuana use or prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin.

A "female" factor (for example, scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes) is responsible for 40% to 50% of infertility in couples. The remaining 10% to 30% may be caused by contributing factors in both partners, or no cause can be adequately identified.

It is estimated that 10% to 20% of couples will be unable to conceive after 1 year of attempting to become pregnant. It is important that pregnancy be attempted for an extended period (at least 1 year). The chances for pregnancy occurring in healthy couples who are both under the age of 30, having intercourse regularly, is only 25% to 30% per month. A woman's peak fertility is in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of conceiving is less than 10% per month.

In addition to age-related factors, increased risk for infertility is associated with having:

A past history of PID (pelvic inflammatory disease) (after a single episode, 10% to15% of women may become infertile)

A range of emotional reactions by either or both members of the couple related to childlessness. (In general, such reactions are greater among childless couples. Having a single child tends to blunt the depth of emotional problems.)

Semen analysis to evaluate ejaculate. The specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.

Measuring basal body temperature -- taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with presumptive ovulation.

Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy, and slippery mucus associated with the ovulatory phase.

Postcoital test (PCT) -- to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.

Measuring urinary luteinizing hormone by using kits commercially available for home use to predict ovulation and assist with timing of intercourse.

Hysterosalpingography (HSG) -- X-ray procedure done with contrast dye that enables evaluation of potential transport from the cervix through the uterus and fallopian tubes.

Treatment depends on the cause of infertility for any given couple. It may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures (such as in-vitro fertilization).

It is important for the couple to recognize and discuss the emotional impact that infertility has on them as individuals and together, and seek medical advice from their health care provider.

As new treatments are announced, couples may either experience new hope or have to deal with old wounds being reopened. Support groups for infertile couples may be an important source of strength and comfort.

RESOLVE, a national organization, provides both informal support and serves as a referral base for professional counseling specific to infertility issues. See infertility - support group.

A probable cause can be determined for about 85% to 90% of infertile couples. Appropriate therapy (not including advanced techniques, such as in-vitro fertilization) allows pregnancy to occur in 50% to 60% of previously infertile couples. Without any treatment intervention, 15% to 20% of couples previously diagnosed as infertile will eventually become pregnant.

Although infertility itself does not cause physical illness, the psychological impact of infertility upon individuals or couples affected by it may be severe. Couples may encounter marital problems, including divorce, as well as individual depression and anxiety.

Call for an appointment with your health care provider if you are unable to achieve a desired pregnancy.

Because infertility is frequently caused by sexually transmitted diseases, practicing safer sex behaviors may minimize the risk of future infertility. Gonorrhea and chlamydia are the two most frequent causes of STD-related infertility.

These diseases are often initially asymptomatic, until PID or salpingitis develops. These inflammatory processes cause scarring of the fallopian tubes and subsequent decreased fertility, absolute infertility, or an increased incidence of ectopic pregnancy.

Mumps immunization has been well demonstrated to prevent mumps and its male complication, orchitis. Immunization prevents mumps-related sterility.

Some forms of birth control carry a higher risk for future infertility (such as the IUD - intrauterine device). However, IUDs are not recommended for women who have not previously had a child.

Women selecting the IUD must be willing to accept the very slight risk of infertility associated with its use. Careful consideration of this risk, weighed with the potential benefits, should all be reviewed and discussed with both partners and the health care provider.

While a missed period is one of the biggest clues that a woman is pregnant, it's usually not the first sign. Some women suspect they are pregnant before their menstrual cycle is late.

When a woman suspects that she is pregnant, she should visit a doctor to confirm her condition as soon as possible.

Laboratory blood tests can verify pregnancy as soon as 6 or 7 days after conception.

The blood and urine test both measure the level human chorionic gonadotropin (HCG), a hormone that is only produced in a woman's body when she has placental tissue growing there. The placenta is the tissue within the uterus (womb) through which the mother provides nourishment to the fetus.

One of the most important things you can do for yourself and your baby is to seek proper prenatal care. Prenatal care consists of:

Monitoring for problems such as abnormal changes in blood pressure, blood chemistry, urine chemistry, and weight

It is also important for a woman to alert her doctor immediately if anything unusual occurs during pregnancy, such as:

Improved technologies and more accurate prenatal tests now make it possible to spot complications earlier and take appropriate action in time to save the fetus and/or the mother.

A woman's habits greatly influence the health of her unborn child. When pregnant, a woman should avoid the following:

Alcohol. Consuming alcohol while pregnant can cause birth defects and other problems. Consistent alcohol use during pregnancy can cause fetal alcohol syndrome, a permanent and lifelong condition.

Cigarettes. Smoking is linked to low birth weight, premature birth, miscarriage and other complications. Nicotine causes blood vessels to constrict. That means the baby won't get the proper oxygen and nourishment it needs to grow.

Medications. Many over-the-counter (OTC) and prescribed medications can harm an unborn child. Your physician can give you a list of which medications you can take safely during pregnancy.

Narcotics. Illegal drugs, such as cocaine, can deprive developing babies of vital oxygen and nourishment. This can lead to birth defects, or cause addictions in newborns.

Caffeine. Discuss with your doctor how much caffeine, if any, you can have during your pregnancy. Caffeine is found in coffee, tea, colas, and other products

Contact with cat feces. A serious disease that can be contracted from cleaning cat litter boxes is toxoplasmosis), which is spread by a microbe that causes lymph-node and nervous-system problems. In pregnant women, this parasite can cause birth defects, stillbirths and miscarriages.

Four in 10 young women become pregnant at least once before they reach the age of 20 -- nearly 1 million a year.

Improved technology has made home pregnancy tests about as accurate as blood tests-nearly 99 percent under perfect conditions.

To calculate the due date, one can follow a guide called Nägele's rule. This calculates the estimated date by subtracting 3 months from the first day of the last menstrual period and adding 7 days. increased

The risk of miscarriage in all pregnancies is around 15 to 30 percent. If the baby is developing normally the risk of miscarriage falls to less than 3 percent.

The overall risk of delivering a baby with a birth defect is approximately 3 percent.

For most women, a missed period is the first sign of pregnancy. But there are many reasons a period might come late or even skip a month, including dietary changes, intensive exercise, travel, and stress. And some women have periods so irregular that they can't predict when the next one will come.

If you're pregnant, it's also possible for you to think you've had your period when you didn't. When a newly fertilized egg attaches to the wall of the uterus, sometimes it prompts a little bleeding. This typically occurs a few days before the time you would expect your period to come if you weren't pregnant. If your periods are normally light, you might assume that this implantation bleeding is your period.

In other cases, wildly fluctuating hormone levels in the first week or two after conception may prompt some bleeding from the lining of the uterus similar to a period. And a few other conditions -- such as infections or uterine polyps (abnormal growths) -- can cause bleeding that may look like a period.

So, although a missed period is certainly your best clue to a possible pregnancy, it's not a definitive sign. Your suspicions may increase if you have other symptoms of early pregnancy, such as:

Some pregnant women experience one or two of these symptoms. Some have many of them. And some have no symptoms at all. Symptoms may even be different from one pregnancy to another in the same woman. The presence or absence of such symptoms is no indication of the health of a pregnancy.

Obviously, many of these symptoms may occur for other reasons, or be confused with other ailments. For example, feelings of nausea or abdominal discomfort might occur with a gastrointestinal virus or food poisoning -- or pregnancy. Fatigue may mean depressiion, a cold or flu, anemia (low iron levels) -- or pregnancy. Frequent urination could be a sign of an urinary tract infection, diabetes, too much coffee -- or pregnancy.

By the time you add the stress of wondering whether you've conceived, either because you're hoping for a baby or because you're worried that your birth control failed, it can be hard to tell what's happening based on symptoms alone. The easiest way to be sure is to use a home pregnancy test.

The qualitative urine human chorionic gonadotropin (HCG) test is usually performed by placing a drop of urine on a prepared chemical strip. It usually takes one or two minutes for the strip to indicate the result. The qualitative and quantitative serum tests are performed by drawing a single tube of blood and sending it to a laboratory. You may wait anywhere from a few hours to more than a day to get the results. Quantitative tests are used to measure the level of HCG in your blood, and give your doctor more information than the qualitative test.

The urine test merely involves normal urination into a cup. The serum tests involve drawing blood through a needle and into a tube. Any discomfort you might feel will only last a few seconds.

Women who are late for their "period" often perform qualitative urine tests at home. "Qualitative" means that the test will only indicate whether you are pregnant or not -- yes or no. Doing the test at home permits greater privacy. Home pregnancy tests are available at pharmacies and do not require prescriptions.

Sometimes, the test will be performed at your doctor's office before the first prenatal visit. This is done just to confirm that you are actually pregnant. Doctors also perform a qualitative urine pregnancy test to rule out pregnancy before starting a medication or therapy that might adversely affect an existing pregnancy.

Qualitative serum pregnancy testing is performed when greater accuracy is sought, but only a "yes" or "no" answer is required. While the qualitative urine test can detect HCG levels above 25-50 milli-international units per milliliter (mIU/mL), the serum tests can detect HCG levels above 5-10 mIU/mL.

"Quantitative" serum pregnancy testing is usually performed at a hospital or doctor's office. This test actually measures the amount of HCG in your blood. It can measure amounts ranging from 5 mIU/mL to 2,000,000 mIU/mL or more. Quantitative testing is performed when it is not sufficient merely to know whether you are pregnant or not. Sometimes, your doctor will need to correlate your HCG levels with the progress of your pregnancy. Ask your doctor to explain the results of your quantitative pregnancy test.

In non-pregnant women, both the qualitative urine and serum HCG tests will be negative. The quantitative HCG test will be less than 5 milliunits per milliliter.

In a normal intrauterine pregnancy, the HCG should rise through the entire first trimester, and slowly fall thereafter.

HCG levels that do not rise appropriately can indicate a problem with your pregnancy. Some problems this could suggest include miscarriages and ectopic (tubal) pregnancies. Extremely high levels can suggest twins. Your doctor will understand the significance of your HCG levels, and should explain them to you.

Qualitative urine pregnancy tests will only be positive when you have sufficient HCG in your blood. If you are very early in your pregnancy, and the HCG level is below 25-50 mIU/mL, the test will be negative. Therefore, if you are late for your period, you should wait 7-10 days before trying the test. If the test is negative, wait a few more days. If you still don't menstruate, try the test again. If you still need more information, make an appointment with you doctor.

The entire process of pregnancy-from conception to birth-takes about nine months, or 40 weeks. The pregnancy is divided into three-month periods known as trimesters.

The first three months of fetal development are, perhaps, the most important. During the first 60 days, most of the baby's organs form. It is at this stage that the unborn child is most sensitive to environmental chemicals, drugs and viruses that can cause birth defects.

The average fetus is about 3 inches long and weighs about 1 ounce by the end of the first trimester. It is normal for the fetus' head to be disproportionately larger than the rest of its body. Some other important developments during the first trimester include:

By week 7, it is usually possible to see the developing baby within the womb and detect its heartbeat by ultrasound examinations.

The liver begins making bile (a liquid that helps break down fats in food so they can be absorbed), and the kidneys begin secreting urine into the bladder.

The fetus also begins to move during the first trimester, although the mother won't feel movement until around the fourth month.

During this time, the fetus begins to grow and its organs mature. The increasing size of the uterus becomes obvious in the second trimester of pregnancy, as the woman's belly begins to swell. Many women need to start wearing looser or maternity clothes at this time.

In the womb, a protective layer of amniotic fluid begins to surround the growing baby. Other developments in the second trimester include:

By the end of the second trimester, the baby is about 1 foot long and weighs about 1 pound. If birth occurs at this time, the fetus will attempt to breathe, but survival is unlikely before week 24.

The baby's genitals are fully formed by week 14. The sex of the child can be determined using ultrasound.

Hearing is well established by 24 weeks, when the baby begins to respond to outside sounds. The baby can now hear the mother's voice and is likely to recognize it after birth.

Beginning at 16 weeks, the baby is sensitive to light, and by 28 weeks a baby can open his or her eyes and turn the head.

By the fourth month, many women feel the first signs of life in their abdomen. The baby starts to kick and move. The amount of movement varies as the pregnancy continues. Babies move more at night and after the mother eats. As long as the mother feels the baby moving vigorously, it is likely in good health. If the movements decrease day by day, the mother should tell her physician.

The third trimester begins at the 27th week of pregnancy and lasts until birth. The baby continues to grow and put on weight throughout the last trimester of pregnancy. During the last month, the fetus grows about one-half pound per week.

By the ninth month, the baby usually settles into a position delivery, with the head down and arms and legs pulled up tightly against the chest.

By week 28, the baby's eyes are open and a child born at this time can move its limbs and cry weakly. However, the infant will weigh only about two pounds. But because of recent advances in caring for premature babies, 90 percent of babies born at this stage will survive.

Once you've absorbed the news that you're pregnant, your thoughts may turn to how much you need to learn and do in the next few months. Here are some suggestions for where to start.

Call your health care provider immediately to set a date for your first prenatal visit.

Evaluate your diet. Make a commitment to taking your vitamins, drinking eight glasses of water daily, and eating small, frequent meals high in protein, iron, and calcium. If your appetite is low or you're suffering from nausea, do your meal planning and shopping in advance. Be sure to pick up lots of healthy snacks, so you'll eat right when you do feel hungry.

Set aside time to rest. While body changes may not yet be visible, your body is still working very hard.

Exercise moderately. Check into pregnancy exercise classes and fitness club memberships. Ask your provider to approve your fitness plans; in general, a reasonable minimum for most pregnant women is a 20-minute walk daily, plus cardiovascular exercise -- brisk walking, aerobics, swimming, or bike riding -- for 15 minutes three times per week.

If you haven't already, stop using alcohol, tobacco, and recreational drugs. Cut down on caffeine. Avoid taking any medications unless your provider says they're OK.

Once you notice breast growth, buy a supportive maternity bra. Be aware that your breasts will continue to grow throughout pregnancy, so plan to buy a larger size later.

Establish connections with women who are pregnant and due the same time you are. Find them at pregnancy exercise classes or through online bulletin boards at web sites devoted to pregnancy and parenting.

Talk with your partner about your hopes, dreams, and fears about parenthood. Take time to recall your own childhoods. In what ways do you want your children's lives to be similar or different? What values would you like to incorporate in your own parenting?

Start envisioning how you'd like to have birth: a home, at a birthing center, at a hospital? Who would you like to be with you? Research your options.

Buy or borrow a few pregnancy books. Be aware that advice on pregnancy and childbearing covers a wide range. Before you settle on a particular guide, spend a few hours in the bookstore or library leafing through the selection to find an approach that feels compatible. In addition to books on health and nutrition, you might want a write-in pregnancy planner, calendar, or diary.

With your partner, decide how and when to tell your relatives, friends, bosses, and co-workers about your pregnancy.

Reorganize your long-term calendar to allow for childbirth and the restrictions of a new baby. Determine when you might schedule parental leave from work. If you had plans for a vacation, you might want to take it sooner rather than later; the second trimester is usually best for traveling.

Start budgeting for life with a baby. How much can you spend on baby clothes, furniture, and gear? Make a plan to cover new expenses such as medical insurance, life insurance, and childcare. Investigate college savings funds.

Check your home for lead and radon, and make arrangements to correct any problems. If paint is flaking or peeling, have a professional remove or seal it.

Decide where the baby will sleep and where you will keep its furnishings. Start clearing out the area, and decide what needs to be done to fix it up. If your home needs renovations, arrange for them now.

Check out the sale racks at maternity departments. You won't need maternity clothing for a while yet, but the items being cleared out now may be the right season for your last months of pregnancy. Many shops provide a strap-on tummy pillow so you can try things on before you develop your own bulge. Buy large, and doublecheck return policies.

The second trimester can be a particularly enjoyable time -- you're probably past most of the discommforts of early pregnancy, and you haven't yet developed the aches and pains of advanced pregnancy. Now is the time to accomplish many of the tasks you'll want to take care of before the baby comes. Here are some ideas of how to use your time.

Check out your options for yoga, aerobics, or swim classes designed for pregnant women, and sign up.

Keep up with your prenatal checkups, which will probably be monthly at this point. During this trimester, your provider may talk with you about scheduling various tests, including the glucose tolerance test to screen for gestational diabetes and the AFP test or amniocentesis to look for birth defects.

Shop for comfortable shoes that are low-heeled with good arch support. You may need a larger size during pregnancy.

Shop for baby furnishings and clothing. In some families, it's traditional not to bring baby items into the house before the baby is born; at many stores, though, you can make selections and set your purchases aside for later pickup.

Talk to friends and family about whether they can spare hand-me-downs or let you borrow baby equipment.

Investigate classes on childbirth education, breastfeeding, and infant CPR. You'll want to consider not only which topics or approaches interest you, but also date, location, and cost. Once you determine your preferences, sign up well in advance.

Verify when and how to request maternity leave and how much you can claim, paid or unpaid. Determine whether your employer is covered by the Family and Medical Leave Act (FMLA)

If you are planning to return to work after the baby is born, check your employer's policies on child care, flexible hours, and personal leave

If you plan to breastfeed, find out whether your employer has arrangements for moms who pump their milk

Take stock of your home, and accomplish these tasks before you're out of energy or time:

Buy a fire extinguisher for your home, if you don't have one already. Install smoke detectors and carbon monoxide detectors

Assemble a first-aid kit that includes what you'll need for a baby. Post emergency numbers next to your telephone

Put non-slip pads under area rugs and on steps. They'll add protection as your balance suffers with pregnancy growth, and later when you're carrying a baby around

Organize any old photos or albums now, as you may never get to them once the baby comes. Buy some new albums to cover your life with baby.

Create mantras or self-affirmations for yourself. Find words or phrases that resonate with you. Then repeat them to yourself, gently and nurturingly. You don't need to share them with anyone else. For example:

Keep records of first movements, waist measurements, weight gain, and other milestones.

As you enter your third trimester, you may begin to wonder how you'll get everything done in time. The truth is, you may not complete all the tasks you've set out for yourself, particularly your growing body requires more of your energy. Here are some ideas on where to place your priorities.

Walk daily and do gentle stretches. Continue other exercise as appropriate, with approval from your provider.

To reduce your risk for episiotomy or severe tears, begin perineal massage by week 36 or earlier.

Keep up with your prenatal exams. Expect these checkups to increase to twice per month by the seventh or eighth month and weekly in the ninth month. In this trimester, you should talk with your provider about the birth process and potential complications and interventions.

Talk with your partner about your concerns or fears about labor, the role you'd like your partner to play, and how he or she can best advocate for you.

With input from your provider and your partner, write a birth plan outlining your preferences on labor methods, birth positions, monitoring, pain management, interventions, infant circumcision, and other procedures.

Take a tour of the hospital or birth center. Find out whether you need to pre-register or fill out any paperwork.

Work out the details of how you will get to the hospital or center when labor starts.

Determine who will be with you during and after the birth, and make arrangements to notify them.

If you have older children, make arrangements for both daytime and nighttime care.

Make plans with your partner for the first weeks after the baby is born. Who will be at home with you? What help will you need?

Complete your shopping for baby clothes, furnishings, feeding supplies, and other gear.

Pick up some disposable diapers and wipes, or sign up for a diaper service and have your first load of diapers delivered.

Buy a few books on parenting and baby care. Be aware that approaches to these topics cover a wide range. Spend a few hours looking over the selection in the bookstore or library to find those whose philosophy feels right for you. If you are planning on breastfeeding or attachment parenting, also buy a book specifically on that topic.

Choose or create baby announcements. Make your list of who will receive them, and address the envelopes. If you're ordering printed announcements, you can often get the envelopes in advance.

If you don't have one already, buy an easy-to-use camera, digital camera, or video camera, and learn to use it. Disposable cameras are a good fast choice.

Take care of your emotional self. Remember that pregnancy may encourage mood swings or emotional responses. Let yourself cry, laugh, and talk to yourself. Ask your partner, mother, sister, or friends to let you vent.

Some tests, called indicated tests, are usually reserved for women who are considered at increased risk due to something her medical or genetic history or an abnormal result in a screening test. However, some indicated tests, such as ultrasound, are being used more often during pregnancy, regardless of whether the mother or fetus is at risk of health problems.

Ultrasound, or sonogram, uses high frequency sound waves to form an image of the uterus, placenta, and fetus. This view into the uterus allows doctors to measure many details about the fetus, including:

Abnormalities of the fetal structures such as heart, brain, limbs, kidneys, and stomach

The test can be performed almost any time during pregnancy. In the earliest months, it can be performed with a probe placed in the vagina. However, most are performed with a wand placed on the abdomen over the uterus.

Between 15 and 18 weeks, the doctor may perform a test to determine the level of alpha-fetoprotein (AFP) in a pregnant woman's blood. AFP is a substance normally produced by a growing fetus. In AFP testing, a blood sample taken from a vein in the arm is analyzed. If the test shows that the AFP level is higher or lower than normal, further tests will be done to confirm or rule out fetal problems.

High AFP levels will occur with twin pregnancies. Also, measuring AFP can help determine the presence of a type of birth defect called a neural tube defect. Neural tube defects are an abnormality in which the spinal cord or brain does not form properly. An increased level of AFP may be found in the blood of a woman whose fetus has a neural tube defect or an abdominal wall defect in formation. An AFP level that is lower than normal may be linked to an increased risk of Down syndrome.

This test uses a fetal monitor to continuously record the baby's heart rate and uterine contraction on special paper. A decrease in the fetal heart rate in response to contractions of the uterus is a positive test result. This may involve the use of oxytocin or other means to cause uterine contraction. The test is performed when the fetus is believed to be at increased risk for stillbirth. A negative test suggests that the fetus is at low risk for stillbirth, whereas a positive test indicates that the fetus may be in danger.

In this procedure, the fetal monitor is attached to the mother's abdomen and records the fetal heart rate. The doctor listens for increases, or accelerations, in the fetal heart rate. If the baby is believed to be asleep, a buzzer is sounded to awaken the fetus. Like contraction stress testing, this test is also performed when the fetus is believed to be at increased risk for stillbirth, but it does not require uterine contractions. A flat fetal heart rate can indicate an increased risk of stillbirth.

There are a variety of ways in which this test is performed but all rely upon a sudden change in the number of fetal movements in a specified period of time. In most cases, the mother keeps track of the number of times she feels the baby move. Further tests will be performed if the mother notes a sudden decrease or absence of movements. Although some physicians use this procedure because it is easy to use and inexpensive, the appropriate role of fetal motion counting in prenatal care is controversial.

The amniotic fluid that surrounds the growing fetus can yield important information. Amniocentesis allows a small sample of this fluid to be collected for analysis. Using sonogram as a guide, doctors insert a long, thin needle through the abdominal wall and the wall of the uterus into the fluid cavity surrounding the fetus.

Amniocentesis is usually offered to women who are at an increased risk for having a baby with a birth defect. These women include those who will be age 35 or older on their due date and those who have a history of birth defects in their immediate family.

Genetic amniocentesis. One of the most common reasons for amniocentesis is to identify genetic defects. Genes carry the master plan of a person's physical makeup. Because the amniotic fluid and the developing fetus are formed from the same cells, they share the same genetic makeup. Amniotic fluid can therefore be studied to see whether the fetus's chromosomes are normal. Amniocentesis may also be done as a follow-up procedure in the event of a positive AFP test. Since the results of genetic amniocentesis may influence parental decisions about whether or not to carry a pregnancy to term, it is performed early, usually during the fourth month.

Amniocentesis for fetal lung maturity. This test is performed if there is concern that the infant may be at risk for lung development problems. In order to remain open, the lungs require a substance known as surfactant, lack of which is a major cause of lung problems in premature infants. Amniocentesis for fetal lung maturity testing is usually reserved for situations in which early delivery is desirable, but the lung maturity of the fetus is in question.

Amniocentesis for isoimmunization. Isoimmunization occurs when Rh or other antibodies from the mother cross the placenta and destroy red blood cells in the fetus, causing anemia. This destruction can be measured by testing the amniotic fluid for bilirubin, a reddish-yellow pigment formed mainly by the decomposition of hemoglobin in worn-out red blood cells. Amniocentesis for isoimmunization is usually performed at various intervals during the second half of pregnancy.

A number of other screening tests provide further assurance that a baby is progressing normally. These tests include:

Human chorionic gonadotropin (HCG). This substance can be measured in blood or urine samples taken from the mother. The most common reason to measure HCG is to diagnose pregnancy. However, physicians also use HCG testing to detect Down syndrome in a fetus.

Estriol. Earlier in pregnancy, this measurement can be used in conjunction with maternal age, AFP, and HCG to help in the prediction of Down syndrome.

Most pregnancies are uncomplicated and end with the birth of a normal, healthy baby. Early diagnosis and treatment of any complications will often prevent serious problems.

Regular check-ups can help you learn to recognize the difference between the normal changes and those that can indicate a problem. Problems during pregnancy include:

If you experience any of the following symptoms, notify your doctor immediately. Do not wait until your next scheduled checkup.

The overall risk of delivering a child with a birth defect is only 3 percent. The most common defects are those associated with the brain and spinal column, heart, and limbs.

The other main defect involves chromosomes in the cells of the fetus. The most common occurrence is Down syndrome. The risk of Down syndrome ranges from less than 1 in 1,000 in young women to 1 in 100 for women who conceive at age 40.

In an ectopic pregnancy, the fertilized egg attaches itself in a place other than inside the uterus. More than 95 percent of ectopic pregnancies occur in a fallopian tube. The narrow

fallopian tubes are not designed to hold a growing embryo, so the fertilized egg in a tubal pregnancy cannot develop normally. Eventually, the thin walls of the fallopian tube stretch to the point of bursting. If this happens, a woman experiences severe pain and bleeding, and her life may be in danger.

Ectopic pregnancy occurs in 2 percent of reported pregnancies in the United States. Even so, death from ectopic pregnancy is rare, occurring in less than 1 of every 2,500 cases. This low rate is largely a result of new techniques to detect ectopic pregnancy at an early stage, when it can be treated successfully.

An ectopic pregnancy can cause a rupture of the fallopian tube. If you are pregnant and experience sudden, sharp, severe abdominal pain seek treatment immediately.

Preeclampsia is characterized by high blood pressure, swelling of the face and hands, and protein in the urine after the 20th week of pregnancy. It is a potentially serious condition that, if left untreated, can lead to complications or death in the mother or the baby.

There is no specific treatment for preeclampsia, nor is it known how to prevent it. The only sure way to end the preeclampsia is to deliver the baby, sometimes despite the fact that the baby may be premature.

Up to 25 percent of all pregnant women have bleeding at some point in pregnancy, and of these women, about half will have a miscarriage. Vaginal bleeding is the chief sign of miscarriage in mid-pregnancy. Bleeding in later pregnancy can result from serious problems with the placenta. These could be that the placenta is too low and covering the cervix (placenta previa) or that it has prematurely separated from the uterine wall (abruption). These conditions often need to be treated by doing a cesarean delivery.

If bleeding is slight or spotty, there may be no cause for concern. But report moderate to heavy bleeding in pregnancy as soon as possible, because it may be a sign of one of the following problems:

Problems with the placenta (the organ that nourishes the developing fetus) conditions in which it lies too low in the uterus or begins to separate from the inner wall of the uterus before birth

If you have any bleeding along with pain or cramping during pregnancy, immediately call your doctor or go to an emergency room.

Miscarriage, technically called spontaneous abortion, is defined as the loss of a pregnancy before 20 weeks of gestation. It has been estimated to occur in 15 to 30 percent of all pregnancies.

More than 50 percent of miscarriages in the first trimester are caused by chromosomal abnormalities. Infections, uncontrolled diabetes, uterine abnormalities, or a woman's production of certain antibodies during pregnancy can also cause an early miscarriage. The warning sign of vaginal bleeding and uterine cramps precedes nearly all miscarriages.

The developing fetus floats in amniotic fluid, which is contained in the amniotic sac. During pregnancy the amniotic fluid increases in volume as the fetus grows. Amniotic fluid volume is greatest at approximately 37 weeks of gestation, when it averages 1,000 ml. Approximately 800 ml of amniotic fluid surrounds the baby at full term (40 weeks). This fluid is constantly circulated by the baby swallowing and "inhaling" existing fluid and replacing it through "exhalation" and urination.

Allows for freedom of fetal movement and permits symmetrical musculoskeletal development

Maintains a relatively constant temperature for the environment surrounding the fetus, thus protecting the fetus from heat loss

Permits proper lung development because the fetual breathes the fluid into the lungs

When a woman goes into labor her "water breaks" and amniotic fluid leaks from the uterus and through the vagina. Normally, a woman's water does not break until labor is underway, however, sometimes amniotic fluid is lost too early. This can make it difficult for the fetus to grow and develop fully before birth, cause premature delivery, jeopardize the baby's lung development, and put the fetus at risk for infection. About 35 percent of preterm deliveries occur because of early rupture of the amniotic sac.

If a pregnant woman notices any fluid leaking from her vagina, she should go to the hospital emergency room at once. She may go into pre-term labor, although many mothers' whose waters break early do not deliver for a number of weeks, this allowing the baby to grow bigger and the lungs to mature before birth.

Many of the potential problems in pregnancy are best managed when they are detected early. The exams and tests done as part of routine prenatal care are intended to detect the early signs of these and other complications.

Gestational Diabetes. A small percentage (one to four percent) of pregnant women develop diabetes mellitus, usually in the second or third trimester, referred to as gestational diabetes. The disease poses a serious threat for both the woman and her unborn child. Gestational diabetes has been linked to neonatal hypoglycemia and having a large newborn. The disease often resolves immediately after delivery.

Hypertension. Hypertension (high blood pressure) during pregnancy can be life threatening to both the woman and the fetus. Hypertension can cause seizures, organ disturbances, edema (swelling of body tissues) and protein in the urine. Together these symptoms cause a condition called preeclampsia, which can result in premature delivery and fetal death.

Rubella. Also known as German measles, the disease is usually not serious in children and adults. But if a woman is infected just before or during pregnancy, the disease can cause heart problems, deafness, and other serious problems for the fetus. A rubella vaccine should not be given to a woman who is pregnant or a woman planning to become pregnant within three months. Most women are immune and, therefore, the baby is not at risk.

No two births are alike. Labor is a series of changing conditions, and no amount of examination can predict how a woman or her baby will respond.

The mother's health and/or baby's condition will largely determine the type of delivery.

Vaginal birth is the traditional style of delivery in which the mother is an active participant.

Often the position of your baby or the placenta affects the course of labor. Cesarean delivery may be needed if the baby's position cannot be changed or if the placenta's position makes vaginal delivery a risk. A Cesarean also is needed if the fetus is unable to tolerate labor and is becoming low on oxygen, or if the labor fails to progress.

Your due date is a good guide in determining if you are indeed in labor. But it's important to remember that babies are often born days or weeks before or after due dates.

Pink or brown-tinged discharge indicating breakdown of the mucus plug sealing the uterus

Labor often starts slowly. Regular, uncomfortable contractions that come more often than one every 10 minutes may mean the woman is in labor.

Many women are told to leave for the hospital when contractions are 5 to 10 minutes apart or if there is bleeding or leaking of amniotic fluid.

If your physician believes continuing the pregnancy might harm you or your baby, he or she may induce labor. Induction of labor often involves chemical or physical stimulation. Techniques include:

Administering a drug to start labor, either by giving it intravenously (oxytocin) or into the vagina (prostaglandins).

Having a baby is one of the most important events in a woman's life. Most women worry about whether the baby they are carrying is healthy.

Early and regular prenatal care is the best insurance against problems in pregnancy.

Prenatal tests usually assure the parents that the pregnancy is progressing normally and allow doctors and parents to spot problems early.

If a woman is concerned about the health of her baby, she should immediately discuss it with her physician. Tests can often alleviate any concern.

Here is a sample list of typical postpartum needs. Your own list will depend on many variables; for example, it will be much more extensive if you have other children or are a single parent. At a bare minimum, you will need someone to:

Be an errand-person on short notice for the first week (a must if your partner will be back at work).

Provide one-on-one care for the first five days minimum. This depends on the circumstances of the birth; if your birth is in any way traumatic, you will need seven to ten days of care. This can be your partner, but if he will be at work or you are single, you must find someone else.

Some women freeze enough meals to last a week and stock the house with non-perishables. Nevertheless you'll still need fresh items, and someone to run for these. Often the father is willing, although he may be loathe to leave you and the baby for very

Help with the laundry is a must, particularly if you are washing diapers. Regarding the housecleaning, note the extended period recommended for assistance. Believe me, that's being conservative; ideally you would have someone weekly for the first year or more. The last thing you'll want to do with a few precious moments when the baby is finally asleep is to spend them mopping the floor!

Your immediate family is an ideal source of postpartum support, but it must not be your only one. Family has by nature a somewhat limited scope, with inbred attitudes and beliefs generally made more extreme by stress. As there is almost no time in your life more stressful than the early weeks with a newborn, you will need the objectivity of those outside your family unit, even if you must deliberately seek it out.

The bottom line in dealing with family members is to be honest and clear about what you do and do not want, what you can and cannot handle. Be specific; if Mom offers to help, go ahead and ask her to take out the trash, scrub the toilet, whatever. And d o be realistic about your emotional state at this time; your explosive and depressive tendencies, your outright limitations. It is not the end of the world if you have an angry outburst; your mother is old enough to understand and should be able to fend for herself.

When I had my last baby, my husband and I were living with my two teenagers in a fairly small house. I had a rather long labor, so my mother offered to come and help out for awhile. After thinking it over, she decided to stay at a nearby motel. She co uld afford it, and didn't mind as long as she could get to know her newest grandson. She was over every morning at 8:00 (unless we requested otherwise) and left in the evening. Several nights she made dinner early and took the older kids back to her pl ace to eat, so my husband and I could have some privacy. She did laundry, cleaning and was totally there for me emotionally. The length of her visit had been open-ended from the start; she ended up staying for two weeks. Looking back, this was a very precious time for us and was one of the greatest gifts she has ever given me.

Depression after pregnancy refers to the negative thinking and feelings of despondency that many women experience after the birth of a child. In addition to the sad, lifeless feelings that accompany any depression, women who suffer from depression after pregnancy often fear that their baby will somehow be harmed and may worry that they are "bad" mothers.

Depression after pregnancy may be mild, moderate, or severe, and may be temporary or long lasting. But it is treatable, manageable, and in some cases, preventable. Depression after pregnancy is generally divided into three types:

The baby blues, also called maternity blues, natal blues, or postpartum blues, is a temporary "down" period common among new mothers. Tearfulness, fatigue, irritability, difficulty sleeping, mood swings, and other signs of the baby blues usually begin one to two days after birth and may last up to three weeks.

Postpartum depression is a mood disorder characterized by negative thinking patterns and feelings of hopelessness, sadness, and despondency. Unlike the temporary baby blues, postpartum depression deepens and lasts beyond the first month after birth. The new mother may feel like she has fallen into a dark hole, have obsessive thoughts, and find herself unable to shake troublesome worries.

Postpartum psychosis is a rare form of postpartum depression that affects one in every thousand women. It usually begins within three to ten days after a woman gives birth. These women experience a break with reality: they may lose weight quickly without dieting, go without sleep for more than 48 hours, or experience delusions and hallucinations. Postpartum psychosis is a crisis that requires immediate professional intervention.

Although depression after pregnancy usually appears shortly after childbirth, it can begin at any time during the first year. If symptoms occur after the first months, they may be more subtle and difficult to detect. Spouses or family members may notice changes before the new mother does.

Q. Instead of feeling happy after my baby was born, I cried constantly and felt terribly anxious. What's normal and what's not?

A. Normal reactions include irritability, anger, crying, exhaustion, tension, restlessness, anxiety, and insomnia, all of which appear about three days after birth and may last for about two weeks. If these symptoms worsen and extend beyond a few weeks, you may be experiencing true postpartum depression and should consult a physician or other health care professional.

Q. I was fine for the first month after my baby was born. Then I began feeling terrible. Is this the baby blues?

A. At least half of new mothers get the baby blues, a mild form of depression that begins a few days or a week after delivery and usually lasts no more than two weeks. Since you started feeling low about six weeks after delivery, it may be true postpartum depression, which can last from two weeks to a year. It is less common, affecting 10 to 20 percent of new mothers. Best to consult your physician.

At least half of all new mothers experience some form of postpartum depression, usually temporary baby blues.

True postpartum depression affects from 10 to 15 percent of women who give birth.

One in one thousand women who have a child will suffer from postpartum psychosis.

Women who have several children can suffer postpartum depression after the birth of any child, whether it be their first or tenth.

Although postpartum depression has been discussed since ancient times, it has only been recognized as a treatable condition since the mid 1980s.

Pediatric well-baby visits are a critical part of childhood care. The examination is intended to assess the infant or young child's growth and development, recognize problems early and supply appropriate intervention, provide immunizations, instruct and educate the parents, and provide treatment for existing problems.

Preventive medicine is extremely important in childhood because it sets the stage for improved health and reduced disease risk as an adult. The typical well-baby visit will provide information about normal development, diet, general care, immunizations, the latest infectious diseases that are "going around", and other important advice and information for parents.

There are several possible schedules for routine well baby visits. The following is based on guidelines published by the American Academy of Pediatrics. It is important to recognize, however, that the timing of visits may be altered based on the special needs of an individual child and his or her family.

Of course, visits and phone calls to a health care provider should be made any time a baby seems ill or whenever the parent is concerned about a baby's health or development.

A well-baby visit usually consists of questions for the parent about the infant's general health and development, followed by a physical examination. The examination includes measurements of length/height, weight and head circumference, vital signs, and a general physical examination.

Special attention is paid to whether the infant has met the normal developmental milestones. The height, weight and head circumference is recorded on a graph, which the physician keeps with the infant's chart. You may want to note the results of the well-baby examination in your own medical record for the baby. You also can keep your own graphs of the height, weight, and head circumference.

The well-baby examination is an ideal time to discuss concerns or questions with your health care provider. This may include special questions you have about immunizations, nutrition, growth and development, accident prevention and family related concerns. If you have important questions, it is a good idea to write them down before going for your well-baby visit -- you will save time and won't forget any of the questions you wanted to discuss.

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For the first 8 weeks, your developing baby is called an "embryo." Tiny limb buds, which will grow into arms and legs, appear. Embryo looks like a tadpole. Heart and lungs beginning to form. By the 25th day, heart starts to beat. Neural tube, which becomes the brain and spinal cord, begins to form. At end of first month, embryo is about 1/2 inch long and weighs less than 1 ounce.

You become pregnant and miss your period. Your body is making hormones needed to "grow" a baby. Your breasts are slightly bigger and sore. If you have morning sickness, try eating crackers. You may have cravings, or hate foods you usually like. You will urinate more often because your growing uterus is pressing on your bladder.

Before you get pregnant, supplement your diet with B vitamin folic acid (found in most multivitamins) to reduce the risk of birth defects of the brain and spine. Visit your health care provider for your first prenatal care checkup as soon as you think you are pregnant. During the first 8 weeks of pregnancy, all of your baby's organs are forming and can be damaged if you smoke, drink alcohol or take drugs. Ask your health care provider before taking any prescription drugs or over-the-counter products. Stop smoking and drinking alcohol.

Here is a month by month guide has to how Your Baby Grows in those nine months.
1st month	4th month	7th month
2nd month	5th month	8th month
3rd month	6th month	9th month

A monthly diary of your baby's development