Babies Tale

“A woman’s place is in the house… and in the Senate” is a popular saying that has grown out of the woman’s movement in recent years. Besides expressing a woman’s right to work at any job she is qualified for, it connotes the choices women have today. The luckiest of career women who become mothers are those who can ask three questions: “Should I go back to work or be an at home mother for a few months or a few tears?” “If I decide to go back to work, when is the best time-how long should I wait?” “Should I return to my old job or type of work, or should I move on to something different?” Unfortunately, not every woman has these options; economic necessity frequently forces a mother’s return to her old job the day after whatever maternity leave she is entitled to has ended.

If you are one of the lucky ones who can make choices, and you choose to stay home, you may find yourself having second thoughts about your decision after a few weeks of uninterrupted baby care. On the bad days when everything goes wrong, you may feel hemmed in, trapped, and angry. You may be jealous of your spouse who escapes every day to the adult world. And if you go back to work, either because you want to or because you must, you probably will not be entirely satisfied either. First, you will need to come to terms with the daily separation from your baby, then with the fact that you will almost surely miss some “firsts”-the first time she smiles, or turns over, or says “Mama.” In addition, you may be bothered by another problem common to working women. One who does not feel pressure and guilt as she tries to satisfy her responsibilities as a wife, mother, and worker is indeed a rarity, even if she is able to stay home for several months, or even years, after the baby’s birth. As some have put it, she takes on three full time jobs and tries to do all three part time. A fragmented feeling of being too much needed, of being pulled in several directions at once, seems to go with the territory of being a working mother.

Of course, many mothers go back to work very soon after their babies are born and neither they nor their babies suffer. Most are gone from home eight to ten hours a day. A few manage to work at home, to work part time, or to have the advantage of working under the flexible-hours provisions that some forward-looking companies now offer, but every arrangement has its disadvantages.

However, many of those mothers and most medical professionals recommend that you wait, until you can, until your baby is four to six months old before you return to work for several reasons. One, of course, is the matter of your health, both physical and mental. Your recovery will probably be complete by that time and your baby’s sleeping habits are likely to have become fairly well established. Proper rest, nutrition, and exercise remain essential for you, even though time for them becomes more scarce. And along with the roles of worker, spouse, and parent, you should devote at least some time and attention to your own needs.

Another of your major responsibilities will be to comfort your baby when she is crying. Crying is especially distressing for new parents, who assume something is dreadfully wrong. However, it is perfectly normal for babies to cry. It gives them a certain amount of exercise, and it is, after all, their only way of letting you know that they need something. The difficulty is to figure out what those needs are. In a newborn, there are only a few things a cry will signify. If the baby is not ill or in pain, hunger, the need for a diaper change [within a few weeks, the baby will become used to the feeling of wetness and a wet diaper will not bother him], and the need to be held and comforted. Infants have a characteristic fussy-sounding cry that often seems to reach a peak when they are about six weeks old and tapers off at about three months.

Babies are individuals. Each will tell you in special ways what he needs from you. Many experienced mothers say they can tell the reasons for their babies crying, saying, for example, that the hunger cry is rhythmic and repetitive, the pain cry is loud and shrill, and the ill cry is continuous, whiny and nasal. As the baby grows, he will have more reasons to complain by means of crying; boredom, frustration, loneliness, fear, over- stimulation, and sometimes the overtiredness that prevents sleep. As you get to know your own child better, you will learn to interpret the reasons for crying.

Occasionally, a baby will cry because he is in pain. One traditional cry of pain is the prick of an open safety pin, largely avoided now by the use of specially designed diaper pins and eliminated completely by the use of disposable diapers that need no pins. Another cause for pain is a raveled thread from the baby’s clothes wrapped tightly enough around a finger or toe to cut off circulation. A baby crying because of sickness will usually have other symptoms of illness, such as a fever, diarrhea, or a runny nose. An earache is indicated by the baby’s pulling on, or attempting to pull on his ear. Generally, a healthy baby will have a strong loud cry. If your baby’s cry becomes abnormally weak, consult your doctor right away.

Sometimes, especially if postpartum depression has you in its grip, you and your baby can get into a joint crying cycle. When the baby cries, you get anxious and nervous. The more the baby cries, the worse you feel, and nothing you do seems to help quiet the baby. The baby senses your feelings; your anxiety in turn, makes the baby anxious and uncomfortable; and the child expresses these feelings by crying even more. You dissolve in tears yourself, and neither of you can seem to stop. One way to help both of you to calm down is to take a warm bath together. The skin contact and the warm liquid environment are soothing and may be all you need. However, if you find yourself getting into these cycles with any regularity, talk with an experienced parent or your doctor.

You’ll find some of the things you do to help your baby stop crying are the same as what you do to help him go to sleep. Most of these are warmth, rhythmic sound, and gentle repetitive motion. These three great comforts can be ideally combined when you cuddle your baby closely as you sing softly to him and you rock together in a cozy, padded rocking chair. This will also soothe and rest you, and you will probably find it a more reasonable solution then letting your baby “cry it out,” as some will likely advise you to do to teach him who is “in charge.” Picking up your infant when he cries does not spoil the baby, whatever you may hear from others. Remember, too, to let your baby know that crying is not the only way to get you to show your concern and love. Pick up and cuddle your baby when he is awake and not crying.

Before leaving the subject of birth and going on to the newborn, we should discuss an important choice; the choice between natural childbirth and medicated childbirth. Your preparation and decision-making and the course of your labor will differ depending on what you prefer.

Having read the previous discussion of labor, you now have some sense of the physical and emotional events of normal spontaneous labor. It is concern about a tear or labor pain that influences many women to choose to use pain-relieving medication in labor.

The Use of Pain Medications or Anesthesia in Childbirth

Pain medication in childbirth has been used for centuries. Alcohol. Opium, and other drugs have been used, though how extensively is not known.

When using pain medications, you make a trade-off in return for relief of pain and tension and possible speeding up of labor, you accept the side effects on labor progress, your mental and physical well-being, or on your baby. You should balance the advantages and disadvantages as they apply in your situation before using or not using a particular medication.

What are the kinds of medications available, how do they work, and what are their risks and benefits? This section provides an overview that will assist you in discussing the subject with your doctor and making a decision on your preferences.

First of all, the choice of natural and medicated childbirth only exists as long as the labor remains normal. Some interventions are painful or stressful and increase the need for pain medications. If, however, you or your baby requires intervention [such as induction of labor, use of forceps, or cesarean section] for medical reasons, you will need pain medication.

Medication for Early Labor

Because the medications that provide the greatest pain relief also tend to interfere with early labor progress, they cannot be used too early, unless you want to stop labor. There are medications available if a very prolonged and exhausting pre-labor or early labor has caused excessive anxiety and worry. Sedatives or barbiturates [sleeping pills or medication] may help you rest. These are given in pill form or by injection, They may temporarily halt your labor while relaxing you or allowing you some sleep. These drugs reach your baby, who cannot easily excrete them, so it is important not to receive large doses. Because babies born with such drugs still in their bodies may have problems breathing or sucking, your doctor will probably only use small doses and will try to be sure that they have worn off before birth.

Tranquilizers are also used in long pre-labors to reduce muscle tension and anxiety. Some also help if you have severe nausea or vomiting. Depending on the drug chosen, you may feel dizzy and confused, your mouth could feel dry, and your blood pressure altered. These drugs also cross the placenta to the baby and may have effects on fetal heart rate, and newborn muscle tone, suckling and attentiveness.

Morphine, a narcotic, may be used in an attempt to stop a long, non-progressing labor. While it may cause you nausea, dizziness, and confusion, it may also do just what you need-put you to sleep and stop your labor temporarily. Narcotics can linger in the baby and can have some effects on behavior and breathing after birth. The greater the amount of the drug given the greater the effect on the baby.

In the early weeks of the new baby’s life especially, a father can share household responsibilities, being sufficiently supportive and perceptive to see what needs to be done and pitching in to do it. By exercising some control over the number of visitors and the time they are allowed to stay, taking over household errands and performing routine tasks, such as getting some meals and cleaning up after them, doing the laundry, and running the vacuum cleaner, he can help provide the serenity and order that will give the family’s home life a semblance of normality in a time of stress. However inexperienced he is at child care, he can learn within a very short time to be skilled at and to enjoy changing, bathing, and comforting the baby, and if not feeding her, performing the important after feeding task of burping.

Though you will find your child reacting to her father differently as the child grows-your eighteen month old, for example, will enjoy roughhousing with Daddy, but when in trouble will very likely turn only to Mommy-the effect of a close, nurturing relationship with a male figure is good for both boys and girls. The popularity of Fred Rogers for nearly twenty years on public television’s Mister Roger’s Neighborhood indicates how enthusiastically children react to caring presence of men in their lives.

Besides lending a hand around the house and accepting some of the responsibility for the care of his child, the new father often takes the traditionally male responsibilities very seriously. He may feel the financial burden of a third member of the family very strongly, especially if the mother’s income has been important and she does not plan to return to work in the near future. And he may envy his wife her opportunity to stay home with the baby as much as she envies his being able to get out every day.

Men who participate as fully as they can in the birth of their babies and who continue to share the responsibilities of home and children, find the rewards great. Their lives take on a new dimension; their marriages are strengthened and become more meaningful. Fathers can “mother” too, and those who choose to accept that responsibility, are today the norm, not the exception. Reports of surveys bulge with statistics. Here are just a few: Eighty-five percent of fathers are present during their wife’s labor; fifty percent during delivery. Ninety-six percent help with baby and child care; eighty percent do not refuse to change diapers.

For a new parent who has had no experience with infants either within his or her own family or during the course of a babysitting career, simply picking up and holding a baby is a little scary, dressing one is frightening, and bathing one is downright terrifying. Luckily, infants aren’t able to squirm about much, so you don’t have to worry right away about yours twisting out of your arms or escaping from your grip on the changing table. And babies are tough; they don’t break under the stress of normal handling [Don’t worry about emotional fragility, either. Your baby’s psyche won’t be damaged for life if you are cross, in a hurry, or preoccupied once in a while].

It will be necessary to support your baby’s head with one hand foe about three months when you pick him up and to hold your baby against your shoulder so his head won’t fall backward when you carry him. It used to be common to swaddle babies loosely in receiving blankets, and some parents like to enclose their infant’s arms and legs this way until they are used to holding and carrying them. You’ll soon find yourself going smoothly through the tasks that involve moving and handling your baby subconsciously avoiding the sudden movements and loud noises that frighten or startle babies.

The Importance of Touching

This statement bears repeating: Picking up and holding your baby will not spoil him. The importance of touch to an infant cannot be stressed enough, a fact now recognized to be part of the bonding process encouraged by doctors, it is even said that mothers who are separated from their newborn infants during the first hour after birth are somewhat less confident about their intuitive mothering skills than those who go through the bonding process. Your baby’s skin in his or her most well developed sensory organ immediately after birth, and the largest organ of the body, its stimulation can have a profound effect on the baby’s behavior. Your gentle, confident, and firm touch, will calm your baby as well as assure him of your love.

Recently publicity has been given to a number of foods that may contain micro-organisms that can cause harmful disease in pregnancy. Listeria is an illness caused by bacteria called listeria monocytogenes. Listeria is a mild, flu-like disease in adults, but in a pregnant woman it can cause miscarriage, stillbirth or severe illness in the newborn baby. Listeria can be found in soft cheeses such as Brie, Camembert and blue-veined cheeses, and can also be found in pates. Cooked foods that tend to sit out, such as rotisserie chicken, food in buffet lines or deli counters, can also contain low quantities of listeria and must therefore be thoroughly reheated. Salmonella, which can cause acute food poisoning, may be found in undercooked chicken and in raw or soft-boiled eggs, so some women prefer to avoid these. Recent research has shown high levels of vitamin A are concentrated in liver. High amounts of vitamin A can be harmful, so don’t overdo eating liver as an iron source.

Toxoplasmosis is another organism that causes only mild symptoms in an adult but that can injure the fetus, causing blindness or hydrocephalus, which can cause brain damage. Toxoplasmosis is found in some raw meat, unpasteurized goat’s milk or cheese, unwashed raw fruit and vegetables, and in anything contaminated by cat feces. Someone else will have to empty the cat’s litter box while you are pregnant. Also, keep the cat off all counters and tabletops. Wash them off frequently.

Since a pregnancy is not usually confirmed until six or eight weeks after conception, and it may take a little time for the body to build up depleted stores of vitamins and essential minerals, it is very important to adjust your diet before you become pregnant if at all possible. A good diet will also make you feel stronger and healthier and help you through the demanding months of pregnancy, through the birth itself and through the postnatal period. If you feel better, you will be more likely to enjoy your baby to the utmost.

Preconception Care

As we learn more about how diet, drugs and other substances in the environment might affect an unborn baby, more and more mothers are trying to prepare well in advance for the birth of their baby. Genetic counselors are available if you know of any genetic disorder in the family or if you are at greater risk of having a baby with disabilities. Advice on diet and general health care in pregnancy may be available at your prenatal clinic or your doctor’s office. Talk with your doctor about getting this extra attention if you would like it.

It is worth having your health checked before you conceive.

You might want a Pap smear. You can also have a swab done to check that there are no harmful micro-organisms in the vagina. Recent research shows that thrush and gardnerella, bacteria that causes bacterial vaginosis, may be linked to a difficulty to conceive, that an organism called mycoplasma may be linked to miscarriage, and gardnerella to premature deliveries. Not all such infections cause symptoms normally, but they may cause problems in pregnancy. Checking on them before you’re pregnant maybe wise.

It is also true that the majority of women do not want to wait months to conceive, and many conceive by accident, or experience problems in conceiving, and these mothers may feel guilty that they are not doing the right thing: “We started out with all the best intentions, stopping smoking and drinking, taking vitamin pills and eating only health-foody things without any additives. But it took me nearly two years to get pregnant. By the end I was fed up with the whole thing-we never enjoyed ourselves, we felt guilty about everything we ate or didn’t eat. In the end I just ate what I felt like and let it go at that.”

Genetic counseling is available at many hospitals for those who are worried that they may be at extra risk of having a baby with disabilities-this includes older mothers and those who have some hereditary illness or genetic defect in their family.

“We had genetic counseling at the hospital because I was 40 and my husband was too, and his child by his previous marriage had had problems. There was a blockage at the entrance to her stomach. She had to be operated on at birth, but she’s fine now. We were told doctors could pick up on this with an ultrasound scan, because the baby would not be able to swallow the amniotic fluid, which otherwise would show up in the stomach. The ultrasound was reassuring. By knowing of any problems in advance, our doctors would be set to do immediate surgery after the baby’s birth. I was also concerned about the extra risk of having a baby with Down syndrome-I was surprised at how greatly the risk went up between the ages of 40 and 41. We decided to have the amniocentesis and other tests done because we felt we couldn’t have coped with a baby with severe disabilities. I thought the counseling was very helpful and reassuring.”

Genetic counseling can be helpful. It enables the couple to talk through any worries they have and to put the risks they are facing into proportion. This is especially true for older mothers who may feel this pregnancy is their only chance to have a baby. It can also be helpful in establishing the reasons for any previous babies born with disabilities in the family, or for several miscarriages, and point toward ways of overcoming them. For example, it has been shown that mothers of babies with spina bifida had far fewer affected babies in subsequent pregnancies if they took supplements of vitamin B and folic acid. Some couples who have had several miscarriages have been told this was linked to a genetic problem but that if they kept going they had a chance of having a normal pregnancy, and this has encouraged them to continue trying to conceive.

Parents eagerly anticipate their baby’s sleeping through the night, but an eight hour sleeping period probably not be something that your baby achieves until she is several months old. Someone will very likely advise you to give the baby cereal at the last late night feeding as a way to induce a longer sleeping period. Don’t do it. Your baby’s doctor will tell you when the baby is developed enough [immune system, swallowing mechanism, etc.] to handle solid foods.

A pacifier may help put your baby to sleep. The Leche League discourages the use of pacifiers on the grounds that they may diminish a baby’s need to suck and therefore make her a less efficient nurser.. Some parents disapprove of them, too, probably because they find distasteful the not uncommon sight of a toddler whose sucking needs have long since been outgrown walking around with a pacifier stuck in her mouth like a plug. In fact, some find the sucking that is one of a baby’s instinctual needs somewhat difficult to understand at all. They may feel that extra nutritional sucking indicates that something is lacking in the emotional development of their child, and that therefore they are “bad” parents.

Nothing could be further from the truth. Newborns need to suck; it is their most satisfying form of gratification. The benefits of a pacifier can be seen when a baby’s need to suck goes beyond her need to eat. Infants may awaken a short time after a feeding and indicate what seems to be hunger by trying to put their hands in their mouths or crying, when what they really need is to suck.. Thumb-sucking would be a good substitute if infants could find these natural flesh-and-blood pacifiers when they want them. Since a tiny baby rarely put thumb to mouth at will, a pacifier meets her need to suck and eliminates unnecessary feedings that inconvenience you and may upset the baby’s digestion.

Another possible benefit of pacifiers has been discovered in using them with premature babies. Those who were induced to accept pacifiers in the hospital were found to develop sucking muscles sooner than those who did not take them, and thus were able to be taken off intravenous feedings and fed by mouth sooner.

If you give your baby a pacifier in bed, do take it away when she is asleep, to avoid the baby’s becoming dependant upon it to stay asleep. And never tie it on a string around the baby’s neck. It could cause strangulation. After six months or so, the need foe extra sucking will disappear. If you dislike the pacifier you could probably arrange for it to disappear about the same time.

The pain of labor is quite different from other kinds of pain. It is the pain of your body doing a hard and laborious job, not the pain of being in any way harmed. However, labor is normally painful to some degree. Many people have tried to gloss around this or give the impression that, properly prepared and armed with breathing exercises and the right attitude, you will not feel pain. This means many women are taken by surprise and believe they have failed when they do experience intense pain in labor and feel they need some relief from it.

We know fear and tension can create additional pain in labor and make it intolerable. If you tense all your muscles and fight the contractions, you make it much more difficult for your body to do its job. You need to think, therefore, in terms of helping your body through the contractions. This thinking is behind the various breathing and preparation techniques that are taught to women in prenatal classes during pregnancy. By accepting the pain and dealing with it, many women find they do not need painkilling drugs, which might also interfere with their being in control. For others experiencing a long and difficult labor, painkilling drugs may provide much-needed relief.

Breathing Techniques

Slow, deep breathing will help you relax between, and at the beginning and end of, contractions. At the height of a contraction, it may help to breathe quickly and lightly, taking air into the top part of your lungs only. (Do that for just a short while.) During the transition between the first and second stages, when you may feel a desire to push out the baby, your doctor or midwife may ask you to wait till she is sure the cervix is fully dilated. At that point, short, rapid, panting breaths may help you overcome the desire to push.

Pain-Relieving Drugs

A number of pain-relieving drugs are available to women in labor. They are particularly useful if you are experiencing a very long labor, if the baby is presenting the wrong way (see below) or if you are becoming exhausted. These drugs, however, can pass into the baby’s bloodstream and affect the baby, or may affect the progress of the labor. Many women find it useful to wait a little between the moments they first feel that they may want pain relief and deciding to accept it. In the meantime, they may find labor is progressing so well that they are nearly ready for the baby to be born. If progress is slow, however, or there is some problem, they can always decide to accept some pain relief.

Meperidine Hydrochloride

This drug, most commonly known by its trade name Demerols’, provides pain relief. It reduces anxiety and thus pain; however, not all women find it is an effective form of pain relief. Some find it makes them feel heavy and out of control without helping the pain much. Demerol crosses the placenta and can affect the baby, making it drowsy at birth, especially if the drug is given close to delivery. (It should be given at least two hours before the baby is born; this means it cannot always be given at the point in the labor when the woman needs it most.) Some babies even need resuscitation after the birth. Many are sleepy and slow at breastfeeding. This medication can also make the mother feel sick.

Epidural Anesthesia

An epidural consists of a local anesthetic that completely numbs the abdomen and legs, thus removing all sensation of contractions. If an epidural is timed just right, it can be allowed to wear off for the second stage so that you can feel and push with each contraction, thus helping the baby out. It seems to have little or no effect on the baby. The main potential problem is that, because some women cannot feel anything, they cannot participate in the second stage of labor, which is likely to be prolonged. The baby is more likely to be delivered with forceps. However, the correlation may be due to the fact women who are having difficult labors anyway are likely to ask for epidural anesthesia.

An epidural is injected into the epidural space in the spine, between the vertebrae and the membrane enclosing the spinal cord. You will be asked to lie on your left side and to draw up your legs to make as tight a ball as possible. This position makes it easier for the anesthetist to put the needle into the epidural space. You will be given a local anesthetic so you do not feel the tube being inserted. After that, the anesthetic is put in. It feels like a cold fluid running down your legs. The catheter is left in your back so the epidural can be “refreshed;” you will also normally have a catheter put in to empty your bladder because you will not be able to control this yourself. An intravenous drip is usually set up too, in case your blood pressure falls suddenly, which can happen with an epidural.

For some women, an epidural is the answer to a difficult labor:

“1 had been in labor for hours, with strong contractions, but I wasn’t dilating much. I became exhausted and thought I couldn’t take any more. They offered me an epidural, and I accepted reluctantly. I have to say the effect was wonderful. Within a few minutes, I was sitting up and talking to the nurses and felt like I could cope again.”

Epidurals can cause problems. About 20% of the time, the epidural does not take and provides inadequate pain relief, sometimes along one side only. Occasionally-in about one in 100 cases-the needle punctures the membrane enclosing the spinal cord. This means you are more heavily anesthetized and may suffer headaches lasting up to a week after the birth. Very rarely, in about one in 100,000 cases, permanent damage can result.

“1 hated it. First the anesthetist had trouble getting it in. In fact, a little piece of plastic tubing broke off and is still floating around somewhere in my spine. Then I had all these tubes and drips set up, and I couldn’t get up and walk for hours after the birth. I didn’t feel or see the baby born at all because I could feel nothing. I had no idea it would be like that. And, because I couldn’t push, he was delivered by forceps-so now I have all the pain of an episiotomy, which I could have done without.”

Women having an epidural should be aware that they are often beginning a chain of medical intervention they might otherwise have done without. On the other hand, if the labor is likely to be difficult, it means you are spared a lot of pain and are already anesthetized if the baby has to be delivered by forceps. And if you should need an emergency Cesarean, the epidural will enable you to be awake and avoid a general anesthetic when your baby is born.

Pudendal Block

This painkilling injection can be made into the vaginal wall with a special needle. With it, you will feel no pain at all from the delivery, and is especially useful when forceps are used. It may be used in conjunction with Demerol.

Local anesthetics are also given if an episiotomy is necessary and for any stitching done on the perineum afterward.

Family life has undergone many changes in the recent decades, and the responsibilities assigned specifically to one or the other to a pair of parents have shifted and become somewhat blurred. There are more single parents today and more never married parents. Many of them shoulder total responsibility for their families. When both parents work outside the home, they learn to share responsibilities for housework and child care as they share the responsibilities of breadwinning. Nearly one million men in the United States are raising their alone. It is no longer cause for eyebrows to be raised and gossips to gather when a divorced father is awarded sole custody of his children. And joint-custody provisions in divorce-described as “equal opportunity in parenting”-have now been adopted by a majority of states. Some men take on the role of househusband, assuming the major part of the nurturing of the children, while their wife’s careers provide financial support.

Still, the traditional nuclear family survives, and in many homes the familiar structure of mother as full-time homemaker and the father as financial provider continues. It used to be customary for the at-home mother to be almost entirely in charge of the house and the children. Today, however, we find fathers taking more interest, helping more often with household chores, and involving themselves more fully in the lives of their children than their father did. They are no longer strict and unapproachable beings who are seen by the children only foe a few minutes a day and demand peace and quiet when they are home. Their relationship with their children is personal and openly loving; they talk about feelings, they show that they care.

There are also more public indications today that men no longer measure their worth only by their achievements outside their homes, as their fathers did before them. Both child care literature and advertising now direct information to “parents” instead of only to mothers; childbirth education classes require the participation of fathers. Parental leave of absence, extended to males in Sweden in 1979, is becoming more common among companies in this country, and federal legislation may soon guarantee men as well as women eighteen weeks of unpaid parental leave from their jobs in any two year period, offering protection for both the employees’ jobs and their benefits during their absences.

Men usually are not able to choose between their children and their work, as some women can, and many have not had the role model of a nurturing father to emulate. However, a father today is apt to involve himself as much as he possibly can from the very beginning of his wife’s pregnancy, sharing the important decisions about the doctor she will see, the birthing environment, and the hospital of which the baby will be born. He may accompany his wife on some of her visits to obstetrician. He participates in childbirth classes, in which he learns to coach his wife during the birth of their child, and then supports and aids her throughout her labor and delivery. Various studies have indicated that delivery times are shorter, anesthetics are used less frequently, mothers and babies are calmer, and infant’s feeding problems are less likely when fathers are present in delivery rooms. After their babies are born, fathers often accompany their wives on visits to the pediatrician, if their work hours allow, and some take their babies for checkups alone.

During labor the cervix thins and softens and then dilates to allow the baby’s head to pass through the birth canal. When the cervix is fully open it is considered “10cm dilated.” This marks the transition from the first to the second stage.

But before we get to that what are the signs and symptons the expecting couple can appreciate as the first indications that the birth of your child is near. These may be:

* Note that all women do not experience all of these signs; the most important ones are the last two. The others are more like warning signs that labor is coming soon.

Forceps deliveries are carried out after the first stage, when the cervix is fully dilated. Forceps are used if for some reason the baby’s head is not coming down the birth canal or if the baby is in distress and needs to be born rapidly. Premature babies may be delivered by forceps to spare their heads from being too compressed as they come through the birth canal. Forceps are also usually used to protect the baby’s head in a breech birth.

If your baby needs a forceps delivery, you will be asked to lie on your back and your legs will be put into stirrups. You will receive a local anesthetic. An episiotomy will be done to increase the vaginal opening. Forceps will be gently inserted around the baby’s head. Gentle pulling helps the head out. Once the head is born, the rest of the delivery occurs normally. If the baby’s head faces the wrong way, forceps may be used to rotate the baby’s head to help delivery.

Forceps deliveries are very safe and there is little chance of the baby being harmed in any way, although most will have marks on the head from the forceps for a few days after the birth. Forceps deliveries occur more often after a protracted labor where the mother becomes exhausted, where she has had an epidural and cannot feel to push with each contraction or where the baby’s head is large or in the wrong position.

Sometimes a vacuum extractor, also called a ventouse, is used instead of forceps. This is a cup placed on the baby’s head that is operated by a vacuum pump. It can be inserted before the cervix is fully dilated and is used, in conjunction with the mother’s pushing, to deliver the baby. A small circular mark where the cup was placed shows on the baby’s head for a few days after the delivery.

Once labor is established, the baby’s heartbeat and the strength of your contractions can be measured electronically. It can be reassuring to be able to hear and actually see throughout the delivery that the baby is well and not in distress, though this can also be checked using an old-fashioned ear trumpet or a fetal stethoscope. The disadvantage of electronic fetal monitoring is, you will be attached to a machine during labor. You may feel it is getting more attention than you are! You will not be free to move around. Sometimes the machines do not work well. Some women have noticed that the slightest change in the baby’s heartbeat will lead to intervention, which may not have been necessary.

There is now evidence that continuous electronic fetal monitoring does not make any difference to the labor outcome as far as the baby’s health and safety are concerned, although it results in a higher risk of intervention. However, in any individual case in which monitoring was not performed and a baby dies, the doctor or staff may be sued. For that reason, monitoring is almost always done to protect them, even though there may be no evidence that it is necessary.

Monitoring can be done with an external monitor strapped to your abdomen. Most women find this is awkward because they have to remain still. Also, the monitor has a tendency to slip off during a contraction:

“They kept fussing around; trying to put it back on… I couldn’t concentrate on what I was doing. Most of the time it wasn’t in the right place and we just heard a lot of noise, not the baby’s heartbeat.”

An internal monitor works better and is less restrictive for the mother. However, the waters must be broken and the cervix must be at least 2cm to 3cm dilated for this to be attached to the baby’s head. A tiny scar, like a pinprick, will be left after the monitor is removed but it is unlikely to cause the baby much discomfort. In cases where it is thought the baby may be distressed, a blood sample may be taken from the baby’s head and analyzed.

Whether you choose to breastfeed or not, your breasts will begin making and secreting milk. At first, they make colostrums, the perfect food for a new baby. Within two or three days the colostrum turns to milk. Sometimes when the milk “comes in,” your breasts become very engorged [full to the point of discomfort]. If you are breastfeeding, the best way to prevent excessive engorgement is to let your baby nurse frequently. If your baby is a sleeper or lazy nurser, you may relieve engorgement by expressing [forcing out] milk from your breasts, either by hand or with a breast pump.

If you have decided not to breastfed, effects will be made to reduce milk production. Cold packs, a well fitting bra, or medication may be used to slow down or prevent milk production. Usually within a few days, milk production stops.

As the baby’s head emerges you will know. You will feel a stretching or burning sensation in your vagina. This is an exiting, intense time. You know the baby is almost here and may be tempted to push as hard as you can to get him out quickly. They could be a mistake, however, because a sudden push to make the baby come out too quickly and damage your perineum [causing tearing]. It is important for you not to push hard at this time. Let your uterus do the work alone. You should breathe rapidly and lightly [pant as animals do during birth]. So the baby can emerge gradually. Your doctor will give you instructions-and help the baby out slowly. You will soon be holding your baby in your arms.

After the head is born, the baby turns to one side and a shoulder and the whole body is born. And what a sense of relief you feel! Labor is over [or nearly so]. You have a baby. It may take a while for it all to sink in. In the meantime, you may be holding your baby and watching as a nurse or doctor examines him and cares foe him.

The Third Stage of Labor

Your job is not quite finished. The placenta still needs to be expelled. The third stage usually lasts from five to thirty minutes. The nurse or doctor will keep a hand on your abdomen to determine when the placenta separates from the wall of your uterus. Then you will be asked to push it out. You may feel some cramps, but there is usually slight discomfort.

The Fourth Stage of Labor

Immediately after birth, while your are holding and admiring your new baby, your doctor focuses on your well-being, The condition of your uterus and vagina is of major concern. It is important that your uterus remain contracted after birth, which keeps it from bleeding as much as when it is relaxed. Most women lose about one cup of blood at the time of birth. While this may seem like a lot. Remember that among the other many changes of pregnancy, your blood supply greatly increased. Thai excess blood is no longer needed, you will lose some of it at the time of birth and will continue to lose some over a period of several weeks [this discharge is called lochia]. Your doctor watches the amount of blood lost immediately after birth and, if necessary, takes measures to reduce this blood loss. These may include massaging your uterus vigorously, asking you to lightly stimulate your nipples, or giving you an injection of a medication [Methergine [methylergonovine] or pitocin [oxytocin]] that will cause your uterus to contract.

Your doctor will also check your vagina to see if you need any stitches. If an episiotomy was performed, you will definitely need stitches. Some tearing of the vagina or the perineum may also have occurred when the baby was born. Although the idea os tearing sounds rather unpleasant, be assured that the tears [or cuts] are usually not serious, and will usually heal rapidly. If necessary your doctor will begin stitching within a few minutes after birth. You will be given a local anesthetic for pain relief if you have not already had one.

As you wind down towards the birth of your baby, you will want to be conscientious about your diet and rest needs. This is the time to take childbirth preparation classes; to prepare your birth plan; to make the decisions on employment, child care, infant feeding, and health care for your baby; and to prepare the baby’s space and equipment. If they have not already done so, this is when most people take a good look at their financial situation, and figure out the impact the birth of the baby will have. There may be a loss of income at least for while, extra bills associated with the birth, other expenses associated with the baby’s equipment, and more. Try to prepare yourself for these financial changes as much as possible so you are not caught in a financial bind because of the birth of your child.

If your income is low, you may qualify for federal or state programs. There are also organizations that can assist you with food, health care, free or low cost baby clothing and equipment, and other help. This is a good time to look into these matters if you have not already. If you have health insurance, find out exactly what it does and does not cover.

Pack your bag a few weeks before your due date and place on top of it a list of any last minute items to add just before leaving.

Suggested Packing List

For Mother in Labor:

• Toothbrush and toothpaste
• Massage oil [not lotion] or powder [cornstarch is best]
• Lip cream or gloss
• Rolling pin or massage aids
• Hot-water bottle and camper’s ice [for comfort]
• Juice or ice-pops [if not supplied by the hospital]
• Music tapes and a tape recorder [battery operated]
• Home-birth supplies ordered by your mid-wife

For Partner:

• Food/snacks
• Breath mints or toothbrush

Maintaining a healthy diet during pregnancy is the best thing you can do for yourself and your baby. Junk food can be harmful in pregnancy because it does not provide enough of the vitamins and nutrients the growing baby needs. It is also high in salt and other additives. That increases stress on the liver and kidneys, which have to eliminate the excess sodium from the body. If you eat the right foods, you will be doing the best for your baby. Your doctor may have you take a prenatal vitamin in addition. Be careful of taking large quantities of vitamin supplements otherwise, because some vitamins, notably vitamin A, can be harmful if taken in excess. Also, if you eat healthfully you won’t need to worry about whether you’re putting on the right amount of weight or not; your body will do that automatically.

Weight Gain

It is normal to gain weight in pregnancy. Most additional weight appears during the second three months. The increased weight is the weight of the baby, the placenta, the waters surrounding the baby, increased fluid and tissue in the breasts as they prepare to produce milk, and a greater quantity of blood circulating in the body. Some women also experience fluid retention, which will adjust itself after the baby is born.A normal weight gain during pregnancy is 20 to 30 pounds (9 to 13.5 kg). Some women gain less, others more-this can be normal, too. If you are planning to breast-feed your baby, remember that you will be laying down some stores of fat to feed your new baby and that the pounds will roll off as you produce milk.

Doctors used to worry a lot about “excessive” weight gain in pregnancy, because it can put an additional strain on the body, making high blood pressure and cardiovascular problems more likely. However, this situation was largely a reaction to the exhortations previously made to women to “eat for two;” that is, very heartily. But aiming for the other extreme and trying to stay slim in pregnancy is equally harmful.

It is particularly damaging to try to diet and lose weight in pregnancy unless you are overweight and under medical supervision, because you may be denying your baby vital nourishment. Again, eating the right food is the key. If you eat well, you will feel well, be less inclined to want to “fill up” on sweet things, and your body will gain and shed weight naturally during and after the pregnancy.

A Healthful Diet

A healthful diet means eating a balanced combination of proteins, carbohydrates, fats and vitamins. This can be achieved by eating reasonable quantities of fresh meat and fish, eggs, pasteurized cheese and milk, fresh fruits and vegetables, whole-grain bread and cereals. Fresh green vegetables in particular are full of the minerals and vitamins your body and your baby need.

Avoid Junk Food

• Avoid foods with “empty” calories, such as:
• Highly refined, sugary cakes and other desserts
• Sweet carbonated drinks
• Cookies
• Fried and fatty foods, such as potato chips and creamy dips
• Salty foods (they encourage fluid retention)
• Drinks such as coffee, tea and cocoa
• All alcoholic beverages

The majority of mothers over the age of 35 who become pregnant can expect a normal pregnancy and a healthy baby. However, older mothers are at greater risk of developing complications. For that reason, an older mother is screened to detect these at an early stage. Older mothers are also at higher risk of having a baby with disabilities, so most are eager to take advantage of the screening tests available.
There can hardly be a mother who has not worried at some time in her pregnancy whether her baby will be normal, and this may be particularly true for the older mother. Fortunately, a number of screening tests are now offered to women at higher risk of having a baby with severe problems. These tests can be very important in easing the parents’ worries. In cases where an abnormality is shown, the screening enables them to decide whether or not to proceed with a pregnancy. However, it is important to remember that not all abnormalities can be detected in pregnancy and that accidents at birth can also lead to disabilities. The tests eliminate certain problems but do not guarantee the “perfect baby.”

How the Baby Develops

A human embryo is more or less completely formed by the end of the twelfth week of pregnancy. After this time it simply has to grow in size and its organs have to mature to make it capable of living outside the womb. All the major developments take place in the early weeks of pregnancy, which is why it is especially important to look after yourself before you even know you are pregnant. The baby’s spinal column, for example, begins to form in the fifth week of pregnancy. You are likely at this stage to realize that your period is late, but have not had the pregnancy confirmed. In the sixth week arm and leg buds are formed. In the seventh week the beginnings of the fingers and toes are visible and dramatic changes are occurring to the head and face. In the ninth week the nose and mouth take shape. By the eleventh week the genitals are formed, and all the internal organs are functioning.
Abnormalities in a baby are usually caused by genetic problems or by an environmental influence, such as poor diet, the use of drugs in early pregnancy or by hazards in the workplace, such as toxic chemicals or radiation. Genetic problems fall into two categories: those caused by either or both parents carrying a faulty gene, or those that occur when the sperm or egg are formed. In the second case, the formation involves an extra chromosome or part of a chromosome being included in the fertilized egg.

At first sight, your newborn may not be quite what you had expected. For the first half minute or so, his skin might be bluish grey, and he may appear lifeless. That may be a shock if you are not expecting it, but this is the color of all babies in the uterus. As your baby begins breathing and more oxygen enters his body, his color will turn pinker or ruddier-first the head and body, then the arms and legs, and last the feet and hands.

Your baby will be soaking wet, streaked with blood, and smeared with vernix, a white sticky substance.. Some babies have a great deal of vernix all over their bodies, and some have only small amounts, only in the creases and folds. Vernix is almost like a hand cream, in that it protects the baby’s skin while he is floating in amniotic fluid.

His face may be swollen and he might have long fingernails. You may also be surprised by the size of your baby’s genitals. The size and color subside in a few days, when their genitals take on a more normal appearance.

Immediate Care

Even though most babies do not really need it, care-givers routinely suction babies noses and mouths very soon after birth to remove excess amniotic fluid and mucous. In fact, sometimes they begin suctioning when only the baby’s head is out. It is done with a rubber bulb syringe or with a little jar and tube called a mucous trap. The mucous trap is used if the baby’s airway seems to be very congested or if the baby was under stress during labor and breathing problems are anticipated at the time of birth.

Your baby’s umbilical cord will be clamped in two places close to his abdomen. Then the cord will be cut between the two clamps. Sometimes the father cuts the cord. Otherwise, the doctor does it. Even though there is a spurt of blood when the cord is cut, neither you or your baby will feel it at all, sense there are no nerves in the umbilical cord. Then your baby will be either be placed on your abdomen or taken to a special warm bed in the corner of the room for examination and other care. If he is placed on your abdomen, you will feel the warm, wet baby on your now soft belly. Many women find this a very pleasant sensation.

Your baby is dried off by rubbing briskly with soft towels to keep him from getting a chill [a major concern of your doctor]. Your baby will be wrapped in a warm blanket or two, and his head will be covered. In fact, it is a very good idea to have a warm little hat to place on the baby’s head as soon as possible after the birth because the baby’s head is such a large part of his body that a lot of heat can be lost through it.

For all those who have delayed parenthood comes a moment of truth, a realization they have not made the decision to have a child and will therefore remain childless. Candace is 43. She says the timing has never been quite right for her to have a baby, although she has not ruled out the possibility altogether. “You have to be a realist and not a romantic about children. It’s easy to fantasize about having a baby … I’m not sure it’s right for me at the moment.”

The woman who at 43 has still not decided to have a baby will probably join the increasing numbers of women who are choosing never to have children. Recent statistics have shown a definite increase in the number of women choosing to remain childless. In I982, 4.9% of all women of childbearing age were voluntarily childless. By I995, the percentage had increased to 6.6%. (National Center for Health Statistics, I995) Although there is a shift towards later childbearing, statistics show that this increase in childlessness is likely to continue among younger women.

Aside from those who decide not to have children, there are those who want children very much and are unable to have them.

Tremendous advances have been made in infertility treatment over the past two decades. Of the nearly 5 million American couples who report difficulty or delays in achieving a live birth, I.3 million will receive medical advice or treatment for infertility. According to the American Medical Association Encyclopedia of Medicine (I989), professional treatment aids approximately half the women who seek help for fertility problems.

For those who have, for whatever reason, postponed having a baby into their mid- to late 30s, infertility can be a devastating blow. “I know it’s covered in the papers and I knew it was a risk, but I still didn’t think it would ever happen to me,” says Gina, 37. “After six months of trying I went to the doctor and he said, ‘Give it time. You’re not as fertile as you were. If you haven’t conceived in another six months we’ll do something.’ I hadn’t, so back to the doctor. He referred us to a clinic, but the first available appointment was three months away. Meanwhile, nothing happened. We had tests. They went on for months; each test had to be done only at the most fertile time of the month, so that took months to arrange. In the end they discovered I had blocked tubes, probably as a result of an appendicitis operation I had when I was a teenager. The discovery that there really was something wrong was appalling. I felt I only had about three years left.” Gina conceived two years later on her second attempt at IVF (in-vitro fertilization).

Many women find infertility is a terrible irony after years of using contraception. “I was on the Pill for I2 years. Then I discovered I had never ovulated to begin with. Those pregnancy scares I had when I’d taken chances before I went on the Pill, all those years of swallowing hormones-it all seemed so pointless. I was really angry and distressed.”

Rachel had always wanted children, but didn’t marry until she was 36. “We tried for a baby immediately. Nothing happened. After about nine months we started to do temperature charts. They seemed to show I was ovulating, and so then there was the awful business of trying to time sex for the most fertile time in my cycle. Those temperature charts started to dominate our sex lifePaul said he couldn’t stand being told when to perform. He thought I was being neurotic. Once he found out it wasn’t his sperm that were at fault, he lost interest in the whole process. I was devastated-if I didn’t have children, what else was there to look forward to?”

Those who remain childless, whether by choice or not, often find themselves put under considerable pressure by others. Questions such as, “So, when are you going to have a baby?” or

“Don’t you think it’s selfish not to have children?” are heard frequently. Some women do feel pressured into having a child by the outside world. “I had been putting it off and putting it off, and I’m not sure I really wanted a child. But then I thought, this is something almost everybody does. Will I feel I’ve missed something?” Pressure is put on women to have children by family and friends and, notoriously, by parents wanting grandchildren.

“My mother went on and on about having a grandchild and finally I said, ‘My career is important to me. If I have a baby, will you take care of it while I go back to work?’ She agreed-and it has worked out really well for us.” Others are not so lucky or do not give in to parental pressures. This can create a lot of stress in family relationships. “My mother complained about it so much, how unhappy I was making her, that she couldn’t see the point in life if she didn’t have grandchildren, that I started avoiding her.

Not only does she not have a grandchild, she’s on the way to losing her daughter, too.”

Most women want to know they are pregnant as soon as possible, especially if they have had problems conceiving. Over-the counter pregnancy tests available now can tell you whether you are pregnant or not as soon as, or even before, your period is due. They are quite accurate. You can buy them at larger grocery stores and at pharmacies. Each box usually contains two tests, so if the first isn’t positive, you can repeat it a few days later to make sure. They are not cheap, so it may be wise to wait for your period, and take the test if you are late.

“When my period was overdue I did a home test and it was positive. Then my doctor did one and it was negative. We were both disappointed. But my period didn’t start, and I felt pregnant. So I did another home test, which was positive. I called my husband and asked him to come home from work to make sure I wasn’t imagining it. He did and agreed it was positive. But the next test from the hospital was negative too-until the doctor called and said they had made an error. It seemed crazy to us that a home test was so much better than the hospital one!”

Having your pregnancy confirmed early lets you, if you haven’t already, stop all drinking of alcohol, take care of your diet, and get the soonest possible prenatal appointment. Once you know you are pregnant, talk things over with your healthcare professional and explain any preferences you have for the kind of birth you would like, which hospitals you prefer, whether you would like a hospital delivery or a home birth if that can be arranged. Your doctor will know the options in the area and will be able to discuss with you what is best. In practice this is not always the case, and older mothers in particular may find they are only offered a hospital birth or are under strong pressure to have the baby in the hospital. In some areas, your choice of hospital is limited.

The vast majority of births take place in hospitals, and most people still have their prenatal appointments under an obstetrician’s care. Although things seem to have improved in prenatal care, the majority of women find the wait for office appointments is still a problem. There are usually no facilities for occupying the attention of older children and toddlers. In some managed care systems, women complain that they are seen by someone different each time and may not even see the professional they were supposed to see. Many women find the care impersonal and offhand. But despite these kinds of problems, on the whole, older pregnant women do not find themselves much of an oddity at prenatal clinics.

“I realized I could be the mother of the woman sitting next to me, but it didn’t seem to matter. We were both going through the same thing. I was never once made to feel that I was old or doing anything unusual by the other women or by the office staff. I’d guess the average age of mothers at my clinic was 30 to 35. My doctor does specialize in women with potential difficulties and older mothers, and I live in a major metropolitan area. I think all that makes a difference. Still, I was surprised at the number of older women I saw.”

Routine Prenatal Tests

Ideally, you will have seen your doctor before you conceived, or as soon after conception as possible. At your first appointment, your healthcare provider will take your medical history, together with any details of previous pregnancies. You will be weighed. You are likely to be given an internal examination to confirm the pregnancy, check the womb is the size it should be for your dates, check for any abnormalities of the pelvis and check that the cervix (neck of the womb) is tightly closed. A cervical smear (Pap smear) is also usually taken. Lab tests may be done now or at a later visit.

If you have had a history of miscarriage the doctor may agree not to examine you internally at this stage if you wish, though there is no particular evidence to suggest this might cause a miscarriage.

A blood test is also taken to find your major blood group, particularly whether you are rhesus positive or negative. About 85% of the population is rhesus positive. If you are rhesus negative and your baby is rhesus positive, and it is a second or subsequent pregnancy, there is a small chance that you may make sufficient antibodies to rhesus-positive blood to damage your baby’s blood cells. Because of this, if you are rhesus negative, blood samples will be taken at various times throughout your pregnancy to check on antibody levels, which only rarely become too high. Very rarely a baby suffering from rhesus incompatibility may have to be delivered by Cesarean section and receive a blood transfusion.

Rhesus incompatibility is becoming rarer because most rhesus-negative mothers now have an injection of Rh-immune globulin, which prevents them from producing antibodies. If this is done after every delivery or abortion, future babies are safe from rhesus incompatibility.

Your hemoglobin level is checked to make sure you are not anemic (this test will be repeated later in the pregnancy). You are also screened for immunity to rubella (German measles) and for any sexually transmitted diseases.

Your breasts are usually examined at the first visit to check for lumps. They are not being checked to see whether you can breastfeed. No matter what size or shape your breasts or nipples are, you should be able to breast-feed successfully. If your nipples are inverted, you will still be able to breast-feed; you may just need a little extra help at first in getting the baby to latch on properly.

At every visit you will be weighed to check the growth of the baby and to see that your weight gain is satisfactory. Your urine is tested at every visit-the first time it will be screened for any infection. At every other visit it will be tested for the presence of protein in the urine, which could indicate you have pre-eclampsia and to check that you are not developing diabetes.

The abdomen is measured at every visit to check that the womb is growing in size according to your dates. After 20 to 24 weeks your baby’s heartbeat can be monitored with a stethoscope. Your blood pressure is also measured at every visit, because high blood pressure can indicate a number of problems, including preeclampsia. Your ankles and fingers will be checked for puffiness, a sign of water retention.

Pre-Eclam Psia

Pre-eclampsia, also called toxemia of pregnancy, is a disorder of unknown cause. Symptoms include water retention and high blood pressure. If the condition is allowed to progress unchecked, the blood pressure rises further and the mother suffers headaches and even seizures (eclampsia). Pre-eclampsia puts the baby at risk. The baby may not get enough nourishment. Mothers with pre-eclampsia have an increased risk of going into premature labor.

Doctors look carefully for signs of pre-eclampsia or toxemia, because it can be prevented if caught early, and the risk to the unborn baby can be reduced. Although the cause of pre-eclampsia is unknown, it has been linked to poor nutrition in some cases. Older mothers are at greater risk of developing this condition, so it’s important to keep all your regular prenatal appointments.

Pre-eclampsia is usually treated with bed rest. Women with this condition are often admitted to the hospital so they and the baby can be monitored. Usually complete rest takes care of the problem. If it does get worse, the baby may have to be born early by Cesarean-section delivery (C-section).

When you figure you’re going to go through approximately six-thousand diapers in the first two and one half years of your baby’s life, it makes sense to spend some time focusing on what you’re going to use for diapers. There are three alternatives, disposable, cloth diapers that you launder yourself, and diaper services that supply and launder cloth diapers for you, and offer pick-up and delivery service.

Since you’ll be going through about sixty-five diapers a week during the first year, it makes good sense to use a diaper service, which could save you either laundering time or the extra expense of that many disposables. During the second year, when laundering cloth diapers don’t require the extra rinses that may be necessary for some hypersensitive newborns, laundering your own diapers might be more practical. Then, in the third year, until toilet training is complete, disposables will be handy and lessen your impatience about the training process, taking the pressure off your child. When it is all over, the old diapers make wonderful cleaning rags!

Regardless what you use for a diaper, you’ll inevitably run into diaper rash. It’s caused by a combination of moisture, warmth, and contact between the skin and irritants in urine and stool. Plastic or rubber aggravates it; cool, dry air makes it better. Most experts assert that disposable diapers, which don’t “breathe” like cloth ones, lead to more frequent and more severe diaper rash, so if you’re using disposables and your baby gets diaper rash, you might want to switch to cloth for a while.

Another diaper danger is the substances that your baby might eat or inhale in the process of diapering. Usually what happens is that the “diaperer” hands the baby something for entertainment or the baby grabs it himself. The baby then ingests or inhales the baby powder, the ointment or cream, or the baby wipes. Symptoms can include coughing, wheezing, choking, shortness of breath and vomiting. It’s important to keep these products away from the baby while diapering.

Disposables

Environmentalists have raised a lot of questions about disposables because they are not biodegradable and can’t be recycled. They also cause a public health hazard, since viruses present in excrement can be spread to those who collect the trash. And after disposable diapers are dumped at a landfill site, viruses can be carried into water supplies.

Some disposables [particularly generic brands] keep the skin warmer and moister than cloth diapers [no brand has been found that really keeps a baby dry], and may cause more frequent and more severe diaper rash. Disposable diapers in general can be expensive-up to thirty-two cents per diaper.

On a more positive note; disposables do save a lot of work, and more convenient. They eliminate the need for plastic pants, and they’re much easier to use when traveling. Because there are no pins, less experienced family members are often more willing to change them.

If you choose disposables, here are some guidelines:

1. Sample different brands. Start with a variety in the newborn size until you find one that fits well and has the softness and quality you like. Name brands will usually be more consistent in quality.
2. Don’t use brands that clump, shred or bunch up when wet, since your baby could ingest paper pieces.
3. Brands that don’t allow any plastic to touch the baby’s skin are better for preventing rash.
4. Once you find a brand you like, shop around for a good discount, and then buy by the case.
5. Inspect each diaper for impurities, discoloration, and foreign materials in the paper padding.
6. Create air holes. Since air circulation is the biggest problem with disposables, pinch out a piece of the plastic liner in the seat area. This will allow air to circulate and will also make it easier for you to tell when the baby needs to be changed.
7. Use the weight and size chart to determine fit. Diapers with elastic legs aren’t necessary but they do prevent leakage. As you fasten the diaper, make sure the leg holes are not too constricting.
8. Some disposables supposedly have parts that can be flushed. These don’t work well. Nonetheless, you should try to flush as much from the diaper as possible. Then tightly roll up the diaper so the soiled area is not open to the air, and seal the diaper with diaper tape before throwing it out.
9. Garbage cans should be lined with plastic bags, which should be tied and sealed tightly for disposal. Garbage cans that have locking lids are good; they keep curious tots out.
10. Diapers with refastenable tape are convenient, but not necessary if you keep a small roll of strapping or masking tape and safety tipped scissors handy.

Your baby’s room will most likely contain a crib and a chest of drawers. You may choose to buy a rocking chair for nursing and feeding the baby, and you may also have a changing table, but neither of these is essential.

Cribs and Bedding

For the sake of the consumer, a lot of attention has been paid to crib safety, so that any crib manufactured after February 1974 has to conform to strict safety codes. If you are considering an older crib, perhaps one that has been in your family, you will want to compare its features with the current safety standards, which were necessitated by a large number of serious crib accidents.

Crib slats must be no more than 2 3/8 inches apart to prevent babies from getting their heads or limbs caught in between them, which could result in strangulation or injury. Never use a crib that has missing slats or spindles!

Make sure that metal hardware on the crib you buy or borrow ahs no rough or sharp edges, in case your baby falls against it. Also, check out the locks and latches on the drop-side of the crib to make sure your baby won’t be able to accidentally release them from inside the crib and fall out. Many cribs have double release mechanisms-you must use a foot release as well as release the side of the crib-which are even safer. And once released, make sure the sides of the crib move up and down easily.

You want to be sure your baby will not be able to climb out of the crib. There should be no bars or other surfaces on railings or end panels that the baby could climb on.

Another crib danger of the past was mattresses that didn’t fit snugly in cribs. Babies would get their heads caught between the mattresses and the crib frame and suffocate or strangle. Now all crib mattresses are a standard size. They must be 27 ¼ by 51 5/8 inches and not more than 6 inches thick.

When you go out to buy a crib, don’t be fooled into thinking that if you spend enough money, you’ll be assured top quality. That simply isn’t the case. While currently manufactured cribs generally meet minimum safety standards, some cribs are shoddy and some manufacturers have poor quality control. There is no substitute for your careful inspection of the floor model and a repeat inspection upon delivery.

Look for a crib that has at least one stabilizing bar beneath the springs; two are even better. Make sure the finish of the crib is smooth and evenly painted. If it’s an older crib, make sure it’s not painted with a paint containing lead. If you suspect that the paint contains lead, ask your local health department where you might have paint chips analyzed for lead content. Do not use a crib finished with lead based paint-babies gnaw on crib railings; lead poisoning can cause brain damage and even death.

The crib’s railings should be sturdy; you shouldn’t be able to flex them. Round railings are better than decorative spindles or those with protruding edges or corners. The teething rails should run the length of the railing tops and should not be cracked or have any jagged edges. Specialty stores now sell teething rails for older cribs. Corner posts should not extend more than 5/8 inch above the end panel, since these knobs can catch clothing and cause strangulation. If you already have a crib with longer corner posts, either unscrew them or saw them off and sand them smooth. The end- boards should be straight and functional and should have no decorative open spaces that the baby could climb on or get caught in. avoid decals; they may have a lot of initial appeal, but they don’t hold up well.

Crib mattresses must meet federal flame-retardant standards. They are available in three types; innerspring, hair block, and all foam. Other variables include the thickness of the outer fabric, the number of vents, and the type of edging used around the borders.

Innerspring mattresses vary on the number of coils they have, the type of cushioning on top of the springs, the presence or absence of a metal grid across the springs, or additional metal supports, and the type of covering and venting. Although they are widely advertised, they don’t hold up to the wear and tear of a bouncing toddler. Protruding metal pats is a common complaint.

Hair block mattresses are constructed of molded animal hair. Because of allergic potential they are not recommended.

Your best bet is a high-density foam mattress, which will not be bouncy and also won’t have any inner-parts that can break. Make sure the sides are well vented to allow air to flow in and out under pressure, since a poorly vented mattress will trap air inside and could pop, tearing the vinyl cover. A torn vinyl cover could prove dangerous to your inquisitive baby. A firm foam mattress will fit a crib more tightly than an innerspring mattress, foam mattresses are often thinner than innerspring mattresses, allowing for extra space between the mattress and the top railing, therefore, making the crib more difficult to climb out of.

Crib bumper pads provide extra protection for your baby at three or four months. They guard against her becoming accidentally wedged between the mattress and the crib side, or between the bars. The pads should cover all four sides of the crib and tie on to the crib sides securely in at least six places. You’ll want to remove the pads as soon as your baby begins to use them to pull herself up to stand-at this point, they can collapse and cause her head to be thrown into the bars. Also they could be used as a prop in an attempt to climb out of the crib.

Bumper pads tend to be of poor quality, and there are frequent reports of plastic snap ties tearing from pads, snaps pulling off, and vinyl seams ripping and exposing foam interiors, which can then be ingested. Tie cords may be long enough to tangle around your baby’s neck. Try to buy a firm bumper pad that is covered in washable fabric. Clip the cords after you fasten them to the crib bars, leaving only an inch or so of excess cord.

The following list is a rough guideline for bedding: three fitted crib sheets, two crib-size mattress pads, one vinyl or plastic crib mattress protector, two crib-sized, flannel covered rubber pads, two small washable quilts, and one set of bumper pads.

Pillows are often sold as baby gifts, but they should never be used. They can suffocate a baby or cause postural stress to the neck.

Portable cribs are smaller and narrower than regular cribs. Many of the regulations that cover full size cribs are similar for portable cribs, but don’t apply to mesh-sided or tubular frame portables. While some families appreciate being able to collapse their portables and take them along, there are frequent problems with portables that should be mentioned; shoddy construction often causes legs to crack or collapse, bottoms that aren’t well supported fall through, teething bars splinter, and very often these cribs just aren’t as portable as they appear.

If you are going to buy a portable crib, look for a wooden one that has no protruding wing nuts that can loosen easily. Make sure the floor supports are sturdy, and check to see if the mattress pad is well finished and firm. The bars should be straight on all sides. Avoid one with latching gates, which can be climbed on or present a pinching hazard to a baby’s fingers. Avoid models that have mesh sides or, worse yet, mesh supported floorboard, since the mesh can tear and cause your baby to fall. Once your baby is sitting up, remove the leg supports from the crib and allow it to sit directly on the floor, or retire it from use, since portable cribs are meant for newborns and very small babies.

Amniocentesis consists of taking a sample of amniotic fluid in the sac surrounding the baby and analyzing it. Amniotic fluid contains some of the baby’s cells, which can be cultured to reveal any chromosomal abnormalities. Amniocentesis can also be used to detect neural-tube defects, because there will be a very high level of AFP in the amniotic fluid in that case. This is much more accurate than the AFP blood test.

Amniocentesis is usually offered to women 35 or older, although the policy may change in the future. Age 35 was chosen originally because at this point it was believed that the risk of potential chromosomal problems with the baby was about the same as the risk of miscarrying the baby as a result of the amniocentesis test. However, amniocentesis is even safer now, so the mother’s age at which the test is recommended is being reconsidered upward.

The risk of miscarriage attached to amniocentesis is small.

Studies used to quote a rate of about 0.5%, but today it is closer to 0.3%. Some doctors dispute whether there is a real risk at all.

However, for older mothers, especially those with a history of miscarriage or infertility and for whom a pregnancy is particularly precious, there is a real fear of inducing a miscarriage. This can make the decision to have an amniocentesis very difficult.

Cindy was unlucky and had a miscarriage a week after her amniocentesis at the age of 39. “I was devastated. I blamed myself. They had told me the risk but it seemed so small. I’d never heard of anyone actually losing a baby. They said it might not have been the amnio that it might have happened anyway. But [the amniocentesis] seemed to me to be the most likely reason, because there was nothing wrong with the baby. It was a girl, and I had wanted a girl. I felt I had gone against nature and been punished. It was a terrible, terrible time for me.

“I did get pregnant again a year later and I had a boy. I decided against an amnio and he is fine. Everything is fine, but now I’m 41 and I may not get pregnant again. If I do, now I don’t know whether to have an amnio or not. I keep thinking that if I hadn’t had one I could now have had two children and my family would be complete. On the other hand, perhaps I should just count myself lucky that I am now a mother and have a healthy child.”

An amniocentesis is usually carried out at about 16 weeks into the pregnancy. This is about the earliest time that sufficient amniotic fluid can be withdrawn for testing. Usually an ultrasound scan will also be done at this time, to help the doctor locate the fetus and to identify the best place from which to draw the fluid. You will be asked to have a full bladder for the ultrasound scan, and then asked to empty your bladder before the amniocentesis is performed.

You will change into an examination gown, and the area on the abdomen where the needle is inserted will be swabbed with antiseptic. The needle is usually inserted without local anesthetic. The doctor directs the needle into the amniotic fluid and takes a small amount of the pale-yellow fluid. When ultrasound is used as well, the danger of the needle hitting the baby or placenta is very small. Most women do not find the procedure painful. They describe a slight cramp or pressure in the womb as the needle passes through the uterine wall. Some women feel a little sore for a day or two afterwards. You are usually advised to take it easy because of the slight risk of miscarriage.

For some women, however, the test is not so straightforward:

“We went along [with it] at 16 or 17 weeks. My husband came and we were all keyed up. They did the scan first and said the baby was lying all spread-out and there were no big pockets of fluid to get the needle into, so it wasn’t worth trying. We had to go back the following week-the anticlimax was awful.”

“While pregnant with Josh at the age of 35, I did worry a lot that he might have disabilities. I was feeling very aware of my age. When I was pregnant with Douglas at 37 I said I wanted an amnio. I was told the risk of this causing a miscarriage was about the same as the risk of the baby having Down syndrome and that I should only consider the test if I was prepared to have an abortion.

“I felt I couldn’t handle having a child with disabilities and that it wouldn’t be fair to the two boys. I had baby-sat for a child with mental disabilities and I had no illusions about how difficult it was and how it had affected her brother. I would certainly have had a termination if anything had been wrong.

“They made light of the procedure, said I didn’t need someone with me, it wouldn’t take long and it wouldn’t hurt. I was I6 weeks pregnant. Allen drove me to the hospital and waited outside. I was not given an anesthetic. Ultrasound was used to locate the baby and the bag of fluid. An enormous-looking needle was stuck into my very tender belly and it was excruciatingly painful. I gripped the nurse’s hand and counted to 60; the nurse kept saying, ‘It doesn’t usually hurt.’ Then it was all over. I was shaking and very distressed. Allen had to help me into the car; there is no way I could have gotten home by myself. I started having contractions when I got home and these lasted for four hours, but I didn’t bleed. I thought, ‘Oh God, what have I done? I’m going to lose the baby.’ I had to stay in bed all day and took things easy the next day.

“Waiting was OK for the first three weeks. Then the results were late, more than four weeks, so I thought something had to be wrong. I started to get very depressed. Although they said they would only tell the mother the results, I couldn’t face calling myself and got Allen to phone from his office. They told him all was well and we were both thrilled, though my mother burst into tears when I told her it was another boy. The whole thing was horrible, but it was still better than another four months of worrying. Now I could look forward to the baby happily.”

Others find the process much easier than they had thought:

“It was simple. I felt nothing. My husband was there and he said, ‘Did you really not feel anything? They seemed to take a ton of fluid!’ Everyone was extremely helpful and reassuring. It was much, much easier than I had imagined it would be.”

Once the test is completed, the drawn fluid is analyzed. Cells in the fluid are cultured and grown over a couple of weeks. Then they are crushed and put under a microscope so the chromosomes can be examined. Very occasionally the test fails and has to be repeated two or three weeks further into the pregnancy:

“I had an amnio at 16 weeks after much thought and consultation. The first one didn’t take, and I had another at 20 weeks, by which time I had felt the baby moving. I couldn’t understand what was wrong with the first test. I was worried it meant something was wrong with the baby.”

The fluid is also tested for high levels of alpha-fe top rote in, which can indicate the presence of a neural-tube defect.

If you are the possible carrier of a genetic disease, tests can be carried out to identify up to almost 80 hereditary diseases. These tests are time-consuming and expensive, so they will only be done if your family has a history of an inherited illness that technicians can test for.

Waiting for the results can be the hardest part of the whole procedure. Usually women are told the results will take three weeks, though sometimes they are received sooner and rarely, later:

“They said the results would take three weeks but it only took two. They had tried to call but we were out, so they wrote us a very nice letter saying all was well.”

You are usually informed by letter or by telephone; you can telephone yourself if the results are overdue. You can also ask to know the sex of the baby if you want to, though some hospitals insist on talking this over with you first:

“We had asked to know the sex of the baby but they were reluctant to tell us. They said to go home and think about it, and asked probing questions about did we want a girl or boy. When they called to say the results were fine, they didn’t volunteer the information. We pressed for it and were told it was a girl. We didn’t really care about the sex, but we both had a slight preference for a girl. We were delighted and it was wonderful to know, which I hadn’t in my earlier pregnancies. In fact, knowing was one of the most important parts of the pregnancy.”

There is some evidence that people who desperately want either a son or daughter have problems adjusting to the baby if they know in advance that it is the “wrong” sex. In the heat of the birth itself, most parents are so pleased to know the baby is all right that they don’t think much about its sex. The baby is there to love and care for. Knowing this fact while pregnant, however, gives a parent time to brood over the as-yet unknown person and sometimes to reject the baby, making it more difficult to adjust when the baby arrives.

This is an individual matter of course and people have different attitudes about it:

“I wanted to know. I thought if it was there in my notes and other people knew, then of course I had the right to know.”

“I told them, ‘Don’t tell me!’ I didn’t want to know-it would have ruined everything, like unwrapping a present before your birthday.”

“If it’s a first baby, I think once you know you feel a little sad no matter what, because you want both - you can’t really decide which your preference is. So when they said it’s a girl, I felt sad in a way that it wasn’t a boy. But it wasn’t that I actually had wanted a boy.”

Most hospitals respect people’s wishes in the matter, but some provide limited counseling to help a couple decide if they want to know or not. Occasionally one partner wants to know the sex and the other doesn’t; this is hard to deal with. If one partner is told and hides it from the other, it puts considerable strain on a relationship at a time when a couple should be as close and open with one another as possible.

Teething is a developmental milestone for your child but can be a stressful and painful time for your baby and you.

Teething is the appearance of the first teeth through the gums; most babies will start teething around six to eight months with their last molars arriving at 20 or 30 months, however teething can begin as early as three months and continue to the child’s second or third birthday. Normally the bottom two incisors or the front teeth will come in, followed by the top four incisors.

Your baby may experience sleep disturbance, crankiness and excessive drooling and your child’s gums may appear tender and swollen. Some babies make it through teething without any pain but others aren’t so lucky and may seem cranky for weeks. Here are some tips to help you through the teething period.

1. Rub your child’s gums with a clean wet finder or cold spoon, anything cold will help ease the pain.
2. Chilled teething rings are very helpful but make sure that you don’t freeze them; frozen teething rings can cause chapped and sore lips and cheeks. Frozen teething rings can also be too hard and bruise already swollen gums.
3. Your baby will probably be drooling more often so make sure to wipe babies face often to avoid a rash or discomfort.
4. Give your baby something to chew on, for example carrot or celery sticks or a cold washcloth, as long as it is big enough for them not to choke it will work.
5. There are some over the counter teething gels that can help ease your babies sore gums but don’t rub whisky on your baby’s gums or place aspirin against the tooth.

Even though the first set of teeth will fall out, tooth decay can speed up this process and leave gaps before the permanent teeth are ready to come in. This can cause permanent teeth to come in crooked. Once the teeth are in make sure to wipe them with a warm washcloth after feedings, especially if your child is eating solid foods.

It is not recommended to put your baby to bed with a bottle because milk and formula can pool in the babies mouth causing tooth decay. It may be a good idea to get a soft infant sized toothbrush and brush them but do not use toothpaste, only warm water. You can use toothpaste once your child is old enough to spit it out, usually around three years.

The American Academy of Pediatric Dentistry recommends waiting to use fluoridated toothpaste until your child is 2 to 3 years old, and then using only a pea-sized amount. Keep toothpaste away from small children because an overdose of fluoride can be harmful.

Like walking and talking there is no exact age that every baby begins teething. If your baby is a little late with teething there is no need to worry. However if your baby has not shown signs of teething by one year old consult your doctor to find out what is causing the delay and rule out possibilities. In rare cases, delayed eruption may be the result of rickets, a vitamin D deficiency that has been linked to exclusive breastfeeding.

Although teething can be a stressful and uncomfortable time for your baby, it is possible for you to ease your child’s discomfort or completely eliminate it and make this transitional period easier on you and your child.

I can’t thank my family enough for throwing me a beautiful baby shower. They went all out - the pink and blue cake, homemade food, plates and napkins with baby buggies on them, the favors, the diaper cake, the surprise - the whole nine yards. My little girl has all pink dresses and rompers, purple bedding, fleece blankets in every sweet pastel color and enough plush toys to carry her through toddler hood.

It’s a whole new world!

You’ve planned the conception and you have conceived, however, six months into it you are bored with your pregnancy and cannot wait until it is over. Don’t worry, this is a feeling that the majority of pregnant women experience and you are not alone.

My journey through pregnancy was full of ups and downs, self-consciousness of my ever growing belly and increased weight gain, awe and joy experiencing the developments of the baby inside, and, of course, fluttering feelings of boredom. Often times, the pregnancy blahs settled upon me. During these times, the best thing you can possibly do is to keep busy.

If you are feeling the pregnancy blahs, why not get excited all over again and start planning for the new bouncing baby girl or boy? The most exciting stage of pregnancy is planning and decorating the nursery. Designing a nursery can be fun and creative and at the same time will bring you closer to the blessed event.

Where does one start?

1. Plan a budget.

   • The most important stage of planning is making a budget. Furniture, sheets, blankets, accessories, paint and extra details can make a dent in the wallet. However, be smart and make a budget for the nursery.

2. Make a List

   • Be organized and make a list of requirements for the nursery. Try and stick to your list while shopping as I can attest there are so many adorable items that make you “ooh” and “ahh” but may not necessarily be something that is required.
   • If you have a limited budget, in reality, the only piece of furniture you truly require is one where the baby can drift off to dreamland such as a crib or baby bassinet. Everything else is for convenience. For example, changing tables are nice to have but I used the floor for both of my babies.

3. Choose the Tone

   • Do you wish to have the nursery bright and colorful or subdued and neutral. Reds, oranges and yellows are colors that stimulate while soft greens, blues and creams are relaxing colors.

4. Choose a Theme

   • This stage is not necessary but makes the planning more fun and the room more interesting. There are a lot of themes choose from and if you are stuck for ideas browse through the crib bedding or nursery artwork section in stores.

5. Think Safety

   • Make your baby’s room a safe place before you bring baby home.
     1. Ensure that the crib is placed away from window treatments with dangling cords or anything that the baby can pull on top of him/her such as lamps.
     2. Place a working smoke detector in baby’s nursery or near baby’s room.
     3. Put plug protectors in unused electrical outlets.

It takes time to create an amazing nursery for baby but if you plan ahead, it will be less stressful and more enjoyable and exciting. Take time to dream about baby while completing your nursery project. It will be a whole new world before you know it!

Becoming a big brother or big sister can be a challenging time for a toddler. It is hard for toddlers and young children to fully understand the concept of a new baby. It is important to prepare your child for the new arrival and continually be sensitive to the fact that without the proper attention the new baby can be threatening and even scary for your toddler. Here are a few ways to make this transition easier on your toddler.

You can start to prepare your toddler for the new baby from the very begging. When you find out your pregnant start talking to your toddler about babies in general, once your toddler has been introduced to the idea of babies tell them that you are going to have a baby. Throughout your pregnancy show your toddler pictures of the baby from the sonograms and explain that the baby is inside of you. Show your toddler pictures of them when they were newborn and tell them the story of their birth at the hospital or home and let them know that it will be similar with the new baby. Get your toddler excited about the new baby; try to guess what it will look like and if you know the sex of the new child tell them they are having a little brother or sister. Take them to doctor’s visits and let them hear the babies heartbeat or feel the baby kick. The more you include your child in your pregnancy the easier the transition will be.

Once your new baby is born it is important to understand what your toddler may feel. They may feel jealousy toward the new baby; they may feel like you love the new baby more because it needs so much attention. Things that you do and don’t do can send the wrong message to your toddler so here are a few strategies on how to facilitate your toddlers adjustment:

• Set aside special time with your toddler every day and focus only on them, even if it’s only for half an hour while the new baby is sleeping. Your toddler is accustomed to having all of your attention and you may now find it impossible to give the same attention to them. By spending special time with your toddler if they demand your attention later in the day when you do not have time to give one on one time you can remind them of the special time you had earlier or that is coming up later in the day.
• During the first few months friends and relatives will bring gifts for the new baby and your toddler may feel left out. So have a few inexpensive gifts ready to give to your toddler so that they feel loved as well.
• Talk to your child about what it means to be an older sibling, let them know that the baby will learn from him or her and look up to them. Include your toddler in helping with the baby’s everyday routine like changing diapers of feeding time.
• A smart idea is to have a big kid box set aside for times that you will be busy with the baby and cannot entertain your toddler. A big kid box could be a shoe box filled with a few independent activities for your toddler. When you need to send your toddler to the big kid box make sure to join them as soon as you’re done caring for the baby.
• Don’t blame the baby if you are unable to do something for your child. This could make your child resent the baby. For example if you can not pick up your child while pregnant tell your toddler it is because your back hurts not because you are pregnant.

Whatever you do to plan for your new baby make sure to include your toddler in the plans as well. Make sure to talk to your child and answer any questions or concerns they may have about the new baby but don’t bring up concerns that your toddler doesn’t mention. By helping your toddler to feel secure and understand what will be happening when the new baby arrives you can ensure that this wonderful time can be shared with everyone in the family.

The first moments after the birth of your baby are wonderful for bonding with your newborn. Newborn infants are very alert during this first hour and are instinctively looking for food. Studies have been done where an infant is placed on Mother’s stomach immediately after birth. They then make their own way to the breast for their first meal.

Although much of the bonding process is instinctive and will happen naturally, it does not always happen immediately. When I was pregnant with my first child, I never felt that close bond I had heard about while I was carrying my daughter. It wasn’t until after she was born, and I got to hold her and kiss her that the bond began to form.

One thing is for sure, once the bond is there, it is impossible to break. The tie between mother and child is perhaps the strongest in existence between two people. So when it is time to separate from your child it can be extremely difficult for both of you.

Probably the first instance of necessary separation of mother and baby occurs when baby is ready to sleep alone. Giving the baby a bottle or pacifier can cause problems with tooth decay - not to mention the issue of milk leaking into the crib or spoiling during the night. If your baby has been used to sleeping next to you, then your smell is a significant factor in their comfort level. Consider using a bonding doll or toy instead of a bottle or pacifier for baby’s first night alone.

Ookie® Dolls make a wonderful bonding toy. Babies love the soft touch of the cotton flannel body and silky satin trim. The knotted hands are easy for baby to grip. Moms like them because they are lightweight and machine washable.

Cuddle the doll between you and your baby for a few nights before making the transition to the crib. This will give the doll the same scent as you and will cause the baby to associate the doll with comfort.

I used a plush bunny as a bonding toy for my youngest daughter. I started placing the bunny in her crib with her from the very first day. She is now almost 2 years old, and still adores her bunny. The most difficult part is getting it away from her to throw into the washing machine once in awhile!

There will be many more times in life when you will have to separate from your children. I also have a daughter that will be graduating from High School in a few months and moving out on her own. I don’t think this event will be any easier then it was when I placed her in her crib to sleep by herself for the first time when she was a few months old.

There’s no doubt that many private and public schools do an absolutely terrific job at providing quality education. Even so, home schooling is becoming more and more popular with parents-and for good reasons.

One of the main benefits of home schooling is pace. In the traditional systems, teachers often are forced to set the pace of learning not by the student, but by the students. A teacher will teach according to how long it takes for the majority of the class to comprehend a task or subject. This means that a special needs student who may need extra time or attention may not receive it despite the best intentions of the teacher. Likewise, especially gifted students may find themselves bored to tears and may not be able to progress as fast as they might if they were being instructed individually. With home schooling, a child’s curriculum can be adjusted to the child’s individual needs and interests.

A second benefit of home schooling is that it can be effectively applied even when a family moves a lot. Thus, home schooling may be the answer for parents who have jobs that require frequent travel. Parents are more actively involved in their child’s learning and get to spend more time with their child.

Third, technology has made home schooling incredibly easy, not to mention affordable. Parents who want to home school their children are only a mouse click away from a plethora of activities, lesson plans, and subject tests. Not only that, but there’s a multitude of various software and other tools that the kids themselves can use in order to learn. Another great benefit of the technology is that parents can do their own research to find the right materials for their child-the child doesn’t have to use a textbook of which the parents might not necessarily even approve or that doesn’t fit the needs of the child.

So what about the notions that home-schooled children are more socially inept, or that they fall behind their privately/publicly-schooled counterparts? Apparently, that may be all they are-notions. Research has shown that, contrary to popular belief, home-schooled kids consistently outperform students who go through the traditional systems-the out-performance isn’t just by a few points, either. One research study found that home-schooled kids out-performed those who go through the traditional system by up to 30 percent across the board! Not only that, home-schooled kids have been shown to be more involved in their community and to be happier later in life.

Home schooling isn’t for everyone (home schooling means that one parent must stay home, which affects family income, for example), and it’s important to realize that each state has its own set of requirements regarding home schooling. Nevertheless, home schooling does have some tangible benefits. The number of home-schooled children thus has risen significantly over the past few years. Currently, over a million children are classified as home-schooled in the United States, proving that although home schooling may not be the option, it is an option that parents can choose.

Remember when you were absolutely the only one would could Band-Aid a knee, read Hop on Pop, or even cook a hot dog? No one else on Earth but you could sew a teddy bear’s stuffing in or comb out knots or even flush that dead fish just so. You were required, necessary and essential-when you were needed.

Those were the days when your child could not live without you. Your grandchild needs you, too. So, how come his mother acts like you’re some type of pox when you come to visit?

Daughters-in-law are not the easiest mothers to please. But, there are a few things to do that might smooth out some wrinkles along the way (no, sorry-not those wrinkles).

You may need to give up your need to be needed. You’re not the first line of defense anymore, and maybe your knees are telling you that’s a happy thing. How many times do you want to get down with the Legos or search for Barbie shoes under the couch? You can be there after Mommy washes the streaming blood off the screaming child’s chin and trundles down to soak the stains out of the new white shirt. You can be there to tell the story of when Daddy fell off his bike and got stitches in the ear he got caught in his spokes-and to hand over the ice cream.

You can be dessert. You don’t have to be meatloaf and broccoli, liver and kale, tofu cubes and soy-milk. You don’t have to be protein and carbs and fiber, vitamins, minerals, antioxidants, life-enhancing flavonoids, or any other such thing. You don’t have to be, you know-nutritious-at all. You can be hot fudge if you want.

That doesn’t mean you’re junk food-don’t go overboard. Maybe a good hot fudge sundae is just the right thing after a day of liver and kale. A perfect apple might be just right after an overdose of chicken nuggets (is it possible to underdose on chicken nuggets? The things they pass off as food today… .). And it’s possible that dessert might be a good walk in the park after a day strapped in a car seat. Dessert might even be some time reading together after an hour in front of the tube. At least with all your experience, you’ll have plenty of ideas on what’s the right treat for any situation, even if the rules on what’s the right meal have changed-and they change all the time.

Your grandchild has parents-and they’re not you. It’s your daughter-in-law’s turn to be required now.

So what if you’re not carrots? Who wouldn’t rather be a cookie?

I wonder if there is anyone out there who doesn’t dread shopping with children. Who doesn’t look with pity on any fellow mom dejectedly admitting to an afternoon of errands ahead-with toddlers in tow? Even mentioning a grocery store run brings on a shudder and heartfelt condolences. There have been times when I myself borrowed milk from a neighbor rather than face those aisles with my precious little darlings pattering along behind.

Sometimes, it gets so bad, that I think the children have ruined shopping. My mother would suggest an afternoon at the mall, and I’d look at her as if she were some pod grandma from an alien torture mill. No, I most decidedly do not want to go to the mall, Mother, and watch my kids transform into bounding balls of greed, little proto mega consumers that want everything they see. I’m not ‘Mom’ at the mall; I’m ‘MommommomcanIhave?’.

Now, I understand that commerce is the American way, and ordinarily I do my part for the economy, don’t get me wrong. I like malls as much as any other citizen and enjoy trolling for stuff I want but don’t need. It used to be fun. I even used to like the grocery store-especially when I could score some tasty samples. Oh, and the warehouse super store with the giant everything? I could spend hours, not to mention dollars, there-back in the day.

So what’s a mother to do? I don’t have a clue.

I’m waiting for some age and/or maturity to kick in as my first strategy. Some day my son won’t expect to find baseball cards or lacrosse sticks in the women’s lingerie store, and my daughter won’t want every single stuffed or plastic animal she spies. I don’t hold out much hope that we’ll all agree on a shopping destination anytime soon, but I can foresee the day we’ll manage it better. Groceries, at least, will be attainable, and the neighbors won’t have to lock their refrigerators when they see me coming up their walk.

Another point in favor of just waiting it out: eventually the kids don’t have to go with me. There will come a day when my son whines, “I don’t wanna go!” (but probably in a deeper voice), and I’ll be able to say, “Fine, don’t,” and it will all be legal. My daughter will balk at the thought of the hardware store, and I will be able to leave her home. It will all be fun again, I hope.

In the meantime, of course, there’s the internet. I do online shopping for everything: groceries, clothes, toys, pet meds, and miscellaneous-which everyone knows in a typical American household is the largest category. All I have to do is fire up the hard drive and take off, and it’s a win/win all the way: No kids in tow, no gas guzzled, no globe warmed. And the best part is, I don’t even have to shower! I may miss the leisurely walk and talk through the mall with my mom, but I can make up for it surfing the net, where there are no aisles, no walls, and no worries.

Some women experience morning sickness. Others suffer drastic ups and downs in hormone levels. I had neither. Instead, I was the pregnant woman who worried about anything and everything for 10 whole months. There was one particular worry that ran through my brain over and over like a hamster on a treadmill: How was my seven-year-old stepson going to handle the change?

My stepson was an only child, and while a baby brother or sister was always top on his Christmas and birthday wish lists, we weren’t really sure how he would react when his wish came true. At seven years old, an only child gets used to having the full attention of both his parents. We spent hours in the early days of my pregnancy discussing how we could help make a smooth transition and how we could involve our big boy in every aspect of welcoming baby into the family, starting with breaking the news.

When we finally decided to share the news of a new sibling, we crafted the moment and imagined his reaction. We brought him into the guest room and told him we needed his help; we wanted to paint the room but couldn’t decide on a color. He wanted orange, his favorite color du jour. We explained it depended who lived in the room. He furrowed his brow, as we scripted he would. “Who’s gonna live in our guest room?” he asked, again, as predicted. We led him through the rest of the conversation until he finally came to the right conclusion. “I’m getting a baby brother or sister!” he screamed. He screamed; I cried. It was all going so perfectly. We tried to lengthen the moment, but as with any seven year old, his attention span was minimal. After a few jumps up and down and hugs all around, he asked if he could go back to his cartoons. No, he didn’t have any questions, he said. “O.K.” Why did I ever worry?

We must have made the offer to answer questions a million times during the next six months. I worried I would have to explain where babies come from, and I did. I was relieved to learn that a simple explanation of love, decisions and doctors was enough to satisfy his curiosity. Whew! Of course, I worried I would have to go into more detail when baby came. Thank goodness, I did not.

I worried right up until the moment I went into labor. Fortunately our son was in school when it happened. I always feared I would go into labor in the middle of the night, and our son would have lasting resentment at being whisked off to a relative’s home in his sleep. I worried again after the baby was born, and my husband left to surprise the new brother at school.

I took a deep breath when our boy walked through the hospital door. His face lit up, and he ran to hug me. He hovered over his baby sister. He was in awe of every aspect of her smallness. He watched sweetly as I fed and burped her, and he held her so gently, it was as if his arms had been waiting for her forever. His voice immediately changed into a singsong replica of his own, cooing and talking away. “I love you, baby sister,” he said. It was at that moment, I knew I would never worry again.

I highly doubt many people follow the suggestions of the experts from this show and that. These experts recommend would-be-parents set aside time before baby’s arrival to discuss how to handle discipline for the child. I think new parents have their hands full trying to make it through the first pregnancy! Despite my sarcasm, I have to agree on one point; discussing how to discipline a child must be done before the child is in need of discipline!

When baby boy is nine months old and repeatedly pulling the dog’s tail, how should you react? Some parents will insist a firm voice repeating “No,” along with physically removing the infant’s hand is enough to deter future tail pulling. Another parent may say this behavior warrants a slap on the hand. Different parents parent in different ways. What to do when the opposing parents reside in the same home? This is where communication is key.

Before baby gets to Fido’s tail, bring up the subject. Try role-playing the scenario. Find our where your partner’s disciplinary measures have their roots. Most likely, you will parent as your own parents did. As partners, you can help each other analyze the success of your parents’ methods. Did you stop hitting your sister when your mom spanked your bottom? If not, why repeat the cycle with your own son? If your wife’s parents used the Time Out method with success, why not try it for a while? No matter the decision, it’s one that needs to be made before the hand hits the tail.

Don’t limit the discussion to one behavior or one age. Consider the possibilities as baby turns one, then two, three and so on. What will you do when she hits or throw tantrums? How will you handle her refusal to eat and her defiant act of holding her breath in protest? What about the six year old who comes home from school using words best left to stand-up comics? Will his mouth be washed out with soap? Will you be truthful and explain the inappropriate meanings of the language?

Sure, it may seem pointless to plan the details of Junior’s revoked privileges when he takes the car out at age 14, but talking out possibilities will kick start an open line of communication between parents that will be easier to continue than start down the line. In addition, partners will be able to identify patterns in their spouse’s disciplinary tactics. If your husband’s reaction to most offenses involves quiet time, hugs and ‘I’m sorry’, and your punishments are more severe, involving loss of playtime or grounding, then you can consider yourself forewarned for the future. In such cases, finding common ground on the discipline field will take more work and compromise and possibly some trial and error with the kids.

So, when baby throws sand in the sandbox, you’ll be happy you and your spouse discussed discipline. Now, when she’s 15 and asks to go on a date? I’m sorry to say there is nothing parents can do to be prepared.

Over the last few decades, most of the experts have said that letting your baby sleep in bed with you is a bad thing to do. Yet, every new mom knows, especially if she breastfeeds her baby, that he is not going to fall asleep, nor will he stay asleep, unless the source of his nourishment is firmly fixed where it belongs - in his mouth.

Mother may walk him to sleep, which works until she is so weary she cannot stand up. She may rock him to sleep, sometimes accompanied with her singing. This works until he gets restless and wants to get down on the floor to play. That is what my daughter liked to do at two o’clock in the morning, after waking me from the only sleep I had been able to get all day. Then of course, the mother can nurse her infant until he just dozes off, and gently, oh so gently, ease her nipple out of his mouth, lay the dear baby down in his own little bed, put the blanket over him just so, turn out the light, tiptoe out the door, and listen to him howl in rage.

He is not where he thought he was. The world has insulted him. The world is unfair, and he will make certain everyone in it knows this.

“Let him cry it out,” my friends and in-laws advised. I was generally good for not much more than ten minutes of that. From the time my children were two months old, they could belt out their protests for hours. It was a matter of who had the stronger character, and generally I lost such tugs-of-war.

Yes, a screaming baby may well make the ugliest sound in the world. Our first instinct is to do anything in our power to calm the infant down. We need to remember that what has been called the ‘family bed,’ is not necessarily wrong, just foreign. People in other parts of the world routinely have their children in bed with them. The very notion that anyone should sleep alone would appear to be a form of torture to them. Their children grow up healthy and feeling loved and accepted in ways most of our children may not.

Most of us want to maintain those private times with our husbands, keeping them absolutely private. Yet still, the infant wails in the night, and will not be comforted except with the warmth and nourishment only his mother can give him. The plush bear in his crib can only offer so much comfort. Should we be made to feel guilty for permitting ourselves to fall asleep with our infant nestled beside us? Some of my most precious memories of my children are of those times when, weary from the day, I curled around my soft warm baby, and let him nurse until we had both drifted off to sleep.

This is not to say that my babies did not have their own beds and their own rooms. It does mean that no one rule is right for all parents and all children at all times. We have to use those wonderful minds God gave us and make the best decisions for ourselves and our children that we can.

I can’t thank my family enough for throwing me a beautiful baby shower. They went all out – the pink and blue cake, homemade food, plates and napkins with baby buggies on them, the favors, the diaper cake, the surprise – the whole nine yards. My little girl has all pink dresses and rompers, purple bedding, fleece blankets in every sweet pastel color and enough plush toys to carry her through toddler hood.

But, it was my office friends, the ones who threw me the “clean-up” baby shower, that I really need to thank. You know what a “clean-up” shower is – it’s the second baby shower, the one your “work” friends throw. They are never sure what to buy because your registry has been purchased, and you keep assuring them you have everything you could possibly need. Well, that’s what you think!

My friends at the office decided to throw a theme shower. The theme was entitled “Books and Butts.” Invitations were simply sent out via email with the poetic request that all gifts fit the theme. All of my presents were geared at keeping baby’s butt clean and dry and keeping Mommy sane with books for Daddy and baby to share!

Granted, opening presents didn’t have the same “WOW” factor, and I would later find writing thank you notes to be a bit monotonous, but each gift presentation came with advice from seasoned professionals. Each mom in the room offered her opinion as to the best diaper brand, the most economical baby wash or which story to read when my not-yet-born turns three and asks how babies are made!

My beautiful little girl is now 7 weeks old, and I have yet to buy a pack of diapers. Thanks to my friends, I know what brand works best for my little one’s bottom, after trying out every brand offered. Thanks to my friends, my husband has yet to make a midnight run for baby wipes. Thanks to my friends, I fear no diaper rash, and thanks to my friends, my little one has a library that rivals her Mommy’s.

My friend, the one who threw me the baby shower, is now pregnant for the first time with her own little one, and I can’t wait to return the favor. Now, a seasoned mom myself, I will send an email around the office, gather my advice, buy her my idea of the best brand of diapers on the market and be ready to tell her exactly why they are so. I will give her the best titles in baby books and smile knowing that whether she realizes it or not, this is the best baby shower anyone could ever have!

I can hardly believe my daughter’s room used to house a queen-size bed. It doesn’t seem natural to me anymore that the windows were once dressed in blue curtains. It feels like the room was always meant to accommodate a crib, changing table and pink galore! But, there was a time when the perfect nursery was nothing more than a vision and a couple of excited parents-to-be ready to make some changes.

Choosing a crib was a monster of a task for my husband and me. We wanted the gender of our baby to remain a surprise until birth, but we had strong opinions on furniture for a boy versus a girl. It took months to settle on a crib color we agreed would be sweet enough for our baby girl and masculine enough should our gift be a boy. Little did we realize color was only the beginning!

We both loved the sleigh bed style of crib. We didn’t like the prices. We both loved the prices of traditional cribs but feared our active infant might tip hers over during a tantrum. Neither one of us wanted a convertible crib, but the styles seemed to fit our senses. In the end we were saved by an angel. An angel, by the name of sister-in-law, presented us with a gift: a crib. And it was perfect. We could now move on to make other decisions.

From the moment I knew I was pregnant, I wanted a green nursery. I pictured sage green walls for either boy or girl. I imagined earthy plaids and denim drapes for our little man or pink gingham and cottage florals for our little princess. In the end, the pink won out. The sage green walls made the cut, and they are adorned with childhood keepsakes and family pictures. Pink gingham curtains shield our little one from the morning sun and match perfectly with her pink floral crib bumper. I believe every child’s room should be full of books, and those little hands will have plenty to choose from when she can reach into her wooden book basket that sits beneath her window. My husband refinished a now beautiful dresser, giving it an aged, distressed finish. It is big enough to hold all the pink clothes we can buy and has plenty of room on top for photos, diapering needs and a changing pad. The room is as it was always meant to be.

One day I hope to turn another guest room into yet another nursery. Moving into a bigger house will have to be the first step, but I am sure when the moment comes to tackle another nursery, I will be ready with color in mind.

Day care in a private home or family day care provides a home atmosphere and personalized attention. Typically, a mother of a child takes several others into her home during the day. This is usually less expensive than having a sitter in your home, and if the caregiver is really able to be with several children and still be sensitive to each child’s needs, the situation is a good one. Your child will develop skills by being with other children in a homey atmosphere but won’t be exposed to different workers, as she would be in a day care center.

If you’re considering family day care, meet the person in the setting where your child would be care for. Gear your questions to find out about the care giver’s priorities, interests, strengths, and experience with children. Give him or her pertinent information about your child’s needs [medical history, diet, interests, and idiosyncrasies] and your expectations. Obtain references-the names of other families whose children stay with him or her-and check them out.

General Considerations:

If you are considering family day care or a day care center, gather information on each placement you are considering so that you can compare hours of operation, vacancies, fees, adult to child ratios, and general philosophies about child care. If the center is handling very small babies, the adult to child ratio should ideally be three to one, but no more than four to one. If the children are between two to five years old, there should be one adult to five children.
Arrange to visit the most attractive options. Bring your child and go at a busy time. This way, you can check your child’s response to the caregiver and also watch the caregiver’s style of interaction of other children.

• Is the caregiver sensitive to the needs of children od different ages [especially at meal time]?
• How does the caregiver respond to a crisis?
• If you’re there early in the, how does the caregiver respond to an upset child being left by his parents?
• Does the caregiver take the time to allow the parents to express concerns/
• Is the child given enough attention to ease the pain of separation?
• Are children sensitively helped to make the transition from one activity to the next?
• When you talk to the caregiver, do you feel as though you would be a member of the “team,” defensive? It is essential for you to feel that the caregiver respects your relationship with your child and your feelings.

Look at the overall cleanliness of the center or home-let your instincts give you a reading on its feel. Does the physical environment seem safe or are there detergents or medicines within easy reach, or such dangers as uncovered light sockets? What kinds of toys are provided? Are they safe? Do they allow for creative play and skill-building? Licensed day care facilities should be able to provide you with a written program description. If you still have questions after your visit, make a phone call or follow-up visit.

Many parents are reluctant to expose a very young baby to the risk of infection outside the home and to take the chance of having an outsider bring disease into the house. Such fears are understandable, but should not be allowed to unrealistically limit your baby’s contact with people and the outside world. Germs are inevitable- you will bring them into your house yourself, and into contact with your baby. You naturally will not knowingly expose your baby to someone who is suffering a terrible cold or other communicable ailment; you can and should watch for such situations in your baby’s day care environment, and elsewhere. This sort of reasonable caution [which includes regular visits to the pediatrician and a regular program of immunizations and inoculations] should ensure that your baby enjoy normal health.

Once your child is placed in out-of-home day care, the only way to be sure that he is safe is to make unannounced visits during the day. If there are rules against this, question the rules.

During the first stage of labor, the cervix thins and softens and then dilates to allow the baby’s head to pass through the birth canal. When the cervix is fully open it is considered “10cm dilated.” This marks the transition from the first to the second stage.

Once labor has begun, contractions tend to become stronger as labor progresses, though they tend not to get closer together than about every three minutes. This means you usually get a break in between to recover from each contraction before the next one begins. Progress is not always uniform; occasionally contractions seem to run into one another, and sometimes a very strong contraction will be followed by a weaker one.

Once the woman is fully dilated, she may experience some strange symptoms. Shivering, trembling, sweating or nausea is all common. Some mothers feel restless and want to change position, often into the position in which they want to deliver the baby. At the end of each contraction the mother may begin to feel that she wants to bear down and begin to push the baby out. When the healthcare professional sees these signals, she will probably want to do an internal exam and check that you are fully dilated. If so, you are ready to begin the second stage. If you are not quite fully dilated, the nurse or midwife may ask you to “pant” during the contractions to help you resist the urge to bear down.

The Second Stage of Labor

Most women having an active labor find that the pushing sensation is a reflex and they can’t stop themselves. Usually women know instinctively to take a deep breath, lowering the diaphragm and putting pressure on the uterus. A series of short pushes at this time can be more effective than one long push. An upright or semi upright position is helpful in promoting the process; if you are lying down you actually have to push the baby uphill because of the angle of the birth canal. Most women also instinctively push with each contraction and rest in between.

With each contraction the baby should descend lower into the birth canal. At some point the baby’s head will become visible from the outside (crowning); this is an exciting moment for a partner or birth companion who is present. The mother can be encouraged to know that the baby is really there and about to be born. Just before the birth, the perineum begins to stretch to its widest. This can cause a stretching and stinging sensation. If you seem likely to tear, an episiotomy may be made (see page 116); otherwise the tissues become numb when stretched further. Once the baby’s head has crowned, it will slip out; another contraction should deliver the shoulders and then the rest of the baby.

When the baby is born it may look strange; somewhat gray colored and slimy with vernix and some blood. (Vernix is a waxy substance that helps protect the baby’s skin from fluids in the amniotic sac.) When the baby draws breath-and usually cries loudly-the color will change to a healthier pink. If the baby is breathing normally you will be able to hold your baby, discover whether it’s a boy or girl, count the fingers and toes and begin to get to know one another. Some mothers will want to put the baby straight to the breast.

The Third Stage of Labor

This is the delivery of the afterbirth. This stage may take up to 30 minutes. The umbilical cord, its job done, may be pulled gently, and the doctor or midwife may press her hand on your abdomen to assist delivery of the placenta. The uterus continues to contract. Your abdomen may be massaged to help the process along. If bleeding is heavy, you may receive medications in an effort to reduce the risk of postpartum hemorrhage.

Soon after the birth is a good time to put the baby to the breast for the first time, because research has shown that the sooner after the birth a baby feeds, the more likely it is that breast-feeding will be successfully established. In nature, the baby’s sucking at the breast helps with delivery of the afterbirth. Not all mothers and babies are ready for a breast-feed, however, so don’t feel rushed; take the time you need to get to know one another.

Women who have spent some time considering pregnancy in general want to make sure they are in the best health and have done everything possible to ensure they have a healthy child. Older women in particular may be anxious to do everything they can to offset the possible risks involved in being an older mother. You can take practical steps in advance to prepare yourself for the healthiest possible pregnancy.

It’s important to check that you are immune to rubella (German measles) before you start trying to conceive. Catching this disease, particularly in the first months of pregnancy, causes severe disabilities in the child or a miscarriage. If you are not immune, you can be vaccinated against rubella before you conceive. It is also a good idea to check whether you may be carrying a sexually transmitted disease. Hard-to-diagnose infections such as Chlamydia, Gardnerella and Mycoplasmas may be implicated in miscarriage and premature delivery. Blood tests for viruses such as cytomegalovirus, which can cause abnormalities in the baby, may also be worthwhile.

Stopping Contraception

If you have been relying on an IUD, you will need to have it removed by a doctor before you conceive. As soon as an IUD is removed, you can get pregnant. If you get pregnant by chance with an IUD in place, it does carry risks for mother and baby. You are more likely to have an ectopic pregnancy-a pregnancy that occurs outside the womb, usually in the Fallopian tubes-and there is a high risk of miscarriage. As many as 60% of such pregnancies end before term. The miscarriages are more likely to occur in the second three months of pregnancy. IUDs are usually removed while you have a period, because the cervix is slightly dilated then and this aids removal.

If you have been taking the Pill, stop taking it two or three months before you wish to conceive. You can use a barrier method, such as the condom or diaphragm, or natural family planning (rhythm method) during this time. (But be aware you are unlikely to use natural family planning effectively if you have not spent some time learning the technique and observing your menstrual cycle.) Studies have shown that women who took the Pill inadvertently in early pregnancy have only a very slight extra risk of having an abnormal pregnancy or a child with disabilities. Those who conceive as soon as they stop taking the Pill face no extra risk.

All the same, it is a good precaution to make sure that your body is free of all drugs before you get pregnant. It also helps to date the pregnancy if you have had one or two normal menstrual cycles before you conceive because this allows for good pregnancy care.

There is, however, some evidence that women who conceive while using spermicides, whether on their own or in combination with the diaphragm, cap or condom, run a slightly higher risk of a miscarriage (and, incidentally, also a greater chance of having a girl). It is obviously better to conceive when there are no traces of spermicide in the vagina. If you intend to try to conceive, it may be a good idea to ask your doctor to do a cervical smear and perhaps to take a swab to check that you do not have any vaginal infection, such as thrush, before you get pregnant. This will usually be done at your first prenatal appointment when you are pregnant anyway, but some women prefer not to have a vaginal examination in early pregnancy, especially if they have had a miscarriage or threatened miscarriage in the past. It also makes sense to clear up any infection before rather than after a pregnancy has begun.

While day care centers often have long waiting lists, they offer good hours and shift workers so they can remain open from very early in the morning until evening.

Your child will have playmates and you will likely meet other working parents, making the day care center the hub of a sort of extended family. If this community aspect appeals to you, you’ll want to find out whether the center does anything to encourage communication between parents.

If you’re considering a day care center, the workers should be well trained and well paid. A poorly trained dissatisfied worker is probably not going to have the skills or the patience to deal well with both the demands of the children and her own frustrations; abuse or neglect could result. Questions you should ask include: How much employee turnover is there? Do the workers seem happy? Do they seem to respect each other?

Day care centers may be privately owned or operated by nonprofit groups such as parents’ cooperatives [which allow parents active involvement], educational institutions [sometimes to provide training for students], or municipalities. A licensed center is governed by regulations concerning things like the ratio of caregivers to children. You can receive a copy of the exact regulations in your state from the human service agency that monitors the licensing. When you have a choice, choose a licensed center or care provider. In some states, in-home caregivers must be licensed.

Many of the ways you can save time center around good organization. Of course, definite scheduling of your time is impossible now; you can’t be sure exactly when or how often your baby is going to need you. Every plan you make that involves other people or a specific time must be expendable of have an alternative. This way, you can shift gears at a moment’s notice when your baby requires an extra feeding or when some other normal but unanticipated takes place. At the very least, you’ll want to consistently allow more time than you think you’ll need for everything. Experienced parents have found many ways to save themselves time and confusion as they go about the business of life with a new baby. Here are some of their ideas:

• Keep shopping lists, lists of chores that must be absolutely done, and lists of thank-you notes to be written for baby presents. By writing everything down, you free yourself of having to remember details at a time when you are most apt to be forgetful and preoccupied.
• At night, do as much as you can to get ready for the next day. Set the table for breakfast, lay out clothes for yourself and the baby, pick up the newspaper. Any nuisance chores and decisions you can handle ahead of time will make the day start that much better.
• Cut down on time consuming trips around town by banking by mail and shopping by phone or through catalogs whenever you can. Try to do several errands when you are out, and plan them so you waste the least possible amount of time driving around.
• Practice doing two things at the same time: make out a grocery list or do your stretching exercises while you talk on the phone; fold the laundry as you watch television; or clean the bathroom as the tub fills.
• Above all, do not rush, “Haste makes waste” is a cliché, but it is as true today as it was when it was first uttered by someone who knew that the faster he or she tried to do something, the more likely it was that there would be an accident.

This is an artificial way of starting labor. Labor may be induced if all indications are the baby is overdue or if there is some need to deliver the baby early. Normally you will not be allowed to go much more than two weeks past your due date if the dates are firm and have been confirmed by ultrasound. There is some risk that the placenta will not be functioning as well by then. This is a particular risk in older mothers. Induction doesn’t always work. Then the mother may be under pressure to have a Cesarean.

“They took me in when the baby was due and said they’d like to induce me. They said that the placenta fails quickly in older mothers and I was 47. They said there was no sign of placental failure, but that this was a fact. They tried to induce me and it failed. The next day they tried again, but the doctor said, ‘Let’s do a Cesarean, we want a healthy baby.’ So they did.”

Tests can be done to find out that the placenta is working normally. You may also be asked to keep a record of the fetus’ movements. If there is evidence the baby is not growing well, that fetal movements are becoming infrequent or the mother is suffering from high blood pressure, then induction will almost certainly be recommended. By this time, many women are quite willing for the birth to be induced:

“The last few months of pregnancy I was in and out of the clinic having tests. I had an agonizing pain under the ribs, which I knew was from the baby, but they wanted to be sure it wasn’t something else. I felt incredibly tired-I couldn’t cope with the pain and not sleeping-so they decided to induce the birth. I was happy about that. But when I went to the hospital they told me I was too tired to cope with labor-to go home, rest for a week, not do anything. ‘Then, if the baby doesn’t come, we’ll induce it next week.’”

Labor can be started artificially in several ways. The membranes containing the waters can be broken if the baby is overdue or near term. This usually starts labor. But if it doesn’t, other intervention will be needed. That’s because if the baby isn’t delivered within 24 hours after the waters have been broken, he or she is at risk of infection. An artificial rupture of the membranes (ARM) or amniotomy is performed with an instrument that looks like a long crochet hook. This procedure is normally painless. The technique is also used to speed up labor. Once the waters have broken, the baby’s head, unprotected by the bag of waters, presses harder against the cervix, encouraging the uterus to contract. The contractions will become much stronger and you will also feel some of the waters gushing out with each contraction.

Prostaglandin suppositories may be used to start labor. These are usually inserted into the vagina. The effect of the hormones close to the cervix is to trigger labor. A man’s sperm contains prostaglandin, which is why women at risk of a premature birth should avoid full sexual intercourse and why one of the best natural ways to induce labor is to make love. A prostaglandin induced labor works well because, once started, it can proceed without further intervention.

If labor does not start in any other way, an oxytocin drip is used. Oxytocin is the hormone that naturally causes the contractions of labor. Various artificial forms of oxytocin can be used. (The trade name is Pitocin’v.) A drip is inserted into your arm-you can ask to have it put into the arm you use least. You can also ask to have a long tube connecting you to the drip so you can move around and change position as much as possible. Contractions caused when you are on an oxytocin drip are usually stronger, longer and more painful. You may also find that you are plunged into the height of labor without having time to adjust to gradually increasing contractions. This can make the pain more difficult to cope with. In fact, pain relief is often necessary in these circumstances. This in itself can lead to further intervention.

Once you’ve made a day care choice, whatever it is, finalize all arrangements in writing. If you are hiring a caregiver, you’ll need to draft a letter that covers your agreement with that person with regards to hours, salary, responsibilities, sick leave, and vacation. A licensed day care will have forma available.

You’ll need to explain all of this to your child-what’s going on, where you’ll be going, who will be taking care of her, and that yes, you’ll be coming back for her. You may need to stay with her a while the first few days; decrease the amount of time each day. Allow a reasonable amount of tome for your child to become accustomed to the arrangement. If your child seems upset at the end of the day, after a reasonable settling in period, you’ll need to find out why. Stay in touch with the caregiver on a weekly basis. Try to maintain a collaborative, supportive relationship. Work together to solve any problems that may arise.

Toilet-Training Equipment

Successful toilet-training will be a combination of good timing [ the child must be ready] and the parents’ understanding of the complexity of the process [being able to break it down into a series of simple tasks] . For most children, the ideal time is around two years of age-a time when they can follow verbal instructions, have good muscle control, and take pride in doing things by themselves.

What you’ll need is really not much. Training pants aren’t necessary, because they shrink a lot when washed, making them hard to take off. They’re also bulky, like diapers-a child may forget that wetting her pants is no longer acceptable. Buy regular children’s underwear to mark the transition and instill some pride in your child about growing up.

You can buy either a potty that sits on the floor or a seat that adapts o the adult flush toilet. There are arguments for and against each. Generally, children who have older siblings are more motivated to use the adult toilet because they want to be grown up like their brothers and sisters; they often do very well with the adapter seat. Children who don’t have older siblings often experience a fear of heights on the adapter seat, and some have a real fear of all that flushing. The adapter seat is more portable and obviously doesn’t involve emptying, but if it fits poorly, it can slip or break, causing the child to fall off or in. Also, children tend to urinate off to the side, wetting the adult seat or the floor. No difference in ease of training has ever been found between adapter seats and potties, so the choice is yours.

Go on a preliminary shopping trip for the potty or seat. When you’ve whittled it down to two choices, bring your child with you to assist in the final selection. Have your child sit on the seats to see which is more comfortable. This will give her an investment in what’s about to take place.

If you’re looking at adapter seats, take them from the package to be sure the edges are smooth and round and not sharp. There should be a flexible front shield for boys, preferably of a rubber-like material that won’t hurt your son bumps against it. The catches holding the seat on should be rubberized or of some other non-scratch material to prevent damaging the adult seat. If your buying an adapter seat, you’ll also need to buy a footstool so your child can climb up to the seat.

Potties are portable and easy for children to use. Look for one with a seat top that can later be used as an adapter seat. Potties with plastic seats are superior to those with wooden ones, they’re easier to clean and fit children better. Find one with a wide base for increased stability. Also, rubber tips under the potty will prevent it from sliding as your child slides on to it. Make sure all edges are smoothly finished., and check to see if the splash guard is flexible. Potties with top loading chambers are best because they’re easier to empty without spills. In fact, children can eventually learn to empty these themselves.

Table and Chair

Get rid of the highchair as soon as you can, since all highchairs present a risk of falls. Besides, once your child is two, she will consider the highchair a prison Having a chair and table. of her own will allow a child to spread out her things for work, play, or eating, making it a very important piece f equipment..

Buy the largest table you can afford or have room for, definitely no smaller than twenty by thirty inches. Many suppliers make sturdy tables and matching chairs for children. Some even have adjustable legs. But you don’t have to buy something that’s sold as a child’s table. One mother covered a Parson’s table with oilcloth and then bought a few sturdy child-sized chairs to go with it. The chart that follows specifies heights for tables and chairs at different ages, but if you can afford only one set, and you can’t find one with adjustable legs, go with a table hat’s at least twenty-two to twenty-four inches high and a seat that’s about thirteen inches high. There should always be eight to ten inches of room between the chair seat and the table.

Shelves for Toys, Books, and Other Belongings

Buy sturdy shelves with no sharp edges. The shelves should be affixed low on the wall, so a child can’t pull things down on his head, it’s a good idea to store soft things, like stuffed animals on the highest shelves.

Toy Chests

Though toy chests are immensely practical [and useful for teaching a small child to put her belongings away], they are not without hazards. The two most prominent dangers are sharp edges that could injure your baby if she should fall against the toy chest, and a tight-fitting lid that could trap your baby inside, suffocating her. Though the possibility of the later may seem remote, it is a very real danger.

When choosing a toy chest, look for the following features:

1. Sturdy construction
2. Smooth surfaces, with no sharp corners or edges
3. A gap of at least a half-inch between the closed lid and the chest
4. A hydraulic closure that will prevent the lid from slamming onto your baby’s head

Be sure that the inside of the box has no latch or other locking mechanism that could trap your child inside. Ideally, the chest’s lid should be light enough for a baby to push it upward with little effort.

If you’re unable to find a commercially manufactured toy chest that suits your specifications, consider making one yourself, or having one custom made. Finally, don’t pass your own old toy chest [or anyone else’s] unless you know it is safe.

This essentially means that you pay a sitter to stay in your home with your child. With a small baby, this may be the easiest option, since only one environment is involved. This is also the most expensive option, and doesn’t always pan out as the best one, since in-home caregivers often burn out and have been known to put the child in front of the television and carry on with their normal routine. Finding a person who has an emotional reason for wanting to take care of someone else’s child may help; financial motivation alone does not guarantee superior care.

If you’re hiring a mother’s helper, you should have a sense that she respects your child and understands his needs-and yours. Is she willing to structure a nap into the afternoon so that your child is not cranky when you get home? If your child is rested, you can spend some quality time with him. Most important, what do your instincts tell you about this person? Do you think you can have a cooperative relationship with her? Check references. Once you’ve hired a candidate, find some reason to go home unannounced during the day in order to get a sense of what’s happening. Does your sitter run out the door as soon as you arrive home, or is she able to tell you what your child did that day, giving you a sense that she is involved and concerned?

The longer a couple has been together before having a baby, the harder it may be to adjust to having a new baby. Research shows that the most stressful and difficult time in a marriage is after the birth of the first baby. There’s no doubt that the birth of a baby can rock a marriage. The couple suddenly has much less time for one another and sex often suffers.

Having a baby can completely change the nature of a couple’s relationship. “Before we had the baby we used to go out a lot, see friends, we were always doing something. Suddenly we were both at home, and our worlds completely diverged. He was still out there, doing things, meeting people, and when he came home all I had to report on was whether the baby had been particularly fretful or some possible problem with his health.”

Sex, too, suffers in the weeks and often months after the birth.

Studies have shown that the majority of mothers do not have sexual intercourse with their partners till at least six weeks after the birth of the baby. One study showed that more than half the women said they were less interested in sex three months after the birth than before pregnancy, and by a year after the birth 57% of women were still not having sex as often as before.

The delay in resuming sex after the birth is partly for medical reasons. Stitches have to heal, bruising has to clear up, there is a possible risk of infection, and the mother often still has lochia, or post-childbirth bleeding. Contraception, too, is an issue. A cap or IUD (intrauterine device) cannot be fitted until six weeks after the birth. The Pill is not advised because it may reduce the milk supply, and hormones are passed through in the breast milk to the baby. (The mini-pill does not affect the milk supply and there is no evidence the hormones harm the baby. However, the mini-pill has not been in use long enough for a generation to grow up and have children themselves, so most mothers are wary of taking this version of the Pill while breast-feeding.) Many women-and their partners-see the six-week check as an “all clear” to resume sexual relations if all is well.

Most mothers, however, find that their libido is altered by becoming a mother and that they do not want to have sex as often as before or even at all. This may be partly physiological, a result of the hormone changes following pregnancy and during breastfeeding. It may be partly psychological, and it may also be partly due to exhaustion.

Breast-feeding in particular seems to have an effect on libido.

While nursing her baby, the mother has a high level of a hormone, prolactin, in her body, which helps suppress ovulation. This seems to dampen libido and may also lead to a decrease in vaginal lubrication. This may be nature’s way of making sure the mother doesn’t get pregnant again too soon and that the baby isn’t therefore displaced from the breast. In hunter-gatherer societies, the oldest kind of social group, it is typical for the baby to be weaned from the breast when the mother conceives again. This isn’t usually until the first child is three or four years old, partly because frequent breast-feeding acts as a contraceptive, but also because sexual intercourse is taboo when the mother is nursing a young baby. In such cultures breast milk is an important source of protein for the young child. In some regions of Africa, the word for some kinds of malnutrition means “baby displaced too soon from the breast.”

Some mothers say sex and breast-feeding don’t mix: “I would have this tiny, delicate baby at my breast, stroking me with his little hand, and then I’d put him down and this big hairy male hand would grab me.” Some women find they do not like having their breasts touched by their partner while breast-feeding: “I felt my breasts were for my baby. If my husband touched them they’d start leaking milk and, because I wasn’t the world’s greatest milk producer, I’d worry about the milk that was going to waste. I also used to leak milk when I had an orgasm, so we always had to have sex just after I’d fed the baby.”

Other mothers find they enjoy the physicality of breastfeeding and enjoy sharing it with their partner: “I had plenty of milk-too much, in fact-so sometimes I’d let Nick have a taste. It was also useful sometimes-I’d get him to suck a little to get the milk to let down when I wanted to express some, or if I got overfull and engorged.”

Psychological reasons why the mother may not want sex have to do with her image of her body and of motherhood. This may especially be the case if a mother has had a bad labor. “I felt as if I had been raped. I had been taken over, manhandled by doctors, and awful things had been done to the most intimate parts of my body. Aside from all the stitches, inside and out, which got infected and took weeks to heal, I felt traumatized. I couldn’t bear to be touched for months afterwards.”

Others feel they have lost some of their sexual attractiveness.

This may be truer of older mothers, who may find that the stresses of pregnancy and birth take a heavier toll on their body and that it takes longer to get fit again. “I had put on weight and my tummy was just a flabby, empty bag. My breasts had changed shape and I just didn’t feel that I could be attractive to my husband.”

Again, other mothers, especially those who have enjoyed a good birth experience, find the opposite. “I felt I was really a woman now-my breasts were large and full of milk. I went back to my original weight very soon after the birth, and I felt really sexy and fulfilled. Maybe that was also because my partner made it clear that he found me very exciting and sexy as a mother.”

Many partners do not understand if the woman has lost interest in sex. Many, especially if they have not had sex at all in the late months of pregnancy and in the weeks after the baby is born, do not see why, after a couple of months, their sex life should not get back to normal. This can certainly strain the relationship. The important thing is to talk about it and get it out in the open, rather than bottling up feelings.

Some mothers find that, although they may not feel like having sex at first, it is very important for their partner. So they make the effort:

“I never felt like making love, with a new baby and a demanding toddler on my hands all day. But every so often I would take a deep breath and just do it. And then I always thought, ‘This is really nice-why don’t we do it more often?’”

Some women find that the more they make love, the more they feel like making love, while the longer they abstain, the less they feel like having sex. In other women, not feeling like making love is a symptom of depression. It expresses a lack of positive feelings for themselves as a mother.

“It took months for me to realize that my lack of interest in sex was really a symptom of postnatal depression. I felt so uninteresting, so ugly and so low in self-esteem that I didn’t understand why anyone would want to make love to me.”

Partners need to be sympathetic, understanding and supportive at this time, and most are. But there are also some who, not finding sex inside the marriage, look for it elsewhere. If the infidelity is discovered, the wife can be shocked and feel betrayed, though many marriages survive an infidelity. Fear their husbands may go elsewhere if they don’t provide at least a minimum of sex is one reason many women say they have sex after childbirth: “It wasn’t for me. I could take it or leave it, and would have been happier to leave it. But I couldn’t help feeling sorry for him, and I didn’t want him to get so desperate he’d start looking elsewhere.”

Perhaps the best solution is for husbands to be actively involved in childcare, getting up in the night, and so on. Then they may also feel too exhausted to want sex.

Because of these tests, many women enjoy their pregnancy free of certain worries. But for many others, the tests present some very difficult choices. Some women feel they can only start a pregnancy in later life because they have the option of learning if the baby has chromosomal abnormality. Others feel uncertain about this “advantage:”

“We agreed we couldn’t cope with a baby with severe disabilities, so I had all the tests. But I don’t think having the tests influenced my decision to have a baby. Having a baby is a very emotional decision. I was glad to have the tests but I didn’t really think about it in advance-I would have taken the risk.”

Other mothers regret the existence of such tests, because they feel it puts an extra strain on the pregnancy:

“Because I was 38 when my first baby was conceived, I decided I would have the amniocentesis done. This turned the first six months of my pregnancy, a time that should have been a happy one for me, into a nightmare.

“First I refused to ‘bond’ with the baby in my mind, in case there was something wrong with him or her. By the time the test was to be done, I’d worked myself into a state about it, and convinced myself the result would be bad.

“When the test was done I felt contractions, as if I were starting labor, which terrified me. Later I had a threatened miscarriage, which I’m sure was connected. I heard results sooner than I expected, but it was neither a positive nor a negative result, because the test hadn’t taken. I was told there was just enough time to repeat the test if I wanted to. After a lot of agonizing I decided to do this.

Again I had to wait two weeks-in fact a little longer-before the result came. Everything was fine. I was so relieved! But the whole episode made me feel very protective toward my baby, not wanting him to be interfered with-and at the same time, alienated all that time from him in case he was abnormal.”

Because amniocentesis is normally carried out at 16 to 18 weeks, and the results take from two to four weeks to come back, a woman can be as far along as 22 weeks pregnant when she learns her baby is not healthy. Recently amniocentesis has been performed as early as 11-1/2 weeks, allowing for vaginal abortion at 14 weeks. This means she will have felt the baby move and she will be having an abortion almost at the time when the baby could live if it were born prematurely. The abortion will be a regular labor, although the fetus is terminated first by the injection of hypo-saline solution or chemicals into the womb. Labor is induced medically, usually with prostaglandins, and may last a long time. Many women find this kind of labor a terrible experience:

I couldn’t bear to think about it or talk about it. It was a travesty of everything I’d ever read about the glory and wonder of childbirth. It was agony, and I just wanted to be drugged until it was all over. I wouldn’t let my husband be there; I couldn’t have stood it for him to have to suffer it too.”

Although choosing to have a termination is a terrible and shocking experience, those couples who do so find it preferable to bringing a child with severe disabilities into the world. However, some couples do choose to bring up their children with disabilities, or adopt other people, and find great rewards in doing so:

“Of course it was hard at first to have a baby with Down syndrome, and we’ve had difficulties since he was born. But in the end we just loved him - he’s our child and he’s brought a lot of love into our lives.”

Some mothers feel the screening tests put too much pressure on them and medicalize the pregnancy. “Before my first baby was born when I was 37, I had all these tests. I felt I had been taken over by doctors. I spent hours waiting at my doctor’s office and at labs. They were offering a whole variety of new tests, including a blood test that was supposed to detect a person’s higher risk of having a baby with Down syndrome.

“After the blood test, I got a phone call to say the result was positive. I was so distressed; I couldn’t understand what they were saying at first. They explained the result was borderline but that I should come in and talk about an amniocentesis. They told me that the risk based on my age alone was 1 in 287 while with this test it was 1 in 100.

“Did he advise an amniocentesis? It was borderline. He thought it would put my mind at rest. I pointed out that until I’d had this blood test my mind was at rest. My husband and I talked it over, and we decided to have the amnio. I hated it, and I hated waiting for the results, which were fine. With the second baby 18 months later, I opted out. Everybody said, ‘But you’re at more risk,’ but I just didn’t want to know. I turned down everything, even the AFP blood test. My obstetrician was supportive; he said it was my right to have the tests or not. The pregnancy and birth were very straightforward and I had a very healthy child.”

A great deal has been written about postnatal depression, but very little about prenatal depression, although it is certainly common for women to be depressed in some stages of pregnancy. Many women feel overwhelmingly tired. Social engagements, work, housework and relationships all suffer if other people do not understand:

“I used to go to bed whenever I could. The house got really, really messy because I couldn’t face cleaning it. I couldn’t be bothered to cook nice meals and I didn’t have the energy to go to parties or to movies with friends. My husband used to groan because every night about nine o’clock I’d just say, I’m exhausted, I’m going to bed now.’ A lot of the time I was too tired for sex as well.”

Depression is perhaps particularly common in a second pregnancy, especially when the woman has a toddler or young child to care for. No one makes quite the same fuss over you after the first pregnancy, and it is harder to get the extra rest you need. Working women may find the second pregnancy particularly tiring and feel that they are not being efficient at their work, which can contribute to feelings of depression.

Older women in pregnancy, particularly, may worry about the health of their baby and about the birth itself-whether they will have complications and whether there will be anything wrong with the baby. Their attitude may depend to some degree on the attitude of the health professionals who care for them in pregnancy:

“I found out I was pregnant by accident in my early forties, too late to have an abortion or even the tests my provider was very nervous about it and my husband worried and thought something would be wrong. The scans indicated a different due date and showed the baby was small-it was a scary time.

“I worried about the birth because of my age, but the genetic counselor was fantastic. He said, ‘You’re a healthy woman-you should have a super-easy birth’ - he was very reassuring.”

The longer a couple has been together before having a baby, the harder it may be to adjust to having a new baby. Research shows that the most stressful and difficult time in a marriage is after the birth of the first baby. There’s no doubt that the birth of a baby can rock a marriage. The couple suddenly has much less time for one another and sex often suffers.

Having a baby can completely change the nature of a couple’s relationship. “Before we had the baby we used to go out a lot, see friends, we were always doing something. Suddenly we were both at home, and our worlds completely diverged. He was still out there, doing things, meeting people, and when he came home all I had to report on was whether the baby had been particularly fretful or some possible problem with his health.”

Sex, too, suffers in the weeks and often months after the birth.

Studies have shown that the majority of mothers do not have sexual intercourse with their partners till at least six weeks after the birth of the baby. One study showed that more than half the women said they were less interested in sex three months after the birth than before pregnancy, and by a year after the birth 57% of women were still not having sex as often as before.

The delay in resuming sex after the birth is partly for medical reasons. Stitches have to heal, bruising has to clear up, there is a possible risk of infection, and the mother often still has lochia, or post-childbirth bleeding. Contraception, too, is an issue. A cap or IUD (intrauterine device) cannot be fitted until six weeks after the birth. The Pill is not advised because it may reduce the milk supply, and hormones are passed through in the breast milk to the baby. (The mini-pill does not affect the milk supply and there is no evidence the hormones harm the baby. However, the mini-pill has not been in use long enough for a generation to grow up and have children themselves, so most mothers are wary of taking this version of the Pill while breast-feeding.) Many women-and their partners-see the six-week check as an “all clear” to resume sexual relations if all is well.

Most mothers, however, find that their libido is altered by becoming a mother and that they do not want to have sex as often as before or even at all. This may be partly physiological, a result of the hormone changes following pregnancy and during breastfeeding. It may be partly psychological, and it may also be partly due to exhaustion.

Breast-feeding in particular seems to have an effect on libido.

While nursing her baby, the mother has a high level of a hormone, prolactin, in her body, which helps suppress ovulation. This seems to dampen libido and may also lead to a decrease in vaginal lubrication. This may be nature’s way of making sure the mother doesn’t get pregnant again too soon and that the baby isn’t therefore displaced from the breast. In hunter-gatherer societies, the oldest kind of social group, it is typical for the baby to be weaned from the breast when the mother conceives again. This isn’t usually until the first child is three or four years old, partly because frequent breast-feeding acts as a contraceptive, but also because sexual intercourse is taboo when the mother is nursing a young baby. In such cultures breast milk is an important source of protein for the young child. In some regions of Africa, the word for some kinds of malnutrition means “baby displaced too soon from the breast.”

Some mothers say sex and breast-feeding don’t mix: “I would have this tiny, delicate baby at my breast, stroking me with his little hand, and then I’d put him down and this big hairy male hand would grab me.” Some women find they do not like having their breasts touched by their partner while breast-feeding: “I felt my breasts were for my baby. If my husband touched them they’d start leaking milk and, because I wasn’t the world’s greatest milk producer, I’d worry about the milk that was going to waste. I also used to leak milk when I had an orgasm, so we always had to have sex just after I’d fed the baby.”

Other mothers find they enjoy the physicality of breastfeeding and enjoy sharing it with their partner: “I had plenty of milk-too much, in fact-so sometimes I’d let Nick have a taste. It was also useful sometimes-I’d get him to suck a little to get the milk to let down when I wanted to express some, or if I got overfull and engorged.”

Psychological reasons why the mother may not want sex have to do with her image of her body and of motherhood. This may especially be the case if a mother has had a bad labor. “I felt as if I had been raped. I had been taken over, manhandled by doctors, and awful things had been done to the most intimate parts of my body. Aside from all the stitches, inside and out, which got infected and took weeks to heal, I felt traumatized. I couldn’t bear to be touched for months afterwards.”

Others feel they have lost some of their sexual attractiveness.

This may be truer of older mothers, who may find that the stresses of pregnancy and birth take a heavier toll on their body and that it takes longer to get fit again. “I had put on weight and my tummy was just a flabby, empty bag. My breasts had changed shape and I just didn’t feel that I could be attractive to my husband.”

Again, other mothers, especially those who have enjoyed a good birth experience, find the opposite. “I felt I was really a woman now-my breasts were large and full of milk. I went back to my original weight very soon after the birth, and I felt really sexy and fulfilled. Maybe that was also because my partner made it clear that he found me very exciting and sexy as a mother.”

Many partners do not understand if the woman has lost interest in sex. Many, especially if they have not had sex at all in the late months of pregnancy and in the weeks after the baby is born, do not see why, after a couple of months, their sex life should not get back to normal. This can certainly strain the relationship. The important thing is to talk about it and get it out in the open, rather than bottling up feelings.

Some mothers find that, although they may not feel like having sex at first, it is very important for their partner. So they make the effort:

“I never felt like making love, with a new baby and a demanding toddler on my hands all day. But every so often I would take a deep breath and just do it. And then I always thought, ‘This is really nice-why don’t we do it more often?’”

Some women find that the more they make love, the more they feel like making love, while the longer they abstain, the less they feel like having sex. In other women, not feeling like making love is a symptom of depression. It expresses a lack of positive feelings for themselves as a mother.

“It took months for me to realize that my lack of interest in sex was really a symptom of postnatal depression. I felt so uninteresting, so ugly and so low in self-esteem that I didn’t understand why anyone would want to make love to me.”

Partners need to be sympathetic, understanding and supportive at this time, and most are. But there are also some who, not finding sex inside the marriage, look for it elsewhere. If the infidelity is discovered, the wife can be shocked and feel betrayed, though many marriages survive an infidelity. Fear their husbands may go elsewhere if they don’t provide at least a minimum of sex is one reason many women say they have sex after childbirth: “It wasn’t for me. I could take it or leave it, and would have been happier to leave it. But I couldn’t help feeling sorry for him, and I didn’t want him to get so desperate he’d start looking elsewhere.”

Perhaps the best solution is for husbands to be actively involved in childcare, getting up in the night, and so on. Then they may also feel too exhausted to want sex.

Normally the baby is born with the head down, facing backwards, so the widest part of the baby’s head passes through the widest part of the pelvis. The baby’s head pressing down on the cervix helps it dilate, and the baby rotates as it is born, helping the body slip out behind the head.

Some babies, however, are born in a different position. This normally causes problems in labor. A posterior presentation means that the baby faces forward; its spine can press against the mother’s as it moves down, causing her pain and slowing labor. And because the widest part of the baby’s head is passing through the narrowest part of the pelvis, the baby can get stuck here more easily, again prolonging labor and sometimes requiring the use of forceps.

A breech birth occurs when the baby does not turn, so that the head is not born first; breech babies are normally born buttocks-first, occasionally feet-first. About four births in a hundred are breech. Most breech births are straightforward, though you are most likely to need intervention, especially in a first birth. Many women are advised to have an epidural; usually the baby’s head is delivered with forceps to protect it, and you are likely to have an episiotomy to help the baby’s head out. If you wind up needing an emergency Cesarean, the epidural will already be set up.

Medical Intervention

Over the past decade or two, hospitals have increasingly used a variety of techniques that have revolutionized the process of childbirth. Most of these are intended to save lives, and frequently they do. However, many interventions have become routine in some hospitals, thus interfering with the birth process for many mothers who are not at risk. Hospitals are now more likely to discuss any possible intervention with you. You should make your views clear, although obviously everyone involved should accept that intervention may be necessary in case of an emergency.

Episiotomy

An episiotomy is a small incision made in the perineum, the skin between the vagina and the anus, to enlarge the vaginal opening and help the delivery of the baby’s head. The cut is made with scissors under a local anesthetic when the baby’s head comes into view. Done properly, the perineum will have stretched very thin and the cut can be made with a minimum of damage and bleeding. An episiotomy should not be necessary in a normal delivery, and you can ask not to have one if you prefer.

However, there is some controversy over whether it is better to have a small episiotomy or risk tearing the perineum when the baby’s head is born. Some feel that a small tear is better and heals more rapidly, while others believe it is easier to sew up a clean cut. You should not be in great pain when the stitches are put in; if you are, ask to have more local anesthetic.

Many babies urinate minutes after birth. This is an important milestone and is recorded in your baby’s medical chart when it happens.

The first bowel movements of a newborn baby are called meconium, which forms in the intestine long before birth. In fact, some babies pas some meconium while still in the uterus. It mixes with the amniotic fluid. While this is usually harmless, when your doctor spots meconium in your amniotic fluid during labor, he or she will be concerned that the baby not inhale it deeply with the first breaths after birth. If meconium is breathed deep into the lungs, it can cause breathing problems, if meconium is present, deep suctioning with the mucous trap is done before the baby breathes.

Many parents are unprepared for their babies’ strange bowel movements. Your baby will have a meconium bowel movement within a few hours after birth. Meconium is black and sticky and difficult to clean off. Some parents think ahead and rub olive oil on their baby’s bottom before it happens. It is then much easier to clean off.

As the baby begins to fed, the bowel movements become runny and greenish-brown. Once the colostrum has changed to milk, a breastfed baby’s bowel movement becomes yellow and liquid and nearly odorless. Breastfed babies normally move their bowels anywhere from once a week to once each feeding. Formula-fed babies move their bowels less frequently, and their bowel movements are dark, firm, and strong smelling.