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.

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.

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).

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.

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.

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.

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.

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.

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.

Once settled in at the hospital, you will find a routine for handling contractions, perhaps based on what you learned in childbirth classes. For example, the following is a routine that many women learn and use successfully with their contractions.

1. Greet the contraction with a long sigh. As you breathe out, release all bodily tension.
2. At the same time, focus your attention in some way [for example, focus on you partner’s face or a picture or object of your choice, close your eyes and "see" your cervix opening as your uterus contracts;" see" a peaceful, relaxing place and picture yourself there; focus on music of your choice, or the soothing voice of your partner; or focus on the feel of your partner holding or stroking you].
3. Breathe slowly and easily.
4. Maintain relaxation throughout the contraction. Stay limp. It may help if you focus on one part of your body with each breath out. Try to release tension in that part as you breathe out. Then focus on another part with the next breath.

You can follow this routine with every contraction and in any position-lying down, sitting, standing, on hands and knees. You can do it in the tub or shower, in bed, in the car, in a chair, in the hospital corridor, or in your room. You can lean on your partner, the wall, or your bed.

These techniques are often effective in keeping pain within manageable limits for part or all of your labor. Women who use them generally need less pain medication than others. Indeed, some women do not need to use any pain medication when using these techniques.

Some women learn several types, or levels, of breathing to use progressively during labor. Besides the slow pattern just described, they may learn a lighter, faster, but still relaxing pattern and other variations.

Besides using a routine for each contraction, you should try and change position every twenty or thirty minutes, go to the bathroom every hour or so, and sip liquids or suck on ice after every contraction. These measures may be comforting.

You may find that hot packs on the lower part of your abdomen, your groin, and your perineum [external genital-rectal area]; cold packs on the lower part of your back; and a cool, moist washcloth rubbed over your face and neck will all feel wonderful. Being rubbed and touched, especially in tense, sore areas, such as the shoulders and lower part of the back, helps a lot if you feel a bit out of control. It helps if your partner holds you lightly or gently but firmly holds your head in his hands.

During intense periods, like the “transition” phase [from about seven to ten centimeters of cervical dilation] you may feel almost out of control. You may feel that your body is running away with you, and you are being swept along in a tide of intense sensations. Fighting these sensations is pointless.

However, you may feel an urge to push but be told that you are not yet fully dilated. It is important that-for the time being-you resist the urge. Pushing too soon could injure the cervix and perineal tissues and lead to heavy bleeding. What helps the most is knowing that there is nothing wrong. Let it happen-accept that your body is in charge, and don’t try to stay “in control”. Let your loved ones help you, moan and complain if you want to, you know that it will not last long.

If you eventually visit a fertility clinic, you and your partner will be asked for details of your medical history: any past illnesses and any surgery. You will be asked questions about your sex life: how many sexual partners you have had, how often you make love, and so on. Many people find this an intrusion into their privacy, but the questions are all relevant.

A routine physical examination will be carried out on both partners. You will be examined to check that your respective reproductive organs are normal. For the man, this means inspecting the external genitalia and in particular the testicles for any signs of a varicocele (enlarged veins) or other abnormality. The woman will have an internal pelvic examination, during which the doctor will insert a speculum to hold the walls of the vagina apart so that she can view the cervix and take swabs for testing if she suspects a vaginal infection. She will also use her hands to feel the internal organs; this may enable her to detect problems such as fibroids, ovarian cysts or scarring from previous infections.

Tests Undergone by the Woman

One of the first tests for infertility is to find out whether the woman is ovulating, by using basal-body-temperature charts. At the time of ovulation there is a small but distinct rise in the body’s temperature, due to production of the hormone progesterone. This temperature spike can be measured by taking a woman’s temperature every morning on waking up. Many women find this to be a bothersome procedure. A three-month record should show

If you are ovulating and if your cycle is normal, but you may be asked to continue keeping a temperature chart much longer than this. Because temperature charts are sometimes difficult to interpret and are not always reliable, the woman will probably be given further tests to measure the level of hormones that control ovulation. Doctors may order a blood-progesterone test, a simple and painless way of measuring the level of progesterone when it reaches its peak at about day 24 in a 28-day cycle. If the level of progesterone is high, it is a good indication that ovulation has occurred.

The postcoital test may also pinpoint why a woman is not conceiving. The woman makes an appointment for the time of the month when she thinks she will be ovulating. The couple is asked to have sexual intercourse on the night before or the morning of the appointment. At the clinic, the doctor will take a sample of the woman’s cervical mucus from the neck of the womb for examination. The quality of the mucus-clear and slippery, or sticky and opaque-tends to indicate whether the woman has ovulated. By examining the mucus under a microscope, it is also possible to tell if the sperm are normal, if there are enough of them and whether the sperm are agglutinated (clumping together), which might indicate the presence of antibodies. If postcoital tests are repeatedly not very good, the next step may be to test the semen and mucus for antibodies to sperm that may interfere with sperm motility (ability to move).

An endometrial biopsy is a procedure that shows whether or not the woman has ovulated. It involves taking a small sample of the lining of the womb for examination. This is a minor surgical procedure, similar to a D&C (dilitation and curettage). The test should show if the womb lining is sufficiently primed by hormones to be able to receive the egg for implantation. If the woman is ovulating normally, the next investigation will be to see if the Fallopian tubes are clear,

Doctors will take an X-ray of the uterus and Fallopian tubes.

A dye is injected through the cervix and into the uterus, The dye passes through the womb, along the Fallopian tubes and into the pelvic cavity. This enables the doctor to see all the organs.

A laparoscopy is used to detect blocked or damaged tubes and other abnormalities of the womb or ovaries. Under general anesthetic, a small incision is made in the navel, and a laparoscope-a telescope-like instrument-is inserted. This instrument helps the surgeon to examine the organs in detail and assess the extent of any damage.

Sometimes a hysteroscopy is performed-an inspection of the inside of the womb with an instrument similar to a laparoscope. Ultrasound may also be used vaginally to assess the ovaries and womb.

Tests Undergone by the Man

The man will be asked to produce one or more sperm samples. This should be done at the outset, before the woman undergoes any major procedures. The man is asked to produce a sample by masturbation into a sterile container either in the clinic or at home. If he does this at home, he must deliver the sample to the clinic within I-I/2 hours. The sample is examined to see if the sperm are healthy, numerous and motile. Since one test is not always reliable, a poor result may mean he has to repeat the test.

Sometimes a man is diagnosed as subfertile on the basis of one test alone. Yet a single sperm count is very unreliable as an indicator of a man’s normal fertility. Sperm counts vary enormously from one act of intercourse to another, If all is well, this may be the only test the man has to undergo. If he has a very low or absent sperm count, however, he may undergo other tests to look for a cause. The sperm may also be examined at the postcoital test (see page 20), which may give some insight into why the sperm are not functioning properly.

Hormone tests may be carried out to check levels of testosterone, a male hormone. His doctor may perform a testicular biopsy. In some cases where the man has no sperm at all, or azoospermia, an operation may be carried out under general anesthetic to check that the vas deferens (the tube that transports sperm out of the testis) is not obstructed and to see whether there are any structural abnormalities.

The infant at birth contains a germ of all that is great and good. Education is simply the process of drawing out and developing dormant energies. The child’s teachers and governors are the parents. They cannot escape this duty if they would, and a large share devolves upon the mother.

If a mother governs entirely by sole, bare authority, by frowns un tempered with smiles; when her conduct produces in the hearts of her children only a servile fear instead of an obedient affection; when accidents raise a storm, and faults produce only a hurricane of passion in her bosom; when offenders are driven to concealment and lying in order to avert unduly severe corrections; when the mother interrupts innocent enjoyments unnecessarily; when, in short, she shows nothing of herself but the unhappy tyrant, can we then expect the child to flourish in such soil? No, unless we expect the tenderest house-plant to thrive amidst the rigors of eternal frost.

At the opposite end of the scale are the parents, particularly mothers, who delay the application of coercive measures too long. The first months and then years of a child’s life glide away quickly; the mother scarce knows when she should have begun to govern her child instead of having him govern her.

If a child has been accustomed to obey from infancy, there need be no contest for power. The yoke of obedience will generally be light and easy. Just as important is for a mother to be always on her guard and allow no encroachments on her own prerogatives.

Often discipline is abortive. It is administered at a proper time but is relaxed just short of success. No correction should be commenced that is not completed there and then. One completed piece of discipline is worth a hundred abortive efforts.

Love is the essential element of the parental character. The human mind is so constituted as to yield readily to its kindness. Men are more easily led to their duties than driven to them. ‘A child: says an Eastern proverb, ‘may lead an elephant by a single hair.’

In all their conduct, let the parents blend the lawgiver with the friend, tempet authority with kindness. Let them act so as to convince the children that their laws are holy, just and good, and that to be so governed is to be blessed.

While many women do “choose” to have a baby later in life, for many, circumstances dictate when they have a baby. Hope had a first child at 39 because she didn’t meet her husband until she was 37. “I had several relationships, but none of them were right. The first man I lived with said he didn’t want to have children, ever.

With the second man the relationship didn’t work out and then I had a long period in which I had a passionate relationship with a man who was totally unreliable. We never lived together; a child would have been out of the question. When I met Marty I knew right away this was it. We were both eager to have children. I got pregnant just before we got married last year.”

Denise was 4I when she conceived her first child. “It wasn’t as simple as just career reasons, although that was part of it. My first marriage broke up partly as a result of my career-I was more successful than he was. My career took me overseas as a banking executive … For some years I wasn’t in a relationship where I could have a child. Then I remarried in I99I and we both wanted children.”

“Not finding the right person” is a common cause of delayed parenthood. Some women go through the agonizing process of wondering whether to get pregnant anyway and become a single mother by choice. “When year after year went by and I didn’t get married, I did seriously think about having a baby on my own,” says Debbie, now 40. “It was very tempting but I kept wondering if it would be fair to my child. When I met Stephen I remember thinking maybe I should just be careless with contraception and see what happens. But then he said he would like to have a baby with me before I said it.”

Disagreements between couples over when to have a baby can be deeply divisive. Often the woman postpones parenthood for years until her partner feels ready. Sometimes he never does. This happened to Ginny. “He said at the beginning that he didn’t really want children. I accepted that at first. Then I thought he would probably change his mind as time went by, but he didn’t. It’s too bad I made such an issue out of it and talked about it so much. It meant I couldn’t get pregnant by accident. It would have been obvious to him it was a conscious decision. He was always very careful about contraception. I couldn’t have fooled him.

“When I hit 40, things changed all of a sudden. I hated him and hated myself for letting him make the decision for me. I should have said, ‘Having a baby is too important for me. If you won’t agree, then I’ll leave you.’ If I had issued an ultimatum he might have changed his mind. I think if we’d actually had a baby, he would have liked it and been a good father. I’ve seen other men not wild about having a baby turn into doting fathers when the child actually arrives. Now it’s too late. I cry all the time because I realize I’ll never be a mother. It’s driving us apart. In the end I may end up with neither husband nor child.”

When the woman postpones childbearing for her partner, the consequences can be even more painful. Ellen went along with her partner’s wishes not to have a child. She was enjoying her job and thought he would probably come around. “But then I felt the biological clock ticking and I thought, it’s now or never. I told him I wanted to have a child and he said he didn’t feel ready. I said, ‘Then it will be too late for me.’

“My fortieth birthday came and went and then the bombshell was dropped. He said he had had an affair with his secretary and had made her pregnant. Her family was Catholic and they were going to make her have the baby. He said he had agreed to pay child support but the affair was over and he didn’t want to see the mother again. He told me he was deeply ashamed.

“I forgave him and we stayed together. But he does keep in touch with the mother and he does visit his little daughter. Can you imagine how that makes me feel? The other day we were out shopping. I saw him looking at some little girls’ shoes in a window. I know he was wondering whether to get them for her. It cut like a knife; I think of that little girl all the time. It torments me, especially at night. He says now that he’d be prepared for me to have a child but I’m 42 and nothing is happening. I should have trusted my instincts and not listened to him.”

Some women go ahead and have a baby despite their partner’s opposition, either by an accidental pregnancy or by “tricking him into it.” Sometimes everything works out well; other times it doesn’t. Greg expressed his resistance to having children over many years until his wife became pregnant through a genuine accident: “She’d used the cap for more than ten years. I guess in all that time the chances of something going wrong must be pretty high.” The couple discussed having an abortion and Greg agreed that if his wife wanted a baby it would be cruel for him to insist. She had the baby but throughout the pregnancy he remained cool and uninvolved. After the baby was born Greg retreated more and more into his job, until he finally left her altogether.

Finding adequate child care is also an important part of making the choice. “At first the idea of leaving her with anyone terrified me,” recalls Georgianne. “Getting adequate child care was a nightmare. I got a list of the places licensed in my area, but when I went to visit the very first one I was discouraged. The woman had three other children and the home was in a depressing, stark apartment building. I just thought, no. In the end I paid a fortune for a series of nannies. They were all OK, but none of them stuck around much longer than six months.”

Very few companies provide day care or nurseries. Local social-services departments have few day-care facilities, and these are mostly filled by single or special-needs mothers. Some churches and temples have day-care facilities, however. Private day-care services tend to be expensive, but they are becoming more common. Baby-sitters can be a good, inexpensive option if you find one you like. Nannies can live in if you have the space, or can come in for the day. Also, if you have one child and work part-time, you may be able to share a nanny with another mother to cut costs. If you work part time, au pairs can work out if you have the room. However, they aren’t expected to work more than five hours a day. Also, they may be very young and inexperienced with small children.

Finding suitable child-care arrangements is often an ongoing worry for the working mother. What works when you have one baby will not be perfect when you have two preschool children. Often child-care problems get even more complicated when children start school: It’s harder to find someone who wants to work for only two or three hours after school or during school vacations. And what do you do when your child is ill? Having both children and a job usually means:

• You have a reasonably understanding relationship with your employer.
• You are prepared to sacrifice some paid vacation days at those times when your child or baby-sitter is ill.
• Your partner is prepared to make some of these sacrifices, too.

Otherwise, the situation may become unworkable.

What about the mother? What changes do you experience in preparation for the birth? The changes that come with pregnancy affect not only the baby, the uterus, and the placenta, but also the mother’s entire body, her mind, and her emotions.

For example, your breasts began changing as soon as you became pregnant. You may have noticed some breast changes [for example, tenderness, tingling sensations, and feelings of heaviness] very early, even before you knew you were pregnant. These changes indicate that your body is beginning to get ready for breastfeeding. By late pregnancy, you may notice more veins in your breasts, indicating the increased blood supply in the area. You may notice that your breasts are somewhat larger than before, and the areolae [the circles around your nipples] may have darkened. Inside the breasts, the milk producing glands have grown larger. They even begin producing a type of milk called colostrums, which enables you to breastfeed whenever the baby is born.

Other parts of your body also change in preparation for the birth. For example, the ligaments begin to soften. This is particularly helpful in the pelvis, through which the baby passes during birth.. Flexible ligaments allow the pelvis to enlarge somewhat, making more room for the baby. These changes sometimes cause shooting pains in the hips, stiffness in the lower part of your back, and soreness in the front joint of your pelvis [symphysis pubis] and the sacroiliac joints. Although inconvenient now, these changes really are a benefit during the birth process.
Like many women, you may experience heartburn and constipation, partly due to slowing of digestion and partly due to the size of the uterus, which is crowding your stomach and intestines and causing you to burp up acid and to have trouble moving your bowels. You can prevent or reduce heartburn by eating smaller amounts of food at a time and by not eating right before going to bed. Constipation can be helped with regular exercise, drinking plenty of fluids, and eating vegetables and fruits. Discuss with your doctor the use of antacids for heartburn and laxatives for constipation during pregnancy. Despit these discomforts, there are benefits. Your body is able to absorb more nutrients from your digestive tract because of the slowing of digestion.

Your uterus undergoes vast changes in the last trimester of pregnancy. Obviously, it becomes much larger. It must accommodate the growing baby,. the placenta [which weighs about one-sixth of the baby’s weight], and about one quart of amniotic fluid. As your uterus stretches around the growing baby inside, it becomes more “irritable’ and sensitive. If you sneeze or bump your abdomen, your uterus often contracts immediately afterward. It is very sensitive to sudden pressure. Sometimes while you are resting, your uterus will spontaneously contract several times in a rhythm. More than one woman has wondered if she is in labor when this kind of contraction pattern occurs. These contractions are called Braxton Hicks contractions, are an indication that the uterus has become more sensitive to the circulating oxytocin.

While Braxton Hicks contractions are not labor, they probably are causing changes in your cervix that prepare it for labor. These changes include ripening [softening], effacement [thinning], and some dilation [opening] of the cervix prior to the onset of labor. Although you are probably unaware of it, the cervix, which is usually quite firm and thick, becomes soft and thin before labor begins. A ripe, thin cervix opens up much more easily than a unripe, thick cervix. The amount of ripening and thinning can be determined only with a vaginal exam. Effacement is measured as a percentage, For example, if your cervix is twenty-five percent effaced, it is twenty-five percent thinner than usual. [The cervix is approximately two centimeters long. Twenty-five percent effaced means that one and a half centimeters remains]

Your cervix opens slightly before you go into labor. This is referred to as dilation, and is measured during a vaginal exam by feeling the circular rim of the cervix and estimating [in centimeters] the diameter of the opening. Many women will be one or two centimeters dilated before they are aware of any signs of labor. During labor your cervix will continue dilating to about ten centimeters [a circle about four inches across].

This preliminary work of the uterus in preparation for labor is thought to be controlled by the changing hormone production of the placenta, the baby, and the mother.

Contraceptive methods are only very rarely a cause of infertility. The interuterine device (IUD) can increase a woman’s chance of suffering from pelvic inflammatory disease (PID), which can lead to infertility. The contraceptive pill sometimes leads to a condition called post-Pill amenorrhoea, in which a woman’s periods do not return when she stops taking the Pill. Research has shown that this condition lasts for a maximum of two years after Pill use. It can also be treated with drugs.

A woman used to taking the Pill for several years, or using an IUD or cap regularly and worrying every time her period is late, may well expect to get pregnant as soon as she stops using her chosen contraception. But often she does not. This does not necessarily mean she is infertile. However, as a woman gets older her fertility declines. Using contraception for years may mean she is less fertile by the time she stops and tries to get pregnant. Also, using contraception, and particularly the Pill, can disguise infertility problems for years. The Pill usually means that a woman has a regular cycle; she may not realize she is not ovulating.

Hormonal Problems

One of the most common causes of infertility in women is a malfunctioning of the complex hormonal interactions that govern a woman’s menstrual cycle. The woman’s monthly cycle is controlled by the pituitary gland in the brain which, in tum, is governed by another gland called the hypothalamus. The pituitary produces a follicle-stimulating hormone (FSH), which controls the production of the hormone estrogen by the ovary. It also prepares one of the follicles inside the ovary to release the egg. A second pituitary hormone, luteinizing hormone (LH), enables the ovary to release its egg. Estrogen causes the lining of the womb to thicken in readiness to receive the fertilized egg.

If the egg is not fertilized, the corpus luteum begins to shrink, levels of estrogen and progesterone decrease, the lining of the womb disintegrates and menstrual bleeding results. Falling levels of estrogen and progesterone stimulate the pituitary to produce more FSH, and the cycle begins again.

If the egg is fertilized, however, and implants into the womb, the corpus lute urn continues to produce estrogen and progesterone until the placenta attaching the fetus to the wall of the womb is mature enough to produce the necessary hormones itself.

Failure to ovulate is normally caused by the woman’s body’s failure to produce enough of the pituitary hormones, or by their release at the wrong time. Since the pituitary is ultimately controlled by the hypothalamus, anything that affects the hypothalamus can also affect this gland. The hypothalamus can be affected by severe physical and emotional stress, as many women know when the stress of travel, work, illness or emotional turmoil disrupts their menstrual cycle. As women age, fewer menstrual cycles actually involve ovulation, so that in her early forties as few as one in every two or three cycles will produce an egg.

Treatment

Help for women unable to ovulate has been available for many years in the form of fertility drugs. There are two main types: those that prod the pituitary into producing FSH and LH on time and those that replace FSH and LH if this approach fails.

Clomiphene citrate (Clomid’P) is an artificial drug that triggers the release of FSH and LH in the pituitary. It seems to induce ovulation in about 80% of women treated with it, though not all will succeed in getting pregnant. One reason for this is that clomiphene tends to prevent the cervical mucus from becoming fluid at the fertile time in the month to enable the sperm to enter the womb. This problem can sometimes be overcome by giving estrogen as well in the few days before ovulation.

Sometimes a combination of clomiphene and human chorionic gonadotrophin (HCG, a hormone produced by the placenta and young embryo) given on the fourteenth day of the cycle will induce women to ovulate who would not do so on clomiphene alone. Clomiphene also seems to help women with a progesterone deficiency. It has been in use for many years and is considered safe, although a few women do have unpleasant side effects, such as nausea, a bloated feeling, or very rarely, enlargement of the ovaries accompanied by pain in the pelvis. Some infertility specialists deny the severity of these symptoms, or fail to inform women of them. Severe symptoms may indicate over-stimulation of the ovaries.

Recently there has been some concern that clomiphene citrate might cause more eggs, which have chromosomal abnormalities, to be released following its use. Others have questioned whether there might be other long-term effects on the children who are conceived after their mothers took fertility drugs, as happened with the children of women who took the drug DES (diethylstilbestrol) in early pregnancy to prevent a miscarriage. This is of particular concern to women who take large doses of fertility drugs to make them produce more than one egg, as is done for IVF and other treatments. However, there is no evidence to support such fears yet.

Human menopausal gonadotrophin (HMG), trade name Pergonalf and Humegonw, is a hormone extracted from the urine of pregnant women. It stimulates the follicles containing the egg. HMG is usually given as a daily injection, followed by the injection of another drug, HCG, which actually triggers ovulation. About 90% of women will ovulate with this treatment, though again, not all will conceive and some will miscarry. About 20% to 30% of pregnancies resulting from this treatment will be multiple births. HMG is responsible for most of the multiple pregnancies that occur with fertility drugs.

The hormone HMG is potent and may over-stimulate the ovaries, so the level of estrogen in the blood must be monitored daily and the follicles are often monitored by ultrasound. A new development, which might overcome this problem, is a small “pump” about the size of a wallet that, attached to the woman’s arm, provides small, even doses of hormone through a fine needle. However, having a pump attached day and night and having to have the needle repositioned when necessary can be unpleasant.

Some women do not ovulate because their blood contains a high level of a hormone called prolactin, which is normally produced in quantity only while breastfeeding and which tends to prevent ovulation. For women with this problem there may be hope with a drug called bromocriptine. Bromocriptine prevents the pituitary from producing prolactin, and after treatment ovulation occurs in about 95% of women who previously produced too much.

You’ve already raised your kids. In fact, you did it so well, this girl-well, woman-actually fell in love with one of them. So why is it she doesn’t seem to trust you with your own grandchild? Pleasing your particular daughter-in-law just may be impossible. But there are some things to do that might at least make her less… shall we say prickly?

Number one, of course, is hold your tongue. Junior’s hair looks like a rat’s nest? “He’s so cute!” Princess poured maple syrup on your car keys and fed them to her gerbil? “What a great imagination!” So what if the two of them played tag-team dervishes in the china closet. “They get along so well!” And when Junior’s a little older and lot more sullen, and Princess strolls the mall looking like last night’s trash, they’ll just be “thoughtful and unique” as far as you’re concerned.

Yes, today’s parents go too easy. Maybe you would have shaved Junior’s head and locked Princess in her room. And maybe that’s the kind of parenting that turned your own Junior into this one’s father-the man your daughter-in-law loves. But your Junior loves your daughter-in-law as well, and he’s part of the team that’s raising those thoughtful and imaginative little ones-their way.

Your daughter-in-law doesn’t want to hear how well you did it, or how you’d do it differently from her. She will, however, hang on every word of every story of every mishap you had. The time your Junior jumped off the roof of the treehouse in the neighbor’s yard and broke his femur and the collarbone of the girl he landed on (where were you? Oh, that’s right, in the house at the time… ). Or the time your Princess stuffed the noise maker from a party favor up her nose and you had to stuff the baby-with measles-in the car with the squeaking girl for a trip to the emergency room, where your Princess promptly snorted out the noise maker and the nurses publicly chastised you for bringing out an infectious baby. Those things will make any daughter-in-law smile.

And those stories are also the best inroads for advice. Tell your daughter-in-law about the time you had to take your Junior to the company picnic right after he’d shaved stripes into his head and painted eyebrows on his forehead with permanent marker. She’s liable to trade you the story of how Junior braided hot-glue strings into his hair and now she can’t even comb it. You’ll know why he’s wearing that rat’s nest, and she might just ask you what you did, or maybe even, if you’re lucky, what you would do now.

Your daughter-in-law will be willing to learn from your mistakes, but she’s still living her own. Right now, to her, they’re momentous occasions, fearful crises, and staggering difficulties. It will take years for her to see them as mistakes-if she ever does. And maybe, as those years pass, you’ll come to see them as something else, too.

It’s an old quip: Parenthood is wasted on the young. We all know that grandparents can do the job much better, especially when the little ones can be sent home, promptly, at bedtime. After all, grandparents have the knowledge that comes with experience and the wisdom that comes with age. Those months after a baby is born are filled with firsts, but the most profound among them is that first time the young woman becomes a mother.

My memory of the day I brought my first child home from the hospital is as vivid as though it had been only yesterday, when in reality it happened more than 30 years ago. The infant - so beautiful in her perfection, was for me - like an alien being dropped into my lap. I had never seen a new born before, certainly never had the responsibility of caring for one - until my daughter came along. I carefully unwrapped the blanket from around her and studied her flailing little legs, her rounded belly, her perfect, tiny arms and her head that appeared to be too heavy for her body. My first thought was, “Is this the way a baby is supposed to look?”

I was alone then, with no one to ask or to reassure me. I will not describe those sleepless nights, times when my daughter had been screaming at the top of her lungs for what seemed like hours without end. When everything I tried from burping her to changing and feeding her had failed to calm her down, I spent the night walking back and forth across the living room, with her in my arms. She had her little arms wrapped around my neck, and as I rhythmically patted her back, she patted my shoulder in response.

Both mother and baby need to be pampered during those early months. There are many wonderful gifts you can give them to let them both know that you care, from an extra layette, to another dozen or two of cotton diapers, or perhaps a new dress for the mother, in order to celebrate her getting her figure back. But, perhaps the best gift of all is one of time. This means that if all you can do is help out with the housework for half an hour, running the vacuum cleaner or mopping floors, would be very much appreciated. Volunteering to take care of things for an hour or two, so that Mom can get a much needed nap would be delightful for her. The long hours she spends taking care of her infant, coupled with her lack of sleep would be overwhelming to anyone. These are the sorts of things the new mother would find nearly impossible to do regularly, at least until her new baby is sleeping through at night.

The last thing a new mother needs is the feeling that she is being criticized, or belittled by well-meaning friends and in-laws, or even by her own mother. A young woman with her first baby is like a mother lioness - ready to defend him against any harm, whether it is real or imagined. It is best to remember to let her be the one in charge, making the decisions about her baby, and she will all the more appreciate the help you offer to give her.

There’s no doubt that today’s is a fast paced world, and there are dozens upon dozens of choices when it comes to what you can give your kids to eat. It’s tempting to buy “convenience” foods, especially when your preschooler makes a fuss, but it’s important to resist the urge to give in to temptation. The nutritional needs of preschoolers are quite different than those of adolescents and adults. Here’s what you can do to make sure your preschooler stays healthy and grows strong.

1. Make sure your preschooler gets an adequate amount of meat or comparable complete-protein vegetable combination. During the preschool years, kids grow at an amazing rate (the birth length doubles by age 4, for example). As preschoolers grow, their bodies need more protein than at other times in their life in order to build muscle and carry out basic bodily functions. Because of this, the protein needs of a preschooler can be up to three times the RDA!
2. Provide a wide variety of nutrient/energy-rich foods and let them ask for seconds. Believe it or not, preschoolers have an energy requirement that is roughly equivalent to the energy needs of sedentary adults. Preschoolers can’t eat as much as adults can because their stomachs and other organs of the digestive system are still growing, so they need to eat more foods that are nutrient/energy rich. (Nutrient/energy-rich foods are foods that provide a high amount of nutrients for the number of calories they contain.) Good nutrient/energy-rich foods are nuts, dried fruits, and cheese. Keep portion sizes small and encourage your preschooler to ask for more if they are still hungry (yes, they will tell you).
3. Limit saturated fats. Saturated fats (the so-called “bad” fats) have a molecular structure that is different from polyunsaturated and monounsaturated fats. Saturated fats are harder for the body to break down, so a preschooler who consumes too much saturated fat runs the risk of becoming obese and suffering other health problems. This doesn’t mean that you can’t treat your preschooler to a few french fries now and then. It just means that the french fry treat should remain just that-a treat.
4. Pass them the greens. Preschoolers frequently suffer from low calcium and iron intakes-again, this is because their bodies simply are growing at such phenomenal rates. Calcium builds bones and contributes to other bodily functions, and iron is important for blood cell construction. Both calcium and iron are found in foods such as green leafy vegetables or dried beans. This is especially to important to remember with calcium, because some youngsters have real trouble digesting dairy products and need another source of that mineral. If your preschooler is chronically tired or complains of dizziness, your child may be iron deficient.
5. Cut it up and let them munch. Preschoolers do need to have structured meals set out for them, but because the nutrient/energy requirement of preschoolers is so high, many preschoolers may need a small snack between regular meals in order not to become faint. In addition, preschoolers are far more receptive to new foods if they can pick them up with their fingers, so if you’re on the go, cut up bite-sized portions and put them in a baggie or a sealed plastic container for when your preschooler needs it.

Of course, eating right is only half the equation for your preschooler-it’s important that your preschooler engages in physical activity as well. Limit the amount of TV they watch and encourage your preschooler to partake in monitored activities that get them working their muscles and cardiovascular system. Not only will your preschooler be healthy and strong, but they’ll also be more likely to continue the healthy habits later on!

My ex-husband took my children from me and for almost seven years I did not know where they were. I had two boys then; Trevor, who was seven years old and still a young child, and Jodi, who had just turned ten.

When a woman is alone and beside herself with grief, few people want to get involved with her problems. I knew no one at the time who was not already a friend of my ex, and either unwilling or unable to help the discarded wife to find her children.

Every night as I went to sleep, I could hear my two boys crying for their mother. Every morning I would awake to sounds of their pleading and begging for their mother. Those waking dreams haunted me for years. My sleep was punctuated with dreams of the sad faces of my two boys peering out the window of a large dark car, as they were being driven inexorably away.

Every time I stepped outside the door and saw somebody’s child racing down the sidewalk, he would remind me of one or the other of my own boys and I would burst into tears. Sometimes I used to think it would have been easier for me if they had died. At least then I would not have been worried about their being mistreated by a man who believed he had been right to beat his wife.

My boys are grown, and I now know where they are. And though their childhood was stolen from me, at least they are all right. Life continues. I walk down the streets of the Boston suburb where I live, and storefronts are brightly lit, people are going about their business - it’s hard to believe we are a country at war. But, I look at the pictures in the news from out of the Middle East, pictures of children dying, losing their families, parents losing their children, and I see my sons in every one of them.

Every mother who has lost a child, from whatever cause, knows what I am talking about. When I see a photo of a Palestinian baby with half its body blown away, I see my sons, and I weep for all of us.

The mother in me who has known loss can only begin to comprehend what it must be to lose children to war. Can only begin to know the grief born of seeing the child of my flesh crippled, or lost to starvation, because the blockade does not permit food, or water, or medical supplies to come through.

Politically, I am inept. I see no glory in destroying a culture, a people. I take my stand with women, mothers, wives and sisters, who have known and will know loss through the cruelty and stupidity of war. We must find ways to blend our voices together to end the nonsense now.

My husband and I knew we wanted to try to get pregnant as soon as we were married. I was just shy of 30 and my husband was on his way to 40. We both knew it could take time before we had any news to share with family. As luck would have it, the news came quickly! No sooner were we home from our honeymoon when the telltale “hit-by-a-bus” feeling swept over me one afternoon. I knew without test or missed period that I was pregnant. We felt so blessed and were so excited; we couldn’t wait to share the news with our families. But, we were cautious as well. We wanted to wait at least 10 weeks before spilling the beans.

At five weeks, my mom called me and asked me if I wanted a favorite family hutch. It had been in my aunt’s kitchen, and she no longer had room for it. Mom told me my husband and I could carry it, “No problem.” Yes, problem. I was pregnant! I couldn’t carry furniture! I tried to dance my way around it, telling my mom I recently pulled my back and suggesting one of the male cousins be on hand to help with the move. My usually sympathetic mother wasn’t making things easy. She suggested I just wait a week and move it when my back felt better. She told me the boys were busy, again reassuring me I had moved heavier and would have no problem with the hutch. I talked the dilemma over with my husband, and we came to only one conclusion; we had to tell them we were pregnant.

Despite our original plan to wait, I couldn’t contain my excitement. We planned on driving to Pennsylvania that weekend, and I spent the rest of the week planning the perfect way to break the news. At first, my husband and I thought we’d divide and conquer. We would catch my dad when he was on the computer and my mom in the kitchen. We would go our separate ways, share the good news and watch as they ran across the house to share it with each other. It was perfect! Perfect, that is, until I thought of something better.

I went to the store and bought two baby bibs. One said, “I love Grandma”, and the other proclaimed the same love for Grandpa. I wrapped the bibs individually, being careful to mark them correctly. I didn’t want to spoil the surprise by giving Grandma Grandpa’s present!

When we arrived at my parents’ house, we brought them together on the front porch. I excused myself and returned with two tiny packages in hand. I casually told my parents we brought something back for them from our honeymoon (which was really the truth!) and handed them each their coded gift bag.

Seconds passed like hours as they opened their gifts. Each pulled out and unfolded a dainty little bib. Each looked closely at the writing, then at each other and then at me. I just started crying. So did my husband. So did my parents.

The news spread like wildfire after that. We took turns on the phone and cell phone, first calling my husband’s parents, then the rest of the family. So much for waiting 10 weeks! Good news is too hard to keep secret!

With motherhood comes power. It’s not the power to fix a skinned knee with a simple kiss or even the power to decipher between an infant’s cries of hunger and her cries of pain, although those skills are well worth noting. Instead, it is the power to know exactly what to get a new mom when it is her turn to join the ranks.

I have always loved babies and baby showers. But, before I was a mom, I was guilty of buying frivolous presents: complicated outfits. Not only that, I was guilty of buying them in the smallest size. I smiled proudly as the swollen mom-to-be opened the package and thanked me for the sweet gift. Never once did I guess that my perfect gift would go unworn, or even worse, would be returned!

At my own baby shower, I echoed the cooing noises of the mothers before me as I opened each adorable gift. I couldn’t wait to put my baby in the cute little outfits. I thought the hardest decision I’d have to make would be choosing which one she would wear!

Then came baby. I quickly learned baby wears nothing more than onsies and layettes for the first several weeks of life, and even then there are certain ones baby favors. I also learned that there is no such thing as too many of either item. Between full-blown dirty diapers and spit-up with every feeding, I would have accepted hundreds of the things if offered!

It took only a few practices on the changing table to learn my baby hated having anything put over her head. Thankfully, a powerful mom had given me several snap-front layettes that saved me from further tantrums. Another powerful mom, my own aunt, sent the cutest onsies with the same snap-front closures. Needless to say, these were always in the rotation.

Once I learned how to harness this newfound power of mine, I set off shopping at the baby stores. I returned all of the complicated outfits the non-moms kindly gave me and gathered up as many snap-front “anythings” as I could find in every size imaginable. I refused to fall victim to my infant’s fussy taste in clothing.

I was lucky to be surrounded by many powerful moms during my first few weeks of motherhood, and I reaped the benefits of their knowledge. Now, I am proud to claim it as my own. I was able to flex my own mom muscles at a shower for my sister-in-law just five weeks after the birth of my daughter. Again, I smiled as she opened the gifts I offered, this time knowing that nothing would be returned.

I packed the ultimate diaper bag with the traveling necessities of any mom. I chose the diaper rash cream that works with one application. I sang the praises of the flexible leather infant shoes that keep socks on baby’s feet, and I made sure she had plenty of snap-front onsies and layettes to ward off any tantrums that may come her way.

My sister-in-law is due in two weeks. She has called upon me several times for my powers, and I am always glad to pass along what I have learned since my induction into motherhood. It’s a beautiful society to which we belong and one we are always happy to share with anyone who wants to join.

Even if your young child has visited you in the hospital, the baby’s homecoming may be a bit traumatic. What had been talked about and thought about as an event to come has become reality-the future is here, and the baby is a real, live creature. There are three schools of thought concerning the best way to bring your new baby into the house. Some parents feel that a toddler or preschooler should be away from the home, perhaps visiting Grandma, and should only be brought back when mother and baby are well settled. Others think a young child should definitely be part of the reception committee. They advise that the mother have someone other than herself carry the baby into the house and that she devote herself to the older child exclusively for a short time after coming home. And still others say the child should accompany the father to the hospital to pick up mother and infant. The method you feel is right for your family is the one you should choose.

Is it wise to come home bearing gifts for your older child? Some parents like to give the older one large present to celebrate the birth of the new brother and sister, choosing one that will emphasize his or her maturity, such as a new game or “big kid” art materials. You may also want to have a supply of small gifts to hand out when visitors bring presents to the baby only. It’s best not to overdo the gifts, though, either before or after the baby arrives. Even toddlers recognize bribery when they see it, and the message you send is an apology for bringing home an interloper.

Willing and able grandmothers, aunts, and cousins-once almost universally available to give generously of their time, material wealth and advice to new parents-have now become rare. Today they are apt to live far away across the country or to be fully occupied with their own leisure or business commitments. A grandmother who does live near you and wants to be involved in the care of your baby can be a help or a hindrance, depending on her common sense and personality and upon your own attitude toward her interest. If she is critical of your efforts at housekeeping or baby care, plays the martyr, or refuses to consider the possibility that any way but hers is the right way to do anything, you won’t be overjoyed to see her coming. But if she gives advice only when she is asked for it, accepts you as you are, and is willing to help you in the ways you choose, she can be the best thing that’s happened to you-and to your child, as well. If you treasure memories of a special relationship with a grandparent, you want your child to have that same experience, one that can develop only between individuals separated by a generation. The baby’s grandfather, too, will have a special interest in your baby-his descendant. Accept his involvement in your baby’s life and encourage him to develop that privileged relationship that exists between a man and his grandchild. He may not be as actively involved with your baby as the baby’s grandmother, but his feelings may be just as strong.

Your first experience in sharing your child with a grandmother may be immediately upon your arrival home from the hospital, when she comes to give you a hand during the first days or weeks. Don’t be surprised if she prefers to do the cooking and cleaning and leaves the care of the baby to you. If she hasn’t been around a newborn for a time, she may be hesitant to test her long forgotten skills. You perhaps prefer that arrangement anyway, but don’t be resentful if she does want to do some things for the baby. You’ll have your chance later when she has left.

It’s possible that as you and Grandma talk about your baby, a difference of opinion between the two generations will arise. The problem will be one of conflicting information. Grandma may have to make many mental adjustments before she can accept and approve of your enthusiasm of some practices that were considered old fashioned and outdated when she herself was a young woman. Giving birth without anesthesia, for example; options such as birthing rooms, overnight hospitalization, and home births; and today’s emphasis on breastfeeding. She may find a young father’s total involvement in birth and child care inappropriate, because her husband left all that to her-and rightly so, according to her upbringing. You may find that you and she disagree about the use of pacifiers, about having a rigid schedule for feeding and bathing the baby, about whether to use cloth diapers or disposables. If Grandma is inflexible, you may dread the years ahead, anticipating continuous conflict about everything from nutrition to discipline.

However, those of the older generation who have raised families have a great deal to offer. Not every piece of advice Grandma will give you is based on a myth or an old wife’s tale, her years of experience taught her much that you can probably make use of. And many older relatives are willing to learn from new-generation mothers that, for example, a baby who is picked up every time he or she cries does not become spoiled and demanding, or that an immaculate house is not important to a baby’s health and welfare, or a family’s happiness.

Labor is described as having three stages; the first stage, from the onset of progressing labor contractions until the cervix is completely dilated; the second stage, from complete dilation of the cervix until the baby is born; and the third stage, from the birth of the baby until the placenta is expelled.

A fourth stage, from after the delivery of the placenta until the mother’s medical condition is stable and safe, is also frequently mentioned.

The First Stage

The first stage is almost always the longest [two to twenty-four or more hours], usually starting slowly and then speeding up when the dilation of the cervix reaches four or five centimeters. Your contractions may not be clear and strong at first, but they will become longer, stronger, and closer together with time.

Much of your time in the first stage may be trying to figure out if you are in labor or not. It may be exiting and fun for you, or it may be a little scary. After all, this is the moment you’ve been waiting for, learning about, preparing for and dreaming of.

It is a mistake to become preoccupied with labor. If you can be distracted from your contractions, it is very unlikely that you are in very advanced labor [On rare occasions, women have been unaware of labor until the baby was about to be born! In these cases, there is no way to prevent a hectic scene unless a woman has had such a birth previously. Then she should watch carefully for any sign of labor-subtle, preliminary, or absolutely clear-and call the doctor immediately].

As labor progresses, there is no longer any question whether you are in labor. It quickens its pace and the contractions usually become painful. Once certain that you are in labor, go to the hospital or birthing center [or if the birth is to be at home, await your care-giver’s arrival]. Of course, if you have any concerns or medical problem, feel free to go to the hospital. Be sure to take your bag and needed items on hand.

You may become serious and quiet, focused on only one thing-your labor. Jokes are not funny, world events lose their importance. You need support, encouragement, help, and comforting gesture from your partner, doctor, and nurse.

You will probably have emotional ups and downs throughout labor. You may feel discouraged and may weep from time to time, but if you accept labor as it comes and understand what is happening and what to expect, you will be able to recover from these down periods and go on.

Arrival at the Hospital

On arrival, your first stop is usually the admitting office., where you are asked to read and sign forms and indicate how you will pay for your hospital stay. However, since hospital procedures vary considerably, prior to going into labor it is a good idea to check with your hospital regarding their admitting policies-especially for late night and weekend admissions.

From there you go to the maternity ward, where a doctor or nurse greets you, does a quick health check on you, assess your contractions and the baby’s condition, and does a vaginal exam to establish how far along you are in labor.

From then on, hospitals vary in their routine care for labor. The following chart describes common procedures. Feel free to discuss these procedures in advance with your doctor and express your preferences.

Besides the routines described in the chart, your nurse or doctor periodically takes your temperature and blood pressure and , if an electronic fetal monitor is not being used, listens to your baby’s heartbeat and feels your abdomen during contractions to determine how labor is progressing. He or she also stays close by, offering encouragement, comforting you and answering questions.

You cannot force a child to sleep; you cannot teach a child to sleep. Neither you nor your baby can control her sleep cycles. Provided the baby gets enough to eat, is not in pain, and is not interrupted constantly, she will get as much sleep as is needed. The need varies widely: one infant may require as many as twenty or twenty-one hours a day; another, only eleven hours. The actual amount of time is not important, except to a parent; a baby who sleeps very little can be as strong and healthy as one who sleeps a great deal. On average, your newborn will have about eight sleep periods a day. Some periods may last as long as two to four hours, others will be catnaps that last for only minutes.

You can intellectually assimilate all these facts about sleeping, and you can realize that your baby’s sleep habits are not an indication of your parenting abilities or the baby’s “goodness”. Still, you feel responsible for helping her get whatever amount of sleep is necessary in any way you can. You will probably find that your baby doesn’t fall asleep instantly upon being put into the crib; in fact, wakefulness, perhaps accompanied by crying, may last as long as a half hour. Put your baby down when she is full and has been thoroughly burped. A warm bath and a massage with a light lotion, a period of cuddling, or a ride in the carriage in the fresh air may encourage sleep. And the room need not be darkened, unless your baby is confusing night and day and you are having trouble changing a sleep pattern started in the hospital, where the nursery is bright and bustling with activity all day and all night. A room temperature of about 70 degrees will be most comfortable for the baby, who should be clothed in a light sleep sack [a covering blanket is not then necessary], a comfortable gown, or a sleep suit.

Do not worry about eliminating all household noise, the baby will become accustomed to the ordinary sounds very quickly. In fact, babies often find certain sounds soothing and go to sleep more quickly if those sounds are present. The intrauterine sounds the baby is used are simulated in various toys and devices, including a rather expensive teddy bear with a tape cassette. You can reproduce very similar sounds at little cost by taping a running dishwasher or washing machine with your own tape recorder. Other sounds babies sometimes find soothing are the running of the vacuum cleaner, the “white noise” produced by a radio station that’s off the air, a ticking clock, or soft music.

A ride in the carriage is only one way to supply the motion that sometimes helps babies sleep. Windup or cradle swings serve the same purpose, and you can rock the baby or walk the floor or dance around the room with her in your arms. You can even lull your baby to sleep by gently jiggling the bed, especially effective if it’s a waterbed.

Vary your newborn’s sleeping positions. Lying on the stomach will provide a pressure that may bring up troublesome air bubbles, but you may find that your baby prefers to lie on one side or the other, or on her back. Don’t worry if the baby is comfortable in only one position at first and her head will flattens a bit. It will regain its normal shape in a short time. Babies often seem to like the feeling of being swaddled. To do this, lay the baby diagonally on a small cotton receiving blanket. Fold one side of the blanket loosely over the baby, turn up the bottom corner, and then fold the other side over. Your baby is snugly enclosed in an “envelope” that will keep her warm and secure. When you pick the baby up, you can let the top corner rest on her head, like a hood, if you wish. Babies also like to be in small spaces. Try placing your baby in a corner of the crib, touching the bumper on one side and a rolled blanket on the other. Putting the baby down on the same small soft, blanket, perhaps one on which you’ve put a drop or two of your own perfume or cologne, may help induce sleep. [And that little coverlet may become your child’s all important security blanket, to be treasured and slept with for several years, so consider changing off between two identical ones in order to have one available while the other is in the laundry.