Frequently Asked Questions About Pregnancy

Other early changes occur in the skin. There are some ever-so-slight pigment changes in the face or all over the body. Some women can get increased oil production and acne as well in early pregnancy.

Morning sickness occurs not just in the morning but actually all through the day. It usually ends at about 14 to 16 weeks. One thing that triggers morning sickness is an empty stomach. One way to battle that would be to actually keep food in the belly every two to three hours. There have also been reports showing that vitamin B-6 and calcium can help as well.

During pregnancy, the uterus grows from about the size of my fist and even smaller in some people, to the size of a large orange or grapefruit, then to the size of a cantaloupe, and then, of course, to the size of a small watermelon at the end.

Around nine to 12 weeks the uterus actually goes from being a pelvic organ to being an abdominal organ. We can feel it in the abdominal exam after about 12 weeks or a little bit earlier.

During early through middle pregnancy, a woman running up a flight of stairs will notice that her heart's pumping away and she'll get a little lightheaded. Her cardiovascular system is taking some time to compensate. As the pregnancy progresses, she will have to be aware of these changes and actually slow down so that the symptoms have some time to settle down a little bit. The increased blood volume is a pretty big load on the heart and lungs. But women are made to actually compensate for that.

The lungs also go through many changes. The diaphragm actually rises. The diameter of your chest increases outwardly. Despite those adjustments, though, you often feel out of breath and you may feel that you can't take a deep breath or that you feel a little bit more out of breath. The hormones again have a big role to play in that and cause those changes and the compensating mechanisms as well.

In early pregnancy, nutrition has a big impact on fetal development. Amazingly, the body compensates and takes the fats, carbohydrates and proteins from whatever you give it, but if you have a healthier, balanced diet there are fewer problems in development. There's an increased need of folic acid — this has been in the media for quite a while. Studies have shown that folic acid actually decreases spinal problems and genetic problems.

Since nutrition is so critical, especially during the early stages of pregnancy, we tell women to actually start on prenatal vitamins even before conception, and to continue that all the way through pregnancy. But it's very vital in the very early stages of pregnancy, during the first four to eight weeks of early fetal development.

Smoking can affect the mother's cardiovascular system as well, including how efficiently the heart is pumping. It can also affect skin changes and general well-being or mood. Smoke affects the weight of the fetus as well, causing a lot of low-birth-weight babies. Even though some women may think, "OK, I don't want to gain a lot of weight during pregnancy" and keep smoking, it actually affects the fetus, not just the mother's weight.

Alcohol has been well studied. Even small amounts and regular doses can cause fetal alcohol syndrome, which is a horrible outcome for the baby. These are two drugs that are so dangerous to moms and babies.

Women who have had more than one or two pregnancies will sometimes get a separation of the muscles that run up and down the mother's abdomen and the rectal muscles. It usually doesn't happen in first-time pregnancies, but it can.

In general, though, these muscle tissues as well as the facia, which is a strong tissue underneath the skin and fat, are made to stretch very, very slowly and can incorporate the very large uterus.

Some of the most noticeable skin changes during pregnancy involve pigmentation. The "mask of pregnancy" is one that is often written about. It's a darkening of the skin usually around the sides of the face and the forehead.

There can also be a change of the line down the abdomen. It's usually called a linea alba, which is a white line. During regnancy it can become a dark line, called the linea nigra. This change sometimes occurs as early as the beginning of the second trimester, and increases and then disappears probably three to four months after delivery.

Some other common changes include little spider veins that pop up in the legs and sometimes on the arms and the abdomen. The reasons why these happen are not quite clear. We know that in many women, these spider veins disappear after delivery.

The pigment changes are probably due to the increase in the melanocyte-stimulating hormone during early pregnancy, as early as the first month, which then usually drops off after delivery. We don't know what levels are associated with women who get a lot of pigmentation.

Another common skin change during pregnancy is definitely acne. You'll notice outbreaks mostly on the face, but sometimes the shoulders and the backs of the arms. Again, there aren't any specific hormones that cause these, but increases in both estrogen and progesterone are known to cause acne throughout life.

Carpel tunnel syndrome is also very common in pregnancy because of that swelling. Sometimes women have to get wrist braces and elevate their legs or undergo hydrostatic pressure, like getting in a swimming pool or a bathtub, to feel better. Those conditions alone are not dangerous, but they are something that we do see in mid- to later-pregnancy.

The cause is not well known. We know that they're there and no cervical change occurs with them, so it's not preterm labor. Braxton Hicks contractions actually increase in frequency during late pregnancy. So at around 36 to 40 weeks, most women will notice they're much more frequent, but without any specific pattern and without pain.

If you notice that one hour goes by and you have six contractions, and then the next hour goes by and you have 10 contractions, and you're noticing that there is actually a pattern — every 10 minutes or every five minutes — that's when we have you call the doctor just to let them know what's going on.

Some other things that you can look for are mucus changes. You might notice bloody mucus or the mucus plug, which is a large amount of mucus that actually passes out some time between two weeks and a few days before actual labor starts.

Sometimes the water breaks before contractions begin, either as a small trickle of fluid or a large gush. Usually when that happens, women are aware and they call us right away.

Sometimes a little bit of bleeding can occur after normal activity or sex. Usually this is not dangerous, but it's very alarming to a newly pregnant woman. Another change that can happen due to hormonal changes is that the cervical opening can become a little more relaxed.

There are several other changes that happen to the pelvis. The pelvic ligaments relax quite a bit. The pelvic bone structure changes. The hips change in their diameter, and actually the hollow of the sacrum flattens with different positions in pregnancy.

As labor approaches, the pelvic opening actually widens a little bit. The pelvic bones separate ever so slightly, which can cause a lot of discomfort. In late pregnancy, there can be much pressure and pulling and tugging in the pelvic region, which we call round ligament pain, and that's usually in the groin area.

When labor begins, the dilation and the effacement progress much more rapidly. The cervix will dilate from 1 centimeter all the way to 10 centimeters. That's how we actually measure cervical dilation. Ten centimeters is where the cervix is at the point of delivery.

Around the same time the cervix will efface, or shorten, usually from a length of 3.5 centimeters all the way to where you can't feel any more cervical length.

The contractions are a physical tightening of the entire uterus. All those uterine smooth muscles work together in concert to squeeze the infant out as well as when the mother pushes. Of course the mother has to push to actually get the baby out, but the uterus itself is expelling the baby with the uterine contractions.

There are also chemicals produced in the body, the prostaglandins, that actually cause pain, and these are released during labor.

What happens in many cases is that the pelvic bones are just not large enough to allow the passage of a certain size baby. If that's the case, the cervix may open to a certain number, say, to 4 to 5 centimeters, and just stop and stay at that number for two hours.

Usually a first-time mom who is experiencing good, strong labor contractions with no progress for several hours would be a candidate for a C-section. Another case would be if the cervix dilated to 10 centimeters and the mom was pushing for a certain amount of time without the baby appearing, we'd assume that the baby's just not going to be able to come out through the pelvic outlet. We allow a shorter amount of time for somebody without an epidural.

But there are two big reasons that C-sections happen. One big one would be where the fetal heartbeat would drop suddenly and stay down rather than recovering after a contraction. That would be an emergency and we would have to get the baby out.

The other situation would be if the fetal heart tracing just does not look normal regardless of the resuscitation that we're doing — oxygen and position change or putting some fluid back up inside the uterus. If things are just not looking healthy or safe for the baby or the mother, that would necessitate a C-section.