Chapter 1. Prenatal Development

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You and {model.partnerName} have been talking about having children since you started dating. You are feeling a little off this month, and you have missed your period. You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

You and {model.partnerName} have been talking about having children since you started dating. {model.partnerName} is feeling a little off this month, and she has missed her period. She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been together for a while now, but you hadn’t really been planning on having a baby quite yet. But {model.partnerName} is feeling a little off this month, and she has missed her period. Sometime these things happen! She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been married for a while now, but you hadn’t really been planning on having a baby quite yet. But {model.partnerName} is feeling a little off this month, and she has missed her period. Sometime these things happen! She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been together for a while now, but you hadn’t really been planning on having a baby quite yet. But you're feeling a little off this month, and you've missed your period. Sometime these things happen! You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

You have been married for a while now, but you hadn’t really been planning on having a baby quite yet. But you're feeling a little off this month, and you've missed your period. Sometime these things happen! You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments, but you get the distinct feeling that {model.partnerName} is not alone these days. She's completely exhausted. Are you ready to be a parent? She's dug out that home pregnancy test she'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of fertility treatments, but you get the distinct feeling that {model.partnerName} is not alone these days. She's completely exhausted. Are you ready to be a parent? She's dug out that home pregnancy test she'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments, but you get the distinct feeling that you are not alone these days. You're completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of fertility treatments, but you get the distinct feeling that you are not alone these days. You're completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo mom! You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo mom! You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo dad! You’ve chosen a surrogate, {model.donorName}, who will carry the child who was conceived with your sperm through the use of Assisted Reproductive Technology (ART). It has taken a few cycles of the fertility treatments, but this morning you got this photo from {model.donorName} on your phone.

You and {model.partnerName} have been talking about having children since you started dating. The two of you spent a lot of time finding just the right sperm donor. You and {model.partnerName} also decided you are going to carry the baby. You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

You and {model.partnerName} have been talking about having children since you started dating. The two of you have decided that for this first child, you are going to be the biological father. {model.donorName}, whom you and {model.partnerName} carefully selected as the surrogate mother, will carry the child. You are using Assisted Reproductive Technology (ART), which combines your sperm and her egg, in hopes that {model.donorName} becomes pregnant. It has taken a few cycles, but this morning you got this photo from {model.donorName} on your phone.

Congratulations! You’re going to be a parent. You may have a mix of emotions. {model.SESphrase} {model.Singlephrase} Welcoming a newborn is part of an exciting adventure! Choices and decisions await.

Congratulations! You’re going to be a parent. You may have a mix of emotions. {model.SESphrase} {model.Singlephrase} Getting pregnant is part of an exciting adventure! Choices and decisions await.

Explain

More than four million babies are born in the United States every year, and you’re one of many expecting parents! Right now, your little blastocyst is just a tiny collection of cells that have implanted into the wall of the mother’s uterus. Click on Look Inside to find out exactly what is going on with your little blastocyst. Click on Learn More to see a video about conception, or to read an article from Scientific American about in vitro fertilization. Answer the quiz questions that follow each Learn More item and earn tokens to use in the Store.

Look Inside

During ovulation, an ovum travels down Mom’s fallopian tube. If a sperm is able to penetrate it, fertilization occurs, forming a one-celled zygote. If more than one ovum is released, both may be fertilized, resulting in two zygotes—twins! Each sperm and each ovum carries 23 chromosomes. They unite to create a zygote with 46 chromosomes.

The one-celled zygote begins to divide rapidly as it travels down the fallopian tube, forming a hollow ball of cells called a blastocyst. When it reaches the uterus, the blastocyst implants itself onto the uterine wall. Only after implantation will a home pregnancy test begin to show that a woman is pregnant, as this is when her levels of hCG begin to change.

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Now that you’re pregnant, it seems like everyone has an opinion about what you should or should not do. Is it safe to enjoy your morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can you get your nails done?

You want to take good care of this baby, but there are so many rules and so much that you can’t control! What’s fact, and what’s fiction?

Now that {model.partnerName} is pregnant, it seems like everyone has an opinion about what she should or should not do. Is it safe for {model.partnerHimHer} to enjoy her morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can she get her nails done?

You want to help {model.partnerName} take good care of this baby, but there are so many rules and so much that you can’t control! What’s FACT, and what’s FICTION?

Now that your surrogate, {model.donorName}, is pregnant, it seems like everyone has an opinion about what she should or should not do. Is it safe for her to enjoy her morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can she get her nails done? You want to help {model.donorName} take good care of this baby, but there are so many rules! What’s FACT, and what’s FICTION?

Look Inside

The embryonic stage begins about 14 days after conception. This critical period is the most vulnerable of all prenatal stages. About 20% of all embryos are miscarried, most often due to chromosomal abnormalities. The neural tube, which becomes the brain and spinal cord, develops 22 days after conception.

At 4 weeks past conception, the developing embryo is about 1/64th of an inch from one end to the other and its head has started to take shape. At five weeks, the embryo has grown twice the size it was at 4 weeks. Its primitive heart, which has been beating for a week now, is visible. Some facial features such as the eyes, ears, nose, mouth, and the nubs that will become the arms and legs are visible.

Six weeks after conception, the legs and arms begin to emerge from buds. A few days later, webbed fingers and toes start to form, and at 52-54 days after conception, tiny fingers and toes separate.

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She has agreed to let you come along.

You’re going to see a {model.PN2_Provider}, {model.PN2_providerName}.

Because you had fertility treatments, you’re currently seeing a specialist in higher risk pregnancies, {model.PN2_providerName}.

In the language of medical doctors, even though you don’t think of {model.yourself_partnername} as being an older parent, your doctors do and because of {model.your_her} age, {model.you_have_she_has} been assigned to a specialist in higher risk pregnancies, {model.PN2_providerName}.

You have a lot to talk about, and {model.you_pname_surrogate} will need a full exam to check {model.your_her} blood pressure and test for diseases like HIV. We want to keep {model.you_her} and the baby healthy throughout {model.your_her} pregnancy. Click on Learn More for additional information on the do's-and-don’ts of a healthy pregnancy. One exciting part of the visit will be a chance to hear your baby’s heartbeat!

But one of the main things your {model.PN2_Provider} will be interested in is how many healthy choices {model.you_will_partnername_will} be making during the pregnancy. Remember that the Explain button can help you make some more research-informed choices. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

But one of the things your {model.PN2_Provider} will be interested in is how many healthy choices {model.you_will_partnername_will} be making about your health during the pregnancy. Remember that the Explain button can help you make some more research-informed choices. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

One of the things your doctor was interested in was how many healthy choices your surrogate has made about her health. She informed you both that she doesn’t drink or smoke, and she eats a healthy diet. The doctor then decided since you will ultimately raise this child that you should answer the same questions. The Explain button can help you learn some more research-based information about a woman’s lifestyle choices during pregnancy. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

One of the things your doctor was interested in was how many healthy choices your surrogate has made about her health. She informed everyone that she doesn’t drink or smoke, and she eats a healthy diet. The doctor then decided since you and {model.partnerName} will ultimately raise this child that you should answer the same questions. The Explain button can help you learn some more research-based information about a woman’s lifestyle choices during pregnancy. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

Look Inside

By 7 weeks after conception, the embryo is just under half an inch long. Eyes, nose, the digestive system, and even the first stage of toe formation can be seen.

At 8 weeks after conception, the embryo has all the basic organs and body parts of a human, including elbows, knees, nostrils, toes and the indifferent gonad. Baby’s head is getting rounder and the features of the face are formed.

Explain

Many studies have linked alcohol use during pregnancy to physical and neurological problems in children that can eventually become fetal alcohol syndrome or a constellation of problems known as fetal alcohol effects. These disorders affect as many as 1% of children born within the United States. Fetal alcohol syndrome can result in mental retardation and any number of neurological issues from trouble with memory to hyperactivity. Research seems to indicate that the severity of the alcohol’s effect on the growing embryo or fetus depends on the timing of exposure during the pregnancy, how much alcohol was consumed, and the genetic vulnerability of the fetus. In the United States, experts advise pregnant women never to drink during pregnancy to avoid any risk to the growing fetus.

Smoking during pregnancy reduces the amount of oxygen the developing fetus gets—and exposes it to a variety of toxins from the cigarette smoke. Babies born to mothers who smoke are more likely to be born premature and at lower weights than babies born to non-smokers. They can also be at higher risk for some birth defects like cleft palate. A pregnant mother’s exposure to second-hand-smoke during pregnancy can lead to low birth weight, and second hand smoke in the environment after the baby is born can lead to a greater chance of SIDS, or Sudden Infant Death Syndrome, asthma, or breathing problems in infancy.

Eating healthy will help your growing baby get the nutrition he or she needs—and help mom stay healthy. Experts advise gaining about 25-35 pounds during the pregnancy—more or less depending on your pre-pregnancy weight. {model.pn3HighBMI} Typically, expecting women are advised to have a diet that is high in fiber, iron, calcium and protein—in addition to the prenatal vitamins they’re taking every day. {model.pn3LowSES}

View Report Card

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Your developing baby is now officially a fetus! Congratulations. Even though {model.donorName} is in her twenties, and at low risk for any genetic abnormalities, {model.PN2_shortproviderName} has asked whether you want to be especially careful and have her undergo the First Trimester Screen, a combination of ultrasound and blood tests that is designed to see whether your growing baby is at risk for some genetic abnormalities like Down Syndrome.

It seems like {model.you_have_partnername_has} just gotten pregnant but {model.you_she} made more trips to see the {model.PN2_Provider} than you could have ever imagined. Now {model.PN2_shortproviderName} is recommending that you have the First Trimester Screen, a combination of ultrasound and blood tests that is designed to see whether your growing baby is at risk for some genetic abnormalities like Down Syndrome.

Take the test

Explain

The First Trimester Screen involves a blood test that can be performed as early as 9 weeks in pregnancy and a special ultrasound that measures the fluid around the back of the neck of the fetus (the nuchal translucency) that can be given as early as 11 weeks in pregnancy. The results of the blood test and the ultrasound are combined to give the parent a sense of their level of risk for chromosomal abnormalities including Down Syndrome, and trisomies 18 and 13. The test is said to be accurate to over 90 percent. Women who are over 35 are at higher risk for genetic and chromosomal abnormalities, so medical professionals are more likely to recommend that they be tested.

There are a number of reasons expectant parents take the test. If the results indicate a high likelihood of chromosomal problems, it gives parents an early opportunity to plan, or even terminate the pregnancy. For parents whose test results indicate that they are at low risk, they will be able to avoid more invasive testing procedures like chorionic villus sampling (CVS) or amniocentesis.

Sometimes parents choose not to take the test because they don’t want or need to know about their risks of genetic problems—and they don’t want the worry of taking what might seem like an unnecessary test.

Look Inside

In week 12 there is a small increase in length, but your baby is still under 3 inches from the top of the head to the buttocks. With all of the amazing development going on, it’s hard to believe that your baby stills weighs less than an ounce!

At 13 weeks after conception, you baby’s face shape is already starting to look like a human. Fingernails are growing and the fetus will weigh approximately 3 ounces.

You didn’t think you’d be this nervous waiting for the results of your screening test. Even though you know that because {model.you_are_partnername_is} under 35, your baby is officially at lower risk for chromosomal problem, you haven’t been able to stop worrying about it. But your {model.PN2_Provider} finally called with the results.

You didn’t think you’d be this nervous waiting for the results of your screening test. Even though you’ve never thought that being over 35 makes you “old”, everyone keeps on saying {model.you_are_partnername_is} at higher risk and you can’t stop worrying. But your {model.PN2_Provider} finally called with the results.

You didn’t think you’d be this nervous waiting for the results of your screening test. Even though you know your developing child is at low risk for any chromosomal problems, you can’t help worrying about the test results. But your {model.PN2_Provider} finally called with the results.

Fortunately, the results were normal. What a relief!

Unfortunately, the results weren’t quite what you were hoping for. The results of the screening indicate that {model.you_have_partnername_has} a higher than normal risk of having a baby with some chromosomal problems. This doesn’t mean that your baby definitely has anything wrong with it—just that there is a higher level of risk.

Based on this information, {model.PN2_shortproviderName} recommends you consider chorionic villus sampling, an invasive test that involves taking a sample (through a needle inserted through the mother’s abdomen), of placental tissue and testing it for more than 200 chromosomal diseases. Because this is an invasive test, it does involve some risk—beyond just the additional worry.

What do you want to do?

Explain

Most of the time when a sperm cell and an ovum cell combine at conception, the 23 chromosomes from the father pair up with 23 chromosomes from the mother—resulting in 46 chromosomes in the developing zygote. In individuals with chromosomal problems, chromosomes don’t pair up in the usual way—and there are (typically) some extra chromosomes. Many cases of severe chromosomal mismatches end in early miscarriages. In Down Syndrome, the most common chromosomal disorder, individuals have 3, instead of 2, copies of chromosome 21.

Experts don’t precisely understand why the pairing of chromosomes sometimes goes awry. They know that there is a strong association between the mother’s age—and some studies indicate the father’s age—and cases of chromosomal problems, perhaps because time takes a toll on the parents’ reproductive cells. Sometimes things in the environment, like radiation, can also cause chromosomal problems.

Take the test

Wait and see

Explain

Most of the time when a sperm cell and an ovum cell combine at conception, the 23 chromosomes from the father pair up with 23 chromosomes from the mother—resulting in 46 chromosomes in the developing zygote. In individuals with chromosomal problems, chromosomes don’t pair up in the usual way—and there are (typically) some extra chromosomes. Many cases of severe chromosomal mismatches end in early miscarriages. In Down Syndrome, the most common chromosomal disorder, individuals have 3, instead of 2, copies of chromosome 21.

Experts don’t precisely understand why the pairing of chromosomes sometimes goes awry. They know that there is a strong association between the mother’s age—and some studies indicate the father’s age—and cases of chromosomal problems, perhaps because time takes a toll on the parents’ reproductive cells. Sometimes things in the environment, like radiation, can also cause chromosomal problems.

Continue

Learn More

Now that {model.you_are_partnername_is} 16 weeks along, some of those uncomfortable symptoms like morning sickness have started to subside and {model.you_are} feeling pretty good!

Even though {model.you_are_partnername_is} 16 weeks along, {model.you_are} still feeling nauseous a lot of the time. {model.PN2_providerName} says {model.you_she} shouldn’t worry about it, but {model.you_she} should make sure to keep on taking care of {model.your_her}self. Hopefully, {model.your_her} body will adjust to these new hormones and the nausea will go away in time.

Since {model.you_partnername} chose not to have a screening during {model.your_her} first trimester, {model.PN2_providerName} has asked again whether you want to consider some testing now. You have a few options: an amniocentesis, an invasive test usually done between 16 and 18 weeks of pregnancy. In this procedure, a doctor takes a sample of the amniotic fluid and to test it to see whether the baby has certain genetic diseases or chromosomal abnormalities. There is a small risk of miscarriage associated with this test, so it’s something you should think carefully about before deciding to schedule it. This test is typically only recommended for older mothers or parents who have specific health concerns.

{model.you_partnername_cap} can also take a less invasive blood test, the quad screen, which is designed to measure hormone levels in {model.your_her} blood which can predict with some accuracy whether your baby is at risk for chromosomal problems and neural tube defects. This test is usually given between 14 and 22 weeks of pregnancy. Remember that you can learn more about these tests—and the disorders they test for in the Explain or in the Learn More.

What do you want to do?

At this visit, {model.PN2_providerName} has asked whether you want to consider some blood testing to screen your baby for birth defects. Mothers who are over 35 are at increased risk for having a baby with chromosomal problems—but they can happen to the babies of mothers of any age.

You have a few options: an amniocentesis, an invasive test usually done between 16 and 18 weeks of pregnancy. In this procedure, a doctor takes a sample of the amniotic fluid and to test it to see whether the baby has certain genetic diseases or chromosomal abnormalities. Since there is a risk of miscarriage associated with this test and you aren’t in a high risk group, {model.PN2_providerName} suggests that this option may not be necessary.

{model.you_partnername_cap} can take a blood test, the quad screen, which is designed to measure hormone levels in your blood which can predict with some accuracy whether your baby is at risk for chromosomal problems and neural tube defects. This test is usually given between 14 and 22 weeks of pregnancy.

What do you think you should do?

Explain

Most of the time when a sperm cell and an ovum cell combine at conception, the 23 chromosomes from the father pair up with 23 chromosomes from the mother—resulting in 46 chromosomes in the developing zygote. In individuals with chromosomal problems, chromosomes don’t pair up in the usual way—and there are (typically) some extra chromosomes. Many cases of severe chromosomal mismatches end in early miscarriages. In Down Syndrome, the most common chromosomal disorder, individuals have 3, instead of 2, copies of chromosome 21.

Experts don’t precisely understand why the pairing of chromosomes sometimes goes awry. They know that there is a strong association between the mother’s age—and some studies indicate the father’s age—and cases of chromosomal problems, perhaps because time takes a toll on the parents’ reproductive cells. Sometimes things in the environment, like radiation, can also cause chromosomal issues.

Amniocentesis is an effective test for ascertaining whether your baby has many of the genetic and chromosomal abnormalities. It also tests for neural tube defects like spina bifida. It does not, however, test for any structural abnormalities (like a cleft lip.)

The risk of miscarriage associated with this test varies. According to the American College of Obstetricians and Gynecologists (ACOG), the miscarriage rate from the procedure is as low as 1 in 300 to 500 — and perhaps even lower if the doctor or center is very experienced at performing this test. Ultimately, deciding to take this test or not is a personal decision. While the risk to the baby is something important to consider, you’ll also need to consider what you might do with the information you receive.

The quad screen is typically given to women between the 14th and 22nd weeks of pregnancy. This test measures four (hence the quad in quad screen), hormones that are in the mother’s blood. The test has a helps identify if the growing fetus may be at risk for certain birth defects including Down syndrome, Trisomy 18 and neural tube defects like spina bifida. The screening test has an accuracy rate of more than 80% (depending on the type of abnormality). This screen can give the parents-to-be more information about any abnormalities so that they can better prepare themselves to handle any special needs the baby may have. If the result of this screen is abnormal, it does not necessarily mean that there is a problem, but it does mean further information should be gathered. Additional tests now and later in the pregnancy, are available to gather more information.

Look Inside

At 16 weeks after gestation, your baby is moving. Though it is too small to be felt, the movements are starting to become coordinated. The fetus’ complex nervous system(CNS and PNS) has begun to function. The internal and external genitalia are now fully developed. You may be able to see the genitalia on ultrasound. If you see an ultrasound at this time, you might even catch your little one sucking his or her thumb, yawning, and making faces.

Fat is forming on your baby, with heat production and metabolism. The lungs are beginning to exhale amniotic fluid, and the circulatory and urinary systems are working.Hair is filling in on the head, eyebrows and eyelashes.

Continue

Explain

In the amniocentisis procedure, the physician takes a tiny sample of amniotic fluid from the sac around the developing fetus. The sample is then sent to a lab where they are able to examine it and evaluate it for any possible errors. The risk of miscarriage in an amniocentisis is very low—especially with an experienced physician is less than one in a thousand.

Look Inside

At 18 weeks after gestation, the baby’s reflexes are kicking in. It can yawn, stretch and make facial expressions, even frown. Its taste buds are beginning to develop and it can distinguish sweet from bitter tastes. The baby will suck if its lips are stroked; it can swallow, and even get the hiccups.

Continue

You didn’t think you’d be this nervous waiting for the results of your screening test. Even though you know that because {model.you_are_partnername_is} under 35, your baby is officially at lower risk for chromosomal problem, you haven’t been able to stop worrying about it. But your {model.PN2_Provider}’s office finally called with the results.

You didn’t think you’d be this nervous waiting for the results of your screening test. Even though you’ve never thought that being over 35 makes {model.you_partnername} “old”, everyone keeps on saying {model.you_are_partnername_is} a higher risk and you can’t stop worrying. But your {model.PN2_Provider}’s office finally called with the results.

Unfortunately, the results weren’t quite what you were hoping for. The results of the screening indicate that {model.you_have_partnername_has} a higher than average risk of having a baby with some chromosomal problems. This doesn’t mean that your baby has anything wrong with it—just that there is a higher level of risk.

Based on this information, {model.PN2_shortproviderName} recommends you consider amniocentesis. Because this is an invasive test, it does involve some risk—beyond just the additional worry.

What do you want to do?

Take a big breath of relief! Everything came back just fine. {model.Your_partners_cap} risk is low and, by all accounts, you have a healthy developing 4-month-old fetus. Congratulations!

Explain

Most of the time when a sperm cell and an ovum cell combine at conception, the 23 chromosomes from the father pair up with 23 chromosomes from the mother—resulting in 46 chromosomes in the developing zygote. In individuals with chromosomal problems, chromosomes don’t pair up in the usual way—and there are (typically) some extra chromosomes. Many cases of severe chromosomal mismatches end in early miscarriages. In Down Syndrome, the most common chromosomal disorder, individuals have 3, instead of 2, copies of chromosome 21.

Experts don’t precisely understand why the pairing of chromosomes sometimes goes awry. They know that there is a strong association between the mother’s age—and some studies indicate the father’s age—and cases of chromosomal problems, perhaps because time takes a toll on the parents’ reproductive cells. Sometimes things in the environment, like radiation, can also cause chromosomal problems.

Learn More

Look Inside

What’s that weird wiggle? Feels like there’s something going on in there. You weren’t sure whether it was maybe just another one of those intestinal problems you’ve been having since you got pregnant…but this feels distinctly different. You’re feeling your baby move!

Your baby has been moving since it was 6 weeks old—although back then you couldn’t feel it because your baby was so small. It has been swallowing and yawning since it was about 12 weeks old.

{model.partnerName} just cried out, “Baby’s on the move!” You put your hand on your partner’s belly as soon as she said something but it all went by too quickly. You can’t wait for it to happen again! Maybe you’ll get to feel it move next time.

But this isn’t the first time your baby’s moved—just the first time mom has felt it. Your baby has been moving since it was 6 weeks old—although back then {model.partnerName} couldn’t feel it because your baby was so small. It has been swallowing and yawning since it was about 12 weeks old.

{model.donorName} just sent you a text. “Baby’s on the move!” She’s an experienced mom, so she knows what she’s talking about. But this isn’t the first time your baby’s moved—just the first time its mom has felt it. Your baby has been moving since it was 6 weeks old—although back then {model.donorName} couldn’t feel it because your baby was so small. It has been swallowing and yawning since it was about 12 weeks old.

Explain

Fetuses move early in pregnancy—as soon as they have a spine and a nervous system to do the moving. Expectant mothers typically feel the first movement anywhere between 14 and 20 weeks into the pregnancy. Women who have been pregnant before typically feel the fetal movements a bit earlier because their abdominal muscles are more flexible—and they know what they’re looking for. The fetus’s movements become more regular—with a day and night schedule—by about 15 weeks. Some physicians and midwives advise keeping track of your fetal movements—even by counting them for a period of time every day—so you can help be sure that your baby is developing normally.

Continue

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You thought {model.you_were_partnername_was} in the clear now that the morning sickness is over, but {model.you_have_she_has} started to feel the extra weight of the baby on {model.your_her} back and {model.you_she} can't find any position to get comfortable to sleep at night.

{model.donorName} has let you know that she’s still feeling terrific at {model.gestational_age_units}.

You’re now at {model.PN2_shortproviderName}'s office for your second trimester ultrasound. This is a chance to really have a good look at your growing baby, which is really starting to look like a baby. And you’ll also get to find out, if you want, whether you’re having a little boy or a little girl.

Explain

After covering the mother’s belly with ultrasound gel, the doctor, midwife or ultrasound technician uses a handheld transducer to generate sound waves that will produce a picture of the fetus. During this procedure, the technician will measure the baby—including its head circumference, the length of its leg bones, and size of its abdomen—to see whether it is growing as it should. Sometimes, due to genetics or environmental factors—like whether the mother is smoking or not getting enough nutrition—some babies are small for gestational age or too big for their gestational age, both of which could be risks for preterm birth.

In many parts of the developed world, finding out the gender of the fetus is part of the experience of pregnancy. Some communities even offer “gender reveal” parties when families celebrate finding out the gender of their fetus. This reminds us that gender is an important part of how we think of our children—even before they are born. Does this set our children up for gender stereotypes before they even breathe air?

Look Inside

BABY: At 19 weeks, your baby measures about 5.2 to 6 inches from crown to rump and weighs about 7 ounces. Skin is developing and transparent, appearing red because blood vessels are visible through it. A creamy white coating, called vernix caseosa, begins to develop. This "cheesy" substance, thought to protect baby's skin from long exposure to the amniotic fluid, is shed just before birth.

Twenty weeks after conception, your baby is covered with lanugo, fine downy hair that helps to keep the vernix caseosa in place. This hair protects your baby and is usually shed at the end of the baby's first week of life. At 21 weeks, hair is beginning to grow on your baby's head.

Twenty-two weeks after conception, the baby’s muscles are getting stronger and the eyelids and eyebrows are developed. Your baby measures about 7.6 inches and weighs about 12.3 ounces. Your baby's acrobatics are pretty constant, and since he or she responds to sound, rhythm, and melody, you can try singing and talking to him or her. It is also the age of viability—a preterm newborn of 22 weeks can survive with advanced medical care.

MOM: At weeks 19-20, Mom may be feeling some mid-pregnancy aches and pains—lower abdominal achiness, dizziness, heartburn, constipation, leg cramps, mild swelling of ankles and feet, and backaches. Dilated blood vessels might cause tiny, temporary red marks on the face, shoulders, and arms.

The risk of bladder infections increases because the smooth muscles in the urinary tract relax. Mom’s breathing will become deeper and she may perspire more than usual from a more active thyroid gland. Mom might be feeling the baby move, called quickening, since the baby is developing muscles and exercising them.

By 22 weeks, Mom’s uterus is continuing to grow, but she’s probably feeling pretty good—no more morning sickness, and her abdomen isn't so large that it's getting in the way very much.

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How are things going between the two of you? {model.You_are_partner_is_cap} not looking quite the same as {model.you_she} used to? Has this changed things between the two of you? Has all that excitement about the new baby taken too much time away from your relationship?

How are things going between the two of you? Has all that excitement about the new baby taken too much time away from your relationship?

Explain

The quality of your relationship will affect how you—and your partner—get through this pregnancy and the transition to parenthood. Rougher relationships create more stress for you—and your child—and can cause developmental and adjustment problems in your child. Research seems to indicate that some things are clearly not good for relationships—like substance and alcohol abuse and depression while other things—like a sense of commitment to the relationship, a sense of fairness and generosity, shared values and religious beliefs, seem to correlate with longer-lasting, happier partnerships. But all relationships have ups and downs—conflict happens in even the most blissful relationships. Over the long term, however, how we deal with that conflict determines how happy we can be.

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You aren’t alone! Your belly reminds you that there is a new person growing close to you. Sometimes when you are by yourself you find yourself talking to your little one.

What signs do you have of being attached to your little person?

You are about to be a Daddy! {model.motherName}’s belly reminds you that there is a new person growing in there.

What signs do you have of being attached to your little person?

You are about to be a Daddy! {model.motherName}’s belly reminds you that there is a new person growing in there.

What signs do you have of being attached to your little person?

Explain

Even though your developing fetus is just a wiggling bunch of hands and legs inside its mother’s belly, many parents-to-be develop strong feelings about their developing fetus. Parents-to-be often spend time imagining (and sometimes worrying about) what their baby is going to be like—calling it names and having (one way) conversations. Some researchers believe that this early fetal attachment can be a good sign of strong, loving relationships between parent and child once that fetus is born. And other researchers find that parents with strong bonds to their developing fetus tend to take better care of themselves during pregnancy, resulting in a healthier newborn. People with sturdy loving relationships with their own parents and partner tend to have these types of strong bonds with their own newborns—which can make for happier, better adjusted children.

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Explain

Relating well to others helps weather changes—like having a new baby. Some researchers measure relationship quality by measuring the level of attachment. Like the concept of attachment between parent and child that you’ll learn about later in your course or this program, attachment between adults is a way of talking about how close the relationship is—how open each member of the pair is—and how anxious everyone is about the stability of that relationship. In general, relationships where people are more secure—both close and not-too-anxious—tend to be more stable in the long run. Couples with stable, secure relationships tend to have an easier time adjusting to parenthood and provide more stable homes for their newborns. Researchers and clinicians have different ideas about how to improve attachment within couples. Some suggest that a couple can work together to improve relationship quality and others believe it is a process that each individual needs to undertake separately, with the belief that our attachment styles are learned in infancy and hard to change in adulthood. Either way, there is reason to hope that we—and our relationships—can improve over time.

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You sit down with {model.partnerName} and go over the questions on the form together. While you are both partners in parenting—many of the questions are directed at {model.partnerName}.

You and {model.partnerName} sit down with {model.donorName} and go over the questions on the form together. Remember the questions are directed at {model.donorName}.

You sit down with {model.donorName} and go over the questions on the form together. Remember the questions are directed at {model.donorName}.

Explain

A birth plan is a list of preferences that tells your medical team how you would like your labor and delivery to be arranged. While each hospital and birthing center might have different options, a typical birth plan allows you to choose who will be in the delivery room for support, the types of medical interventions and pain relief mom would like, and any non-medical methods for pain relief or relaxation. You can even specify fetal monitoring during labor and who will hold the baby first after delivery.

Read the article ‘Birthing choices of pregnant women’ in the Learn More section to find out more about your birthing options.

Look Inside

BABY: At week 29, your baby measures about 10.4 inches from crown to rump, or a total length of about 16.7 inches from head to toe, and weighs about 2.7 pounds. At this stage a fetus's eyes are almost always blue and can distinguish bright sunlight or artificial light through the uterine wall. Baby is performing fewer acrobatics as conditions in the womb become more cramped, but still doing a lot of kicking and stretching. Most of your baby’s organs are well-developed and the brain continues to grow in size and complexity.

At 30 weeks and with only 10 or fewer weeks to go before birth, your baby spends much of the time head down. Finger and toenails are forming! And by 32 weeks, your baby is now developing his or her own immune system.

MOM: At 28 weeks, Mom’s uterus is about 3.5 to 4 inches above her navel. Weight gain is probably between 19 and 25 pounds. As odds improve that your baby could survive outside the womb—although in a neonatal intensive-care unit—Mom may be feeling relieved and excited, or anxious about motherhood, the baby's health, and labor and delivery.

Many pregnant women are surprised to experience mild contractions long before their delivery date. These are called Braxton Hicks contractions, a normal part of the physiology of pregnancy. If she does experience premature labor, signs include menstrual-like cramps or lower back pain, a trickle of amniotic fluid, or a watery pinkish or brownish discharge preceded sometimes by the passage of a thick, gelatinous mucus plug. Her practitioner often can stop labor from progressing with bed rest, muscle relaxants or other drugs, possibly requiring hospitalization.

Mom’s blood pressure typically may rise a little around the seventh month, but contact her practitioner if she gets severe headaches, blurred vision or severe swelling of hands, feet or ankles, or if she experiences severe weight gain. These symptoms could signal the beginning of preeclampsia, a dangerous condition marked by high blood pressure and high levels of protein in the urine during pregnancy.

By 32 weeks, moms might be experiencing some symptoms such as: flatulence, constipation, backaches, shortness of breath, and leaking colostrum.

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Look Inside

BABY: At week 29, your baby measures about 10.4 inches from crown to rump, or a total length of about 16.7 inches from head to toe, and weighs about 2.7 pounds. At this stage a fetus's eyes are almost always blue and can distinguish bright sunlight or artificial light through the uterine wall. Baby is performing fewer acrobatics as conditions in the womb become more cramped, but still doing a lot of kicking and stretching. Most of your baby’s organs are well-developed and the brain continues to grow in size and complexity.

At 30 weeks and with only 10 or fewer weeks to go before birth, your baby spends much of the time head down. Finger and toenails are forming! And by 32 weeks, your baby is now developing his or her own immune system.

MOM: At 28 weeks, Mom’s uterus is about 3.5 to 4 inches above her navel. Weight gain is probably between 19 and 25 pounds. As odds improve that your baby could survive outside the womb—although in a neonatal intensive-care unit—Mom may be feeling relieved and excited, or anxious about motherhood, the baby's health, and labor and delivery.

Many pregnant women are surprised to experience mild contractions long before their delivery date. These are called Braxton Hicks contractions, a normal part of the physiology of pregnancy. If she does experience premature labor, signs include menstrual-like cramps or lower back pain, a trickle of amniotic fluid, or a watery pinkish or brownish discharge preceded sometimes by the passage of a thick, gelatinous mucus plug. Her practitioner often can stop labor from progressing with bed rest, muscle relaxants or other drugs, possibly requiring hospitalization.

Mom’s blood pressure typically may rise a little around the seventh month, but contact her practitioner if she gets severe headaches, blurred vision or severe swelling of hands, feet or ankles, or if she experiences severe weight gain. These symptoms could signal the beginning of preeclampsia, a dangerous condition marked by high blood pressure and high levels of protein in the urine during pregnancy.

By 32 weeks, moms might be experiencing some symptoms such as: flatulence, constipation, backaches, shortness of breath, and leaking colostrum.

You may have thought you were done with school for at least this part of your life, but {model.PN2_shortproviderName} suggested that you take some prenatal classes to get you ready for your little one. They are available at your local hospital at low cost.

You may have thought you were done with school for at least this part of your life, but {model.PN2_shortproviderName} suggested that you take some prenatal classes to get you ready for your little one. They are available at your local hospital and birthing center.

You may have thought you were done with school for at least this part of your life, but {model.donorName} asked you if you and {model.partnerName} wanted to take some prenatal classes with her to get ready for the birth and caring for a newborn. They are available at your local hospital at low cost.

You may have thought you were done with school for at least this part of your life, but {model.donorName} asked you if you and {model.partnerName} wanted to take some prenatal classes with her to get ready for the birth and caring for a newborn. They are available at your local hospital and birthing center.

Yes, I'll take class.

No, I don't have time.

Explain

Prenatal classes are popular among many parents and health care providers who believe that they are an effective way to provide parents-to-be with social support and information about healthy pregnancy, childbirth and newborn care. Fewer parents are taking these classes than they used to— currently fewer than 60 percent of first time parents are taking prenatal classes, maybe because everyone is busy nowadays and feels like they have access to all the information they might need from their health care provider or online.

Explain

Prenatal classes are popular among many parents and health care providers who believe that they are an effective way to provide parents-to-be with social support and information about healthy pregnancy, childbirth and newborn care. Fewer parents are taking these classes than they used to— currently fewer than 60 percent of first time parents are taking prenatal classes, maybe because everyone is busy nowadays and feels like they have access to all the information they might need from their health care provider or online.

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Look Inside

BABY: At birth, much of the baby's skeleton is cartilage which will gradually turn to bone, a process called ossification.

Girls develop more quickly than boys throughout the prenatal period, infancy and childhood. At birth, girls' skeletons are between 4 and 6 weeks more mature as measured by degree of ossification.

MOM: Most mothers lose about 12 pounds immediately after birth: the weight of the baby, placenta, amniotic fluid, and some water content of the tissues and blood.

Within a week, the new mother loses an additional 4 pounds of water weight. Still, it is common for women to weigh somewhat more than their average weight before pregnancy.

When a baby is born, the uterus weighs 2 pounds—15 times heavier than it was before pregnancy. Within 4 to 6 weeks, the uterus shrinks to its original size and weight.

After you got home from your last office visit, {model.you_partnername} started to feel some weird pains in {model.your_her} back. {model.you_she_cap} took a shower to see if a bit of relaxation made them feel better. {model.Your_partners_cap} mother suggested that maybe you should time them. You’re shocked to see that these weird pains seem to be kind of regular. They are about 7 minutes apart.

After you got home from your last office visit, {model.donorName} called to say she was feeling some weird pains in her back. She took a shower to see if a bit of relaxation made them feel better, but you were a bit worried. You called your mother and she suggested that maybe {model.donorName} should time them. You’re shocked to hear that these weird pains seem to be kind of regular. They are about 7 minutes apart.

Explain

Early contractions can last for hours or even days. In a first time mother, irregular contractions could last for days before true “active” labor begins. Most experts advise trying to keep comfortable, rest if you can and get something to eat—because labor can last a long time and once the contractions start being fast and strong, mom won’t be able to rest and will need all the energy she can summon. But no matter what you decide to—whether to wait at home, take a walk around the block or go into your medical provider’s office or into the hospital, checking in with your medical provider is always a wise idea. They know you and your history and can give you specific medical advice.

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Your surrogate, {model.donorName}, gave you a call in the middle of the night saying that she felt that the baby was coming. You and {model.partnerName} rushed to meet her at the hospital.

Your surrogate, {model.donorName}, gave you a call in the middle of the night saying that she felt that the baby was coming. You rushed to meet her at the hospital.

You haven’t been sleeping through the night for some time, but when you woke up at 3 o’clock this morning, you felt like you’d landed in a puddle. That dream you’d been having about getting to lounge in a hot tub wasn’t real. Your water broke! The amniotic sac that surrounds the growing fetus begins to leak or breaks before, or just as, labor begins. While this may be the dramatic start to labor many women worry about—and the stuff of movies—fewer than 15 percent of births begin this way.

In the middle of the night, when {model.partnerName} calls out to you that her water just broke, you can hardly believe it’s finally time. The amniotic sac that surrounds the growing fetus begins to leak or breaks before, or just as, labor begins. While this may be the dramatic start to labor many women worry about—and the stuff of movies—fewer than 15 percent of births begin this way. She is feeling a little nervous, so you give her a big hug and tell her how much you love her. You remind her that it will take a little bit before the actual hard labor will begin—it could even be days, so you help her take ten deep breaths to calm down. Next you both get on the phone to your {model.PN2_Provider}’s office and they recommend going to the hospital. As you settle in and wait, you are so nervous and excited!

{model.partnerName} was amazing—{model.partnerHeShe} stayed up all night with you and was with you every step of the way.

The whole thing was hard on {model.partnerName}, too—{model.partnerHeShe} was so worried about how things were going to turn out.

Now that it is over, all the stress is starting to be forgotten. Your little {model.baby_boy_girl} is in your arms looking up at you, lying on your chest for a little skin-to-skin contact.

Now that it is over, all the stress is starting to be forgotten. Your little {model.baby_boy_girl} is in {model.your_partners} arms looking up at you, lying on {model.your_partners} chest for a little skin-to-skin contact.

Explain

In the United States, about 30% of babies end up being born by Cesarean section. A few are scheduled Cesareans for what are called “convenience” reasons—which may not be as “convenient” as they may sound—perhaps because a partner is going to be deployed on a certain date, because the couple has only a specific amount of family leave that has to be used at a certain time—or perhaps to coincide with a special date that is important to the family. The rest of the babies are born vaginally after what is, for first time mothers, a period of active labor that can last a few hours—following a period of early labor contractions that may have lasted days, or more like 10 to 14 hours, depending on when you start counting. Typically, the “pushing” phase—as the baby passes through the birth canal—is relatively short, lasting only about 30 minutes (though sometimes as long as an hour or two!). For second time moms and lucky first time mothers, the whole process can be even faster.

Many women choose to take medication to manage pain during labor. A popular choice is a regional anesthetic often called an epidural, and spinal anesthesia. These can only be administered by an anesthesiologist in a hospital. Different types of epidural or spinal anesthesia can allow the mother to “feel” her contractions. Some even allow her to walk around, so called “walking epidural.” The downside of an epidural is that it can be uncomfortable getting it started—and some studies indicate that having an epidural may make labor longer.

Look Inside

BABY: At birth, much of the baby's skeleton is cartilage which will gradually turn to bone, a process called ossification.

Girls develop more quickly than boys throughout the prenatal period, infancy and childhood. At birth, girls' skeletons are between 4 and 6 weeks more mature as measured by degree of ossification.

MOM: Most mothers lose about 12 pounds immediately after birth: the weight of the baby, placenta, amniotic fluid, and some water content of the tissues and blood.

Within a week, the new mother loses an additional 4 pounds of water weight. Still, it is common for women to weigh somewhat more than their average weight before pregnancy.

When a baby is born, the uterus weighs 2 pounds—15 times heavier than it was before pregnancy. Within 4 to 6 weeks, the uterus shrinks to its original size and weight.

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You were scared when you saw that {model.babyName}’s first APGAR score was only 6. {model.baby_He_She_cap} has been taken to the special care nursery for some extra help support with breathing. They think this may have something to do with the fact that your baby was low birth weight (or LBW) at birth.

All is well! {model.babyName}’s APGAR score was {model.apgar_total1} at birth—which is really perfect since almost no babies score a perfect 10. And by 5 minutes, {model.baby_he_she} scored {model.apgar_total5}. Congratulations!

Explain

The APGAR test was developed by American anesthesiologist Virginia Apgar and is designed to measure whether a baby needs immediate medical intervention. At one minute after birth, the test is not usually very predictive of the future health of the baby, as it can reflect medication taken by the mother during labor and how the baby was born, and not the actual health of the baby. Between birth and the five minute interval, many babies’ health improves, as they start to breathe better. But at 5 minutes, a low score on the APGAR test—particularly an extremely low score below 4—can be predictive of whether a baby may have some long term challenges.

Look Inside

The newborn’s skull is composed of seven flat bones that are relatively soft and elastic at birth. These bones are flexible to accommodate the brain as it grows. The separations between the bones are called “fontanels,” also known as "soft spots."

In the brain, myelin—fatty substance that covers brain cell axons—makes the transmission of neural impulses faster and more precise. Very few of the brain’s neurons are myelinated at birth, but myelination accelerates soon after.

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Look Inside

The newborn’s skull is composed of seven flat bones that are relatively soft and elastic at birth. These bones are flexible to accommodate the brain as it grows. The separations between the bones are called “fontanels,” also known as "soft spots."

In the brain, myelin—fatty substance that covers brain cell axons—makes the transmission of neural impulses faster and more precise. Very few of the brain’s neurons are myelinated at birth, but myelination accelerates soon after.

Explain

Newborns aren’t always the cherubic bundle of job parents expect—they can be a bit bumpy and bruised at birth, particularly if there was a long vaginal delivery involved.

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Look Inside

While babies are not always in control of what their bodies do, their minds are still very active. Babies brains are growing quickly. This animation provides two perspectives of brain development in infants and toddlers. A microscopic view highlights the formation of myelin on the connecting fibers (axons) of neurons. A macroscopic view shows the brain growing in step with the enlargement of the infant’s head.

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Explain

Babies are born with some basic reflexes—some of which don’t seem to have a practical purpose (like the Babinski reflex, for example) and may just be a vestige of some evolutionary past. Others, like the sucking and rooting reflex, make sure that a baby, who can’t control its own head, can still get nourishment. So your baby may look helpless, but it has a set of survival skills. This is just an introductory list of reflexes—there are even more—like the swimming reflex, where a baby placed in water seems to display basic swimming movements.

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Look Inside

While babies are developing new social and emotional relationships, their brains are also growing quickly. This animation provides two perspectives of brain development in infants and toddlers. A microscopic view highlights the formation of myelin on the connecting fibers (axons) of neurons. A macroscopic view shows the brain growing in step with the enlargement of the infant’s head.

Explain

A parent’s relationship with their child is an important part in helping kids to have a happy, successful life. There are a lot of myths about how this relationship should develop—some parents feel stressed when they find out that parenting a newborn can be stressful and difficult and isn’t the blissful experience they may have expected. Some parents—estimates are between 15 and 20 percent of mothers—experience depression after they have their children which can affect the quality of their relationship with and caregiving for their children. Other parents just have trouble connecting with their children. Research has shown that some interventions—from better parent education, to contact with nurses, therapists or just community members, and things like more touch—can help improve the quality of the parent-child relationship in the early months. However, remember that like so many other things in child development—one experience (for good or bad) does not determine the child’s path for ever more. For example, if a good relationship between parent and child is challenging or difficult in the early years—because a parent is extremely depressed or because a child is sick—does not mean that child is doomed forever. Children (and parents) can recover and, particularly in the early years, are extremely resilient. For example, even though they may spend months in an unusual and maybe not ideal early infancy, children who are born extremely premature often develop normal social and emotional connections—just like children born on time.

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Since {model.you_have_partnername_has} to go back to work right away, you might be worried that breastfeeding will be impossible because {model.you_have_she_has} to take time off of {model.your_her} shift to breast pump during work. But luckily {model.you_work_she_works} for {model.PN9_job}—so they give {model.you_her} time to pump during work—although it isn’t necessarily paid if it is extra break time and you’re not really sure where you’ll be doing it.

Explain

In the long run, most researchers advocate breastfeeding as the ideal first food for babies. However, breastfeeding can be challenging for some families who can’t breastfeed or need to make other choices. Babies can thrive without breastmilk. Pediatricians and nurses try to advocate breastfeeding for all families—while understanding that it can be extremely difficult for some families. For example, breastfeeding in adoptive families or families where babies have been delivered by surrogates can be extremely difficult—although some hospitals offer “milk banks” where breastmilk can be obtained. Other families have challenging logistical issues that can make breastfeeding—and particularly extended breastfeeding very difficult. While many employers may be legally required to allow breastfeeding mothers to pump at work—in practice, this can be very challenging for many mothers—from nurses who work 12 hour shifts to retail workers who need to be out on the floor.

However, breastfed babies tend to have less asthma, diabetes, intestinal diseases and even colds than formula-fed babies. They’re sick less frequently. And some studies even indicate that breastfed babies have higher cognitive development than formula-fed babies. Even a little breastfeeding can help reduce infections and disease. Breastfeeding can be good for moms too—it decreases the rate of diabetes, breast and ovarian cancers. In the United States, the rate of breastfeeding at birth has been rising in recent years—in part because an emphasis on rooming in–having newborns stay with their mothers rather than being taken care of in a hospital nursery and skin-to-skin contact right after birth.

Rates of breastfeeding have been going up in the United States in recent years—as hospitals work hard to urge all mothers to try breastfeeding right after birth. Around the world, public health officials encourage exclusive early breastfeeding to keep babies from exposure to water-borne disease and reduce infant mortality. There is extensive regional and national variation in success of these efforts.

Look Inside

MOM: Within 48 to 72 hours after birth, a mother's breasts may become tender and firm. This is caused by an increase in the blood supply to the breasts, a change that helps produce a greater supply of milk.

A high-calorie milk called colostrum is produced in small quantities at birth and contains a high proportion of protein and antibodies. A mother's milk will begin to shift from colostrum to mature milk after three days.

Milk begins to flow ("let down") when the nipple and areola are stimulated, sending a signal to the pituitary gland, which releases the hormones prolactin and oxytocin. Together, these two hormones bring about physiological change that cause milk to flow from the breast.

Each nipple has between 15 and 20 openings for the flow of milk. The small bumps on the areola of a woman's breast are called Montgomery glands. They produce oils and enzymes that lubricate the nipple and keep it germ free during breastfeeding.

Newborns will want to feed every 2 to 3 hours for the first 2 to 4 weeks (i.e., 8 to 12 times a day). A mother's breasts will automatically adjust the supply of milk based on the amount the baby consumes each day.

Do you want to review some of the highlights of nutrition in early infancy? What we eat in infancy can have short and long term health benefits.

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Video: The Prenatal Period: Conception to Birth

This video depicts prenatal brain development, including light animation of drawings and week-by-week depictions of brain development.

Article: Conception

Whether or not you are a parent in the real world, you may not really know how life begins. Since you are going to be a parent in Developing Lives, let’s review the basics:

A woman typically ovulates or releases an ovum into one of her fallopian tubes in the middle of her menstrual cycle.

A male releases more than 40 million sperm cells each time he ejaculates.

Both sperm and ovum are referred to as reproductive cells, or gametes. These reproductive cells contain genes from the 23 chromosomes of each parent. Conception occurs when a man’s sperm combines with a woman’s ovum—typically in the woman’s fallopian tube, although in certain kinds of infertility treatments, it can occur outside of a woman’s body.

The sex of your soon-to-be-child is determined by the 23rd chromosome of the sperm that combines with the ovum. The 23rd chromosome from the ovum is always an X. The 23rd chromosome of sperm can be an X or a Y. If it is an X sperm cell, it’s a girl! If it is a Y sperm cell, it’s a boy!

Video: Genetic Disorders

The video discusses genetic disorders including Huntington’s Disease, Down’s Syndrome, sex-linked disorders such as Rett syndrome. It includes footage of kids with these disorders, including footage of Rett syndrome girls climbing steps to raise awareness.

Video: Genetic Testing

This video is from CBS News and includes a discussion of the implications of genetic testing (voice over asks: “Do you really want to know what might kill you?”). Dr. Robert Green (a medical doctor from Boston’s Brigham and Wormen's Hospital) is interviewed regarding his research on people’s reactions to good versus bad news from genetic tests (results: people actually respond equally well to either–they just like to know the results either way). Footage includes research on eye cancer and a genetic test conducted to determine one’s survivability rates, as well as an interview with an eye cancer patient on whether she is treatable. The reporter asks the question: “Why would you want to know?” Patient’s response: “Because I have a bucket list.” In addition, the video segment includes discussion of Huntington’s Disease and an 18-year-old girl who had a 50/50 chance of getting the disease. She felt the burden of not knowing was too great and opted for genetic testing. The patients’ genetic test results are shared at the end.

Video: Genes and Development

The interaction of genetics and environmental influences are discussed. The difference between genotype (inherited characteristics) and phenotype (expressed characteristics) is explained. Additionally, new fields of study that examine the interplay of genes and environment, such as epigenetics and behavioral genetics, are outlined.

Fact or Fiction Quiz

More information about the do’s and don’ts of pregnancy.

Drinking a few beers on the weekends won’t harm my growing fetus. Fact or Fiction?
Fiction. Fiction. Many studies have linked alcohol use during pregnancy to physical and neurological problems in children, which can eventually become a constellation of challenges known as fetal alcohol spectrum disorder. This disorder effects as many as 1% of children born within the United States. Fetal alcohol spectrum disorder can result in intellectual disability and any number of neurological issues from trouble with memory to hyperactivity. Research seems to indicate that the severity of the alcohol’s effect on the growing embryo or fetus depends on the timing of exposure during the pregnancy, how much alcohol was consumed, and the genetic vulnerability of the fetus. In the United States, most experts advise pregnant women never to drink during pregnancy to avoid any risk to the growing fetus.

Some kinds of sushi can be good for the developing fetus. Fact or Fiction?
Fact. This is a trick question. You will want to avoid uncooked fish during your pregnancy. But there is some sushi—like a California roll—that is actually cooked. Eating any raw or undercooked foods is hazardous during pregnancy because they may harbor bacteria that are usually killed off during cooking. And during pregnancy, a woman’s body is particularly susceptible to bacteria. Also, certain types of fish used in sushi should also be avoided due to high levels of mercury. Mercury consumed during pregnancy has been linked to serious neurological problems and brain damage. Certain fish like tuna, mackerel, and swordfish, have higher levels of mercury and other toxins. However, mothers are advised to eat fish that is low in heavy metals or mercury at least three times a week during pregnancy—these are fish like flounder and lobster or other shellfish—since consumption of fish during pregnancy has been tied to higher intelligence in children.

A pregnant woman should eat her steaks rare in order to increase her iron intake. Fact or Fiction?
Fiction. Super rare beef should be avoided because it could be contaminated with coliform bacteria, salmonella, and toxoplasmosis. You need to cook all your meat thoroughly while you are pregnant to kill off any bacteria that could cause serious health issues for a pregnant mother or the growing fetus.

Deli meats can be contaminated and can lead to infection. Fact or Fiction?
Fact. Deli meats, along with some hot dogs and smoked fish, can be contaminated with listeria, which is a type of bacteria that can grow even in cold temperatures. Listeria is able to cross the placenta and may infect the baby and cause miscarriage or a serious infection. Pregnant women who eat deli meats or hot dogs should reheat them until steaming. After handling these meats, she should wash her hands thoroughly.

Not washing fresh vegetables can pass contaminants to a fetus. Fact or Fiction?
Fact. It is essential to make sure vegetables are washed to avoid potential exposure to bacteria that may be present in the ground where they were grown—this even applies to those pricey organic or farmers’ market veggies. Bacteria like toxoplasmosis may contaminate the soil where the vegetables were grown and can cause stillbirth, neurological damage, and other devastating disabilities to a fetus.

Some soft cheese such as brie, feta, and queso blanco can be hazardous. Fact or Fiction?
Fact. Some soft cheeses can be contaminated with listeria, which is a type of bacteria that can grow even in cold temperatures. Listeria is able to cross the placenta and may infect the fetus leading, to miscarriage or serious infection. Pregnant women should avoid soft cheeses like brie, camembert, feta, gorgonzola, Roquefort, queso blanco, and queso fresco, unless the packaging says that they are made from pasteurized milk. Soft cheeses made in the United States with pasteurized milk are safe to eat. And in fact, they can be a great source of calcium during pregnancy.

Changing a cat’s litter box can be dangerous to a pregnant woman. Fact or Fiction?
Fact. This is a good time to pass this chore on to someone else! While there is only a slight chance your cat carries toxoplasmosis, a pregnant woman should recruit someone else to change the cat’s litter box. If that isn’t possible, wear gloves and wash your hands thoroughly afterward. Toxoplasmosis is a disease that can cause birth defects. Outdoor cats may get it if they eat animals that carried the disease.

It is safe for a pregnant mother to drink herbal, caffeine-free tea? Fact or Fiction?
Unclear. Herbal teas may be caffeine-free, but their safety for pregnant mothers is unclear. There are no human studies on the safety of products containing herbs, including supplements such as Echinacea and St. John’s wort, during pregnancy. The FDA also does not monitor the quality of herbal teas or dietary supplements. Check the label and the herbs with your medical provider before you drink a lot of it. Some teas like peppermint or chamomile seem to be safe during pregnancy—but others may have teratogenic or even labor-inducing qualities if consumed in large quantities.

It is safe for a pregnant mother to paint the baby’s room. Fact or Fiction?
Fiction. If a pregnant mother must paint, she should use latex paint and choose a paint that is low in Volatile Organic Compounds, or VOCs. Most latex paint doesn't contain solvents and is considered safe to use and be around during pregnancy as long as the area is well ventilated. Oil-based paint contains solvents and requires turpentine or mineral spirits for cleanup. Studies have shown that exposure to solvents may increase the risk of miscarriage, and heavy or long-term solvent exposure may raise the risk of birth defects and learning problems, so using oil-based paint or being around the fumes during pregnancy should be avoided.

Lead-based paint, commonly used before the 1970s, is no longer sold but is of particular concern because it was used in so many buildings. Scraping or sanding any kind of old paint, or being in a place while scraping or sanding is taking place, is definitely not advisable. The pregnant mother could inhale lead dust, which can be harmful to both her and the baby. Leave removal of lead-based paint to others and make sure the pregnant woman is out of the house. After the paint has been removed and the dust has been cleaned up, it's safe for her to be in that room again.

A pregnant woman can relax or color her hair without any concerns about the effect on her fetus. Fact or Fiction?
Fiction. You need to read the fine print and try to get your hair done as safely as you can. Hair straighteners, relaxers, or dyes that have high levels of chemicals like lye, ammonia, or formaldehyde and are going to be on your scalp for a long time are probably not the safest choice in pregnancy. In addition, breathing in the fumes from these products is probably not ideal for your fetus. Many health care providers err on the side of caution and recommend that pregnant women not have harsh hair treatments during the first trimester. But some believe that, if the chemicals are only on your scalp for a short period of time and they are used in a well ventilated room you and your fetus will be fine. In any case, check the labeling and consider getting your hair done less frequently during pregnancy. Or consider transitioning to going natural while you are pregnant.

It isn’t a good idea to smoke cigarettes, but marijuana won’t hurt my fetus. Fact or Fiction?
Fiction. Just like smoking cigarettes, when women smoke marijuana she reduces the amount of oxygen the developing fetus gets—and exposes it to a variety of toxins from the smoke. Babies born to mothers who smoke marijuana tend to be born prematurely and at lower weights than babies born to mothers who don’t smoke marijuana. And some studies seem to indicate that babies born to mothers who smoked marijuana during pregnancy are at higher risk for some behavioral problems later in childhood. In addition, since in most states marijuana is still unregulated, you don't know exactly what you are smoking when you smoke marijuana—you may be inadvertently exposing your fetus to something more toxic than pot.

Some birth defects are caused by hazards in the environment. Fact or Fiction?
Fact. Environmental hazards can be potent teratogens. Things like polluted water (which can happen when women in rural areas drink from wells that are contaminated with minerals like arsenic or when pollutants or chemicals get into public water supplies), chemicals used in some kinds of factory or industrial work, or the fertilizers, pesticides, and herbicides used on farms, can all harm a developing fetus. The effect on the fetus depends on when the fetus is exposed: Generally, exposure earlier in the pregnancy causes more potent physical damage, including potential miscarriage, while exposure later in pregnancy can cause more effects on the fetus’ brain. Effects can also depend on the type of chemical and amount of exposure.

Most doctors recommend avoiding most recreational and prescription drugs during pregnancy. Fact or Fiction?
Fact. Most doctors recommend completely avoiding recreational drugs—particularly alcohol, which has a high potential for harming the developing fetus—and limiting prescription and over-the-counter medications to when they are absolutely necessary. Prescription and common over-the-counter medications (like cold medicines), are mostly evaluated by the drug manufacturers and the Food and Drug Administration and categorized as to degrees of safety in pregnancy. Some, like Tylenol, seem to be basically safe to use while you are pregnant. But others, like ibuprofen, are not. The rule of thumb is typically that you should use the safest—or the least amount—of medication you can while you are pregnant.

Almost 15 percent of pregnant women take prescription anti-depressant medication. Fact or Fiction?
Fact. Around 15 percent of pregnant women take prescription anti-depressants during their pregnancies. Research is ongoing as to whether these drugs have any effect on the growing fetuses. Some early studies seem to indicate that the anti-depressant medications could cause serious birth defects. Some medical providers believe that the risks of taking women off these medications may be worse than any potential for birth defects—because depressed women may be a danger to themselves or their fetuses. Women who feel depressed should talk to providers about alternatives to prescription drugs for treatment of their depression—including specific kinds of therapy and regular exercise. But some women may decide that the benefits of anti-depressant medications are worth any potential risk to their future children.

Many kinds of bread are now fortified with folic acid, a mineral that protects against some birth defects, including spina bifida. Fact or Fiction?
Fact. In the United States and many countries around the world, many products that contain flour are automatically fortified with folic acid, a mineral that protects against neural tube birth defects, like spina bifida, in which the developing neural tube does not close correctly, which could cause an opening in the spinal cord or even cause the baby’s brain to form incorrectly. These neural tube defects can sometimes be detected through early screening during pregnancy—and sometimes treated with fetal surgery—but if untreated, they can cause lifelong complications. Since these neural tube defects happen in the first month of pregnancy, women who are planning to get pregnant should get 400 mcg (or 0.4 mg) of folic acid per day. But about half of pregnancies in the United States are unplanned, so fortification of common foods is a way of trying to make sure that women get the folic acid they need— even before they know they are pregnant.

My friends tell me the most dangerous thing I can do when I am pregnant is to get the flu shot. Fact or Fiction?
Fiction. Actually one of the most dangerous things for a pregnant woman is the seasonal flu. Pregnant women are particularly susceptible to the flu because their immune systems are repressed as a result of pregnancy. The effects of the flu virus on the fetuses are not clear—but the high fevers the flu causes in the pregnant women seem to cause greater numbers of birth defects, including neural tube defects, in their babies. Pregnant women who get the seasonal flu are hospitalized in much higher numbers than the adult population and can even die from the flu. All women who might be pregnant during flu season are recommended to get the annual flu vaccine and any pregnant woman who suspects she might have the flu should go directly to her medical provider. Some medications can be effective at reducing the severity of the flu and the possibility of birth defects in the fetus. In addition to preventing the seasonal flu for pregnant women, the vaccine also confers some protection on the baby until it is about 6 months old.

I teach in a preschool, and one of my students has come down with chicken pox. My friends tell me that my developing embryo is too small to worry about. Fact or Fiction?
Fiction. Communicable diseases like chicken pox can be serious for pregnant women and their fetuses. Depending on how far along you are, the chicken pox may have no effect on your fetus or may cause some serious complications—typically getting exposed in your last trimester causes the most serious complications. There is an easy way to prevent this, however. If you’re planning to get pregnant, check with your medical provider about making sure your vaccinations are up-to-date. You’ll want to make sure you’ve been vaccinated with the MMR vaccine that protects against measles, mumps, and rubella (which is one of the worst communicable diseases for your fetus), as well as chicken pox. Vaccination is the safest way to protect your growing fetus—and many vaccinations are safe to have while you’re pregnant, so if you’re already pregnant, it may not be too late to get your shots in order.

I like nothing better than relaxing in the hot tub or hitting the sauna at the gym after a work-out. But I’ve heard they aren’t safe during pregnancy. Fact or Fiction?
Fact. Research indicates that it isn’t safe to get too hot while you are pregnant. Sitting outside on a warm summer day won’t harm your fetus, but getting a high fever over a long period of time or sitting in a hot tub or sauna long enough to raise your body temperature significantly isn’t a good idea for your growing fetus. In some places, like Finland, pregnant women take saunas regularly—but it isn’t clear whether they are staying in the sauna for long enough to get really hot or whether there are any protective factors involved. In the end, most experts recommend avoiding hot baths, saunas, hot tubs, and steam rooms while you’re pregnant. But they’ll be terrific to help you relax during labor.

Video: Challenges During Pregnancy

This video discusses the various forms of teratogens and their general effects on development during pregnancy.

Video: Prenatal Animation: Fetal Development

Video: Prenatal Development

Video: Prenatal Period: 3D Ultrasound

An ultrasound is a diagnostic tool that uses sound waves to create an image, or sonogram, of the developing fetus. While 3D images are becoming popular, 4D images are available. Ultrasounds can be completed during anytime throughout the pregnancy. During the first trimester they can be used to determine the viability of the pregnancy, detect multiple births, and determine gestational age. During the second trimester they can view normal prenatal development and can even determine the sex of the baby. During the third trimester ultrasounds are usually performed for high risk pregnancies and can assess fetal movement, abnormalities, and verify the due date.

Video: Low Birthweight in India

Video: The Experience of Pregnancy: The First Trimester

In this video clip, a couple describes their experience of the first trimester of pregnancy, from emotions each member of the couple experiences to physical symptoms the woman experiences, including food aversions.

Article: Having a Healthy Pregnancy

Congratulations on beginning prenatal care! More than 80 percent of new mothers are in prenatal care and it is strongly correlated with a healthier pregnancy—and a healthier baby.

Most pregnant mothers are prescribed a daily prenatal vitamin—high in folic acid. They are encouraged to drink lots of milk or yogurt—for calcium, every day. Eat a healthy diet with plenty of whole grains, proteins, leafy green vegetables, fruits and some dairy. Avoid undercooked or raw meats, fish and eggs to protect yourself from parasites or bacteria such as listeria. Of course, you’ll need to stop drinking alcohol. Most doctors also suggest you limit or cut your caffeine intake as well—some studies have shown that caffeine may cause miscarriage early in pregnancy.

You can keep exercising as before, except avoid activities that present a risk of falling like biking, skating and running. Swimming is excellent exercise for pregnant women—the water does most of the work of holding you up! Remember that now is not the time to start an ambitious exercise regimen if you have not been exercising regularly before the pregnancy. If this is the case, start slowly, and remember—walking is excellent exercise.

Try to avoid stress. This may be easier said, than done! Some studies show that children whose mothers suffered from stress while pregnant may be more susceptible to stress themselves. Avoid stressful situations and try prenatal yoga and meditation to decompress. Staying calm will help you—and your baby—feel better!

A lot of what’s good for you and your growing baby is common sense, but here are some recommendations to keep you safe and happy:

You are what you eat:

• CALORIES: Despite your cravings, you only need about 300 more calories per day than your pre-pregnancy diet. If you eat an additional 300 calories a day your weight gain will stay on track.
• ENJOY the good stuff! Talk to your doctor or midwife about adding the following to your diet: folic acid (or folate), omega 3 fatty acids, and calcium. Your prenatal vitamins include these, but make sure you are eating a healthy diet of protein, veggies, grains and fruit.
• DON’T consume the bad stuff:
  • Drugs: They’re bad for you and worse for the developing baby.
  • Nicotine: Smoking can decrease the amount of oxygen the baby receives. Low birth weight, premature birth, and other problems can result from smoking during pregnancy.
  • Alcohol: There’s no data on exactly how much alcohol will hurt the baby. To be safe, avoid alcohol entirely. Consuming large amounts can lead to serious birth defects, and children with FAS suffer from cognitive deficits, developmental delays and behavioral and emotional problems.
• Some more specifics:
  • Caffeine: Some studies have found that consuming large amounts of caffeine, especially in the first trimester, can increase the chances of miscarriage. Stop drinking coffee and other caffeinated beverages or limit the amount you consume to less than 200 mg per day.
  • Cheese: Stick to hard cheeses; soft cheeses can carry potentially dangerous bacteria.
  • Fish/meat: Some fish contain high levels of mercury, which can damage the fetus’ developing nervous system. Avoid processed lunch meats, which can contain harmful bacteria.

EXERCISE: It’s good for both of you! Maintain a regular exercise routine throughout your pregnancy to stay healthy and feel your best. Regular exercise during pregnancy can improve your posture and alleviate some common pregnancy discomforts such as backaches, fatigue, and swelling. Don’t exercise more than you did before you were pregnant, but do keep up your pre-pregnancy level of fitness. Walking and prenatal yoga are great ways to stay in shape while pregnant, and will make the birth easier, too!

Avoid exposure to toxins in the environment:

• Cat litter: Cat feces contain toxins that can be potentially harmful to the baby. If cleaning the litter box has traditionally been your chore, now is the time to ask for help!
• Gardening: Avoid using pesticides in the garden, and always wear gloves and wash your hands frequently to protect yourself.
• On the job: Do you work in a job where you’re exposed to chemicals or toxins? Talk to your supervisor and your medical provider about staying safe on the job.

Video: Brain Development Animation: Prenatal

Video: Brain Development Animation: Process of Myelination

Video: The Prenatal Period: Brain Development

This video depicts prenatal development including light animation of drawings and week-by-week physical developments. It also includes an interview with a pregnant mother about the experience of pregnancy and shows her with the baby once she is born.

Video: Ultrasound

This video discusses the use of ultrasound technology during pregnancy.

Video: The Prenatal Period: Ultrasound

Article: Birthing choices of pregnant women

This article contains some statistics regarding the birthing choices made by other women.

Social Support

Social support can be helpful during the long hours of labor and delivery—and women who have support during labor and delivery typically are able to give birth with fewer complications and less medical intervention then those who have to, or want to, go it alone. Partners who share in the birth of their baby often report that this is extremely rewarding. But the support person doesn’t have to be your romantic partner—it can be a friend, a sibling, or a good friend. A partner in the delivery room can offer emotional support, by holding the mother’s hand and providing a calming presence. For those who can afford it (and this isn’t an option for players who are in lower income categories), a doula is a non-medical support person who is paid to help women and their families before, during, and after labor and childbirth. The doula takes the “pressure” off the partner by meeting some of the needs of the mother and advocating for the new parents with the hospital staff.

In a recent survey, the vast majority of women reported had some support person with them during labor, most frequently a partner.

Pain Reduction Techniques

Over the millennia that women have given birth, there have been thousands of different ways women have tried to make the experience less uncomfortable. These are some of the common ways you’ll see in a current hospital or birthing center. Meditation, relaxation, hypnosis, acupuncture, water therapy, and massage are all different ways to eliminate some of the discomfort of labor. A birthing ball or water can reduce the need for pain medication; and some women choose these as an alternative to the traditional, Western hospital birth position—lying in a hospital bed.

In a recent survey, these were some of the options women chose to distract themselves and reduce their discomfort while laboring.

Pain Medications

In the 1940s, women gave birth under general anesthesia. But since then, we’ve made some advances in the sophistication of our methods for making labor less painful. Some women (almost twenty percent) choose not to have pain medication during childbirth. Others try a spinal or epidural block, where an anesthesiologist in a hospital puts some anesthetic directly into the cerebrospinal fluid or epidural space in the woman’s spine—reducing the pain and sensations of labor. (This wouldn’t be an option if you are planning to deliver in a birthing center with a doula or at home.) Some women find a narcotic or opioid anesthetic helps to make the experience more bearable and others choose a specific type of pudendal nerve block that just blocks off sensation from the vaginal area.

Typically women who have a Cesarean section—and usually they don’t know this early on in pregnancy with a first child whether this will be an option—have either an epidural or general anesthesia.

Video: Interview with Susan Beals: Sudden Infant Death Syndrome

Video: Birth

This video discusses birth, with a focus on babies born in the United States and includes footage of women giving birth, birthing practices in the US and in other countries, and includes footage of C-section births (30% of all US births) and discussion of C-section risks. It includes a discussion of midwives’ and doulas’ roles.

Video: Newborn Reflexes

This video depicts infant reflexes (e.g., rooting, sucking, Moro, etc.) and discusses infant senses—all five of which are operating at birth.

Video: Nutrition in Infancy and Toddlerhood

This video discusses the importance of early nutrition, especially for brain development and discusses health benefits of breast milk (e.g., opportunity to pass on antibodies). It also includes an interview with a mother regarding breast feeding. Also covers early obesity.

Video: Nutritional Needs of Infants and Children: Breast Feeding Promotion

UNICEF is partnering with various government entities in the battle against malnourishment by promoting exclusive breastfeeding for the first six months of life. In the Philippines the rate of malnourishment is 30%. Malnourishment exists is other countries as well, such as Sierra Leone. UNICEF is promoting breastfeeding in these countries in hopes to reduce the number of children suffering from malnourishment.