Pregnancy

A woman usually knows she is pregnant when she misses one or more periods, and may not experience any other symptoms of pregnancy before missing a period. However, missing a period does not always mean a woman is pregnant. While some women experience multiple symptoms, others don’t experience any.

These symptoms are also similar to those of premenstrual syndrome (PMS) and other medical conditions. To confirm pregnancy and rule out other medical conditions, women should talk to their doctors if they notice any of these signs.

Many women use a home pregnancy test before calling their doctor. The tests do not require a prescription and are typically accurate. The best time to take the test is a week after the first missed period or at least one to two weeks after sex.

The first trimester lasts 12 weeks, beginning with the last menstrual period. During this trimester, substances such as alcohol, illicit drugs, certain medicines and illnesses can do the most damage to the fetus. According to the American College of Obstetricians and Gynecologists, this trimester is also the riskiest for miscarriages, with approximately 80% occurring in the first trimester.

After eight weeks, the embryo becomes a fetus and is one inch to an inch and a half long. By week 12, the fetus begins to move more frequently, and its genitals are developed. Eyelids, toenails and fingernails appear.

From week one through four after conception, women usually experience symptoms such as breast tenderness, mood swings, constipation, bloating and heightened senses — such as taste and smell. Morning sickness begins around week six for some women. This may last until the second trimester.

Weeks seven and eight bring symptoms such as frequent urination, headaches and extra saliva. Reduced blow flow may cause some women to have dizzy spells throughout the day.

First Doctor’s Visit

Women should schedule their first doctor’s visit sometime during weeks eight through 10 or after their menstrual period is four to six weeks late. Some doctors will not schedule the first exam until week eight unless there is an issue.

During the first visit, the doctor will ask many questions about the woman’s health, habits and menstrual cycle. The doctor will also perform a number of tests or exams. Women of different ethnic backgrounds may take different tests because they may be at a higher risk for certain diseases.

Exam Timeline

If the initial exam does not produce warning signs women generally see the doctor on a set schedule. Between 24 and 28 weeks, pregnant women are tested for gestational diabetes, a type of diabetes that forms during pregnancy. Women who are at higher risk for gestational diabetes may be tested sooner.

The second trimester lasts from week 13 to week 27.

As early as week 12, but usually around week 16, a doctor can determine the sex of the fetus. Bones, muscle tissue and skin have formed by then.

Women usually feel movement around the 20th week. Around the 24th week, footprints and fingerprints are formed and the fetus sleeps and wakes frequently. The size and shape of the woman’s uterus may also be measured in the 22nd week to determine whether the fetus is growing and developing normally.

At 28 weeks, an estimated 92% of babies survive. However, there is more risk of serious health complications at that time, with the risk decreasing as gestational age increases.

False Labor Pains

In the second trimester, women may begin to feel Braxton Hicks contractions, also called “false labor pains.” These sensations come and go and are usually mild.

This is the body’s way of preparing for true labor. Braxton Hicks contractions feel like a mild menstrual cramp or abdominal tightening that comes and goes. This is a normal part of pregnancy and is nothing to worry about.

Unlike real contractions, Braxton Hicks contractions are mild, occur in the front of the abdomen or one specific area, and last from 30 seconds to two minutes. They are also inconsistent and sometimes subside when the woman moves or changes positions. Staying hydrated also helps relieve Braxton Hicks.

During this trimester, many of the uncomfortable symptoms of pregnancy subside. Women may have more energy, increased appetite and higher sex drive for the first few weeks.

Some women may experience nasal congestion, tender gums and leg cramps. Backaches are common. Because of fluid retention, fingers may feel tingly. Women also gain weight regularly until the baby is born.

Many women are pleased to notice their skin and hair look healthier.

To avoid symptoms of heartburn, women can eat smaller, non-greasy meals and avoid lying down after eating.

The third trimester lasts from week 27 to week 40, or until birth.

Around the 32nd week, the fetus’s eyes can open and close and the bones are almost fully formed. An infant born before the 37th week (preterm) is at an increased risk for developmental, hearing and visual problems.

Infants born during the 37th and 38th (early term) weeks face less serious health risks, but may not be as healthy as babies born in the 39th and 40th weeks (full-term). Babies born during the 41st week (late-term) and after 42 weeks (post-term) are also at a higher risk for complications.

During this trimester, women may feel more tired and develop hemorrhoids. The body experiences more aches and pains. Stretchmarks may appear because of swelling and stretching of the skin. Breasts will leak as they prepare for breastfeeding. If women have sex, they may have spotting after.

If Braxton Hicks contractions didn’t start in the second trimester, they will often begin around week 29. Women can sleep through one of these weak, false labor pains. If changing positions doesn’t make them go away, they will eventually go away on their own.

True labor contractions last between 30 and 90 seconds and increase in duration, coming closer together, as it gets closer to delivery time.

Almost a third of women who become pregnant experience some kind of complication. Prenatal care helps prevent the risk of pregnancy complications and increases a doctor’s chance of detecting complications if they occur.

Prenatal care refers to the health care women receive while pregnant. It includes checkups, screenings, and dietary and lifestyle changes. In a perfect world, women would begin prenatal care before they become pregnant. When that is not possible, women should begin prenatal care as soon as they realize they are pregnant.

Prenatal Supplements & Medication

A prenatal checkup before pregnancy involves testing for any diseases or conditions that could affect a pregnancy. Many women decide to either change or discontinue medications or potentially unhealthy habits during this visit. They may also begin taking prenatal vitamins, folic acid, calcium or iron supplements.

Weight Gain & General Health

Weight gain is a typical and healthy aspect of pregnancy. Most women should gain 25 to 35 pounds during pregnancy, but overweight women should only gain 15 to 25 pounds and underweight women should gain 28 to 40 pounds.

Although many women worry about gaining weight, a failure to do so could result in inadequate fetal growth or premature labor. Accordingly, most women should not start a weight loss diet during pregnancy. Rather, they should begin a healthy diet if they do not already practice one.

Women should avoid foods that could contribute to food borne illnesses, like unpasteurized cheese, milk or juice, and raw meats including fish, eggs and deli meats. Additionally, some seafood contains high amounts of mercury which may harm the fetus.

For most women, eating an additional 500 calories a day is enough to properly nourish themselves and their babies, according to the Cleveland Clinic. About 200 to 300 of these calories should come from whole foods with a lot of nutrients, such as whole grains, vegetables, fruits, lean meats and low-fat dairy.

Women with healthy, normal pregnancies should exercise to maintain optimal health. But it’s important to discuss exercise routines with a health care provider first. Walking, swimming, stationary bicycling, modified yoga or pilates are good choices.

Avoiding drug use during pregnancy is easily understood, such as the use of street drugs (illegal or illicit drugs) including cocaine, ecstasy and methamphetamines, heroin and marijuana. While about 1 in 20 women take street drugs during pregnancy, it is typically known that these substances are harmful to adults, and are also harmful to a developing fetus.

But the safety of prescription drugs or even over-the-counter drugs and supplements during pregnancy may not be as well-known.

The Centers for Disease Control and Prevention states that little is known about the effects of taking most medications during pregnancy. This is because, ethically, pregnant women are often not included in premarket studies to determine the safety and efficacy of a new drug or treatment. The CDC estimates that less than 10% of FDA-approved medications since 1980 have enough information to determine their real risk for birth defects.

However, it is necessary for some women to take medications during their pregnancy to treat certain health conditions, such as asthma, epilepsy (seizures), high blood pressure or depression. If the pregnant mother does not continue medication for the management of these and other health conditions, it can actually be more harmful to her health as well as the health of the unborn baby. It is always important for a pregnant woman to speak with her doctor before discontinuing medications.

OTC Drug Use in Pregnancy

According to an article published by the American Academy of Family Physicians (AAFP), “despite the absence of randomized clinical trials to guide their use during pregnancy,” more than 90% of pregnant women take a prescription or over-the-counter (OTC) medication.

Most OTC medications used during pregnancy are for allergy, respiratory, gastrointestinal or skin conditions. But acetaminophen, a pain reliever, is also used by approximately 65% of expecting mothers, although it’s generally considered safe to do so.

Cold medicines are also generally considered safe if taken short-term and outside of the first trimester. But AAFP advises pregnant women to use pseudoephedrine, a decongestant, with caution. Overall, doctors should be cautious in recommending, and mothers should be cautious in taking any OTC medication during pregnancy due to the potential for adverse effects to occur to the developing fetus.

According to AAFP, at least 10% of birth defects are believed to result from drug exposure via the mother. Of all the new OTC drugs marketed between 1975 and 1994, 30% were previously prescription medications.

Alcohol Use and Smoking

The National Institutes of Health (NIH) recommends that pregnant women do not smoke, as this exposes the unborn infant to nicotine, carbon monoxide, and other harmful substances. Furthermore, smoking can keep the developing fetus from getting the nourishment it needs and increases a mother’s risk of stillbirth or premature labor.

Because e-cigarettes are marketed as a safer alternative to smoking, some pregnant women may think it’s safe to vape while pregnant. But even if e-cigarettes have fewer toxic chemicals than cigarettes, they have been linked to serious side effects. Those that contain nicotine are especially harmful to developing babies and pregnant women. Nicotine can damage a developing baby’s brain and lungs, and flavored e-liquids may also be harmful to fetuses, according to the CDC.

The agency recommends quitting all tobacco products if you’re pregnant.

The NIH also warns against drinking alcohol during pregnancy, noting that “there is no known safe amount of alcohol a woman can drink while pregnant.” The NIH stated that drinking alcohol while pregnant can cause chronic physical and behavioral problems in children, including fetal alcohol syndrome, which is a condition that can result in facial abnormalities (including wide-set and narrow eyes), growth problems and nervous system problems.

Prescription Drug Interactions in Pregnancy

Adverse drug interactions may occur in pregnancy when certain drugs present potentially harmful effects to the unborn baby and in some instances, the mother as well. These interactions can include increasing or reducing the overall effectiveness of a drug due to the woman’s pregnant state or causing unexpected side effects to the mom or her baby.

Before taking any medications during pregnancy, and sometimes before pregnancy while planning to get pregnant or after pregnancy if breastfeeding, a woman should consult with her doctor about the known (and unknown) risks versus benefits to herself as well as her baby.

Some examples of medications that have known interactions in the health of pregnant women and developing fetuses, include:

Even when women receive proper prenatal care and avoid dangerous drugs, they could still experience complications during pregnancy. This includes women who led healthy lives and maintained healthy weight before pregnancy. When a woman has health complications while pregnant, her pregnancy is considered high-risk.

High-Risk Pregnancies

A high-risk pregnancy can threaten the mother or the fetus’s life. With proper prenatal care, health care providers can detect and treat complications early to improve the chances of a healthy pregnancy.

High Blood Pressure

Hypertension (high blood pressure) occurs when arteries from the heart to organs narrow causing extra pressure. This makes it hard for blood to travel to the placenta and provide nutrients and oxygen to the fetus.

Women with hypertension before pregnancy should monitor and attempt to control it. Some women develop high blood pressure, called gestational hypertension, during pregnancy. About 4% of women develop the condition, and it almost always goes away after childbirth.

Gestational Diabetes

Gestational diabetes is another condition that develops during some pregnancies. It occurs when changes in hormones during pregnancy prevent the body from making enough insulin or using insulin properly. When this happens, glucose (sugar) builds up in the blood, causing high blood sugar.

About 8% of pregnant women develop gestational diabetes. If untreated, it can cause heart disease, vision problems, kidney disease or preeclampsia.

Preeclampsia

Preeclampsia is one of the most common causes of maternal death and one of the most serious complications associated with childbearing.

Preeclampsia causes high blood pressure and can be fatal during and following pregnancy. Most deaths from preeclampsia happen in the days, weeks or months after a woman gives birth.

It affects 200,000 expectant and new mothers in the U.S. every year. Preeclampsia accounts for about 8% of all pregnancy-related deaths in the U.S.

It is more dangerous for African American women. Preeclampsia accounts for nearly 12% of pregnancy-related deaths for non-Hispanic Black women.

Symptoms of Preeclampsia

Women suffering symptoms of preeclampsia should seek immediate medical attention. Some women may not experience any symptoms even though they have preeclampsia. Their health care provider should monitor them for any warning signs.

Preeclampsia that occurs after a woman gives birth is often misdiagnosed. Its symptoms mimic conditions people associate with normal childbirth. These can include headaches, swelling and stomach pain or other stomach problems.

Preeclampsia causes high blood pressure and can lead to premature delivery, increasing the need for a cesarean section. Preeclampsia can also lead to protein in urine or edema — fluid buildup in body tissues causing swelling.

Pregnancy Loss

A miscarriage is a loss of pregnancy from natural causes before the 20th week. It occurs in an estimated 20% of pregnancies. Signs of a miscarriage include vaginal bleeding, cramping and fluid or tissue passing from the vagina. Bleeding does not mean that a miscarriage is happening, but women should contact their health care provider if bleeding occurs.

After the 20th week, a loss of pregnancy is referred to as a stillbirth. Doctors cannot determine the cause of stillbirths in about half of all cases, but factors that could contribute to stillbirths include infections, chromosomal abnormalities, inadequate fetal growth, placental issues and a mother’s health issues.

Depression

Depression involves feelings of sadness, anxiety or emptiness that interfere with daily activities. About 13% of pregnant women and new mothers suffer from depression. Symptoms of depression can be mild or severe, but doctors can treat almost all of them. Women suffering for more than two weeks should contact their doctor.

A family history of mental health problems, changes in brain chemistry that occur during pregnancy, stressful life events and hormones all contribute to depression during pregnancy.

Postpartum Depression

Postpartum depression occurs after childbirth. The rapid change in hormone levels after childbirth or a decrease in levels of thyroid hormones after childbirth may lead to postpartum depression. Other factors like exhaustion, feeling overwhelmed, doubts about the capabilities of being a good mom and lack of free time can contribute to postpartum depression.

The amount of time it takes for a woman to get pregnant depends on factors such as age, overall health and genetics. Nearly 85 out of 100 women who want to get pregnant and have unprotected vaginal sex succeed within a year.

Women trying to get pregnant should pay attention to the days when they ovulate and plan vaginal sex around those days. This also applies to women who are planning to use insemination to get pregnant.

According to Planned Parenthood, ovulation usually starts about 14 days before your period starts. Five days before ovulation and the day of ovulation are the most fertile days. Sperm can live in the body for six days, and the egg survives for one day after it is released.

There are apps that make it easy to track the menstrual cycle. Most pharmacies and drugstores also sell ovulation predictor kits.

People trying to get pregnant should ask their health care providers for advice. Planned Parenthood also provides tips for getting pregnant and having a healthy pregnancy.

How Birth Control Affects Fertility

Most women in the U.S. use some type of birth control. In most cases, women who want children can stop their birth control and fertility resumes immediately. Some forms of contraception may affect how quickly a woman is able to become pregnant.

Birth Control Pill

Most women choose a form of oral contraception, also known as “the pill.” More women are choosing to have babies later in life. This means many have been on the pill for several years to prevent pregnancy. The good news is fertility usually returns as soon as a few days after stopping the pill.

Birth Control Shot

Some women receive birth control shots such as Depo-Provera once every three months to prevent pregnancy. After three months, it is no longer reliable as birth control. But, because it goes into the muscle, its effects linger. For some women, it can take about 10 months after the last shot for fertility to return.

Mirena and Other IUDs

An IUD is a small plastic implant inserted into the uterus. Most release hormones (Mirena) and one (Paragard) uses copper to prevent pregnancy.

Fertility usually resumes immediately after removal of an IUD.

Labor is the process of childbirth in which the fetus and placenta leave the uterus.

During the final weeks of pregnancy, the fetus is still developing its lungs and brain. Thus, a woman should be pregnant for at least 39 weeks before giving birth to ensure the highest chance of a healthy outcome. However, a health care provider might recommend inducing labor sooner if there is a health risk to the fetus or mother.

Health care providers may use various devices to monitor the baby’s heartbeat during labor and the strength of contractions. They may use a special stethoscope belt wrapped around the abdomen called a Doppler transducer to monitor the baby. Electronic fetal monitoring uses a belt wrapped around the abdomen or electrodes placed on the part of the fetus that is closest to the cervix, usually the scalp.

Women can give birth in a number of different ways. The two general delivery methods include vaginal birth and cesarean sections, or C-sections.

Drugs that Induce Labor

If labor hasn’t started when it should, health care providers may use drugs to induce labor. Two drugs used to induce labor are Pitocin (oxytocin) and Cytotec (misoprostol).

Pitocin is a synthetic form of the hormone that causes contractions. Doctors administer it intravenously to start or strengthen contractions. Doctors will monitor the mother and baby and adjust the dose as needed. Contractions usually start 30 minutes after the drug is administered.

Adverse reactions to oxytocin are not common but can include heart rate abnormalities, nausea and vomiting, hypo or hypertension, and fast heart rate in the mother.

Adverse effects for the baby are related to the intensity of uterine contractions.

Cytotec is not approved for inducing labor but is often used for pre-induction cervical ripening off-label. It is contraindicated if the mother has had a previous C-section due to the risk of uterine rupture and severe bleeding.

Medicated Birth

A “medicated” birth is the most popular delivery method in the U.S. About 61% of women give birth while receiving pain medication, usually in the form of an epidural block, spinal block or (rarely) general anesthesia in the case of cesarean section. An epidural is injected into the space just outside the spinal canal, and a spinal block is injected into the spinal fluid. If given general anesthesia, the woman is asleep during the delivery.

Although non-medicated births are growing in popularity, there is no evidence that delivering a baby while medicated affects the baby’s Apgar score — a test that measures a baby’s health immediately after it is born — or increases the chance of a C-section.

Unmedicated Birth

About 39% of U.S. women give birth using no pain medication. Instead, they may rely on relaxation and breathing techniques to reduce pain. Many women feel a sense of empowerment by giving birth without the assistance of medication.

Some women avoid medication, because it may cause their blood pressure to drop, affect the speed of labor or cause them to become nauseated.

Cesarean Section

A C-section is a surgical procedure in which a doctor makes an incision in the mother’s abdomen and uterus to deliver the baby through. After the delivery, the doctor closes the uterus with stitches that eventually dissolve and the abdomen with staples or stitches. About 33% of babies are born via C-section.

C-sections are generally considered safe, but like all surgeries, complications can occur. Recovery usually takes longer, infants may be more likely to experience breathing problems and future pregnancies could be affected. Women who have had a past C-section have successful vaginal births about 75% of the time.

Alternative methods to medicated births (using epidurals and other anesthetics or pain relievers), such as immersion in water, hypnobirthing (using hypnosis), and utilizing doulas and birthing coaches that focus exclusively on the mother throughout the labor and delivery process, and even for a short time after birth (postpartum), are drawing increased interest among pregnant women, U.S. News & World Report said.

Doulas Versus Midwives

DONA International defines a doula as a trained professional “who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying [childbirth] experience possible.”

Doulas receive training to support mothers and families emotionally and physically, but they are nonclinical professionals, according to Jessica Costa, a certified nurse midwife with Cleveland Clinic.

This means they can coach women during labor with relaxation, pushing and breathing, but they do not deliver the baby. They provide emotional support during pregnancy and during the postpartum period, but they cannot give medical advice.

In contrast, there are different types of midwives with varying levels of education and experience. Each state has its own laws governing what midwives can and cannot do.

Nurse Midwives, Certified Nurse-Midwife (CNM)

Nurse midwives are trained in midwifery and nursing. They are registered nurses with master’s degrees who can deal with low-risk pregnancies and deliver babies in hospitals or at a mother’s home. They can also perform gynecological exams and advise on matters of women’s health.

Many hospitals have CNMs on staff. They have passed a national exam and can practice in all 50 states and the District of Columbia.

Direct-Entry Midwives

Certified Midwives (CM) and Certified Professional Midwives (CPM) are called direct-entry midwives. They don’t have nursing degrees, but CMs have master’s degrees in health and are trained and certified in midwifery. Only a handful of states recognize CMs and allow them to legally practice.

CPMs must demonstrate knowledge and experience in providing midwifery services out of hospital settings and must have graduated from an accredited midwifery education program. Twenty-seven states recognize CPMs.

The Bradley Method

The Bradley Method is a birthing technique taught in a 12-week class that takes place throughout the last trimester of pregnancy. This method was developed by Dr. Robert Bradley in the late 1940s and it encourages women to deliver naturally, with little or no drug intervention, in the presence of their partners, looking to them as a coach.

The courses focus on nutrition, exercise, relaxation and pain management, and teach women how to “tune into their bodies” and find positions effective in easing labor pains and preparing for each stage of labor. This method is supposed to be successful in assisting women with their birthing plans and avoiding surgical deliveries (C-section).

Hypnobirthing

Hypnobirthing is a labor pain relief program developed by Marie Mongan in 1989. It focuses on eliminating a woman’s birthing fears with self-hypnosis as well as breathing and relaxation techniques.

According to the American Pregnancy Association, women who have used this method report “feeling lost in a daydream, relaxed, calm, aware and in control.”

Hypnobirthing involves courses with an instructor, along with self-hypnosis exercises that can be used at home. Mongan created the program referencing the natural birth theories of Drs. Grantly Dick-Read and Jonathan Dye.

Lamaze

Lamaze is a birthing technique that involves the proper use of breathing. Women are taught to control their breathing, change positions and walk throughout labor. Dr. Ferdinand Lamaze developed the method that emphasizes distraction during contractions “decrease the perception of pain and reduce discomfort,” according to the American Pregnancy Association.

This method also encourages the support and participation of the mother’s partner, with classes focusing on partner involvement in controlled deep breathing techniques, massage, concentration and learning how to maintain control during labor.

Even though Lamaze is considered a natural birthing method, women using this method can still opt for an epidural if they should decide it’s needed.

Water Delivery

Some women may find that giving birth in a warm tub of water is relaxing, and the buoyancy is believed to help relieve discomfort and pressure. Some also believe that the water “helps the baby enter the world with less light, sound and dramatic change,” as stated by the American Pregnancy Association. However, U.S. News & World Report interviewed the chief of maternal-fetal medicine and director of obstetrics at the University of Florida Health, Anthony Gregg, who concluded: “There’s no evidence that [a water delivery] improves perinatal outcomes, or decreases the C-section rate.” He did, however, state that it helps decrease pain, reduce the need for anesthesia and shorten delivery times.

But Monica Svets, OB-GYN at Cleveland Clinic’s Hillcrest Hospital in Ohio, said that water births have not been studied enough to be recommended, and the American Pregnancy Association warned that this method is definitely not recommended for women with high-risk pregnancies and that deliveries should occur out of water in situations where complications arise.

Non-Recumbent Birthing Positions

A woman can give birth in a number of different positions. The supine recumbent position is the traditional position for giving birth in most health care facilities because many of the medical devices and monitoring tools used in hospitals limit other options.

However, women squat while giving birth in many parts of the world, including Asia, Africa and parts of South America. There is no perfect position to give birth in, but some experts recommend changing positions during labor to help with pain.

Breastfeeding is the most popular way to feed and nourish an infant. Breastfeeding should begin within one hour after birth and can occur up to 12 times per day in the first weeks of life.

Many infants are breastfed exclusively, receiving no other form of nutrition for the first six months of their lives.

Whether or not a woman chooses to breastfeed is a personal decision every new mother has to make for herself and her baby. However, the U.S. Department of Health and Human Services (HHS) does list several benefits for not only the newborn but the mother as well.

Benefits of Breastfeeding

A mother’s first milk is called colostrum, and it’s referred to as “liquid gold” due to its deep yellow color. This thick type of milk is made during pregnancy and just after birth, and it is extremely rich in nutrients and antibodies that protect your newborn from infections.

Colostrum also helps a new infant’s digestive system to grow and function. As a baby grows, its mother’s milk changes, becoming mature milk within three to five days after birth. This milk consists of sufficient amounts of fat, sugar, water and protein. It is thinner than colostrum but still packed with nutrients and antibodies.

Although not quite as lengthy of a list, the mother is not without her own equally important benefits. Breastfeeding not only helps a mother to heal following childbirth but leads to a lower risk of Type 2 diabetes, certain types of breast cancer and ovarian cancer. As a bonus, breastfeeding may help women lose weight. HHS states that “many women who breastfed their babies said it helped them get back to their pre-pregnancy weight more quickly,” however, experts are still researching the link between breastfeeding and weight loss.

But most importantly, HHS finds that breastfeeding can save lives. The governmental health department said research shows that if 90% of mothers breastfed their infants exclusively in their first six months of life, nearly 1,000 deaths among infants could be prevented each year. Additionally, breastfeeding is more cost-effective, more convenient, and keeps mom and baby close.

When Is Breastfeeding Not Beneficial?

Breastfeeding isn’t always the more beneficial choice. The Centers for Disease Control and Prevention (CDC) pointed out that in rare instances, human milk is not recommended for newborns.

These exceptional circumstances include when an infant is diagnosed with galactosemia (a rare genetic metabolic disorder that affects a person’s ability to metabolize — process — the sugar galactose present in many foods), and when the mother has certain infectious diseases, such as the human immunodeficiency virus (HIV) or tuberculosis, is using or dependent upon illegal drugs, or is taking prescribed cancer chemotherapy treatments or undergoing radiation therapies.

Breastfeeding Complications

New mothers should expect to have some discomfort, breast fullness or nipple tenderness as they begin breastfeeding their infant, especially if it is their first time nursing or they are first-time mothers. Although rare, it is also sometimes possible that a mother will produce too little milk. Frequent feedings, adequate rest, good nutrition and staying hydrated are all ways in which a mother can maintain a good milk supply.

Complications of breastfeeding can include:

Engorgement

When the milk ducts do not adequately empty during feedings, the breasts can become hard, painful, hot, and taut or shiny in appearance. Once the breasts are engorged, feeding can become painful and difficult, further exacerbating the problem.

Thrush

Thrush is a common yeast infection that can be passed from the mother to the infant, or from the infant to the mother, during breastfeeding. This type of yeast infection (Candida albicans) thrives in warm, moist areas, which makes the baby’s mouth and the mother’s nipples prime locations for its growth.

Symptoms of thrush in the mother may include deep-pink nipples that are tender and uncomfortable, especially during feedings. The infant may have white patches and increased redness in the mouth, diaper rash or a change in mood.

Antifungal medications can help to clear the infection.

Plugged Duct

Tender spots or lumps in the breast are indicative of plugged milk ducts. When milk ducts become plugged, the milk is unable to be expressed freely. This condition can be uncomfortable or even painful, but it typically does not lead to more severe symptoms, such as fever, when treated properly with rest, moist heat, massage and pumping often in between feedings to completely empty the breast.

Mastitis

Mastitis is a breast infection and one of the more serious complications of breastfeeding. When a plugged duct or cracked nipple goes untreated, it can result in mastitis. This serious condition can also be impacted by anemia, stress or fatigue.

Antibiotics are often a necessary part of treatment. It is important to note, however, that the use of antibiotics can sometimes lead to thrush. Additionally, some medications, including antibiotics, may be passed from the mother to the infant via breast milk.

Reminder:

Pregnancy can be a rewarding experience, culminating in bringing a new life into the world. Women must be open with their health care provider to identify and address health issues throughout pregnancy.