Q

Is it safe to go jogging when youre pregnant?

Exercise is recommended in pregnancy to improve your circulation and energy levels, boost
the immune system, and increase your stamina for labor. Although low-impact activities,
such as walking, swimming, and gentle toning and stretching, are ideal, if you are used to
jogging and your pregnancy is progressing normally, it is fine to continue in pregnancy.
However, it is not advisable to take up jogging for the first time now, particularly since there
is a risk of falling and hurting your abdomen, and you should avoid jogging if you have a
high-risk or multiple pregnancy. Other sports and exercises to avoid include gymnastics,
horseback riding, downhill skiing, and scuba diving.

Kegel exercises
Strengthening the muscles that support pelvic organs
Learning how to exercise your pelvic floor muscles is vital in pregnancy to help you avoid stress
incontinence (leaking urine).
This discreet exercise can be done any time. Kegel exercises involve squeezing your buttocks and
pulling in your stomach muscles, then holding for 5 seconds and releasing. Repeat this 56 times
several times a day. You could imagine your pelvic floor going up like an elevator, contracting
your muscles a little more at each floor.

As well as practicing the exercises shown above, another way to exercise your pelvic floor
muscles is by inserting a finger into your vagina and tightening the muscles around it.

Exercise at work

There are simple measures you can take while at work to reduce the risk of developing a
clot. Try ankle movements every hour, get up and walk around every 34 hours, take the
stairs whenever possible, and walk over to see a colleague rather than email.

Exercise in late pregnancy

adapting your routine to suit your changing needs

Toward the end of pregnancy, you will inevitably slow down, but you may not want to stop
altogether! Here are some sensible ways to modify your exercise.
In later pregnancy, avoid exercises that involve sudden movement, such as tennis, as your
balance is less steady now.
Swimming is perfect in late pregnancy and aids relaxation.
Reduce the intensity and length of your workout to avoid exhaustion.
Exercise in 10-minute increments 3 times a day, rather than one 30-minute session.

Fatigue
coping with fatigue in pregnancy
One of the most cited complaints in pregnancy, particularly in the first trimester, is extreme
fatigue as your body deals with its extra workload.
Accepting this and adapting your routine accordingly can help you cope.
Slow down and take a break, or even a catnap, whenever possible.
Eat small, healthy snacks throughout the day and drink plenty of fluids to maintain energy
levels.
Try to get nine hours of sleep each night.
Perform regular, gentle exercise to relieve stress and improve your fitness.

backache
For lower backaches, warm baths and a warm compress can help, and gentle massage done
by an experienced practitioner. Regular exercise, such as yoga, pilates, or water aerobics
classes (see p.55), strengthens back muscles, but check with your doctor before embarking
on a new exercise regime.
Watch your posture, making sure that you sit upright you could try using a birthing ball
and wear flat shoes.
If you have sciatica, ask your doctor or midwife to refer you to a physical therapist to assess
your condition and teach you exercises to help relieve the pain and minimize a reoccurrence.
Some women find a maternity girdle or support belt to be useful.

What is perineal massage?

Clinical trials indicate that perineal and vaginal massage can reduce the extent of tearing
and so some consider it beneficial.
Use a lubricant such as KY jelly, cocoa butter, olive oil, vitamin E oil, or pure vegetable oil on
your thumbs and massage around the perineum. Place your thumbs about 11 in (34 cm)
inside your vagina and press downward and to the sides at the same time. Gently and firmly
keep stretching until you feel a slight burning, tingling, or stinging sensation. With your
thumbs, hold the pressure steady for about two minutes, or until the area becomes a little
numb and you dont feel the tingling as much. As you keep pressing with your thumbs,
slowly and gently massage back and forth over the lower half of your vagina, avoiding the
urinary opening, and along your perineum, working the lubricant into the tissues for three to
four minutes.
This helps stretch the skin in much the same way that the babys head will stretch it during
birth. Do this massage once or twice a day, starting around the 34th week of pregnancy.
After about a week, you should notice an increase in flexibility.

Sex during pregnancy.

The hormone oxytocin increases during sexual arousal and the effect from the oxytocin is to
cause the muscles of the uterus to contract.

During pregnancy, the muscles of the uterus experience practice contractions, known as
Braxton Hicks (see p.168), which are not harmful, and orgasm may increase these practice
contractions.
If you have gone past your due date and are at a point when your body is ready to go into
labor, some experts feel that sexual intercourse may help things to start for two reasons: the
prostaglandins in semen will help the cervix to soften at this stage of pregnancy, and the
contractions stimulated by orgasm have more chance of developing into early labor
contractions.

Do you have any suggestions for labor positions?

Some popular positions for labor are:

Leaning on a work surface or the back of a chair. Putting your arms round your partners
neck or waist to lean against.

Leaning on to the bed in the delivery room.

Kneeling on a large cushion or pillow on the floor and leaning forward on to the seat of a
chair.

Sitting astride a chair and resting on a pillow placed across the top.

Sitting on the toilet, leaning forward, or sitting astride, leaning on to the sink.
Kneeling on all fours.

Kneeling on one leg with the other bent.

Rocking your hips backward and forward or in a circle; this can also be done using a
birthing ball.

Labor
The only true sign that labor is underway is the occurrence of frequent and regular
contractions that are causing your cervix to dilate (open).
Mucus Plug
During pregnancy, a plug of jellylike mucus seals the lower end of your cervix to keep
infections out of your womb. This plug comes out toward the end of your pregnancy,
and although it may mean that labor is going to start soon, it can dislodge (with no
harm to the baby) up to six weeks before your labor starts.
Its normal for a show to contain either fresh red blood or old dark blood (like at the end
of your period)
A show is not an absolute sign that labor is starting.
Braxton Hicks contractions
The difference between these practice contractions and real labor pains, however, is
that they occur irregularly, perhaps one or two an hour, then fade away, whereas true
labor pains usually begin slowly and build in intensity and frequency.
Labor Contractions
If they are regular (less than 30 minutes apart), and painful (you have to stop what you
are doing until they pass), you should contact your midwife or doctor.
Breaking Water
The membranes usually break as your cervix opens, once labor is actually in progress.
The contractions that are opening your cervix may cause the baby to press down,
creating pressure that bursts the membranes.
If they dont break spontaneously, they may be broken artificially by your midwife or
doctor to speed up your progress.
Put on a sanitary pad and then examine the pad.
Urine looks and smells different than amniotic fluid. Amniotic water is normally clear or
a light straw color, with little odor, and trickles beyond your control.
If you are between 37 and 42 weeks pregnant and your water breaks without your
contractions having begun, it is quite likely that you will spontaneously go into labor
within 24 hours; within 48 hours, over 90 percent of women will have gone into labor. In
certain situations, you may be induced to help your labor get started.
If you see a dark green fluid when your water breaks, it means your water contains
meconium, it can mean fetal distress. If you have a lot of blood mixed with the fluid, or
bright, fresh bleeding that continues after your water has broken, this also needs to be
checked out at once.
At the hospital
Your caregiver will confirm that you are in labor by timing your contractions and by
giving you an internal examination to see if your cervix is dilating and has softened.

When to GO INTO THE HOSPITAL

If your water breaks, if you have fresh vaginal bleeding, if your womb becomes painful
without contractions, or if you feel your babys movements reduce over a short space of
time.
Induction
Most doctors advise induction of labor between 4142 weeks. After 42 weeks, the
chances are still that you will go into labor at some point and deliver a healthy baby, but
the risk of fetal distress in labor, and even stillbirth, climbs steeply.

IS AN INDUCED LABOR LONGER THAN ONE THAT STARTS

SPONTANEOUSLY?

Usually, yes. This is because the whole labor process must be initiated first: this

may take many hours. Usually this is done by breaking your water (ARM, or artificial
rupture of membranes) and giving prostaglandin gel or a prostaglandin tablet (into the
vagina).
Once you are in labor, you may also need an intravenous drip to get your contractions
coming regularly. Sometimes, especially if youve had babies before, just breaking your
waters or giving one dose of prostaglandin is enough to get your labor going on its own,
without further outside help.

MY WATER BROKE TWO DAYS AGO. WHY IS MY LABOR BEING

INDUCED?

Once your membranes have ruptured, there is a high chance that you will go into

labor naturally within 24 hours. The longer you wait after this, the stronger the risk of

infection getting into your womb and affecting the baby. To reduce this risk, many
hospitals will give you the choice of induction of labor right away, or waiting for a day
before starting the induction process off.
Prostaglandin
It stimulate uterine contractions so that labor can begin
If your cervix is firmly closed, your midwife or doctor may put a gel or a tablet containing
synthetic prostaglandin into your vagina, which helps ripen your cervix. This procedure may
be repeated several times in one day, or even continued the next day, until you go into labor
or your cervix has opened enough for your waters to be broken.
Artificial

rupture of the membranes (ARM)

If your cervix is sufficiently ripe, this can be an effective way of inducing labor. Your doctor or
midwife will give you an internal examination, then use a long, thin plastic hook to brush
against the delicate membranes, which is usually enough to break them.
Syntocinon

This is a synthetic substance fed into your arm via a drip to increase the
strength and regularity of your contractions. It is similar to oxytocin.
An induced labor is less likely to be successful if your cervix is completely closed and your
babys head has not properly engaged in your pelvis.
What to consider
An induced labor may be more painful and take longer than one that starts naturally. You
may need to have an epidural; this means that you will be prepared if you later need a
cesarean, or even an assisted delivery.

THE FIRST STAGE OF LABOR

Labor has three distinct stages:
The first starts with regular contractions that open up your cervix, and lasts
until the cervix is fully open (about 10 cm) - eight to 24 hours
The second stage of labor begins when your cervix is fully open and concludes
with the birth of your baby - one to three hours
The third stage is from the birth of your baby until the delivery of the
placenta - ten to 60 minutes
If this is your first baby or your labor is induced, it can take longer.
Once you are having between two and four contractions every ten minutes, you, your
baby, and the progress of your labor will be closely monitored.

Latent Phase

The cervix needs to soften before it can dilate. Labor doesnt always begin when your
contractions start. You may have irregular, painful contractions for hours or even a day
or two before your cervix dilates, especially if this is your first baby.
So you may feel tired, nauseous, and be unable to eat properly while waiting for your
cervix to dilate.
This is called the prolonged latent phase.
Contractions can sometimes start regularly, but then die away halfway through your
labor.
If this happens and the progress of your labor halts for a few hours, your midwife or
doctor may suggest breaking your water (if it has not already broken) or artificially
stimulating your labor with oxytocin.

HOW YOUR CERVIX OPENS

The first stage of labor begins with the onset of regular contractions. This causes the cervix
to thin out, known as effacement. Once the cervix has softened, the contractions cause
the cervix to dilate (widen) progressively, so that your babys head can pass through.
Contractions draw the cervix up over the babys head like a sleeve, toward the vaginal walls.

Transition Phase

After the cervix has fully dilated there is often, but not always, a period before the

second stage of labor with its intense urge to push arrives. You may find this
interlude, called transition, one of the most difficult stages of labor.
If you feel a strong urge to push but your cervix is not quite ready, your caregiver will
ask you to slow things down by panting during contractions.
Your water does not always need to be artificially broken unless there is a problem such as: a
long labor not progressing satisfactorily breaking your water could speed things up
because your babys head will then push on the cervix and help it to dilate; signs that your
baby is distressed (see p. 188); the need to attach an internal monitor, called a fetal scalp
electrode (FSE), to your babys head.
There are instances when breaking your water is not a good idea. One reason is if your
babys head is too high and is not yet engaged properly in your pelvis. In this situation, if
your water is broken artificially, there is a risk of the umbilical cord coming down ahead of
the baby (cord prolapse).

SECOND STAGE OF LABOR

The second stage begins when your cervix is fully dilated, and ends with the birth of
your baby. This stage averages about one to two hours for a first baby. The second
stage means that you can now bear down and push your baby out; this stage may start
as soon as full dilatation is confirmed. If the head still has quite a way to come down
through your pelvis, you may be discouraged from pushing immediately, so that you do
not become exhausted. Therefore, the second stage is often divided into passive (you
wait for the head to come down on its own) and active (you push with each
contraction).
Signs:

A strong urge to push

Involuntary grunting with contractions
Your perineum may bulge because your babys head is just behind it
You may feel a need to defecate and may do so

Contractions

Your contractions will change, often becoming less frequent and more intense. You may
only have two every ten minutes but they will last longer and allow you more time to
make the most of your pushing technique.
How to push

When you get the urge to push, take a deep breath at the start of the contraction, put
your chin on your chest, and push down into your bottom for as long as you can. You
can usually take several breaths with each contraction and, as you bear down, your
baby will gradually move farther through your pelvis.
The pelvic floor exercises suggested in Chapter 5 (see p. 111) help you to relax the
muscles of the pelvic floor during labor. You may find that giving your body time to
stretch can help: try to push down for as long as possible, so that the perineal area is
encouraged to stretch.
However, if you have an epidural, do not push down too hard as the babys head is
delivered.
A warm washcloth placed on the perineal area between the vagina and the anus during
labor can help this area to stretch more easily. Massaging the area during pregnancy
with oils or creams (particularly vitamin E creams) may also help it to become more
supple.

Q
A

HOW DO I SPEED UP THE THIRD STAGE WITHOUT USING DRUGS?

You can try to speed up the process by getting your baby to suckle at your breast.

This sucking action stimulates the release of oxytocin, the hormone in your body that
causes your womb to contract, thereby encouraging the placenta to shear away from
the womb wall. If you prefer, or if your baby doesnt suckle immediately, you can roll
your nipples between your thumb and forefinger, which should have the same effect.

CAN I PUT MY BABY TO THE BREAST RIGHT AWAY?

Yes, you can. It may only be for a short while until you need to be stitched up but

it is worth getting your baby to suckle as soon as possible; this helps you and your baby
to bond, and also helps to stimulate the womb to contract and expel the placenta.
Breastfeeding is not immediately possible if your baby needs to be given oxygen to help
with breathing, or is taken to neonatal intensive care, or if youre still feeling sleepy
after an anesthetic.

CAN ANYTHING BE DONE TO SPEED UP LABOR IF IT IS GOING TOO

SLOWLY

If your contractions are not powerful or regular enough, your midwife or doctor

may rupture the amniotic membranes (see p. 176) to speed up and increase the
intensity of contractions.
If this doesnt work, you may be given a drip containing oxytocin (see p. 171). The drip
is regulated according to the rate of your contractions.

Q
A

WHAT IS MEANT BY FETAL DISTRESS

Fetal distress usually occurs when the blood flow from the placenta to your baby is

reduced so that your baby is not receiving enough oxygen.

This may mean your baby will need to be delivered quickly. If it is severe, your
obstetrician may decide to deliver your baby by cesarean.

Q
A

HOW WILL THE DOCTORS KNOW THAT MY BABY IS IN DISTRESS

Your babys heartbeat will be monitored regularly during labor via fetal monitoring

(see p. 168), and any changes will be picked up.

If there are irregularities, or your babys heart beats persistently very quickly or very
slowly, it can mean that your baby is short of oxygen. Another common sign of distress
is if your baby passes dark green meconium; this drains out of your vagina in your
amniotic fluid (see p. 66). Serious signs of distress indicate that your baby must be
delivered quickly and treated if necessary.